The experience at the Betty Ford Center showed students that addiction can happen to anyone, even doctors, and it's important to keep a watch on friends and family, as well as themselves.
Phillip Seymour Hoffman, Cory Monteith and Lindsay Lohan have all brought to the national forefront the issue of addiction and why someone who has everything to lose cannot stop a chemical dependency.
But addiction happens more often than it makes headlines.
Through the Betty Ford Center’s Summer Institute program, TTUHSC medical students and faculty had a first-hand look at what happens to those suffering from addiction, what struggles the disease brings, and how the disease is treated.
Tom Cammack, M.D., is one of more than 23 million Americans who had a problem with alcohol or drugs. He became addicted to hydrocodone pain pills for several years while in private practice as a urologist. His addiction would later cost him his medical license, his job and his marriage.
“After losing everything, I went to the Betty Ford Clinic in 2002 and started getting my life back together,” Cammack said. “Getting to see this program years later with medical students was pretty powerful.”
After surrendering his medical license, Cammack began working at the Starlite Recovery Center outside of Kerrville, Texas. He served as the administrator and chief operating officer for the chemical dependency treatment center thinking his days as a physician were over. After three years of sobriety in recovery, Cammack reapplied to the Texas Medical Board for his license.
“The board said, ‘we applaud you for your efforts in recovery and helping others in recovery and want to give you another chance’,” Cammack said. “But in order to get back my license, along with all the requirements to fulfill, I needed to find a mini-residency, which didn’t exist at the time.”
After failed attempts at finding a mini-residency at other academic institutions, Cammack heard about the TTUHSC School of Medicine and found they were recovery friendly and willing to work with recovering physicians.
“I thought the Lord was opening a door and I needed to go through the door,” Cammack said. “That openness and willingness to give people a second chance is why I am here. I started here in 2009 as a 50-year-old chief resident and committed to stay on as junior faculty for two years. And now, I have been promoted to associate professor and my goal is to finish out my career here.”
Cammack said once he arrived at TTUHSC, one of his missions was to be more vocal about chemical dependencies.
“I had one hour of addiction education as a medical student and it wasn’t enough,” Cammack said. “During what I call my ‘dark period’ as a physician, I didn’t know where to turn. I thought I was the only one this happed to; thought I was worthless; was afraid if I talked to anybody I would lose my license and I struggled with this for a number of years before I got into trouble. I didn’t identify with anyone or have anyone to talk to.”
Tom McGovern, Ed.D., a former School of Medicine professor, led efforts for addiction treatment in the West Texas area and celebrated more than 30 years of recovery himself.
Educating the Next Generation
McGovern appointed Cammack to a physician’s health and rehabilitation committee where he talked to students and lectured about his addiction. Simon Williams, Ph.D., associate dean for Academic Affairs, heard his lecture and encouraged him to attend the Betty Ford Institute’s Summer Program with medical students.
“The irony was that we would be at the Betty Ford Center on my 10th sobriety birthday,” Cammack said. “I went thinking I would be a chaperone or just a faculty advisor because I had been there as a patient. It turned out to be much more of a personal experience in terms of being there exactly 10 years later as an educator. It completely underscored my mission and my passion to one, continue to get this information to medical students and other health care professionals; two, vocalize how addiction is a serious problem and it can happen to anybody, and three, that if it does happen, here is what you can do about it before you end up like me.”
Donors Jay and Mimi Bonds approached Williams four years ago. Jay who is a lawyer from Dallas and a recovering addict, wanted to support a program for medical students to learn more about addiction.
“This was one of the most amazing experiences of my life to witness how the 12-step program works, but most importantly to see students recognize that addiction is a chronic disease and not a choice by an individual,” Williams said. “There is still such a stigma of substance abuse. This was the fourth group of medical students and faculty we took to Betty Ford, and it has been tremendously beneficial to their medical education.”
