LANDER -- Medical professionals call it "narcotic-seeking behavior." ER doctors see it almost every shift they work. It's just one of the many manifestations of drug dependency.

A person comes into the emergency room with the chronic side-effects from addiction to methamphetamine, for example. He's suffering pain from dental deterioration. Or he's at the tail end of his "high" -- "tweaking," physically exhausted, but anxious and unable to sleep, maybe feeling a little psychotic, and looking for something to help him "even out" so he can relax and finally get some rest.

Others are simply addicted to narcotics, legal or otherwise. They come to the ER with one goal in mind: Get some hydrocodone, oxycodone, some sort of opiate like those found in the brand name drugs Percoset and Vicodan.

It puts doctors in a tough spot. They have to learn to distinguish between the addicts and the rest. They have to become adept at differentiating between the side-effects of drug addiction, non-drug-related problems, and lies.

An analgesic that might be of great help to a normal patient might instead aid in furthering the problems of a chemically dependent person. This is why it is essential that an emergency doctor learn to identify the addicts.

"Obviously, we don't want to feed their addiction -- we want to help people," said Dr. Greg Clifford, head of emergency medicine at Lander Valley Medical Center.

The best way for a doctor -- in the context of the ER -- to help a drug addict is to refuse to prescribe narcotics, Clifford said. The physician must then try to explain to the individual about the risks associated with his or her drug dependency, give the patient information about treatment options, and hope that someday soon the person will decide to "get clean."

More likely than taking the physician's advice, the individual will probably just try another ER, or some other avenue for obtaining the drugs.

Until a chemically dependent patient desires to get clean, or until the individual is arrested, doctors must simply treat the side-effects of his or her addiction, and give the patient the medical information he or she needs in order to make an informed decision. The idea is that you never want to discourage people from seeking medical care, but if doctors were asked to "play cop" with drug users, the net effect would be to do exactly that.

"I don't think it's our job to be the law -- it's our job to educate," Clifford said.

Current medical knowledge says that substance dependency is a disease. Once substance dependency is understood from the medical perspective, the criminal and social delinquency that is related to this disease look more like symptoms -- and less like simple "bad behavior."

Clifford says that given all the best information, a patient ultimately must make his own decisions. And a patient must always feel that he can go to see a doctor in confidentiality. Unless an individual is a threat to himself, or a threat to others in the community, a physician cannot -- and should not, according to Clifford -- treat the case as a legal matter.

Many addicts, however, don't seek treatment until having run-ins with the law, or until "hitting bottom" some other way. However, no matter how they get there, treatment can be effective for drug and alcohol addicts, officials say -- as long as certain things fall into place first.

A treatable disease

Doctors and counselors have become skilled at caring for chronic alcohol and drug abusers. Although a lifelong disease, chemical and psychological dependency can be overcome through serious alterations in behavior, lifestyle, habits and self-knowledge, experts say.

Overcome, that is, if the individual is ready to make wholesale changes. Treatable, only if the person with the problem is ready to accept that he or she has a problem in the first place.

Darton Brown -- a Lander resident who recently completed an intensive residential treatment program for drug addiction at Wyoming Substance Abuse Treatment and Recovery Center, or WYSTAR, in Sheridan -- understands the veracity of that concept firsthand.

"Your friends and families and everybody you know can push on you to get help, but it's not going to work until you're ready yourself ... you've got to be a willing participant," Brown said.

Not that voluntary participation can't be legally and socially inspired.

"The (misconception) is that court-ordered treatment doesn't work, and I wholeheartedly disagree with that," said Pamela Peldo, executive director of WYSTAR. In fact, she knows from experience that court-ordered treatment often does succeed.

At WYSTAR -- previously known as Sheridan House -- about 80 percent of the program's clients are court referred. But sometimes being arrested, and "hitting bottom" in that way, turns out to be just what the doctor ordered.

"It is important that people acknowledge that they have a problem ... but I would say that (for) a majority of folks the light bulb goes on after being here for a little while," Peldo said.

Sometimes it takes a court order and all of its implications for a person to become a volunteer in his or her own recovery. And once an individual becomes personally invested in the program and in his or her success, one's chances of recuperation are rather good, Peldo said.

'How do you live your life?'

While substance abuse is a disease, it is a chronic one, not something that is simply treated once and is then cured.

"It is something that you actively have to deal with every day," Peldo said. "Treatment is just the beginning of the process ... Much of what we need to do is teach people: How do you live your life?"

WYSTAR's program not only offers immediate, intensive treatment, but it also prepares participants for the days, months and years after initial treatment is over.

One basic objective of the program is to instill an understanding of the need for structure and schedules in a person's life. Another aim is to teach people how to foster and maintain a healthy support network, while learning to manage and avoid the "triggers" of addictive behavior.

"We strongly encourage folks (after leaving WYSTAR) to attend AA and NA meetings," Peldo said. Another important step is making sure that the individual returns to a healthy environment -- instead of, for example, returning to a home where one's partner is still using drugs or alcohol -- and that the individual works to cut out the old negative acquaintances from his or her life.

Another important part of an addict's recovery is getting back into the general population and participating in a productive way.

"Community integration is huge," Peldo said. "We're trying to teach [our clients] how to be responsible individuals." She believes that being a responsible, confident, self-aware, productive individual goes a long way toward keeping a person from engaging in compulsive, self-destructive behavior.

Individualized care

Although WYSTAR is a 12-step based program, there is not a single, blanket formula used to treat everybody, Peldo said. Each person who comes into the program receives an individual assessment -- which examines the patient's medical status, emotional and mental stability, his or her "readiness to change," daily living skills, relapse potential, and the expected quality of his or her recovery environment. The patient then receives a subsequent personalized treatment plan.

"We offer individualized care (because) we need to meet each person's needs," Peldo said. "We don't just plug them all into the same program."

The type and length of stay, therefore, varies widely. Some people are treated on an outpatient basis, while others check into the residential course. Those who enter a residential stay could be there for 30 days or up to nine months. Most WYSTAR residents stay 30 to 80 days.

The treatment at WYSTAR is not exclusively drug-or alcohol-related. The program incorporates the approach of holistic medicine, which stresses all facets of a person's health, including physical, psychological/emotional, social, economic and cultural factors. This follows the classical idea of treating not just one aspect of an individual's health, but treating concurrently the trio of body, mind and spirit.

Often patients complete an anger management course as part of their treatment. Other people will spend a good deal of time learning parenting, vocational or life skills. Patients attend group therapy as well as one-on-one cognitive therapy with a counselor. Each individual also learns practical exercises and activities to modify unhealthy behaviors, and receives ongoing progress assessments.

If patients are personally invested in making changes in their lives, and if they "buy into" to program, Peldo said that more often than not things will turn out well. For some, it takes repeating the program one or two times, but if they stick with it, they tend to see good results.

"We do see a lot of success," she said. "... there is hope for people who want recovery."