Why are doctors clueless about addiction? Redux

A 3-pronged perspective from my own experience

Why is it so hard for medical doctors to understand and treat addiction? The answer is complex, but one simple reason is that they’re not trained or incentivized to.

I published this essay in April 2023. It was seen by a couple dozen early followers who have stuck with my on this Substack journey and I’m most grateful. Since then, many of you have jumped on board with Of A Sober Mind. I write about life—but without question there’s a solid foundation of sobriety and recovery which supports how I view the world. Which means that there was also a period where my addiction was the shifting ground beneath me—caving in—sliding under my feet.

I repost this essay as a reminder of what brought me here to this place. There is a wasteland in our medical system as it relates to addiction. It is getting better to be sure but only in increments that pale in comparison to the overwhelming and vast volume of need. Today’s newly trained physicians have an ever-growing universe of maladies and diseases to respond to. Their curriculums are not responding fast enough to properly educate them. The situation gets more dire as it relates to addiction and/or mental health issues.

---

When I was struggling with my own substance use disorder—which is the less judgmental term applied to addiction these days—I found that the advice given to me by my own general practitioner was weak at best. My physician was widely recognized as one of the finest in the Denver area. He had worked with the local professional sports teams—was widely respected and published in his field—and had an impeccable reputation. We discussed my drinking on several occasions, and his advice was simply you should quit…it will kill you one day, either slowly or quickly. Fair enough. This is fairly common advice from most doctors to their patients. Generally, the discussion arises because of some alarming trends in blood labs such as elevated liver enzymes. Rarely—if ever—is the line of questioning from the doctor based in any real knowledge of the complexities of addiction. The doctor asks how much are you drinking? Are you using any illegal substances? The patient lies—of course. The doctor moves on to the next topic in their brief 15-minute consultation.

In a recent study performed by the Stanford Medical School, numbers indicated that less than 1,200 of a million graduating medical students sought any certification or further study in addiction treatment. Many medical students have barely one day of focused study on addiction in their entire curriculum. This is slowly changing, but not nearly fast enough. Doctors today face new financial pressures running their own practice, as evidenced by far fewer independent medical practitioners today, and many operating in more consolidated and corporate medical environments. Additional pressures are applied by pharmaceutical companies who hold one powerfully manipulative key to doctor’s profits. How else can you explain the massively disproportionate number of opioid prescriptions written? Financial incentives, lack of education, and clients with higher treatment demands in less time.

When I went through my 93-day treatment cycle at the Betty Ford Center in Rancho Mirage, California, I was enrolled in a residential program for professionals. It differed from normal residential treatment in that it was designed for doctors, lawyers, business owners, and other professionals who had specific accountability and confidentiality issues with employees or state regulators. I lived in a home off campus with 5 doctors: a chief of radiology from a high-profile west coast university, an osteopath, an orthopedist, a dentist, and an anesthesiologist. We were considered tougher nuts to crack given the success we’d had in our respective fields—our attached egos—and our resistance to changing how we lived our lives. Each of my housemates was under some form of state licensing review based on the regulations in the state their practice resided in. Several had simply lost their licenses, and it would take several years of proven sobriety, and other measures of accountability in order to be reinstated. We were all required to set aside our preconceived notions about what had brought us to treatment, and to our knees. In our nightly discussions, it was made clear to me that these men had very little education on the topic of addiction during their training years and their practice years.

As is the case with most functioning addicts, we had all been under tremendous pressure in our careers, and we had resorted to unhealthy coping mechanisms to get through the day-to-day. As is also the case, our addictions had become progressively worse as our tolerance grew for our drug of choice. Symptoms and behaviors had gotten to the point where they impacted our ability to do our jobs effectively. Friends, family and business colleagues had noticed, and in most of our cases, had been the catalyst for change. Why and how had the red flags been ignored? How had these smart and educated men lost their battle with addiction to date—when clearly—they had an up close and personal look at its impact and consequences in their clients?

The good news is that there are organizations like Hazelden Betty Ford that are offering programs for working medical professionals and also for medical students in the early stages of their curriculum. Hazelden Betty Ford Foundation’s SIMS program (Summer Institute for Medical Students) has been in existence for over 30 years and works with dozens of top medical schools around the world. This one-week summer program, the cost of which is 100% funded by the support of generous donors. There is no cost to the university or to the attending students. Those students interested in the program are selected after applying through their medical school, writing essays about why they feel drawn to the program.

Another perceived step in the right direction was The Affordable Care Act’s requirement for all participating insurers to cover the expense in treatment in a confidential way for their covered plan members. The resulting downside of Obamacare is that we now have a situation where insurance claim benefit managers are making uneducated decisions for their covered claimants about how long—and how many treatments—rather than the treatment professionals themselves. Perhaps we need to develop more programs for insurance claims adjusters just like the ones offered to medical professionals.

My nephew-in-law Grant applied and was accepted into the SIMS program after his 2nd year of study at the University of Georgia Medical School. He became that university’s first applicant and enrollee. Grant called me after his week in Rancho Mirage at the Betty Ford main campus in August 2022. He related to me that what he learned was so profound and so life-changing that he’d decided to pursue a career in mental health as a psychiatric physician—with a focus on addiction. He is now in his psychiatric residency in Greenville, SC. The relationships he developed with the thirteen or fourteen students he went through SIMS with from other medical schools was closer and richer than those he had with his own colleagues back in Georgia.

Every single medical student and every single practicing physician needs to have further focused and intensive training on the holistic and integrated approach to treating addiction in their own patients. Now, more than ever, these front-line first responders need to be able to recognize, intervene, and discuss the downstream consequences of their patient’s behaviors around substance use disorders. Without it, the alarming trends will continue.