Image courtesy Forbes Magazine. In my years of practice, I have seen the issue of opioid addiction come up time and again. Opioid addiction is hardly a new phenomenon; the British even fought two wars to ensure that they could deal opium in China (while simultaneously banning opium in Britain), perhaps cementing Great Britain as the world's first modern narco-state.
In any event, now that the opioid epidemic is an official national priority, and with the imminent implementation of national policies on this issue, perhaps it would be wise to take a step back and try to figure out how to deal with one of the most addictive drugs in the world.
But in order to deal with it, we have to face some facts -- facts which are not as well-publicized:
- Over 40% of American soldiers who had served in Vietnam during the Vietnam War tried heroin, and 20% became addicted.
- But, 96% of the soldiers who did not receive treatment for their heroin addictions resolved their addictions without treatment.
- Yet, of the soldiers who did receive treatment, 67% relapsed.
One can definitely argue that perhaps those who did not receive treatment, either by choice or because their addictions were not sufficiently problematic to result in forced treatment, were not as addicted as those who were subject to treatment. This might mean that those who received treatment were more troubled and therefore had more potential for relapse. Other arguments may be that treatment was less sophisticated in past years, or that the statistical analysis is flawed in some way. These are all valid counterpoints, but then look at this statistic:
"Of the Vietnam vets who were addicted to heroin in the war, 98% of them didn't get treatment, yet only 12% relapsed. Recovery, without treatment, is the norm."
In any event, now that the opioid epidemic is an official national priority, and with the imminent implementation of national policies on this issue, perhaps it would be wise to take a step back and try to figure out how to deal with one of the most addictive drugs in the world.
But in order to deal with it, we have to face some facts -- facts which are not as well-publicized:
- Over 40% of American soldiers who had served in Vietnam during the Vietnam War tried heroin, and 20% became addicted.
- But, 96% of the soldiers who did not receive treatment for their heroin addictions resolved their addictions without treatment.
- Yet, of the soldiers who did receive treatment, 67% relapsed.
One can definitely argue that perhaps those who did not receive treatment, either by choice or because their addictions were not sufficiently problematic to result in forced treatment, were not as addicted as those who were subject to treatment. This might mean that those who received treatment were more troubled and therefore had more potential for relapse. Other arguments may be that treatment was less sophisticated in past years, or that the statistical analysis is flawed in some way. These are all valid counterpoints, but then look at this statistic:
"Of the Vietnam vets who were addicted to heroin in the war, 98% of them didn't get treatment, yet only 12% relapsed. Recovery, without treatment, is the norm."
The current model of addiction is that of a "disease", like "diabetes, cancer and heart disease". The current model for treatment involves the twelve-step program, therapy, incentives (getting paid to not use drugs), encouragement and medication such as methadone. Obviously, this treatment model is not working, because despite the proliferation of treatment options and the more than a trillion dollars spent (that's One Thousand Billion) so far in the War on Drugs, we still have an explosive "opioid epidemic".
Notice what is missing in the current model of addiction treatment: Empowerment. Socialization.
Instead, addicts are called "patients", as if they caught the "disease" of addiction like one catches the flu or gets cancer, which takes choice and self-determination out of the equation. I am not saying that opioids like heroin and pain pills are without addictive qualities. What I am saying is that the method of getting addicts out of dependencies on opioids is flawed. To be sure, judgment and self-control are adversely affected when there is an addictive craving and so disease-like symptoms are exhibited. But, my point is that the understanding of how one gets into, and gets out of, an addictive state is wrong. It is not like a "disease" where one happens to catch it without personal choice (an addict generally makes a choice to use, and keep using, a drug), and where one cannot exit without medical intervention (e.g. being administered drugs, standard drug treatment methods, etc.).
