An Interview With Dr. Jenny Melamed – Addiction Medicine Woman

This post is an Interview I conducted with Vancouver BC addiction physician Jenny Melamed. Jenny is a great example of a progressive physician who works collaboratively with counsellors like myself to help people recover from dependency on drugs and alcohol.  Incorporated within the addiction medicine specialty are the processes of detoxification, rehabilitation, harm reduction, abstinence-based treatment, medical management at recovery houses, treatment of withdrawal-related symptoms, acute intervention, and long term therapies designed to reduce likelihood of relapse.  Jenny is a team player who works with patients to find the psychological and social supports they need in order to strengthen the physical benefits they achieve through their medical treatment.


Glynis Sherwood:  Jenny, addiction medicine seems to be your passion.  Can you tell me why you decided to specialize in this area, and what keeps you enthusiastic about your practice?


Dr. Jenny Melamed:  My interest in Addiction Medicine developed after 20 years of Family Practice – I found no joy in going to work on a daily basis. I started prescribing Methadone for Opiate addiction and found working with people who struggled with addiction an honest and rewarding profession.  Recovery is all about honesty, trust and belief – both in yourself and your ‘team’.


GS:  You are known for you commitment to ‘collaborative care’.  Can you tell me your definition of collaborative care, and why it means so much to you?


Dr. JM:  Addiction is defined as a Biopsychosocial disease.  It is associated with uncontrolled cravings, loss of control and use of drugs (or repetition of a behaviour) despite the consequences – the ‘3 C’s’ that tend to define addictive behavior.  It is a complex illness.  It requires team work, which is my definition of ‘collaborative care’. Recovery requires commitment. It is not easy. The team can consist of counselors, physicians, groups (12 steps or other), church members, family or anyone else the person considers imperative for their recovery. It is important to allow the team members to share information. Remember – addiction can only survive in an atmosphere of denial and lies.


GS:  From your perspective, what does recovery from addiction entail?  What are the most effective approaches? Who are the ideal members of a collaborative care recovery team?


Dr. JM:  Recovery from addiction requires a commitment to hard work and dedication.  It is so much easier to return to old habits and blame everyone else for your problems.  For example, “I use because you make me mad, sad, glad”, etc. No, you use because you chose to use. People struggling with addiction very often do not have the tools to keep them sober. This is where the work comes in. You cannot trust yourself when you are in the spiral of addiction – this is where the collaborative team is required. Sometimes this will initially require residential treatment or a recovery house.   Sometimes it can be done in an outpatient setting meeting with a counsellor or attending groups.


GS:  How have medications like Suboxone and Methadone revolutionized addiction medicine?  Where do these drugs fit in to the big picture of addiction recovery?


Dr. JM:  Methadone, and more recently, Suboxone Maintenance Therapy, are an aid to help people struggling with an opiate addiction. This is the group of drugs including oxycontin, morphine, heroin and dilaudid. The methadone or suboxone is an opiate but does not cause any of the features of addiction (I.E. The three C’s) when taken as maintenance therapy. The medications allow for the person struggling with an opiate addiction to learn the skills required to remain in an abstinent lifestyle without the cravings and withdrawal which otherwise can interfere with the recovery process. Yes, patients are dependant on the methadone or suboxone (you will get symptoms of withdrawal if you discontinue it suddenly) but you are not addicted to it!  We do a controlled withdrawal when patients are ready.


GS:  In your opinion, what are the most important recent advances in the field of addiction medicine?  What do you feel is missing, or needs more support and/or research?


Dr. JM:  Addiction is finally being recognized as what it is – a chronic disease with common brain pathways, and very often genetic components. This has helped in the formulation of new medications for some addictions that help minimize cravings.  Addiction medicine also makes the link between anxiety, depression and other psychiatric problems and addiction, and underscores that we cannot treat any of these challenges in isolation. To answer the question ‘what is missing’, boils down to social and psychological supports.  It is very difficult to ask someone to choose sobriety when they live on the street and have no counselling available to them.


GS:  What should patients look for when seeking an addiction doctor’s services?


Dr. JM:  This is a difficult question to answer. Whether you are looking for an addiction physician – and there are very few available – or a counsellor, you need to have a relationship based on honesty, trust and acceptance.  You need to be able to work together and not feel judged.


GS:  Any final words of encouragement for people seeking recovery from addiction?


Dr. JM:  It is never to early or too late to get help. Everyone has a different ‘ bottom ‘. Reach out, never give up on yourself…you are worth it.


Dr. Jenny Melamed is a family physician with a special interest in addiction medicine.  She is certified to prescribe Methadone for both addiction and pain management.  She has worked at both the Cordova and Vancouver Detox Centres in Vancouver Canada and has an addiction practice in Vancouver and Surrey working in both a private capacity and for Fraser Health.  She has a large Suboxone practice and has been involved in Suboxone use and education since its introduction in January 2009.  She is board Certified by the American Society of Addiction Medicine (ASAM) and certified by the International Society of Addiction Medicine (ISAM).

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Glynis Sherwood – MEd, CCC, RCC, is a Psychotherapist and Certified Addictions Counsellor based in Halifax Canada.

Visit my Addiction Recovery Counselling web page