Treatment Without Blame

We have been fighting drug abuse for almost a century. In June, 1971, Richard Nixon called for a “war on drugs,” and increased the size and presence of federal drug control agencies, and pushed through measures such as mandatory sentencing and no-knock warrants. Four Presidents have personally waged war on drugs. Unfortunately, it is a war that we are losing. Drug abusers continue to fill our courts, hospitals, and prisons. The drug trade causes violent crime that ravages our neighborhoods. Children of drug abusers continue to be neglected, abused, and abandoned.

The government has, to no avail, spent countless billions of dollars in efforts to eradicate the supply of drugs.  Making the most headway to solve the problem is to make a shift in spending from law enforcement and penalization to education, treatment, and prevention.

There were approximately 20.6 million people in the United States over the age of 12 with an addiction in 2011.  Although most people don’t get the treatment they need, over 3 million people in 2011 received treatment for their addiction.

  • Over 20 million Americans over the age of 12 have an addiction (excluding tobacco).
  • 100 people die every day from drug overdoses. This rate has tripled in the past 20 years.
  • Over 5 million emergency room visits in 2011 were drug related.
  • 2.6 million people with addictions have a dependence on both alcohol and illicit drugs.
  • 9.4 million people in 2011 reported driving under the influence of illicit drugs.
  • 6.8 million people with an addiction have a mental illness.
  • Rates of illicit drug use is highest among those aged 18 to 25.
  • Over 90% of those with an addiction began drinking, smoking or using illicit drugs before the age of 18.

There is a slew of reasons why society and addiction treatments have largely failed to help the 20 million Americans with addictions, beginning with how we, as a society, view addiction.  If we can correct the misconceptions about the disease, it will be the first step towards improving the social support and treatment for those struggling with addictions. 

First, we must tackle the myths.
 
Myth No. 1: Good kids don’t use drugs, bad kids do.

Eighty percent of America’s children will at least try alcohol or other drugs.  Do we really believe that most of our children are bad?  These are not bad kids. They’re our kids.

It isn’t a question of good and bad, it’s a question of health and safety.  If we keep this in mind, we can better help our kids grow up without succumbing to drugs and continuing to use, trying new and more dangerous drugs, and even become addicted.

Myth No. 2: It’s impossible to prevent drug use. Kids who are going to use are going to use.

Prevention efforts will be effective when we focus not on “just say no” tactics, but instead address the reasons kids use.

Kids who have drug problems often use drugs as a way to alleviate stress and otherwise help them cope with stressful lives.  Kids who experienced trauma are more likely to have drug problems as are those growing up in poverty or violent neighborhoods, children whose parents divorce or suffer loss, those with addiction, including alcoholism, in their family, young people with ADHD, with learning disabilities, with a host of psychological disorders including depression and bipolar disorder.

We’ll effectively lower or potentially prevent drug use when we address these risk factors and replace them with protective factors.

Myth No. 3: People who get addicted are weak and without morals.

Addiction isn’t about character.  Addiction is a disease.  People who think that addicts are weak assume that will power is enough for a person to stop using.

So if weakness isn’t the reason why, when someone’s life is negatively affected by their drug use, why don’t they just stop? It’s because their brains have been in a sense, re-wired, so the new “normal” is the presence of drugs.

Dependence is real, not a choice, biologically rooted, and therefore addicts must be treated. It’s critical that people understand that addiction is a serious illness, usually chronic and progressive and often fatal. Addiction is the cause for 120,000 deaths each year.

Myth No. 4: Addicts must hit bottom before they can be treated.

This myth kills addicts. Don’t wait for an addict to hit bottom; do everything you can to get them into treatments. Addicts are often told that they must hit bottom, but they need to know that people who enter treatment can and do get well. Many people die before they hit a bottom. We must reject this archaic belief.

Myth No. 5: You don’t treat drug problems with drugs.

Wrong again. Many addiction treatments can and should include medication. A variety of medications, when prescribed, monitored, and adjusted by a good psychiatrist, in combination with behavioral therapies, dramatically up the odds of successful treatment.

For many addicts, the impact of medications can be profound — even lifesaving.  And for addicts with concurrent mental illnesses, drugs can be essential. Some of the same medications that help during detox can be part of primary care.  Some of these prescriptions inhibit cravings.  Some treat the symptoms that come with sobriety following intense and consistent drug use.  Some replacement drugs not only reduce cravings but act as deterrents; they block certain drugs from attaching to receptors, thereby preventing the drugs from triggering a high if they’re taken.  In addition, medications can treat the concurrent and underlying problems, including anxiety, depression, and other disorders, that contribute to addiction.

Myth No. 6: The only way for addicts to stop using is by going to AA meetings.

Alcoholics Anonymous (AA) and the Twelve Steps have helped countless addicts get and stay sober.  It’s a profound program that works for many people. But it doesn’t work for a majority of addicts.

People must know that there are other treatments that are effective. Some are used in concert with AA, but AA isn’t a requirement to managing addiction. When treatment programs insist that patients must practice the Steps, they can alienate some addicts, often teenagers.

Effective programs should offer many types of treatment, including behavioral and psychological treatments.  Some addictions should be treated with medication in addition to behavioral treatments.

Myth No. 7: Marijuana is not addictive.  No one’s ever died from marijuana.  It’s not a gateway drug.  Marijuana should be legalized.

Marijuana should be legalized, but not because it’s safe, especially for teenagers and young adults. It should be legalized because we must treat marijuana use like all drug use — as a health issue.  The fact that it is illegal just drives using marijuana underground.  The last thing we want to do is increase those things by kicking kids out of school or throwing them into the criminal justice system because they were caught smoking pot.

But those who support legalization by saying that pot is harmless — “it’s natural, harmless” — are also wrong.  Marijuana is dangerous for kids.  Part of the reason is that their brains are developing during adolescence and early adulthood.  Drugs impede and alter the brain development, and these changes can harm cognition and memory, and can impede kids’ emotional maturation.

Marijuana is a gateway drug for some kids who smoke.  You will likely never met an addict who started on heroin — it’s usually pot and drinking.  And marijuana is addictive for about 7 percent of those who try it.  Yes, people don’t overdose and die from smoking pot, but those who drive while high are twice as likely to get in car accidents, including ones that are fatal.

Myth No. 8: America’s drug problem is unsolvable.

We’ve failed at solving America’s drug problem not because it’s impossible to do so, but because we’ve been focusing on the wrong things. The main problem is that we’ve treated drug use as a criminal problem and drug users as criminals or undesirables.  Recently, there’s been a growing understanding and acceptance that addiction is a disease and must be treated like we treat other diseases. There are advances in treatment that will  dramatically improve the likelihood that addicts will get well. New prevention strategies, early assessment, and brief intervention strategies all point to progress toward making sure that people who need treatment will be able to find evidenced-based treatment programs.