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| About twenty years ago I witnessed the most devastating site I have every experienced as a doctor, or a person. A patient with whom I was very close finally agreed to seek in-patient treatment for alcoholism. After prolonged prodding and with the help of a psychologist, we managed to get the anxious patient to agree to meet us at the hospital on Sunday at 4:00pm. When the psychologist and I arrived, we were informed that the patient had left, very nervous. The psychologist, the hospital security guard, and I proceeded to look for him. The patient arrived a few minutes early, but the thought of losing his relationship with alcohol was so overpowering it resulted in him losing his life. He walked across the street to the hospital parking structure, went up to the eigth floor, and jumped to his brutal death. I was the one that found him. At that moment I found a chilling need to learn about addiction. Addiction is the most prevalent disease in our country, and has the least resources available to treat it. Medical schools do not educate us in this area. Less than 1Ž2 of one percent of all doctors are specializing in addiction medicine. Addiction is not a politically popular disease. When do you remember the last telethon you saw for Heroin Addiction? Most doctors don’t want to treat this illness – the connotation of an addict is all negative. The perception is that addict’s lie, are not dependable or reliable for follow up, are constantly in trouble with society and their families, and fixing this problem requires much more effort and resource than is possible in most practices. Addicts will blame the doctor when they don’t recover. It is not surprising that physicians don’t want to invest the time to treat a disease that seems untreatable, is abusive to their life and practice, and carries such potential risks. Addiction is a chronic illness, and usually is symptomatic of an underlying biochemical imbalance (too little Serotonin, too much Dopamine, etc.) which becomes aggravated by life’s inevitable stress. I am currently completing a book on this, which describes the origins of our addictions and how we can intervene. I actually believe that addiction is simply a symptom of the underlying psychiatric disorder provoked by stress. We “self-medicate” our underlying neurotransmitter imbalance, and we do a lousy job by using dangerous substances that only create a secondary problem, addiction. Understanding addiction requires understanding the patient’s entire profile, including their family history, since this is a family disease. Every addict has someone in his or her family with similar behavior – the genetics are well established. Treating addiction also requires addressing the entire family dynamic. For this reason, children and adolescents need to understand their particular risks for turning to drugs and alcohol to deal with their bad and uncomfortable feelings. Drug education is much more than just “saying no”. Because addiction has so many influences, it takes a team to treat. 12 step programs, psychologists, addictionologists, neuropharmacologists, nutritionists, hypnotherapists, acupuncturists all can play a role in managing an addiction problem. Addiction is considered a chronic disease because the behaviors go on for life, and managing to stay sober on a daily basis is the goal. 28-day programs are only a start on the right path, relapses are the norm, and patience is critical to successful therapy. Treating addiction requires building lasting and caring relationships around a team of professionals dedicated to understanding this complicated illness. Unlike most other chronic illnesses that I treat in my internal medicine practice, such as diabetes, heart disease, and high blood pressure, this disease has the potential for saving lives. You can manage to keep someone’s blood sugar in a good range which delays the inevitable complications of diabetes, but you can completely redirect the course of someone’s life that has been crippled by addiction. Imagine helping someone repair severed relationships and restore their productivity and self-esteem. This is a homerun for a doctor. The problem is, more doctors need to come to the plate. |
Curing Addiction › The Buprenorphine Program › Why This Specialty?
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