Dental professionals are in a unique position to recognize when a patient or colleague is struggling with substance use — but recognizing a potential concern is only the first step in offering support. Knowing how to respond with compassion, reduce stigma, and connect someone with support can be more difficult.
Brett Kessler, DDS
During last week’s CareQuest Institute webinar, “From Stigma to Support: Addressing Substance Use Disorders in Dental Settings,” Brett Kessler, DDS, the 161st president of the American Dental Association, shared his personal experience with substance use disorder and recovery, including the challenges dental professionals may face when struggling themselves.
“I could not fix my broken brain with my broken brain. I needed help,” Kessler said during the webinar. “Once I got the help, I was able to get through it.”
David Beckmann, MD, MPH
David Beckmann, MD, MPH, with Thomas Jefferson University, offered strategies for talking with patients about substance use concerns through motivational interviewing and person-centered, nonjudgmental communication.
“Patients generally put a lot of trust in their health care providers, and that includes dentists, dental hygienists, and other dental professionals,” Beckmann said.
More than 650 learners attended the webinar, which was moderated by Lisa Simon, MD, DMD, a physician and dentist at the Harvard School of Dental Medicine and Harvard Medical School. During the closing Q&A, learners asked about supporting patients and colleagues, responding when someone isn’t ready to make a change, and reducing stigma. Here’s what the experts had to say:
- What should dental professionals do when a patient isn’t ready to address a substance use concern?
Dr. Beckmann: The goal isn’t necessarily to convince someone to change right away. Motivational interviewing is about helping someone move a little closer to considering change. For a patient who isn’t yet considering change, that might simply mean encouraging them to think about their substance use differently.
Rather than becoming more forceful if someone isn’t receptive, focus on building trust and keeping the conversation open. Let patients know you’re concerned, you care about their well-being, and you’re available to help without judgment. Even if they aren’t ready to make a change, a supportive conversation can help them feel more comfortable considering it in the future.
Change may take multiple conversations. Maintaining trust and keeping the door open can make it more likely that a patient will turn to you when they are ready for help.
- How should dental professionals approach a colleague when they’re concerned about substance use?
Dr. Kessler: Start from a place of empathy. A simple phrase like “I’m concerned” can be a powerful way to open the conversation. Share specific things you’ve noticed, such as changes in behavior or reliability, and ask whether there’s anything you can do to support them. They may not be ready to acknowledge a problem or accept help, but the conversation can plant a seed and let them know support is available.
At the same time, dental professionals have a responsibility to consider patient safety. If there are signs that a colleague may be practicing while impaired or putting patients at risk, a more direct conversation may be necessary. If serious concerns continue, additional action, including reporting to the appropriate dental board, may ultimately be required.
The goal is to balance compassion for a colleague who may be struggling with the responsibility to protect patients and the community.
- How should dental professionals respond when a patient appears impaired?
Dr. Kessler: If you believe a patient is impaired, consider their immediate safety and whether it’s appropriate to proceed with treatment. Impairment can affect their ability to provide informed consent, so depending on the circumstances, rescheduling may be appropriate.
Patients in early recovery may also have anxiety about dental care, particularly around pain and pain management. Address those concerns directly, discuss how you’ll manage treatment together, and work at the patient’s pace.
Dr. Beckmann: Think beyond what happens in the dental chair, too. If a patient arrives at an appointment while obviously impaired, consider how they will leave safely, particularly if they drove themselves. The conversation should focus on immediate safety while continuing to treat the person with dignity and compassion.
- How can dental professionals use less stigmatizing language when documenting substance use?
Dr. Beckmann: Write with the understanding that your patient may read their chart. Person-first language can help keep documentation respectful and focused on the individual rather than defining them by a diagnosis. For example, use “person with a substance use disorder” instead of labels such as “addict” or “alcoholic.”
Stick to objective, specific information, such as documenting reported alcohol, tobacco, or other substance use rather than using judgmental descriptions. Documentation should give other health care professionals useful information without unnecessarily stigmatizing the person receiving care.
Editor’s Note: View the full presentation — and download the accompanying slides — in CareQuest Institute’s webinar library.