10-15% of health professionals will develop an addiction at some point in their lives.
Another important statistic is that 30-35% of those health professionals with an addiction will also have an additional mental illness such as depression, bipolar illness (also known as manic-depression), anxiety disorder, obsessive-compulsive disorder or schizophrenia, to mention just a few. This additional mental illness frequently preceded the onset of the addiction disorder which may have resulted from the health professional’s attempts to self-medicate the symptoms of the mental illness.
Unfortunately, our medical system has not dealt with this co-morbidity effectively because the training of psychiatrists and of substance dependency experts occurs separately and to the exclusion of the other specialty. Therefore we find psychiatrists who have little or no understanding of substance dependency and substance dependency experts who minimize the importance of mental illness in the treatment of substance dependency.
I have encountered psychiatrists who have mocked my regular attendance at recovery meetings in the community. “How much longer are you planning to attend those meetings?” one psychiatrist asked me with a smirk. Likewise, substance dependency experts sometimes ignore or misdiagnose obvious signs of mental illness and use a cookie-cutter approach in treating substance dependency. I witnessed the shaming of a severely suicidal patient by an addiction counselor in a treatment center. “You think you’re special? You’re just an alcoholic! Snap out of it!” he told this patient who was literally pacing the room in suicidal anguish. He was never properly assessed nor was he sent to the emergency room. He was found hanging from a beam the next day.
What is the take-home message? In my opinion, a 35% co-morbidity rate mandates a careful psychiatric assessment in EVERY substance dependency patient. If a co-morbidity in fact does exist, it is advisable to have two qualified health care specialists – a psychiatrist and a substance dependency specialist – since it is rare to find a single professional competent in both fields. Close communication and mutual respect between these two specialists is preferable.
Training of psychiatrists and other physicians in the field of substance dependency in medical school is still woefully inadequate. It seems medical schools are finding it difficult to accept their own scientific evidence pointing to the medical illness model of addiction. Addiction is still viewed as a moral defect. This dictates medical school curriculum choices and, more broadly, our social and law-enforcement policies.
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