Addiction Medicine in Center City, MN: One-week program at the Hazelden Betty Ford Foundation

Hazelden Betty Ford Foundation
Women's Recovery Center
Center City, MN

I finished my first year of medical school. We had our final Immunology exam a couple of weeks ago, and I left that weekend very excited for a unique one-week Addiction Medicine educational program in Minnesota.

I spent last week in Center City, MN at the Hazelden Betty Ford Foundation, a world-renowned center for chronic alcoholics and drug users. Thanks to the tremendous generosity of the Hazelden Betty Ford donors, the Summer Institute for Medical Students (SIMS) was able to host 15 medical students this past week in Center City, MN from schools across the U.S. (and one resident from the University of Minnesota), and another group of medical students at the other site in Rancho Mirage, CA. They placed us in a nice hotel in Chisago City ("SHI-SAGO"), about 10 minutes from the treatment center.

The picture above shows only one section of this large center at the campus in Center City. Hazelden is a co-ed treatment center that is fully committed to the recovery of alcoholics and drug addicts. 

We spent one week attending lectures and presentations by professionals in the field of Addiction Medicine. These presentations touched on topics such as the neurobiology of addiction, the process of SBIRT (Screening, Brief Intervention & Referral to Treatment) to screen patients for a substance use disorder, and medications for addiction. We were also assigned to different treatment "units" where patients were staying for the duration of their recovery. Most were completing the 28-day program. Each unit is either all male or all female. I believe only a couple or so are co-ed. I was assigned to an all-male unit with another medical student. It consisted of about 25 men, all ranging from ages 22 and up. I'll talk a little bit more about the demographics later in this entry, because I found this aspect of the experience shocking.

How do we define addiction? Drug addiction, in particular, is a chronic brain disease that causes continued use of a drug in spite of harmful consequences (i.e. physical impairments, health risks, brain changes) (Elite Rehab Placement).

It is important to reduce the stigma associated with addiction. The biggest goal of SIMS is to educate physicians-in-training about the bio-psycho-social complexities of this gripping disease, the recovery and treatment process, and the impact of addiction on patients and families.

I could write an entire reflection paper on this experience, but I'll focus on four main highlights.

1) Addiction is a chronic disease

There are a couple of people within my own family who struggle with alcohol and substance use. This personal experience with addiction was the main reason why I chose to apply to the Hazelden SIMS program. I also wanted to be immersed in the experiential learning atmosphere of this program. What better way to learn about a disease than to actively engage with patients who are living with it? We receive very little training on addiction during our medical education despite the reality that it is a crisis in our nation, as it affects 1 in 10 Americans. 

Alcoholics and chronic drug users have significantly
fewer dopamine receptors in the brain
Photo taken from here

Addiction is NOT merely a choice. It is a chronic disease, much like Type II diabetes and cancer. There are 2 primary factors that can increase one’s risk for addiction: 1) genetic predisposition and 2) early environmental exposure to the alcohol and/or drugs. A patient with a substance use disorder or drinking problem has a disease of brain reward, motivation, memory and related circuitry. This dysfunctional circuitry can be a risk factor for chronic drinking or drug use, and has likely been influenced by the individual's genetic makeup (i.e. the parents struggle[d] with addiction) and the environmental circumstances in early childhood (i.e. social, economic, geographic, etc).

The abnormal neurological functioning can also be a consequence of drinking or drug use. The "Hijacked brain hypothesis" states that addictive drugs are more powerful in activating the reward center than "biologically essential ways" (i.e. food, sex, socialization). 

"Why can't addicts just quit?" society asks. "Just stop drinking or taking the drug." Nancy Reagan's "Just Say No" billboard messages are not that easy. Addiction changes brain circuits. The reward of the drug/alcohol overrides the brain's control center (prefrontal cortex), thus creating a greater drive to acquire more alcohol and drugs. 

I'm refraining from going into too much detail about the changes that occur in the brains of addicts. If you're interested and would like to learn more, I highly recommend Dr. Gabor Maté's book "In the Realm of Hungry Ghosts: Close Encounters with Addiction". This book is one of, if not the best introduction to addiction medicine, the neurobiological changes seen in addicted patients, and the psychosocial complexities associated with this chronic disease.

2) Addiction does not discriminate

I admit that before I came to Hazelden I had the stereotypical image of an addict in my mind: homeless, from a broken home, abused during childhood, of a low socio-economic status, etc. However, I now understand that that is not always the case. The Hazelden Betty Ford treatment center cares for patients who have private insurance or pay out of pocket. Needless to say, the demographic is quite different from what I expected to see. There is no ethnic diversity at this center. It's safe to say that the majority of the patients are white, insured, and of a higher socio-economic status.

For a couple days this week I struggled to understand how someone who grew up with loving parents in a privileged, well-to-do home could fall into the awful clutches of alcohol and drugs. I just didn't get it. It made sense to me why individuals with more traumatic experiences (i.e. abuse, financial adversity, addicted parents, etc) became addicts. But how does someone who lives what seems like a decent life turn to artificial substances for relief?

