Stephen Holt, MD, MS, is a primary care physician, addiction medicine specialist, and director of the Addiction Recovery Clinic.
Dr. Holt says his initial interest in addiction stemmed from an abnormal psychology class he took in college. “I was fascinated by why people repeatedly do things that are so self-destructive. However rational people can be, there is so much erroneous thinking and acting that we all do,” he says.
He went to medical school, thinking he wanted to be a neurologist or psychiatrist. “But I realized that when you are trying to understand the human condition, it’s so much more than a single maladaptive network in the brain,” he says. “There are all these social determinants, from your childhood to your environment to your health to your network of friends and family members.”
Understanding this complex web is the bread and butter of primary care, and the type of care he was looking to give, Dr. Holt says. “When you are a general internist, you want the patient’s whole story,” he says.
During his internal medicine residency, he worked with a primary care physician who offered outpatient addiction care. “Most residents are only exposed to addiction care in the hospital. It’s folks who have overdosed or are having heart valves replaced from IV drug use,” Dr. Holt says. “These patients are typically in the worst phase of their addiction. They’re likely to be in withdrawal, or in pain, they don’t trust the hospital and they aren’t looking to form relationships with doctors.”
For medical residents, seeing patients in this setting often doesn’t help them cultivate an interest in addiction medicine. “But in the primary care setting, I saw the opposite. Patients had long relationships with the doctor and they were so appreciative of how their lives had turned around,” he says. “It completely changed the way I thought about addiction medicine and, after finishing my internal medicine residency here at Yale, I helped start the Addiction Recovery Clinic.”
The Addiction Recovery Clinic cares for patients with substance use disorders (including opioid and alcohol use disorders) and educates Yale Primary Care residents and other health professional students.
“I love taking care of patients of all ages and with all different diseases, but I build the quickest, tightest bonds with patients who have a history of addiction, especially if I’ve met them when they were in crisis,” he says. “Once they realize that I, as a provider, will not judge them or get upset with them for illicit drug use or lying—all of which is so common with addiction—they begin to trust me. And if I am starting them on treatment, I might see them nearly every week for several months, which allows that relationship to grow quickly.”
Dr. Holt’s research interests include innovative ways to teach addiction medicine, and strategies to grow the pipeline of addiction medicine clinicians. He is also interested in the art and science of physical diagnosis and he has created comprehensive courses on both addiction medicine and physical diagnosis topics with several international medical educational companies.
