The G Spot: Addiction – There is Hope

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I walked up to the room and peered in the open door.  Within the room, between two flimsy partitions, there was an array of chairs in a horseshoe shape.  The room was bathed in fluorescent lighting raining upon the generic hotel conference room chairs and tan carpet.  Two men who clearly knew each other well were loudly discussing something, the closest was a loud, obese man with a booming voice and a southern accent.  They were at least twenty years my elder and were quite comfortable there. I felt like an alien presence.

I dreaded my inevitably awkward entrance and contemplated skipping this meeting.  Instead I walked into the room, poured myself a cup of coffee, and sat down opposite the two men.  They introduced themselves and we shook hands.  We exchanged small talk about flying for a while and I started to feel like I belonged.

The discussion veered into the realm of flight physicals as this physician shared his story of difficulty obtaining his medical certificate as a pilot after his addiction treatment. Assuming that I was also in recovery he stated, “as you probably know” in reference to flight physical difficulties. I immediately felt like an outsider as if I were attempting to blend in.  Not wanting to offend him, I clarified that I didn’t have addiction issues of my own.   At this time, the seats were filling up with others for the meeting.

After further small talk, the meeting was called to order.  The facilitator lead us in the serenity prayer,

God grant me the serenity
to accept the things I cannot change;
courage to change the things I can;
and wisdom to know the difference.

The speaker was an older physician who had spoken in some of our meetings the previous day.  A very kind and caring man, he clearly had compassion for others who were struggling with addiction.  He shared his story of dealing with addiction in his life. The addiction was not his own but those of his family and he found Al-anon to help him cope at a time where his life felt out of control. He spoke about his gratitude with their sobriety and for the support that he has received.

Another physician discussed his addiction. With the help of providers who subsequently became his colleagues, he was sober and helping others in addiction medicine.  His son fell into the same trap as him and he has managed to find sobriety despite his genetic disadvantage for which this man carried some guilt.

After each share, the group would thank the speaker. After some silence, another speaker would introduce themselves followed by the ritual, “Hi, ____!” It struck me how the ritual gave many comfort at a time where their lives had no order. There were others like myself who were observers at that meeting. Nevertheless, most of us spoke at some point about how addiction had touched our lives. Some lost family members and attempted to share through tears and sobs. Many explained how their loss or their family member’s struggle motivated them to help others.

This was the second day of the conference that I attended, the California Society for Addiction Medicine Review Course. Attending were over 850 physicians, physicians’ assistants, nurse practitioners, and therapists who practiced addiction medicine to some extent. The first thing that caught my attention were the name badges when I picked my registration packet. “Greg” it stated in large, bold letters, with “Greg Greenberg, MD” much smaller underneath. It might surprise you to know that physicians are pretty narcissistic and I found this act of humility to be refreshing.

I attended the meeting through a scholarship from the Medical Education and Research Fund (MERF) which sounded a lot like smurf to me. I knew I would have a merfy time. Our badges should have been blue. As part of this scholarship, we had early morning meetings, lunch meetings, and dinner meetings throughout the conference. This was designed so that we could share our experiences, learn from each other, and have a support network for difficult problems that arise in the treatment of addiction. What I did not expect was the amazing group of people from whom I am learning to be a better physician.

Most conferences that I attend are in emergency medicine. That field carries the highest burnout of any specialty and as one would imagine, many of those who attend are adrenaline junkies, cowboys, and crusty. Juxtaposed against those in addiction medicine is a sharp contrast. Many of those who were teaching us at this conference have been in addiction medicine for decades. Everybody was positive, enthusiastic, supportive and incredibly excited about what they could do for their patients. I was expecting everyone to hold hands and sing Kumbaya at any moment. I wasn’t sure if we were going to leave in Priuses or old Volkswagen Beetles. When one of us spoke, they thanked us for sharing. What kind of doctor thanks another doctor for sharing? Surely I must have entered the Twilight Zone with a sprinkling of Ecstacy.

Treating addiction is very difficult. The patients are going through horrible times in their lives, often early in recovery they will take it out on their treating providers, and people who are struggling with addiction are often not very nice to those around them. Nevertheless, everybody at this conference was so positive, so excited, and everything we learned was an opportunity to bring that knowledge back to their practice and help people. We had residents, psychiatrists, allied health providers who were all part of the team contributing what they could to help our patients.

