Healthcare and Addiction

Addiction and healthcareHealthcare and addiction, in reality, are closely connected – in obvious ways and not so obvious ways. I want to address the hidden costs of chemical dependence/addiction. Our healthcare system treats mostly symptoms of addiction. One of the problems is often with addiction the effects are so far removed from the cause in time it’s hard to follow the path from cause to effect. If early healthcare costs could be immediately associated with addiction, then maybe the fundamental problem could be treated, thus, in the future, saving billions upon billions, not to mention quality and length of life in general.

The healthcare system, like many systems in business, especially when it comes to addiction, is driven primarily by short term financial concerns. This systemic drive to cut costs rejects proposals to treat fundamental problems so costs are significantly lowered in the future. If there’s not a short-term financial benefit, then most healthcare concerns will not properly treat addiction today to save money in the future. Most healthcare concerns don’t even identify addiction as a significant cause of current healthcare costs when it’s obviously a fundamental problem. Emergency rooms are filled with addicts who get bandaged, stitched and temporarily fixed up then sent back out to return over and over. Who’s following the dots from early addiction to death and recording the consequences in between? I’ve worked in the addiction field long enough, since 1983, to see clearly causes and effects related to healthcare and addiction. 

Research shows that long-term quality treatment is effective for many addicts. Some addicts can recover through shorter term treatments, and some alcoholics can go straight into Alcoholics Anonymous and do well. But, most addicts require treatment, and long-term treatment is the most effective means to establish long-term recovery. The problem is in the present healthcare system there isn’t a desire to fund long-term treatment. The main reason long-term treatment is not funded is because it costs too much money — this is what you’ll hear over and over. Insurance companies will officially say it’s not medically necessary, but the reason they say this is to cut costs short-term (am I too cynical?). Never mind the insurance company will pay for the addiction in other ways — accidents, liver disease, gastritis, gun shot wounds, heart disease, stress related illnesses, etc.

Also, when we talk about the effectiveness of addiction treatment, we’re talking about addiction treatment that’s never received the funding or resources equivalent to other major healthcare concerns. There are many professionals in the healthcare system who don’t believe addiction is a chronic brain disease requiring treatment, although this has been established in medicine and science for many decades. There has never been a concerted nationwide attempt to consistently treat addiction as a serious medical condition that requires major resources and expertise. You don’t hear young people going to college saying they are going to start a career in the field of addiction treatment. Healthcare and addiction have been loosely associated, although in reality they are closely connected, and addiction treatment has been haphazard. Once addiction is accepted as the major health concern it is then, perhaps, insurance companies and others involved in the healthcare system will follow the dots from early addiction to all the consequences that follow.

Alcoholism and Opiate Addiction

alcoholism and opiate addictionAlcoholism and opiate addiction are similar in many ways. The reason alcoholism and opiate addiction have been so difficult to treat is that both forms of addiction are what I’ll call ingrained. Some might think “ingrained” is not a useful description when addiction creates that implication, but alcohol and opiate addiction are different from, say, cocaine addiction. Cocaine and meth are bingeing drugs. The brain changes caused by cocaine make it difficult for the cocaine addict to not return to cocaine after a period of abstinence, but the human body can’t tolerate sustained, daily use of cocaine. Because cocaine and meth damage the body so quickly, cocaine/meth addicts usually reach a bottom fairly quickly.

However, with alcoholism and opiate addiction, a person can use the drugs on a regular basis for decades. The alcoholic and opiate addict usually live with the drug closely and intimately for a long time before there’s physical damage. Because alcohol or opiates gradually become normal for the addict, it’s difficult to treat. The drug becomes such an important and steady part of day-to-day living, trying to live without it is often overwhelming. The current plans to deal with the opioid crisis lack true understanding of what it will take to deal with the problem. Throwing money at the problem and locking dealers up will not solve the problem — and ignoring alcoholism while focusing totally on opioids misses the larger crisis of addiction in general.

Addiction is not about which drug is legal or socially acceptable — addiction is a medical issue that unless treated by medical professionals will continue to get worse. Yes, there’s a psychological component, and morality/spirituality is even a topic of treatment, but unless the science of addiction is understood as a medical issue there’ll be no progress finding solutions. The demand for drugs, alcohol, opiates, etc., will ensure a supply. We found out in the 20th century that prohibition efforts don’t work. Also, stating that if people never use drugs they won’t get addicted is so naïve it doesn’t deserve a response. The reality is that alcoholism and opiate addiction will grow worse unless there’s access to quality, long term treatment, along with widespread understanding of addiction among all healthcare and insurance professionals. It will also help if employers gain a good understanding of addiction, from the social/economic impact side of the issue. Our society is bleeding resources like never before mainly because addiction is misunderstood and mistreated. The worst part, though, is all the broken homes, suffering and preventable, premature deaths — we can deal with the problem, but not unless it’s understood.

