Frequently Asked Questions substance abuse treatment addiction treatment An

Substance use disorder is a disease that causes abnormal thought processes and resulting behaviors. People with SUD have overwhelming compulsions to use the substance. They crave it and even use it despite knowing the consequences of use include disease, social isolation, and even death. Ultimately, they have lost control over their own choices. dd an answer to this item.

Before discussing the issue of addiction the precursor to it, dependence, needs to be addressed. This is important because many people – patients and loved ones – often confuse dependence and addiction. When they confuse dependence with addiction, they often do not want treatment with any medication that might cause “addiction” when they are really referring to dependence.

It is understandable that a heroin addict would confuse addiction with dependence. They know that they physically and mentally depend on heroin to make them feel better. And when it comes to medical treatments for opioid addiction – like Suboxone – they have likely seen it offered along with heroin by the same dealer. Suboxone looks to them like it is part of the same mess in terms of addiction.

Dependence simply means the body and mind have become accustomed to a certain substance. I once heard a recovered heroin addict talk about being dependent on his glasses. He wanted to keep using them for the rest of his life even though he wasn’t addicted to them. From a medical standpoint, dependence occurs with many medications that aren’t typically thought of as addictive.

Ultimately anyone can choose to participate in unhealthy behaviors. The unhealthy behaviors all have consequences. Unfortunately, some people, making the exact same choices as many other people, but with the wrong genetics, family history and social background, develop a disease called substance use disorder (SUD).

When my son was abusing heroin, his behavior baffled me. Things he loved, like snowboarding, were gone from his life along with all the equipment as he pawned it. I watched his legs turn from healthy skin to ugly sores over every inch. He used them when the veins on his arms could no longer be found. I took him to the hospital for admission when an infection, likely from dirt in the heroin, lodged in his lung and caused pneumonia. He never had a dollar or a friend, but despite it all he kept using. 

Realizing that my son had made a mistake in exposing himself to drugs, but that all the associated behaviors of addiction were not all within his control, helped me look at him differently. It helped me find more compassion as I better understood he wasn’t just choosing to act badly. Ultimately, it helped me in finding better treatment.  

Type 2 diabetes is a disease much like addiction: a combination of behaviors and factors not caused by the person with the disease. Type 2 diabetes is caused by eating too much and exercising too little combined with certain genetics, family history, and even how people are raised with regards to eating. Over 30% of the US population is overweight and inactive. Yet only 10% have type 2 diabetes. The behaviors alone are unhealthy but do not cause disease.  

Like type 2 diabetes, people with addiction make choices and they have other contributing factors over which they have no control including genetics, family history, social background and worse of all ACEs: adverse childhood events. Looking at the ACE questions you can see that none are the choice (or behavior) of the child that might later become the adult with addiction. 

https://preventchildabuse.org/what-we-do/aces/?gclid=Cj0KCQjwj7CZBhDHARIsAPPWv3fR0r4Nx3bIkkekjHCJIugtz-6cErLwPOT9qPD72hgjd2IyEFJHtE0aAtYwEALw_wcB

Erroneously, people conclude that making something legal means it is safer. In fact, the marijuana industry has convinced enough people of the safety, if not alleged benefits, of smoking marijuana while the Drug Enforcement Agency (DEA) continues to define it as a schedule 1 drug: A drug or other substance that has a high chance of being abused or causing addiction and has no FDA-approved medical use in the United States. Other schedule I drugs include heroin, LSD, and ecstasy. 

My point is not to argue marijuana is as bad as heroin. My point is that legal classifications often have little to do with the health consequences or dangers of a specific drug. Marijuana likely has benefits and dangers. More specifically certain drugs in marijuana likely can be identified as mostly beneficial or mostly dangerous. Because of its schedule I classification, it hasn’t been studied sufficiently due to federal legal restrictions. People with little scientific information pass state laws legalizing it. Simultaneously the DEA identifies drugs with potential benefits as being dangerous. 

