8 thoughts on “A Doctor’s Most Dreaded Patient: The Addict

  • May 24, 2014 at 11:03 am

    Thank you for this honest post. I think one of the reasons it is so difficult for doctors to like/treat addicts is that they are scapegoats for problems in society. Maybe we should be grateful in some way that they take that burden on for us?

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  • May 25, 2014 at 8:15 pm

    I sometimes wonder if they don’t treat it because the success rate is so low. With pharmaceutical companies telling us everything under the sun can be cured and the reality that everything cannot be fixed with a pill, doctors are in a tough spot.

    We go to them expecting to be healed and they frequently cannot fix the problem. If they take on addiction, pretty soon they will have a far higher failure rate than they do now.

    You can only be ineffective for so long before people lose confidence. Not taking on addiction could be a self preservation effort.

    Also:
    Health care insurers want doctors to see a patient every 5 minutes (I’m being facetious). That is no where near long enough to figure out what is happening with an alcoholic. In AA you get a sponsor you can talk to at all times. Doctors you get once a month.

    More importantly:
    I think some doctors do not believe addiction is a disease.

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  • June 6, 2014 at 7:38 pm

    Doctors should be able to turn away addicts, and not treat them in any way. Addicts have given up their rights to be treated or healed. They are liabilities for those in the field of healing. Addicts care nothing for anyone but themselves.

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    • September 1, 2016 at 3:49 pm

      In other words, doctors should only treat people who are eminently treatable, or those who present with no medical problems at all. That leaves us making sure that there is nothing wrong with us before our next visit.

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  • June 25, 2014 at 3:04 am

    Having been in the addiction treatment field since I started my first therapeutic community for addicts while still a counseling-psychology grad student at Cornell in 1971, I have seen this whole substance abuse treatment industry evolve into what we know today. I used the work evolve rather than progress because I am not too sure that treatment is much better now then back then.

    Dr. Sack is on track regarding the medical profession. I attended the International Conference on Alcoholism and Addictions in San Juan, Puerto Rico in the early 1970s. My biggest takeaway from that experience was that I realized that I was probably one of the few people there who was clean and sober. Here was a gathering of the top treatment doctors and researchers in the world at a conference on alcoholism and these folks consumed more alcohol that the drunks at my local bar. When we walked out of every meeting room, we were greeted with a rolling bar and a line backing up into the meeting room. This was a great example of the inmates running the institution. They didn’t have a clue then and all these years later, I don’t see that much has changed.

    Since then, my conclusions have been reinforced by many encounters with doctors, especially psychiatrists, who knew so little about addicts that they willingly enabled them. Two such encounters stick in my memory. Once, while working with street-kid, I talked an 18 year old out of killing himself. When he handed over the Seconals, he was planning on using to do the suicide, I was surprised that all five bottles were prescribed by the same GP in one week! (I still have the empty bottles for show and tell when I lecture on this subject.) When I confronted the doctor, he said that he suspected the kid was an addict but he thought that if he wrote the scripts he could eventually refer the kid to treatment. Sure!

    Another one of my young clients was addicted to Xanax and regularly used Methamphetamine. He had used so much Meth one day that they took him to Kaiser. The psychiatrist who saw him never asked about drug usage, decided he was having a manic attack, admitted him for two weeks of in patient observation and upon discharge gave him a months supply of Xanax to calm his nerves warning him that they had to last a month. That afternoon, found him a couple of blocks away hanging onto a parking meter having taken all 28 Xanax!

    I absolutely second Dr. Sack’s call for much more training of the medical community. I have worked with way more medically addicted people than street drug addicted ones, especially since psychiatrists have stopped talking to patients before medicating them.

    I actually have a problem with the whole medical model of addiction. Perception of reality changes with the belief filters the observer is looking through. When viewing substance abuse through medical belief filters, one is looking for a disease that can be cured and the cure usually involves a medicine. The problem with viewing addictions from that perspective is that the focus is on the symptoms and not the root causes. The symptoms are the excessive and compulsive use of mind altering substances. The medical approach attempts to treat the symptoms. This works quite well with bug-type physical diseases. Got a bug running around, medicate it, kill it, end of problem. With addictions, this approach is a trap that only perpetuates the problem.

