What are the most common concerns of individuals struggling with substance use/abuse?
Over and over patients stated they were scared of being accepted by the medical system because they were “a user.” Many times they had sought help but they were denied medical treatment because the team just chalked it up as "they are just withdrawing" or they are "user."
I appreciate their perspective because it is a common thing I have personally felt in regards to having physical pain and anxiety. Medical providers use the heuristic of "oh your pain is normal because you have chronic pain," or your current symptoms are just because you are anxious.
As providers we need to be more aware of the words we use in front of patients and in their chart because they can be damaging and prevent these individuals from wanting to get medical treatment when they actually need it. It is better to use the phrase "substance use" over addiction or "addict" because individuals rarely want to be stuck on the substance they are using. Instead of further stigmatizing their use it instead places it as any other medical condition when they are presenting to the hospital. Yes there are a lot of substances that cause addiction which means that they develop a tolerance and need more and more overtime, they experience withdrawls when they don’t have the substance, and that body and mine does everything I can to get that substance sometimes including hurting themselves or the individuals around them.
From: words_matter_-_stigma_and_sud_nida_.pdf
While working with the Substance Use Intervention Team, I had an opportunity to speak with multiple individuals to their lives had been turned upside down by becoming addicted to heroin, alcohol, cocaine, and other substances. A substance use (alcohol, cocaine, heroine, meth…) is a lifetime illness of the brain, and we have so many scientifically proved strategies to help these individuals. Unfortunately these individuals and their treatment (ex: suboxone & methadone) have been stigmatized so much that rarely can the individuals who need it most recieve it. Also, government laws and regulations have decreased funding for research and longer term treatment facilities.
There are so many reason individuals start using substances. Some misuse the medications they were originally prescribed for pain, because individuals in their family had been using it, they have been exposed to it at a young age, or it was just the social required thing to do in their community. Others had to turn to stronger opioid options (heroin) after being unable to acquire their normal pain medication their doctors used to prescribed to them for many years, but then suddenly had cut them off when the government changed they way doctors prescribed options. These individuals were used to having a set level of pain free days and their brain needed that release.
It is important for medical providers to understand that it is a life time illness that impacts all aspects of an individual's life. Every individual is different and has different biological and social needs and resources to be able to overcome or manage their substance use. Therefore, all available options should be frequently provided to individuals because you never know when it will actually stick and whether that will be the day the individual chooses to go forward with said technique.
Unfortunately trauma is the base of a lot of stuff substance use whether that is because of the original reason they turn to the new substance, the continuation of the substance or, they face by the medical system society and their family while using. Instead of coming from a place of compassion and a lot of medical providers look down upon these individuals and classify them in another category as if their medical means or not worse as much as others who are not using that substance.
Multiple times I have worked with individuals who waited until the very last moment to come to the hospital because they were scared of the persecution they would receive by the medical system through asking for help. Unfortunately, it was often too late and they had had to suffer unfortunate consequences which could have been easily managed earlier if we had assisted them by treating the addiction to begin with.
For example, I once worked with an individual who had been stuck at home for so many years injecting themselves that they had developed a hole in their foot that prevented them from walking to get food or clean clothes. Eventually one of their family members brought them to the hospital. This particular individual had an infection so bad that there were literally pieces of metal in their foot. The infection had gotten so bad that it had traveled into the bone, which is called osteomyelitis.
Unfortunately when infections become this serious into the bone antibiotics are rarely helpful to stop the infection. Therefore the only thing we can do is clean out the wound daily and hope that there is enough blood flow for it to heal up by itself.
However, this individual also had other chronic medical conditions (such as diabetes, anemia, malnutrition) which they were unable to manage by getting to a doctor. Their diabetes impacted their blood vessels in their foot through accumilating sugars and slowly die off. This lead the tissue in the foot to be unable to provide healing inflammatory substances such as white blood cells.The only option at this point was to amputate the foot possibly all the way up to the knee, since the infection was spreading from bone to bone. The worst part was this individual obviously did not want to get an amputation because it would further prevent them from being able to move around their house and complete their basic needs.
The only option at this point was to amputate the foot possibly all the way up to the knee, since the infection was easily spreading from bone to bone. The worst part was this individual obviously did not want to get an amputation because it would further prevent them from being able to move around their house and complete their basic needs. To complicate things more the team working with them wanted to confirm that the patient really wanted to stop using so they decided to discharge them and asked to return to the clinic at further dates to demonstrate their willingness to change their substance use habits. However this is individual didn’t have insurance or transportation so how were they going to even achieve that goal?
Unfortunatly, this is a very common story and challenge that I have seen repeated while working with individuals who are struggling with being un-housed, homelessness, or couch surfing. Many do no have the transportation or financial ability to make it back and forth between doctor's appointments and specialty medical clinics.
When we get stuck and feel like we are starting to view a patient through the tunnel of them being a "user" remember that these individuals also have medical and social needs. Therefore, ALWAYS ask all patients if they are using any substances, how it impacts their health and life, and how they feel about receiving medical help.
Check out: THE NEUROBIOLOGY OF SUBSTANCE USE, MISUSE, AND ADDICTION https://www.ncbi.nlm.nih.gov/books/NBK424849/
What does it mean to be "in recovery?"
As mentioned over and over before, substance use is a lifetime illness. Therefore, it is expected for one to go through multiple periods of use, treatment, and sobriety. Relapsing is NOT A FAILURE but part of the process of treatment and recovery.
I once heard a speaker on a podcast on Substance Use say that he felt that he was in recovery when he was able to step outside of his self and realize that he could take his experience and his growth to impact others positively instead of only focussing on when he could next use his substance.
"As far as service goes, it can take the form of a million things. To do service, you don’t have to be a doctor working in the slums for free, or become a social worker. Your position in life and what you do doesn’t matter as much as how you do what you do.” Elisabeth Kubler-Ross (Quoted in Teachers in Wisdom, 2010)
This is where the idea of using support groups to help individuals suffering and recovering from substance use. Once one goes through a disorder such as addiction, it creates a trauma which tints their glasses on how they view the world. The can’t just remove these glasses because then they wouldn't be able to see well. However, they can learn to use this colored version to assist others who are also seeing the world through the tinted glasses.
Here is a great list of Community Support Groups for Individuals working to recover from various forms of Substance Abuse:
https://wellness.uchicago.edu/mental-health/therapy-groups/substance-abuse-recovery-support-groups/
***Some might benefit more than others on having a community of supporters to manage their sobriety when others need more of pharmaceuticals (medications) to help manage their addictions, and others need both to be successful through their recovery.
Substance Use in Medical Providers
https://www.kevinmd.com/2022/09/let-doctors-in-recovery-be-able-to-recover-their-careers.html
***This Blog Post is for educational purposes only and is not intended nor implied to be a substitute for professional medical advice, diagnosis or treatment. This does not imply a doctor-patient relationship. All opinions are the opinions of the writer and not reflective of any institution or employer. Please follow up with your health provider and therapist for any additional questions or support.***