We All Want to Flourish, Those Served in Substance Use Care Deserve Nothing Less

A few weeks back, fellow writer and colleague Jason Schwartz posted a piece titled Meaning and purpose in the context of opioid overdose deaths. It and the related article of the same title written by outgoing Editor in Chief, Dr. Eric Strain of Drug and Alcohol Dependence deeply resonated with me. Dr Strain lists some critical questions delineated in Jason’s blog post linked above. Dr Strain also writes:

“If we are committed to helping people fully address their SUD, then we need to do more than prescribe a medication or to prevent them from an overdose. We need to help them find meaning and purpose, to grow, as we all need to grow. We should not wither or stagnate in our lives, but continue to grow in our relationships, our health, in our view of the meaning and purpose we have that gets us out of bed in the morning and engages us in enterprises that are bigger than us. We should strive for the same for those who suffer from a SUD.”

This is worth reading again. The truth of our care systems is that we do not provide the same care as we would wish for our own loved ones. We all know this. People in recovery have been advocating to change this for several decades. Those of us we who have successfully navigated our limited, flawed and fragmented care systems know that if we actually did these things – focused on assisting persons with addictions to find proper meaning, support and hope in their own lives, we would radically change our care systems for the better while saving lives and resources.

None of this is new information. Nor is the fact that substance use disorders are complex conditions. Reflective of this fact, the current definition of addiction by the American Psychological Association is:

Addiction is a chronic disorder with biological, psychological, social and environmental factors influencing its development and maintenance. About half the risk for addiction is genetic. Genes affect the degree of reward that individuals experience when initially using a substance (e.g., drugs) or engaging in certain behaviors (e.g., gambling), as well as the way the body processes alcohol or other drugs. Heightened desire to re-experience use of the substance or behavior, potentially influenced by psychological (e.g., stress, history of trauma), social (e.g., family or friends’ use of a substance), and environmental factors (e.g., accessibility of a substance, low cost) can lead to regular use/exposure, with chronic use/exposure leading to brain changes.

Despite its complexity, we treat SUDs like single substance issues with narrowly focused, short-term strategies. I have written about this at length. To provide some analogy here, if we treated complex fractures of the femur in this way, we would pin the bones and send people on their way without a cast and hope it sets itself straight. We may even suggest that the healing of the bone properly would be the patient’s choice and hope they made good decisions on bracing it. If we did that, we would have a lot of people who could no longer walk or who were limping around on bowed legs. We may even blame them for not healing their own leg properly. We have more compassion for people with broken bones than to consider such barbaric care and attitudes. In respect to substance use care this is unfortunately not the case.  

People in recovery started a movement 20 years ago to fix our SUD care system and design care that met our needs. It is called the New Recovery Advocacy Movement (NRAM). Suffice it to say we still have a very long way to go. That we have made rather limited progress is instructive on the breadth and depth reflective of implicit bias against persons with substance use disorders. Essentially, our care systems do not see the persons served as having the same value as we see ourselves or our own family members. It is hard to swallow and undeniably true in the same breath.  

We appreciate Dr Strain for stating what we all know. A reflective care system would consider our needs and commit to radical change. Yet what we see is like a form of cognitive inertia within our behavioral health care systems. We even experience instances where those of calling for such change are ostracized or called uneducated, the pejorative “drug addict” label silent but ever present. This is how the voices of lived (and formally educated) experience are dismissed.

Having spent my entire adult life through age 55 immersed in work to support recovery, I can tell you that very often I would get calls from people seeking more comprehensive care for their loved ones than the average person gets. The conversation invariably turns to their perception that their loved one started down an innocent path the led to addiction and their loved one is not like those others and deserved to be treated better. Their person is not like “those people.” Having treated thousands of people seeking public funded care, I know this to be entirely false. Mahatma Ghandi once said “A nation’s greatness is measured by how it treats its weakest members.” If we want better care for our own family members, we must concentrate efforts to dramatically improve care for those who have the least. Perhaps we start with Dr Strain’s point and change care to reflect what we would want in our own lives.