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Media Postings and Official Blog for Michael Schiesser MD
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Read/Listen to this addiction specialist's own battle with addictionDr. Michael Schiesser: Good morning, and welcome back to "Health Dimensions." This is, Dr. Michael Schiesser in Seattle. For this half of the show I have Dr. Mark Menestrina with me, who's a family medicine doctor, who has been practicing addiction medicine exclusively for the last 10 years at Brighton Hospital in Michigan.
What makes Dr. Menestrina an especially interesting guest, is not only does he work at Brighton Hospital as an addiction expert, but he was also a customer there, and he's not afraid or shy to talk about that today.
Dr. Menestrina, welcome to "Health Dimensions."
Guest.
Dr. Menestrina: Thank you Dr. Schieser, and thanks for having me.
Dr. Schiesser: You bet. I think that the first teaser that I mentioned that you stated you were happy to talk about, is your own history with addiction. Can you tell our listeners more about that?
Dr. Menestrina: Well, sure. I can guarantee that growing up I wanted to be a doctor, or a stenographer, or a physicist--not an alcoholic, or drug addict--but nonetheless that's what happened.
It's pretty much an equal opportunity disease, and it was rampant in my family. It is a progressive, chronic disease that most people know that you have it before the patient knows they have it. In other words, people knew I had a problem before I did.
It took its toll on my career, and family, and life -- until I sought help numerous times, and then entered recovery myself. It's been the biggest surprise of my life, in that it's been one of the best things ever happen to me -- the recovery that is.
Dr. Schiesser: Was this exclusively alcohol, or what were you dealing with?
Dr. Menestrina: Pretty much any alcohol the first few treatments, and then I remember thinking that my problem wasn't alcohol, my problem was that everyone could smell alcohol on my breath.
So I tried literally any other substance I could get my hands on -- including pain pills, and sedatives, and stimulants.
Dr. Schiesser: How did this effect your life, to be trying to get through life, and using all these various substances?
Dr. Menestrina: Well because the onset is insidious, and gradual, and then one of the hallmarks of the disease is the denial aspect that, "Oh, I'm just under stress, or it's just a tough time I'm going through."'
I was able to compensate for a period of time. Then eventually after initial attempts at treatment weren't successful, then I had help recognizing problems through law enforcement, and the State Medical Licensing Board, and my family.
Dr. Schiesser: Well, that's really remarkable. I want to ask you, because I talk to my patients quite a bit who are also struggling with similar problems. You are remarkable however, in that you appear to have sort of an open-book approach to your past in a culture where there's a tremendous stigma around these problems. Can you talk a little bit about how ignoring the stigma can really help in your own recovery?
Dr. Menestrina: Oh, sure. You're absolutely correct about the stigma. I think everybody's got an image of someone who's an alcoholic or drug addict--that's "One-Eyed Willie" on the corner with a bottle of muscatel, or the crack guy that's selling his or her body, or the heroin addict stealing your stereo.
What congress in their right mind, is going to give 10 billion for research in that? What radio show is going to say, "There's a good cause to talk about for half an hour"? Like any chronic or progressive disease, I think it's very important -- in fact critical that we address the recovery aspect that people "can" and "do" get better from this disease.
Dr. Schiesser: When you first started to try to get better, did you kind of succumb to that shame. or did that take some time to get over?
Dr. Menestrina: Absolutely--the shame, and in fact because of the stigma. I mean the American Medical Association, as you probably know, but most people don't, and in fact most physicians don't -- 51 years ago the AMA designated that alcoholism should be treated as a disease, and yet it seems that we're just now getting around to it, and then fighting a lot of resistance.
But there's a critical difference between just stopping a drug, or stopping alcohol, or "abstinence" as we say, and recovery -- and they're not the same. I like many other people had no troubles quitting. I've quit hundreds of times, but starting again kept giving me problems.
Because when I just quit without a recovery program in place, and working the cycle of Social Support, I was left with that horrible image, and guilt, and shame, of what I an alcoholic and drug addict had done to myself, family, and friends.
Dr. Schiesser: I'm talking to Dr. Mark Menestrina this morning, from the Brighton Hospital in Michigan. He's a family medicine doctor, and addiction specialist. He's been talking with us this morning about his own struggle with addiction through his life.
Mark, tell me, how does your own personal experience with addiction inform your treatment with your patients?
Dr. Menestrina: How do I inform my patients?
Dr. Schiesser: Well, how does your background help you in being more successful as a doctor for these patients?
Dr. Menestrina: I don't know if it's more successful, and I certainly believe that any quality treatment facility for alcohol and drug dependence, requires both recovering, and non-recovering people--you need the mix.
But, typically when I see a new patient for the first time, and introduce myself and begin talking, I frequently get this look, "What's this guy in a shirt and tie going to tell me?" The facility where I work at I usually ask them -- when I sense that resistance may be there, I usually say, "Tell me, do you smoke cigarettes?" Most alcoholics and drug addicts are addicted to nicotine, and they say, "Yeah." I say, "Do you know why you can't smoke in this hospital?" They go, "I don't know, fire code I guess." I go, "No, in 1983 I set me in bed 138B on fire, and that's the last day they allowed you to smoke here." Then they look and they say, "You"?
Dr. Schiesser: [laughs]
Dr. Menestrina: As a good friend of mine in recovery says, "This is an equal opportunity disease." It doesn't care if you're educated or not, if you're old, young, black, white, male, female -- it can affect you.
Dr. Schiesser: Now, Mark at the time you were being treated for addictions at Brighton Hospital, were you also a physician at that time?
Dr. Menestrina: I was. My first treatment was in '79, and my last for all intents and purposes, my last treatment was in '87. I was able to maintain multiple treatments in a medical license through those first eight years.
