Episode 8 – What Is Misdiagnosis?
Dr. Ashish Bhatt ❘
Receiving the wrong diagnosis can impact the trajectory of someone’s life, but misdiagnosis still occurs. Dr. Bhatt explains why.
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Hayley: Hello, this is Hayley, and you’re listening to Straight Talk With The Doc, the podcast that gets real about addiction, mental health, and treatment. I’m here with our content director Jeff and our medical director Dr. Bhatt, how are you two doing today?
Dr. Bhatt: I’m doing well, Hayley, how are you, Jeff? How are you and Hayley doing?
Jeff: I’m doing good, it’s a good day today.
Hayley: It is. I’m doing great too. So today I wanted to bring up a topic. That’s probably at the forefront of all of our minds, and that is the vaccine that’s been released for the coronavirus. Now this is great news, obviously, hopefully lives will be saved and eventually, we can move towards things being a little bit more normal. But that raises the question of how a return to normal might affect someone with an addiction. If there’s nothing holding them back from say, going to the bars or meeting up with people that they used to use with, how has that temptation going to be handled. I’d like to get into that. But first I wanted to ask you Dr. Bhatt, as an addiction specialist, how has COVID impacted the rates of substance abuse overall?
Dr. Bhatt: I think we’ve seen it at least in the treatment industry that we’ve seen a variance in numbers. There has been an increase in certain substances. Alcohol use seems to have gone up. We have seen people who might have been in recovery at the time dealing with the stress and isolation of the pandemic and relapsing. And we’ve seen increases in certain areas regarding overdose and opiates and meth and other substances. So, depending on where you are and what population we’re dealing with, we have seen an increase in both alcohol and other illicit substances in overdoses throughout the country.
Hayley: The vaccine rolls out and more people are more comfortable returning to daily life, how could this return to normality impact someone with an addiction?
Dr. Bhatt: That’s hard to tell because it probably depends on the trajectory these people were going on in the first place. I would consider someone who was headed to relapse, probably being facilitated by it. If someone who was headed to relapse, who was maybe unable to get ahold of their drug dealer or access certain things or go certain places that the isolation and pandemic stopped them from going, now opening up those doors, maybe can fuel that destination, and they will be on a full-blown run. On the opposite, maybe somebody who is teetering with getting help. And was trying to seek treatment, maybe the fact that they’ve been isolating and they’ve been afraid to go out or afraid to go to rehab due to some fears or something like that, of catching the coronavirus. Now, if there is less threat, they may be more inclined to go and actually seek out treatment.
Hayley: I wanted to kind of break that into two parts about how a return to normal life could benefit someone with an addiction. Maybe they can go and have a better support system in person. Can you talk about the potential benefits?
Dr. Bhatt: I think you just started that out already. One of the things that the pandemic did was take away access to all of us, not those suffering from addiction only, but everybody around the world. When you take away access to things that helped you stay away from drugs, such as your meetings, your sponsor, access to treatment centers that are communal environments. We deprive people of treatment and treatment options, but the structure that kept them or maintained someone sober often entails the socialization and that was also taken away for all of us. Depending on what side we’re looking at, but having the access now to maybe go back to some level of normalcy will probably help those who were heading in that direction who were clinging to, when is this going to happen? When can I get back to seeing my sponsor in person? And when can I go back to my groups and my meetings that were live, when can I go back to my IOP or treatment center? When can I start hanging out with my family again, when am I going to get to go see my grandmother, who I used to visit every weekend? All of these things that keep people preserved and keep people whole hopefully will be there and available for those people who benefit from it.
Hayley: I also want to look at the flip side of that, who you surround yourself with really makes a big difference in your life. Of course, if you have a supportive family that you get to be around, that can keep you sober, but on the other side, who you’re surrounding yourself with, if it’s people that also abuse drugs or alcohol, that could influence somebody. So, I want to talk about how the return to normal life could negatively impact someone with an addiction.
Dr. Bhatt: That’s right. The flip side of all this is that now you can go out and maybe interact with those. When we’re in treatment, we talk about how do we identify a person, places, things, and situations that lead to certain thoughts that maybe rise certain feelings, and that leads to certain behaviors. Now maybe those were bottled up during the pandemic and still are. Is this vaccine, is this opening up of the country or potential opening up … right now, we know the numbers are pretty bad. And we know that certain areas of the United States are really, really bad, but in the upcoming weeks or months, or even in the anticipation of this, people might have this false sense of security that we can go out and interact with those persons, places, things, and situations that were negative, that were bad, that led to certain thoughts and ultimately feelings that lead to certain behaviors and that connection can accelerate. This could really be a double-edged sword. Depending on really who we’re talking about, where we’re talking about and what level of recovery they’re in or not. And how close they are to accessing those people and how much the pandemic actually stopped them. So, for those people who the pandemic stopped them from having access to drugs and their drug dealers and their bad influences and their bad emotions, yes. This could be a portal to resuming all of this again.
