A new definition of addiction, final installment (6 of 6)
An opening in the ice beckons to spring….
Having processed Szalavitz's book Unbroken Brain in five previous installments, covering the philosophical, biological and temporal evidence she presents supporting the idea of substance use disorder as a learning disorder, the important question, "What to do about it?" arrives. Today we close out with education.
One of harm reduction strategies that quickly rises to the top is to reduce adolescent drug use, while the brain is in formation and at its most vulnerable to addiction. We now know so very much more about the affect of drugs on brain development than we did when I was in school and drug education was just "don't do it". Studies have shown that adolescents are very receptive to concrete information about why something is a bad idea, and also we know their brain is primed for learning. In particular, it is important to directly address the individual psychological traits that increase addiction and mental health risk: impulsiveness, sensation-seeking, hopelessness, and anxiety sensitivity. Coping and management skills could be addressed at the same time, in junior high health class curricula. Learning is bolstered when these messages are delivered to children from trusted, familiar sources, in familiar environments, like school.
We've already covered a bit about the idea of teaching recovery, that by eliminating negative reinforcement (punishment, stigma, shame, fear) learning will increase. Reducing stigma starts with language changes - rather than "addict", or "alcoholic", the current thinking is to use the term "person with substance use disorder". It has also been shown that a lesson framed in a positive way, i.e. what is to be gained rather than what must be given up, is more effective. Finally, hope, confidence and self-worth are needed to set the lesson, that the student is capable and a brighter future is available to them. Part of that hope may evolve from concrete services and experiences offered to an individual:
Job training - facilitate productivity and pride of services
Mindfulness training
Political activism, which also helps builds community
Learning from peer example/social contagion, in community
Reinforced early wins
I'll add that education of us all, regarding how to handle subtance use disorder with a loved one or in ourselves, regarding effective policy and advocacy, needs to be a major part of the solution. Substance use disorder must become an acceptable health condition to discuss openly, with medical professionals, policy leaders as well as our friends and family. The shame and stigma attached to substance use, taught to my generation in the late 70's and 80's, must be erased, and all notions of punishment those caught in addictive cycles. Instead we all need to be ready to offer support, know how to access treatment programs, know how to talk effectively with someone struggling, and change housing and social service policy to support everyone - when lives become more stable, drugs become less attractive. This too should be part of middle-school health curricula, and reinforced in later years through the media, churches, community health or services organizations, everywhere.
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All of these strategies really come down to treating the vulnerable among us - including people with substance use disorder and children at risk - with respect and decency, erasing any stigma or shame, ensuring them access to basic human needs, and providing information that allows an individual to make the best decision for themselves. It means erasing the defining criteria of the underclasses (often labelled "those people") in our country, bringing them into our community and supporting them by giving them options. It is realistic to expect we will not save everyone, but we will hope to save more people - many more people - than we are now.
