Addiction is finally starting to get attention in the media. For over a decade, those of us on the front lines of this epidemic have known it has been worsening. We’ve understood that if we didn’t take a comprehensive and aggressive approach to the problem, the ripple effect was going to be devastating. Only now is the rest of the country starting to pay attention.
The fact that we’re finally beginning to tell the stories of mothers and fathers and sons and daughters who have died needlessly; that we’re finally starting to talk about the role major pharmaceutical companies play in this nightmare; that we’re no longer glossing over the impact our healthcare system has on the growing number of deaths from opioid overdoses; and the fact that we’re changing the narrative around addiction in general—this is the step forward we’ve all been waiting for.
Still, there’s one thing that continues to bother me. We need to stop calling this the opioid epidemic. It’s extremely short-sighted and it’s not effective in getting to the root of the problem. What we’re in the midst of is an ever-worsening addiction pandemic.
According to studies, it’s not only opioid use that’s on the rise. Alcohol is also becoming an ever-increasing problem. Read the heartbreaking statistics in this article from Vox, which suggests “nearly 30 million Americans now suffer from alcohol addiction.” Thirty million. That’s up almost 50% from 2001. And it’s getting worse by the day.
I wish I could say it ended there. But the use of meth is also on the rise at a rate that could surpass opiates. Brad Schimel, Wisconsin's Attorney General, goes as far to say, in this NBC news article, that “…we are entering another full-blown epidemic with meth."
And cell-phone or technology addiction? CNN reports that over 50% of teens meet criteria for cell-phone addiction while this recent study by Front Psychiatry reports that "this addiction can lead to an increased likelihood of substance use, interference with sleep, poor self-esteem, impulsivity and sensation seeking."
We've got a massive problem folks.
It’s important we take these dire statistics into account and talk about addiction in a comprehensive way, because if we approach this like it is only an opioid problem, we might address things like Big Pharma, and healthcare and policy—all of which are necessary and important. At the same time, with this take, we will miss what I believe is really driving the addiction pandemic: pain.
As a survivor of the Columbine tragedy almost two decades ago, I’m no stranger to pain—both physical and emotional. And as a person in long-term recovery, and someone who has worked hands-on in an addiction recovery setting for the past six years, I can tell you that there is no such thing as addiction without underlying emotional pain and trauma. And for our culture to be able to recover from this massive problem we’re facing, we have to approach it not only by implementing policy, but also by addressing the cause.
Opiates aren’t responsible for what’s happening in our society, their availability has just made it more deadly.
Emotional pain and trauma is a major driving force in addiction. According to studies, Adverse Childhood Experiences (which can encapsulate anything from emotional neglect, to household mental illness, to physical violence, to a family member being incarcerated) increase a child’s risk of early initiation into alcohol, leads to a higher risk in self-harm, and increases their risk of abusing prescription drugs by 62%. 62%! We cannot ignore that statistic.
And yet we also have to acknowledge that, if they weren't medicating with opiates, they’d be medicating with something else. They already are.
In order for us to make any kind of real progress with this problem, we must begin to see that simply changing prescribing habits and putting patients on Suboxone isn’t the answer. We won’t see real, tangible progress with addiction until we address the root cause: pain.
I believe we need to take a four-tiered, macro-level approach to plot a course forward: two tiers focused on prevention and two tiers focused on rehabilitation.
1) The first reform is to the healthcare system, which as it stands now takes a very two-dimensional approach to pain management. By this I mean that if you are in a car accident where you break your leg, you’ll be treated for the physical pain of your injury, but rarely if ever asked about the emotional pain or trauma involved. Even if, as a part of this car accident, you lost a close friend or relative who was injured worse than you were, your medical provider is still unlikely to ask you about the emotional pain associated with your experience.
The problem is two-fold. First, as it relates to the opioid problem, prescription opiates are actually far more effective at relieving emotional pain than they are with relieving physical pain. Meaning if you were in a car accident like the one I described above, where you suffered a variety of painful physical injuries and also lost a loved one, the prescription pills offered to you would be best at relieving the symptoms of grief and PTSD you’re about to experience—a pain your medical provider likely doesn’t even address.
