Present a cancer diagnosis to even the most psychologically stable and otherwise physically healthy person, and it is going to take some time and effort for that person to process the information effectively.
But if the patient also has substance abuse issues, the situation becomes even more challenging, with potential physical and psychological implications for not only the patient but also those providing treatment and care.
“Having an addiction or a substance abuse or dependency really moves people into a stressful state,” explains Laura Sunn, MD, a psychiatrist at Cancer Treatment Centers of America® (CTCA) in Zion, Illinois. “This makes it difficult for them to logically comprehend what’s being told or said to them. They are unable to pick up information, and they can’t even communicate in a healthy manner because, whether they are using substances or in withdrawal, their executive functions are impaired.”
Addictions are the “ultimate distraction,” says Lynn Bornfriend, MD, Psychiatrist at CTCA® in Philadelphia, Pennsylvania. At a time when patients need to be fully aware of their health situation and participating in the treatment discussions, they can be completely preoccupied with their craving—whether it’s their desire for the substance or their efforts to fight that desire.
Navigating a Dual Challenge
For many, substance abuse is a form of self-calming, a way of dealing with or escaping stressful situations. This can make it even harder for patients to stop these unhealthy behaviors when they are faced with cancer and all it entails.
“Patients are told they may undergo surgeries or chemotherapies, that they may suffer tremendously or that their life may be shortened, and then they are told they need to give up this coping mechanism—the only one they know,” says Dr. Bornfriend. To help patients navigate this challenge, mental health professionals can work with them to provide alternative tools to manage their stress and anxiety. “One of the things we do as psychiatrists is challenge their unhealthy coping mechanisms and try to help them choose healthier ones,” she says.
While some patients are very self-motivated, making it comparatively easy to adopt healthier patterns, Dr. Bornfriend says that for others overcoming their addiction “is going to be another loss, another challenge, making them more vulnerable and sensitive. And we have to acknowledge that.”
But it is not just the psychological impact that needs to be addressed. Substance abuse also takes a toll on the body (see the sidebar “Types of Cancer Linked to Substance Abuse”). When cancer therapies, such as surgeries or powerful medications, are added to the mix, the patient’s health is put at further risk, especially if those treating him are unaware of the existence or extent of the addiction.
Unfortunately, patients with substance abuse issues can be less than honest about their addiction, often either denying or minimizing the extent of their actual use. This can put their health at further risk because addictive drugs can interfere with cancer medications and can have an impact on long-term recovery and overall health.
“We are aware of this tendency [to deny or minimize],” says Dr. Sunn, “so we are very comfortable asking direct questions about use. We know how harmful it is if the person is still using, and we know how much their health can be improved when we help them overcome the addiction.”
Supporting Patients with Addiction Issues
At CTCA steps are taken to screen for addiction before patients begin treatment. The intake process includes a thorough conversation about all aspects of a patient’s life that could have an impact on treatment, including all psychiatric and psychological stresses.
“Our nurse navigators often pick up on tobacco use before the patient ever gets here,” Dr. Sunn says. In this case—or if other substance abuse is suspected—referrals are made to the Social Work, Mind-Body or Psychiatry Departments, she says. And should other issues arise, similar proactive steps are taken to help the patient; for example, Dr. Sunn says, identifying and treating depression can double the chances of being able to overcome the addiction.
Helping patients work through the underlying issues and concerns that may be fueling substance abuse can be key to helping them overcome addiction and improve their overall health throughout treatment. Dr. Bornfriend says that many patients with substance abuse issues struggle with feelings of guilt and worthlessness. Questions such as Did I bring this on myself? and Why didn’t I quit? can lead to a belief that they don’t deserve to get better. Then comes the hopelessness, she says: I tried to quit a million times and couldn’t and now I am so sick. What makes you think I’ll be able to do it now? I’m under more stress than ever.
Facing not just the diagnosis but the possibility that one’s lifestyle choices may have contributed directly or indirectly to the disease puts patients in “a very sad and difficult spot,” says Dr. Sunn. But these issues can be addressed with appropriate interventions and support. “We do not support blame. That is a cycle of self-denigration,” Dr. Sunn says. “We have an entire program, created through our Pastoral Care program, focused on forgiveness, which helps people learn to forgive themselves.”
This multidisciplinary and integrative medicine approach at CTCA for patients with addiction issues continues throughout the treatment phase. Patients are offered resources from the integrative care modalities as well as proven tobacco-cessation programs. “We’ll use nicotine patches, acupuncture and direct tobacco-cessation counseling from our pulmonary specialists,” Dr. Sunn says. “Our psychiatrists may also prescribe medications that can help, such as Wellbutrin [bupropion] and Chantix [varenicline tartrate].”
Naturopathic physicians also play a role at CTCA, providing insight about herbal therapies and supplements that can ease cravings and withdrawal symptoms. Additional integrative therapies offered include acupuncture, Reiki, hypnosis and counseling—all focused on easing cravings and withdrawal. Patients are also encouraged to turn to organizations such as Alcoholics Anonymous or to smoking-cessation programs in their communities to find support in their effort to overcome their addictions.
An Opportunity to Turn the Tide
Ultimately, for those battling addiction a cancer diagnosis may prove to be a catalyst for making healthier choices in many aspects of life. “Cancer is a potent opportunity for change,” says Dr. Sunn. “It can be a wake-up call to shift lifestyle choices to healthier eating, more exercise, cleaner living and positive affirmations.” This opportunity for positive change, she says, can lead patients to make transformative choices: “In many cases, when someone is diagnosed with cancer they make the decision to make very significant lifestyle changes. And when the lifestyle changes include giving up tobacco and alcohol, things are far better than they ever were before.”
This article is repurposed from Cancer Fighters Thrive®, CFThrive.com.
