Sentences to Ponder (addiction medicine physician)

Several years ago I was at a national conference in our field. It’s a very well known conference with thousands in attendance. On one of the mornings in particular, I was 2 minutes early for the 7:00am breakfast in the giant ballroom. One person was there, seated, and just starting to eat breakfast. It was a rather well-known addiction medicine physician. I’ve had the pleasure of hearing this person in multi-day trainings for very small audiences, speaking with them about our work over the years, and so forth. They have always been quite generous with their time and easy to be around.

I sat down with this person and ate some eggs as we both looked at the hundreds and hundreds of empty chairs. We ate together while we enjoyed the quiet of the early part of the day’s schedule.

I started to share information about our methadone maintenance program’s treatment philosophy and practices. I described how, if we figured out as we had in one recent case, that someone also had alcoholism in addition to an opiate addiction, we would refer that person up to one of our residential programs to treat their alcohol dependence. And we would continue medicating the person with methadone from our clinic, having one of our RN’s drive it to the residential program each day. And how, after their residential treatment was concluded, we would have the person simply continue to get their methadone at our outpatient clinic and attend weekly group and individual counseling as they had prior to being referred up a level.

That’s when I proudly said, “We would consider the alcohol dependence a co-occurring disorder. That is, we would consider the alcohol use disorder to be a co-occurring condition along with the opioid use disorder. Why does ‘co-occurring’ have to mean a substance use disorder and a mental health disorder? It can also mean two substance use disorders. And so, when we figured out the person also had alcoholism, we sent them to the residential treatment program for that.”

After telling me they agreed with having the person enter the residential treatment program they needed for their alcoholism, and with continuing the methadone dosing the whole while, this very well known addiction medicine physician paused, looked me in the eyes, and calmly said,

But we would never consider two substance use disorders co-occurring conditions. Addiction illness is one illness. And the brain is one brain. The person is one person.

The profound simplicity and utility of this was so clear and immediately helpful to me on so many levels, my breath was nearly taken away when I heard it. Especially coming from one who is so well known, longstanding in our clinical addiction work, and of such an academic bent.

It was so powerful, clear, simple, and profound. And so calmly stated. I’ve never forgotten it.

“Sentences worth pondering”? This certainly has been one example of exactly that for me.