Addiction & The Physician
Q&A with Tom Fowlkes, MD
In lifelong recovery, one of the most important allies you can have is a physician who understands addiction.
The desire to gain that understanding — and, in turn, to pass it on to colleagues — drove Tom Fowlkes, MD, to study addiction medicine for a second board certification in addition to emergency medicine. It’s an expertise he applied as medical director for detox services at Region IV Mental Health Center before becoming a co-founder of Oxford Treatment Center.
In recent years, Fowlkes has served as part of a lecture series to educate prescribers around the state of Mississippi on the safe use of controlled substances. He continues to serve as a resource on addiction to physicians and other professionals in mental and behavioral health fields.
What are the most common misconceptions people have today about addiction?
“The two that are most pervasive are, first, that a 30-day treatment will ‘cure’ someone of addiction. The truth is that addiction is a lifelong illness.
“And second, that if you’ve received treatment for one kind of substance abuse in the past, it’s safe for you to take other kinds of mood-altering drugs in the future. When, for example, it’s very dangerous for people who’ve been treated for alcoholism to take benzodiazepines for anxiety or opiates for pain.”
Why should people not expect to be “cured” after a stay in treatment?
“Addiction is similar to other chronic illnesses like hypertension, asthma and diabetes. Each of these is characterized by periods where the illness is under control and periods of time when the illness gets out of control. People can manage it, and after managing it well for a long period of time, they may not have any more times when it gets out of control. But that doesn’t mean they don’t have the illness.
“People in recovery from addiction need specialists to follow them, just like people who have asthma and diabetes would. And compared to those diseases, addiction has very similar rates of compliance with treatment and relapses. You have to do the things necessary to keep the disease under control.”
Is there a standard of “success” in recovery?
“Some people say that success is when you haven’t had a relapse in one year, or in three years. Others might say it’s that you’re drinking on fewer days than you used to. There are so many definitions of success, it becomes a difficult thing to gauge.
“That’s one reason I’m excited about the research American Addiction Centers is doing in following people in recovery over many years. These long-term outcomes studies haven’t really existed in addiction medicine. Part of it has been due to the anonymity of 12-step programs; it makes it hard to follow up. But this kind of research will add to our understanding of the most effective tools we can use to support people in long-term recovery.”
As a physician, how has your own understanding of addiction evolved over the years?
“I started learning more about addiction when I realized that physicians in general didn’t understand it or know how to treat it.
“I was much like other people, thinking that treatment was much more a black-and-white, plus-and-minus thing: ‘You’ve been to treatment, and if you ever use again, treatment had failed.’ That was my understanding. I didn’t realize it was a chronic illness — that relapses may happen, and that they can be managed.
“For example, a young person gets a couple of DUIs and goes to treatment because their drinking has gotten out of control. That doesn’t guarantee they will never have problems with substance abuse again. But if they do, the information they received during treatment can help them realize what’s going on and get help more quickly if a relapse does occur.”
When you and Billy Young established Oxford Treatment Center, in what ways was it built around this understanding of addiction?
“It is designed around the chronic-disease model of addiction, with our program reflecting the several phases of treatment.
“Medical detox is where people are safely separated from their addictive substances. Then they move through primary residential treatment and into secondary treatment, which we offer through our sober living homes and outpatient offices. Then they continue in lifelong maintenance of recovery.
“Even our choice to invest in a sophisticated electronic medical records system was based on our goal of being able to follow people over the long term, to track and support their recovery.”
What are some of the most important things people can do to support their own recovery and guard against relapse?
“When you are in recovery and you are dealing with other health issues, you need to have a specialist in addiction medicine as, essentially, the ‘quarterback’ of your treatment team. That physician needs to be aware of any other doctors you’re seeing, to make sure that those people are aware of your substance-use history and not giving you something that’s going to be unsafe.
“Having an addiction changes the whole way you need to receive healthcare. You need to be cautious and not presume the doctors you go to see are going to understand addiction. As we saw recently in the story of the young mother who was prescribed opiates for pain during pregnancy, physicians are still uneducated about which medicines are safe to give and which ones may cause dependency. They’ve inadvertently caused part of the problem. But having an addiction specialist who truly understands your disease is one of the best ways you can protect yourself and maintain your long-term recovery.”
Read More — Get to know Oxford Treatment Center’s Medical Staff
A founding partner of Oxford Treatment Center and former Chief Medical Officer, Dr. Fowlkes has transitioned to director of professional and medical relations. His role includes representing Oxford Treatment Center among organizations and agencies at the state and national level.
Dr. Fowlkes is board certified in emergency medicine and addiction medicine, and is a member of the American Society of Addiction Medicine (ASAM). He is a graduate of the University of Tennessee College of Medicine in Memphis and completed a residency in emergency medicine at the University of Pittsburgh, where he served as chief resident. He has practiced medicine in Oxford since 1996.