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.

Heroin Laced With Fentanyl

Heroin laced with FentanylWhile heroin is a commonly known drug, you might’ve heard lately about heroin laced with Fentanyl, yet not know much or anything about Fentanyl. Here is a description:

Fentanyl is a synthetic opioid, meaning it is made in a laboratory but acts on the same receptors in the brain that painkillers, like oxycodone or morphine, and heroin, do. Fentanyl, however, is far more powerful. It’s 50-100 times stronger than heroin or morphine, meaning even a small dosage can be deadly.

Fentanyl can be produced in illegal laboratories, which means, for the foreseeable future, availability won’t decrease through government regulation. This synthetic opioid is very, very powerful, so it makes a dangerous drug like heroin much more dangerous and deadly. It only takes a small amount of Fentanyl to increase the effects of heroin and cause overdose. Even scarier, some drug dealers are selling a combination of heroin, Fentanyl and cocaine.

Those who buy heroin on the street and start using heroin laced with Fentanyl are at a much higher risk of overdose and death — the drug user becomes dependent on how much Fentanyl is used, their tolerance and other physical factors that in combination can create overdose. It sounds perverted, but a drug dealer might increase business if someone overdoses and dies from heroin laced with Fentanyl, because, on the street, the word of a powerful heroin/Fentanyl mix will likely create a buzz of interest as users seek greater highs. In the experienced user’s mind, they’ll think they can handle the more powerful mixture and that those who died were neophytes.

As congress begins decreasing the amounts of opioids doctors can prescribe, a certain number of patients who’ve become addicted to opioids, but need the drug for management of chronic pain, will seek drugs from alternative sources – if they begin buying synthetic opioids on the black market, this will increase the number of deaths, not lower the number of deaths. I don’t think drug addiction will respond to regulation — it can be treated, though. Heroin laced with Fentanyl is nothing to play with. The entire opiate/opioid addiction epidemic will only get worse until society decides to take action to find fundamental solutions.

Easier, Softer Way

easier, softer wayIn Chapter 5 of the book Alcoholics Anonymous there’s a warning about alcoholics seeking an easier, softer way to deal with alcoholism. Often someone suffering from addiction will seek help through a friend, a pastor, their doctor, a family member or maybe an individual therapist. I won’t say that any of these forms of help can’t work. I do know that addiction treatment is usually required if there’s to be much lasting change at all. The tough decisions and commitment necessary to deal with a medical condition as powerful as addiction are not easy. Some people deal with the problem through non-professional methods, but most people who suffer from addiction require some level of specialized addiction treatment.

The mistake most people make when trying to help someone who’s addicted to alcohol or some other drug is to immediately assign psychological reasons for the constant drinking or use of drugs: She had a bad childhood – He lost his wife – She has never fit in. In addiction treatment, we deal with the medical condition first. Addiction is a medical condition, a chronic brain disease, with a strong genetic influence that’s complicated by social and psychological factors.

Treatment begins by stabilizing the medical condition — detoxification, medical assessment, and understanding the chronic brain disease. Medication might be needed for detox, but the ideal course of action is to become drug free as soon as possible. When dealing with opiate addiction, Suboxone might be prescribed for the early period of treatment, long enough for the client to get into treatment and establish a support network. If the client can’t detox on an outpatient basis, inpatient detox will be recommended, and perhaps a few weeks of inpatient treatment.

Once there’s medical stabilization and we develop a treatment plan, then we begin dealing with the social and psychological aspects of addiction. Sometimes, a person is depressed and anxious in the beginning, but this is common for someone who’s been living a life torn apart by addiction. In some cases the depression and anxiety might have preceded the addiction, so that these co-occurring conditions are addressed and treated along with addiction. Depression and anxiety are not known to cause addiction, but they can co-exist with addiction, and addiction almost always makes co-existing conditions worse. So, when someone says that they’re drinking because they’re depressed, they don’t understand that alcohol is a depressant (although the first few drinks might have a stimulant effect) and makes depression worse over the long run, not better.

The life of addiction creates or masks problems that are dealt with if a person is to have the best chance at recovery. If a person stops drinking and nothing else changes, they’re usually filled with chaotic emotions, guilt, remorse, anxiety, depression, resentments, etc. These lingering consequences of addiction can overwhelm a person, making them restless and discontent, so much so they that go back to their drug of choice. If the person resolves the social and psychological problems, though, this doesn’t mean that he/she can return to social drinking or recreational drug use. Once biological predisposition to addiction is established, active addiction will recur once the person starts drinking or using again. Addiction is a chronic brain disease and so far there’s no known cure. If the person remains abstinent, however, they can lead a normal, fulfilling life. It’s not just people with addiction who are filled with chaotic emotions and psychological scars, but the person recovering from addiction has a chance and a need to deal with these problems and gain peace of mind — who wouldn’t benefit from taking time out to assess our emotions and psychological state?

So, if a person with an addiction problem tries to deal with the symptoms of addiction with symptomatic solutions, they might miss the fundamental nature of addiction which has to do with how the drug affects the brain. Many people who’re searching to find help, want help that will allow them to one day drink and use drugs socially with no consequences — the easier, softer way actually becomes very hard and painful. Ironically, (paradoxically?) it turns out that, for the addict, the easier, softer way is abstinence and recovery management.

