Treatment of alcohol and drug addictions in the USA: how an immigrant runs a unique clinic in California
It's no secret that there is an opioid epidemic in the United States. When we hear this, we most often imagine homeless drug addicts on the streets of San Francisco or Philadelphia. But in fact, opioids are much closer to us ordinary people than it seems. We talked about the problem of addictions, why they arise, how to recognize them and, most importantly, how to fight them with Dr. Adrey Dokukin, owner of a California clinic Roots Mental Wellness, which has been successfully treating addictions of various types for many years.
The story of Dr. Andrei Dokukin is a ready-made script for a movie about the miracles of immigration. In the past, he studied as a dancer at the Bolshoi Theater school in Moscow, but when the USSR collapsed, he decided to move to the USA. Here he entered the legendary Juilliard School in New York and got a job with the American Ballet Theatre. But a few years later he realized that a dancer’s career was short-lived, and began to look for himself in medicine. He now runs an addiction treatment clinic. Roots Mental Wellness in California and vast experience in helping people. But the path to this was not easy.
“When I realized what this specialty was, my hair stood on end!”
After graduating from Downstate Medical Center at the State University of New York, Dokukin moved to California and became a so-called Pain doctor - that is, a doctor specializing in pain management. And this is where the fun began.
“When I realized what this specialty was, my hair stood on end! We prescribed a bunch of drugs to patients, we gave them some kind of injections. I quit this job because I realized: we are just killing all these people! I wanted to figure out why everyone was suddenly prescribed drugs and began asking questions. These questions led me to another world of medicine.”, says Andrei.
So he gradually moved from pain medicine to addiction treatment. Soon Andrei inherited his deceased friend's practice in Long Beach, California. Now here is a large rehabilitation center Roots Mental Wellness, whose specialization is the treatment of alcohol, drug, gaming and other addictions.
“Before me, the drug treatment clinic existed for about 10 years, but at that time they only provided psychological assistance to people with addictions. We have also integrated medical practice here. Now we have medical and psychological assistance in one place. In this we are unique; there is nothing like this anywhere else in California.”, - Andrei shares.
Drug rehabilitation centers in the United States are common, but there are very few comprehensive drug treatment clinics like Dokukin’s. Treatment of any addiction here is carried out in several stages, including work with a psychologist and physical procedures.
Addiction is not a disease, but a symptom
The doctor says the most important thing he tries to convey to his patients is that addiction is a consequence of something, not a cause. According to Andrei, anyone can become addicted, and the first thing they begin with in treating addiction in his clinic is to find the answer to the question “why?” Why did you start drinking, taking drugs or gambling? What does this give you? What hole are you trying to close with this?
“Genetics, of course, plays a huge role in the case of addictions. But some things that happened to people in childhood, some psychological traumas are also important. To cure a person, you first need to get to the bottom of what the underlying problem is. This is not the same as, for example, breaking a leg. In the case of my leg, I put on a plaster cast - and everything was great. When it comes to some more complex diagnoses related to psychological health, we cannot put on a cast, so we definitely need to get to the bottom of why this happened. Before prescribing treatment, you need to know what we are treating. We can treat the symptom, but if we don’t address the cause, the symptom will appear again, it’s only a matter of time,” - says Andrei.
To support this idea, the doctor shared his personal observations: “A patient came to me today and said: give me an injection for alcoholism. I tell him: do you think the injection will make you feel better? He says: yes! I explain to him that if the cause is not treated, 95% of people return to their addiction again. Or a woman calls me and says: I want to get coded. Well, firstly, we don’t do that here, and secondly, I ask: how many times have you already been coded? He says: I’ve already been coded five times and it helped me! I advised her to do something differently for the sixth time, maybe it will help".
The doctor says: of course, there is a big difference between patients who want to get rid of addiction themselves, and those who were brought by the hand by relatives or sent by the court. The latter usually break down sooner or later - they don’t see the motivation. However, sometimes even such people can be convinced to take themselves seriously.
Is a glass of wine a day an addiction?
Everyone can enjoy a glass of wine or a joint once in a while. How can we understand that we have crossed the line? How to determine whether it is already an addiction or not yet? U Andrei Dokukin here the answer is simple: as long as the habit does not interfere with the life of you or your loved ones, it is not yet an addiction. But when it starts to affect your health, finances, relationships, then you should sound the alarm. Therefore, if you like to drink or indulge in recreational drugs, the main thing is to always be on your guard.
“It happens to everyone. With people of any race, any gender, any education and any income. Yes, and at any age! For example, do you know how many addicts there are in nursing homes? Patients 70-80 years old who are addicted to cocaine come to me! They often have heart attacks due to this. And I have many such stories,” says the doctor.
How to recognize a drug addict
Now, according to the doctor, opioid addiction is leading among addictions. Approximately 60% of all his patients are drug addicts, another 35% are alcoholics, and 5% are all other addictions.