Williams said there are only two schools in the United States that offer this program as an elective TTUHSC and the Texas College of Osteopathic Medicine at the University of North Texas Health Science Center. The program is a part of the Addiction Medical Curriculum. Third-and fourth-year medical students apply to attend this unique one-week program. Total immersion takes place with students and faculty participating in all aspects of the Betty Ford program.
“Addiction is a controversial subject,” Williams said. “The key messages from this program are first, to understand those afflicted with this terrible disease and second, the need for rigorous investigation of the underlying cause of the disease so that permanent cures can be developed.”
A Disease, Not a Choice
Williams stressed that addiction is a chronic disease affecting the deep structures in the brainstem.
“Researchers in the area of neuroscience and neurology are beginning to make tremendous progress in understanding these processes,” Williams said. “People who are addicted cannot control their need for alcohol or other drugs and experiences like those at the Betty Ford Center demonstrate the powerful effects, almost entirely negative on people’s lives.”
Andy Cruz, a third-year medical student, said the medical school experience at the Betty Ford Center taught him that first hand.
“Before my trip to the Betty Ford Center, I ignorantly thought that addiction was mostly weakness,” Cruz said. “The Betty Ford Center, through patients and through instruction, taught me about addiction the disease and discounted my thoughts about addiction the weakness.”
David Trotter, Ph.D., assistant professor and director of Behavioral Sciences in the Department of Family Community Medicine, attended the program along with the 10 medical students.
“When you can see the human face on addiction, you learn that really anyone can be affected,” Trotter said. “Affected individuals are people we see and interact with every day, neighbors, friends, parents, grandparents, professionals, even you or me, all just humans struggling with a terrible disease. Our role in this experience was to observe and learn.”
Trotter said watching students witness the 12-step program at Betty Ford was wonderful because addiction medicine is not a major focus of the curriculum in most medical schools. Each student was assigned into a different track. Six went to the inpatient program and the other six went to the family program. All were assigned to a specific hall, and each experienced across the spectrum of addiction from detox issues, spirituality and addiction, chronic pain programs and Al-Anon support groups for family member and friends of addicts.
It Can Happen to Anyone
“The students applying for this program are often open minded regarding mental health and addiction issues,” Trotter said. “Some of the group had had some experience with addiction in one form or another, in their personal lives and some had not. For those who had experience, it was great to see them starting to connect the dots about why things happen in their lives and to learn about the process of recovery, but from the other side. For those without personal history, it was great to see them develop a general understanding of the disease. It also was great to witness the amazing transition from passive learner to passionate advocate of the disease model of addiction.”
Trotter said as a clinical psychologist, he thought he would attend this program with a unique perspective because of his work with those suffering from addiction.
“I was curious to see how much I would learn from this experience. By the time we left, I realized I had learned a great deal and was thankful,” Trotter said. “I learned a lot about myself from this experience. I walked away with a great respect for the 12-step program Betty Ford uses. I also came away with a renewed passion for education.”
Cruz was placed with a small group of patients at Betty Ford and said it was eye-opening to see who is affected by addiction.
“My small group was made up entirely of health care professionals,” Cruz said. “I couldn't believe that so many doctors struggled with addiction. Addiction is strong, cunning and powerful and it can affect any person. The Betty Ford Center taught me to keep a vigilant watch for addiction in my colleagues, family, friends and perhaps most importantly myself.”
Cruz’s experience at the Betty Ford Center played an integral part in his decision to choose psychiatry as his specialty.
“It was a time in my life when I came to intimately know the human condition we all share,” Cruz said. “That condition intrigued me and drives me to find a common ground that can be a starting point for a medical treatment in any specialty. At the Betty Ford Center I learned that my strength lies in relating to others and I decided that those relationships are the way I would like to make my contribution to medicine and the greater good.”
The Betty Ford Center treats patients with alcohol addiction and drug addiction.