At the meetings and the lectures, there were no discussions about how to protect yourself from law suits. Not once did anyone complain about salaries or not being paid enough. There many discussions about advocacy. Advocacy for our patients, not for us. There was a lot of discussion about the growing opioid epidemic and concerns about our politicians doing what is right for those who need treatment. In a room of so many health care providers, the focus was clearly on helping as many people treat addiction as possible.

One of my workshops was on motivational interviewing. Apparently, my usual approach of “stop using meth or you’ll die,” may not be the most effective approach. We learned how to partner with our patients, show them that we care, and let them tell us what they want to change. Each table had a facilitator and every one of them had an amazing amount of energy and excitement about what we were doing. They clearly wanted to help us learn so we could find a way to help patients steer clear of bad habits. My facilitator, Ladonna, could best be described as having the enthusiasm of Mary Poppins, the skill of Marcus Welby, and the patience of a kindergarten teacher. Our instructor, Ken, was one of the most kind, gentle, and supportive physicians I’ve had the pleasure of learning from. The emergency department would eat him alive! In our discussions, many of us lamented patients who we lost, hoping we could learn from that experience to try not to repeat it. We all have some element of guilt. Although it was the patients’ actions that resulted in their death, we still grieve for the loss of a human being who we could not save from addiction.

I’m writing this column after returning from a reception for us to meet and talk. We talked with other people treating addiction in the hopes of learning something to improve our own practice. I received advice from some of the founders of addiction medicine and gave advice to others who wanted to know my experience with implementing an addiction medicine program. You could feel the excitement in the room. I even forgot that we were talking about the “junkies” and “addicts” that “choose” their disease in Redding. Because in fact, that’s not what they are. They are human beings who are fighting the most difficult fight of their lives, and I was in a room full of people who will do what they can to help those who the rest of society shuns.

At my table sat six clinicians from Redding. One was a physician from Shasta Community Health Center who advocates for the homeless, whose dedication is amazing. Another who has dedicated her career to helping those battling addiction, especially pregnant women. We even had a resident in Family Medicine with a big heart who wants to help our community. We had a physician and physician assistant from Hill Country; both very dedicated and compassionate. Last and probably least was me, making the metamorphosis from burnt out emergency physician to compassionate addiction medicine specialist. All six of us are fully committed to helping Redding with its problem with addiction without asking, “What’s in it for me?” There are many others in Redding who are dedicated to helping as many people as possible. I am committed to continue my practice in addiction medicine even though it pays much less than my work in emergency medicine.

I now have a different view of addiction medicine. The science and the medicine has not changed. The people who are practicing addiction medicine are truly remarkable. Many are motivated by their own struggle with addiction or that of a loved one. Many others are motivated because that is where they feel that they can do the most good. I feel privileged to be a part of a truly amazing group of people who are so dedicated to helping others. I am motivated by their amazingly positive approach to a condition that society views as very negative. I am inspired by what amazing clinicians and human beings have chosen the calling of addiction medicine and I hope that I can proudly follow in their footsteps.

Greg Greenberg
Greg Greenberg grew up in Santa Monica, California. After undergraduate training at UCLA he attended medical school at Ohio State University and completed a residency in family medicine in Columbus, Ohio. He moved to Redding after residency in 2004 and has served the Redding community as a family physician, hospitalist, emergency physician, and, most recently, in addiction medicine. When he’s not enjoying the calm atmosphere of the emergency department he enjoys the chaos of being a full-time parent as well.
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21 Responses

  1. Avatar cheyenne says:

    That sounds like the six week DUI sessions I attended years ago, not voluntarily. I learned a lot and think everybody, not just drinkers or addicts, should attend. It really helps to connect with people who one normally would never have a conversation with.

  2. Avatar Julie Winter says:

    Thanks for sharing , Greg. Having had a brother struggle with addiction, I can relate and have tremendous respect for those working with addicts. We have a lot of work to do in our city.

  3. Avatar sue k says:

    Beautiful, Greg.
    Thank you for your compassion, wisdom, energy and openness.

  4. Avatar Beverly Stafford says:

    Compassion and dedication could be the “middle name” of all of you who are working so diligently with those who suffer addictions. Does chocolate count?

    • Greg Greenberg Greg Greenberg says:

      I don’t think “chocolate use disorder” is in the DSM-V, maybe in the next edition. My Diet Coke addiction escaped as well.

