Why Doctors Can't Deal With Addicted Patients - Page 2

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.

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What The Parity Bill means is that your primary care doctor is now reimbursed for screening, counsel, follow up sessions, family sessions, medications, and in-home visits for addiction / mental illness related problems —exactly the kind of care that a patient might receive for hypertension and diabetes. According to McLellan, the significance of this is that these diseases are similar to alcoholism in that “you can’t get them unless you have the gene, but to develop them even with the genetic predisposition, you have to eat to excess, smoke, refuse to exercise—or, in the case of addiction, abuse alcohol and substances.” McLellan says that those doctors who—as in Lauren’s case—were once loath to diagnose addiction and the mental health issues it entailed are finally finding time to study the topic, now that it’s become comparably compensated under insurance plans.

Of course, this doesn’t change the fact that many patients are still in denial about the magnitude of their problem and a doctor must be able to judge the right moment to broach the issue. The same Columbia study that proved that doctors don’t receive enough addiction-related training also found that many physicians—47%—found it difficult to discuss misuse of prescribed medication with their patients.

How, then, should a doctor deal with an addicted patient?

According to Scott Bienenfeld, a New York based addiction expert, they should have a basic understanding of addiction, preferably through specialized training with societies such as the American Society for Addiction Medicine or the American Academy of Addiction Psychiatry, and they should display a basic level of proficiency in screening for addictive disorders.

In addition, they should try to keep up with the massive changes regarding medical understanding of addition In the past 20 years, major discoveries about the brain’s reward generating dopamine system—and the effects of drugs of abuse on this system—addiction is now morte treatable than it has ever. Incredible advances in science have allowed have helped to dispel damaging myths that addiction is merely a social, psychiatric disorder that belongs in the realm of the weak-willed, the immoral or the dysfunctional. While we were once subject to PSA’s telling us all drugs would turn our brains into fried eggs, Nora Volkow’s work, for example, allows us to actually see how heroin, nicotine, cocaine, meth, and alcohol work at a neurological level—and this has not only heralded new, more effective medication to treat both cravings and addiction, while creating more trained specialists.

In the process, psychiatry has had to shift towards a more biological framework. Notwithstanding the advances in understanding and treatment, and despite the increased awareness of medical malpractice regarding the misuse of medication, personal bias among physicians still means there is some way to go before the treatment of addiction reaches a universally recognized standard.

What is that standard? Bienenfeld suggests that a physician’s responsibility to the addicted patient is to first ensure that their physical health is stabilized before referring them to a seasoned addiction specialist who can do a full evaluation and advise them on the best ways to detox as well as specific medications that may help. The addiction specialist should also recommend methods such as Relapse Prevention Therapy—a blend of coping skills training, lifestyle modifications and cognitive therapy—and Motivational Interviewing, which is similar in its approach.

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