Pulse
Putting a Face on Addiction
By living with recovering alcoholics and addicts, physicians learn about the realities of addiction.
Laura Skrocki, D.O., didn’t think alcoholics and drug addicts looked anything like herself. Most of the second-year family medicine resident’s encounters with addicts had been in Hennepin County Medical Center’s (HCMC’s) emergency department after they had gotten into a fight, had an accident, or passed out in public. “You see people who have hit rock bottom,” Skrocki explains.
Her perception changed last May when she met Amy,* (the name of the patient has been changed) a woman in her mid 30s, who had held a high-level nursing position at a major hospital and was being treated for alcoholism. “I could have been working along side her very easily and not known she had a substance abuse issue,” Skrocki says.
Skrocki was attending the Hazelden Foundation’s Professionals in Residence program in Center City, Minnesota, a week-long educational program for physicians and other professionals interested in alcohol and drug addiction when she met Amy. During Skrocki’s time at Hazelden, the HCMC resident lived with and followed the recovering nurse through her days, attending 12-step meetings and even recreational activities with her. “We really got to know the inpatients as people. … We heard the stories of how intoxicated they were and how people didn’t notice and how long they were able to go on,” she says. “It was helpful to see how people functioned at a very high level yet were very intoxicated on a daily basis. You wonder, ‘How did they get away with it? How did they go unnoticed?’”
The Problem No One Teaches About
Such questions, as well as warning signs that either a patient or a colleague might have a substance abuse problem, weren’t addressed during Skrocki’s medical training at the College of Osteopathic Medicine at Des Moines University in Iowa. “We had a lecture on substance abuse in our psychiatry module, and we learned how to use a CAGE questionnaire as a screening tool [for alcohol abuse], but we had no extensive training,” she recalls.
Nor do most medical students and residents. “Medical schools average between a single day up to a week devoted to addiction medicine, and residency training usually doesn’t address it,” says Marv Seppala, M.D., chief medical director for the Hazelden Foundation. “With the prevalence of this disease, that’s horrible.” And what students do learn about addiction often focuses on its effect on the liver and other organ systems.
According to Seppala, up to 25 percent of patients have some form of addiction or have a history of it in their families. However, a study conducted in 2000 by the National Center on Addiction and Substance Abuse found that two-thirds of physicians surveyed did not carefully screen for substance abuse, and fewer than 7 percent accurately diagnosed alcohol problems in adults. More than half (54 percent) of patients said their primary care physician did nothing about their substance abuse.
Seppala and program manager Margaret Roe struggle to say exactly when the Professionals in Residence program began. But by the early 1990s, practitioners at Hazelden’s New York facility had created a formal program for physicians. As interest spread, the program was extended to Hazelden’s facilities in Center City and Plymouth, Minnesota. It was offered for the first time this year at Hazelden’s Springbrook facility in Newberg, Oregon. The type of professionals attending broadened to include not just physicians but also nurses, nurse practitioners, psychologists, social workers, clergy members, judges, and others who routinely see chemical abuse and addiction in their work.
According to Roe, approximately 200 health care professionals go through the program each year. Sessions are kept small—the New York facility can accommodate 11 professionals at a time; the one in Center City, up to eight; and the facility in Oregon, five. Participants spend about half their time attending lectures about the pathophysiology of addiction; interviewing techniques; pharmacological treatments; dual diagnoses and comorbid disorders such as depression, eating disorders, and gambling addiction; spirituality; early signs of relapse; long-term management of the disease; and drug and alcohol abuse and addiction within the medical community.
The rest of the time is spent with the inpatients. “We try to put a face on addiction and give the physician an experience of treatment and what patients are actually experiencing,” Seppala says.
In a New Light
Seppala says physicians often come into the program believing that treatment doesn’t work and that alcoholics and addicts don’t have a disease, but rather a character flaw and that they can control their drinking if they really wanted. “Our research, and this is brain research, has shown than it is a disease associated with the reward centers in the brain. It’s really clear-cut,” he explains.
But it’s the time spent with inpatients that makes the biggest impression on physicians and other participants—and that washes away the misperceptions. “Hearing their stories is very different from going to a lecture,” says Abby Kirschner, a social worker and co-director of behavioral science for HCMC’s family medicine program. Kirschner works with Hazelden to make sure all of HCMC’s family medicine residents go through the training.
“Residents come back and say ‘Oh my God, this is the best experience I ever had,’” she says. “They talk about the incredible strength so many of these people have. They talk about how they had no idea such smart people could be in such trouble. And they talk about how powerful it was to hear the stories, and how privileged they felt to be allowed into that.”
Skrocki admits that she is more aware of how substance abuse can affect anyone who might walk into her clinic. “I look for it in places where I previously didn’t,” she says, explaining that she has become much more aggressive about asking questions about her patients’ use of substances.
“I look at people I never would have looked at before for substance abuse,” she says. —Kim Kiser