Dr. Myra Mathis is a board-certified addiction psychiatrist with the University of Rochester’s Strong Recovery Clinic. In our “Meet the Specialist” series, we highlight the perspectives of various medical specialists on the types of patients they see and what they find rewarding and challenging in their daily practice.
As an addiction medicine specialist, here’s the most important thing I want people to know: treatment works. When individuals receive treatment for substance use disorders, they get better–and it’s a phenomenal thing. One of the most rewarding parts of my job is being on this journey with them, seeing them gain the ability to re-engage with their lives in meaningful ways.
An addiction medicine specialist is a medical doctor who first trains in psychiatry or another primary specialty and then goes on to subspecialize in addiction; our jobs include evaluating, diagnosing, and treating people with substance use disorders. As an addiction psychiatrist, I also help people manage psychiatric disorders that may or may not be linked to their substance use, and address the ways that substance use and mental health intersect. It’s a privilege to be a part of each individual’s process, whether we’re working together to address unhealthy use of opioids, alcohol, or any other addictive substance.
My career in medicine stems from a desire to combine my interest in science and biology with my passion for helping people. Growing up, there were very few Black female doctors around me. As a Black woman, I want to improve the health and wellbeing of my community, while also doing something I truly enjoy. I sort of stumbled into psychiatry; it wasn’t initially what I thought I would pursue as a doctor. My parents are clergy members and it was part of their everyday lives to sit with someone in a really difficult situation, offering counsel and support. I’d join them for hospital visits, funerals, and other activities, and without realizing it, I developed skills that every good psychiatrist needs: the ability to listen to the experiences of people going through challenging times and figure out a way to best support them. I was drawn to addiction psychiatry for this reason, as well. Now, when I look back, it makes sense that I landed where I did.
Opioid use disorder involves an unhealthy relationship with opioid drugs in which someone takes opioids in a manner that goes beyond their medical use and causes problems in their lives. Often, opioids, both prescribed and non-prescribed, offer short-term relief of acute pain, but their addictive properties–and in greater doses, euphoric “high” effect–can cause people to fall into a destructive pattern. When folks come to me, they’re often fairly motivated to change their relationship with opioids and reach recovery. It’s common for someone to have tried to quit in the past, only to pick back up because the withdrawal symptoms were intolerable. Our bodies can quickly develop a physical dependence on opioids, so when we stop taking them, we may experience symptoms like muscle aches, agitation, anxiety, teary eyes, runny nose, excessive sweating, sleep problems, gastrointestinal issues, and more. These symptoms can last for weeks in some cases.
Patients often explain to me that they’ve tried to quit, but they can’t tolerate the withdrawal; they can’t keep feeling sick to the point where they aren’t able to do anything. Some people have told me the withdrawal symptoms make them feel like they’re going to die. It’s a scary and difficult thing to go through without support. The good news is, there are resources to make the process much easier.
The medications used to treat opioid use disorder can reduce withdrawal symptoms, prevent cravings, and block the effects of opioids. We decide which medication is best for each person based on their individual situation. We also include counseling and other resources like support groups in every treatment plan, because it’s imperative to address the underlying reason that an opioid use disorder developed. After an individual is stabilized on medication and they find they don’t have to use just to prevent withdrawal, there may be scenarios in which they end up continuing to use for other reasons. And that’s when we have deeper and more nuanced conversations.
Some people start the recovery process by turning to their primary care doctor, others are referred by social service agencies. Primary care doctors can prescribe medications and offer guidance. But often, working with an addiction medicine specialist will provide more resources and comprehensive support. You can ask your doctor for a referral, seek out an addiction clinic, or look online for addiction specialists in your area. I think it’s important to find a specialist who embraces the concept of harm reduction in their practice style. Harm reduction involves a non-judgmental, non-stigmatizing approach that keeps patients safe while also setting realistic goals. As someone who practices this approach, I want patients to know I’m not here to make anyone feel bad about what’s happening in their life. They have a medical condition, and that medical condition can be treated. I’m not here to judge you or moralize your substance use. I’m here to offer you options to improve your life and help you figure out what that means for you.
