By Dr. Mark Calarco
Modern science tells us that addiction is a brain disease with a strong genetic component, often exacerbated by environmental factors–similar to other genetically driven diseases such as diabetes or hypertension. And yet addiction, whether to alcohol, drugs, or other substances or activities, still carries a powerful social stigma.
People are shamed for struggling with addiction, despite all society has come to understand about this health condition. This flawed perspective can have deadly consequences, as the United States remains in the throes of an opioid epidemic. The scale of this public health emergency cannot be overstated: An estimated 10.1 million peoplemisused prescription opioids in the last year. Opioid overdoses killed nearly 50,000 people in the U.S. in 2019. That’s 130 people dead each day. And that is just from opioids–other drugs and alcohol claim additional lives.
20 million Americans are battling a substance use disorder, yet most do not seek treatment. Those fighting addiction can present a particular challenge to health providers, with the disease at times resulting in negative or dysfunctional behaviors. Negative attitudes of healthcare professionals toward those abusing substances can even hinder the delivery of empathetic, quality care. Imagine if our healthcare system were set up to identify these vulnerable patients and provide them with the care they deserve.
To achieve this change, healthcare providers’ perspectives on addiction must continue to evolve. The medical and recovery communities must treat those with addiction with the same respect we treat those struggling from any other ailment. In order to do so, the medical establishment must discard outmoded ideas of addiction as a moral failing or personal weakness, instead fully recognizing it as a genetic brain disease. I treated a large population of Type 2 diabetics as a community physician in an underserved area. When some of my patients insisted on continuing to eat the Little Debbie snacks and doughnuts they loved, ignoring the recommended regimen to control their blood sugar, I did not stigmatize or disrespect these patients or their choices.
If doctors, nurses, recovery specialists, and other caregivers label people with addiction as weak or lacking willpower, those individuals will feel trapped by guilt and shame. Feelings of shame lead to isolation and secrecy, making it virtually impossible for a person to seek help or make positive changes. Even more dangerously, individuals trapped by their own shame, who feel unworthy of help, health, or happiness, are less likely to disclose additional struggles or access the treatment that could save their life.
Catch the Signs Early
This transformation in how people with addiction are cared for begins in the primary care doctor’s examination room. A brief screening tool provided to patients can serve as the first line of defense to help someone fighting addiction connect with help. Addiction specialists use an effective, validated screening tool; a large-scale education campaign among primary care providers could help integrate this valuable screener into their patient visits and make it a standard element of their patient care. Such a tool does take a bit of extra time to complete, but isn’t it worth taking five minutes to potentially save a life? Without it, physicians miss unreported numbers of people who might benefit from support and treatment.
Diagnose with Data
Addiction is a disease like any other. The more peer-reviewed, quantitative data points can be used to detect, diagnose, and measure addiction, the more we can reduce stigma surrounding it. The American Psychiatric Association’s DSM-5 entry for substance abuse disorders can be a blunt measurement that sometimes falls short. Rather than a subjective observation of physical or psychological symptoms, advances in science offer physicians new research-based metrics to help understand and identify substance use disorder.
Just as a blood sugar score above a certain level can reveal diabetes, MRI brain imaging can reveal activity patterns consistent with substance abuse disorders. Seeing a concrete visual of a brain showing addiction patterns can help frame the disease as a specific, scientifically measured, treatable ailment of the anatomy, rather than a value judgment on an individual’s personality and life choices.
Recent advances in medical technology have helped demystify brain activity, particularly around addiction. Emerging techniques such as magnetoencephalography and next-generation electroencephalograms reveal fluctuations in brain activity among thousands of people with certain substance abuse disorders. Variations can even differentiate addiction to particular drugs, such as methamphetamines versus opioids. These sensitive instruments can show the brain’s submicroscopic response to certain activities. Such fine-grained brain images can enable recovery specialists to modulate treatment accordingly, resulting in more effective patient outcomes.
Transcranial magnetic stimulation offers a promising, noninvasive treatment option for those dealing with addiction. The use of magnetic fields to stimulate the brain’s nerve cells has been used to help treat depression, but it is also thought to have application for substance abuse disorders as well. Such treatment also eliminates the potential negative side effects of some medications used in recovery. Addiction science is beginning to move toward more data-driven diagnostics and accompanying, multifaceted treatments, but this shift must accelerate.
Bolster Addiction Education
With record numbers of Americans dying of opioid overdoses every day, medical and nursing students must receive more training in respectful, proactive care for people with substance abuse disorders. While there is certainly more recognition of and education on addiction than before, there is still work to be done. Addiction medicine has historically been considered a challenging, even unpopular subspecialty. Nevertheless, every doctor, no matter their specialty, should have the basic tools to recognize addiction in patients, and the knowledge to help connect them with customized care.
Slowly, addiction is being recognized by the public more and more as a serious health crisis. When beloved celebrities or public figures share their own struggles with addiction and recovery, that is a powerful force to reduce stigma. The medical community has an opportunity to help build a new paradigm of addiction as a genetic brain disorder whose patients deserve clear-eyed, compassionate care.
Dr. Mark Calarco is currently the National Medical Director for Clinical Diagnostics the Dr. Mark Calarco served as the national medical director for American Addiction Centers from 2013 – 2018. He works closely with Addiction Labs to conduct medical and laboratory research as well as develop innovative products and services that will improve patient outcomes.
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