In the following interview, “DK” tells the story of his experiences with addiction, both as a physician and patient. He provides unique perspective and advice for future physicians on providing care for patients facing or recovering from addiction.
Can you introduce yourself in terms of your experiences with addiction? This can include your journey, challenges faced, and any insights you would like to share.
I had been drinking since before high school, graduating with what was called ‘The Brew Crew of ’82’. At that time, it wasn’t just expected to drink; it was frequently considered unusual not to. There were no Mothers Against Drunk Drivers or stigma against it. It was a different atmosphere back then compared to nowadays. For me, it was just a normal part of life. And I always felt I was in control and could handle it, just like many others I’ve come across.
I also had a bad neck injury and had to undergo spinal fusion. I tried everything to control the pain, including steroid shots and consultations with various specialists. Along the way, I accumulated pain medications, which didn’t help my process either. However, because I always felt in control, the issue of combining pain medications and alcohol was never even a debate. I believed I could conquer anything if I wanted to.
March of 2005 was when I got sober. My now ex-wife was an integral part of that process, even though she was struggling with her own issues. We both got to the point where it was time to do something different because we were no longer in control. But stopping was difficult. I even resisted the intervention my ex-wife presented, where family and friends shared how my alcohol use and addictions were affecting them. I basically still gave them the middle finger because I think the chemical addiction was too strong for me to see there was an alternative to what I was already doing at that time. Even then, I only started to feel like I just wasn’t in as much control as I thought, but I never believed I was out of control. That is probably one of the hallmarks of the disease for me. The concept of all the evidence mounting around me still wasn’t enough because the process of quitting didn’t seem possible at the time. I felt others around me didn’t understand what I was going through. Nobody could possibly feel the pain my neck was causing me or the circumstance I was in at the time. No one could possibly understand what I was going through. It is almost surreal looking back on it that I now truly understand that it was part of the disease process, making me believe I always had some control over it. I attempted to cut back, to reduce my consumption to weekends or once a month, or any other desperate idea to prove that it didn’t have a handle on me. I am not one to back down from a challenge, especially at that time. I had a high-win streak too. Even during the peak of my addiction, I was still getting some of the best awards in medicine and performing at extraordinarily high levels at my job. Probably receiving more awards during that time than ever before, solidifying the idea that I’m not only in control, but I am also excelling at what I am doing. Looking back, that was not in my favor.
Then, I started to realize that I had what I now call “recovery capital.” Continuing down the path I was on would have led to the potential loss of everything, including my kids, my work, and my wife at the time. And in medicine, specifically, it’s a different set of expectations you’re held to. Just like airplane pilots or any other role like that, you can’t really afford to be intoxicated. So I got enrolled in a recovery program, and it was not easy. I spent three months in an in-patient recovery program, attending classes for 10 to 12 hours a day. We had classes that educated on group understanding of what addiction is and worked through the process of what it was to be addicted. It’s a process most alcoholics don’t get, and I didn’t call it this at the time, but it was truly an honor and privilege to be able to go through something like that. As intense as it was, and I’m talking every day would cause me to cry and get to the basic core of do I want to even live. So it was still one of those experiences I look back on and think about all the time. Rarely a day goes by almost 20 years later that I don’t think about it. It has given me tools I use in everyday life that most people cannot fully understand. It was just a better way to live and to focus more on making my life and the people around me better. It’s not always perfect, and I didn’t play it out perfectly.
After those months, I stayed deep in recovery after those months. For years, I was in a recovery group with those all in the same boat; plastic surgeons, internal medicine doctors, and all sorts of different specialties that I worked with for years afterward. Transitioning from a newbie who was just barely understanding stuff to after five years basically running the group. I was fortunate to help a lot of people and doctors who ended up helping a lot of other people. Paying forward to those that were struggling with addiction was a huge part of allowing me to stay in the middle of it and stay in the process of what it means to be in recovery. It’s pretty intense, and it allowed me to grow to become who I am today. And I am definitely better today than I would have been if I hadn’t gone through that process.
Losing had been one of the best things that had ever happened to me. For years, I still look back and when I talk to people who are in the middle of the grips of addictions, I know my weakness became my strength. That is what I still work with now, that the disease forced me to look at life very differently and I am now just a very different person because of it. I quit at 40 and now I am 59, so almost 19 years under my belt.
How has your experience with addiction influenced your interactions with medical professionals?
Part of what I do now is make sure whoever I work with knows about my history. It’s an important part of disclosing my medical history. You don’t hide medical problems from your medical team, and it is something that can be easily done when it is embarrassing a little initially or shows that you have flaws or anything else that goes through your head about why you don’t want to tell your medical professional. Regardless, it is important. Granted, it can be a challenge on medical records and people can see you differently. But at the same time, when alcoholism or drug addiction is truly understood as a medical problem and not a weakness or something you look down on someone for, you take it like you do diabetes. You address it like you address any medical problem. You don’t omit those issues from those you trust to keep that information protected because that is medical information. From a medical perspective, there still must be a level of trust involved to reveal something like that. But the probability of my medical professionals betraying that trust is very low, so I know it helps me more to disclose that information.
