A reader’s comment on “Killer disease”

After my blog post "Killer Disease" (here), I received the following comment from a friend who knows the substance use recovery world well:

Gretchen,

I read that in 2021, 106,000 Americans died of overdoses. That is died and not just destroyed their lives. Or, even moderately damaged them. Or, broken the hearts of their loved ones.....one way or the other.

106,000.

How can addiction not be the #1 crisis in America? It just far exceeds everything else in my opinion. I realize that any improvement might be terribly difficult to effect but our Government should be trying hard. I don't see that it is.

My friend hits the nail on the head, not surprisingly. 106,000 deaths from drug overdoses in 2021. That is a number that is growing rapidly, nearly exponentially. It is projected to double by 2029.

When you add in alcohol- and alcohol-and-drug-related deaths, growing at a similar speedy rate, the number in 2021 was nearly 202,000. That number is similar to a mid-sized city, like Little Rock or Worcester. Per year. I picture a nuke wiping out Little Rock this year, Worcester next year, Des Moines the following year - imagine that scale of tragedy on an annual basis.

But, as my friend points out, those numbers don't account for the impact of people living with this chronic condition, and the echo of impact on our communities. How many people are struggling with substance use disorder (SUD)? We know this number is 23 million. 23 million people are experiencing substance use disorder (SUD) right now. One in ten in the U.S. Add to that the impacts to family members, friends and loved ones. ANOTHER 23 million have experienced SUD in their lifetimes, and recovered. And their families, friends and loved ones suffered too. Consequences of SUD may include homelessness; joblessness; poor mental and physical health; poor human relationships; poor self esteem; and, loss of time, money and energy focused on the next high. Lives ruled by drugs and alcohol are unhappy, it is safe to say; it is not a happy circumstance to face an anchor dragging one down, a barrier to living up to one’s potential. For instance, 9 million males in prime working years between 25 and 54 are not working, and studies show that in over 40% of the cases it is due to substance use. If they went to work, they could feel more connected and constructive in society, help address the labor shortage, and perhaps find more financial security (granted, we also have to address training and education for good positions).

"How can addiction not be the #1 crisis in America?" Because it is stigmatized. People don't want to talk about it and don't know how to, either. Consciously or subconsciously, our culture wrongly ascribes fault to the person struggling with substance use disorder. They are "weak" or "have no willpower", or "unmotivated". People with SUD are embarrassed and ashamed, and inclined to isolation. This is a crisis we need to drag out from under the rug.

Our culture does not yet recognize the two driving forces for (going out on a limb here) any addicted individual, forces that would garner empathy towards them:

• Getting high is a coping mechanism for a person dealing with trauma or mental health issues, or both, as the first generally causes the second; and,

• People are biologically vulnerable to the compulsive need for the "reward" of a high, perhaps more so with a brain geared towards one of the learning disorders, and the compulsive need for the "reward" of a high grows out of proportion to the pleasure of the high, or in spite of adverse consequences.

Is the Government "trying hard"? More recently, maybe. Congress has passed several measures funding substance use treatment and education efforts since 2016, including measures imbedded in COVID-19 and Recovery Act legislation. On March 6, 2020, President Biden pledged $125B over 10 years towards the overdose epidemic. It may take a while for the funding to turn into successful interventions, especially in light of politics - and stigma. There are many battlefronts to the problem of helping people find treatment - cost, availability, connecting people with the services, educating as to why treatment is helpful and effective. Qualified professionals in the recovery field know what to do to help, but only 10-20% of substance users receive treatment (Alvanzo et al., 2014). We think of addiction in urban areas, and also a failure to provide adequate services of all kinds in the last 40 years in rural areas led to skyrocketing addiction there. We know that the rural areas with highest rates of addiction correlate to Trump's voters and/or right-wing, conservative voters and leadership - not the kind of folks inclined to replace punishment with services to solve a problem. Treatment and harm reduction centers often face NIMBY resistance not only in conservative communities but also progressive, because in both cases prospective neighbors, municipal regulations and law enforcement have not yet shed a punishment mindset in favor of a harm reduction and an empathetic treatment mindset.

Clearly our government has a role in the management of prisons and jails. 85% of the U.S. prison population has an active substance use disorder or were incarcerated for a crime involving drugs or drug use. (NIH, June, 2020) Frequently, these individuals have no access to treatment. Many communities are trying to build more prison capacity rather than treat the SUD problem. There is a disproportionate representation of people of color among those incarcerated and addicted - Black Americans make up 12% of the population of drug users, but 38% of the population incarcerated for drug crimes (NIH, 2022). Other minorities are over-represented in the same way. Again, much of this results from being trapped in a punishment mindset in which incarceration is more important than solving the problem.

Perhaps the only positive outcome of the rapid increase in drug-related deaths is the growing sense of crisis and resulting grassroots efforts that are bubbling up. There are more locations across the country with harm reduction centers or services now than ever before; nowhere near enough, but still progress. There have been multiple best-selling books addressing the topic, some of which are/will be represented in pieces on this blog, all raising awareness; where there are best-sellers, there are people reading. Communities across Massachusetts have created organizations for SUD services and education, and Minnesota has a fairly sophisticated network of services it’s developed.

There is so very much left to do. When you vote or advocate, please remember the need for enhanced access to SUD treatment and ask questions about/make requests for substance use disorder policy and education services.