Enduring the Weight of Addiction in Clinical Practice

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COMMENTARY

“It’s not like anybody wants to be here.”

These words were uttered by a woman who had been discarded by society because of her substance use disorder. In a recent, deeply moving CNN documentary,¹ the stark realities of addiction were laid bare through the lens of Kensington, Pennsylvania—a place now synonymous with a harrowing, dystopian struggle against addiction.

This poignant portrayal not only halted me in my tracks but also brought me to the brink of tears, compelling me to confront the profound emotional toll of my work as an addiction and emergency department psychiatrist. It was a stark reminder of the devastating impact of this illness, not only on the individuals who suffer from it but also on the society that all too often chooses to overlook them.

Set against the backdrop of Kensington’s bleak landscape, this documentary underscores a grave reality that millions across the nation face. According to the Substance Abuse and Mental Health Services Administration 2022 National Survey on Drug Use and Health,² 48.7 million individuals aged 12 years or older, or 17.3% of this demographic, had grappled with a substance use disorder in the past year. Among them, 29.5 million were battling an alcohol use disorder, 27.2 million were dealing with a drug use disorder, and 8.0 million were fighting both.

These numbers are not just statistics—they represent real human lives caught in the throes of addiction. They highlight the urgent need for a compassionate, comprehensive approach to addiction treatment and recovery—one that goes beyond mere numbers to acknowledge and address the complex interplay of social, psychological, and biological factors that contribute to substance use disorders.

My initial foray into the workforce out of high school involved interviewing pregnant women about their substance use for research. This was an eye-opener. My high school, the very location where Breaking Bad was filmed, also served as a reminder of the pervasiveness of drug culture. As a medical student in Albuquerque, New Mexico, I witnessed the vast and indiscriminate reach of addiction.

It became evident that this formidable illness spared no one, cutting across every facet of society—every specialty of medicine, every socioeconomic status, every race, every gender, every age (including in the womb), and every community felt its impact. As the opioid crisis escalated, it became clear to me that addressing substance use disorders would be paramount in my medical career.

My journey took me from the optimistic corridors of medical school to the rigorous training in psychiatry at Massachusetts General Hospital and the role of chief addictions resident at McLean Hospital. My training exposed me to street medicine, where I saw the heroic efforts of physicians meeting patients in their environments (on street corners, in the cold, amid the harsh elements), bringing home the reality that effective treatment transcends the confines of a clinic. These experiences fortified my resolve and equipped me with the skills I believed would allow me to make a meaningful difference.

Pursuing an addiction psychiatry fellowship at the Medical University of South Carolina, I was ready to confront this challenge head-on. This journey has not only shaped my professional outlook, but it has also instilled a hope that we can fight the scourge of addiction through prevention, compassion, innovation, and relentless dedication.

Years of practice have peeled away the naivete I once held close, revealing a stark reality far removed from the idealistic dreams of my youth. The notion that I could significantly impact the world, or even dent the pervasive spread of this disease, now seems more like a reflection of my own privileged optimism than an attainable goal.

The crux of the issue lies not only in the disease itself but also in our collective response to it: evidence-based medical and psychological interventions, access to necessary treatment and social resources, the pervasive societal stigma, critically underfunded programs, and lackluster prevention efforts. These elements are not only failing to advance at the pace required but are also often several steps behind the rapidly evolving and expanding reach of this illness.

The formidable strength of the disease seems to engulf and overshadow most of our efforts to combat it, casting a long shadow over our best intentions and hard-fought battles. This realization is not only a reflection of personal disillusionment but also a clarion call to reevaluate and significantly bolster our approach to a crisis that continues to outpace our best efforts.

This disease has infiltrated my very own family. This disease has killed patients I had vowed to heal. This disease has caused me to cry alongside too many mothers mourning their dead children, each moment of shared sorrow etching a permanent scar on my heart. These experiences have not only inflicted pain, but they have also fractured a part of my being.

The individuals caught in this battle are more than statistics—they are compassionate, resilient souls who are too often overlooked and forsaken by a society that stigmatizes their struggle. The always present, all-consuming, debilitating shame that victims and their families feel is almost worse than the illness itself.

As mental health clinicians, we are not immune to the devastation wrought by addiction, whether it visits us professionally or personally. Yet, amid this landscape of loss and despair, we must remember the humanity at the core of our practice. These are individuals of inherent worth who deserve our compassion, understanding, and relentless advocacy for better support and treatment options. The fight against addiction demands more than just medical intervention—it requires a holistic approach that addresses the profound stigma and isolation these patients and their families face.

Let us, as a medical community, lead the charge in transforming the narrative around addiction, championing a future wherein those affected are met with empathy and effective care rather than judgment, incarceration, and exclusion. Let us not forget the human stories behind the statistics and work tirelessly to ensure no one is left to navigate this path alone.

Despite my grief and brokenness, I still fight the fight alongside my patients in my emergency and outpatient psychiatry roles. Witnessing the triumph of patients over their struggles is among the most gratifying experiences in my medical career. Unlike other diseases, addiction cannot be excised with a scalpel; it demands a comprehensive approach characterized by empathy, patience, accountability, encouragement, and unwavering consistency from those who provide care. The journey to recovery often spans years, necessitating a form of agape love that is both sacrificial and profound.

I count myself fortunate to share in the joy of my patients’ victories and to support them through the trials of relapse. The emotional toll of this work is mitigated by the unwavering support of my family and faith community, who recognize both the pain and the joy that is inherent in this vocation.

Ultimately, I have no brilliant solutions—just a heaviness in my chest and empathy to share with my patients. In the face of such a pervasive crisis, being present—literally and figuratively—for those in the throes of addiction can ignite hope and foster healing. I imagine if God were here on Earth in the flesh, he would be sitting right next to my brothers and sisters on the streets in Kensington.

Dr Albright is an adult, adolescent, and addiction psychiatrist and owner of Sweetgrass Psychiatry in Mount Pleasant, South Carolina, as well as an emergency medicine psychiatrist with the South Carolina Department of Mental Health.

References

1. ‘I’ve never seen anything like it’: inside the center of the tranq drug crisis. CNN. February 5, 2024. Accessed February 15, 2024. https://amp-cnn-com.cdn.ampproject.org/c/s/amp.cnn.com/cnn/videos/us/2024/02/02/tranq-xylazine-fentanyl-kensington-deaths.cnn

2. 2022 National Survey on Drug Use and Health (NSDUH) releases. Substance Abuse and Mental Health Services Administration. Accessed February 15, 2024. https://www.samhsa.gov/data/release/2022-national-survey-drug-use-and-health-nsduh-releases#annual-national-report