Addiction, Education and Employment

addiction, education and employmentUsually when addiction, education and employment are discussed together it’s from the perspective of how poverty, unemployment and illiteracy drive people to misuse alcohol and other drugs. Some even imply, or make the claim outright, that misery and other environmental negatives experienced in poverty stricken areas cause addiction. While it’s likely that those growing up in areas of poverty, and who have problems in school, misuse drugs at a high rate, there’s no scientific evidence that poverty, illiteracy and dire living situations cause addiction. If more kids in areas of poverty are using drugs, around 10 percent of these kids will become addicted, but correlation and causation are not the same. I will write a blog post about this soon – however, the angle I want to approach in this blog post is how addiction affects the employment prospects of everyone who becomes addicted to alcohol or any other drug.

In the new economy, rapid changes in technology require specialized education along with problem solving and analytical skills. Rapid changes and uncertainty also place importance on the ability to deal with stress and anxiety. When blue collar workers worked in factories and had repetitive jobs that didn’t place complex demands on the worker, a person with an addiction problem could hide from detection as long as they were still functioning at all. Co-workers and supervisors would often cover for the person with a alcohol/drug problem. I witnessed this working at a GM factory when I was 19 years old. Things have changed. That factory is now closed.

One aspect of the changes in the workplace is that it’s knowledge-based. Most kids don’t have the luxury of barely getting by in school, then graduating and going to work at a local factory. Almost every job in the new economy requires technological knowledge, social skills and the ability to analyze and to solve problems. When a young person starts using alcohol, pot, cocaine or opioids, it puts them at risk. If the young person is one of the 10% or so who’ll become addicted, not only are they at risk physically, they’re at risk employment-wise. Addiction negatively affects the problem solving and analytical skills required in the new economy – addiction also affects a person’s ability to complete college. Addiction affects motivation and the ability to retain knowledge, so even if a young person who’s addicted makes her way through college, she might take the easiest route and not go further to a higher education. Getting an easy, generalized degree just to have a degree, to please others, basically, is not useful in an economy that requires specialized knowledge and skills.

The problem is not that the young addict is unable to become a good little robot in the new technological economy, it’s that the young person usually drifts and doesn’t gain the skills and knowledge in their areas of interest – they give up on their goals. There are many interesting, challenging, enriching and helpful endeavors in the world of work, but the young person who’s struggling with an addiction will not likely complete the necessary education and acquisition of skills.

The older worker who has a drug problem is also at high risk. In the new economy, gaining knowledge and new skills is constant. The same things hold true for the 40 year old worker who finds they have to adjust midstream to acquire new knowledge and skills. It’s difficult to make the changes and deal with the stress when you’re addicted to alcohol or some other drug. You don’t have to be a genius to find your calling in the new economy, but it will likely take all the intelligence you have. I talk to people in recovery all the time, and I hear over and over that recovery brought back the desire to further their education and accomplish goals that slipped away in addiction.

Employment and Addiction Recovery

employment concerns in recovery

Addiction and employment

When considering consequences of addiction, the realities of employment and career management are serious considerations. Employment and career concerns are important to the addict in recovery regardless of age or past accomplishments. Successful addiction recovery requires a person to deal with all parts of his/her life. It’s important to make a living and fulfill our human need to contribute and create, whether it’s a formal job or it’s raising a family or pursuing some artistic goal.

When a person starts drinking alcohol or using some other drug heavily at an early age, and if that person is in the beginning stage of addiction, the constant impairment of judgment might lead the addict to disregard the importance of clear judgment, skill development, education, employment and career planning. Mind altering substances, including alcohol, can lead someone to believe that they have power over reality, that they’re smart and capable and impervious to consequences. When an addict is faced with consequences the addict usually blames some person, place or thing for the consequence, thus protecting the fantasy world the addict slowly constructs.

Our problem in the 21st century is that good and steady employment that leads to a successful career is hard to find, even if a person keeps a clear head and goes to college. If a person’s operating with impaired judgment under the mistaken belief they’ll figure it out as they go along, then they’re probably not going to fare well in the job market. If a young person with a drinking or drug using problem goes to college, they’ll likely have difficulty succeeding and gaining the knowledge and skills necessary for a job market that demands specialized knowledge, complex skill sets and sharp thinking. Even manufacturing jobs are no longer done by rote. Almost all good jobs require knowledge and skills and a clear mind.

Even an older person whose addiction progressed slowly and who’s been getting along for years at a job that’s no longer demanding has to make employment and career planning a major concern, because employers aren’t hiring on for life like the old auto-maker jobs, or IBM career jobs, or traditional jobs with the railroad companies. Unions are much weaker, and technology’s creating constant change in the job market. Older workers find themselves looking for work in a job market they no longer understand. If the older worker is in recovery from addiction, it makes it even more imperative to manage recovery and remain abstinent, if the person wants to find new work and start a new career if and when the situation arises.

