RP 101 – Addiction



Session Readings

 

BACKGROUND: (under CONSTRUCTION!)

 

The stigma around substance use disorders is high, particularly among health care professionals. Indeed, the very same people who spend their lives devoted to caring for the ill and injured often shun patients who struggle with substance abuse or dependence.  A large systematic review (2) that looked at this issue showed that we, as clinicians, feel manipulated by these patients and helpless to offer them anything meaningful that will restore their health. We sometimes resent these patient and avoid them. We often label them as “drug-” or “pain-seekers”. We perceive patients with substance use poorly motivated to change and “weak-willed.” It also showed that negative attitudes of health professionals caused them to be more task-oriented in their delivery of health care and less empathetic. This led to patients’ diminished feelings of empowerment and poorer subsequent treatment outcomes.

Physicians enter medicine with the desire to help patients, alleviate suffering, and restore health. Perhaps for this reason, addressing situations in which we have a concern that one of our patients has become addicted to a substance and that patient disagrees and reports the need for pain relief can be quite challenging.

As we think about this topic, it is critical to recognize that while some perceive addiction to be a consequence of bad luck or personal failure, resulting from poor choices, others identify addiction to be an illness. We might think to ourselves that our perspective on the topic is borne out of proven scientific inquiry, but the fact that we understand addiction so poorly strongly suggests that our perspectives have more to do with our personal contexts (the experiences over the course of our lives) than with science. As such, we potentially enter a physician-patient relationship with long held biases and assumptions that may or may not pertain to the individual patient for whom we are caring at a given point in time.

 

OBJECTIVES

By the end of RP 101: Addiction, you (the learner) will be able to:

  1. Thoughtfully examine your own biases around and reaction to addiction and people who suffer with addiction.
  2. Bring a question for discussion and explore, in a small group setting, the experience of listening to the stories and struggles of people living with addiction.
  3. Identify and explore the sources of your bias and your reactions.
  4. Identify the positive and negative implications of your biases and reactions, to help understand the implications for patient care in the future.
  5. Consider what you’ve learned about yourself and about addiction, and develop a plan to mitigate the negative and enhance the positive implications of the reactions you identified above.

ASSIGNMENT:

  • Attend the group meeting as requested at the beginning of the module.
  • Review at least one of the resources listed on this page
  • Bring to your assigned group discussion notes about the following:
    • your reaction(s) to the group meeting and one of the resources listed below.
    • your personal context for your reaction
    • 2 positive implications and 2 negative implications for future health care based on those reactions
    • a question for the group to discuss around this topic
TEDxEverything you think you know about addiction is wrong Johann Hari talks about the importance of love, connection, and community to help addicts recover, rather then punishment, shunning or dislike.
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mscp-logoGripping Interview: How One Addicted Doctor Recovered Log-in required (registration is free). Dr. Cheryl Karcher, MD, a dermatologist, shares her experience with addiction and her process of recovery.
huffpostOur Compassion is Being Challenged -- the Opioid crisis in America a military veteran and physician talks about the crisis in West Virginia and the country about the opioid addiction epidemic.
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PulseConfessions of a 75-Year-Old Drug Addict The story of an older man who struggles with drug addiction after being prescribed high levels of Percocet while recovering from a pelvic fracture, and his struggle and shame in his inability to stay sober.
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Washington-PostThe Doctors Prescribed Me Pain Medication but Couldn't Help Me Stop Them. a first person narrative about one patient's struggle to extricate himself from opioid pain medications, and where he did and DIDN'T find help.
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The Irrationality of Alcoholics Anonymous "Why do we assume they failed the program, rather than that the program failed them?" Read about how the efficacy of 12-step programs, such as Alcoholics Anonymous, are becoming increasingly debated.
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TEDxWhy we need to end the War on Drugs Why we should regulate drugs, rather then make such an effort to vanquish the drug trade.
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