Hannah Kaufman, MSS, MHSc, BA, Assistant Professor, University Health Network and University of Toronto, Joint Centre for Bioethics, University of Toronto, Toronto, ON
Working With Families Institute, Department of Family & Community Medicine, University of Toronto
Posted: March 17, 2015 Format: PDF
Addiction and Substance Abuse: Working with Patients and Their Families
Addiction is a chronic, relapsing disease, which is most likely to manifest when a person with a genetic predisposition is raised in an environment that fails to meet his or her need for connection and safety. It often co-arises with major mental illness and should be a red flag alerting the physician to a history of trauma and/or adverse childhood experiences. Children who grow up in families plagued by addiction often experience difficulties with self-regulation and in their relationships with others. They tend to form traumatic attachments, which perpetuate the cycle from one generation to the next. Effective treatment must therefore include the family, not just the affected individual.
Unfortunately, many people with addictions report negative experiences in health care settings, including in primary care. These negative experiences can lead them to stop using health care services. On the other hand, patients state that the most important determinant of a successful treatment outcome is a strong and supportive relationship with their primary caregiver, who can advocate for and assist them as they navigate the health care system.
Family physicians are in an ideal position to provide integrated care for patients with mental health and addiction problems because they are accessible, they are experts at managing chronic disease, they have longitudinal relationships with patients, and they look after families.
This is one educational module in a series produced by the Working With Families Institute to provide a learning resource for physicians dealing with common medical and psychosocial issues that have an impact on families. The modules seek to bridge the gap between current and best practice, and provide opportunities for physicians to enhance or change their approach to a particular clinical problem. They use a problem-based style and real case scenarios that pose questions to the reader. The cases are followed by an information section based on the latest evidence, case commentaries, references and resources. The modules are designed for either individual learning or small group discussion.