I’m a psychiatrist. I’ve been practicing for 30 plus years. I’ve worked in inpatient and outpatient settings seeing the typical mix of general psychiatric patients.  About five years ago, I was asked to take the training for a buprenorphine license to serve as a backup for our addiction psychiatrist in her suboxone clinic.  I did the training, doubting that I would every really use it on a consistent basis. But gradually I found myself becoming more and more drawn to the treatment of addiction.

Why?

Treating patients with addiction led me to challenge some of my underlying beliefs about addiction. Yes, even as a psychiatrist, before really learning about addiction, I too thought that there was a “choice” as to whether or not someone used drugs.  Sure, I knew that people who were addicted had craving and withdrawal symptoms if they didn’t use.

But I felt that if they really wanted to be clean, they could choose to endure those symptoms.  When someone failed treatment, I used the go-to excuse that they weren’t “ready” for treatment. That excuse may make us feel better as physicians, but it doesn’t do much for the patient.  When someone fails a cancer treatment, do we say that they weren’t “ready” for treatment?

Most importantly, I began to realize that they are not addicts, but they are persons with the disease of addiction.

Some of my most rewarding experiences have come from treating addiction. For one thing, the patients that I see do not want to be addicts. They see themselves as losers. I don’t think anyone with addiction truly wants to be an addict. Their lives are miserable. I do believe that some people are so far into addiction and have such limited social support and have lost so much (or never had it), that they can’t envision a sober life.

However, I’ve been amazed at what support, validation, empathy, and in some cases, medication can do even for the most entrenched patients. The trick is getting them to treatment.  But when they get there, they want to be there.

Do some patients still fail treatment? Of course. The pull back into what is familiar can be strong. I often tell patients that sobriety is not necessarily fun in the beginning. They must deal with emotions that they haven’t experienced in years, and they clearly see the fallout of years of using, the toll on their families, children they’ve lost touch with, husbands and wives who divorced them. For some, it’s just too much.

I do realize that I’m seeing people who want treatment. Those of you in the family practice, ER, internal medicine and pain treatment worlds are seeing people with addiction at their worst. They still feel desperate; they are still trying to manipulate to get the thing that they believe they must have.   As I began seeing more addiction patients and hearing their stories, I better understood their mindset. They truly believe that they can’t survive without the pills or the heroin or the meth or cocaine. It sounds crazy to those of us who aren’t addicted. But ask yourself this question. What would you do if you felt that you had to have something just to function on a daily basis, just to survive? Would you lie, steal, manipulate? Probably.

I currently work with a man in his 30s who lost everything due to his opiate addiction: his house, his job, his family. He came into treatment and got on suboxone (after failing a couple of abstinence based treatments).  He’s been clean for about five years. He just graduated from college, got promoted at work, and was able to buy the home that he and his fiancée had been renting. His fiancée, their two children, his mother and all of his siblings were present to see him graduate.

One patient, a man in his early 30s, has a history of heavy drug use and gang involvement.  After a couple of unsuccessful attempts at treatment, he is working steadily laying carpet, looking to buy a house, and finally able to be a role model for his five sons. We discovered, through some testing, that he also has attention deficit disorder.  I have women who have gotten jobs for the first time in years and are repairing relationships with children being raised by other family members.  I have several patients who are the only members of their immediate family who are sober. One woman recalls growing up in a household where pills were simply thrown into a bowl on the table, available for anyone to take.  Sadly, it is not unusual for one of my patients to come to the session grieving over a family member or friend who overdosed and died.

I only wish we could get patients to treatment more easily. I know that these are the least favorite patients of most physicians.  They are people with a possibly fatal illness that can be treated. You don’t have to like them, but I hope that you can believe in them enough to refer them to treatment.  If they don’t take you up on it immediately, they may later.

Colleen Ryan is a psychiatrist who blogs at Dr Colleen.

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