He made the appointment, showed up, and told the truth. I think I'm struggling with addiction, he said. The doctor said it was not something they could help with, and he later died of that untreated illness. Devika Bhushan, a public health physician and former acting surgeon general of California, explains why fewer than one in five people with addiction ever get treatment, and what stigma costs the people who ask for help.

⏱️ Chapters:
0:00 Introduction
0:28 The former state surgeon general who lives with bipolar disorder
2:31 He told his doctor the truth and was turned away
3:58 One word changed how 500 clinicians judged a patient
5:10 When clinicians called a jail sentence a wake-up call
5:29 Why fewer than one in five ever get treatment
6:19 Why primary care doctors are the least comfortable treating this
6:54 The 24 years a substance use disorder takes off a life
7:56 Why a chart label costs patients their heart care
8:42 Abuse is a crime, a use disorder is an illness
9:23 Three in four people do reach long-term recovery
11:02 Clean, dirty, addict, and the words to retire
12:46 Six things patients can do in the exam room
16:01 What the health care system has to fix
16:46 Take home messages

About this episode:
Devika Bhushan is a pediatrician, public health practitioner, and former acting surgeon general of California who now advises startups, investors, and nonprofits across the mental health ecosystem, and who speaks openly about living with bipolar disorder. She joins Kevin Pho to discuss the KevinMD article How addiction stigma in health care costs lives, co-written with medical student Taylor Moss, whose father asked a doctor for help with addiction, was told it was not something that doctor could treat, and later died of the untreated illness. Bhushan walks through the randomized trial in which roughly 500 mental health clinicians read vignettes that differed by a single phrase, substance abuser versus person with a substance use disorder, and were measurably more likely to blame the patient and to endorse a jail sentence as a wake-up call when they read the first. She explains why fewer than one in five people with addiction ever receive appropriate treatment, why general practitioners report more fear, anger, and mistrust toward these patients than psychiatrists or addiction specialists do, and how a stigmatizing diagnosis on the chart translates into roughly 30 percent less guideline-adherent care for unrelated conditions like cardiovascular disease and diabetes. She reframes substance use disorder as a condition that is about half heritable and comparable to asthma and type 2 diabetes in heritability, and points to survey data in which three in four people report long-term recovery. She offers concrete language swaps, retiring addict, clean, and dirty in favor of describing the presence or absence of a substance. She then gives patients and families six practical moves for the exam room, from leaving a clinician they do not trust to asking that a refused test and the reasoning behind it be documented in the record. She closes on the systemic side, better reimbursement for behavioral health, addiction training for clinicians at every level, anti-bias education, and expansion of recovery models like clubhouses.

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