Angels and Demons

I was warned when I started my job as a Case Manager in addiction, that there will be times when my entire client list would catch fire.

The addiction patient comes in several forms, ranging from first-time in recovery, young or older (sometimes in their 70’s) to the “readmit” who has been in multiple times (I have one young man in his 30’s who has been in rehab 41 times). Some are very motivated and others are counting the days. They come to us for many reasons. Some are court-ordered and others made the brave choice to change their lives and are willing to make bold moves to do so. One thing I have learned is that there is no room for assumptions about outcomes (that is obviously way beyond our scope) and there is no connection between willingness, enthusiasm and cooperation and stability during treatment.
There is no such thing as a stable patient.
Any patient can turn on a dime in one day, often defying every expectation. The addiction patient is dealing with a plethora of internal forces that pull and tug at them. One day there are doing fine; motivated, encouraged, and on course. The next day they may decide that it’s too hard, that they are needed at home, that they can deal with their addiction on their own, that getting back to work is the key, and my personal favorite…they think they are ready. Even when they are not. It is the mental push/pull that comes with making major change against a force that is larger than them. I attribute it to the dichotomy of human nature. Think of it as the scene in the Flintstones when Fred has a little devil Fred on one side and a little angel Fred on the other.

When this occurs, the adrenalin kicks in and the push to keep them from leaving begins. I know it sounds awful, but we know what is good for them even when they don’t. We have at our disposal the research to support it, compiled over millions of patients worldwide. We are trained, and we have the additional resource of many co-workers who have been through recovery themselves. We are armed with every tool, backed by sheer good intentions to help them recover. When we tackle this obstacle, it is exhausting. At least to the new guy, which I am, and my more experienced colleagues are more able to cope with it than I. While these waves of change occur in nearly all patients, it happened with too many of mine this week.

I approach my position as I do my own matters. aggressively and with passion. I challenge, poke and prod, tell the truth, and insist on reciprocation. While I am not a clinician, I get the information we need and I learn the ins and outs of the person in front of me. I invest, and I am here acknowledging that I do so at the sake of my well-being, of myself into my clients. I know it sounds corny as hell, but I care about people and despite my best efforts to dial it down, I can’t. Sue me, I give a shit. I need to know at the end of each day/week/month that I did the absolute fucking best that I could for those in my charge.

And it is taking its pound of flesh.

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