We are More Than Our Disease

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Imagine you are a diabetic, complaining to your doctor’s office manager about poor treatment you’ve received by the doctor’s staff. How would you feel if the office manager said something like this?

“That’s just your disease talking. Your perceptions are wrong because your diabetes wants you to feel resentment and self-pity. Your diabetes wants to give you an excuse to go back out there and eat a bunch of sweets. Your diabetes has you confused. You really weren’t mistreated. Your thoughts and feelings aren’t real.”

Sounds kind of nutty, doesn’t it? Yet people with addiction are sometimes told similar things by their treatment programs.

While it is true that addiction can damage the structure and function of the brain, patients don’t lose all their higher brain functions and often have very accurate perceptions.

This week I encountered a patient who said workers at his opioid treatment program discounted his legitimate complaints about problems he saw at his program. He said he felt like personnel at this program thought because he was an addict, he didn’t know what he was talking about and had no right to complain.

I listened to him, and what he said resonated with me.

I outed myself a few months ago on this blog as a person in recovery. I’ve been abstinent from drugs and alcohol for over sixteen years, and my recovery is one of the most precious possessions I have. And yet, I do remember similar frustrations with my treatment program.

I went to an intensive outpatient treatment program many years ago. It was highly recommended by other doctors in recovery, so I hadn’t shopped around for treatment programs. Besides, who has any idea what to look for in a drug addiction treatment program? I just followed the recommendations of my state’s physicians’ health program.

I do admit that my brain had been damaged by drugs and by withdrawal. I knew my perceptions were not completely reliable, and yet, sometimes I heard my counselors say things that I knew were not OK, and that were offensive to me. I can’t remember exact words after so many years, but the essence of their remarks was I wasn’t able to think clearly, all my perceptions were wrong, and I had no right to be angry about anything, including disagreements with treatment staff.

Which is a rather convenient position to take if you are treatment staff. Essentially, you win any argument with patients, because you can say the patient’s brain is damaged, yours isn’t, so therefore you are right and the patient is wrong.

I remember when I was in aftercare, I overhead a comment made by my counselor to another counselor about another patient who frequently relapsed: “She can’t come to aftercare because she keeps getting drunk.”

His breach of her confidentiality was bad enough, but when I heard him I thought, “Aha! All this talk of disease, but he doesn’t really believe it or he wouldn’t blame her like this.”

Yes, maybe my brains were still scrambled, but I got that one right.

Now I’m on the other side of the treatment fence, and things look different. I think there is a temptation to take the easy way out when faced with a patient complaint, and dismiss the complaint as being irrelevant.

I’m not rising up on a self-righteous scold of all treatment staff; I’m writing this blog as much for me as other staff.

We must always be able to look honestly at our actions and attitudes as addiction treatment professionals. If a patient complains, we need seriously to evaluate our behavior.

For me, it helps to have a good treatment team around me, who are willing to tell me if I’m off the mark with my thinking. I also do my own mini-inventory at the end of each day (OK most days). Did I treat people the way I’d like to be treated? Did I try to do the best thing for them? Sometimes this means making a decision that angers patients or angers treatment staff.

Most importantly, when I’m with a patient, I want to remember he may have drug addiction, but that’s only one small part of who he is. He’s also other important things. For example, this person may also be a son, father, husband, artist, good provider for his family, have a great sense of humor, etc. Treating the addiction should help him get back to being himself. He is so much more than just an addict. Sadly, many of our patients have family who have written them off as “Just an addict,” and are no longer able to appreciate their wonderful qualities and talents.

Addiction treatment personnel: Let’s not make the same mistake.

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15 responses to this post.

  1. Posted by Nathan dean on September 15, 2014 at 9:56 pm

    I agree. There is nothing at all wrong with my brain except maybe some serotonin dysfunction but I take Effexor XR for that. If a counselor treated me badly I would request a different counselor or go to another program.

    Reply

  2. This made me cry bc when I got on subutex in 2007, I was mistreated by staff, drs, and over 35 different pharmacist.

    I held my head down in shame bc they thought I was a low life addict, nothing more! I seeked treatment alone and scared! And didn’t have a very good first visit! I was scared to death!

    And yes some of my family think that of me bc I still am tapering off subutex now.

    I believed all of them for soooo long that I was carrying so much shame, that had I not gotten pregnant a month after getting on the subutex, I wouldn’t have cared to live.

    And looking back- all of those ugly comments over me taking hydro condone that was first rx by a dr for legit pain. It lasted one year and yet I was treated as if I was making meth and a crack whore who had committed murder or something! The hydro addiction lasted one measly year! Which I am blessed to be able to say. I never mixed pills or drank, thank God bc I’d prolly be worse off than I am now.

    I was so offended that my very first visit with my very first doctor 7/12/07- his very first words were- have you ever had sex to obtain pills?!

    I was knocked off my chair and it made me cringe!!! I went into a long spill to him in rage bc he didn’t introduce himself or anything! That was his first words! I informed him I was a Virgin till my wedding night and the answer was hell no!

    I won’t ever forget his rudeness! And I understand that is a relevant question but introduce yourself first! Haha!!

    He was also the type, I was crazy and he wasn’t! Go figure!

    I appreciate this blog! Thanks!

