Category Archives: Addiction
It is an unfortunate reality that most doctors don’t like treating addiction, and they don’t like addicts. They’ll treat the consequences of the disease but they won’t always confront the underlying issues, discuss treatment options or provide referrals to an addiction specialist or even a self-help support group like AA. What’s behind this institutional bias against addicts?
A Health Care System in Denial
Denial keeps addicts stuck in their disease. It’s also keeping our health care system sick. An estimated six million addicts receive health care in hospitals, emergency rooms and primary care clinics each year. This kind of access puts doctors in an ideal position to recognize and treat addiction, yet they receive very little training on how to do so. During medical school, there’s no required course in addiction and only a few states require continuing education in the use of narcotic medications and the management of chronic pain.
In surveys by Columbia University’s National Center on Addiction and Substance Abuse, 80 percent of doctors felt they were qualified to identify drug abuse and addiction, yet only 1 percent correctly identified substance abuse as a possible diagnosis when presented with the case history of an addict. Only 55 percent said they learned how to prescribe controlled drugs during medical school.
This lack of training denies recognition to one of America’s leading public health problems and graduates physicians who are not competent to treat an illness that affects 23 million people. The fact that doctors tend to focus on the illnesses they can treat isn’t entirely bad – it means they understand their own limitations and treat patients they feel they can truly help. The broader issue is how we train our nation’s health care providers.
Fortunately, as knowledge spreads that addiction is a chronic brain disease, not a moral failing or lack of willpower, efforts are underway to educate more doctors about addiction. Although some institutes have offered programs in addiction medicine for years (without accreditation), the American Board of Addiction Medicine has begun training doctors in the first accredited residency programs in addiction medicine.
The goal of these programs is to establish addiction medicine as a recognized and respected specialty similar to pediatrics or dermatology. A new doctor can now specialize in addiction as a primary residency, where they will learn how to recognize and diagnose addiction, prescribe medications appropriately, and guide patients through their treatment options.
A Shared Prejudice
Even when doctors have the knowledge needed to treat addicts, they don’t always want to. Doctors share the prejudices of the societies they live in and we have a very strong bias in our country against people with addictions. Many blame addicts for being immoral, unmotivated or weak and don’t believe they deserve to get better. Inexperience and lack of education advance a view of addicts as criminals rather than sick patients.
Indeed, addicts can be tough patients. Even if they can admit to a drug problem, not every addict is ready to get help. A physician who confronts the issue may be met with denial and anger rather than gratitude. During treatment, the problems aren’t limited to what the doctor sees in the office as addicts also struggle with legal, financial and family problems.
Treating the disease of addiction can be extremely challenging. Addiction is a chronic brain disease for which there is no cure or quick fix. Since it has both biological and behavioral components, treatment can’t be limited to a single intervention – say, medication. While a number of medications, such as naloxone and Suboxone, have proven useful in treating addiction, lasting recovery requires learning a new way of life.
Treatment typically requires a blend of medication, therapy and self-help support groups, and is most effective when delivered by a multidisciplinary team of professionals. To fully understand the illness, the doctor must learn about the patient’s entire profile, including their family history, lifestyle, home environment and any psychiatric conditions. When addiction is complicated by co-occurring mental health disorders like depression or anxiety, patients need specialized, integrated care. Because every individual has different needs, a one-size-fits-all approach is ineffective. There is no “take two of these and call me in the morning” for addiction.
High Stakes, High Rewards
These complexities, combined with a high relapse rate, can make addicts a frustrating bunch to treat. In few other fields are the stakes so high. Substance abuse disorders are a leading cause of death in the U.S., and successful treatment requires a long-term commitment.
What makes addiction complex is also what makes it interesting to treat. Doctors are in a position to do a lot of good – in every field, but especially addiction. They have a unique opportunity to destigmatize an illness just as the profession has done with cancer and other misunderstood diseases. It’s a chance to break the mold – to treat addicts like human beings, to approach addiction as a medical problem and to help patients not only get well but completely change the course of their lives.
