Many people have viewed substance use disorders – or, more commonly, addiction – as a moral failure for far too long. It is this misguided perception that has unfortunately contributed to the shame that addicts may feel, which not only steers them away from seeking help but leads to greater substance use disorders.
If we truly desire to help our friends, family, and those who feel they have neither, the cultural mindset that addiction is a character flaw needs to change. The first-ever Surgeon General’s Report on this topic, Facing Addiction in America, addresses this stigma and seeks to help us better understand addiction and how to help its victims.
The U.S. Surgeon General’s Remarks on the Addiction Crisis
In his preface to this report, U.S. Surgeon General Vivek H. Murthy began by revisiting a moment from his past. What has shaped Murthy’s goals in his time as Surgeon General came in the form of a powerful yet daunting wish from the nurses at the hospital where he previously worked. It was this: “Please do something about the addiction crisis in America.”
Tackling this crisis is no small task, especially when substance misuse and substance use disorders range anywhere from prescription opioids to alcohol to unregulated street drugs. Murthy acknowledges that, unfortunately, no single solution exists. However, he does propose a few ways in which the country can positively move forward.
Ultimately, Murthy calls for an increase of policies that enable access to proven treatment programs; investment in and expansion of scientific evidence base for prevention, treatment, and recovery; as well as our acknowledgment that addiction is a chronic illness the deserves the same respect as diabetes, heart disease, and cancer.
Addiction as a Health Issue, not a Character Flaw
When you start to explore the factors of addiction, it becomes clear that there are many things that contribute to the resulting addiction. Studies about the neurobiology of individuals with substance use disorders strongly suggest that they do not simply have character flaws. Instead, they have chronic illnesses, which are:
- Subject to relapse, and
- Influenced by a combination of genetic, developmental, behavioral, social, and environmental factors.
Substance Addiction is a Chronic Brain Disease
As individuals fall deeper into alcohol or other drug misuses, the brain’s structure and function go through neuroadaptations (i.e., changes). Over time, these neuroadaptations can turn their seemingly controlled substance use into something that becomes extremely challenging to control.
Murthy noted that over sixty percent of treated substance abuse patients relapse within their first year of recovery. This stat scarily implies that substances’ effects on the brain can last for many years which puts individuals with substance use disorders at significant risk.[6,7]
Areas of Brain Disruption
In substance use disorders, drugs mainly affect three areas of the brain:
- The Basal ganglia are located deep in the brain. These set of structures control the feel-good, rewarding effects of substance use, and the substance-taking habits that people form.
- The Extended amygdala is located below the basal ganglia. It helps control stress levels and responses to discomfort, anxiety, and irritability often associated with withdrawal symptoms.
- The Prefrontal cortex is located above the eyes, right at the front of the brain. It controls the more complex cognitive processes, or, “executive function” (e.g., time management, decision-making, and impulse regulation).
3-Stage Cycle of Addiction
1. Binge/Intoxication (Basal Ganglia): Person A uses an intoxicating substance and being to experience its rewarding and/or feel-good effects.
2. Withdrawal/Negative Affect (Extended Amygdala): Person A has not used the intoxicating substance that made them feel good in stage one. As a result, this person experiences a negative emotional state.
3. Preoccupation/Anticipation (Prefrontal Cortex): Should Person A continue to experience this negative emotional state being apart from the intoxicating substance, they will seek it out after a period.
Now that you generally understand how substance use can affect the brain, we cannot soundly chock up an addiction to be a flaw in someone’s character. The statistics in the report’s fact sheet clearly illustrate America’s serious substance misuse problem.
The Report’s Recommendations
Murthy’s report highlights a crucial cultural shift that has begun and absolutely must continue. This shift involves a move away from the Criminal Justice-Based Model to a Public Health Approach for dealing with substance misuse and substance use disorders. We list some alternatives to this better approach below.
Individuals and Families
- Reach out, if you think you have a problem
- Refrain from judgment and be supportive if a loved one has a problem
- Be supportive toward recovering individuals
- Advocate for changes in your community
- If you’re a parent, talk to your children about alcohol and drugs
Educators and Academic Stakeholders
- Widely implement evidence-based prevention interventions
- Provide treatment and recovery supports for students (i.e., primary school through university)
- Teach accurate and recent information about alcohol and drugs, as well as its misuse
- Enhance health care workers’ training (e.g., only eight percent of American medical schools offer a separate, required course on addiction medicine)
Health Care Professionals
- Treat substance use issues with the same care and respect as other chronic illnesses (e.g. diabetes, coronary heart disease, and cancer)
- Support high-quality care for substance use disorders
Health Care Systems
- Promote primary prevention (i.e., hold staff accountable for safe controlled substance prescription, alternative ways to manage pain and anxiety, etc.)
- Implement health information technologies for efficiency and high-quality care
- Build awareness of substance use as a public health problem
- Invest in evidence-based prevention interventions and recovery supports
- Promote only responsible, safe use of legal substances by adults
- Support youth substance use prevention
- Collaborate with federal initiatives to reduce overdose, death, and dependence on prescription opioids and heroin
Various Levels of Government
- Be leaders by providing guidance and a vision that supports science-based approaches to substance use-related health issues
- Implement reforms to the criminal justice system so that it models a health-focused approach rather than a punitive one
- Conduct research with an emphasis on finding implementable, sustainable solutions for high-priority substance use issues
- Consider innovative ways that their research can inform public policy
- Promote a rigorous evaluation of current programs and policies with the aim to make them better
One of the hardest, most heartbreaking things to go through is not knowing what to do or say to a friend or family member who suffers from addiction. What we can do is not define them by their addiction and to remember that they are human beings who need help the same as you.
Ultimately, if we do not respond to this crisis effectively, scientifically, and lovingly, that will be the real moral failure. Use this knowledge to help end the addiction stigma.
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