Rewind one month ago to my final week of Med 3, a week that naturally included me hosting a family party, two band practices, a live radio interview, a final call shift, an NBME, an out-of-town house guest, and an album release.
Heathen Eve’s radio debut on UMFM’s “Made You A Mixtape”! http://www.umfm.com/programming/shows/episode/43586/
Album Release!! “Reconcilable Differences” now available on Spotify, iTunes, Google Play, Bandcamp, and local music stores near you 😀 https://heatheneve.bandcamp.com/releases
12 hours after our show ended, I hastily shoved some clinic clothes and my stethoscope into a backpack and climbed onto a plane to Sudbury for my first Med 4 elective – a three-week placement in Addictions Medicine. My weeks were spent in a vast variety of community services aimed at helping patients recognize and manage their substance use disorders (SUD). One of the clinics I worked in specialized in “opioid replacement therapy,” which some people may recognize by names like “methadone,” “MMT,” or “Suboxone.” This is a treatment option for people with opiate use disorders (morphine, hydromorphone, Percs, Oxy, etc.) that provides a carefully-prescribed amount of medication (either Methadone or Buprenorphine/Naloxone) that acts in a similar way to opioids in people’s systems, helping them to safely reduce the amount of opioids they need to take and avoid crippling withdrawal symptoms and/or overdose. Harm reduction houses are another valuable service in the Addictions field, where individuals at risk for or experiencing homelessness are offered assistance in securing housing, while also addressing alcohol use disorder through harm reduction strategies such as monitored alcohol administration. Residential treatment programs are a major component of Addictions, ranging from abstinence-based programs (where clients cannot use any substances for a period of time before entering treatment) to harm-reduction programs (where clients are able to be actively using substances while seeking treatment, and efforts are made to minimize the risks associated with using), to anywhere on the spectrum between the two.
Residential treatment programs such as Benbowopka aim to address SUD by helping clients re-establish balance in their mental, physical, emotional and spiritual health
In particular, I spent several days working with Monarch Recovery Services, an “Addiction Centre of Excellence” that offers treatment programs spanning individuals who are managing active withdrawal, who are acknowledging their SUD for the very first time, who have been living in a recovery home for a year, who have started work again and require some help with housing, who have an SUD and discover they are pregnant, who have five kiddos and are struggling with an SUD, who have been abstinent for 10 years and continue to come to Aftercare for support with their SUD.
I know for some this is a hard topic to read about, hear about, or even think about. I know addictions and substance use have not, historically, been topics that have been treated with the greatest grace. But the fact of the matter is that addiction is a chronic health condition. The Canadian Society of Addiction Medicine (CSAM) defines addiction as “a primary, chronic disease of brain reward, motivation, memory, and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social, and spiritual manifestations.” But with that definition comes hope: As a recognized medical entity, addiction is now recognized as “a preventable and treatable disease, helping to shed the stigma of misunderstanding that has long plagued it.” In other words, addicts are not necessarily “bad” or scary people. They are people with a serious health condition that, like any health condition, requires a balance of external support and personal action in order to prevent (ideally!), recognize, and manage it. More often than not, addiction co-occurs with trauma, since “addictive behaviours [are] a way of coping with emotional pain, a way of self-soothing that is not appropriate.”
An individual I spoke with eloquently summarized all of the above: “I know I have an addiction. But the question is – why do I have it?” A crucial component of recovery from an SUD is learning healthy life skills and effective coping mechanisms to replace the destructive dependance on substances as a means to attempt to handle challenges. But, as stated by Dr. David Marsh, a NOSM Addictions Specialist, “A drug user is never going to come to treatment if they die of an overdose.” In other words, while modalities like wet shelters or opioid replacement therapy do not address the underlying why? of an addiction, evidence shows without a doubt that they reduce the number of overdose deaths (see page 21), thus allowing patients the chance to stabilize to a point where they can enter further treatment to address the root causes of their addiction.
As someone who is both a professional in the medical looking to help clients with addictions, as well as an individual who is personally affected by people with addictions, this has been a difficult topic to approach. It has been challenging to recognize that I feel able to offer a very different type of support to clients who are struggling with addictions compared to those I know personally who are struggling. Does this make me a hypocrite? Am I callous towards those I claim to love?
But I have come to recognize that “caring about” and “caring for” are two very different things, and are fulfilled by different people occupying very different roles in the client’s life. Unconditional love is the role of a family member or friend. It proclaims, “I see you as a human being worthy of love, and I care ABOUT you.” But unconditionally loving someone does not mean you can or should care FOR them.
Caring for someone’s withdrawal symptoms, assessing the need for counselling through past trauma, helping them recognize and address a dearth of essential life skills – these are needed roles for professionals such as physicians, social workers, therapists. Caring for someone with a SUD requires a certain level of neutrality and distance. As the healthcare professional, I am not living with the individual struggling with an SUD or affected personally by their finances/relationships/housing/behaviours. Therefore, I am able to advocate for that individual 100% without compromising my own health or safety – as is often the case with family members or partners involved.
In the last several decades, we have made amazing advances in our understanding of and ability to manage chronic diseases like diabetes and arthritis. Let us open the door to understanding the world of addictions in order to start breaking down barriers to effective care.