People who use drugs and alcohol can get medically ill, just like anyone.  But when they go to the Emergency room, all too often any medical illness is overshadowed by the stigma of addiction.

Recently I was involved with an adult relative, in recovery for several years, suddenly a patient with a new onset of illness.  But the main question asked by the ER doc was “When was the last drink?”  Granted it is important to know so the patient does not go into alcohol withdrawal seizures or develop delirium tremens.  But the problem was this person has not had a drink for years.  He carries his history not as a scar but as an open festering wound.  Not to himself.  But to the cadre of clinicians who first meet him. 

“Oh, he’s an alcoholic.” 

          As the medical director of a psychiatric hospital I was always dismayed when a patient who had self-harmed out of anger and despair, out of a deep and profound psychic pain, would come to us from the ER.  All too often their wounds were not carefully stitched and sutured,

but stapled together, quickly, with a meta-message that said, “You cut yourself so why bother really caring for you?” The patient, usually a young girl, was dehumanized and looked like a Frankenstein. Not only would they have their sliver scars as a reminder of their torment, but now the pockmarked atlas of a dismissive doctor whose first charge is meant to be “Do No Harm.”  How we view our patients can be profoundly destructive if we perpetuate the mythology that a person with a psychiatric or addiction challenge is somehow morally decrepit.

          So today I made sure to redirect the other clinicians.  To be sure they knew this man in front of them was a wonderful, creative person who had a challenge with alcohol in the past and carries the memory and a cirrhotic liver.  He had fallen several days before but was too ashamed to seek help after cutting his head.  He used to show up at emergency rooms like that before, just another drunk who had injured himself, and been stapled together with no attempt to try to carefully suture together the growing gash of a disrupted life.  He did not go to seek help those days ago when an infection could have been prevented,  perhaps too proud but definitively aware that he would be treated like a pariah, our modern day leper, labeled as a drunk.  Why would he want to seek help? 

          Repeatedly I made sure to reframe the impression of the clinical team as he lay feverish and confused.  Something else was driving his current illness.  This was not the residua of an alcohol related injury.  He was in heart failure, but just days before his heart was whole.  He was living and laughing and spending his moments as any of us do every day:  cooking a meal, calling a friend, creating a unique influence on the world around him.  But today his body failed, and seeking help, he was at risk of the shroud of addiction which hid him like a cowl that blindfold the eyes of the Emergency Room team. 

          Each of us needs a champion at times.  A person who not only believes in us, but is willing to let the world know, one person at a time, that this is another human being at a time of need, not just “an addict.”  Today I was that champion for my relative. 

Every day in my work with my adolescents I try to be their champion and depathologize, destigmatize, the world of addiction.  And you, dear reader?  Join me. Bring out the champion in you.  Bring out your I-M.

The Four Domains of the I-M

About the Author

Joe Shrand, M.D.

Joe Shrand, M.D., is an instructor of psychiatry at Harvard Medical School.

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