Q&A: How does UVA Health treat addiction without judgment?

“People with substance use disorder learn early that others don’t approve of their use, whether it’s their family, people at work or others they encounter,” Tiouririne said. “For a long time, there was also a lot of judgment among physicians. The majority of patients with substance use disorder know it’s bad for them. Judging someone for using when they feel they have no control over it is really not helping.”

She talked more with UVA Today about how patients can get help at UVA Health in a nonjudgmental environment.

Q. How do you and your colleagues remove stigma from treatment so patients feel supported and not judged?

Dr. Nassima Ait-Daoud Tiouririne is an addiction specialist who helps lead UVA Health’s support services with no judgment. (UVA Health photo)

A. When I’m working with someone for the first time, they may say, “I’m here to stop drinking.” I’ll say, “Why? Why do you want to stop drinking?” They may say, “I don’t know. Isn’t that what I’m supposed to do?”

I tell them, “What you’re supposed to do is what’s right for you.” That helps us identify their motivation to change. 

By not being judgmental and saying, “Alcohol has obviously played a role and has been with you for years, so it’s doing something. What does it do?” a lot of them will say, “It gives me that release. It lets me stop thinking. It makes me feel calm, even if it’s only for an hour or two.” 

Instead of telling them they need to stop, we help them recognize that alcohol plays a role: It helps with anxiety and decompression, but it’s also bad for their liver, affecting their relationships and making them depressed. When we get there, we’re able to engage a patient meaningfully in treatment, instead of lecturing them.

Q. What are the warning signs of addiction?

A. One of the key signs is continuing to use a substance, or continuing a behavior, whether it’s gambling or another behavioral addiction, despite increasingly negative consequences. 

Q. What should patients tell their doctors if they are concerned about their alcohol or drug use?

A. Patients should report their drinking (or drug) use. We see a lot of minimization of drinking because people are embarrassed and ashamed. One of the first steps is to be very forthcoming.

The good thing is substance use disorder is a medical disease with medications and evidence-based approaches to treatment.

For many patients, what’s needed is a combination of medication and psychotherapy, or talk therapy, to support them through their recovery efforts.

Q. What is the first step toward recovery?

A. Talk to someone. A lot of times, when we are in our addiction, it’s like a prison. We’re just going from use to use. By talking to someone, it really opens the door to a lot of options and support and helps you see what’s available.

Q. What should someone do if they’re concerned they have an addiction?

A. If they have a primary care physician, the physician can make a referral. If they don’t have a primary care physician – and that is often the case – they can call our clinic at 434-924-2241 and ask to be seen for treatment. We see people even without a referral because we know that many of them do not have a primary care doctor. We will schedule them and get them seen.