Opioid overdoses now kill more Americans every year than guns, breast cancer, or car accidents. 20 million Americans suffer from addiction to alcohol, illicit, or prescription drugs. On the second anniversary of Prince's death from fentanyl overdose last weekend, the President of the United States demonstrated a deep ignorance of this medical epidemic, calling someone he considers an alcoholic and addict a "drunk/drugged up loser."
Days later we learn that Dr. Ronny Jackson, the physician Trump nominated to lead the country's largest healthcare system, the Veterans Administration, is known to have a drinking problem and is nicknamed "The Candyman" because of his reputation for freely distributing controlled substances to White House staff. With 1 in 10 soldiers seen by the VA for problems with alcohol or drugs – the majority as an outgrowth of being treated for chronic pain – Jackson was a dangerously ignorant choice.
Both the president's regressive drug policy and his impulsive social media outbursts are conflicting, misinformed, and poorly executed, so his recent post about addicts being "losers" must seem pedestrian to most. In the same tweet he also managed to insult a Pulitzer Prize winning journalist and engage in thinly veiled witness tampering before taking off for a round of golf while his wife attended Barbara Bush's funeral. Numbed and spotty outcries ensued, and we moved along to the next week's insults. It became just more white noise.
Leadership and policy drive the public's attitudes about addiction and these opinions have very real consequences in people's lives, as it did for Prince. After his death, I wrote a Boing Boing piece about the influence these negative perspectives about addiction had on the way Prince pursued treatment options for a pain management regimen that became a dependency, and ultimately an addiction. That's a common risk in treating chronic pain with opioids. Prince used back channels to get help. He used cover stories. People covered for him. In other words, he and everyone around him behaved as though addiction was something to be ashamed of. As a result, treatment was delayed because concealment was prioritized. The California specialist in addiction and pain management who was privately deployed to Paisley Park to begin Prince's treatment with Suboxone arrived that morning to a dead body.
Prince may not have been happy about the need for addiction treatment, but he knew it was time, and he had a close enough call on the plane to ponder the thought that his addiction could end his life. Clearly, he wanted to live. But he didn't want anyone to know. Sadly, addiction is particularly lethal in the case of performing artists with egos and identities whose destruction could mean the end of their careers. Hide it, hide it, hide it. Hide it from you. Hide it from us.
From my perspective, lumping Prince into the bin of rock stars done in by overdose, dismissing the tragedy as another example of excess and bad choices, is not only inaccurate, it perpetuates dangerous attitudes and ignorance about chronic pain and addiction. Every medical treatment has inherent risks. So why the shame?
The shame has long been broadcast from the top down. Since the Nixon era, the trend of drug policy drifted away from rehabilitative treatment towards criminalization and punishment. The result? The prison population jumped by 1000% in the last 40 years, giving rise to the for-profit private prison industry. Those imprisoned for alcohol and drug-related offenses became a reliable and steady supply of bodies for their bottom line.
Obama finally set guidelines curtailing the use of for-profit prisons, which have no financial incentive for treating prisoners incarcerated for drug use offenses, but now Attorney General Jeff Sessions is reversing those guidelines and indulging his personal fetish for rebooting the war on drugs and criminalizing addiction. In general, the current administration appears to be clueless about the epidemic.
This was immediately evident after the election when Trump praised Philippine President Duterte's drug policy, which primarily involves murdering addicts and dealers on the street, saying he was "doing a good job." He even invited Duterte to the White House. There was little uproar. In the social media hellscape at the time, anyone taking offense to negative attitudes towards addicts would probably get them called a "snowflake." But it's not political correctness that's upsetting. When the new president-elect is lauding the murder of people with a specific medical condition as good drug policy, it's broadcasting dangerous myths about addiction from the very top down in a terrifying way.
For most Americans, especially those who continue to insist that addiction is a choice and not a medical condition, there was a big piece of news that came out a week after the 2016 election proving otherwise. But it got buried and didn't capture much attention from the American public, perhaps because our media diet had been so dominated and infested with pussy grabbing, email servers, anchor babies, and the minutiae of every pendulum swing from the alt-right to the alt-left. Post election, it just got louder and increasingly exhausting.
On November 16, 2016, the Surgeon General released the results of an exhaustive and comprehensive study, in a report called "Facing Addiction in America: The U.S. Surgeon General's Report on Alcohol, Drugs, and Health." Though it contained hundreds of newsworthy findings and data, one stood out: addiction was reclassified as a chronic brain disorder. It was not a choice, a character flaw, or weakness. It wasn't caused by bad parents or drug dealers or laziness or video games or stupidity. The substance being abused didn't cause the disorder, it revealed it. Addiction was caused by atypical reward system wiring in some people's brains.
"For far too long, too many in our country have viewed addiction as a moral failing," Murthy said in the report. "It is a chronic illness that we must approach with the same skill and compassion with which we approach heart disease, diabetes and cancer." –-U.S. Surgeon General Vivek Murthy
The unsexy "Alcoholism and Addiction reclassified as chronic brain disorder" headline probably got skipped over in everyone's juicy news feeds at the time. Facebook was still busy spoon-feeding everyone Russian propaganda, and it wasn't trending on Twitter the way #MAGA, #NeverTrump, #LockHerUp, and all the misspelled #BasketofDeplorables hashtags did. In a nation where there are now more people with substance abuse disorders than people with cancer, it was terrible timing for such revolutionary and significant news that impacted so many lives: addiction is a brain disorder.
