art by Kyle Uricchio
The Struggles in Addressing Addiction
by Anjana Murali
Addiction and substance abuse continue to be a prominent issue in the United States. Beyond understanding the basic groundwork behind this topic, which has been studied extensively over the years, it has been my pursuit to recognize and delve into its finer aspects. How is addiction viewed by society? What are the factors impeding its resolution? What can we do to effectively approach this issue?
In my journey towards this goal, I have had the firsthand opportunity to converse with Dr. Antoine Douaihy, who is a professor of psychiatry and medicine at the University of Pittsburgh School of Medicine.
Discussing the issue of societal depiction, Douaihy contends that our society and popular media tend to view individuals with addictions as morally corrupt, pathological liars and even sociopaths: “Unfortunately, even health care practitioners are not immune [from perpetuating stereotypes]; they can, either consciously or unwillingly, reflect those judgmental attitudes towards patients with addictions.” The consequences of these actions are quite pervasive, leading addicted individuals to sense the differential treatment they may receive and internalize these judgments. As a result, they can lose their dignity, tend to blame themselves and terminate treatment in order to avoid these negative feelings. Persons suffering from this burdening situation are usually unable to benefit from the health care system due to a fear of being judged and discriminated. Douaihy goes on to describe this outcome as a vicious cycle: “It escalates to a point where these individuals do not get into treatment and they end up with serious consequences because of their addictions. The impact is going to be on the community at large.”
A prime example of this occurrence is the current heroin epidemic, which is a result of the growing availability and lower street price of the drug, combined with a widespread crackdown on prescription painkiller abuse. Not only are more people using heroin, but they are also using it with increasing frequency in public spaces. According to the Centers for Disease Control and Prevention (CDC), opioid overdoses have quadrupled since 2000. Nationally speaking, there are 125 reported deaths everyday due to drug overdoses, with heroin and painkillers alone causing 78 of those unfortunate events.
According to Douaihy, addiction is a diagnosable disorder and should be viewed and treated as a chronic medical condition. Just as physicians highlight the importance of continuous medical care for chronic ailments such as diabetes, the same emphasis should be applied to addiction as well. “The whole idea of a quick fix and going to rehab and everything is going to be great is not the way we should address addictions.”
Douaihy further argues that society tends to judge people with addiction rather than understand the ailment as a chronic illness. However, once you truly see the plight of addiction, both personal responsibility and societal acceptance rise as paramount components when dealing with this complex situation. The same thinking applies to diabetes, where patients have a self-driven initiative to manage their condition while society recognizes the potential effect of the condition on a person’s life. As stated by Douaihy, “Anybody can have an addiction just like anybody can have diabetes.”
Unfortunately, the difference between addiction and diabetes comes down with moral judgments and disapproval. When somebody with diabetes comes into the emergency room (ER), they are usually not judged for a “slip up” in managing their condition. However, when someone with an addiction comes into the ER, more often than not, the medical staff immediately labels the patient as relapsing. Douaihy suggests that, rather than blaming these individuals, we should focus on why they are struggling and how we can help them figure out a way to get back on the right track towards recovery.
The biggest misconception regarding addiction is the inability of people to see it as a treatable condition, as opposed to diabetes. In actuality, addictions are treatable as well. There are effective evidence-based tools at our disposable, such as relapse prevention and harm reduction.
“The problem that we have in our health care system is that people don’t have access to treatment or the right kind of treatment,” according to Douaihy. The Substance Abuse and Mental Health Services Administration’s National Survey on Drug Use and Health held that 23.5 million people 12 years or older needed treatment for an illicit drug or alcohol abuse problem in 2009. Of these, only 2.6 million (or 11.2 percent) of those who needed treatment received it at a specialty facility. In 2014, the CDC collected nation-wide data on the number of drug overdose deaths (depicted in Figures 1 and 2). “We have serious problems in our country in terms of implementing and disseminating evidence-based treatments when it comes to treating addiction,” states Douaihy. “We have great treatments for diabetes, but if you don’t do it the right way, what would be the point?”
In terms of addressing addiction, relapse prevention is a premier example of psychosocial treatment that focuses on helping patients identify triggers and high-risk situations, developing coping strategies and strengthening their motivation for change. Douaihy also stresses the importance of a holistic approach to addiction treatment, which addresses the whole person from the biological, psychological, social and spiritual perspectives.
Harm reduction is yet another evidence-based modality for addiction management. According to Sarah Danforth, a specialist at Prevention Point Pittsburgh (PPP), the whole concept of harm reduction is for the care provider to meet the patients at their current stage in dealing with the addiction rather than pushing them into treatment. “We build a relationship that’s not based on shame so that when people are ready to make a change, they feel more comfortable coming and talking to us.” Currently, PPP is the only needle exchange program in Southwestern Pennsylvania. By providing injection-drug users with clean needles and various other supplies for safe injection, PPP reduces their risk of contracting HIV or Hepatitis C.
“I think that when people are using drugs, they are doing it for really good reasons for their own lives—they might be in a lot of physical/emotional pain or they might be experimenting, which is what most people do,” according to Danforth. While there are multiple reasons why people are drawn to opiates, we need to recognize it and bring it out from the shadows. “People don’t make change under the threat of shame and judgment—they just isolate themselves more and more. And with injection drug use the more that people isolate, the greater risk there is of death.” In addition to the needle exchange program, PPP also offers counseling, Narcan prescriptions (to reverse an overdose), assistance to drug treatment and non-judgmental outreach services.
Although evidence based treatments are available, Douaihy holds that we are not doing enough to train people in these types of approaches, along with an added lack of monitoring of the treatment process by health care providers who can make sure people are receiving the right care. To address this stigma around addiction, we need to advocate for the integration and coordination of care within the broader range of health and social services. As proclaimed by Douaihy, “We need to make addiction a medical problem rather than a social problem.”
Whether you are a young college student or an adult citizen of society, addiction and substance abuse have likely touched your life in one way or another. Join the effort to help those who need our support and guide them towards a better life. Eventually, it is what we do as a society that defines who we are.