Meanwhile, the death rates associated with alcohol and tobacco should be sufficient evidence that legal does not mean safe. If you were to take the DEA’s definition of a schedule 1 “drug or substance that has a high chance of being abused or causing addiction” then alcohol and tobacco should be right at the top of the list. Yet alcohol remains a completely normal part of our everyday experience and people smoke tobacco legally every day.

Often, we further confuse legality with morality. Someone that is using heroin becomes an outcast of society and is looked down upon. Those looking down on them frequently have a mug of beer or glass of wine in their hand. Or maybe they are one of the 20% of people that admittedly drink too much. But they haven’t done anything illegal, and they sometimes think their behavior is somehow morally superior to someone using heroin.  

If one wants to truly help another person with an addiction, the drug of addiction needs to be irrelevant in terms of legal definitions. If heroin could be purchased legally in a clean, pharmaceutical grade, the health consequences of using/abusing it would likely be far less than the abuse of and addiction to alcohol. In fact, heroin in the body is in part immediately converted to morphine. Morphine is legal, with a doctor’s order, and given by the gallons in hospitals each year. Addiction, regardless of the substance, is the disaster we must address, not simply legal or moral notions about the substance itself.

Professionals -- doctors, psychiatrists, and insurance companies, -- use 11 criteria found in the “Diagnostic and Statistical Manual of Mental Disorders (DSM-5)” to identify or diagnose addiction. They are all essentially behaviors. While those 11 criteria are definitive, the abbreviated 4 C’s of addiction make it a little easier to define the disease of addiction. The criteria and the 4 C’s are all related to or are behaviors. Behaviors that are not normal: i.e., the disease. Using the 4 C’s let’s compare how people without SUD (WOSUD) and people with SUD (WSUD) behave differently in similar situations:

1. Compulsion

WOSUD drinks a beer or two most days of the week after getting home from work. Some days they don’t drink any beer. 

WSUD drinks beer daily. When they pass a convenience store or see a beer commercial, they feel an overwhelming urge to stop and buy beer.

1. Craving

WOSUD is given opioid pain pills (e.g., Percocet) after a medical procedure and takes one every four hours as prescribed. 

WSUD takes their friends Percocet. After taking two pills, they begin watching the clock and can’t think of anything but the next dose and running out.

1. Consequences

WOSUD accustomed to using cocaine at parties decides to stop using it completely when their employer starts doing drug testing. 

WSUD uses cocaine regularly even knowing their employer does frequent drug testing.

1. Control

WOSUD tries smoking heroin offered by a friend. They like how they feel but decide to never use it again because of the dangerous consequences. 

WSUD is arrested for heroin possession and held in jail over the weekend. When they are released from jail, they find a dealer and immediately use heroin 

"In 2018, opioid overdoses in the United States caused one death every 11 minutes, resulting in nearly 47,000 fatalities.1 The most effective treatments for opioid use disorder (OUD) are three medications approved by the Food and Drug Administration (FDA): methadone, buprenorphine, and naltrexone.2 Using one of these can reduce a person’s risk of illicit opioid use and fatal overdoses,3 which underscores the need to increase access to medications for people with OUD.4 While many people with OUD may also benefit from counseling, medications are proved to be beneficial even without such counseling services. Unfortunately, medications often are not available due to a lack of providers who can deliver these therapies, inadequate funding and reimbursement for treatment programs, and the stigma surrounding OUD that can keep people from accessing medications.5 It is therefore critical for patients, providers, and policymakers to understand the efficacy of these medications in order to ensure that people with OUD have access to this evidence-based treatment. "

https://www.pewtrusts.org/en/research-and-analysis/fact-sheets/2020/12/medications-for-opioid-use-disorder-improve-patient-outcomes 

Substance Use Disorder (SUD) or addiction is not a binary question. People do not simply go from SUD to recovery in a single step. There is a continuum of interventions and behaviors. Rock bottom, while seemingly a powerful concept in motivating people with SUD to change, is a dangerous falsehood. Rock bottom for someone with SUD could easily be death and then no recovery is possible. How you help your loved one with their SUD depends on your situation and your level of tolerance. Keep in mind that your tolerance must be addressed on two levels: first, how much of their behavior can you tolerate but more importantly second, how well can you tolerate possible outcomes of their bad choices.