Here is a short list of some common brain disorders. Which ones do you think it is reasonable to be ashamed of or killed for?
We used to think mental illness was caused by demonic possession, pneumonia was caused by "night air," that your stomach would explode if you ate Pop Rocks and drank soda at the same time, that you can get warts from holding a frog or toad, and that dipping people's hands In warm water while they sleep will make them wet the bed. Add addiction to the list of things we didn't get right until the realities of science were fully applied.
Some people will never be convinced. They believe it's another excuse for someone's bad choices and need for their help. But whether we realize it or not, the public has skin in the game and needs to wise up. Ignorance about addiction is not only dangerous to those who might suffer from it, it's costly to every American. According to the National Institutes of Health, addiction, whether it's alcohol, illicit drugs, or prescription opioids, costs the public $520.5 billion dollars a year in costs related to crime, lost work productivity and health care. The problem is more than hurt feelings of "drunks and drugged up losers." It's $520.5 BILLION DOLLARS.
•That's the amount of our current federal deficit.
•That's the entire budget of the U.S. Department of Education nine times over.
•That's the cost of 25 F-16 Fighter Jets.
•That's the entire valuation of Facebook, depending on the news day.
It's a lot of damn money that could change American life in a huge way if it weren't being spent on the consequences of millions living with an untreated brain disorder. Instead, common wisdom about addiction is that "you people just need to behave." It's like telling a nearsighted person they don't need glasses, they just need to look a little harder. The myths persist despite the evidence.
From the LA Times:
The 426-page report, titled "Facing Addiction in America," was modeled on the 1964 surgeon general's report on smoking and health, which first linked cigarettes to cancer and led to a successful national campaign against tobacco use.
Murthy described the report as "a new call to action." It lays out recommendations for elected officials, the medical community, law enforcement and the public to improve the way addiction is treated.
More than 20 million Americans suffer from substance abuse disorders, far more than are diagnosed with cancer, but only about 10% receive treatment, according to the report. Murthy said that stigma surrounding addiction dissuades people from getting help and the report repeatedly referred to addiction as "a chronic brain disease.
When Trump fired the Surgeon General a few months later, the Surgeon General's "call to action" was essentially killed along with the hope that the American public would finally understand that addiction was not a choice but a disorder present even when the substance of abuse was not being used. Instead, it's a largely unknown revelation.
An eye disorder affects your vision. A skin disorder affects your complexion. But a brain disorder affects your personality – your thoughts, mood, behavior, and feelings, so it's far more complicated to detect and treat. Also, let's face it, we judge people and hold them responsible for their choices. I don't want to over-simplify a 426-page report, but basically, when an addiction-disordered brain finds a substance – or activity – that gives them relief from their symptoms, they are self-medicating. But the best treatment plan for a brain disorder is not a DIY application of whatever's on the drink menu at TGIFriday's.
However, once the alcohol or drugs hit a disordered brain, it triggers the phenomenon of craving, they lose the normal capacity to choose. Can they still choose? Sure. But the reward system in their brain is telling them that they need to drink or use more drugs as if they needed it for survival – a primal instinct. "Choosing" to stop is like choosing not to run from a lion chasing you. It goes against every driving instinct in your body and mind. It's not the same kind of choice a regular person feels about whether or not to drink or do drugs. That's why it's called a disorder. It's fucked up and it sucks.
As an addict with 15 years of physical sobriety, I can assure you, the problems with my thinking and decision making didn't begin when I started drinking and taking drugs and they didn't end when I stopped. An alcoholic or addict – someone with this type of wiring – who is not using alcohol or drugs is still an alcoholic and an addict. Physical sobriety from whatever substance is being abused doesn't cure the problem, because the brain is still programmed for pursuit of the biochemical reaction, the short-term gratification, regardless of consequences.
This is why people need treatment and many go to AA meetings long after they stop drinking or using drugs, in fact especially after they stop. It's their brain – their thought life – that needs continued treatment. I am one of those who attends AA meetings, and they are filled with people from all walks of life, races, genders, economic and education backgrounds. My first sponsor was a kindergarten teacher. These are regular people that didn't know they were walking around with a brain glitch that, left untreated, could destroy their lives. That's why the Surgeon General's report is such a revelation.
From LA Times:
[U.S. Surgeon General] Murthy said that stigma surrounding addiction dissuades people from getting help. Some of the top government scientists studying addiction showed an audience of advocates, recovering addicts and family members brain scans that they said made clear addicts were suffering from a legitimate illness rather than moral weakness.
"Science tells us clearly that addiction is a disease of the brain," Murthy said.
I know Trump name-calling someone on Twitter isn't news. But this report on addiction should still be big news. When we see Trump mock a disabled reporter we are rightly outraged, but when we hear him refer to someone who might have a substance abuse problem as a "drunk/drugged up loser," it doesn't get much of a reaction. Just Trump being Trump. That's a bad sign. A really bad sign o' the times.