Pair these notes with the lecture summary here.
Substance abuse or dependency is of great concern to both health care and health professionals. Psychoactive drugs permeate society today and health and health professionals have greater knowledge and easier access and are also subjected to high stress levels. Libertarians defend the rights to liberty and freedom of choice as long as it does not interfere with, or hurt the freedom of others. The harm principle applies here-it allows mandatory drug testing as impaired judgement can do grave harm, if there is no clear and present danger-it is said to be an explosion waiting to happen.
The therapeutic trend is to view abuse or dependency as an illness. Psychiatrists consider it a mental disorder if:
- There is tolerance of the substance
- Withdrawal effects are present
- The individual takes more than is needed
- The individual cannot cut down or control use
- The individual spends a great deal of time obtaining, using and recovering from the substance
- The individual gives up important activities in order to use the substance
- There is continued use of the substance despite knowing the harm it is causing
The moral and legal view is that it is moral failure to control the abuse and face responsibility. Thus the intoxicated driver is still responsible for the damage caused. Yet, the legal system accepts both views by sending people for mandatory therapy after repeated offences. This clash of moral and therapeutic views gives rise to dilemma in dealing with colleagues the victim of sickness needing help? In SA law YES-the Ethical Rule of HPCSA states that it is the duty of a practitioner to report impaired colleagues but the ethos of the special committee in dealing with impaired practitioners to assist in healing and dealing with the dependency and oversee safe return to practice. Should one observe a colleague acting in a strange manner, yet the colleague denies anything wrong, proceed as with any dilemma, i.e.:
- Gather information, talk to others, maintain confidentiality
- Weigh conflict duties-protection of patients, the colleague, the profession, the organisation
- Consider reasonable options
- Proceed with courage, at the same time minimising the harm, then act
In this episode of the Making Sense podcast, Sam Harris speaks with Sally Satel about addiction. They discuss whether addiction should be considered a disease, the opiate epidemic in the U.S., the unique danger of fentanyl, the politicization of medicine, PTSD, and other topics.