Julia Berry, a third-year medical student, had a personal reason for applying to the Betty Ford student program. Addiction runs in her family, from her grandfather and uncle to her brother who suffers from alcoholism.
He started drinking in high school with his addiction later escalating in his 20s His struggles with alcoholism led to legal issues including four DUIs and jail time. Most recently, he was involved in a one-car accident, flipping his car and ended up in the hospital. With that incident and his prior record, Berry’s brother ended up in the Dallas County Jail. As a part of his sentence he was sent to addiction rehabilitation.
“One thing with my brother is that his problems and legal battles have put a huge financial strain on my family, especially my mom,” Berry said. “Each time he relapsed worse, deeper, each time faster and with more consequences, and I would see that simply throwing money at the situation was not helping. Addicts have to hit rock bottom before they decide they need to get help. They have to reach that point that they are tired of living that way or have consequences if they don’t get sober, like jail time. My brother’s situation was a huge frustration. Every time he would relapse again, and logically I would think, ‘You know what will happen if you take that drink?,’ and, ‘How can you do this? You know the consequences.’”
Berry’s brother has been in and out of several rehabilitation programs over the years. Thinking she understood addiction first hand, she went to the Betty Ford program believing it would be helpful. Fourth-year medical students went through the inpatient program, the more acute setting where patients have recently detoxed and have stayed sober short term. Third-year medical students experienced the resident program for addicts who are maintaining and have stayed sober.
“I learned that no matter what medicine specialty I go through, I will deal with patients who are going through addiction,” Berry said. “Addiction is more prevalent than people realize. When we went to the Betty Ford Center as third-year students, we had just completed the psychiatry rotation and dealt with mental illness, but not at this level. I was thinking that the Betty Ford program would help me relate to my patients who are going through addiction and they would have totally different life experiences than myself. But instead, I also saw all walks of life including doctors who are going through treatment. We saw patients who are sober now and asked how do we keep them there. It’s a different perspective than we see in medical school.”
Berry’s experience involved observing daily group therapy and getting to know the women, hearing their stories, relationships and insecurities.
“We see them as people and see them for who they are, not addicts. Addiction does not have one face. It can happen to anybody,” Berry said. “Through this program, I had the opportunity to see it from other people’s perspectives. Everybody’s story is unique. Everybody has something to lose. Addiction is so strong and it takes you over so much that you cannot apply normal logic to it. The program made me more empathetic to addicts, including my brother.”
Berry said one of the most eye-opening experiences at Betty Ford came from hearing patients’ life stories. She realized addiction was something a person cannot control or stop. She used to have a lot of resentment, anger and frustration towards her brother.
“To me it was simple, ‘why can’t you just stop drinking’?” Berry said. “Now, I see it from an objective stand point. Hearing the personal stories made me realize that some of addiction is choice but not all of it. It is a disease. I always knew, but needed to see it from different perspectives to fully appreciate how devastating and strong a disease it is. People who have so much to lose, and still roll the dice and use their substance no matter what the cost was very eye opening.”
Williams said Berry’s story along with millions of others also brings to light the genetic component to addiction in families.
“Researchers continue to gain a better understanding of the genetic factors that increase our predisposition to alcoholism,” Williams said. “Addiction is so complex. And my hope is that programs such as this will educate our medical students to see addiction for the terrible disease that it is.”
Cammack said Bonds created the original endowment for medical students to participate in this Betty Ford program because of his personal story. He was concerned and frustrated that physicians who examined him throughout his years of alcoholism never diagnosed him, challenged him or intervened. Bonds wanted to give back to those struggling with addiction. Cammack said the School of Medicine would like to continue this medical education with the Betty Ford Center for perpetuity.
“Watching the medical students transform from when they first got to the Betty Ford Center to the end and how it impacted them, was significant,” Cammack said. “A couple of them were angry with addiction and didn’t understand it, some had misconceptions about addiction, but at the end of this program, all recognized it for what it is a disease.”