Working in the field of addiction has the tendency to put M.D.s and other health care professionals in a very unusual and often disorienting position; we are expected to give in to the instructions and demands of ‘counselors’ and other self-proclaimed addiction experts who are not professionally or medically trained. This is often very frustrating to us when we attempt to make our voices heard. We are used to being respected for our education, the number of years that we have put into training, our professionalism, the standards we try to uphold, and our expertise regarding issues of human health and disease. Yet, in this particular field, we are often viewed by others as knowing less than the patients we treat. And it’s all because most doctors and highly-trained professionals don’t have a personal history of addiction.
I have experienced this strange anti-non-addict prejudice many times in my online discussions with representatives of 12-step programs. (In one memorable argument, I was ridiculed for having letters after my name — as though the ‘M.D.’ was a pair of mystic runes that prevented me from seeing the truth.) Trained doctors are relative newcomers in addiction-related fields. Our profession has not, historically, been the one leading the treatment of this disease. In fact, many blame us for ignoring addiction, not understanding it, offering false hopes, enabling it, or in fact being a major cause of it through our prescription pads. And while it’s true that mismanagement by uninformed doctors has been a contributing cause of addiction — particularly addiction to prescription painkillers — that is reason for more doctors to come into the field and get the education to understand this disease and its causes. Efforts to keep physicians out of addiction certainly won’t help us understand and deal with addiction as a disease.
I’ve seen it said often that “nobody understands but another addict”. This attitude does not exist anywhere else in medicine, and I am not sure where it comes from. While it can certainly be helpful and emotionally supportive to speak to someone who’s shared the same problems you have, there is a limit to this idea. Cancer patients don’t refuse to be treated by doctors who have not themselves had cancer. A patient with chronic headaches won’t storm out of a doctor’s office because the doctor doesn’t have chronic headaches and “wouldn’t understand”. Physicians are trained to be able to offer help, understanding, and compassion to patients in many different situations. In fact, a physician who has specialized in treating a particular disease may “understand” better than the patient what the disease is doing to their body, and how to fix it. Most people who have a problem are anxious to explain their problems to others, to make them understand what it is like from their viewpoint, and to seek their understanding and help. Only in this field does there seem to be this rejection of assistance from those who have not had addiction problems.
I believe that the tide is changing, and that physicians do have both a stake in this disease and some very valuable ideas to offer, which is why I write this blog. There are certainly going to be some bumps in the road, and physicians will have to prove that they are compassionate and competent in treating addiction, but there is only so much proof that can be offered. I am afraid that no amount of successful care from trained professionals will convince some of those who cling to ineffective treatment methods and are not interested in learning anything new.