Breaking the Silence: Hearing and Changing the Story

The multifactorial disease of substance use disorder is defined quickly and neatly in medical schools. Covering the topic in a mere lecture or two focused predominantly on neuropathology, medical education fails to comprehensively describe the far-reaching and long-lasting impact substance use disorder has on those touched by the disease.


Meanwhile, the heart-breaking story of substance use disorder is being shouted on a macro scale in the form of statistics that can no longer fall on deaf ears. With the advent of the opioid epidemic, drug overdose has become the number one leading cause of accidental death in the United States. Additionally, substance addiction is associated with increased suicide risk and increased incidence of comorbidities. Right now, approximately 23 million Americans 12 years of age and older suffer from this debilitating condition.

Furthermore, one in every five American children live in homes with a legally responsible adult who drinks heavily, putting these children in acute danger and at risk of long-term psychosocial problems. Sadly, children of alcoholics are four times as likely to develop problems with alcohol. Such statistics provide evidence that substance use disorder is a complex family disease in which the cycle of addiction and associated trauma affects entire families across generations. Criminalization and institutional denial, two ways society has historically combated substance abuse and addition, are ineffective and even perpetuate this cycle of addiction. Substance use disorder is a chronic disease that must be treated as such.

Despite alarming statistics that ensure all physicians will encounter substance abuse, addiction, and their impact on a near-daily basis, medical students receive little to no training on how to properly screen for, counsel, and refer those who either suffer from substance use disorder themselves or through a loved one.

Instead, students are taught to adhere to strict time constraints, quickly asking one or two checklist questions about substance use almost as an afterthought at the conclusion of taking a patients’ history. These questions, while a start, have been proven insufficient by studies at breaking the silence around substance use disorder. The haste and format in which these questions are generally asked encourages patients to give generic, checklist answers. When in-depth questions are not asked, stigma, shame, the nature of the disease, and lack of knowledge keep patients silenced, preventing them from telling their story and receiving treatment.

The void in education on substance use disorder is a hollow echo of the resounding silence surrounding this disease in our society at large. Silence allows the disease to persist untreated and worsen, affecting entire families transgenerationally. In my family, substance abuse paired with turmoil coupled to this disease became an omnipresent black cloud no one had the knowledge to fully comprehend or the voice to properly identify. For years, there was confusion, stress, arguing, and misplaced blame centered around the unnamed elephant in the room. This suffering could have been mitigated by earlier identification and proper treatment.

As healthcare professionals, we have a responsibility to overcome this silence and learn to hear the story of substance use disorder, to guide others through the pain afflicted by this disease, and to better facilitate successful recovery of patients and their families. As healthcare professionals, studies support that we can begin changing the story of substance use disorder by breaking the silence.

Ask your patients deeper questions: “Why do you drink?” “Are you concerned about a loved one’s use of alcohol or drugs?” “What effect do substances have on your life?”—allow patients the opportunity to share their story, take the time to listen for subtly mentioned problems, and help create a new story of treatment, recovery, and hope.