Medical care in recovery

We're working on improving linkages between our clients and primary medical care. We've borrowed from these guidelines and have been discussing this with local primary care physicians. 

I drafted the document below for clients and I'm interested in your thoughts. Keep in mind that I'm trying to keep it brief so that people will actually read it. Please post comments or email me with your comments.

Thanks!

UPDATE: A few updates throughout the day. The most recent version can be viewed here.

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Medical care in recovery

It's been said that the doctors office can be one of the most dangerous places for a recovering alcoholic or drug addict.

Here are a couple of data points from studies on the subject:

• 29.5% of patients said their physicians knew about their addiction and prescribed psychoactive drugs such as sedatives or Valium, which could cause additional problems. (Source)
• 94% of primary care physicians fail to diagnose substance abuse when presented with early symptoms of alcohol abuse in an adult patient. (Source)
• In a study of third-year medical students, only 19% recognized alcoholism during a mock chart review examination, even though the alcoholism diagnosis, a family history of alcoholism, and a 10-year history of extensive alcohol use were included prominently throughout the chart. (Source)
• A national survey of residency program directors found only 56% of the programs require training in substance use disorders. Even when training is required, very little is provided—median curriculum hours ranged from 3 to 12. (Source)

We've seen countless relapses begin with a visit to the doctor's office. It can happen even when the recovering person is clear about their recovery status. We've heard time and time again from recovering people who go to the doctor for something like pain or sleep problems and the doctor insists that a drug like vicodin, ambien or ultram is "mild" or "safe".

For this reason (and a couple others) it's important to recruit your doctor to support your recovery. 

Reasons to make your doctor a recovery ally

1. To help assure that your doctor will not prescribe you anything that might put your recovery at risk.
   
2. To help assure that you won't make a bad decision when you're scared, unhappy and/or in pain. When we're suffering we're at risk for making poor choices, we just want the pain to stop, we feel like we're going to go crazy if we don't get some sleep or if the anxiety doesn't stop. Everyone wants a quick, easy fix when their suffering, but the consequences are much more dire for us. This doesn't mean that we shouldn't take our symptoms seriously, we just need to be careful not to put our recovery at risk.
   
3. To help your doctor with diagnosis and treatment. Some symptoms of addiction (even in abstinence) can look like other medical and psychiatric problems. You want to be sure that the right problem is being treated. Your doctor can't make the right diagnosis if they don't have all the relevant information.
   
4. Addiction is a chronic illness and requires long term care, monitoring and support--longer than Dawn Farm can provide.
   
   Here's one way to think about it. If you get cancer, say Hodgkins, you are likely to go through a course of chemotherapy and radiation. If all goes well, within a period of months there will be no signs of cancer left in your body. Does your cancer treatment stop there? Let's hope not! Your doctor will probably want you to get periodic body scans for a period of around 5 years to be sure that a relapse is not occurring. If there is a relapse, the patient gets more treatment before the cancer get too bad. Why 5 years? Because recovery from the cancer is not considered stable until relapse rates drop below 15% and it takes about 5 years that to occur. It just so happens that it takes about 5 years for alcoholism relapse rates to drop below 15% and about 7 years for opiate addiction relapse rates to drop below 15%.
   
   For this reason is makes sense to make sure that you are getting recovery monitoring and support for a period of at least 5 years. A primary care physician is an ideal person to provide this monitoring and support.
   
5. It's your recovery and you're responsible for protecting it. There is tons of research that suggests this is important and there are thousands of stories that speak to its importance. 

What you can do

First, if you do not already have a doctor, choose a doctor that know something about addiction and recovery. We recommend the following:

Academic Internal Medicine 5333 McAuley Drive, Suite 4015 Ypsilanti, MI 48197 734.712.5300 (Sliding scale down to $0)	Corner Health Center 47 N. Huron Ypsilanti, MI 48197 734.484.3600 (22 and younger. Sliding scale down to $0)
Pain Recovery Solutions 4870 Clark Road Ypsilanti, MI 48197-1104 734.434.6600	Integrated Health Care 1290 South Main Street Chelsea, MI 48118-1454 734.475.1107

Second, make an appointment for a checkup. We have prepared a letter that you can send your doctor before your visit or bring with you to your appointment. It may seem corny or unnecessary, but it's important that it's in your file. You may end up working with other doctors and, let's face it, they are probably not going to remember.

Third, have your counselor prepare a release that allows your doctor and treatment staff to coordinate your care. Your counselor will then send them a letter letting them know that we are happy to help if they have any questions.

Fourth, bring it up with your doctor and let them know you'll welcome them asking how your recovery is going.

Fifth, keep in mind that it's likely you'll have to remind them when you come in for medical visits.

One more thought

All of this also applies to visits to the dentist too! It's easy to let your guard down and overlook the risks in a dental office then find yourself with a prescription for vicodin or offered nitrous oxide.

All of this may seem like overkill, but is it really? We're vigilant about all sorts of other things in our lives. All of us organize our lives around protecting things that are important to us, whether it's our job, family, health, creative outlets, faith--whatever. So much depends on our recovery. Shouldn't we be just as vigilant in protecting it?