By Peter Loeb, CEO of Lionrock
It’s no secret that substance abuse is a major problem in our country, and healthcare workers are especially at risk. With the inundation of news headlines detailing traumatized healthcare workers in war zone-like conditions over the last two years, we shouldn’t be left wondering why they are turning to desperate measures to cope with their trauma. But we should be wondering why they aren’t asking for help, when it’s so clear the wellbeing of healthcare professionals is in serious jeopardy.
Of course, they’re not alone. A staggering 20.7 million Americans – about 8 percent of the U.S. population – need SUD treatment, and disturbingly, only 4 million of those people, or approximately 19 percent, receive treatment.
The answer is not as complex as you would think, in fact, it’s one word that holds enormous power: stigma. People who struggle with drugs or alcohol fear judgment in their social and professional lives, and given the very real bias associated with SUDs, their fears are justified. Recently, 24% of Lionrock Health’s current clients who hold jobs reported that fear of stigma had kept them from letting anyone at work know that they were in SUD treatment.
Understanding why crushing stigma is so powerful in the fight against SUDs requires a deep understanding of what SUDs are. Everyone knows the “easy” answer to this question: people struggling with SUDs are weak people, bad people, lazy people, hedonistic – take your pick – and often people throw in a “not us” for good measure. Why do we think that? Easy again. “Addiction is a choice” and people struggling with SUDs can become unreliable, remain prevalent points of view. But if we want to reduce the damage that SUDs cause, we must recognize that the easy answers are not accurate, and the stigma they generate makes the problem even worse.
People with SUDs have fallen into a trap. They are self-medicating – sometimes a physical ailment, or more often a mental illness. It may be big or small, internally or externally-generated, and it usually presents as anxiety and/or depression. Too often it is underlaid by trauma. Before their substance use becomes a disorder, they are in fact making a choice; they are choosing what they think is a way to keep going, to do their jobs, to take care of their families. They are self-medicating – seeking pain relief – analogous to taking ibuprofen for a headache.
A study published in the Journal of Addiction Medicine in 2013, uncovered the top five reasons why physicians misused prescription medication: “(1) to manage physical pain, (2) to manage emotional/psychiatric distress, (3) to manage stressful situations, (4) to serve recreational purposes, and (5) to avoid withdrawal symptoms.” Among the study’s conclusions was that the “results emphasize the importance of self-medication as a leading reason for misusing prescription medications…”
Other studies indicate that 70% of people struggling with a SUD have a comorbid mental health problem. Substance Abuse and Mental Health Services Administration (SAMHSA) reports that 75% of people in SUD treatment have histories of abuse and trauma.
Here’s where stigma comes into play. Stigma and shame are two sides of the same coin. Stigma characterizes how you feel toward someone else. Shame is how you feel about yourself. People struggling with SUDs are terribly ashamed. The substances they were using to stay in control, now control them, which the American Society of Addiction Medicine (ASAM) classifies as a brain disorder.
The dismay piles up. Embarrassment, scorn from others, and physical brain damag,e add more maladaptive behavior on top of whatever problem (physical or psychological) is at the root of the SUD. Add the high standards of hard work and discipline which characterize healthcare workers, and the pile of pain just keeps growing. Of course, the person with the SUD struggles, but so do you and the people and organizations who count on this person being a productive member of your team.
The bottom line? If there were no stigma, people would seek help earlier, while their SUD was still manageable. How do I know this? More than a decade ago, I co-founded Lionrock, the leading all-telehealth SUD treatment company, with the goal of bringing people the most private way to get help. Privacy protects against stigma. Here are some of our findings:
As a baseline, 85 percent of Lionrock clients are employed, and many have families. Half of our clients told us that they would not have gotten help if their only choice had been a traditional brick and mortar setting. Another 20% said they weren’t sure that they would. The level of privacy which telehealth provides brought them to treatment pre-crisis, typically without a “rock bottom”.
Specifically relevant to pandemic era healthcare teams, 6 percent of the clients Lionrock treated in 2020 and 2021 told us that they were employed as nurses. For comparison, nurses represent 2.4% of the U.S. workforce. It’s not a stretch to say that the privacy and convenience of telehealth persuaded 2.5 times as many nurses to get help as we might have expected from their representation in the broader workforce. When fear surrounding stigma is lower, more people get help.
With luck, you’re willing to test for yourself how stigma affects your team’s health. Here are some ways in which you can run that test in your own healthcare setting:
The number one thing you can do is normalize the existence of SUDs. People struggling with SUDs feel alone and often hopeless that they can fix the problem themselves. Talk about SUDs, especially in the context of the enormous stress which healthcare workers have experienced during the pandemic. Are there people in your community who are willing to discuss their own recovery? This is a touchy subject, but in addition to those who – because of stigma – choose to remain anonymous, there are often some brave souls who have decades of recovery and are willing to concretely demonstrate that recovery works. If not, reach out to in-person or online resources willing to do educational presentations and/or which offer a hotline people can call.
Second, offer high quality treatment benefits to your team and consider including telehealth options. Everyone wants a quick fix for their problems, but SUDs tend to be chronic and require as much care (treatment and support meetings) as possible during the first year. The convenience of telehealth can make staying in treatment longer more palatable.
Third, make sure that everyone knows that they are eligible and that there’s a private way for them to access help. Don’t make your team go through organized internal channels to get help. Their fear of stigma will prevent them from doing it. Until we crush the stigma, safeguards are still needed.
On a final note, despite the factors that put healthcare workers at risk for SUDs, there’s evidence that recovery works well for healthcare workers too. In studies that followed physicians post-SUD treatment for five years, more than 80 percent of the providers involved maintained sobriety and 95 percent returned to their jobs in healthcare. Let’s vanquish stigma, the silver bullet in the fight against SUDs, so the people in charge of well-being can manage their own.