Opioid addiction is much more difficult to recognize. Very often, parents of teenagers find themselves in this situation, who for a long time do not even notice that something is wrong with their children. Unlike alcohol, drugs do not smell and a person may look quite adequate in appearance. This is especially true for people who are genetically predisposed to this addiction.
“When a person first takes opioids, he may feel a little nauseous, have a depressed consciousness, drowsiness, but there is a certain category of people, approximately 20-30%, for whom everything is completely opposite! They take opioids and they have energy, the depression stops, and they want to do something. They rush to clean the garage or do laundry. With such people, it is very difficult at first to understand that they are sitting on something.”, the doctor warns.
However, in the case of drug addicts, even the most active people begin to change quite quickly. They stop taking care of themselves, their problems grow like a snowball: in the family, at work, with finances or even with the police. Strange things begin to happen to them: they may fall asleep somewhere, not come to work, men may not shave, women may not comb their hair. According to Andrei, it is precisely from such things that one can suspect that a person is addicted to opioids.
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Surprisingly, most drug addicts are not the scary heroin addicts we are used to seeing in the news about America's inner cities. Everything is much more banal and scary - they are often hooked on opioids in doctors’ offices.
“I, as a doctor, killed these people myself! As a doctor, they told me: prescribe them pills! Has their pain subsided? Give us more! And I prescribed more, and more, and more. I have prescribed colossal amounts of drugs to the people I am now trying to treat. Because of people like me, 12 people a day are now dying in Los Angeles. Because their doctors got them hooked on drugs, and the doctors didn't tell them that 20% of the people we give strong painkillers or antidepressants will develop an addiction problem. They will not be able to take the 2 tablets per day prescribed by the doctor. They will take 5, 6, 7 tablets. I have patients who take 120 pills a day and spend $35 a month on them!” – Andrei laments.
First, complete detoxification.
So how do you treat addiction? IN Andrei's clinic For this purpose, an integrated approach is used. First, everyone must undergo so-called detoxification. That is, for some time a person must survive without stimulants - drugs, alcohol or anything else to which he has become dependent. But there are no universal terms; they are individual for each patient. He can spend these days at home, or he can be hospitalized in special clinics or hospital departments. This usually becomes a kind of first test of the seriousness of the patient’s intentions.
“Unfortunately, often when people are addicted to chemicals, they relapse and then are embarrassed to come back and admit that they relapsed. Therefore, it is very important when a person tries for the first time that he succeeds. Because if they don’t succeed the first time, they then give up and often don’t even try again. A big mistake is to mess everything up the first time.”, says Andrei.
After detoxification, the main stage of addiction treatment begins in a rehabilitation center. A diagnosis needs to be made. Here the clinic employs psychologists who specialize in working with addicted people. The reasons for becoming addicted can be very different. Some had mental trauma, others had chronic pain, insomnia, and anxiety. The psychologist’s task is to open up the patient and find the key to him.
From magnetic waves to leeches
In addition to traditional therapy, the clinic also uses new technologies for treating addictions. For example, here they do so-called transcranial magnetic stimulation. It helps in the treatment of alcohol and drug addictions, as well as depression and obsessive-compressive disorder.
"Magnetic stimulation works like an electric shock, but it only affects certain parts of the brain, so there are no harmful effects. If we look at MRI scans of people with depression, we realize that in some areas of the brain their brain is not as active as people who are not depressed. And with this magnet we can regulate these impulses. As a result, people become calmer and their anxiety goes away. This therapy is painless and has no side effects.”, says the doctor.
Another experimental approach to treating addictions is blocking the sympathetic system of the cervical vertebrae. This treatment helps reduce the release of adrenaline into the blood, which is also effective when working with addicted patients.
"We are constantly looking for new methods! For example, we sometimes use leeches as an additional therapy. Hirudotherapy helps those patients whose liver or pancreas is damaged, for example, due to alcohol. In addition, leeches help produce the neurotransmitter dopamine, which improves the mood of patients. We will also soon begin using hallucinogenic drugs when they are approved by the government. We are now taking part in scientific research on these drugs.”, says Andrei.
You will have to be treated for the rest of your life
Andrey insists: addiction is not a disease that can be cured completely. Anyone who has ever been an alcoholic is forever an alcoholic, but you can go into deep remission and not remember your addiction for the rest of your life. The main thing here is attitude and determination.
“Doctor, translated from Latin, means teacher. My task is to pass on knowledge. Unfortunately, I can't force anyone to heal if they don't want to. People often say: you are a doctor, so you are treating me. But in my profession this does not happen. If I could cure anyone, I would cure everyone! But to succeed, they must become doctors like me! So, if people want to be treated, let them come, I will teach them. And they will heal themselves” – the doctor shares his secrets.
And he adds a secret: he himself had problems with alcohol, so he knows firsthand how to get out of the abyss.
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