Motivating Physicians to View Treating Addictions Differently

I suspect that an important part of having an impact on an audience composed of medical students and physicians is being able to invite them to see beyond any individual case of effective treatment, e.g., "the case of Brad," and focus on a more generic patient with an addictive disorder. They will all know of or at least heard of patients who “quit.” For them to become motivated to consider doing something different, however, they are going to have to see beyond "Brad" and recognize that “these patients,” that is, "addicted patients," can change and the way they change is by my doing “more of this” and “less of that.” This is the challenge I believe we face when inviting physicians to rethink the treatment of patients with addictive disorders. I suspect physicians may be more motivated to consider changes in their treatment strategies if seeing the “The case of Brad” as the result of an effective process to which "Brad" responded rather than something idiosyncratic about him as an individual that resulted in, for lack of a better term, a spontaneous remission.

When presented with the opportunity to speak with physicians or medical students, my goal is to impress upon at least some in the audience that: (1) change is an inside job, i.e., “physicians do not change patients (at least those with addictive disorders), but patients change patients,” and (2) the physician’s job with addicted patients is almost counter intuitive when considering what physicians generally do when treating “real” diseases. Historically, physicians conduct a differential diagnosis, prescribe a course of medical treatment, administer that treatment, follow-up on that treatment, and then discharge the patient...end of story. At best, the patient is a passive participant in the change process. With addictive disorders, however, nothing changes until and unless the patient makes that internal decision—choice, if you will, to change...the “inside job” mentioned earlier. Basic factors in the “keys to success” when treating an addictive disorder are: (1) recognizing that the addicted individual has progressed from a pre-contemplative stage of readiness to change to an action stage and eventually on to a maintenance stage, and (2) this happened because the individual realized he or she wanted to change rather than felt obligated or manipulated or forced to do so...again, the “inside job.”

I do not believe that the way to motivate physicians to think about treating addiction differently is to charm them into doing medicine with addicts differently—they will have 100 examples of how treatment does not work and even more reasons why this is so. Rather, it is to present them with a way to lessen their personal frustration when working with addicted patients. Put another way, we cannot push them into treating addicted patients differently, but we might be able to lure them into reducing their personal frustration when interacting with such a patient. It is sort of like Tom Sawyer getting his buddy to paint Aunt Polly’s fence...he entices the buddy to want to have the experience rather than talk him into doing his work for him.

As Sandra Anise Barnes has suggested in her poetry, "It is so hard when I have to (change), and so easy when I want to."

What do you think?

Robert