When Your Mother Knows More Than Your Doctor
We all have stories about when the doctor was wrong. As a parent, I firmly believed that we knew our kids better than anyone else, and if we thought there was something wrong, there was something wrong. I’ve met hundreds of such parents in my time as a physician. I’ve heard countless times, “Doctor, I know my child. You can’t be right.” I’ve learned to listen to those times. As the modern American philosopher, Mark Yusko, says, “Humility = edge.”
In treating addiction, I’ve also seen times when a family needed to be right. By “need,” I mean that the family members had a stake in the patient’s outcome that had nothing to do with the patient. They believed that a patient’s diagnosis reflected on them, and they had a stake in the matter. I guess it’s one thing to bring your son to the hospital and go home and tell your neighbors he has a heart condition and a completely different thing to bring him to rehab and go home and tell them he has addiction. As they say, addiction is a family disease. So in treating addiction, it’s hard to know when a family is telling you what they know or what they “need” to know.
This is complicated by the widespread knowledge of the culture, neighbors, and the press. What a family hears from the people around them tells them what is acceptable and what isn’t. They take that inside and make it their own. It becomes their reality. So no matter what the doctor says, if the local anchorman or your next-door neighbor believes something in error, it has a strong pull on you. After all, who’s this doctor you just met, and why should you trust her?
In the middle of this “opioid epidemic,” it’s gotten even worse. We so want this to be an opioid problem that the doctor’s opinion about the brain seems less critical than our knee-jerk social reaction. It’s not uncommon at all for a doctor’s ideas about medication to be discounted by a family that hears from their friends, “You just got to get him off all that shit.” So I was reminded a few days ago.
A colleague is the medical director at an Intensive Outpatient Treatment Program (IOP) for addiction, not just opioid addiction, but addiction in all its forms. He treats anyone who needs treatment and has a great deal of experience. He was treating a young man who finished the IOP and was doing well in continuing care on a partial agonist medication for his addiction. The patient was getting a lot of pressure from people in his family to stop taking the medication because it, too, could be classified as an opioid and was controlled. If the government controlled it, they reasoned, it couldn’t be good. The government only controls dangerous, addictive drugs. Why would a good doctor keep my boy on a dangerous drug? The doctor must be wrong.
Though my colleague disagreed with the patient’s plan, it was the patient’s care, so my colleague planned out a medication taper with the patient. He rightly told the patient that having no medication on his opioid receptors is associated with a very high risk of relapse and overdose. If he didn’t want to be on an agonist medication, he should be on an antagonist medication. “No,” the patient said, “my family wants me off all that shit.” My colleague again advised against it and pointed out the high risk of relapse and overdose in a person who hasn’t taken full agonist opioids in months. He discussed with the parents the same thing. They confirmed that they knew their son was better now and didn’t need medication. He’d be okay because he was never going to use drugs again.
The young man died of an overdose a few weeks later.
Addiction is a disease that doesn’t go away because you’ve been to treatment or “been good.” It doesn’t go away because you want it to, your mother wants it to, or your mother needs it to. Addiction is a peopleikilling-son-of-a-bitch that waits patiently for that day when whatever you want to imagine about it doesn’t work anymore. And then it kills you.
We haven’t had an opioid crisis, an alcohol crisis, a cannabis crisis, or an amphetamine crisis. All the times you’ve heard those things in the newspaper or on TV, they were missing the point. We have an addiction crisis, and we have had it for over 100 years. And by ignoring it, we set ourselves up for serial drug crises. Until we see the illness for what it is and use every means at our disposal, it will continue to kill young and old alike.
This isn’t a problem of the cortex, the thinking part of the brain. It’s a problem of a much deeper part that we aren’t in good touch with. We can’t wish it away or talk our way out of it. It’s an actual medical illness. I know we, as doctors, aren’t always right, and I want to keep that humility. And the humility tells me that I can’t fight addiction in your child by myself, and neither can you. We need all the help we can get.
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Dr. Wetsman is an addiction psychiatrist and is currently studying data science. He has released his serial Ending Addiction. He also has something else in the fire — more to come. Nothing he writes is financial advice. Don’t do anything he suggests; look at other sources and make up your own mind.
