General Practitioners: Dealing With Patient Addiction

By Nancy Wurtzel

General practitioners are often the first health care professionals to identify addiction in their patients.  Dependence on alcohol and nicotine were once the most common culprits, but the this has shifted in recent decades, altering the types of addiction that are being seen.  A greater understanding of the brain, the rise of prescription drug abuse, as well as new definitions of what constitutes addictive behavior, has altered the landscape of addiction.

Now, front-line providers, especially family doctors, are seeing patients struggling with dependence to a wide-range of substances and behaviors, including opioids, other illicit drugs, food, sex, gambling, spending, hoarding, self-harm, violence, and more.  The “more” involves modern technology such as videogames, smartphones, and social media.

Society once viewed addiction as a habit or choice that could be solved with sheer willpower.  However, addiction – in all its many forms – is now seen as a psychological/physical condition that a person is unable to control without intervention.

According to the American Society of Addictive Medicine, “Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.”

While more resources have gone toward the study of addiction, consensus in the medical community is still lacking.

Meanwhile, front-line doctors are usually the first health care provider to see that something is amiss.  While they are not addiction specialists, they have one significant advantage: They know their patients.

The signs may be obvious, such as physical and personality changes.  He or she may display erratic, caustic or unpredictable behavior.  Other markers could include noncompliance with office protocol and an unwillingness to follow a course of treatment.

On the other hand, most addicts, especially those who are high-functioning will go to great lengths to mask their problems and come across as if everything is normal.

Casey Heidenreich writes in “How to Spot-High-Functioning Addicts, “Many people have preconceived ideas of what an addict looks like and how they act. They are often depicted as skinny and stringy-haired, with ratty clothes and no job. This is no longer, and really never was, an accurate portrayal of an addict.”

Physicians may find that in cases of high-functioning addicts, it is often a family member who will voice concern, point out symptoms, and ask for help on the patient’s behalf.

Here are some ideas to help you get started.

• Throw out your preconceived ideas about addiction. There is no typical addict.  Age, sex, and socioeconomic background are not barriers to addiction.