Drug Addiction Among the Over-60

Addiction rehab for the elderly

Addiction can happen to anyone

According to, addiction among the over-60 is one the nation’s fastest growing health problems. There are several reasons why this problem’s growing so quickly. First of all, as is now commonly known, people are living longer. The retired Baby Boomer population’s growing at a staggering rate. As people become older, they can become bored or lonely in retirement, or they can suffer from chronic pain, or they experience losses as friends and family die.

Most elderly people aren’t using drugs to get high and party necessarily, but they might misuse drugs for the above reasons –then a certain percentage of these older drug users become addicted. There are more drugs now than ever to deal with practically every human problem imaginable, and many of these drugs are potentially addictive.

There’s also an increase in alcohol abuse. Maybe a person had a career that prevented her from drinking as much as she would’ve liked, but now in retirement she can drink like she wants to drink, thus developing a problem. It could be in many cases that alcoholism progressed slowly and now in a longer life the late stage of alcoholism is more prominent.

Unfortunately, drug addiction among the elderly is often overlooked. As I’ve written here before, health care providers often don’t know what to look for when it comes to drug addiction — they’re busy dealing with the symptoms of drug addiction. Family members are sometimes dependent on the person who has the drug addiction, and they don’t want to create problems. Many times it’s overlooked in families because of the stigma still attached to addiction. It’s embarrassing socially, although it should be treated like any other health concern.

This is also from

A study in the Annals of Epidemiology projects that the number of people age 50 and older abusing prescription drugs could increase 190 percent over the next two decades, going from 911,000 in 2001 to almost 2.7 million by the year 2020.

I predict that age-specific treatment facilities will emerge in the next decade. Our seniors deserve better. Drug addiction among the over-60 is a serious problem that requires specialized treatment.

Addiction is a health issue

treatment not jail

Addiction is a health issue

It’s past time to treat addiction as a health issue, not a stigma, not an opportunity to shame others and feel superior to their “weakness”, not a socio-economic issue that places addiction in poor, inner-city neighborhoods, not a criminal problem, not a skid row problem — addiction is a health issue.

It’s really amazing that in the Information Age people still whisper about addiction as if it’s a nasty sin too vile to speak out loud. It’s also amazing that many people place addiction as a problem affecting poor people, mostly in inner cities. While it might be true that many addicts suffer financially, it’s usually because financial deterioration is a consequence of addiction. Most people whose addiction advanced quickly never got far in life because of the craziness of addiction which led to behaviors that aren’t amenable to climbing economic ladders.

This is certainly not true of all alcoholics or drug addicts, or not even most. Most alcoholics become relatively successful, or at least financially secure, before the addiction progresses to the point it begins interfering with their occupation. Many addicts are wealthy and will never lose all their wealth, no matter how bad the problem gets — they might lose their family, their self-respect, their reputation, their minds or their lives, but they won’t likely lose their wealth, although many have lost fortunes.. I’ve written about this lately because I continue to hear people talk about addiction in ways that confound me. The various explanations of addiction are mind-blowing.

As much information as there is from scientific studies, it would seem that more people would have a good understanding of addiction and not fear the word, but this is not the case. Even many doctors and healthcare professionals still have mindsets regarding addiction that date back to the 1920s. It’s either that extreme, very old ideas, or another extreme, new ideas that avoid addiction just as thoroughly. Whether addiction is seen as a moral weakness, a failure of will power, or whether addiction is seen as a symptom of a mental disorder that only requires talking therapy and positive support, the facts about addiction are largely ignored.

The reason this is important is because when the facts of addiction are ignored, society’s response to addiction is counter-productive. The legal/law enforcement system has filled prisons with addicts — hospitals have sent addicts away with band aids and pills — churches have shamed addicts — companies have fired addicts, only to hire someone from the labor pool who’s as much an addict as the one fired — therapists have under-treated and mis-treated addicts — insurance companies have blocked addicts from decent coverage — government declared a War on Drugs and it has done nothing but hurt those in society who have the least power to lobby for themselves, while rich, international drug dealers thrive. Most efforts to “fight” the drug/addiction problem have failed. There are no national standards of treatment that are consistently applied. One addict might go to a therapist who advertises addiction counseling but has no direct training in addiction treatment, and the another might go to a psychiatrist who hands the addict a prescription and that’s all, and another might go to treatment facility that’s under-staffed and under-funded and burnt-out. One form of addiction treatment might be regulated, requiring a license, while another form of addiction treatment might go unregulated requiring no state licensure.

Addiction treatment works, but it takes a strong, specialized, quality effort. As long as people are afraid to even talk about the problem, or as long as they are ignorant of the problem even when it’s affecting them, or as long as there’s no coordinated healthcare effort to treat addiction like other diseases, then America’s addiction problem will continue to waste lives and resources, break up families, and needlessly imprison men and women who can easily contribute to society with the right treatment. If you search “recovery from addiction” on Google, you’ll see a side of addiction you might not have seen before — recovery happens all the time. It can happen much more often if the facts of addiction win out over ignorance. Addiction is a health issue and must be treated as such.