About 70% of my patient population has a history of substance abuse. I’m used to it, I deal with it. Being in recovery myself helps a lot. One thing that helps me stay clean and sober day after day is the frequent raw denial I see in my patients.
For your consideration, a patient encounter:
Mr. Kztrimbel is back in prison, after serving about 6 years, and being out for nearly a year. He didn’t reoffend, he just violated his parole, so he’ll do another 18 months at least in prison. He’s seeing me to complain about not getting his oxycontin. He has back pain. He’s complained of it over a decade. While in prison before, he got quite a thorough evaluation for it; it’s run-of-the-mill musculo-skeletal non-malignant intermittent back pain like everyone gets, and he made it thru his last incarceration with some tylenol or ibuprofen, exercises, and occasional ice/heat.
Upon discharge, he found a physician who believed his story of intractable pain, and gave him his oxys.
He’s got a long history of drug and alcohol abuse. Suffice it to say that drugs and alcohol are the underlying reason he got a prison sentence in the first place. He’s had some halfway decent rehab while in prison in the past. Apparently he just went thru the motions.
I evaluate him, realize that nothing has changed with his back, and I tell him he won’t be getting narcotics for his symptoms, it’s not medically necessary and certainly not appropriate. Needless to say, he’s not happy. Mr. Kztrimbel says “I knew it, I knew it, I knew that if I came back in, you’d never give me my drugs! I NEVER should have had that beer!”
“You mean you got revoked for drinking alcohol? Complete abstinence was a condition of your parole, you knew that any alcohol consumption meant that you would get returned to prison, and you drank anyway?” I queried.
“Yup, doc. That’s right. I never should have let my friends talk me into a beer”
“Mr. Kztrimbel, are you an alcoholic?”
“No, doc. I am not.”
“Mr. Kztrimbel, you knew that if you took a drink, you’d return to prison for a year and a half, you would not be given narcotics for your back, and you took that drink anyway. Now to me, that’s something an alcoholic would do, because they can’t control their drinking. We expect that behavior from alcoholics who aren’t in recovery. It’s understandable. But for a non-alcoholic to do something like that, they’d have to be either crazy or an idiot.”
“Doc, I’m NOT an alcoholic.”
“I see. Welcome back to prison, Mr. Kztrimbel. Let’s review your back exercises, and I’ll order some ibuprofen for your pain.”