Dr. Anna Lembke

Like, I used to think that I could predict when a patient came in whether or not they would be able to get into recovery, and I've long given up that idea. I've seen people with decades of severe and life-threatening addiction miraculously late in life get into recovery. And I've seen people who I thought for sure were helpable who ended up dying of their disease. So...

Like, I used to think that I could predict when a patient came in whether or not they would be able to get into recovery, and I've long given up that idea. I've seen people with decades of severe and life-threatening addiction miraculously late in life get into recovery. And I've seen people who I thought for sure were helpable who ended up dying of their disease. So...

You know, there is still a lot we don't know.

You know, there is still a lot we don't know.

So my father's alcoholism was a major factor in my childhood. He was a surgeon, but he would go long periods without drinking, and then he would have long periods where he was drinking large amounts every day.

So my father's alcoholism was a major factor in my childhood. He was a surgeon, but he would go long periods without drinking, and then he would have long periods where he was drinking large amounts every day.

I remember coming home from elementary school with my best friend Laura and finding him not on the hammock but under the hammock passed out and just looking at her and saying, let's go to your house. So, you know, that was sort of a specter in my childhood.

I remember coming home from elementary school with my best friend Laura and finding him not on the hammock but under the hammock passed out and just looking at her and saying, let's go to your house. So, you know, that was sort of a specter in my childhood.

What I first did with that in medical school and residency was to not want to have anything to do with addicted patients, just because that's kind of what we call negative countertransference, but also hadn't really learned very much in medical school or even residency. So I didn't have the tools, didn't know what to do.

What I first did with that in medical school and residency was to not want to have anything to do with addicted patients, just because that's kind of what we call negative countertransference, but also hadn't really learned very much in medical school or even residency. So I didn't have the tools, didn't know what to do.

And then very early in my career, I was specializing in treating mood disorders. And I had a young woman in my clinic I was treating for depression. Her parents were paying for the care. And I saw her weekly and we had in-depth discussions about her childhood. I talked about every conversation she'd ever had with her mother. I was prescribing an antidepressant.

And then very early in my career, I was specializing in treating mood disorders. And I had a young woman in my clinic I was treating for depression. Her parents were paying for the care. And I saw her weekly and we had in-depth discussions about her childhood. I talked about every conversation she'd ever had with her mother. I was prescribing an antidepressant.

And I noted that she would often nod off in the sessions. And I thought, huh. That's funny. I wonder why she's so sleepy. Maybe she's a slow metabolizer. You know, I was like, I was trying to draw on, you know, what I had learned in medical school. And then one day her brother calls me out of the blue and he says, she's been in a rollover car accident. I said, oh my goodness, that's terrible.

And I noted that she would often nod off in the sessions. And I thought, huh. That's funny. I wonder why she's so sleepy. Maybe she's a slow metabolizer. You know, I was like, I was trying to draw on, you know, what I had learned in medical school. And then one day her brother calls me out of the blue and he says, she's been in a rollover car accident. I said, oh my goodness, that's terrible.

What happened? And he said, well, she's been using again. And I literally did not understand anything. the structure of that sentence. As using, I said, using what? He said, well, using heroin. Isn't that what you've been treating her for? Oh, wow. Yeah.

What happened? And he said, well, she's been using again. And I literally did not understand anything. the structure of that sentence. As using, I said, using what? He said, well, using heroin. Isn't that what you've been treating her for? Oh, wow. Yeah.

And that was the moment that I realized I'm a bad psychiatrist because the kind of don't ask, don't tell policy, because I never once did ask her about drugs and alcohol, and she never once volunteered the information, but that's not really her job, right? It's my job to get that information.

And that was the moment that I realized I'm a bad psychiatrist because the kind of don't ask, don't tell policy, because I never once did ask her about drugs and alcohol, and she never once volunteered the information, but that's not really her job, right? It's my job to get that information.

So I was really doing harm to patients out of my ignorance, and that was a huge turning point in my career. I realized, oh my goodness, I need to figure out something about addiction or I'm going to be a menace. And the irony is that... As soon as I started asking patients about drugs and alcohol, they were eager to talk about it.

So I was really doing harm to patients out of my ignorance, and that was a huge turning point in my career. I realized, oh my goodness, I need to figure out something about addiction or I'm going to be a menace. And the irony is that... As soon as I started asking patients about drugs and alcohol, they were eager to talk about it.