It’s likely that no one is completely honest with his or her doctor. People often feel vulnerable or even judged in the doctor’s office and they may not want to let on that they eat fast food most days or that the only exercise they get is looking for the TV remote. Other times, people are just not aware of the extent of their unhealthy behaviors. This is why self-reporting in studies is always slightly suspicious.
People are even more reluctant to discuss their substance use. They don’t want to admit they drink quite as much as they do or they may not want to admit to using illegal drugs. Part of this is just embarrassment or habitual evasiveness but sometimes there are good reasons for not mentioning substance use. People with substance use disorders often have a harder time getting medical care and when they do, their doctors may be suspicious of their motives. Doctors may also be more reluctant to prescribe certain medications. Sometimes this makes sense and sometimes it results in a lower level of care. Despite these valid concerns, the best course of action is typically to be honest about your substance use or addiction history. Here’s why.
First, you don’t have to worry that disclosing your drug use to your doctor will get you in trouble. Your doctor can’t release your information to a third party without your permission and your doctor can’t be called to testify against you. The purpose of doctor-patient confidentiality is to allow patients to tell their doctors all relevant information, allowing doctors to provide the best care. In other words, substance use is exactly the kind of situation doctor-patient confidentiality was created for.
Many drugs don’t get along. Sometimes drugs have additive effects and sometimes they cancel each other out. For example, if you already take benzodiazepines, either recreationally or by prescription, you don’t want to add opioids on top of them, since both are powerful central nervous system suppressants. Marijuana may interfere with various drugs, including antidepressants, blood thinners, and NSAIDs. Alcohol interacts with almost everything in one way or another. Whether you’re just embarrassed to admit what drugs you’re using or you’re deliberately trying to get more drugs, you need to be aware that there’s a very good reason your doctor wants to know about other substances you’re using.
There are many situations in which your substance use history is directly related to your treatment. One that people often overlook is when they are admitted to the hospital. It’s perhaps obvious that if you are admitted for an overdose that you should tell your doctor exactly what you took so she can save your life. Less obvious is if you are hospitalized for something else, you may not have access to drugs and alcohol and go into withdrawal. If your doctor doesn’t know you have a substance use history, she might start looking for other explanations for your symptoms, perhaps something related to why you were hospitalized to begin with. This wastes time and may put you in danger. Doctors can typically manage DTs if they know what they’re dealing with.
Your substance use history may affect treatment in other ways too. For example, if you’re having a heart attack, certain standard treatments might actually make it worse if you’ve been using cocaine, so it’s crucial to disclose this fact. It’s also important that people in recovery from addiction let their doctors know about their history since it’s common to prescribe addictive opioid painkillers following surgery or other procedures. And it’s still fairly common for doctors to prescribe opioid painkillers for chronic pain even though there are some serious drawbacks to this approach even for people without an addiction history. There are often alternative ways of treating pain and, if not, there are ways to hedge against opioid use getting out of control.
Substance use can significantly change your risk profile. Exactly how depends on the substances you’ve used and for how long. For example, heavy drinking leads to an increased risk of heart disease, liver disease, diabetes, and certain cancers. Cocaine increases your risk of heart failure, stroke, and high blood pressure. IV drug use increases your risk of infections such as hepatitis and HIV. Typically, these risks decline the longer you’re sober but your doctor should know to watch out for warning signs of conditions that might be related to substance use.
Much as everyone assumes he is an above-average driver, most people assume their substance use is more or less normal. This perception is often perpetuated by spending time with other people whose drinking or drug use patterns are similar to their own. Therefore, they may not be aware of how excessive their drinking or drug use is. Your doctor may provide objective feedback about whether your substance use is excessive. Your doctor may also be able to help you get started in recovery by advising you on how to detox safely or by referring you to a therapist or treatment program.
Finally, there’s no need to worry about being embarrassed in front of your doctor. Not only is she bound by confidentiality, but she has probably heard much worse than whatever you have to tell her. She has likely spent many long days over the course of years or decades dealing with embarrassing health problems. You probably won’t be the one to shock her. Even if you do, she works for you and you both share the same goal of achieving the best health outcome.
If you have a loved one who is struggling with addiction, Hired Power and our team of dynamic, experienced recovery professionals are here to guide you every step of the way. We offer many services, including helping you choose the best treatment program and transitional services, including interventions, sober monitoring, and personal recovery assistants. Call us today for information on our recovery services: 714-559-3919.
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