Letter to Providers
Unfortunately, the vast majority of my patients have had many traumatic and humiliating interactions with healthcare providers over the course of their illness. This is largely due to the fact that most providers, while having had no training whatsoever in addiction, have very strongly held beliefs about addicts and the disease of addiction. As a practicing ER physician for over 20 years, I witnessed these attitudes in staff and other physicians on a daily basis. While addiction is as common as diabetes, we unfortunately receive little or no training in addiction in medical school or residency. This leaves a huge void which is filled with conjecture and prejudice. But despite the belief among many providers that there is little science in the treatment of addiction, there is a huge body of data and research largely unknown to the general medical public. This data clearly shows that addiction is a disease like many others, or as the AMA states “a chronic, relapsing illness, much like diabetes”. And there are excellent, scientifically proven treatments for addiction that have only become available within the last two decades. These treatments have taken the success rates for some forms of addiction from less than 20% to nearly 80 percent. In any other field of medicine these advances would be lauded, yet in the disease of addiction many people see this as “trading one drug for another”.
In untreated schizophrenia, when we use Haldol to stop an individual from self-medicating with street drugs and alcohol, is that trading one drug for another, or are we in fact treating the disease? Is it not acceptable to treat mood disorders with SSRIs indefinitely, why then is it unacceptable to treat addiction indefinitely? Is there any other single disease in the field of medicine where forced tapering is the norm? Do we taper people off their blood pressure or diabetes medications if their disease is well controlled, or take someone off of their schizophrenia or depression medicine if they do poorly off of them? Why then do we treat addiction differently? There is no scientific basis for this whatsoever. On the contrary, studies have repeatedly shown that people force tapered off their medication relapse, resulting in increased morbidity and mortality as well as worsening of their legal and social difficulties. Why would we want that? Addiction is the only disease treated punitively. Facts seem to be irrelevant to most medical professionals when it comes to addiction. Most medical professionals won’t even take the time to read an article about the current treatment of addiction. They just take the attitude that they don’t want “those people” in their practice. These attitudes must stop. The reason there is a crisis in addiction in the United States (which has more than twice the addiction mortality rate of any country in Europe) is largely due to the dysfunctional attitudes of our healthcare system. Other more enlightened healthcare systems see addiction as the disease that it is, where in our country we see it as a crime. This also must change.
Another important issue is the strong correlation between sexual abuse and addiction. A large percentage of female addicts are addicts because of rape or sexual abuse. A woman who becomes an addict because of childhood rape did not choose to become an addict any more than she chose to be raped. Yet this is the primary reason for addiction in 60 to 80 percent of addicted women. And to treat them with scorn and derision literally exacerbates their disease. Have we not all sworn to “above all do no harm”?
It is time that we as professionals reevaluate our stance on addiction and get the education on the subject that our patients deserve. To do otherwise is simply malpractice.
If you have any questions about your patient’s treatment, or the treatment of addiction in general, please do not hesitate to contact me at Evidence Based Addiction Medicine.
Vance Shaw, MD, FASAM
Board Certified in Addiction Medicine
Medical Director Evidence Based Addiction Medicine