Talking with patients about their substance abuse problems can be problematic for physicians. Miriam Komaromy, MD, an internal medicine specialist, addiction consultant and the associate director of Project Echo — a free distance education model designed to connect physicians with specialists — has some tips about how to approach the topic of substance abuse with patients suffering from addiction.
Here are three pieces of advice from Dr. Komaromy on how to begin a potentially life-saving conversation.
1. Get them talking: Warm them up to conversing before launching into substance abuse issues. "I usually start by saying, 'Tell me a little bit about yourself,'" Dr. Komaromy said. "If they don't immediately jump in talking about their substance use disorder, I say, 'OK, now would you be comfortable telling me a little bit about your history of issues with substance use?' The story really unfolds from there."
2. Pinpoint the trauma: Understanding the catalyst for a patient's substance abuse issues is essential in determining the best treatment option for them. "Part of what I try to do is not just help figure out how to address the substance use disorder right here and now, but also how do we start to address the underlying trauma or the possibility of post-traumatic stress disorder," said Dr. Komaromy.
3. Be respectful: Respect is crucial to eliminating stigma from these conversations. "People with substance use disorders, because of the stigma, are used to being treated badly," Dr. Komaromy said. "It's so important to convey respect. The message — on a really gut level — is that I'm just another human being like you, and I want to figure out how I can help." Dr. Komaromy shared some prescriptive advice in regards to conveying respect: make eye contact, sit at the same level as the patient and use language that suggests empathy and encouragement.
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