Are they a bad person? Are they a pathological liar? Should they be judged? No, who cares? It is part of this overall social, physiological, cognitive situation that they’re in. There might be shame associated with it. There might be fear associated with it of not being treated. There might be guilt associated with it. They might have a loved one in the room. Hey everybody, welcome back to the channel. This is Dr. B and the topic I am going to consider today

 

is the addict lying to the provider. I think this is a really important topic. Listen on because I will cover some nuances of why you should never lie to your provider. Let me talk about how this came up. I was going through some of the comments, a recent video I made, and I made the mistake of in there saying what I was thinking in the work I do as a clinician. And again, as it is often the case, what I said was mistaken, misinterpreted, and it’s very nuanced,

 

the work you do as a clinician, believe it or not, right? It takes a lot of information, a lot of knowledge, a lot of experience, and it’s difficult sometimes to really understand for the general public. But what I said was when an addict says, or when the patient suffering from substance abuse says, I’m on two milligrams of Xanax, and I quickly blurted out, always assume four or six milligrams, double it and triple it. And this sort of came out as I was trying to get to a different point

 

in describing the issue that I was considering. I received a comment and it said, Dr. B, when an addict tells you they’re on two milligrams of Xanax, for example, you should believe them that they are on two milligrams of Xanax. And I gave a clinical response to that, and I’m not sure how far that will go. So I thought this is a great opportunity to describe what the issue is, what I was talking about. I think this is educational, both for the providers, as well as the patient suffering from

 

substance abuse, presenting to the provider and trying to communicate clinical information and why it matters. What I was referring to in this case, and this is not to say all addicts lie or addicts are liars. It is a situation where there’s no judgment passed, but it is the nature of the disorder, the issue, substance abuse, that when a person suffering presents to the provider, certain information is left out or

 

minimized, period, end of story. Now, this is really, really important, both from the addict side, and hopefully we get some education out to the provider side. From the addict side, there’s two drugs or two sorts of medications that I always see that are minimized. One, alcohol. Two, benzodiazepines. Keep that in mind. Two groups of medications that always seem to be minimized. Alcohol, benzodiazepines. Number two, it also depends on, in terms of pills goes, who the patient is. If someone is older, has been dealing

 

with issues with benzodiazepines, is in a certain place, they are often very truthful because of the type of help they’re seeking. And they’re very honest with you and you can sort of pick that up. But if you’re in a situation with benzodiazepines, where you have a younger addict, and they’re taking poly substances in addition to the benzodiazepines, and in fact, in their mind, that’s not even the main issue. And you may ask, hey, how much Xanax are you taking? And where are you getting it? You often get a minimized answer. Should I judge that person?

 

No. But from enough experience, I’m fully aware of the fact that he says, oh, I take a couple of the two milligram bars twice a week or three times a week. I should not trust that. And I’ll tell you why it’s important for both sides, the provider and the patient. The other place I see that is with alcohol, where it’s often minimized the amount of intake on initial presentation, especially if they’re presenting for something else, for example, to their emergency department. And years and years and years, I taught residents

 

to go back and press on this issue. Let’s talk about the side of the patient. Are they a bad person? Are they a pathological liar? Should they be judged? No, who cares? It is part of this overall social, physiological, cognitive situation that they’re in. There might be shame associated with it. There might be fear associated with it of not being treated. There might be guilt associated with it. They might have a loved one in the room. Okay. All of these things

 

contribute to them minimizing pills like benzodiazepines and alcohol. And then you might say, why do they not minimize the heroin intake or the meth intake? Maybe they do, but for sometimes, but for the most part, they don’t think that the other person, the provider, has the familiarity to be able to judge quantity and judge the individual for how much they’re taking in. Ironically, the stuff that is being abused, that the provider actually needs a very, very

 

as detailed and specific amount of intake as possible is the class of drugs that are sedative hypnotics, benzodiazepines, alcohol, barbiturates. So when I said in the previous video in reference to something else and sort of just blurted out, if they say two milligrams, bump it up to four milligrams, it was really misunderstood from the audience. The one person that responded and said, you should believe people I’m making, I’m working in a clinical space and I have to figure out what is actually going on.

 

And that being said, it’s not like in my head, I’m sitting there saying, oh, he’s a liar. He’s lying about the dose. No, I have to, if it’s benzodiazepines, I have to make calculations for cross tolerance and get them off the stuff on the street and try to figure out how much they’re actually on so I can make sure they don’t have withdrawals, seizures, and don’t continue to abuse illicit substances. So I don’t just write them off as a pathological liar and make a judgment on them. I couldn’t care less. I understand the situation that the patient is in. And what I do do

 

is create a comfort zone and be very honest and say, look, really think about how much are you taking in daily, weekly, hourly, whatever it is. How many beers are you taking in and what is the size? How many Xanax are you taking in? Are they illicit? Are they pressed? And so forth. This is crucial for everyone to understand. When you go to the provider, communicate as specifically as you can the amount of substances you are ingesting. On the treatment side, I advise all

 

of the providers to do the same thing. This is not an issue of judgment on the individual, okay? They are not operating when they’re dealing with the substances that they’re taking in. They’re not operating as that person, Jack, Joe, Henry, Jill, Tanya, whatever their name is. That’s a human being. They’re dealing with a very, very complex disorder, let’s call it. And part of that comes this territory when they’re reporting to you how much they’re taking in.

 

And when they think you’re going to make a judgment on what they’re taking in, their reporting to you may be minimized. And so the provider needs to do the same thing under intake or the office visit or whatever it is. If you’re going to make a decision on how you’re going to treat that benzodiazepine or that sedative hypnotic, you need to create a comfort zone, explain to them there’s no judgment here. I’m not going to be able to make a good decision.

 

I couldn’t care less how much drugs you’re taking in. But I need to know quite specifically on some of these drugs so I can make a good decision in making your care treatment plan so you can move forward and be successful. I wanted to pass that on. So for those that are seeking treatment, be as honest as you can and don’t fear judgment. Don’t be ashamed

 

and don’t fear retaliation such as, hey, you’re getting kicked out of that practice, treatment center, or provider’s space. On the provider’s side, you should absolutely not judge or care less. In that moment, you are A, you always have to create a clinical rapport of trust and safety with the patient, whatever their situation is. Otherwise, send them to the law enforcement, send them to the judge, send them somewhere else. In the space of health treatment, there has to be trust and faith for you as the provider. Don’t do any

 

transference and counter transference, okay? This is not your world. You have to take in what they give you and you have to take in if they’re not being completely honest with you about what they’re taking in. You have to understand what’s going on. And then you have to dig in deep or make the best decision you have with the information you have, and then be ready to correct your decisions in one to two days. I hope that information is helpful for everybody.