Hayley: Can you also talk about why someone may have the urge to abuse drugs or alcohol during lockdown and like when they’re feeling really isolated?
Dr. Bhatt: Some of the risk factors involved with addiction is depression, anxiety, being in your mind, being by yourself, and it’s being lonely, boredom. All of that was kind of catalyzed with the pandemic, we saw more of this around the world and here in the United States. That right there is a huge risk factor for using, and especially when you suffer with addiction, those are scary times. A lot of people are in recovery due to our social supportive mechanisms through AA and NA, which have a social component to them, that being taken away, or at least initially not accessible, led to a lot of people using. Even access to your doctor, your antidepressants or other co-occurring things that might’ve been going on with you.
But just the fact that life got turned upside down. The unknown, the fear, the apprehension. Again, I don’t want to just call it out for people. Of course, we’re talking about subject of addiction, but this impacted people who did not suffer with it, it impacted everybody. The bottom line was we were under and still are under a tremendous amount of duress. Most people are gonna feel it. And if we have bad coping mechanisms, unfortunately, this was an opportunity to act out on them.
Hayley: I want to talk about the excuse to use. Somebody with an addiction who doesn’t want to stop, they’re probably going to find any excuse that they can. And like you mentioned earlier, I drank because I’m sad, I’m depressed and lonely, but then these people may also drink because they’re like, Oh, I feel safe. I feel happy. I want to celebrate. Can you kind of talk about using the same method, such as drinking or abusing drugs when you’re both grieving and celebrating?
Dr. Bhatt: It goes down to the construction of the addiction process. I know we’ve spoken about this, maybe in other episodes. When we have an altered, motivational hierarchy, we’ve put in order different things that are important to us. And usually when we’re not under the influence or when we’re thinking properly, sanely, unadulterated, we can tend to prioritize what’s important and what’s not. Similarly with our thoughts of what is important and what’s not, but the rationalization of what we should pursue, that’s distorted oftentimes when we suffer with addiction. It really depends on how our brain manipulates itself. When you’re under the umbrella of suffering from addiction, you’re not thinking straight, you’re not thinking properly, so you can use whatever mode, whatever reason as a cause or a justification to go out and use.
When the pandemic hit, Oh, crap, this is bad. I need to go and get high. And now when this perceived relief has been provided, Oh, the vaccine is coming. Now we need to go celebrate, I need to go get high. It really depends on how the person’s suffering wants to manipulate the information and absorb it, and then rationalize the need to go and use. And unfortunately, when you have this flipped up cognitive distortions and altered motivational systems, they’ll use when it’s a good day they’ll use when it’s a bad day.
Hayley: You mentioned a few minutes ago potential triggers for somebody. Can you talk about how you handle triggers? How do you help people in treatment approach those triggers when they come up, because things happen, you’re going to run into people, you’re going to go certain places. How do you handle that?
Dr. Bhatt: There’s a lot of behavioral and cognitive restructuring, reconditioning, obviously we try and do more convenient steps or more tangible steps of like, look, if we know that going around a certain person makes you use drugs together. Well, we educate people. We talk about how we can avoid these individuals. Similarly, if there’s certain situations or certain places somebody is accustomed to using at, avoid these places.
We talk about a deeper process and the association in our mind, because in between these people, there are microseconds, there’s periods in between these things that actually trigger one. Well, when I see this person, it makes me think a certain way. That makes me feel a certain way. That makes me behave a certain way, which is the behavior that we’re talking about is drug use. And so we have to separate these. This might happen in real life. In one second, I hit that gas station. I know I want that six pack cause that’s that trigger, but then we expand those things in treatment by breaking it down and say, okay, that gas station, what does this mean to you? How does it make you think? What’s the thoughts that you have, well I know that there’s beer inside. Okay. What happens next? Or how does it make you feel? Well, I feel excited. I feel excited and the next thing I need to do when I’m excited like that, I have to go in and grab that beer. So when we break down these and I’m somewhat simplifying these, but ultimately you have people recognize certain thoughts that are maladaptive and certain emotions that are maladaptive or unhealthy and help seek alternative outcomes.
So if a certain thought led to a certain negative emotion, catch it at that stage and seek alternative ways to deal with that. And then if an emotion leads to a certain thought, we’ll see our alternative ways to think about that. Even though this is bi-directional, and I know I’m getting a little lengthy in this explanation, ultimately we want people to see, perceive, and recognize these triggers or these stimuli and have them manipulate them, and then hopefully have a more positive outcome to this because in the end, we can’t ultimately avoid everything. Things mirror things, things resemble things, things exist. We have to not only change just those more tangible things, ultimately change the cognition behind them and the behaviors that are associated with them. And that takes time and that exists through treatment, through therapies, and through practice.
Hayley: You mentioned at the beginning of this episode about how some people have developed an addiction during the pandemic, maybe they’d never had an issue before and now over this past year they have a full-fledged addiction that they didn’t have before. How do they cope with this now?
