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Greetings to everyone, an introduction

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Hello to the Greetings group, I would like to introduce myself Mike Tino , a physician from Tennessee. I Joined ASAM back in 2008 & became ABAM Certified in Addiction Medicine in 2010.  I had Transferred over from prior careers as an Army Medical Corpsman, and Registered Nurse.  Although I had originally trained in Family Medicine beginning in 2000, for me, my passion for medicine awoke after seeing my first few addiction & alcoholic patients when I walked into their rooms on the detox ward, or saw them in the MAT Clinic.  I grew up with a father that tended towards physical abuse, violence towards my mother,  myself & verbal aggressiveness whenever he drank alcohol.  However, he tended to be a peaceful quiet man between his daily drinking episodes, if you could catch him during that 45 minute episode.  This being the early 1960's,  our family doctor at that time treated my mother with Valium as a mechanism for "coping with our family problem".   I lived my early formative years in fear most nights hiding under the bed until  my mother arrived home from work around 10:30PM yelling for my help & the beatings would begin. I generally caught the blunt of the physical part by trying to get between the 2 of them. We lived with this big "secret" for many years until at about 13 yrs of age I summoned enough courage & rage to push my dad over a table & completely through the drywall behind it. After that he moved most of his personal items into the basement, I stayed out most evenings until I knew he was home & either sleeping or passed out downstairs.  My mother quickly divorced him afterwards, but the living arrangement changed very little. Being a difficult situation for educational studies, as well as activities I loved such as baseball & football, I pretty much bailed out of my High School studies and at 17, and I enlisted in the US Army.  During orientation to boot camp I will never forget the senior NCO asked If I wanted to study for & test for my G.E.D. I asked him 2 questions at that moment, 1) Could I go ahead & take the test immediately, and 2) Will it ever be possible for me to become Medical Doctor with a GED in lieu of an actual High School Diploma. He responded yes you can test today but I doubt you will pass it, and its very unlikely you will ever become a Doctor. These statements motivated me then and still do to this day particularly during the most difficult times.

This summary of my own early years is not that unique, but I cannot cannot say enough about the lessons I learned about dysfunctional family dynamics & chaos, defined by Sharon Wegscheider-Cruse as; (The Addict, Enabler, Hero, Scapegoat, Mascot, & Lost Child), and how coping skills & the roles that are taken on within the alcoholic or addicted family to support the chemically dependent family member. and how much of that chaos was due to a tightly held secret  including a feeling of shame, and something is wrong with me because we don't talk about whats going on at home.  This is the point where many will choose drugs to escape the inherent sense of shame & find a group where they feel can fit in.  It so eloquently explained when a patient says I have this feeling of "walking on eggshells" when the addicted family member is around because they dictate the mood for the entire family.  It is so common with my own MAT clients that after a decent period of stabilization & maintenance   I love to open the dialogue with a brief discussion of dysfunctional family roles, followed with a discussion about "tell me about who raised you in your own family of origin?". Although most clients take on a blend of the different roles, it gives an excellent starting point to start to look at the way the addict learned some of their coping mechanisms and then look at ways of breaking that cycle. For many family members these roles continue even after the death or departure of the addict and the roles get passed down through generations by modeling the same roles..

Although many patients are not quite ready for this level of emotional work. I am blessed to have many patients that have been with me now for up towards 13 years. For my own practice I find that the identification of this family dysfunction can become very "freeing", and help the addict begin to identify the root causes & conditions of their addiction. Particularly in an Office Based Opioid Therapy environment where we generally do not have the benefit of this type of time set aside such as within an in-patient facility.

Thankfully with the addition of MAT-OBOT clinics it helps me facilitate my patients recovery with the ability to reach & work with more patients. Many will take years to reach this level of emotional work, and some may never get there as they are more than happy to just be In treatment and on their medication..

The beauty of this MAT is they have the option to move as slowly or as quickly as they like, and they are all unique. I am blessed to see them have that choice today, and the passion of being their advocate through their individual journeys.

Thanks for your time, & a pleasure to meet you all.




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