If Addiction is a Disease, Why don't We Treat It Like One?
It was a dark and stormy Friday night. I was driving to meet with the family of a young man who is in the midst of a very active addiction to prescription pain medication. I met his sister-in-law earlier in the week when I spoke at the school of nursing she's attending. She had the courage to approach me after the presentation and ask for help for her sister and brother-in-law.
As I was pulling into the place where we had chosen to meet, I thought, why should it take courage to ask for assistance when someone has a chronic, progressive, fatal disease? More specifically, why should it take courage to ask for help with THIS disease? It doesn't take courage to ask for help with diabetes, high blood pressure or asthma. Why does it take courage to just ask for help for addiction?
The answer? Stigma.
- A mark of disgrace or infamy; a stain or reproach, as on one's reputation.
- Medicine/Medical .
- a mental or physical mark that is characteristic of a defect or disease: the stigmata of leprosy.
- Archaic . a mark made by a branding iron on the skin of a criminal or slave.
1. blot, blemish, tarnish.
brand, mark, stain
Pretty good descriptions of how we (meaning society in general, and as a profession specifically) treat those unlucky enough to have the wrong genetic makeup and exposed to the right triggers (stress, poor coping skills, and exposure to the right substance or substances).
Science continues to discover the cause of many (if not most) disease states is a combination of genetics and environmental triggers. Lifestyle choices are definitely included as environmental triggers.
Cancer can be linked to many lifestyle choices, including smoking, drinking alcohol, exposure to ultraviolet radiation (like sunbathing...whether it's actually the sun or one of those goofy “tanning beds”), certain diets, and career choices (shipbuilders, pipefitters, insulation installers, tile workers, and more http://www.lawyershop.com/practice-areas/asbestos-mesothelioma/lung-cancer/high-risk-jobs), etc.
Cardiovascular disorders have been related to lifestyle choices as well. Diet (high saturated fats, high sodium, etc.), activity (couch potatoes, video game wizards, internet surfers), careers (“High-flying career women with stressful jobs face a higher risk of heart disease, warn researchers.” http://www.dailymail.co.uk/health/article-1273305/Stressful-jobs-giving-women-heart-disease.html), along with genetics increases the risk of hypertension, heart attacks, and stroke.
Type II diabetes risk is increased by genetics, diet (high fat/high carb), lack of physical activity, high alcohol intake, obesity, and other lifestyle choices (http://www.emedicinehealth.com/diabetes/page2_em.htm#Diabetes%20Causes).
So if “choices” are an integral part of other chronic, progressive, fatal diseases, why don't we rag on diabetics, cancer patients, and those who have heart attacks and strokes? Because we believe these are all legitimate (or “real”) diseases, while we believe addiction is a lack of will power or a lack of “moral fiber” (the capacity to do what is right, no matter what the circumstance. http://www.urbandictionary.com/define.php?term=moral%20fiber). (If addiction is a disease, why do many colleges place “Addiction Studies” in the Criminal Justice Department?)
Because of the stigma associated with the DISEASE of addiction, several things occur:
* People won’t seek treatment;
* Many health care professionals refuse treat addicts;
* Colleagues ignore the “problem” as long as possible (allowing the disease to progress and increase the risk of harm to patients); and
* Insurance companies won't pay for services, or severely limit payment.
I cringe when I recall some of the things I said to people when I was an ER nurse. “If you loved your family, you'd stop doing this!” Gee. If addiction is a chronic disease that alters the brain and makes it impossible to “stop doing this”, telling the person to stop is pretty stupid, don't you think? “What do you mean your blood sugar is 300!? If you loved your family you'd stop letting your blood sugar get that high!”....”But doctor, I watch my diet, exercise, and take my insulin. I need help!”... “You obviously don't really WANT your blood sugar to go down! You worthless piece of $#%&!! Get out of my ER!”
So why don't we believe addiction is a disease? Based on my experience as an ER nurse and nurse anesthetist, our educational programs don't educate us about the DISEASE. What they do educate us about is the side effects of the disease...cirrhosis, gastritis, renal disease, infections, etc.).
Research has provided us with the SCIENCE associated with the disease of addiction. It tells us why addiction is a disease. It let's us know the target organ (the limbic brain), how that organ is affected, the signs and symptoms of those changes in the brain (obsession on obtaining the drug, uncontrolled use of the drug(s), and caving for the drug when the addict can't get their drug(s)), how to intervene, how to treat the person, and how to help them maintain remission (called “recovery”).
Unfortunately, if we as health care professionals don't understand the science we continue to base our “treatment” on what I call “the 3 Ms of Addiction” - Myth, Misbelief, and Misinformation.
If you're a nurse struggling with addiction, or know a colleague who might be, and you aren't sure what to do, contact me at email@example.com or 513-833-4584.
There is hope. There is help.