Dr. Bhatt: Hopefully if the pandemic was the reason, was the trigger let’s say, that took someone who was vulnerable and made them act out upon it. Hopefully now that it is being potentially preventable with the vaccine, and hopefully in the next many months to years, we will see this stuff start to be more in control. Hopefully the same individuals will then also look at this in a more positive way. If the negative part of the perception of the pandemic led them to use, hopefully the positive perception will lead them to not, or lead them to seek treatment or have them have access to this. It’s hard to tell right now because it’s so new, it’s hard to predict what the vaccine is going to ultimately translate into for us as humanity. Hopefully, if there is a light at the end of this tunnel, it will resonate into those who suffer with it.
Hayley: I also want to look at that on the flip side, say for somebody who used to have an addiction, but got sober during the pandemic, what should they do to prepare for the potential return to normal life?
Dr. Bhatt: Keep doing what they’re doing. Obviously if they got sober, look at what you have right now, look at the system that you’ve created, your ecosystem, who is your team? Who are the people and the things around you that have maintained your sobriety? And hopefully it’s not just because you’re locked up in a house and you don’t have access. If that is the case, now is the time to seek treatment, and now is the time to reach out to your loved ones. Maybe reach out to a treatment center and let them know your fears of coming back out into society and having this in front of your face, because there are treatment centers that are prepared to help people who feel that they are at risk and that they have somehow gained some level of sobriety right now, but that’s because they’ve been put in a certain condition once they’re not in that condition, their risk is going to be higher. They need to seek help and have this assessed for them and create that opportunity to maintain that sobriety as the world hopefully starts to come back to a pre-pandemic situation.
Hayley: That brings me to my next question about if somebody relapses, should they just immediately return to treatment, should they try to handle it on their own? Is there a right way to handle it?
Dr. Bhatt: I think that the knee-jerk reaction is to seek help, go and get professional help. Due to the unfortunate nature of addiction for many people there is a cycle of relapse and remission, often it’s because they haven’t been able to stay sober on their own. So, looking at that, some people do have insight and they’re capable of recognizing what it took in the past that helped them achieve sobriety and get into recovery and some people haven’t. And then for those people who hopefully will listen to this, that are family members, don’t be in denial either. They need to ensure that if they see that this person is looking at this and having dialogue and thinking that, Hey, you know what, I’m somewhat liberated now.
Again, it’s this weird paradox that we’re in, although yes, this vaccine has come out we still have to be cautious because the coronavirus hasn’t gone away. There’s so many cases out there, there’s so many people getting ill. The bottom line is, is that if the perception is that everything is okay, family members need to recognize it too and look back at the habits of these individuals. And if they have a tendency to use, when they look at things in a positive way, they get a certain level of confidence, then they may be willing to take more risks. So ultimately it’s looking at these patterns, if they’re able to tap back into their resources, look at what’s worked for them in the past, but not just for the person suffering, but for those supporting members around them. Just so they can anticipate hopefully the outcomes and put in place what’s needed that has been successful in the past.
Hayley: What kind of advice would you give to those supportive family members? If they know that their loved one is relapsing or is going to soon, what can they do?
Dr. Bhatt: They need to seek help, seek professional help, get guidance. I spoke about this in the previous question that if some family member knows that this is what has worked and they have helped their loved ones achieve sobriety in the past. Well do that again. If it means giving them that ride to the AA meetings, if transportation is an issue, making that call to their therapist, if they have a release and they’ve been involved in their treatment in the past, calling an interventionalist that’s associated with a treatment center to help them get somebody professionally trained to speak with somebody who’s in the throes of addiction. Or calling a treatment program directly to get guidance. But these are steps that they can take proactively. And in worst case scenarios, there are legal means if a loved one is using to the point that there is an imminent danger, and the consequences of that are dire, many states have the ability to have involuntary commitments put in place. Someone can legally be pushed into treatment.
Hayley: Is there anything else on this topic that I didn’t ask you that you want to talk about, or you think people should know?
Dr. Bhatt: As a society, as a world we’ve gone through tough times and we see this light, the vaccine is obviously something that you said at the beginning that we hope the world is going to benefit from. It’s hard for us to determine, but the best thing we can do is continue to take safety precautions, and safety mechanisms for those who are suffering with addiction and those family members, there are resources available out there, available through www.addictioncenter.com There’s multiple educational and treatment resources available that they can look up. In the end, we’re going to have to look and see hopefully in the next months coming up, hopefully we’ll have some semblance of normalcy. The resources that are available will become more solidified to individuals.
Hayley: Well, thank you for breaking this down with me today, and thank you to anyone listening. We have more episodes on www.addictioncenter.com. And like you mentioned, Dr. Bhatt, we have resources on Addiction Center as well for individuals and family members. There’s also a place where you can write in if you have any questions for Dr. Bhatt. We hope to have you next time for another episode of Straight Talk With The Doc.
Dr. Ashish Bhatt
Dr. Ashish Bhatt, MD, MRO is an accomplished physician, addiction medicine specialist, and psychiatrist with over 20 years of medical and administrative leadership.