How did you choose psychiatry as your specialty?
While in medical school in Chicago, I did both a Harborview ER and outpatient psychiatry clerkship [part of medical school] through the University of Washington, and I absolutely loved both of my rotations. I came back for a psychiatric residency because I loved the staff. I knew I wanted to be a clinical psychiatrist who treated patients. And during my residency, I had a couple of attendings who were not only great clinicians, but doing incredible clinical research; I was surprised to see you could actually study what you’re doing with patients and see what helps to make people better. That sounded good to me.
How did you get involved with addiction?
Back in the late ’70s and early ’80s in psychiatry, drugs and alcohol were not seen as problems in themselves, but they were seen as ways people dealt with other problems. I found there were other psychiatrists like me who had thought half of the people that we see in the ER are there for reasons related to their drug or alcohol use, like making a suicide attempt while they were intoxicated. I started educating myself in drug and alcohol issues, and in the ’80s helped to form the American Society of Addiction Medicine (ASAM); much later, I became editor of the ASAM Principles of Addiction Medicine. I developed expertise in both psychiatry and addiction—sometimes called “dual disorders”—when there were very few of us locally or nationally.
Are attitudes toward addiction changing?
All throughout medicine and certainly in psychiatry, the understanding of addiction is changing. It’s getting better. We now have addiction experts in psychiatry and in primary care. I’ve worked to integrate addiction doctors and counselors into primary care medicine, inpatient trauma service, women’s health program, outpatient mental health center, in the Harborview ER. I became the first Division of Addictions director for our department of psychiatry, which I still am. It’s been my life’s work to bring alcohol and drug intervention services, diagnostic services and research more broadly into the medical world locally and nationally.
Is there a recent development in your field that you’re especially excited about?
Yes, there is. Everybody’s aware we have an opioid epidemic. Unlike other addictions, where counseling can make a big difference, it does much less so with opioids. But now we have several opioid system stabilizing medicines. These can be prescribed by doctors who take special training, and we have a growing number of these throughout UW Medicine; in fact, the biggest clinic for this is at Harborview’s Adult Medicine Clinic, which interacts with our Addictions Services. The silver lining of a very ugly opioid epidemic is that it’s forcing the medical care system to start developing addiction treatment that’s integrated into the medical system.
What’s the biggest misconception that people have about what you do?
It’s thinking that nobody with addiction gets better. One of the reasons I work with addiction patients is that when on fire, addictions severely damage both the person and those around them; however, when in recovery, many get better than they have ever been in their lives. This is actually pretty common.
Is there a patient behavior that you wish you could change?
I think one of the problems we run into in all of medicine is people’s unwillingness to adhere to treatments that would probably help them. For example, research shows that about 50 percent of patients prescribed blood pressure, lipid, asthma or other chronic disease medicines don’t take them regularly, and the same with most psychiatric and anti-addiction medications. As clinicians, we need to find better ways for engaging with our patients, educating them, and doing whatever we can to improve adherence and outcomes.