Saturday, August 3, 2013

Would You Allow Your Doctor to Get Away with This?

I have been working in the field of substance abuse and mental health services for over 20 years as a direct counselor the entire time and additionally as a supervisor/trainer for the past 15. Just the other day, at the outpatient substance abuse clinic where I work, we were discussing a new client at our facility who was referred to our program after being discharged for a positive test for alcohol from another outpatient program. It turns out that this client is knowingly addicted to heroin but has not used heroin or other drugs in quite some time however he apparently was discharged from the other outpatient program for drinking alcohol. One of the newer counselor's jokingly asked me "What are we doing wrong?" in reference to the fact that at our program, we do not automatically discharge someone for a positive urine screen. My response was: "This situation illustrates what we are doing RIGHT -  We look at situations on a case by case basis as the change process for people is individualized and unique from person to person and situation to situation".

Suppose a morbidly obese man was seeing his doctor for treatment of his high cholesterol and he was making progress and slowly losing weight but one day came in to his doctor and confessed that he had a bad weekend and ate a big greasy double cheeseburger. Would the doctor simply look at him and say "You're not compliant, now go somewhere else!" Now suppose a diabetes patient told their doctor that he ate a banana split with extra whipped cream, would that doctor discharge him from the practice? In both cases, the doctor likely would do their best to first acknowledge the prior progress that had been made and then help their patient get back on the right track. Both clinically and logically speaking, continuing to help the patient is the wisest course of action for the doctor, few would disagree.  However, the substance abuse treatment field has been getting away with discharging people prematurely from treatment programs due to setbacks and relapses for decades. It is time this contradiction has ended.

Of course there does come a time when someone who relapses needs to be discharged. There often comes a point in treatment when someone is having repeated relapses or showing a persistent lack of effort or displaying a dangerous decrease in progress, when cutting the cord is without a doubt clinically indicated. However, most people need more than just a few chances to get better because change so often occurs incrementally or little by little with lots of ups and downs along the way. This fact cannot and should not be ignored by treatment providers. Think about your own situation and think about the last time your doctor recommended a lifestyle change for you (such as changing your diet, for example) Were you 100% compliant with your doctor's recommendations or did it take some time and patience to get it right? Did your doctor threaten to kick you out and stop seeing you right away if you failed to follow his recommendations? Should a diabetes patient get discharged over a banana split? Should a patient with high cholesterol be given his walking papers because of a double cheeseburger? By the same token should someone with a drug problem be automatically discharged just for using drugs?


  1. I think relapses are normal. The only possible reason that outpatient program could have reason to discharge him was under the possibility that other patients would relapse in result of his? Even that doesn't make sense. But I know for me, the people in my life have been too nice about my relapses, including my recent overdose. A part of me wishes there wasn't so much forgiving and easy going nature. I struggle caring and feel alone because people refuse to treat my issues as problems.

    1. Excellent point. I figured someone with personal experience was going to say something similiar to that because it is a valid point. There definitly is a line that has to be drawn at some point, its just that some programs are way too quick to pull the trigger. I sincerely hope things work out for you and you make sure not to give up on yourself and just keep working at getting better not matter what other people say or do. Thanks for the comment.

  2. I love this post Kenneth! I especially love what you say about a case by case/ person by person basis. The more I think about it, the more I feel that no two people are identical and so many times it's difficult to blanket sweep a solution. I submit that addiction recovery varies even slightly with each person and like you say there will be ups and downs with relapses along the way but the hope is little by little to see the improvement.