Dr. Paula Cook and Dr. Darlene Petersen specialize in addiction medicine, and practice in different parts of Utah. They joined People First Radio and shared a number of topics, including systemic barriers to accessing treatment in the U.S., intersections between addiction and other determinants of health, and the role of trauma in substance use.
Petersen says one common issue is that systems will only allow people support for a short withdrawal management stage while they detox from a substance, leaving them to fend for themselves afterwards.
“insurance companies only want to pay for withdrawal management and then think we’re done, and then we’re just leaving people out in the cold, no treatment. We don’t treat any other chronic disease in this way. You don’t think that you treat somebody for three days and you’re done and you should be cured,” she said.
“Then we get into this blaming, blaming the person for just manifesting the symptoms of their disease. I think that’s really why we’re so passionate about advocating for understanding addiction and using evidence based treatment models and engaging people in long term care and supporting them in that care.”
Petersen says there is a poor understanding of the neurobiology of addiction.
“You get these changes that happen when you have a drug on the brain, and then when you take that drug away, you have to recover from that, and that doesn’t happen in just days or weeks, and so that’s where we need stabilizing.”
Petersen says its probable that significant childhood or adult trauma is the driving factor behind the substance use of 50 to 75 per cent of her patients.
“The key is you have to address the underlying reasons why somebody’s using,” she said. “Whether it’s a significant mental health issue, it’s trauma, it’s pain, whether physical or emotional.”
She says within the last 5 years there’s been a greater understanding within the field of the role of trauma.
“I think historically and currently, we traumatize people all the time in the medical system,” Cook said.
“And having a substance use disorder is traumatizing. You end up doing things you never would do. You end up exposed to situations that are violent and degrading and dehumanizing, but how do we approach that from a humanistic perspective? It comes down to supporting families and communities and prevention.”
Cook says efforts to reduce adverse childhood experiences within the population would likely help.
“Most of our patients start using drugs before even the age of 12. And, you know, when you have intergenerational substance use…and or you’re exposed to substances at such an early age, with all the traumatic fallout that occurs, including violence and assault and poverty and delinquency, it’s a difficult problem to fix,” she said
“But I think starting to recognize it is the first step. And hopefully we can bring together. Criminal justice systems with medical systems with social service systems in a more cohesive way, because we’re in the U. S. We’re far too siloed and I think, you know, once we start working more together, maybe we’ll make some headway”
The pair have a podcast aimed at physicians, residents, and others within the medical community, called The Addiction Files, which features interviews with other experts within the field and aims to de-stigmatize addiction treatment within the medical culture.
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