Many, if not most family physicians, don't like or want to treat patients suffering from drug or alcohol addiction. In fact, one national survey found that nearly half of all doctors consider alcohol addiction to be "a personal or moral weakness." And it’s basically the same for prescription drug addiction and illegal drug addiction. To an addict seeking help, no matter how committed to recovery he or she is, a doctor’s contempt can't be disguised for long. It not only discourages a patient’s hope, it can actively sabotage his or her reach for help, and send them back to their addiction. People don't normally expect that kind of attitude from a doctor, no matter what’s wrong with them. To most of us, doctors are often who we turn to in our darkest hour of need. And we expect to be received, listened to and treated with the highest standards of care and respect. But unfortunately, that isn't the way things always are. According to surveys and studies here and in Europe, health professionals generally have negative attitudes towards patients with substance use problems. For example:
- A 2011 study found that health professionals' regard for working with substance users, especially drug users, was "consistently lower compared with other patient groups, such as patients with depression or diabetes" (Gilchrist et al., 2011).
- Physician attitudes towards illicit drug users were especially negative in another study. The majority of professionals preferred the care for these patients to be provided solely by addiction specialists, because they were unable or unwilling to 'empathize with patients who use illicit drugs' (McLaughlin et al., 2006).
- A study of nurses found that most nurses were "poorly motivated to care for patients who use illicit drugs" and reported "low levels of satisfaction" in having to do so (Ford et al., 2008).
- A small but revealing study showed that professionals hold "more stigmatizing attitudes" towards patients with an active substance use disorder compared to patients with mental illness. Their attitudes were more positive about patients already in recovery compared to those in relapse. And patients that were abstaining and holding down jobs also drew a more positive attitude (Rao et al., 2009).
Any idea that addiction is a character flaw or psychological failing flies directly in the face of modern scientific evidence. Substance dependence and addiction may stem in part from a psychological need, but once it’s taken hold, there are purely biological conditions that need to be addressed as well. Addicts lose the ability to voluntarily control drug-related behavior, but their physical health is also seriously in jeopardy. At this point, medical help is always indicated. In a nationally representative survey of 400 primary care physicians conducted by the National Center on Addiction and Substance Abuse at Columbia University (CASAColumbia), 80 percent of them said they were "qualified to identify drug abuse and addiction." But when the confident 80 percent were presented with the case of a middle-aged woman displaying symptoms of alcohol and prescription drug abuse, only 1 percent of them correctly diagnosed substance abuse - or even considered such a diagnosis. Keep in mind that this wasn't a patient addicted to some rare or exotic drug. It was the case history of an aging American alcoholic and pill popper - absolutely the commonest patient type in the country with a substance use problem, the exact type of patient that every family physician encounters multiple times during his or her career. And only 1 percent recognized the symptoms, which would have been obvious to someone properly trained in addiction. But let’s look back at that 20 percent of physicians who did not feel confident about recognizing addiction symptoms. That’s a fifth of the nation’s 210,000 family physicians - roughly 44,000 doctors - who aren't qualified to diagnose even the most basic and common substance abuse cases. Yet most of them are presented with substance abuse and addiction on a regular basis. The main cause of such a situation is little or no training on addiction and addictive drugs at medical schools. A survey from CASAColumbia found:
- Less than 20 percent of physicians received instruction in identifying diversion of controlled prescription drugs, most had only a few hours of instruction, and only 7.4 percent completed an entire course.
- Less than 40 percent of physicians received instruction in identifying prescription drug abuse/addiction. Again, half received only a few hours or less, and only 7.5 percent had an entire course.
- Just over 50 percent of physicians surveyed received instruction in prescribing controlled drugs, half of them received only a few hours or less, and only 5.5 percent had an entire course.
The results are obvious. Most doctors don't learn all that much about:
- How to recognize symptoms of drug and alcohol addiction, especially early symptoms
- How to treat patients with substance dependence or addiction
- How to properly prescribe and manage controlled drugs
- When prescribing controlled drugs, how to first identify patients at risk of addiction
- How to identify and deal with diversion of addictive prescription drugs.
