Killer disease

Listening this morning to Tim Ferriss's latest podcast interview (here) with Dr. Peter Attia, talking about health indicators for longevity, I noticed something.

It's a good episode, with Dr. Attia sharing many aspects of increasing health levels across a lifespan. In one segment (roughly 25:00 to 40:00), he talks about how, in modern medicine, we've made astonishing headway against infectious disease. Pneumonia, Polio, AIDS, COVID, Flu; even Hepatitis-C was cured. He argues that we need to now focus on chronic disease, where progress has not been made. Fascinating example: he said that, overall, the survival rate of cancers has increased 5% since 1970.

Here's a chronic disease that was not mentioned in a 2-hour, 20-minute discussion of health: substance use disorder (SUD). All of the usual suspects were mentioned - heart disease, cancer, neurodegenerative diseases like Alzheimer's, diabetes - but not SUD. Dr. Attia even mentions alcohol use and the new and evolving evidence indicating it is never healthy, without the topic of addiction being raised.

I am suspicious that its absence in the conversation was significant. For all we recite the trope that substance use disorder is a disease, there are ways that we and our culture don't fully believe it. So many of the leading-edge sources on SUD say this. That Dr. Attia did not even mention SUD demonstrates that it is not considered in the same category as other chronic diseases. It seems to be a sign of stigma.

The leading causes of death, from most impact to least, as listed by the CDC for 2021 follow. I've inserted drug- and alcohol-related deaths from another source, as the CDC did not directly include it in this list of diseases:

• Heart disease, 695,547

• Cancer 605,213

• COVID 416,893

• Accidents 224,935

• Drug and alcohol-related deaths combined would be here, at 201,850

• Alzheimers 119,399

• Drug-involved Overdose Deaths 106,700 (National Institutes of Health, https://nida.nih.gov/research-topics/trends-statistics/overdose-death-rates), doubled since 2015, and the rates of growth are continuing to increase rapidly

• Alcohol deaths 95,150

• Diabetes 103,294

• Chronic liver disease and cirrhosis: 56,585 (can be caused/exacerbated by alcohol use disorder)

• Nephritis, nephrotic syndrome, and nephrosis 54,358 (can be caused/exacerbated by alcohol use disorder)

Because of the rapid growth rate in SUD-related deaths while other disease mortality is relatively stable, it is an instrumental contributor to the decreasing life expectancy in the US.

Looking for data for this post, often substance use disorder is placed in a difference category of disease, "preventable disease" rather than a medical or “real” disease. My hackles raised when I saw that, repeatedly - preventable by whom? I think the subconscious assumption is by the person experiencing the disease. A disease that is labelled "preventable" seems more the responsibility of the sufferer, and less eligible for medical/clinical help, or help of any kind. It's a sign of stigma. Strong, subconscious stigma, the kind that is preventing our communities from developing the programs and resources to save lives.

37.3M Americans reported using illegal drugs (within the past 30 days, 2020, drugabusestatistics.com). Note that that number includes children 12 and older. What if, once treatment and medical support is made available to people, substance use disorder turns out to be a highly preventable cause of death - like Hepatitis-C, like AIDS? All of my SUD research indicates that the strategies exist, data prove they work, and yet we are lacking the political will and resources to implement the programs that would slow the increasing death rates. I'd like to see SUD get half the resources of cancer, and it is likely we could save many lives quickly by doing so. Surely we can do something to help people - children! - avoid this disease.

It's been many years since cancer was considered communicable or a sign of undefined failure by the diagnosed; it was so long ago that my mother had to recount those times to me, before I was born or aware. Our culture has, over time, erased the stigma of cancer, and assigned the resources to develop better treatments and save lives. It's time to do that with substance use disorder. One way to do that is to mainstream its data alongside the other diseases we are battling, for the health of our community.