Photo taken from here

The answer isn't that simple, but in his book "In the Realm of Hungry Ghosts: Close Encounters with Addiction", Dr. Gabor Maté explains it well: "In short, the addiction process takes hold in people who have suffered dislocation, whose place in the normal human communal context has been disrupted - whether they've been abused or emotionally neglected or whether they're inadequately attuned children or peer-oriented teens or members of subcultures historically subjected to exploitation" (279). ("Attunement is, literally, being "in tune" with someone else's emotional states… It's not a question of parental love but of the parent's ability to be present emotionally in such a way that the infant or child feels understood, accepted, and mirrored" (249).)

Given this information, it sounds like nearly anyone can become susceptible to the disease of addiction. This includes anyone who, in summary: was abused, neglected, not attuned in their upbringing (i.e. raised by caregivers who could or would not adequately connect with them emotionally), peer-pressured (which we've all been at one point in time), or part of a community/ethnic group that has suffered deep oppression for generations in our nation (i.e. African Americans, Native Americans).

All of the aforementioned sources of stress can adversely affect one's brain development during childhood, and thus increase addiction risk later on in life.

Addiction does not discriminate. Not only the poor, disheveled, and abused are alcoholics and druggies. They can also be the rich, kempt, and coddled.

3) Addiction is a disease that is not only seen by psychiatrists 

Psychiatrists are not the only physicians to encounter addiction in their practice. This is a disease that covers all specialties. A pulmonologist may see a patient with degenerating lung function due to many years of smoking (i.e. nicotine addiction). A primary care physician could certainly encounter an alcoholic after taking a thorough psycho-social history during one of the visits. A neurologist might see a meth addict who, after years of use, has a significant reduction in dopamine receptors in different areas of the brain. This occurs as the brain works to compensate for this hyperdopaminergic state that the drug induces. Chronic drug use and drinking affects nearly every major organ system in the body. Thus, any specialty is likely to encounter a patient who is struggling with an addiction.

Knowing this, it’s important for all physicians-in-training to receive proper training in Addiction Medicine. Again, one in ten Americans struggle with addiction. 2.6 million people with an addiction are dependent on alcohol and illegal drugs. 100 people die every single day from a drug overdose (this has tripled in the past 20 years). We owe it to our patients to have a solid understanding of the complexities associated with the illness of addiction.

4) An alcoholic/drug addict is no less of a human being than a non-addict

During a conversation I had with one of the patients (let’s call him Patrick) on the unit, he told me firmly, "When you become a doctor, you need to treat everyone the same way." Earlier that morning he shared with the rest of the group his story. He’d been through hell during his childhood – he grew up in dire financial straits with a drug-addicted mother, an absent father, family members who abused and molested him... The community they lived in was of a lower socioeconomic status, with constant gangbanging and shootings… He told me later that these tragic circumstances just scratch the surface. I began to tear when I heard this. I couldn’t imagine what he’d left out.

Patrick had constantly been in and out of the ER during his addictions to meth and cocaine. The doctors knew him well and were fed up with him. “I get their frustrations,” he told me. “I completely get it. But I can’t help going back to the drugs. I’m addicted. I got a problem. But I’m still a human being. They treated me like I wasn’t.”

I listened to him share some more of his experiences in the ER. I understand the doctors’ frustrations as well. Who wouldn’t be fed up with a patient who keeps wasting your time and resources with these problems that could be avoided if they just stopped using or drinking? But let’s put it this way: what if that patient were our own brother, sister, father, mother? When Patrick shared his story, I thought immediately of one of my own relatives who has a substance use disorder. We should treat our patients like we’d want our own loved one to be treated: with respect and compassion.

Photo taken from here

In many ways, addiction is an illness like Type II diabetes and cancer, and patients need treatment to recover. Unfortunately, not all physicians (nor society) believe this. Despite the existence of research showing that addicts are neurologically impaired individuals, we still consider them execrable members of our society. We see the drunks and druggies as undeserving of proper care and treatment, as filth, the embarrassment of our nation’s image, and as individuals who choose the lifestyle that they’re leading. We’ve got it all wrong. We need to develop a more pragmatic, compassionate, and humane approach to handling this crisis in our nation.

The War on Drugs created more issues than solved them. Chemical addictions are exploding at an alarming rate in our country, such as the opioid and heroin epidemic. Further changes need to be made in public policy. We desperately need to attack this public health problem in a more humane and practical way.

“We really need… and I know it sounds kind of corny…we need to be very loving, very accepting, and very patient with people who have these problems. And if we are, they will have a much higher probability of getting better” – Dr. Bruce Perry, Psychiatrist, Adjunct Professor of Psychiatry and Behavioral Sciences at the Northwestern Feinberg School of Medicine

~*~*~

This experience has ignited a passion within me for Addiction Medicine, as well as motivated me to begin an Addiction Medicine Interest Group on my medical school's campus. SIMS has solidified my understanding that empathy and patience are critical components of the physician-patient relationship. It has also emphasized for me the importance of mobilizing support and galvanizing others into action to make a difference for desperate lives. I am excited to lead others in my university community to help tackle the substance use epidemic that is plaguing many lives in our society.