On a recent afternoon at the Athol, Massachusetts, center of CleanSlate, a national provider of outpatient addiction medicine, I met with two new patients who suffer from substance use disorder. One told me how badly she felt about herself. When I thanked her for the privilege of allowing me to work with her, she looked down at the floor (see supporting a loved one in recovery for more).
I’m just an addict, she said softly. The other patient sat in silent agreement.
No, I corrected them: I don’t see addicts when I meet with patients. I see people who have a chronic disease, no different than other chronic diseases like diabetes. I see people who are battling not only addiction, but also the stigma of addiction, which only multiplies the obstacles to recovery.
Can you talk to my family the patient asked. They think I’m not anything. They won’t even let me in the house.
I told this young woman that I’ve seen many families welcome back their loved ones after they had proven their commitment to recovery.
You’ll have to earn back their trust, I told her. But it’s possible.
As we go through the process of recovery, you will rediscover hope, I said. You can reclaim your life. You can regain everything that you’ve lost.
The patient started crying. I asked her why.
You’re the first person who ever made me feel like I was worth anything, she said.
This is why I do what I do.
I am an addiction medicine physician. The American Board of Addiction defines that as a physician who is trained and certified to provide comprehensive care for addiction and substance related disorders, including the diagnosis, treatment and prevention of such health conditions. I define it as a doctor who treats addiction with the evidence-based practices that every disease requires, and who treats patients with the same compassionate care that every person deserves.
Addiction Medicine is a specialty that’s not nearly as widely practiced as it should be, and therefore medical treatment is less pursued by addiction patients than it should be. This deficit is the impetus behind National Addiction Treatment Week, observed October 21st through October 27th. Created by the American Society of Addiction Medicine (ASAM), National Addiction Treatment Week is designed to promote four key messages:
- Addiction is a disease.
- Evidence-based treatments are available.
- Recovery is possible.
- More clinicians should enter the field of addiction medicine.
I love my work, and I want to encourage more doctors and clinicians to pursue addiction medicine as a specialty. That’s why I agreed to be an ASAM ambassador for National Addiction Treatment Week.
Working on the frontlines of the current opioid epidemic and the overall war against addiction is one of the most important jobs in the world today. In 2018, approximately 20.3 million people aged 12 or older had a substance use disorder (SUD) related to their use of alcohol or illicit drugs in the past year. And sadly, more people die from drug overdoses than from car accidents. This doesn’t even account for alcohol-related causes, which cost the lives of 88,000 people each year.
Here’s what National Addiction Treatment Week wants everyone to know:
- Only about 17% of those diagnosed with addiction receive the treatment they need.
- In 2018, an estimated 2 million Americans were addicted to opioids, yet only about 400,000 people received treatment at a specialty facility.
- Just 2% of all providers are trained to provide medications for addiction treatment.
- One study found that when looking to just get assessed for treatment, less than 1/3 of participants got an appointment within 24 hours, 40% of patients waited for treatment between 3-7 days, and 12% waited more than a week.
- Nearly 90% of large rural counties lack a sufficient number of opioid treatment programs.
A day in the life of an Addiction Medicine specialist
People who struggle with substance use are trying to cope. Our first job as clinicians is listening.
When clinicians, nurses and physicians ask me about my work, I tell them that I meet with the broadest cross-section of patients you can imagine. Men and women of all ages, of all nationalities, of all professions, from every type of socio-economic background. You can get a snapshot just by looking at the diversity of shoes on the feet of people in the waiting room: sandals, heels, business shoes, sneakers, sensible flats you see it all.
Addiction medicine requires a team approach. I start my workday each morning with a huddle with the nurses as we talk through our patient list for the day. I’m always so excited when I hear about a patient who just had a baby because I know it will only be a matter of time before I’m holding a baby. Pregnant moms are some of the most determined patients we work with and seeing their success stories through recovery is incredibly gratifying.
As the day goes by, I spend a lot of time really listening to the challenges that my patients face in their daily lives. For example, one patient was experiencing trust issues with his wife. The trigger was that he was paid in cash for his job; he would go a few weeks maintaining his recovery and then lapse. I suggested that he have his wife come with him on payday so that she could take his paycheck; then he wouldn’t have the temptation of excess cash in his pocket. We found that this solution worked. The patient started feeling better and believing that he has the strength within him to work through this disease. He was proud of himself, and I was, too.
People who struggle with substance use are trying to cope, and substance use has become a way for them to feel normal or to numb pain. Their unhealthy coping strategies may have stemmed from struggles with stress, financial troubles, unemployment, grief, social issues or other difficult life events. Our job as addiction medicine specialists is to treat the whole patient, which requires an approach that combines medicine with behavioral health.
There is nothing more rewarding than helping people rediscover life.
If you would like more information about pursuing a career in addiction medicine, read the article I wrote for AAFP, Family Medicine Is Poised to Lead on Addiction Care, which offers more details about this field and certification.
Fighting the war of addiction is not only important, but it’s also profoundly rewarding. Nothing could be more life-affirming than helping others reclaim their own lives, bringing back their families, children, housing, jobs, education, their dreams and aspirations and hope itself.
Flora Sadri-Azarbayejani, D.O., M.P.F., is a regional medical director for CleanSlate Outpatient Addiction Medicine, a national medical group that provides office-based outpatient medical and behavioral health treatment for the chronic disease of addiction, primarily alcohol and opioid use disorders. She is also the ASAM ambassador for National Addiction Treatment Week and part of the opioid review council for Arizona State Senator Kate Brophy McGee.