Dismantling the Disdain
Welcome and thank you for taking the time to read my first blog post. Moving forward, I plan to write a series related to alcohol and drug related problems (AOD) in the United States. It is one of the most prolific issues with which society has to contend. Most people have either been personally impacted or know someone who has been significantly impacted by drugs and alcohol. I am a Licensed Clinical Social Worker and specialize in substance use disorders. Years of work in this field have left me with a healthy respect for the sheer power drugs and alcohol exert on a huge segment of the American population. Over 23 million Americans experience active drug or alcohol addiction. Alarmingly, only an estimated 10% of these people get the treatment they need. I have always known the numbers in this arena were not positive, so I generally don’t pay attention to these statistics, as I see people recover and live happy, productive lives as well. Despite my respect for the power of substances on humans and being in the field and aware that getting treatment for these particular problems can be very challenging, I still felt I was missing something. How could 20.7 million people living in the United Stated NOT be getting treatment they need?
I decided to investigate this further. I began a literature review to learn more. I identified the prominent researchers, studies, and surveys. For the size of the problem there is actually little data out there in regard to barriers to substance use disorder treatment. Funding has largely gone to other areas within the realm of alcohol and drug related problems such as prevention, education, and statistical data on the health/societal consequences. This information, while useful, is not getting millions of people help for alcohol and drug related problems, and the research clearly demonstrates that AOD issues are TREATABLE. Why will people go for help when they have illness but not a substance use problem?
What I have learned and continue to learn has profoundly changed my clinical work and the lens through which I view AOD problems. It has changed how I speak to the public, professionals, and to anyone who has experienced the incredible suffering and pain AOD problems create. Researchers found that the primary reasons why people are not getting treatment are largely DISCRIMINATION, STIGMA, PREJUDICE and BIAS. This is a view that I have held to a limited degree for some time. It was then I realized clinical skills are not enough to treat AOD problems effectively. I needed to revisit my roots as a social worker and commitment to social justice and advocacy. As I continued my quest to understand more I was shocked at times by what I learned.
This blog series will explore the various ways people with AOD problems are marginalized, thus making them reluctant to pursue treatment. I hope that by sharing what I discovered, others will rethink their approaches to AOD, and change will happen. I refuse to sit silently while legions of people are dying from stigma that comes with AOD.
Words are important. If you want to care for something, you call it a “flower”; if you want to kill something you call it a “weed.”—Don Coyhis
I found the above quote in a prominent study, and it sums up the dialogue around AOD well. Let’s examine three words that language professionals, the general public, and many in long term recovery use: ALCOHOLIC, DRUG ADDICT, and ADDICT IN RECOVERY. It has been demonstrated that these words are all “weeds.” They are pejorative and reinforce false notions that relapse is imminent, the person will never get better, and you or the person, family, or acquaintances are struggling. Take a moment to consider some of the stereotypes that people think when they see or heard the word ADDICT. If I was running a group discussion with either adults or adolescents, we could fill a dry erase board in just a few minutes with words like:
junkie, dishonest, thief, lazy , abuser, bad habit, dirty, immoral, homeless, poor, crazy, weak, loser, bad family life, unemployed, uneducated, risk takers, prostitutes, unsuccessful , illegal.
The feelings that the words above evoke are precisely why many people won’t get help. Would you sign up for a club or apply for a job if those words were used to describe it? Probably not. Instead it reinforces the problem by compelling individuals to hide and deny a problem exists. Research shows that the terms like ADDICT are unlikely to be associated with anything that would contribute to eliminating the discrimination that prevents people from getting help. Let’s face it, you probably wouldn’t expect a close friend in your neighborhood who has a spouse, children, a high paying job in a respected profession, and watched your children was living on the streets shooting heroin 15 years earlier. But you most likely will never find out. That individual is already well aware of what could or would happen if they shared that they are in recovery. They remain in silence because the consequences associated with the stigma are thought to be far too great, and they won’t put the most important people in their lives at risk.
What I write in this first post is just the tip of the iceberg in the dialogue about AOD and solutions for getting people the help they need. I just used three terms—alcoholic, drug addict, and addict in recovery–as examples that trigger stigma, discrimination, and bias. We need to change the dialogue and correct misconceptions about addiction and recovery. The implications of not finding a solution for a problem of this scale are serious. I don’t think enough research has been conducted to accurately assess the financial cost of not making changes in this arena. We are spending significant money on the legal and health related costs, but perhaps not adequately considering the human costs around those who are suffering. It is not only the life of the person who is using the substance; it is the family, friends, and the innocent bystanders at the wrong place at the wrong time who suffer as well. AOD related problems maim, scar, and eventually kill if left untreated.
Conversely people who get treatment can go on to long-term recovery and actually end up offsetting their expense to society through civic engagements, repayment of debt, and taxes paid through successful employment. There are reductions in medical, legal, and social costs across the board. Current activity within the advocacy realm is higher than it has been in quite some time. It is getting more organized. Government funded agencies like NIDA and SAMSA, the major sponsors for research, are awarding funds to learn more. The Recovery Movement is here and those involved are starting a new conversation. More and more people are being empowered to speak and no longer be ashamed and afraid of being identified as a person in recovery. I believe this is the future of change in the world of AOD, and I am excited about the possibilities ahead. In subsequent entries I will discuss other forms of discrimination, the recovery movement, and ways it is trying to change public perception, policy, and access to treatment.