Shedding Light On an Issue in the Shadows
After December’s singing and celebrations, partying and presents and let’s face it—over-indulgence—for too many Americans, the New Year opens on a darker reality: addiction. The abuse of and addiction to drugs—including alcohol, tobacco and prescription drugs—costs the US a staggering $700 billion a year in increased health care costs and lost productivity. No price tag can quantify the human misery, sense of failure and loss of hope for individuals and their families dealing with addiction. Tremendous pain surrounds addiction; but there is also promise. As a result of scientific research, it is now known that addiction is a brain disease that affects behavior. Groundbreaking discoveries are enabling scientists to develop effective medical prevention and treatment approaches with remarkable, sustainable outcomes for recovery.
Despite these advances, much of what people think about addiction is shrouded in powerful myths and misconceptions that have persisted over the past century and shaped society’s response to drug abuse and addiction.
FACT: Addiction is not a moral failing by people with flawed characters who lack will power. Addiction is a disease that affects both the brain and behavior.
According to the National Institute on Drug Abuse (NIDA), addiction is defined as a chronic, relapsing brain disease, characterized by compulsive drug seeking and use, despite harmful consequences. The word addiction is equivalent to the term substance use disorder as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5, 2013).
Professionals who work with substance abuse patients insist language is important. Addiction is a medical disorder that requires medical treatment not punishment or stigma. For a professional perspective, Pink met with Dr. Ravi Srivastava, the medical director for SunspireHealth Hilton Head, a recently-opened private residential treatment facility for men and women suffering with substance use disorders and co-occurring mental disorders.
Dr. Srivastava graduated from medical school with a specialty in addictive medicine. Before joining SunspireHealth, he had a private practice on Hilton Head and knows first-hand the severe toll of addiction. He stated that in America every other family is dealing with a person in addiction. Addiction is not a problem isolated in a marginalized segment of our population. It is a pervasive social issue that affects people we know and care about.
Dr. Srivastava had a straightforward message for our Pink readers. He said addiction to drugs and alcohol is a bigger problem among women than men. He noted that women in the workforce have added all the stressors previously associated with men, without a reduction in the traditional stresses of home and family life. Among women there is widespread misunderstanding about the adverse effects of alcohol and what constitutes light, moderate or heavy drinking. Dr. Srivastava said drugs and alcohol affect women differently than men. He gave three guidelines that may indicate a woman has a drinking problem: 1. If you feel guilty about drinking; 2. If you get defensive or angry if someone says you’re drinking too much; 3. If you decide to cut back or stop drinking and find yourself making excuses why you don’t.
Dr. Srivastava also noted the increase in underage drinking, particularly among young girls. According to the Centers for Disease Control (CDC), 37 percent of 9th grade girls have used alcohol and binged (five drinks or more) more than once. A major concern with underage drinking is the impact on a child’s brain. The prefrontal cortex—the part of the brain responsible for decision-making and emotional control—continues to develop until we are 25. Alcohol use in young people disrupts the growth and function of this very part of the brain that can inhibit addictive behavior.
Dr. Srivastava said addiction isn’t about using a substance; it’s about the inability to stop using a substance. One of the confusions about addiction is choice. Initially, the decision to take drugs (again, the term encompasses alcohol, tobacco and prescription drugs as well as illegal street drugs) is voluntary. However, continued use alters the way the brain works. Repeated substance use creates a craving in the deep brain that is as involuntary as a seizure. This craving response can continue to exist one to two years after a person has quit using. Dr. Srivastava noted there are now anti-craving drugs (i.e. Vivitrol) that can be injected once a month to block the “high” or pleasure sensation in the brain, if a patient relapses. The patient experiences no adverse physical effects if she uses drugs or alcohol while taking the medication, but there is also no benefit; thus the craving is not stimulated.
These new medical technologies effectively help prevent relapse while patients work with inpatient and outpatient clinical treatment programs, which enable them to change the behaviors that put them at risk initially. There is a mix of early social and biological vulnerability factors. These include unstable family relationships, exposure to physical or sexual abuse, genetic susceptibility and/or mental illness, which put young people at greater risk for substance use disorder. In many cases, addiction is a developmental disease, which begins in childhood or adolescence.
Dr. Srivastava offered strong encouragement for people seeking treatment. In facilities like SunspireHealth, which offer clinical interventions supported by Medication Assisted Treatment (MAT), the outcomes for recovery after a year of treatment is a remarkable 86 percent. This is compared to a 67 percent relapse rate for individuals who tried to stop on their own.
Last month, 60 Minutes aired a segment (December 13, 2015) with Michael Botticelli, director of the National Drug Control Policy. Mr. Botticelli acknowledged after 40 years and a trillion dollars the nation has little to show for its war on drugs. Twenty-one million Americans are addicted to drugs or alcohol and half of all federal inmates are in for drug crimes. He declared, “We can’t arrest or incarcerate addiction out of people…it’s inhumane, ineffective and costs us billions upon billions to keep doing this.” He reiterated the essential fact: Addiction is a brain disease that changes the brain’s chemistry. Addicts should be patients not prisoners.
Director Botticelli believes the misuse of pain medication—with prescriptions jumping from 76 million in 1991 to 207 million today—is largely driving the new heroin epidemic. Addicted to the opioid pain meds, more and more suburban housewives and urban businessmen are using less expensive heroin. A large majority of these people are not criminals or doped-up dropouts. These are people whose brains have been altered and they require medical intervention and treatment.
FACT: Legal substances, which include alcohol, tobacco and prescription drugs, are responsible for the majority of deaths resulting from drug abuse in the US; over 500,000 Americans per year.
Director Botticelli has been in recovery from alcohol abuse for several decades after being given a choice to seek treatment or proceed with criminal charges. He was asked what he would say to people addicted to drugs or alcohol. He responded: “There’s help. There’s hope. There is treatment available. If I, in some small way, help people to see that there is a huge, incredible life on the other side of addiction, you know, I will feel accomplished in my job.”
The secrecy, shame and stigma that surrounds addiction belongs to an outmoded paradigm based on misinformation and misunderstanding. There are proven treatments with remarkable outcomes that are available. Making them more widely available requires individuals, families, community service providers, faith-based organizations, schools, the medical and insurance establishments and government agencies to become educated. If you—or someone you know—has a substance abuse problem be proactive in getting information.
There’s help. There’s hope.
For additional information: National Institute on Drug Abuse: www.drugabuse.gov
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