The solution seems simple enough. Just stay in hospital until the infection is under control, then continue treatment at the CTCT, a clinic in the Downtown Eastside. If going to that area causes too many triggers for someone fighting an addiction, then all they have to do is stay in hospital for 6 weeks to treat their infection. So simple, but why do so many patients check themselves out of the hospital before the treatment is completed, only to return a few weeks later with a much worsened state?
Addictive behaviour can seem irrational, indeed, and it can be quite maddening at times. There is one article related to addictions, Reflections on Treating Addictive Disorders: A psychodynamic Perspective published in the American Journal on Addictions, which broadened my understanding of addictions. I had read this in medical school, and decided to go through the article again when working on 10C and feeling discouraged by the failed treatments. The author reminds us of a very important fact: that addiction is not about “pleasure-seeking”. Rather, he summarizes that causes of addictions are related to difficulties with feelings, self-esteem, relationships and self-care. It’s an important distinction, as it’s much easier to get frustrated at patients who aren’t doing their part simply because they want to feel a “high”. His conclusion, after 40-50 years of experience in addictions medicine, is that, no matter the patient and his or her other comorbidities, there are a few essential elements health-care providers need to use in their work: kindness, comfort, empathy, avoiding confrontation, patience, instruction, self-awareness, climate of mutual respect and balance in listening/talking.
I believe that it’s this conclusion, so simple and humane, that had struck me when reading the article. It was oddly comforting. And so, when I rounded on a few patients in the Urban Health Unit of St. Paul’s Hospital who had visibly used the same day and appeared very unwell, I remembered the complexity of what was driving them to use. The pleasure-seeking hypothesis made no sense in these patients who were in obvious distress after using. And I actually felt relief when watching the 10C team in action- every essential element for helping patients suffering form addictions in the list cited in the article were vividly present. Now if only other wards and environments could demonstrate the same kindness, comfort, empathy, patience and respect as seen on 10C…
The article: Khantzian, E. J. (2012), Reflections on Treating Addictive Disorders: A Psychodynamic Perspective. The American Journal on Addictions, 21: 274–279. doi:10.1111/j.1521-0391.2012.00234.x