However, after about the eighth year in many treatments, and a lot of run-ins with the law, the state deemed that I should not practice medicine any more. So I lost my medical license in '87, and that had a profound affect on me in allowing me to work solely on my recovery. Of course when I got sober, the State Medical License did a dramatic turnaround. No, they didn't do a turnaround. I was the one who changed.
Dr. Schiesser: I'm talking with Dr. Mark Menestrina this morning and I want to remind listeners to go to the turntohelp.com website for resources in managing addiction. I'm talking with Dr. Menestrina this morning about his own struggle with addiction in the past.
Dr. Menestrina, in the state of Washington we have a remarkable program for physicians that I've heard if they're impaired through chemical dependence that they can remove themselves from their job anonymously and get treatment and be reinstated in the workforce. Does Michigan have something as progressive as that?
Dr. Menestrina: Absolutely and in fact I'm glad you brought that up. The one reason I went to so many treatments without I think getting a successful recovery is that they did not have that program in place when I was in my addiction. Now the law mandates that every state have some program for professionals. If I can tell you the average person coming to any one treatment facility at any given time as any facility may have maybe a 10 or 15 percent chance of success from that point on forever.
If you're a physician who is enrolled in Michigan's program and I'm sure Washington has a similar, then that person has approximately 85 to 90 percent chance of success. Now, people who aren't physicians say, "Why is that?" And I tell them, "Well, it's not because when a doctor signs up we give them a special bit of advice but no one else knows about it." It's because treatment works if treatment continues and the success of the state-monitored programs such as Washington and Michigan is that they support and monitor usually in a very non-disciplinary way, your recovery process or your treatment. And that's the bane to your bucket.
Dr. Schiesser: Mark, tell us a little about some of the worst problems that you're seeing right now in Addiction Medicine. What kind of patients are coming in to see you and what kinds of problems do they have?
Dr. Menestrina: Well, a couple of trends that if you will. In addition to the stigma that we continuously fight again is just recognizing that this is a disease. Usually, I hear, "Wait a minute." I speak a lot to the public in public forums. Usually, there's an older gentleman who said, "Don't give me this disease business!" And I go, "Why not?" He goes, "I tell you why not. Now diabetes, there is a disease but not a drug addiction."
Dr. Schiesser: How do you explain to somebody coming out from the mindset?
Dr. Menestrina: Well, when they say that, I go, "Why is that? Because in drug addiction you have a choice." In this country as you are probably are aware, we live in a magical thinking medication seeking society. We're not supposed to have itchy ears, runny eyes and hemorrhoids or erectile dysfunction without taking something to feel better. And so this is a mindset of our society that we tend to think in terms of taking pills to feel better.
We have a lot of diabetes in this country because we don't eat very well; we're overweight and don't exercise. We have a lot of addiction because we're exposed to addictive substances. The very first painkiller narcotic I ever took was when I was 16 and had pneumonia in a small town. A local doctor gave me a shot of penicillin and a prescription for phenergan with codeine cough syrup and I took that as directed, one to two teaspoons every four to six hours as needed for cough.
38 years ago, Mike. And I still remember that because in people who are susceptible to addiction, roughly 10 percent of the population, it has a very profound and reinforcing effect on me. So I will say to the person who resisted this is a disease. Now wait a minute, I didn't have a choice. I just took it as directed.
Dr. Schiesser: And ongoing for someone who knows that it's a problem, someone who's trying to stop or someone who is engaged in treatment and is having a difficult time, how do you walk that tightrope between explaining that it's a disease they have no control yet, trying to instill a sense of responsibility around making good choices?
Dr. Menestrina: Exactly. There are a lot of expressions from the self-help groups that maybe serve us well here and one is that "You're not responsible for having the disease but you are responsible for your recovery." The other point I often make to the patient and their family is because the family is obviously affected. It's a brain chemistry disease in a very primitive part of the brain, the mesolimbic system or the emotion and feeling part of our brain and the parts of our brain that tell us when to sleep and breathe and drink and procreate, very powerful drive.
And so to expect the alcoholic or addict to see that this is a problem - their continued use- and they will rationally think themselves away from it is no different than expecting someone to just think about not breathing. Sooner or later, we have override systems and we will breathe if we hold that breath. Untreated addicts and alcoholics no matter how much desire or willpower they have, they will eventually without treatment continue using it.
Dr. Schiesser: So you're making an analogy between the core bodily processes like breathing and drinking water and reproducing that essentially our emotionally driven and extremely strong need but what I understand is this not even so much an analogy. When we do MRIs of people's brains, looking at the activity of their brains (in an addict), the same areas of the brain light up when someone is thirsty from not drinking water for five days.
Dr. Menastrina: Exactly. These are very powerful drives. I think far from relieving anyone of responsibility, I think it helps patients understand because as we spoke earlier that guilt and shame on "Why can't I do this?" As an addict on recovery, I can tell you that one of the worst things about my disease is that when it continued unabated despite my promises not to use, the worst thing is I knew I hurt the people I loved the most. That guilt and shame is so overwhelming in someone who's addicted, the most likely source of rescue is continued use of the substance.
Dr. Schiesser: Sometimes it's not enough to feel bad or to go through withdrawal in order to stop using it. [music] It just almost perpetuates the use.
Dr. Menastrina: Yeah. I believe it's a myth that while you let that addict suffer real hard, they'll be withdrawing, they'll never use again. [inaudible]
Dr. Schiesser: Sort of "No pain, no gain" myth.
Dr. Menastrina: Right.
Dr. Schiesser: If you're just tuning in, you're listening to Health Dimensions with Dr. Michael Schiesser. Please visit turntohelp.com for more information on addiction medicine resources.
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