Saturday, September 20, 2014
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Addiction: Recovering Main Street

Dramatic increases in overdose rates now terrorize rural and suburban neighborhoods, not just inner cities. What can we learn from this about our attitudes toward addiction and those who suffer from it?

Addiction: Recovering Main Street

Dramatic increases in overdose rates now terrorize rural and suburban neighborhoods. Inner cities have long dealt with the quiet desperations of addiction, but now these new communities also are overrun. This clashes with our stereotypes of misuse and addiction.

My point isn't to criticize very real and merited terror over prescription drug and heroin epidemics. It is to ask: what can we learn from this about our attitudes toward addiction and those who suffer from it? Specifically:

  • Why are physicians inadequately prepared for medicating pain and screening for addiction? While pain and addiction are widespread, causing extraordinary human, health and economic harm, formal physician training short-shrifts both. Yet primary care and hospital emergency department physicians may have the most influence and leverage to initiate interventions. We need that influence and leverage to reach most of 1 in 7 Americans suffering from addiction. Another third engage in such risky substance use that contact with health care providers or law enforcement may result.
  • Given rising public concern as fatal drug overdoses have more than tripled since 1990, why is there such policymaker resistance in Pennsylvania to making naloxone more available? In the hands of first responders, clinics and even families, this safe, easy-to-administer drug (brand name Narcan) can prevent drug and alcohol poisoning (that's what overdose is) from killing. There is similar Pennsylvania resistance to allowing "good Samaritans" to call for medical help without fear of being investigated themselves. To see how much the inaction in Pennsylvania contrasts with progress in New Jersey, explore the Law Atlas, a compilation of laws affecting public health, including Good Samaritans and legal issues surrounding naloxone for overdose prevention. public health laws . Yet New Jersey has a lower drug overdose mortality rate than Pennsylvania (see page 12 for state-by-state comparisons).
  • Why isn't there more concern about what happens to overdose victims who survive and need to overcome stigma and discrimination, e.g., housing, employment, that create barriers to long-term recovery?

There is a common thread through all three questions: despite scientific certainty that addiction is a chronic disease, perhaps best compared to diabetes, 19th and 20th century imagery of immorality and criminality, of dissolute drunks and shooting galleries, still hold sway. The powerful, disparaging mindset that addiction is behavioral, that "addicts" should resist or simply throw off the shackles of the disease still dominates otherwise modern minds. This keeps us from acting compassionately and decisively.

 

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This stigma maintains its grip partly because of what isn't seen. On every corner are survivors, individuals managing their addictions and living such normal lives that you have no idea of the struggles that once defined them. About 23 million people demonstrate every single day that as tenacious and disruptive as addiction can be, recovery is a reality.

What does all this mean for the prescription drug crisis that has caught society off guard? Increasing access to prescription opioids expands pathways to addiction. While fatal overdose among teens is frightening, that's just the headline. Worse: 90% of addictions start in the teen years when our brains still are developing physically. See  and

Here are three broad categories of actions we all can take:

Respect the Risk

Parents, schools and communities need to prepare and respond with more urgency.

  • Parents are not talking with their teens about the risks of prescription drugs, even when they do talk about illegal drugs. Prescription suggests doctor-approved, but there is no such approval when a drug is used in a different way or by a different person. Parents themselves must first learn about the many categories of medicines, how they work, and how they can do serious harm. Physicians and pharmacists can help. They can reinforce the counsel parents give, and review specific medicines and their risks.
  • A large proportion of misused prescription drugs come from family medicine cabinets. Parents should keep their own medicines in safer places and inventory their supplies. Unused medications should be disposed of properly, particularly through take-back programs. Medicines flushed down our toilets will make their way into our water supply and streams.
  • If you think there's a problem, act. Sooner is better. If you need help, call our free information line 24/7 -- 1-800-221-6333. Click here for more information for yourself, or a family member or friend:
 

Support the Struggle

The public often mocks celebrity comings and goings from addiction treatment programs. Millions of ordinary citizens, however, experience the same ups and downs in their battles with their addictions.

Many people actually recover from their addictions with modest help. However, others confront more powerful biological, genetic and life-situation hurdles. Such hurdles require significant assistance over long time periods. Research suggests that, for some individuals who battle severe and persistent substance dependence, to sustain recovery for one year may require 3-4 treatment episodes over an eight-year period. They need support and encouragement during this difficult process – not doubt, and certainly not disapproval.

To learn more about the 23 million Americans living in long-term recovery, watch the new documentary, The Anonymous People. It is the uplifting story of citizens, leaders, volunteers, corporate executives, public figures and celebrities who put themselves out front to transform public opinion, and engage communities and elected officials to promote more long-term addiction recovery. (Disclosure: I was interviewed for this film and The Council I lead is organizing screenings.)

Next Philadelphia showings:

  • Tuesday, April 8: National Museum of American Jewish History. 101 South Independence Mall East; doors open at 5:30, film and discussion, 6:30-9 p.m.
  • Wednesday, April 23: William Way LGBT Community Center, 1315 Spruce St.; doors open at 5:30 pm; film and discussion, 6:30-9 p.m.

(For more information about these showings and future showings, call 215.345-6644)

Enable Recovery

Addiction recovery is a life process, not something accomplished in hospitals designed to treat acute illness and injury. Getting a diagnosis of type 2 diabetes, a chronic disease, has many similarities. Those patients also differ dramatically in terms of the severity of the condition, overall health, family support, financial resources, dietary habits, and much more. Once you get a diagnosis and accept it, the battle is just beginning. Similarly, recovery from addiction involves not only treatment, but also coaching and peer support, training in life skills, help with managing finances, housing and employment resources, and general health care.

With well more than half of Americans saying they have been directly affected by addiction, we need to treat the disease as compassionately as we do diabetes. That will make it easier and more likely for individuals with more severe addictions to seek and accept help. More compassion will reduce feelings of shame, and make it easier to recover. More compassion will encourage policymakers and health care providers to do everything possible to help.

And, with more compassion, one reward will be more stories told about the everyday triumphs of recovery by people who, because of our history of opprobrium, don't often speak about their experiences. That makes it easier for families unsure of what to do, and individuals struggling to take their first steps toward recovery.


Since 1981, Beverly Haberle has led The Council of Southeast Pennsylvania Inc, a 501(c)(3) charitable organization providing recovery management services and education to reduce the impact of addiction. The Council maintains a 24/7 information line for the five-county region: 1-800-221-6333. It manages the annual Recovery Walk in Philadelphia, the largest in the nation, which brought together 20,000 supporters in 2013. Haberle holds a Master’s in Human Services,  and is a Licensed Professional Counselor and a Certified Addictions Counselor. 

Read more about The Public's Health.

About this blog

What is public health — and why does it matter?

Through prevention, education, and intervention, public health practitioners - epidemiologists, health policy experts, municipal workers, environmental health scientists - work to keep us healthy.

It’s not always easy. Michael Yudell, Jonathan Purtle, and other contributors tell you why.

Michael Yudell, PhD, MPH Associate Professor, Drexel University School of Public Health
Jonathan Purtle, DrPH, MSc Assistant Professor, Drexel University School of Public Health
Janet Golden, PhD Professor of history, Rutgers University-Camden
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