Last year, as I sat in attendance at the Institute for Functional Medicine’s Annual Conference, I was fidgeting in my chair. The unifying theme was stress, addiction, pain. The shadows of society. The shadows of medicine. Having become an internist to alleviate suffering—for patients, and also for myself—the last thing I wanted was to confront these states of existential darkness for three straight days.
One of the first keynote speakers, however, put me at ease. Dr. Stephen Loyd was the “opioid czar” of Appalachia, treating IV heroin-dependent pregnant women, inmates, among others. A tall, broad-shouldered man with the eyes and smile of a Labrador retriever, he began his talk, accented in a warm Southern drawl, “This is a message of hope.”
An Unlikely Story of Hope
Loyd grew up on a small farm in East Tennessee, surrounded by mental illness, alcoholism, drug addictions, and abuse. He became the first in his family to attend college, went on to medical school, and became president of his class. During residency training, the pressure began to mount, and the shadows of his past began to haunt him. He popped a Vicodin prescribed for a dental procedure, which melted away his problems. He would rise to the top ranks of his class into academic medicine, all while hiding what had escalated into a self-destructive addiction.
By the time his father intervened, Loyd was ingesting or snorting 100 pain pills a day. He checked into a residential rehabilitation center, received comprehensive care, and has remained sober since. Using his personal journey to bring compassion and personalized care to others, he left academic medicine, became Tennessee's medical director for Substance Abuse Services, and currently serves as Chief Medical Officer for an addiction treatment center outside of Nashville, TN.
The Opposite of Addiction
Loyd tried to describe the experience from within. “If you imagine not eating for several hours and getting really hungry, or being outside on a hot day and feeling really thirsty, the cravings for drugs are 10 times stronger than that.” People addicted to a substance, he continued, think and feel like they will die without it, so they will sacrifice anything and everything to get it.
In functional medicine, we’re always looking beyond symptom management to the root causes of the health challenge. “The opposite of addiction isn’t sobriety,” Loyd said, “it’s connection and purpose.” If connection and purpose are the medicines, their opposites are the causes. Namely, isolation and neglect.
I began to reflect. I opened my laptop and looked up the word origin of “addiction.” It comes from the Latin addicere: to deliver, award, devote, or sacrifice. In essence, an addiction is a delivering over to something, or an attachment to someone to satisfy an intense craving. A yearning for wholeness, for satisfaction. The deep and lasting kind.
In that sense, I wondered if most chronic diseases are some kind of addiction. Are there harmful or unhelpful habits, activities, sleep patterns, foods, relationships we choose on a daily basis, consciously or unconsciously, not from ill-will to ourselves, per se, but a craving for stability (peace), pleasure (joy), and connection (love)? Is there, at the root of it all, a loss of community and a loss of connection to ourselves?
Harmful patterns also lie beyond the individual, embedded in the culture or the environment. They can be so pervasive as to be invisible. Social determinants of disease like racism, violence, and poverty. Environmental determinants like air pollution, global warming, and chemical exposures. All of these can be traced down to a breakdown of connection to each other and to the air, water, and earth that sustain us.
Hope in Dark Times
Nothing reveals this confluence of factors like the current pandemic. With the most vulnerable and marginalized communities at highest risk, Loyd’s patients have been hit hard. He told the story of a patient he'd just counseled: a young man who had been sober, was holding a job, paying his rent, then Covid-19 hit. Non-essential businesses closed up, he lost his job, couldn’t make his rent, got evicted, was now living out of his car, and had fallen back into addiction.
As Loyd said this, his face was warm, his shoulders relaxed. I knew healing on any scale means change, and change often demands going into the shadows. Still, I had to ask how he continues this work without burning out. Quite the opposite, he looked energized.
With everything on telemedicine now, he said, there’s greater access to care. Whereas in the past, they had a 65% show rate for group or individual visits, now they have 90%. Longer-term efficacy rates of telemedicine models for this field remain unknown.
“When I was an internist, I felt like my job was to document the slow decline of the human body,” Loyd said with a deep laugh. He now works at the edge of life and death where great transformation can happen. He’s driven by his own experience. He knows they can save lives and will win in the end. Hope can shine the brightest in the places that scare us. His eyes beamed as he concluded, “This is fun work.”
