Substance Abuse

[Ahmed Yeddi]

Substance abuse is often a cause of homelessness. Addictive disorders disrupt relationships with family
and friends and often cause people to lose their jobs. For people who are already struggling to pay their
bills, the onset or exacerbation of an addiction may cause them to lose their housing.
In many situations, however, substance abuse is a result of homelessness rather than a cause. People
who are homeless often turn to drugs and alcohol to cope with their situations. They use substances in
an attempt to attain temporary relief from their problems. In reality, however, substance dependence
only exacerbates their problems and decreases their ability to achieve employment stability and get off
the streets. Additionally, some people may view drug and alcohol use as necessary to be accepted among
the homeless community. Breaking an addiction is difficult for anyone, especially for substance abusers
who are homeless.
To begin with, motivation to stop using substances may be poor. For many homeless people, survival is
more important than personal growth and development, and finding food and shelter take a higher
priority than drug counseling. Many homeless people have also become estranged from their families and
friends. Without a social support network, recovering from a substance addiction is very difficult. Even if
they do break their addictions, homeless people may have difficulty remaining sober while living on the
streets where substances are so widely used.
There is evidence to support the recommendation that treatment and recovery approaches should not be
limited to professional interventions. Self-help models have been highly successful in helping individuals
recover from alcohol and other drug problems and in preventing relapses. Long-term sobriety without
peer support is extremely unlikely. In addition, sobriety cannot be maintained without adequate housing
and job training.

[Kendall Bell]

When I was in medschool I was apart of a public health program. As part of this program one day we went to a family court, where clients were trying to regain priveledges for visitation of their children or for custody. On this particular day most of the clients were there as a part of a substance abuse program. When the judge introduced us as future doctors, one of the clients approached me and my wife (who was also a medical student in the program) and said “whatever you do don’t ever prescribe your patient’s benzos it ruined my life.” This really stuck out to me, as I realized how much damage some of the medications we prescribe can have on our patient’s lives. I’m sure the doctor who prescribed this woman the benzodiazepine originally, was attempting to help her, likely she and anxiety issue and the doctor thought they were doing what was best for his or her patient. However she became addicted to the medication, and as a consequence she lost custody to her children. All of the people in this program had served prison time as a consequence of their drug addiction, so it had upended their lives.

[Carli Denholm]

Substance abuse is an important SDH to consider. It can affect anyone regardless of their zip code, socioeconomic status, race, age, etc. It does not discriminate and it can ruin lives or even end them. It can affect their health not only directly through the effect of the substance, but also through diversion of resources toward obtaining the substance, causing relationship conflicts that can cause the user to lose their support structure, loss of jobs or homes, and other ways. We should be mindful of the way we prescribe potentially addictive medications and careful that when we do, it does not get out of our patient’s control. Because it can affect anyone, we should be cognizant of it and screen everyone. Substance abuse can also affect our colleagues. We have to be able to take action when we find that a colleague is a victim of substance abuse so that they can get help and avoid negative consequences on the care of patients. Substance abuse is a complex issue that has been an ongoing problem for hundreds if not thousands of years. We are unlikely to eradicate it, but as physicians, we can help identify those at risk and direct them to appropriate support services. Also we can help reduce future cases prescription medication addition by using medications like opioids and benzos wisely and only when necessary.

[Jasleen Kaur]

Substance abuse is a complex issue that has been ongoing since many years now and we physicians have an important role to play, unfortunately to lead to it.

I had a 70 yrs old male come to clinic today with medical history of HTN, OA, Back pain. I was worried about his BP which was high, but his focus was only to get his Norco 10 refilled. He is not my follow up patient, but last two visit notes were consistent with refills and advise to take anti-HTNsives, one of the visits even requiring patient to go to ER for BP of 190 systolic. Though, pt didn’t follow instructions regarding following of the BP meds and ER visit, he was very inflexible on getting Norco this visit.

I did a focal exam of musculoskeletal system which showed no deformities, no swelling, erythema, but patient complaint of stiffness and pain. I reviewed his images in the EMR (next gen and Citrix) and found no images suggestive of severe degenerative disease. I offered the patient physical therapy (declined), Orthopedics referral (declined). He said “ nothing works for me, but Norco”. He just wanted Norco. I did his MAPS and it was consistent with 120 tablets of Norco filled on 3/26/19.

I thought to myself…what have we done? Did we try giving him PT, Ortho referral, NSAIDs before Norco. Did we try figuring out the cause, social support, do imaging before he was given refills on Norco last visit. May be all was done. So, where did we lack?
We are unlikely to eradicate this very same problem happening in many clinic rooms across US, but as physicians, we can help identify those at risk and direct them to appropriate support services or start approach to pain in a different way. I have tried this during my last 2 years of residency, and I am happy that I have succeeded in few.

[Author]

Posts