"The Doctor's Art" is a weekly podcast that explores what makes medicine meaningful, featuring profiles and stories from clinicians, patients, educators, leaders, and others working in healthcare. Listen and subscribe/follow on , , Amazon, , and .
Addiction and substance use disorders have long been mired in misconception and stigma, seen as moral failings or a lack of willpower. But the reality is far more complex and nuanced.
In this episode, Henry Bair and Tyler Johnson, MD, are joined by , a psychiatrist and addiction medicine specialist who is the co-founder of , a tech-enabled provider of comprehensive and longitudinal care for substance use disorder and mental health. Harrison holds a faculty appointment at the Morehouse School of Medicine in Atlanta, previously served on the Board of Directors of the and is the author of the upcoming book, .
Over the course of their conversation, they discuss the rapidly evolving understanding of addiction as more akin to a chronic illness with heritable and environmentally shaped components, the omnipresence of addiction in modern society, and the centrality of finding life purpose in truly transformative healthcare.
In this episode, you will hear about:
- 2:40 Harrison's early experiences -- good and bad -- with physicians and how they shaped her path to medicine
- 8:41 What brought Harrison to a career in psychiatry
- 13:50 How Harrison came to focus on the emerging subspecialty of addiction medicine
- 17:57 The reckoning our society has gone through surrounding addiction in the face of the opioid epidemic
- 22:49 The definition of addiction and its pervasiveness throughout our society
- 26:44 How we can intervene in earlier stages of substance use disorders
- 31:23 Approaches to speaking with patients about substance use without buying into the stigma
- 34:45 A glimpse into Harrison's upcoming book, Un-Addiction: 6 Mind-Changing Conversations That Could Save a Life
- 39:17 The most important question to address with a patient as they grapple with addiction in their lives
- 45:01 The importance of valuing meaning and fullness over productivity in order to bring meaning back to medicine and to life
The following is a partial transcript (note errors are possible):
Bair: Dr. Harrison, welcome to the show, and thanks for being here.
Harrison: Thank you very much for having me.
Bair: To set the stage for our listeners, can you share with us what initially drew you to a career in medicine?
Harrison: Oh, I can. So I actually decided to be a doctor when I was like 5 or 6 years old. I don't have any doctors in my family. So how I came to this conclusion is interesting, but I was just really fascinated with the way the human body works and learning about bones and anatomy and ... funny, which gives you probably a peek into my personality both then and now. At 5 years old, I didn't think my pediatrician was a good doctor.
How a 5-year-old ... looking back now, I know how a 5-year-old knows this.
Johnson: Was your pediatrician a good doctor?
Harrison: He was not. He was not by my standards today or by my standards at 5 years old, apparently. And it was ... I actually told my parents I'm going to be a doctor and a teacher. Looking back, pediatrician was the only doctor I had until 12 years old, diagnosed with scoliosis, went to see an orthopedic surgeon.
And the contrast of the experience is what was making me draw that conclusion. I now know, looking back, so my pediatrician never saw me, which is so unusual for a pediatrician, right? But, like, walked in the room, didn't talk to me, asked my mother, what is she here for? How is she feeling? What symptoms is she having? Like literally did not see me. I was invisible and then also, like, I could sense the way he talked to my mother was dismissive. And that's what was making me draw the conclusion that he was not a good doctor, I can look back on now. I probably couldn't articulate it at that time.
My surgeon, on the other hand, Dr. Mark, whose last name I don't know because otherwise I would find him and be like, thank you. I was only 12, but he's like, oh, you're interested in being a doctor? Here's the anatomy of your scoliosis. And here's how we decide when you need surgery. And let's look at your x-ray together, and tell me about cheerleading. And Mom, do you understand all of this? Right? And I was like, that's good doctoring. And so that ... I decided to be a surgeon at 12. And obviously today I'm a psychiatrist. So there's the story. I was going to be a pediatrician, then it's going to be a surgeon. And I landed where I needed to land, which is an addiction doctor and psychiatrist.
Johnson: It's so funny, though. I just have to remark in passing that as a dad who has kids that are going through sort of the stages of school right now, that ability -- I don't know if it's an ability or a skill or a gift or all three of those things -- but the gift that some people have of seeing kids as whole people. Yes, honoring them as like whole little people and like understanding that when you are 7, Pokémon may actually be the most important thing in the world. And like being in that place where you can like honor the importance of Pokémon. Not in like a condescending pretending way, but in a way that you like actually care about it.
Like we have this teacher who our youngest now has who, she is like Miss Honey, but times a thousand right, from Matilda. Like she is the best teacher ever. And I still remember the first time I went to parent-teacher conferences with her. She was like, you know, people tell me that I'm like, such a great first-grade teacher and whatever, and she's like, but they don't understand first-graders. These are my people. And I just was like, oh my God. Like, I will walk over hot coals to have our children in your class because it makes such a huge difference.
But I think that that's, I mean, it's one thing with children, but I think that's such actually such a universalizable, if that's a word, lesson for any kind of doctor, you're really just for being human, right? Like learning to see a person for who they are and where they are is so deeply important.
Harrison: 100%. So I am enthusiastically allowing the word generalize. What was the word you just made up?
Johnson: Universalizable.
Harrison: I allow it, I allow it, and I endorse it because same. So to bring this in, I'm a psychiatrist and my specialty has always been people with severe substance use disorders, serious persistent mental illness. And what I've said is what that first-grade teacher said, which is these are my people. And I think exactly what you said, like, yes, it is a skill. Yes, it is experience. Yes, it absolutely is a gift to be able to see a human as a whole person, regardless of their current situation.
And so we tend to discount kids, right? Because, like, you're a kid. Being able to see a kid as a whole person and genuinely make that connection is a gift. We discount people with substance use disorders because quote, "you make bad decisions," right? Being able to connect genuinely. We discount people with serious, persistent mental illness because "you don't really know what's going on in reality." I'm obviously ... these are not how I feel about it. These are the stigma that exist, right? It's being able to make that connection.
And I think you're right, not just in medicine, hugely important in medicine, but just in everyday life. You met a barista at Starbucks that had a gift for seeing people. You met a ticket person at the Georgia Dome if you're in Atlanta. Oh, that was old school. The Mercedes-Benz Stadium. The Georgia Dome has been torn down. Right? That's a gift, I think, in medicine. Many of us come to medicine with that gift. I think the system beats that gift out of a lot of people. But it should also be a skill we're intentionally developing IMO [in my opinion].
For the full transcript, visit .
Copyright © The Doctor's Art Podcast 2023.