Also, while the availability of opiates certainly makes them an easy target for this conversation, without their availability, human beings would find something else to reach for in order to numb their emotional pain. As long as emotional pain exists, and we lack healthy ways to deal with it or education around it, we’ll keep self-medicating with prescription pills, alcohol, pornography, sex, and anything else we can find to numb the pain. To not be present. To not have to feel.
In order to turn the tides on this, there needs to be a more collaborative approach between physical and mental health. We have to evolve the healthcare system to address not only the physical injury of patients, but also the emotional trauma involved. We must educate patients on how this sets them up for addiction and other adverse behaviors in their future. This is especially important to think about as mass shootings spiral out of control in our culture and these emotionally traumatic events become more and more common.
I don’t believe it’s effective to treat only the physiology of an injured person.
2) Another way we’re failing at curbing the addiction epidemic is by failing to educate youth about addiction, trauma, pain and adverse childhood experiences. Especially our young boys. We’re socializing them to compete, rather than connect. We teach them not to talk about their feelings, that “real men” don’t cry, and not to admit when they are in pain. As a result, I meet so many adult men who are medicating emotional pain with pornography, promiscuity, or even technology. They may not be “drug addicts” yet, but they’re set up for it, given the right access. An access that most are offered at some point in their life.
If we think this isn’t contributing to the massive problem of addiction in our culture, we’re kidding ourselves. We have to find a way to give people—men in particular—permission to emotionally connect. This is what will heal our culture and turn the tides on this pandemic. Fellowship, community and camaraderie might seem like “secondary” solutions to the problem, but I promise they’re not. What keeps people healthy is connection.
We have to find a way to normalize conversations around trauma and the necessity of relationships and connection. We must create a culture where everyone feels free to speak up about emotional pain. We must start early, equipping youth with resources to deal with emotionally traumatic experiences. If we don’t, we might as well sit back and watch this problem get worse and worse. It’s time to bring real world conversations about addiction, trauma, pain and adverse childhood experiences into the classroom.
3) The third tier to my approach involves the criminal justice system, which does a horrible job of separating punitive and rehabilitative approaches. There are times, of course, when the punitive approach is necessary and appropriate, but for those who might respond to rehabilitation, the punitive approach does far more damage than it does good. Correction officers aren’t clinicians and clinicians aren’t correction officers.
Not only that, the population of prisoners who need a punitive approach are toxic to the population of prisoners who need a rehabilitative approach. They have to be segregated. We need two completely separate tracks in our criminal justice system.
4) Finally, if we’re ever going to see any level of improvement in this pandemic, we must begin offering greater accessibility to long-term treatment. The old “28 day” treatment program has long been disproven by the science, and yet thanks to Hollywood and our own stubborn ignorance, we have a whole healthcare system and culture built around this idea that an addict can get clean in 28 days.
While a patient can physically detox in 28 days, all the research shows it takes at least 90 days for the brain to begin returning to normal. And from my experience, it’s usually around the 12-month mark that people in recovery begin to embrace their new normal. Meaning our healthcare and insurance models are built around an old understanding of addiction, so most treatment programs are built around the old understanding of addiction, and as a result, we are sending addicted brains back out into the world to make sober decisions. No wonder it’s not working. There is no fast path to long-term recovery.
By providing greater accessibility to long-term treatment, we dramatically increase the changes of patients staying sober. If the insurance companies could understand this, and would be willing to make a more significant investment up front, they’d save millions of dollars from relapses and we would all see a dramatic shift over the next decades. The length of time a person spends in treatment is the greatest predictor of long-term success. Why aren’t we paying attention to that?
We cannot be short-sighted about this. It will get worse before it gets better. We must think about what this issue is going to look like in 10, 25 and 50 years. If we can do that, I believe we will begin to see marked improvement. This is our best shot. There’s no quick fix. But there is no time to waste. We have to act now.