My friend, a doctor, reached out to me recently and asked if I would write a few words for her annual address to medical students at a fairly prestigious school. The topic was “opioids”, but she wondered what a recovering person would say if they had a few moments with a future physician departing into their career. I thought about all those conversations I’ve had in 12-step meetings about doctors pushing Vicodin, or ignoring the ‘Substance Use Disorder’ diagnosis on a chart. I wrote down the few points below.
As a person living in recovery from a substance use disorder (SUD), who was once told by a physician that my accelerating painkiller use was merely a “bump in the road” before he sent me out the door, here are four things I wish every physician would know about caring for people with SUDs and those in recovery:
- Recovery is probable. The era of addiction as a death sentence is over. Evidence-based medications, interventions, and mutual support groups provide a menu of options for your patients to succeed. You may have heard the slogan “recovery is possible”, but this is underselling it. According to SAMHSA data, of the 31 million adults who ever had a drug or alcohol problem, 74% have resolved it. Recovery is a highly probable event. And the potential to inspire your patients is enormous. Let them know that effective help is available if they seek it.
- Medication is just one tool. Your training may prepare you to prescribe Buprenorphine or Methadone for your patients. This is a welcome development for evidence-based care. But the roots of addiction are like a layered web of knots – isolation, trauma, distrust – and each must be untangled by human connection. In the UK, physicians practice social prescribing, where prescriptions include attendance at Alcoholics Anonymous meetings or referrals to sober social groups. You must find ways to guide your own patients to sources of human community.
- Peer specialists can be your greatest allies. Some of you may find yourself in hospital settings or clinics where your colleagues are openly in recovery, certified to provide support as peer specialists, recovery coaches, or navigators. The worst thing you can do is dismiss these amazing individuals as ex-patients or write them off as ‘assistants’ for menial tasks. Their ability to build trust in your patients may be the most valuable asset you have in healing SUDs. Ask for their guidance, and your humility will be repaid ten-fold.
- Your patients are looking to trust you and walk beside them. Do not be afraid. Be curious. The letters behind your name will hold a special place in the minds of many people. For some, your words will be the only thing they trust. But more than anything, ask questions. If you see a substance issue on a patient’s chart, ask about that history. When you consider prescribing an opioid to a person in recovery, ask about their comfort level and its potential for disruption. The less you assume and more you ask, the more you will be seen as an ally in your own patients’ recovery journeys.
