An empathic acknowledgment of the suffering experienced by a person struggling with active addiction is perhaps the best place for a clinician to start the process of effective treatment and recovery from addiction. This was one of the points made by Dr. Michael Fingerhood when he presented the annual Louis J. Kolodner Memorial Lecture last week entitled, “Treating Substance Use Disorders in a Primary Care Setting.”
Dr. Fingerhood, an internist at Johns Hopkins Bayview Hospital, has developed a model of treating patients for alcohol and drug problems within the context of his general primary care practice. His approach recognizes that the severe isolation and feelings of despair that so frequently accompany patients’ addiction can act as barriers to recovery. He begins the difficult process of awakening realistic hope by forming a relationship that is characterized by kindness and respect. He communicates his understanding of how difficult and lengthy the recovery process can be and that the setbacks that can occur along the way can be overcome if they are properly addressed.
When appropriate, medication is used as part of the treatment plan. He is particularly impressed, as am I, with the usefulness of buprenorphine and methadone for opioid use disorders. He makes the point that referring to “medication” rather than “medication-assisted treatment” would be preferable and equivalent to the treatment of other diseases, such as diabetes.
Resistance to the use of medication by Narcotics Anonymous complicates the important process of helping opioid-addicted patients to get engaged in the recovery support community outside of formal treatment. Dr. Fingerhood has addressed this problem in an innovative way by traveling away from his office once a week to Dee’s Place, a community recovery support center in East Baltimore, where he sees patients and prescribes buprenorphine. A Narcotics Anonymous meeting has been established there that explicitly regards people taking buprenorphine as being in recovery and equal to those not using buprenorphine – allowing them to celebrate anniversaries and lead meetings.
Most people with addictions never receive treatment for their disease and only a small number of people with addictions are able to access treatment in specialized addiction programs such as Kolmac. People’s needs and preferences are so varied that many different settings are suitable to help them navigate through the process of recovery. Dr. Fingerhood has created an effective model, which after becoming familiar with it, other primary care physicians will hopefully choose to adopt.