  5. Avatar Virginia says:

    Thank you for what you are trying to do. Addiction is a horrible affliction. You were attending an AA or NA meeting. They have the best rate for controlling an addiction than all other agencies or other type of organizations. Their is 12%. The norm total for the Country is 5%. Staying “clean” is a minute to minute and if lucky only a day to day. Addiction never ends.

    When I volunteered at a addict run, live-in facility in 1970, I pray for the ones who I came to know. But, there were so many I never really knew as they weren’t there long enough. Even the ones I knew that had been clean for 2 years ended up on Methadone because it was easier.

    I can fully understand you trying to help these individuals. In 1970, most of the addicts were young from the “drop out generation.” Today the fight is worse as there are so many parents and even grandparents from the 70s grown up and addicted.

    Will the fight be won? My feeling is not unless the youth of today learn to accept that not everything is giving to them. That they have to earn “things”. And, find the reason why, one doesn’t want to be aware, versa being aware of life as it is, good or bad.

    Pot is a gateway drug. As the addicts said, “You can’t handle pot any better than any other drug!” We can only pray for our future. Mine is very short, but my are just starting out……..

    • Avatar Virginia says:

      Oops: Used “giving” when it should have been “given” to them.

    • Greg Greenberg Greg Greenberg says:

      The only way to win the fight is to not fight. Treatment is vital but prevention is more important. Once addiction has taken its toll it’s often a lifelong battle.

      • Avatar Virginia says:

        Yes, prevention is the most important part of pre-addition! To do that, one must get past the people who don’t care enough, people who don’t believe it will happen in their family, and the addicts themselves addicting others. Most never reach sobriety for any length of time, which is unfortunate. I’m not saying treatment isn’t good, but I have seen so many fail even for a short time.

        Even in 1972, I heard people, including the doctors in the town, say there was no drug problem in their small Washington town north of Seattle. That was until all that changed around when there was a big drug raid in town a few months later. I had so much information on the drugs from gov’t studies, the Chief of Police took all of it for his own department to use. What a shock it was to the townspeople to find out many of their own children themselves were using.

        Now it is how to change it. Unfortunately if there is any success it will take generations to really wipe the big problem around. I disagree about the way to win the fight is not to fight. But, that is OK to have a different opinion. The main thing is to keep on trying by all means. I applaud you for your willingness to work in the substance abuse field.

        Maybe you will make the difference here in Redding. We can only pray that is true…

  6. James Montgomery James Montgomery says:

    Thank you for the article. You have a lot to learn, but I do not know any doctors who learn slowly. You will be an asset to the recovery community.
    Most striking to me is that, although the title of your article uses the word “hope”, it does not occur in the body of the article. In my own struggle to understand addiction, both within myself and others, I have come to believe that hope, although it is intangible and cannot be prescribed pharmaceutically, is the key element to beginning the process of recovery.
    Nor is the word “spirituality” used, but I know very few people with long-term recovery who do not practice a program of spirituality. Yeah, I’m talking about the 12 steps, tho a few find other ways. I know that the clinical community is not particularly attracted to spirituality, but if you want to find the folks who have actually recovered from addictions- including alcohol- you must get comfortable with the idea.
    If you are serious about this, get a Big Book and read “The Doctor’s Opinion.”

    • Greg Greenberg Greg Greenberg says:

      True, I think many of my articles have hope as an underlying theme. I’m hopeful that we will stabilize this problem that’s out of control.

      Spirituality is a big part of recovery. Many of the physicians at this conference spoke about spirituality. Just as I’m learning the medicine addiction, I’m trying to incorporate this into my practice as well. As an atheist raised by atheists, I don’t normally speak in terms of spirituality but that’s part of the learning process. I approach recovery from the values and beliefs of my patients.

      Thank you for your comments.

      • James Montgomery James Montgomery says:

        Yes, I hope we can stabilize it, too.
        This is actually the second epidemic of heroin I have seen in my life, tho much bigger. The first came after the first wave of speed (meth) that hit the hippie movement (Haight-Ashbury, etc.) If the progression is the same, alcoholism will follow for most of the junkies who do not die or find recovery.
        FYI, I have a dog in this fight. I have 26 years of sobriety, and I sit on the Board of Directors of Empire Recovery Center.
        As an atheist, you will want to read Ch. 4 of the Big Book, called “We Agnostics”, as well
        as “The Doctor’s Opinion.”
        Here are links, just to make it easy:
        Most of us with long-term sobriety have open minds regarding other paths to sobriety, but AA is the only one I have personally seen work on any scale. Of course, my experience may be limited by the fact that my own sobriety came thru the 12 steps.
        Thank you again for your efforts.

