Why Doctors Can't Deal With Addicted Patients

By Ruth Fowler 05/09/11

Just because your physician took a Hippocratic oath doesn’t guarantee that he’ll be able to confront you about hitting the bottle. (Or that he’ll treat you like a human being.)

Some doctors simply push pills on patients who have substance problems.

Lauren is always amazed when she hears people in her 12-step group share that a doctor or therapist coerced them into AA. “I hear so many people say, ‘My shrink refused to keep treating me unless I came here,’” she says. “And that simply wasn’t my experience.” Lauren relates how, in her twenties, she was hooked on a cycle of Ambien and cocaine. Her psychiatrist didn’t seem to realize she had a problem, despite the fact she was getting repeat prescriptions from him for sleeping pills (as well as anti-depressants). One day, after another session in which she’d broken down for the umpteenth time, Lauren admitted she was abusing cocaine and medication. It was an unconscious cry for help to a medical professional—but no help was forthcoming. Her psychiatrist merely told her that if she didn’t report her regular cocaine use to those in her group therapy, he would. A few weeks later, he informed her that he couldn’t help her anymore as he “couldn’t deal with her problems.” He then refused to give her any more anti-depressants, asked for $300 dollars, and sent her off with a prescription for three month’s worth of Ambien.

Lauren got lucky. After her money ran out and she had a similar experience with another therapist, she was contemplating driving her car into oncoming traffic when she managed to make it to an AA meeting instead. When she was a year sober, she received a bill from that old psychiatrist and immediately wrote him back—reminding him that he had refused to treat her, had denied her access to anti-depressants, and yet had given her enough Ambien to kill herself. “If I hear from you again, I will report you to the American Medical Association,” she wrote. She never heard from him again.

At no point during Lauren’s interactions with her primary care doctor, group therapist or psychiatrist did any of these professionals directly confront and address Lauren’s obvious substance abuse problem. “I was a wreck—suicidal, totally depressed,” she recalls. “The weirdest thing was I later found out my primary care doctor, who I used to score painkillers from, was sober and in AA. And yet he didn’t seem to register that I had an issue.”

Lauren’s story highlights the biggest challenge facing patients in a society where addiction still struggles for recognition and acknowledgment. In the medical community, this is primarily because most doctors themselves do not recognize addiction until it is too late—or may even harbor latent prejudices about addicts and alcoholics which are uncorrected by exposure, experience or medical training. This is primarily because the traditional focus of the medical community has been on the consequences of addiction—for example, cirrhosis of the liver or Hepatitis B, rather than on the complex, underlying causes of the disease.

Regarding the problem of addiction, until recently, there has been little a primary care physician can do except offer patients detoxification. A 2003 survey carried out by Columbia University’s Center for Addiction and Substance Abuse revealed that doctors do not receive adequate training when dealing with patients suffering from addiction or alcoholism. Dr Nasir Naqvi, a Fellow in Addiction Psychiatry at Columbia University, sees the failings of the medical field in this respect as “a story of individual practitioners who are either ignorant of what they are being taught in medical school and residency, or who cannot overcome their individual moral biases in order to help their patients.”

This is partly the fault of the American medical system. It wasn’t until 2008 that Congress passed the Parity Bill, which ensures that mental health and substance abuse is covered under insurance. Dr. Tom McLellan, a psychologist, psychiatry professor and former Deputy Director of the Office of National Drug Control Policy, sees doctors’ ignorance in treating addiction as a direct consequence of the fact that until recently, it was excluded from insurance plans and mainstream medicine. “The Parity Bill is one of the greatest gifts that’s ever been given to the insurance industry,” he says. “By actively treating substance abuse problems, they’re going to get far greater returns than from the other very expensive healthcare it generates later.”

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