Chronic Relapse and Secondary Gain

By secondary gain,  I’m referring to a psychological or emotional advantage or benefit that occurs from an illness or behavioral disorder.

I’m following up on an earlier post on the subject of the so-called ‘Hardcore’ recidivist in addiction treatment – the one with numerous prior treatments, all followed by a return to substance use. We're left wondering what to do.

Part of the solution can include understanding and addressing, in the context of therapy, secondary gain attached to the behavior. It’s something the relapser may not be aware of. In fact, in my experience that’s usually the case.

I should clarify: By secondary gain,  I’m referring to a psychological or emotional advantage or benefit that occurs from an illness or behavioral disorder.

It’s different from a secondary agenda, where the perceived advantage is mainly a practical one. An example of the latter: the Medicaid administration in one state decided to severely limit access to inpatient psychiatric units unless the patient was assessed as actively suicidal. The intent was obviously to reduce inpatient hospitalizations and...

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Perilous Prosecution

In one instance, a Corporate Compliance manager came right out and advised a pharmacist that his role was to drive sales for the company. Meaning to keep pushing opioids, above all.

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