        • Greg Greenberg Greg Greenberg says:

          Thanks for the imformation. And the homework! I was trained in the cognitive behavioral model of recovery but didn’t get much in the social model which I’m learning more about.

  7. Avatar Gilbert Sanchez says:

    Awesome Greg. Addiction has caused turmoil and pain in my family. A perspective of compassion, hope, and love is so refreshing. Peace.

  8. Avatar K. Beck says:

    PBS had an interesting program focusing on addiction in “The South”…low income people. It turned out the main reason people got hooked was through physician’s prescriptions. I think the pain management Docs need to take some of these classes. Instead of throwing pills at people they need to learn techniques to help with pain management without, or with less, medication. The other thing that was talked about is the prescriptions were often written for 6 months…too much time without being checked on by a Doc. There is a lot that needs to be worked on it seems to me.

    • Greg Greenberg Greg Greenberg says:

      Fortunately a lot of that is changing. Some is too little, too late. Dr. Dhruva, one of our pain specialists stopped prescribing opioids a few years ago. Dr Soloniuk was at the addiction conference and he has always been a conscienscous prescriber. The pill mills are getting stifled. We are making progress!

  9. Steve Towers Steve Towers says:

    I feel genuinely bad for addicts of drugs (including prescription drugs) and alcohol. It’s not something that many families escape, and addiction has hit some of my extended family hard.

    I have more difficulty feeling sorry for the people who three times broke into my vehicles in town and stole thousands of dollars worth of gear; or the ones who tore the screen off of my house’s window to see if they could pry their way in and when they couldn’t, knocked a door knob off the door (and still couldn’t get past the dead bolt); or those who occasionally wandered into my office at Pine Street School to say they needed to use my phone, and then unleashed vile streams of profanity when I said no; or the couple who were having sex in the restroom stall of the library and thought it was funny that I’d clearly noticed them when I turned and walked out. Yesterday I took my daughter and granddaughter to Turtle Bay. Someone had taken a dump and wiped their a** in the middle of the parking lot—surely some sort of “f*** you” to everyone—and we were forced to walk around it. What I feel for that person is pretty close to the opposite of compassion.

    You’re a better man than I.

    • Greg Greenberg Greg Greenberg says:

      There is a huge difference between those who seek treatment for their addiction and those who do not have respect for other’s property. Addiction is not an excuse for doing bad things. In the emergency department I see many people every night who have addiction problems but are not seeking treatment and do bad things. My empathy for them stops when they are harming others.

  10. Avatar K. Beck says:

    Perfect timing:

    From: “Marketplace”
    Mon, Sep 11 2017 4:10 PM

    Finding opioid alternatives: In response to the opioid epidemic gripping the U.S., some operating rooms have moved away from using fentanyl, a commonly used IV opioid anesthetic. Instead, doctors and nurses are piecing together other medications and methods, like using a nerve block, to avoid giving patients any opioids. These techniques can be costly, sometimes not covered by insurance and require medical staff to get additional training. But any additional costs are dwarfed by the rising costs of the opioid epidemic, estimated at $78.5 billion in 2016 alone. And besides, patients are increasingly asking for alternatives. “We’re getting more and more patients that are coming in who have been addicted to opioids saying, ‘Look, is there any way that we can do this without any opioids, because I don’t want to risk relapsing?’” said Tom Baribeault, a nurse anesthetist who founded the Society of Opioid Free Anesthesia.

  11. Avatar Liz A. says:

    This month’s National Geographic covers addiction —- cranial electro stimulation devices are showing great promise as a tool to combat cravings for alcohol and other addictive substances.

  12. Well said Greg. Thanks for sharing so candidly! Wouldn’t it be great if there were simply answers to complex problems. As we learn daily, it just ain’t so.
    So much must be tackled in the realm of “prevention” to help our young population adopt and make healthy lifestyle choices. That’s the real solution, but just not as easy as it sounds with all the outside influences. Keep up the good work!