I understand that being an addict can be a stigma, so labeling addiction a "disease" takes away some of the shame in being an addict, and also justifies public policy, the employment of doctors and other professionals to treat this "disease", scientific research (scientists researching addiction are generally blind or silent to their own bias of being funded through orthodox public policy framework of treating addiction as a "disease"), treatment spending, and the provision of current, deeply flawed treatment options in a neat package. But this is a poor argument to base a treatment model on -- should we call other antisocial or self-destructive conditions or issues a "disease", such as wife-beating, drug dealing and fraud? Sounds preposterous, doesn't it? But this is the result if the "disease" label is used -- "an individual pathologically pursuing reward and/or relief" due to defects in the brain's "reward, motivation, memory and related circuitry".
I disagree with the assertion, however, that "legalization" is the solution; it is a fallacious argument. Did you know that cocaine is already a prescription drug? A highly controlled prescription, to be sure, but still available for prescription for certain uses. Opioids are, of course, also legally available (perhaps too available). So is marijuana (more specifically, THC, the active ingredient in marijuana).
So how should this "opioid epidemic" be treated?
Change the current model. Narcan, getting paid to not use heroin, therapy may all achieve short term results, but it's all part of a flawed framework. Start over with a new, scientific framework for understanding addiction. What is this framework?
Notice what is missing in the current model of addiction treatment: Empowerment. Socialization.
Instead, addicts are called "patients", as if they caught the "disease" of addiction like one catches the flu or gets cancer, which takes choice and self-determination out of the equation. I am not saying that opioids like heroin and pain pills are without addictive qualities. What I am saying is that the method of getting addicts out of dependencies on opioids is flawed. To be sure, judgment and self-control are adversely affected when there is an addictive craving and so disease-like symptoms are exhibited. But, my point is that the understanding of how one gets into, and gets out of, an addictive state is wrong. It is not like a "disease" where one happens to catch it without personal choice (an addict generally makes a choice to use, and keep using, a drug), and where one cannot exit without medical intervention (e.g. being administered drugs, standard drug treatment methods, etc.).
I understand that being an addict can be a stigma, so labeling addiction a "disease" takes away some of the shame in being an addict, and also justifies public policy, the employment of doctors and other professionals to treat this "disease", scientific research (scientists researching addiction are generally blind or silent to their own bias of being funded through orthodox public policy framework of treating addiction as a "disease"), treatment spending, and the provision of current, deeply flawed treatment options in a neat package. But this is a poor argument to base a treatment model on -- should we call other antisocial or self-destructive conditions or issues a "disease", such as wife-beating, drug dealing and fraud? Sounds preposterous, doesn't it? But this is the result if the "disease" label is used -- "an individual pathologically pursuing reward and/or relief" due to defects in the brain's "reward, motivation, memory and related circuitry".
I disagree with the assertion, however, that "legalization" is the solution; it is a fallacious argument. Did you know that cocaine is already a prescription drug? A highly controlled prescription, to be sure, but still available for prescription for certain uses. Opioids are, of course, also legally available (perhaps too available). So is marijuana (more specifically, THC, the active ingredient in marijuana).
So how should this "opioid epidemic" be treated?
Change the current model. Narcan, getting paid to not use heroin, therapy may all achieve short term results, but it's all part of a flawed framework. Start over with a new, scientific framework for understanding addiction. What is this framework?
Addiction is learning, very simply. It's learning a habit of thinking. It's deeply entrenched learning. So are relationships when you're in love with someone. If that person happens to be abusive, you might still be in love with them for 12 years or the rest of your life. That's through learning. So is being a sports fan or a Jihadist. Religion is another deep substantiation of deep learning. That's what I think it is. The fact that it could be gambling, or eating, or heroin, or meth, it shows there are certain addictions that involve substances that create physical dependency. Physical dependency is a whole other layer of shittiness on top of addiction.
Psychological and interpersonal tools are very important. Addiction has to do with isolation and feeling alone, not having a support network and not being able to deeply connect with other people. You can superficially connect and have a nice circle of addicts, but not connecting with people in a way that's harmonious and fulfilling, those are the people that are really vulnerable to addiction. They're lonely, depressed, anxious, and traumatized. It's just like the Rat Park [Canadian study into drug addiction]. What I said doesn't just apply to humans, it applies to other animals, too. Isolation is really bad for you and it's the underlining factor of addiction.
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