Reading or hearing the word addiction triggers an image in the minds of most--usually emotional and negative. Discussing the topic in a scientific, non-emotional way is a challenge. As a society we constantly deal with the complications, but seldom the cause.
Our institutions of criminal justice, social welfare, police, schools, and health care are overwhelmed by dealing with the consequences of addiction, and we seem to make little progress. We declare war on drugs, and illicit drugs are more prevalent and cheaper than ever before. We incarcerate for non-violent behaviors at record levels to the point that it compromises our resources for other necessary services. We struggle with safety-net issues and childhood neglect due to parents in the ravages of addiction.
Sometimes I'm reminded of John Godfrey Saxe's version of the famous Indian legend of "The Blind Men and The Elephant." Depending on the part of the elephant they examined, they felt it was a snake, fan, rope, tree, spear, or wall. So while they each proclaimed they clearly knew the object, they had not seen the entire whole of the object--but each was convinced they "knew" they were right. Perhaps those in charge of each of our societal approaches should step back and ask themselves if they really understand that with which they deal. My contention is that the elephant in our collective living room which we are ignoring is the illness of addiction.
In 1919, Dr. Ernest Bishop wrote in the American Journal of Public Health: "There is urgent need for widespread and early education of the medical profession, legislators, administrative authorities, and laity into the facts of addiction disease." Almost a hundred years have passed and we have failed to learn the lessons. In the interim, we have experienced the opioid addiction problem in the early 20th Century, prohibition, and then the war on drugs--and still haven't come to grips with the science of addiction.
Addiction is more about brains than it is about drugs. Some lose the ability to control drugs and have simply lost their "off" switch to addictive drugs--whether the drug is legal and sanctioned, is prescription and for legitimate medical use, or is illegal and has no known usefulness. Most all our approaches to this problem involve control of the supply of the drug, and little attention is paid to reducing the demand produced by addiction.
If you look at many of the issues confronting us today, addictive illness is usually lurking on the sidelines. We have never developed public policies congruent with our scientific understanding of addiction. Have we had enough failures that perhaps we could come together and discuss, dump our rigid ideologies, and see addiction for what it really is--an exaggerated desire to take a drug despite the consequences? No amount of incarceration, burning of crops of drugs in foreign countries (or praying to eliminate one addictive drug while praying to keep the one that we choose to like) is working.
Could we look at other options? What if we worked as hard at salvaging lives as we do at incarcerating offenders? What would education look like if we had parents engaged in their children's lives that are now in the fog of addiction? What if we spent as much on infrastructure repair as we do on prison operation? What if emergency departments in our hospitals were void of the trauma secondary to "under the influence" mishaps? What if drug/alcohol-fueled domestic-violence cases were eliminated? What if our court dockets were lessened by fewer drug possession/distribution cases? What if county jails were emptied of those incarcerated for breaking and entering in order to finance an addiction? Studies have suggested that for every dollar we invest in treatment, society will save seven dollars in return.
I do not buy the idea that people want to lose control of drugs. It is hard for most of us to understand how a behavior that began as a choice can turn into a behavior that defies most attempts at control. Yet most addicts that I've met want to use the drug they choose for the purpose they intend--just like all the non-addicts do.
But it transcends to something else. Addicts seldom understand the illness they suffer until too late. The behaviors from active addiction result in guilt, shame, and untold damage to themselves, those they love, and society at large. Perhaps we should recognize the elephant of addiction that sits among us, provide treatment, and work to restore lives as intensively as we work to deal with the aberrant behaviors triggered by addiction.
History is replete with examples in which science has changed the way we treat our fellow man. Before we understood that a spirochete was destroying brain tissue, syphilis was treated as a behavioral issue. Epilepsy was once understood as a behavioral disorder before we understood it as abnormal electrical activity in the brain. Yes, individuals have to be responsible for their behavior in a civilized society. However, we have an obligation to develop public policy based on our best understanding of science.
We can do better.
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Dennis Moore is a pharmacist, but spent most of his career managing addiction treatment centers in Georgia and North Carolina, and currently lives near his hometown of Batesville.
Editorial on 04/13/2015