On honesty and addiction

I love “the Dude." It is worth remembering that as a culture we support, nurture, and celebrate substance use and abuse as often as we condemn and punish it. So one must remember that the voices telling a person to use are at least as loud, and as many as those telling one to stop.

Abuse and addiction represent part of a continuum of human behavior. Health care professionals get to see it, feel it, treat it, ignore it and smell it every day. It’s an area where we see success, sadness, and our own frailty. Clients with substance abuse problems frustrate caregivers because they manipulate their care and their caregivers. This creates anger, mistrust and frustration, which in turn results in escalating behaviors to get more medications and attention. This video shows a dysfunctional dance that plays out daily in hospitals and clinics. (Notice the behaviors and prejudices of the caregiver are as predictable as those of the patient. Remember, it takes two to Tango and this isn’t a dance you want to learn.)




To work well with addicts one must understand that recovery is incredibly hard work, and most of it is done by the patient. This video is from “The Wire” but the actor is in recovery and the monologue speaks to his experience.




Our job as caregivers is not to “stop abuse” but rather to "support recovery". There is actually evidenced based data that shows that supportive coaching and Motivational Interviewing (MI) helps clients with addiction and other chronic conditions. Listening often helps more than talking and questions can lead to more answers than ultimatums or directives. Every patient knows their disease in ways we cannot, and in the case of substance abuse and addiction a client has to want help before you can give it.