Every now and then I hear about a therapist or addiction doc who is doing such a disservice to the practice of addiction medicine as to deserve special mention. This week’s award goes to a certain counselor at a treatment program in Oshkosh, WI, who I’ll refer to as ‘This Jerk.’
I’ve made no secret, over the years, about my hope for addiction to eventually be treated with the same respect for patients and attention to medical principles as for any other illness. I certainly try my best to work according to those ideas, and find that doing so really helps when it comes to making treatment-based decisions. In other words, I’ll ask myself—if this person had diabetes, what would an endocrinologist do? Or better yet—if I had diabetes, what would I want MY endocrinologist to do?
We all know that certain professions attract certain types of people. Some of us have been pulled over by the cop who was the kid subject to playground taunts, now all grown up, determined to make life a living Hell for anyone with a loose seat-belt. When I worked in the state prison system, I worked with guards who belonged in the same category; men and women who loved to carry keys to cages that held real people. It’s the power trip, I suppose.
This Jerk apparently loves the power trip of ‘treating’ people who are sent back to jail for ‘failing’ his treatment. He doesn’t have to worry about being a lousy therapist; he has a captive audience, and likes it that way. One difficult aspect of being a therapist is treating patients who don’t like us for one reason or another, or who don’t kneel every time we enter the room. But when This Jerk feels disrespected, he picks up the telephone and calls the patient’s PO to report ‘noncompliance with treatment’– then gloats about sending the patient to jail.
Treatment professionals who are in a position of unusual power over a patient must be particularly careful to empathize with their patient’s position. In medical school, we were placed on gurneys and wheeled around by fellow students, to emphasize the vantage of patients coming to the emergency room. We were taught to sit at the same or lower eye-level of our patients, as speaking down to people creates an unsettling power differential.
The power to prescribe or withhold buprenorphine (let alone the power to send to prison!) comes with an obligation not to abuse that power. Withholding buprenorphine causes patients to go into withdrawal—something dreadful to people addicted to opioids. Worse, withholding buprenorphine places patients at very high risk of relapse—which in turn places them directly in harm’s way from overdose and legal repercussions.
This Jerk, I’ve been told, takes issue with psychiatrists who continue to treat patients on buprenorphine who struggle with sobriety. He considers it ‘good care’ to withhold buprenorphine from an addict who uses, supposedly to punish the patient into sobriety.
In case This Jerk (or a similar ethically-challenged counselor) is reading, I’ll point out the obvious: when a doctor pulls the rug from under a patient by withholding medication, that patient might easily join the ranks of other dead addicts. On the other hand, when I work with a patient who is struggling with sobriety, keeping the person on buprenorphine and working to identify triggers for using, that person almost always ‘gets it,’ eventually.
I’ve been working with people addicted to opioids, using this approach, for so long that the other approach—the punitive, ‘cut ‘em loose for struggling’ approach—seems barbaric. I don’t understand how people identified as healthcare workers (nothing professional in his behavior!) rationalize the dismissive approach. I suppose, if This Jerk views addicts as the scum of the Earth, or as people with weak characters, or people who lack ‘will power,’ punishing relapse by withholding treatment feels about right. But most of us leave that world behind when we commit to helping people suffering from illness.
What’s This Jerk’s excuse? Is it that he just doesn’t get it? Or are there other motives at play? With the current cap on patients on buprenorphine, the most lucrative way to practice is to keep turnover high, rewarding practices that hire therapist-idiots like This Jerk.
Or is it the power trip– that people with difficult addictions are an affront to therapists? I’ve met therapists with this attitude before, who seem to have a form of codependency with their patients. They take credit for any success by their patients, but think the patients who fail are not worth their time, and should be dumped, expunged, or kicked-out to relapse and die. I suppose This Jerk would say ‘not my problem! I did MY job!’
Readers may suspect that this topic irritates me—and they’re right. Maybe I’ve seen more death, up close, than the typical counselor. I’ve attended autopsies; I’ve reviewed post-mortem photos from overdose scenes; I’ve pushed IV fluids into people with fatal injuries who presented for emergency surgery. I have spent hours with the parents of young patients who died from overdose. I’ve seen the parents’ faces as they struggled with the thought that they could, or should, have done something else—just one more thing to save their child. Death, to me, is not ‘theoretical.’ It is not something to toy with, and certainly not something to invite into the life of a person who made me angry, for not recovering at MY pace.
I suspect that the Jerks of the world will continue to justify their sadistic approach to ‘treatment.’ But patients—at least SOME patients—don’t have to put up with that behavior. People like This Jerk hold power over an individual with an addiction history, but there is power in numbers. It is not appropriate to use one’s power vindictively, or to gloat over a patient’s struggle. It is not appropriate to humiliate a patient in front of others. If you see that behavior, collect witnesses, and bring it to someone’s attention. Maybe that ‘someone’ will write a blog post about it!
Doctors in particular should treat patients with ALL diseases—including addiction—with respect. It is not respectful, or ethical, to deprive a patient of life-sustaining medication—especially out of spite. I look forward to the day when the thought of ‘kicking someone off Suboxone’ is viewed as similar to kicking a poorly-compliant teenage diabetic off insulin.
Would THAT make sense— even to This Jerk?