ABSTRACT
Editor’s introduction The second of two chapters dealing with the second component of patient-centered medicine, 'understanding the whole person’, this section focuses on two key areas of the patient’s life context: the family and the work environment In healthy families, as individuals are connected biologically, emotionally or legally within the family unit, they create a nurturing, safe and continuous environment which serves to promote the physical, psychological and social well-being of its members (Brown and Weston, 1995). Substance abuse often results in a dysfunctional family unit which is unsafe and emotionally destructive and erodes the physical and psychological well-being of its members. Indeed, the dysfunctional patterns of co-dependency and enabling were first recognized and defined through the study of substance-abusing families. While much of the research cited in this chapter was done with alcoholic families, the findings are also typical offamilies affected by abuse of virtually all kinds ofpsychoactive substances. Substance abuse may present in the primary care setting due to physical or emotional consequences in either the patient or another family member who is trying to survive in this dysfunctional family system. Thus, it is essential that the patient-centered clinician understands the full impact of this disease on the family system and is prepared to recognize it and inter vene. The work environment, another key part of the system in which most patients function, assumes an extremely high level of importance for the substance abuser. Because substance-abusing patients frequently experience negative consequences of their disease on the job, which is necessary for their day-to-day survival, the work environment provides a key opportunity for disease recognition and a powerful moti vator toward recovery. In this chapter, Drs Shellenberger and Phelps pro vide us with an in-depth analysis of how the patient-centered clinician can better understand the substance-abusing patient as a whole person by gaining insight into his or her family and work situation and use these insights to facilitate diag nosis and recovery.
