Think your life hasn’t been touched by addiction? Think again. We are all affected, both in terms of missing out on the lost potential of those struggling with drugs or alcohol and in dealing with the wreckage left behind.
Dr. David Sack is board certified in psychiatry, addiction psychiatry and addiction medicine. As CMO of Elements Behavioral Health, he oversees a nationwide network of treatment centers including drug and alcohol rehab programs at The Ranch in Tennessee and The Right Step in Texas.
Editor: Muhammad Talha
About a third of hospital costs are linked to addiction and substance use, for example, according to statistics from The Center on Addiction and Substance Abuse at Columbia University. Of those who enter the juvenile justice system, 44% meet the criteria for addiction (and that doesn’t even include nicotine). And 16% of state budgets are spent on addiction and risky use, and almost all of it — 96% — goes to pay for the consequences.
Clearly, the human and economic savings would be astronomical if we were able to put in place successful prevention measures. We learned just saying no doesn’t work, so what can we do as a society and as individuals to stop addiction before it starts? Here are three areas that deserve our attention:
Prevent and Treat Trauma
Look behind an addiction, and you are likely to find trauma. And it comes in many forms: childhood neglect and abuse, bullying, combat experiences, sexual assault, to name only a few of the most common. When those who are traumatized try substances such as alcohol and other drugs, they often feel as though they’ve found just what they need — something to help them forget, to quiet the noise in their head, to ease the self-loathing, and to lift their mood.Preventing trauma and helping those who are traumatized deal with it becomes by extension a powerful way to keep substance use problems from gaining a foothold.What we can do:
- Increase access to parenting programs that can help lower the incidents of childhood trauma in the first place. These are particularly important for parents who were themselves abused as children. The feelings of competence such classes bring can help break what’s often a cycle of abuse, research shows.
- Promote school programs that teach emotional control, such as the mindfulness-based Kindness Curriculum developed by the University of Madison-Wisconsin and shown to help preschool kids regulate themselves. Childhood trauma can prompt impulsivity and compulsiveness, both of which are linked to an increased risk of addiction. A 2011 study shows that those who get the hang of self-control in childhood are not only less likely to abuse drugs but to be healthier and to do better financially as adults.
- Encourage anti-bullying campaigns that emphasize empathy not just in schools but in the workplace as well. Home should also be part of the equation. Sibling bullying is often shrugged off but it can traumatize, and just like outside bullying, it’s linked to substance use.
Reevaluate Treatments for Chronic Pain
Over the past couple of decades, prescription opioids have been our go-to response for those in pain. Problem is, such painkillers have proven to be dangerously addictive, leading to a quadrupling of prescription opioid overdose deaths since 1999.Efforts to pull back on the rampant overprescribing and use has had an unintended and tragic consequence: heroin, also an opioid, has become a substitute. So we now have not only a prescription drug epidemic but a heroin epidemic as well.If that’s not bad enough, a recent National Institutes of Health (NIH) position paper concluded there’s scant proof that opioids are even effective for chronic pain, and the studies we’ve relied upon to justify their use are generally of poor quality. Truth is, the scientific community knows little about how chronic pain develops, and our reliance on opioids to fill the treatment void continues to boost addiction risk.What we can do:
- Support quality research that better identifies when opioids will and won’t help so that they can be used appropriately, effectively and safely.
- Explore alternatives and complementary therapies for chronic pain that might be able to replace conventional opioids or reduce their use. It’s long past time for such research, the NIH paper noted, adding that our society’s tendency to turn to the quick and easy expedient of pills for every ill has prevented other options from receiving the attention and study they deserve. There’s also encouraging research that we may be able to rewire our brains, which are much more plastic than once realized, to bypass pain.
- Educate primary care physicians about opioids. A recent Johns Hopkins study discovered that most doctors misunderstand crucial facts about opioids that may lead to unsafe prescribing. Patients should be educated too, so they can better understand what to realistically expect from the drugs in terms of pain relief and how to minimize their risks.
Prioritize Mental Health
About half of those struggling with mental health issues such as depression, anxiety, bipolar disorder and schizophrenia are also struggling with substance use, studies show. In some cases, drugs and alcohol become a form of self-medication, providing a temporary escape from symptoms. In others, drug and alcohol use prompt the onset of mental illness.That means we aren’t always sure if the mental illness or the substance use came first, but we do know the two issues only serve to make each other worse. We also know that anything that can be done to safeguard and improve our mental health means addiction becomes much less a risk.What we can do:
- Pay as much attention to our mental health as we do our physical health. Many experts advocate annual mental health checkups along with physical checkups, as well as combining mental health and general medical offices. This will help take us away from the tendency to see mental and physical health as somehow separate. Both are, in reality, deeply entwined.
- Boost the mental health offerings in schools so that we can reach those who are vulnerable to issues such as depression and anxiety before they turn to substances. A program instituted in a Canadian school system, for example, screened its entire student body for mental health issues, helped those who needed it, and taught lessons on resilience, stress reduction and empathy to all. Within just three months, depression was down 15%, anxiety was down 11%, and the students had learned skills that would serve as a buffer to substance use for the rest of their lives.
- Increase funding and support for mental health services, and make use of creative solutions such as mental health courts, which direct those with mental illnesses away from jail, where problems are destined only to get worse, and into treatment.
- Reduce stigma. Social media campaigns such as Be Vocal, Project Semicolon, Love is Louder and others have done much lately to advance a conversation about the need to get past the stigma surrounding mental illness. But more is desperately needed. The best mental health services in the world are useless, after all, if people feel too embarrassed or ashamed to use them.