What is a common misconception or stigma associated with addiction that you feel medical students should be aware of?
I think there is a lot of judgment of those with this disease. You come into medical school and see things you’ve never even thought you’d see. It can be easy to judge and say, “Oh, he’s just an addict,” or “Look, he’s going to ask for more pain or sleeping pills.” That is the problem. Medical professionals need to push home the idea that the space is a non-judgment zone. Medical students must realize it is a disease just like any other medical disease they learn. When people treat it like that, they have much higher success at actually helping people.
From your perspective, what are key factors that contribute to the development and maintenance of addiction?
I can answer that easily based on what leads to the development of any disease: genetics and environment. I believe if you don’t have any genetics involved, it’s much less common. It’s unusual to develop an alcohol problem if there is no family history. So I think genetic history is a big part of it. And then you need the environment. And you can have genetics, but if you don’t succumb to the environment, you won’t get the disease either. Usually, in my opinion, and experience, it is a combination of both. I have seen too many people not take both of those things seriously. Some alcoholics become bartenders, some surround themselves with people they call friends that happen to be at the bar only or fellow drinkers. So how you surround yourself is a big part of continuing to look for enablers. If you can find enablers to help you maintain your addiction, that is super helpful for someone addicted because they are going to make things okay. They aren’t going to let you hit the bottom, bottom so you can continue the dependency as long as possible until something physically or something around you implodes, whether you get your fifth DUI or whatever. For me, I surrounded myself with alcoholics and drug addicts all the time. I mean my current friends are certainly struggling with it. My ex-wife struggles with it. Everyone I surrounded myself with in the middle of addiction were other drinkers and people who didn’t look at it in a different way. So part of it was by self-design, and that was part of the disease. Surrounding yourself with people who allow you to continue dysfunctional behavior, whatever it is, goes for everything, but certainly with alcoholism, that is a huge part of it.
What kinds of support or resources were most valuable to you in your recovery journey? Are there specific healthcare interventions or treatment approaches that made a positive impact on your recovery?
The first three months in an in-patient center, removing myself from the environment, was huge. The statistical probability of quitting an addiction is very low for the average population. Just joining AA has less than a 5% success rate. If you go to a one-month in-patient program, you have a higher likelihood of recovery. The longer you spend in that initial recovery to really educate yourself and deeply believe it the higher probability there is of success. You must believe it, though, and at the beginning, you don’t want to. That’s one of the interesting hallmarks of this process, wanting to just say you are going to do the process and go through the motions because people need you to. But the longer you are in it, seeing people come in cloudy-eyed and come out clear-eyed, you start to realize that’s exactly what is going on with you. Once I left, I immediately spent every day in an AA meeting. For years, I went to many meetings and was a part of multiple groups, one for professionals and one open for everyone at the local church. I not only dove into the meetings, but I also chaired and ran them. I sponsored some people, which I’ll admit I didn’t do enough. My particular sponsor was a big part of my recovery. He helped me through and was able to understand different parts of recovery. I didn’t always agree with him, but he was in recovery for 12 years before me, so he had some days under his belt that I could respect. So I could listen to his guidance. Not as him telling me what to do, but as him telling me how he walked through similar experiences that I was walking through at the time. One of the biggest problems with recovery is if someone gives you advice, most people consider that an insult. Tell me how you walked through it, and then I’ll take what I can and use it in my current situation whatever that is. That is how recovery works.
How can medical students contribute to creating a supportive and non-judgmental environment for individuals seeking help for addiction?
If a medical student doesn’t understand recovery, then at a bare minimum, I would expect students to not show physical repulsion at things when they hear them. They can decompress later, but if someone is going through a difficult time in recovery, I don’t think a medical student would make it better by saying, “You did what?!” I think reactions need to remain professional, and students need to really be aware of nonverbal cues like body language. If all of a sudden, you’ve discussed the issue and your body closes off by crossing your legs or arms, for instance, that is a bad interview style. Remaining open, physically and verbally, and saying things like, “Tell me more.” Making sure that someone else is aware of what is going on is also important. That is important medical information about someone’s history that needs to be not ignored. At the same time, students also cannot push someone who doesn’t want to get better to get better. I guarantee that won’t help them get better. They are most likely just going to drive them deeper underground to not look for help. You can lose them fast, especially if they think you don’t fully understand what is going on. I think if you drive home the point that this is a disease just like any other disease, but the complexity of this disease isn’t based on the difficulty of diagnosis. It’s more that the patients won’t get better until they believe they have the diagnosis. You can present them with all the facts, and until they truly believe it, the disease will continue. That is one of the hallmarks.
How can medical professionals do a better job of leading patients to recovery while also remaining supportive?
