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On Being a Doctor |

The Seductress

Russell Andrew Johnson, MD, MSc
[+] Article and Author Information

From University of Minnesota Medical School, Minneapolis, Minnesota.

Requests for Single Reprints: Russell Andrew Johnson, MD, MSc, Department of Medicine, University of Utah School of Medicine, 30 North 1900 E, Room 4C104, Salt Lake City, UT 84132; e-mail, russell.johnson@hsc.utah.edu.


Ann Intern Med. 2014;160(3):209-210. doi:10.7326/M13-0962
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Tammy lay sprawled on the mattress in her hospital room. She was a heroin addict. Every inch of her skin was covered with tattoos. A passerby could easily have written them off as a statement of rebellion.

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Posted on February 8, 2014
Lynn Malinoff, EdD, Herbert Malinoff, MD, FACP
Eastern Michigan University (LM), University of Michigan (HM)
Conflict of Interest: None Declared
In “The Seductress” (On Being A Doctor – February 4, 2014), Dr. Russell Andrew Johnson, MD, MSc, passionately shares his experience working with a heroin addict. What is missing in this piece is acknowledging that this is a disease that, like cancer, is best left to professionals who know how to treat it. Far too often, physicians and other helpers impede recovery by their kindness and enabling behavior. The goal in treating patients with addiction is to form a therapeutic relationship to support them in a process of engaging in behaviors that they do not yet believe in, understand, or think will work in their particular case. Neither an authoritarian angry approach or an overtly codependent stance is of benefit. Addiction is cunning, baffling and powerful. It is a disease that takes hostages, runs on fear, and results in a set of addict skills in manipulation and denial that humble any of us who live or have lived with the active disease. I have experienced this first hand with my husband, a physician, when he was in the throes of his disease. We have 23 years of recovery and a long view on this illness. Addiction medicine professionals skillfully intervened and supported my husband as he entered recovery. He left in the wake of his early attempts, an assortment of internists, therapists and psychiatrists. Recovery became accessible through a combination of compassion and tough love offered by the addiction medicine physicians. My husband, the addict, became willing to follow directions, and I, the codependent, learned to detach with love and allow him the dignity of recovering without my loving interference.
In response to comments on The Seductress
Posted on March 24, 2014
Russell Andrew Johnson, MD, MSc
University of Utah School of Medicine (Internal Medicine/Pediatrics)
Conflict of Interest: None Declared
In their response to my essay “The Seductress” Drs. Lynn and Herbert Malinoff provide an engaging and highly personal perspective on addiction from a unique vantage point; the spouse of a recovering addict and physician. They rightly point out that treatment of addiction is best left to addiction medicine professionals, and reiterate the power addiction holds over those entrapped by it. I know all too well from my family’s experience with addiction that it is a disease as abhorrent as any cancer or chronic medical condition that requires daily attention to stay ahead of. In my essay I chose to focus on the dilemma faced by physicians not trained in addiction medicine who regularly take care of the medical complications of addiction and the other health care needs of addicts both on the wards and in the clinic. In our current system it is not feasible for addiction medicine specialists to fill all of these roles. Inevitably physicians of every training background will encounter addicts in various stages of recovery throughout our careers. The challenge for physicians in these settings is to walk the tight line between enabling through naiveté while also not acting judgmental or condescending to this patient population when they present to our care, or fall short of our expectations.
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