Summer Sky - Medical Director

Texas Drug and Alcohol Treatment Center, Summer Sky




Fifteen years ago my wife of 20 years developed complications of her Multiple Sclerosis. She started having severe pain for the first time. Her neurologist, at the time (incorrectly) said pain is never a part of MS and was unwilling to treat her pain. After many sleepless nights of watching her suffer, I began writing scripts for a potent narcotic pain medication. She was so Texas Drug and Alcohol, Dr. Wilsonill; I was in fear of her dying. Very soon, I began taking her pain meds and found that they relieved my mental discomfort as well as it relieved her physical pain. Soon, I was taking increasing amounts for the same effect. Her prescriptions were not sufficient to supply both of us, so I began forging prescriptions. Gratefully, because of tolerance, I do not believe my ability to practice was impaired to the point that I harmed anyone. Unlike most of our patients, I was 44 years old before I had my first problem with addiction.

A local pharmacist notified the medical board and my professional association. I was intervened on in my home by a peer and an employee of my professional association 7/15/94. Until that moment I had honestly never thought of myself as an addict, even though I regularly referred sick patients to A.A. and N.A.

I went to a psychiatric hospital for 14 days Detox and then 4 months to half way house living in Atlanta Ga.  I had already practiced Family Practice for 20 years.  I felt grateful to be able to do a job I mostly enjoyed. My father worked long hours at a job he hated, just to provide for his family. But while in treatment, I fell in love with the practice of Addiction Medicine and I ordered the textbook form the American Society of Addiction Medicine.  When I returned back to my partnership, my partner did not want to continue working together. By “coincidence“, at an N.A. meeting , one of the recovering Summer Sky nurses mentioned that they were looking for a medical director. I contacted the administrator and was offered the job, After two years working full time in the field, I was able to sit for the board certification exam in Addiction Medicine, and did so.

Working with fellow suffering addicts and alcoholics made a very difficult first few years easier for me to remain sober. I saw a psychiatrist once a week as past of my medical board order. He was a recovering alcoholic, but had never experienced a craving. One day, in all sincerity, he asked me what a craving felt like. I answered that:” hold your breath for two minutes, the urge you have to breath at that point is similar to the urge I feel to use all the time”  If I had relapsed during the 5 years I was monitored by the board and my professional association, I would surely have lost my medical license for good. Twelfth step work (working with fellow suffering addicts and alcoholics) gave me the strength to remain sober as well as provided enormous personal satisfaction.

Since 1995, I have treated 8000 adults and adolescents through 28-42days of treatment.  For the last six years, I have served on the same Texas State Physician’s Health and Rehabilitation Committee that intervened on me 15 years ago. I have become board certified in Addiction Medicine and am a Diplomat of the new American Board of Addiction Medicine. I still look forward to coming to work every day, love meeting new patients, and watching them grow spiritually over their time at Summer Sky. I will always be grateful to Al Conlan and Summer Sky for trusting me with the Medical Director Job early in my recovery.

After 34 years of practicing medicine, I think about retirement, but I cannot imagine of anything I would rather do with my time.  As long as my health allows, and I feel like I am doing a good job, I would like to continue doing what I do every day. Not everyone who works at Summer Sky is in recovery. We all have our own motivations for working with recovering men and women. But we all work for more than just a paycheck; the work is just too daunting and (rewarding) otherwise.

PAIN AND ADDICTION by Robert S. Wilson, D.O.


Opinions on the use of opiate narcotic medication for non-terminal pain have changed over the last 20 years. When I trained, 35 years ago, opiates were never considered appropriate for non-terminal patients. This was for a very logical reason: tolerance.  Tolerance is the natural reaction of the brain accommodating to the opiates and requiring increasing doses to achieve the same effect. Of course, with terminal patients, this was not an issue. However, with patients with years left on their lives, enormous doses can be required just to prevent withdrawals. The opinion about use of narcotics changed with one widely read article that said addiction was a minimal problem with chronic pain patients. This let loose a flood of marketing to physicians from narcotic manufacturing companies and a virtual explosion of pain clinics.  This was known as the “pain management movement”.  Some good did come from this movement. Physicians were less likely to withhold necessary narcotic treatment for short term pain or terminal cancer patients. However, I have attended conferences for pain specialists where an addiction specialist asked for a show of hands for how many doctors had addicts in their practice. NO one raised their hand. Addiction and pain are not mutually exclusive, one can have both, and in my opinion, many do.

First off, all daily opiate users will have withdrawal when they stop using.  This does not mean that they have an addiction; this simply means physical dependency is present.

Addiction is a complex set of behaviors. Some of the rules of thumb about pain and addiction are to ask the following questions: “does the pain medicine make life better or worse for the patient and his/her family”, “does the patient ‘doctor shop’ to get multiple prescriptions of similar meds, or supplement their supply from friends or dealers” and “do they mix opiates with alcohol or tranquilizers like Valium, Xanax, or Soma?” Pain patients with a high risk for addiction tend to be younger, have a history of drug or alcohol abuse or other psychological problems such as a history of trauma or depression.

Since Suboxone has become available, it has become very valuable for pain and addiction patients. Suboxone is a very unique medication. It binds strongly to the opiate receptors so that one cannot use opiates successfully with it. It also blocks cravings and controls pain better than most of the stronger opiates the patient has ever tried before. This way what percent is “addiction” and what percent is “real” pain is unimportant. I have followed some Suboxone patients for 5 years now, and they are the most grateful patients I have ever treated.  Pain management is an “off label” use of Suboxone, meaning the FDA has not approved its use for pain. However, the same medication: buprinorphine, has been available in injectable form for 30 years or more for pain, and is ideal for many patients.




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