    Reply

    • Nacho – Stand tall and proud, wear your Opiate survival on your sleeve, and don’t let ANYONE have so much power over you that you feel ashamed of your disease. Pardon me, but fuck them; THEY are the ignorant and uniformed ones. I take raising awareness about the efficacy of MMT/MAT very seriously and don’t give two dry dog turds what the ignorant ones say about me because I know – methadone saved my life, gave me a future, and provided me with the stability to get on with my life. this is recovery and a return to life, and those who know nothing about me and my journey can kiss my ass if they chose to diss me over it. Standing in proud solidarity with you.

      Reply

  3. Posted by Rachel on September 15, 2014 at 11:06 pm

    Thank you Dr. Burson, you’re a human! I really appreciate both you and Dr. Junig for your incredible courage.

    Reply

  4. Posted by John Cunningham on September 16, 2014 at 12:04 am

    I so wish the doctors and drugs of dependance in Australia that I have seen and still see over 23 years of Methadone. The way you just put… Essentially we win every argument with patients is so much how I get treated all the time. I have walked in to see my presciber and he has asked “so how have you been going” and I have said more than once is there really any point in telling you as what ever I say or ask you will not do anything about it. He doesn’t argue or if he says what’s going on and I do tell him nothing ever comes of it anyway. It really gets down heartening. My main problem is in my state in Australia we are only allowed 4 T/H per week. I am 47yo I have brought up 2 beautiful girls who have given me 4 grandchildren and have not given a dirty U/A in 17yrs or so. Only having 4 per week when 1 has to be for Sunday is virtually impossible to get a full time job as I can only pick up between 9am and 5.30pm so I can have T/H for 3 out of 5 work days. I applied for a job last week and I went and saw my Doctor and without getting on my knees I begged him to try and get 6 T/H per week but every reason I gave why it would make my life easier…like you said The doctor thinks he can win every battle and again he did. I walked out more let down than before I went in even knowing I had no chance anyway. I just can’t work out why people on Morphine even Physeptone? can get a month supply. My chemist agrees with me. They give no chance of bettering your life and I really wish they would.. I am at a point in my life that I want something to happen but get no help. I am not ready to come off Methadone, I am on 150mg which is the max dose..but because I lived on the streets at 11 and used heroin till 28 I am still beinng punished now.. I really enjoy your blogs ..Thanks John

    Reply

    • Hello John
      Seventeen years??!!! That is wonderful.
      I’m not familiar with Australian regulations but that seems mighty harsh to me. Is it your doctor, or your country’s regulations?
      At any rate, congradulations on your recovery. It is a shame that your treatment is getting in the way of a job, and ironic as well

      Reply

      • Posted by John Cunningham on September 16, 2014 at 1:24 am

        Thankyou Jana… I have just started reading your blogs about a month ago and it is nice to see a doctor showing empathy as you do. Yes it is my syates law I live in South Australia and 150mg is max dose and 4 take homes per week is maximum and you have to have a dose between so you couldnt get 8 and go away for a holiday or anything. I am fine with all the rules when you start as it took me about 2 years to get the maximum 4 p/w but being on the program for so long it would be nice to be shown an iota of trust but it just does not happen. Their reasons are to keep it off the black market which I do not get as I have hardly ever seen Methadone on the streets as the people on Methadone need it. There is plenty of Morphine and Oxys on the streets but in saying they don’t want it on the black market if people were going to sell it they could sell the 4 that they can get… I can either not work or not see my family that is all they are doing to me by not letting me have 6 p/w. They give you the medication to better your life but when you are in the position to do that they put these rules that do not help anyone. I wish I could work out a way but I really can’t see any

  5. Posted by Leslie Moravcik on September 16, 2014 at 12:17 am

    Sadly I believe this to be so true. You hit the nail on the head.

    Reply

  6. Posted by Tony Sanders on September 16, 2014 at 9:27 am

    Nice Article! As recovery professionals you must keep the confidentiality of every client. You must the one who will encourage addicts and not be the reasons to disappoint them in their recovery. Your job is to help them recover, not to push them away and feel taken for granted.

    Reply

  7. Fully support this. There is no excuse for bad attitude towards clients. Period. Too many treatment providers are still confrontational, judgemental, argumentive, prescriptive and not fully meeting their clients where they’re at. Thanks for this Jana.

    Reply

    • Posted by nspunx4 on December 14, 2014 at 6:24 pm

      Patients. We are patients that are under the care of medical professionals for a medical problem. IMO client makes me think of a non medical relationship and adds to the stigma that MAT is not legitimate medical treatment.

      One of my pet peeves is programs that refer to thier patients as clients. But I agree with what you said.

      Reply

  8. Reblogged this on Our Young Addicts and commented:
    Another important perspective …

    Reply

  9. Bravo, Dr. Burson! One of the most honest, candid and important entries of ANY blog I’ve seen written in a long while… Thank you!!

    Zac Talbott, CMA
    NAMA Recovery of Tennessee
    National Alliance for Medication Assisted (NAMA) Recovery
    http://www.tnmethadone.org

    Reply

  10. Reblogged this on Journeys with Zac and commented:
    We are Not Our Disease by Dr. Jana Burson… One of the most honest, blunt and important pieces written in 2014.

    Reply

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