Written By: Fred Menachem
If a person is diagnosed with breast cancer the medical protocol is different than for someone diagnosed with lung cancer. One patient might respond positively to a protocol that failed in someone with the same or similar disease but the profession keeps trying and giving up is rarely, if ever an option. Diseases manifest themselves in subsets and spectrums that are consistently evaluated and assessed by trained medical professionals to identify appropriate treatments, scientists test new medications, while researchers collect data and study ways to treat and hopefully prevent the disease in the future. Yet in 2016, more often than not, we view and treat the disease of addiction from the singular lens of a monolithic telescope, while many loud voices in both the recovery and even the medical community fiercely resist data driven research, new treatment methods and scientific approaches.
If someone is a smoker we would never suggest withholding treatment from them “until they hit rock bottom” or quit smoking entirely, nor would we cast them out, shame them, stigmatize them and encourage a “tough love” approach if they weren’t able to live up to our expectations or standards. If someone is diagnosed with the disease of diabetes and after appropriate medical and clinical intervention does their best to take responsibility, yet, continues to relapse by eating too much sugar, we certainly wouldn’t throw our hands in the air medically, send them to a self help group, tell them they suffer from a spiritual malady, defects of character and are doomed if they can’t accept that only a “higher power” can remove their cravings while only viewing the scientific component as an after thought not the primary form of treatment. If the medical community behaved this way that would be considered medical malpractice and would most likely end in the suspension of their professional license. Yet, with the disease of addiction, this has been the acceptable protocol for almost a century.
In the 1930’s doctors were limited by their lack of medical advances and fortunately found a method that worked for a subset of the population. But at some point “Twelve Step” based programs were universally adopted and became the “gold standard” of treatment while we accepted the fallacy that medical science was incapable of combatting and treating substance use disorders. At that time no malice existed, doctors were only admitting their limitations, but over the years it became a cop out and an easy way for physicians to ignore the “Hippocratic Oath”, and helped to perpetuate a stigma that not only freed them from responsibility but instead placed the sole failure at the feet of the patient. While we clinically spoke the language of disease our actions told a much different story. When a loved one dies from cancer we grieve loudly, yet when substances take their toll we shake our heads in disgust at the persons lack of morality and their poor choices, rarely acknowledging the disease and often turning a blind eye to their suffering. The reality as it relates to the disease of addiction is that moral failing has never truly been eradicated from our collective thought process.
No one doubts that “12 Step” programs play an invaluable role for some in the treatment of addiction but they aren’t a solution for everyone plus for many they need to be complimented with a triage of integrated care to include continuing medical, psychiatric and psychological components. They certainly don’t justify courts and medical practitioners throwing their hands in the air, limiting the options to a spiritual solution that is supposed to combat a disease that’s killing more people in the United States than car crashes and ruining the lives of those that are living without the appropriate resources. Imagine if we sent someone who had cancer or diabetes to a self-help group and told them they must pray to remove their “condition” with modern medicine only serving as an afterthought. It would be a return to the “middle ages” when “barbers” thought that taking blood would help cure the patient of sickness so they would barbarically apply leeches to the patient killing more people than they saved.
In the 1980’s we saw how stigma played a role in those afflicted with HIV. Those who were diagnosed with AIDS were demeaned and cast out while many voices claimed they had a moral failing, were not worthy of saving and deserved everything they got. For a long time because of those ideas, research wasn’t funded at the appropriate levels causing tragic suffering and unnecessary deaths. There was also a time in our history when we used to put those with leprosy into colonies, separating them and ostracizing them from the rest of society until we came to terms with the cruelty of those actions. Yet today 75 percent of people suffering from addiction never receive the treatment they so desperately need and often times the treatment they receive is sub par, far from adequate and barely recognizes the mental health component that often goes hand in hand with substance use disorders. Rarely do we implement long-term integrated care because insurance companies find it too costly and because of that many who are addicted and also may have mental health issues will either die or never live a normal and functional life.
As it relates to research, very few legitimate studies exist, most are manipulated by an unregulated industry that is tasked with saving lives but instead encourages protocols that do little to make an impact on the disease. Instead the “research” provides unscrupulous providers with new funding sources so they can justify billing insurance companies for bogus services while increasing their profit margins. The responsible data that does exist shows little or no improvement in treating the disease of addiction over the course of the past 100 years. Researchers like Dr. John Kelly, Professor at Harvard Medical School and the founder and Director of the Recovery Research Institute at Massachusetts General Hospital (MGH), are starting to generate responsible data driven clinical studies but they too are limited by a lack of appropriate funding. Frankly the medical professions failure to make any real improvement in those with substance use disorders has traditionally placed all the blame at the feet of those struggling with the disease, ignoring our failure to adequately treat and fund appropriate research at the levels that we fund other diseases. While no one can deny that a patient needs to take responsibility as it relates to their own medical condition, common sense alone would tell us that the 40 million Americans age 12 and over that meet the clinical criteria for addiction wouldn’t make the choice to destroy their lives if that choice existed.
Did you know that doctors aren’t limited by the number and strength of opioid painkiller pills prescribed to their patients? Yet physicians who agree to prescribe buprenorphine (Suboxone), the medication that assists with withdrawal from these opioids are only permitted to treat 30 patients at any one time in the first year and up to 100 patients in subsequent years. Through the use of medication-assisted therapies, France was able to lower its drug overdose rate by 79 percent over a four-year period. Yet here in the United States, we still restrict their use. Finally, in a weak attempt, 26 Senators recently sent a letter to HHS pressuring the agency to change its policy. If this was any other disease you would see tremendous protest from every facet of society but due to the stigma that continues to plague addiction, we accept minimal progress as tremendous gain.
President Obama has taken tremendous leadership on this issue and has requested 1.1 billion in new funding to combat substance use disorders but has continued to hit a brick wall in the House. Michael Botticelli the Director of the Office of National Drug Policy and in recovery himself, is tirelessly trying to change the conversation, reframe the failed “war on drugs” by helping people instead of incarcerating them and working to eradicate an unfair stigma by encouraging the use of new methods to treat the disease. But Congress needs to get their act together and pass the “Comprehensive Addiction and Recovery Act” so he can be more effective, yet, up to this point they refuse to provide the additional funding. The sad reality is if bills like CARA aren’t properly funded, it will be lauded as a political victory but will only be another empty piece of legislation that doesn’t come close to providing the necessary tools to combat the growing epidemic of addiction that’s plaguing our nation. If Congress doesn’t responsibly act, and soon, then they are partially responsibility for the tragic suffering and deaths that will continue to occur due to their inaction. We have gone too long without the proper resources to combat this disease, the time to act is now and soon, if not, it just may be too late.
Fred Menachem, Substance Abuse and Mental Health Reform Advocate, POLITICO CAUCUS Team and frequent contributor to Miami Herald, Sun-Sentinel and Palm Beach Post Twitter @FredMenachem