The first Surgeons Generals report on Addiction was released last month. While the reported statistics were staggering, very little of the data was surprising. The vast majority of our population has now been touched in some way by addiction and many of us know intimately the cost to life, liberty, love and happiness. If you are one of the few who has not personally been touched in some way, you have no doubt noted the increased number of “died suddenly” entries in the obituary section of your local paper.
This report indicates that now is the time to abolish the stigma that accompanies substance use and substance dependence. As with most things in life attempting to understand and come together as a society that substance dependence is a chronic disease is the first step. This disease of the brain circuitry requires not only initial intensive treatment but (often) ongoing lifelong g maintenance to manage health. This is not unlike the care required for infectious disease, diabetics, cardiac and oncology patients. It was not so very long ago that diseases like cancer and HIV were diseases that caused patients harm in terms of judgement, appropriate medical care and financial hardship. Today it would be unthinkable to blame a breast cancer patient for his/her disease with the thinking that this was some divine retribution for past sin. The shame and discrimination surrounding dependence can be the very tall wall that prevents individuals and their loved ones from seeking help. Helping people understand their innate worth as human beings with a physical disorder can provide a ladder to help them climb over the wall and ask for help.
In addition to the shame that exists in our communities there is also judgement within the recovery community. People who utilize medications such as methadone, buprenorphine, naltrexone, etc…are managing their disease in a manner that contradicts those in recovery who do not believe in the use of support medications. This too is a form of stigma that needs to be avoided. As a community we must support any and all initiatives (including medication assisted treatment) that keep patients involved in the recovery community and engaged in their care. We must also show patience through the process that leads to sustained recovery (remission of at least one year). Currently, in order to manage this time in recovery it can take as long as 8-9 years after first seeking formal treatment. Therefore, while we address the changes in programs of prevention and care, we must exhibit patience and support in all aspects of care. This patience is needed because this disease will not go quietly, even after 2 years of remission is achieved, it can take 4-5 more years before the risk of relapse falls below 15%.
Lastly, but incredibly importantly there needs to an understanding among us all that prevention works can help prevent the issues of substance misuse from moving people into the dependence realm of treatment needs. There are a number of age appropriate evidence based programs available to provide support for schools, families, primary care offices and occupational medicine offices that can be used. The overall healthy, finance and safety issues that will be prevented when we treat this disease pro-actively are innumerable and lasting.
Support for the government agencies that are embracing this issue as a Public Health concern is paramount to saving lives. Please write, email or call your representatives today to show your support for these initiatives.