    Although 12 Step programs have been way more effective in dealing with drug and alcohol addictions, they have also missed one important ingredient due to their having adopted medical model terminology and thinking. They talk about “the disease,” meaning the substance of choice, when referring to their addictions. Because of that, they, too, overlook a huge component of addictions.

    Having spent many, many years in 12 Step meetings, it has amazed me that no one has put together the obvious. How come there are folks who faithfully work a 12 Step program for years and still think they are not much stronger than when they arrived, that they couldn’t make it without daily attendance? How come people with years of very successful recovery from alcohol and drugs, switch to non-substance addictions; compulsive over-eaters, gamblers, workaholics, sleepaholics, gymaholics and the like? When I listen closely to speakers in meetings telling their “how it was” story, a major clue as to the root cause of addictive behavior becomes quite apparent. Regularly the narrative will include the line that when they had that first taste of their substance of choice, “it filled that empty hole inside me!” How come no one questions, to just what “that empty hole” is a reference?

    “That empty hole inside” is a reference to a lack of self-esteem and resulting low self-confidence. Alcohol has been labeled “liquid courage,” ever question why? Same answer. If there is a disease that is the root cause of addictive behavior it is the disease of very low self-esteem, self-confidence and self-love. The antidote to this behavior is to build those internal strengths. The medical community misses this completely . The 12 Step programs come close but miss it, too, as do most 12 Step based recovery programs. The 12 Steps are a perfect prelude to inner esteem work because working the Steps, especially steps 4-9, clears out lots of accumulated past negative feelings, thoughts and emotions, a vital prerequisite for successful esteem work. Adding self-esteem building to the 12 Steps will permanently fill that empty hole and contribute greatly towards eliminating addiction switching and recidivism.

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    • February 21, 2015 at 9:04 pm

      You are the first person ever that makes any true sense on what is happening to lack of education on addiction. My son has been to rehab five times and has relapsed every time. I do not know where to turn anymore cause no one seems to care. If you could give me any doctors in the Pittsburgh or Beaver County Pa area that are dedicated to the underneath problems that I know he has to get out of this. He is now in outpatient clinic they give him meth. That is not the right path. He has very low self esteem,anxiety,depression,no willingness etc. He never finished high school and I had him tested in school for not paying attention and not good grades he was on lower level but passed barely. Theres no money to get his teeth pulled and dentures hes skinny his appearance has a lot to do with not getting job also let alone his attention span. I could go on and on. You wouldn’t be anywhere near my area would you. If you have any answers for me please email at cinnamongirl58@yahoo.com Thank you

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  • July 1, 2014 at 10:19 am

    I can appreciate that a doctor may not want to treat an addict as it does require a much more in depth relationship with the patient, a high level of commitment, a very specific level of training and is for most medical professionals outside their scope of practice.
    Having said that, I do believe that they do have a fiduciary duty however to exercise due diligence in recognizing the illnesses presence and acting accordingly.
    With the amount of publicized evaluation forms available it would in my opinion be prudent for physicians to include one in their patient history packet as well as require it to be updated annually. Review of these evaluations can be done in a reasonable amount of time and will at the very least allow the doctor to have formed questions, referrals and recommendations upon entering the examination room.
    The fact alone that just about any doctor can and willingly do write scripts for anxiety and depression medication implicates that they are at least familiar with and willing to treat symptoms that typically co-occur with or may foster increased use in a substance dependent or abusing patient. The monitoring of these medications needs to be highly active and revisited at the same level as a psychologist is required along with mental health evaluation documents or they should not be afforded the ability to prescribe more than a 30 day supply.
    The RX abuse issues are clearly out of control.
    I will end by saying that I am completely baffled as to why it is so easily impossible to by more of a decongestant product than the government sees fit by monitoring drivers licenses, yet getting narcotic medication in excess is as easy as a request for refill or doctor and pharmacy shopping.
    Why not scan drivers licenses and finger prints for all controlled substances?????????

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  • January 9, 2015 at 2:36 pm

    This is why addiction specialists are needed. Each doctor seems to know what they know, but I have made comments to doctors in the past and all I got back was a blank stare because they were not familiar with addiction, but they were experienced PHD’s.

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