For me, there is a basic premise. Most patients come in and say, “I drink 8 to 12 a day,” or “Yeah I do that,” or “Yes, that is my fourth DUI.” You can present it to them saying, “And your life is kind of where you want it then, right,” and they respond, “Well no. I am going through a divorce and losing my job over this.” They need to have mounted information that piles and piles. Everyone’s bottom is different, and finding out what their bottom is is important. For me, the possibility of losing my kids was my bottom hands down without a debate. My job was important. Losing my job would have sucked. But my kids were huge and drove me into the arms of recovery.
You must remain compassionate and find out if they are willing to change. It’s interesting because that question is on the cigarette questionnaire but not the alcohol and drug ones at my work. Like we have a question that says, “Are the patients willing to discuss quitting smoking?” And that is huge because if they are not willing, you have zero chance. They need to go out and experiment a bit more until that bottom is truly hit. Once that bottom is hit, they may be more willing. But most people realize recovery is actually about stopping completely, which shocks most. They think they can still drink on the weekends or just have a little bit. They think they can control their drinking. The concept of control, to think you are in control…they call it the great obsession in addiction. Always thinking you can go back and control it because you know and have learned so much and that you can control it now. NOPE. That’s an interesting part of the disease.
Are there any particular challenges or triggers individuals in recovery may face, and how can medical professionals assist in developing effective relapse prevention plans?
Not to sound fatalistic, but if you’re going to relapse, you’re going to relapse whether your medical professional wants it or not. But for me, I certainly don’t want the medical professional to put me on sleeping pills even when I ask or beg for it. I expect them to be smart enough to know that I can’t start things that may mess with me, like downers, sleeping pills, narcotics, or anything addicting. So I expect my medical professional to treat me very strictly when it comes to any scheduled drugs. But if I am going to mess up my recovery, it is all me. I’m going to do it. But I certainly don’t want my medical professional to be enabling me and giving me just any medication, even when it’s completely medically justified. It’s not justified because I have the disease of addiction. Like how those with diabetes should not be eating cake for breakfast, lunch, and dinner, it’s just not reasonable to potentially give me more slippery slopes to walk on. I don’t need it. I can’t. Even after 19 years, I am not going to ask for certain things from my medical professional. I don’t want him to be contributing to my process. I don’t think there is much they can do other than support you. It’s so much easier to write a prescription than to spend 30 minutes talking with a patient about options. But I would push on spending time with the patient, talking to them, and discussing what is really getting at them. Most of the time it’s something like the death of their parents or they are going through really bad times, and they want to treat it with narcotics. It does take a lot to actually get into that topic with them because most don’t want to just bring that out. They just want to say they are in pain. It’s a tough topic, but don’t fall into the trap.
How can medical professionals who haven’t gone through addiction and recovery learn more so they can be better for their patients?
That’s tough. In my medical school class, we went to AA meetings. I just sat, listened, and wrote some notes after the meetings. It was pretty revealing and helpful to hear real people tell their stories. The problem though was that my school only required 4 meetings, and that was it. And those are four hours you could use to be doing something else or studying other things. But at the bare minimum, students should be going to some open meetings. Or go to some professionals that are going through it. That is harder because finding out those people are tough because again it is protected information. But go to meetings, and learn from those that have had recovery under their belt. After you’ve been in it for a while and have seen very difficult things and walked through very difficult times, those are the people to learn from. That’s how you see they are real people, even one’s that are professionals like you. Even as a medical student, I remember looking down my nose at some of these people and not taking them as real people at first. But when you talk to pilots who have gone through it that were intoxicated flying your airplane or surgeons who were intoxicated doing your surgery, the first impulse is, “I hate you. How dare you put my life in jeopardy because of your addiction?” But then you realize, that could have been me if I had that disease. I think that is the key thing. Don’t look down on these people. You don’t look down on an obese patient going to the gym because they are trying. They are trying to do the right thing. They are making an effort and trying to be better.
In your experience, how can medical students balance their own well-being and self-care while providing care to patients with addiction?
I think it’s the ability to ask for help, which is essentially what recovery is also all about. And that is the hardest for those generally self-reliant or who think they don’t have the luxury of showing weakness, for instance. In medicine, we are held to stupid high standards. You don’t have the luxury to mess up. In the real world, we are human, and we mess up. So asking for help from the right person is key. Many times, we don’t have mentors like we should. Like in recovery, we are tasked to go out and get a sponsor that is someone we highly respect and are willing to take their advice because they have much more experience than you do. I think sometimes in medicine, when things are difficult, trying to find someone honest enough to give you how they got through it is very valuable. Finding someone who you don’t have to present perfect to all the time. That is hard, especially if you want to be in a highly competitive field. You may feel like you can’t have any kinks in your armor because that could look bad somehow to someone. But finding a mentor you can respect, love, and trust to give you advice through difficult situations is absolutely priceless. I recognize this is challenging to do, and I don’t know the answer. But keeping yourself willing to find that person is important.