The point is that life and work are becoming evermore demanding, and addiction muddles a person’s mind and eventually kills motivation and drive. It’s a sad and demeaning existence to become dependent on the goodwill of others, or to find yourself broke and jobless with limited options. When a person gets into recovery, they might find themselves in this situation and wonder why they should even try. The answer is that if they don’t try their situation can get much worse, and the reality is that people can start over, learn new skills and gain new knowledge — new days are possible, recovery can happen. But it’s not likely to happen if the addict returns to alcohol or their drug of choice.

Alcohol, drugs and motivation

technological demands

Addiction and ability to learn

I chose motivation in the title because motivation is usually affected by alcohol and other drug dependence — however, I’m writing here about how drug abuse and dependence affects a person’s ability to learn and retain knowledge and how it all relates to developing and maintaining a good livelihood. This is aimed primarily at young people, but it applies to everyone with an alcohol or other drug problem. It’s never too late to change, and if alcohol or some other drug holds a person back or has prevented them from ever achieving their goals over a scan of decades, then now is the time to act — time might be running out — the world is quickly changing and it takes all the intelligence we can muster.

This is definitely not a time to dumb down with alcohol or pot or get lost in a fantasy world of any types of mood-altering drugs – not if a person wants to meet the technological challenges of the new workforce. Keep in mind that moderate drinking, one or two drinks a day, doesn’t have the same negative impact — I’m writing about drinking and drug use that’s beyond moderate. I’m not calling for prohibition, just a realistic look at how an alcohol or other drug problem can negatively impact a person’s ability to make a decent living in an advanced technological society.

Most therapists are trained to help clients with their emotional and mental difficulties. In addiction treatment, when performing the assessments, there’s a category for employment, but it’s not often highlighted in treatment unless the person was sent by the employer and their job is in jeopardy. Most clients are worried about keeping the job they have or finding a new one, but I’m not sure if enough attention is paid to alcohol and drug use and 21st century technological advancements as they relate to stable, good-paying employment.

There are more and more demands on young people entering the workforce related to specialized knowledge, especially specialized technological knowledge. How does alcohol use affect memory, ability to lean and motivation? How does marijuana affect the ability to focus, to remember and retain knowledge? How do opiates stop young people in their tracks before they gain the knowledge and skills they need to make it in a highly technological workforce?

Again, it’s not just a concern for young people, because, now, workers in their 40s and 50s have to gain new knowledge and skills to make it in today’s workforce. If these workers in their 40s or 50s are dependent on alcohol, or they’re still smoking pot or using cocaine, how will they fair in this demanding technological transition? I couldn’t find any studies specifically dealing with this problem, but it’s well known how different drugs like alcohol, marijuana and opiates negatively impact motivation, learning and memory.

When I was 19 years old working on the assembly line at GM, there were older workers all around me working by rote who drank on the job, but the job was not that demanding. Those types of jobs are disappearing. 21st century jobs will demand a clear head and the ability to retain and handle lots of information. Alcohol and other drugs work against the demands placed on workers in today’s workforce. Even the executives’ two martini lunches are a thing of the past. Many workers dependent on brain altering drugs will likely be left in the dust as technological changes increase each year. This has to be a treatment concern — one more reason to deal with an alcohol or other drug problem before it’s too late. This is not a scare tactic — it’s reality.

Addiction and Economics

Addiction and productivity

recovery and the economy

On a personal level addiction prevents individuals from accomplishing what they could without an addiction problem — this is fairly obvious. Then there’s the societal costs from addiction. Yes, some individuals are successful despite their addiction, but as a rule most people who become addicted to alcohol or some other drug suffer financially and employment-wise. There’s also no way of knowing how much better off even the successful person could become without the addiction. One reason addiction affects the economy, both the personal economy and the larger national economy, is that judgment is impaired. Another reason is health costs due to the physical effects of addiction. Under judgment we can include legal costs. These are the main economic/financial associations that can be tied to addiction.

This chart is from the National Institute on Drug Abuse:

economic costs of addiction

Addiction costs to society

 

This is a low estimate, because, again, we can’t know what could be. We can only measure the costs, yet how much better off would our economy be if addiction were cut in half? How much more innovation would there be with those clear, energetic minds adding to the productivity of the nation? How many of those healthy people would contribute great things to society? Addiction is a waste of mind, body and spirit, and it negatively affects the economy in ways we can’t even measure. I don’t know how many moderately successful men and women I’ve seen suffering from addiction who were smart and capable enough to do much more. Many of them were fired from their jobs and their reputations were ruined.

On the individual level, it’s a no-brainer that recovery from addiction boosts the chances of the average person succeeding and making a good living, being much more useful to family and society. Of course, recovery is about more than making more money and being more productive, but this is a benefit that’s not discussed as often as it should be discussed. In the beginning, a person starts drinking or using some other drug with the calculation that the highs will be worth any lows. But over time the lows increase and the highs decrease. Like a business that has lost it’s way, there’s often denial, and people continue trying the same thing expecting different results. When the lows are so great they break through the denial, it’s usually when everything has fallen apart. Treatment is about breaking through that denial earlier and realizing what’s ahead if the same actions are continued.

It makes personal sense — it makes economic sense, too.