“When two codependents enter a relationship, they often overtly or covertly try to manipulate the partner to provide the love and approval needed to fill what John Bradshaw calls the “hole in the soul”. Both partners attach themselves to the other for a sense of completeness, a strategy that stunts personal growth and development. By surrendering responsibilty for our happiness to other people, we create power struggles, arguments, and ultimately broken promises, expectations, and hearts. We can break out of the codependent trap….by working through the pain of our unmet childhood needs and by cultivating an inner life.” Ronald S. Miller
1. A Room of Mama’s Own; Why I Stay
“When my son was a baby, he used to cry all the time and his only comfort seemed to be breastfeeding. I’d be up every hour all night breastfeeding him, and before long, I was beyond exhausted. One night, Mark got up with me. “Go back to bed,” I said, “You have to work in the morning.” “So do you,” he replied, “and your job is taking care of our son, which is much more important than mine. Let me help, even if I just sit with you.” And I… Well, I did what any exhausted, frazzled, breastfeeding, new mother would do: I burst into tears. He got up with me every night after that: to change diapers or get me water or just doze next to me.”
“A few years later, when I found out about his sex addiction, I couldn’t believe how much he had lied and cheated through all of our years together. He seemed more like a monster than the good man I thought I knew. But when I stopped and held all the lies in a balance with his one simple act of love and tenderness for me, and for our son, I was able to look into the face of the abyss, and say, “This is a good man. It doesn’t matter what wrong he has done; it can’t hold up in the face of that proof of goodness and great love.”
“I know that Mark stood in the hospital room holding our son on the day of his birth and made him a great promise. He renewed the promise he made but couldn’t keep when we started dating, when we got engaged, when we got married. As he looked down at that fragile baby in his arms, he silently swore to himself and his son that things would really be different this time: he would change, he would never do those horrible things again, he would never bring hurt or pain into our family, he would protect us from himself. He couldn’t keep that promise: not a year, not a month, not a day. He is a good man and a strong man, and he meant well; he wanted passionately to keep that promise, but he didn’t know how.”
2. Ettuhusband: “Glimpses of Me”(no longer online):
“I talked to a dear friend today who is going through a horrible time. She is understandably devastated, sad and scared and thinks she will probably be getting a divorce.”
“I wish I had the right thing to say to help her cope with her grief.”
“But I’m telling you: this girl is amazing. Just amazing. Smart, beautiful, accomplished in every way. (seriously, what is it about sex addicts that make them pick the most amazing women?!)”
“I think our talk was good for both of us, since by talking to her, I saw glimpses of old me by hearing her out. It was so strange to feel like I could understand what talking to me in the old days must have been like.”
“I remembered saying such similar (and valid) things: that I felt tainted, that I felt used. That I felt sexually abused and that no one would ever want me. As I heard her ask who would want her (poor baby), I also thought– my God, anyone. Anyone would. She’s really a total catch. And for the first time, I understood why people always leapt to assure me that I would find someone amazing. It always bothered me that people said that– like what– I’m not valuable enough on my own?”
“Why does everyone think a women is less full of inherent worth if she’s single?! (and this still bothers me, to a point.) However, I think I also get that unasked-for commentary on my marital status, too. Because, wow, here’s this incredible woman asking how anyone would ever want her, when the truth is, the only person in that relationship who shouldn’t be wanted by anyone again is the sex addict. He’s tainted– she’s not.”
3. Discoveringrecovering: “Pound Puppy”
“So, my partner is now on involuntary psychiatric hospitalization number 2, along with 2 partial hospitalizations- 1 “successfully” completed and one not, all since mid November. When I can separate myself and my feelings from all this, it’s interesting to see her fight with herself. She wants help and she doesn’t. She wants somebody to take care of her and she resents being controlled. She wants someone to keep her safe, and she wants to push limits of the people whom she’s asked to do so.”
“When I can look at the behavior from a place of healthy detachment, some of her behavior is really funny. She actually told the nurse last night not to put a needle in her hand because that would hurt and not to put a bandage on her arm after they took blood there because it would leave a bruise. That might make sense if it weren’t for the fact that she was there because she couldn’t contract to keep herself safe from significantly more pain and resulting in significantly more physical evidence.”
“That’s what’s going on with her.”
“As for me, I’m pretty pleased with my commitment to myself to maintain my balance. I left her at the emergency room and went to my naranon meeting. Before I went back to the ER, I treated myself to a nice dinner and coffee. I’m enjoying having space. I’m doing my work without too many intrusive thoughts.”