Am Fam Physician. 2012 Jun 1;85(11):1034.
I started drinking alcohol heavily and using methamphetamines and marijuana when I was 25 years old. I am now 54 years old and, thankfully, drug- and alcohol-free since 2006. My drug habit cost me a lot. It affected many of my relationships. I lost my friends and some of my family members. Overall, I know I am lucky because several of my family members have remained very supportive and have been there for me through my recovery.
I wanted to quit using drugs and alcohol for so long, but I just couldn't do it. I was always broke, because I spent all of my money on drugs. I was arrested multiple times, and was always in and out of court. I spent one week in jail, too. Additionally, my dad, who was an alcoholic all his life, had a stroke as a result. All of these events finally pushed me to quit. My religious beliefs helped me greatly during recovery, as did my girlfriend, whom I met in rehab. We are still together, supporting each other every day. She even comes with me to many of my doctor visits.
I have rheumatoid arthritis and saw many doctors for this condition, but I never sought help for my addiction. Then one day, one of my doctors bluntly asked me if I drink alcohol or do drugs. He urged me to join a detox and rehab program. After participating in this program for two years and attending seven meetings a week, I slowly began to heal. It saved my life, and I am so grateful that my doctor addressed my alcohol and drug problems during our routine visit.—r.a.
Whether it's because they are in denial, are ashamed, or simply are not ready for help, patients don't always reveal their battles with addiction. The U.S. Preventive Services Task Force reports insufficient evidence to recommend for or against alcohol screening in adolescents, and substance abuse screening in both adolescents and adults, but it does recommend screening for alcohol misuse in adults and pregnant women. However, in my personal experience as a family physician, I have found it revealing to screen adolescents and adults for substance and alcohol abuse, especially at the very first visit. Screenings should also be performed when patients present with ongoing or unexplained symptoms, during pregnancy, after motor vehicle crashes or unexplained or recurrent injuries, and in those with mental health diagnoses. Alcohol and drug use is an important part of the social history that often gets overlooked. However, since some patients may want help and are too ashamed to seek medical attention, or simply may not know how to get help, it is important that we, as family physicians, offer our support and resources to help them.
Close-ups is coordinated by Caroline Wellbery, MD, associate deputy editor, with assistance from Amy Crawford-Faucher, MD; Jo Marie Reilly, MD; and Sanaz Sara Majd, MD.
A collection of Close-ups published in AFP is available at http://www.aafp.org/afp/closeups.
The editors of AFP welcome submissions for Close-ups. Guidelines for contributing to this feature can be found in the Authors' Guide at http://www.aafp.org/afp/authors.
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