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Changing the Perceptions of Drug Addiction in the Realm of Public Health

The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.

By Julie Swafford
March 19, 2018

Introduction

The current opioid crisis has focused the medical research, legislative and fiduciary spotlights on what can and should be done to solve this problem. Treatment methods of the previous 30 to 50 years have not been successful because the focus of drug treatment centered around the assumption that drug use was a voluntary action. However, scientific research over the past 20 years has attempted to chart a course-correction and change the perception of drug addiction as a disease rather than a voluntary choice of self-destruction. This multi-disciplinary approach among neuroscience, psychology, sociology and public health researchers and practitioners are shifting the paradigm of addiction treatment from one of acute illness to that of a chronic illness like diabetes.

Change in Medical Profession Perception and Treatment

The historical perception of substance abuse has been negative. According to researchers McLellan, et al in an October 2000 article in the Journal of the American Medical Association entitled “Drug Dependence, a Chronic Medical Illness: Implications for Treatment, Insurance, and Outcomes Evaluation”, these negative perceptions are inherently based in the social problems that are the manifestations of substance abuse. The expensive effects of drug abuse on social systems have been an important component in shaping public opinion around the notion that the “drug problem” is a social problem that “requires interdiction and law enforcement rather than a health problem that requires prevention and treatment.”

Dr. Nora Volkow, director of the National Institute on Drug Abuse (NIDA), is taking the lead in the course correction of understanding drug addiction as a chronic disease. In her May 2017 blog post “All Scientific Hands on Deck,” Dr. Volkow provides a framework for getting the drug abuse problem, especially abuse related to opioid addiction, under control using a trifecta of approaches: overdose reversal, addiction treatment and pain management. Dr. Volkow states that the growing knowledge of neurobiology in opioid addiction has helped researchers identify specific targets that may lead to more and safer treatments for opioid use disorder. Dr. Volkow believes that more research and better medical treatments are the keys to ending the opioid crisis and other forms of addiction. There is no mention in her blog about the need for more laws and law enforcement to curb this epidemic which is indicative of a major shift in approaches from previous decades.

Drug Addiction is a Chronic Illnesses

One of the most common misperceptions is that drug abuse is voluntary. While in most cases, the onset of drug use is voluntarily, the increase in addiction to prescription pain medications nullifies this argument because people are becoming addicted by taking medications that were prescribed to them by medical professionals. According to McLellan, et.al, there are many illnesses wherein voluntary choice affects initiations and maintenance, especially when they interact with genetic and cultural factors. McLellan, et. al also assert that poverty, lack of family support and psychiatric comorbidity are major and equal predictors of non-compliance and relapse across all the chronic illnesses examined in their study. This gives addiction the medical equivalence of other chronic illnesses.

Imagine if we treated other chronic illnesses such as diabetes, high blood pressure, asthma and congestive heart failure acutely, which has been the historical norm for drug addiction. In their research McLellan, et al. observed the following:

“…it is interesting that relapse among patients with diabetes, hypertension, and asthma following cessation of treatment has been considered evidence of the effectiveness of those treatments and the need to retain patients in medical monitoring. In contrast, relapse to drug or alcohol use following discharge from addiction treatment has been considered evidence of treatment failure.”

Our acceptance of “approved” methods of substances such as alcohol and nicotine call into question the rationale behind the legal classifications of what is legal and illegal. No one would argue that alcohol is any less addictive, or less dangerous to the drinker than “illicit” drugs. Drunk drivers kill and harm innocent people every day, yet alcohol is legal and available to anyone over 21, regardless of their criminal history or health status. The nicotine in cigarettes is just as addictive and causes many downstream health problems to smokers as well as non-smokers. However, these drugs are not illegal, but freely available and taxed by the government.  We must begin to ask the question, what is the difference between alcohol, nicotine and heroin?  The science seems to indicate that where the brain is concerned, there is not much difference at all. From a public health perspective, the prevalence of opioid addiction is a public health crisis, the same as a Salmonella or E. Coli outbreak.

Conclusion

The perception changes in the medical community must be complemented by a change in the public perception of substance abuse and those addicted to the substances. We need to change the mental imagery that comes to mind when one hears the terms “drug addict.” The stigma associated with the disease of drug addiction prevents many from seeking help. People with substance abuse disorder need to know that it is ok to seek help for their addiction, the same as they would if they had a diagnosis of diabetes or congestive heart failure. Additionally, our lawmakers need to revisit drug laws that are currently on the books. Considering the new scientific advancements and discoveries that support addiction a chronic brain disease, these laws should be re-evaluated and nullified or modified. After all, how can it be illegal to have a chronic medical disease? Imagine what would happen if suddenly insulin and other diabetes medications were made illegal. Would diabetes just go away, and all diabetics change their eating habits and lifestyles to optimize their health? Why isn’t substance use disorder covered by Family Medical Leave? These are the types of questions, that when answered, will lead to real solutions and treatment plans, and that will save more of the people we love.

Author: Julie Swafford has a BA in Political Science and History from the University of Kentucky and is pursuing a Master’s in Public Administration at Eastern Kentucky University. Julie has worked in a public healthcare setting for over eleven years and is the founder of the Own Your Own Mind Project. You can reach her at [email protected] or Twitter: @julie0285.

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