Researchers from Weill Cornell Medical College, Columbia University and Cornell University wanted to know what happens to the prevailing negative attitudes when doctors who don't specialize in addiction received some supplemental addiction medicine training. Before and after receiving a 10-hour course intended to increase understanding of addiction issues, a group of 128 doctors stated their attitudes towards patients suffering from heartburn, pneumonia, addiction to opioid medications and alcoholism. Before the training, every single doctor, regardless of levels of prior training or experience, gender, age or anything else, plainly viewed drug- and alcohol-addicted patients much less favorably than the other patients. After the course, some "marginal" improvement was seen in their attitudes. But the researchers said it was too little to offer any advantages to patients with addictions. So here’s the bottom line: We have an ongoing situation of doctors unable to diagnose or treat patients with substance abuse symptoms, and they generally harbor widespread negative attitudes towards patients with addictions. How has this happened? We live in a country that prides itself in its excellence of health care, yet it’s a country where millions of people are addicted to drugs and alcohol and living ruined lives. Countless thousands die of drug-related causes. And yet, close to a quarter of a million Americans somehow manage to struggle into treatment programs every year, in spite of legions of physicians who would rather not have to treat them at all. How bad can it get? How negative and discouraging can a doctor be about addiction and addicted patients? Perhaps the most extreme example would be Missouri State Senator Rob Schaaf, a licensed family physician who is vehemently against a prescription drug monitoring system for Missouri - the only state in the Union without such a system. In a New York Times article in July, 2014, reporter Alan Schwarz wrote: "Mr. Schaaf said of drug abusers, 'If they overdose and kill themselves, it just removes them from the gene pool.'" Now there’s a tidy solution for America’s countless millions of addicts, from a state lawmaker and doctor of medicine: Addicts, just drop dead. Because we don't want anything to do with you, not politically, and not medically. Schaaf’s mind-bending attitude towards addicted patients may be far from typical. But it reveals the most horrifying depths to which a doctor possibly could sink. And it shows what some patients might be up against when they're looking for a doctor to help them overcome addiction. But to be fair, it’s certainly not all bleak and black out there for addicts seeking medical care. There’s always a flip side to everything. Some studies have found very positive and helpful attitudes, but more among mental health professionals and addiction treatment specialists than regular doctors:
- In one study, mental health professionals generally had positive and non-discriminatory attitudes towards patients with substance use disorders. They were positive about treatment interventions, and rejected "moral stereotypes" about patients (Pinikahana et al., 2002).
- And a study among primary care physicians back in 2002 actually found some positive attitudes towards patients with substance use disorders (Saitz et al., 2002).
We do need to remember that doctors are also people, exposed to and subject to believing the same kind of wrong-headed opinions as anyone else. Of course we would expect their scientific training to discount poor information. But when you combine an absolute minimum of scientific training in addiction and controlled substances, it’s not all that surprising to encounter doctors with discouraging attitudes. Meanwhile, explaining a bad attitude doesn't alter the fact that it exists. And as long as it does, treatment from such doctors very likely results in less than optimum care. Certainly the care would be inferior to that provided by a doctor with thorough training and a positive attitude toward patients. And when you're dealing with addiction treatment, you're depending on an enormous amount of the real work to be done by the patient. After all, the whole process begins with the decision to get sober, the determination to try as hard as one can to make it all the way. It is far less likely to be successful, to maintain that positive intention to overcome, when the patient feels belittled and looked down on for their condition. So what is someone looking for help to do? When you've decided to finally deal with prescription drug addiction, heroin addiction or alcohol addiction, where do you turn? If you're going to look for some medical help, it’s vital to take some extra time to find out as much as possible before committing yourself to a doctor for treatment. Actually, that goes for anyone needing help for any condition. But for help with addiction, it’s essential. There are numerous specialized addiction clinics in larger towns and cities. These generally may be a more comfortable starting point. If you're in an area without such dedicated resources, you need to do your homework on local doctors. With the internet, you can find out a lot about a doctor. But also with the internet, you can find drug detox and treatment centers from coast to coast. And their toll-free numbers mean you can call anywhere and get some advice without racking up long distance phone bills. Just keep in mind that there are many ideas about what’s the best approach to detox and rehab and relapse and recovery and all the other questions people have. Novus receives calls from all over the country, and even from other countries, from people needing help and advice about addiction treatment. There’s no negative attitude here - we're all about recovering people’s lives. And we look forward to your call.
