Addiction touches the lives of more than 100 million Americans every single year. It’s time to rethink how we view this devastating condition, and that means acknowledging that it is a chronic illness and not a moral failing.
A shift in thought
Here is a shocking truth about addiction: There is a 75 percent success rate with treatment among people who with substance use disorder, yet only 10 percent of people with addiction seek help. Why? One big part of the answer is the continued stigma surrounding the illness. All mental illnesses still carry a stigma, and addiction is one of the most stigmatized. Psychiatry is the redheaded stepchild of medicine, and addiction is the redheaded stepchild of the redheaded stepchild.
I saw firsthand in medical school, when I did my psychiatry rotation, that the standard of care was to denigrate and humiliate—not a winning formula. Even the way many families treated a loved one with addiction—tough love, for example—did not deliver the support needed. We’ve made some progress in the past few decades, but not nearly enough.
We need to view addiction as a chronic illness and treat it the same way we treat high blood pressure or asthma. The one-year relapse rates for high blood pressure and asthma are the same as or higher than the relapse rates for addiction. Would you say, “Stop treating blood pressure and asthma because those people don’t want to get better, and treatment doesn’t work anyway?” Never. And yet that is what we say about addiction and actively undermine the most important element of recovery—hope—all but ensuring that people will continue to die from addiction, hopeless and untreated.
Factors that increase risk
Every state of illness or wellness has biological, psychological, and environmental inputs. Every single one—not just addiction. There are inherited ones that you’re born with and acquired ones you are exposed to when you’re older. Roughly 40 to 60 percent of addiction risk is inherited and 40 to 60 percent is linked to where you grow up and the life experiences you’ve had. Looking at those numbers, you can see that it’s pretty hard to “make a different choice” when it’s actually addiction that “chooses” you, based on your DNA and the environment you happened to grow up in. It’s often a combination of biological, psychological, and environmental factors that pushes someone over the edge to addiction.
Inherited risk factors
The first set of risk factors is inherited.
Biological. Addiction is passed along in our genes like so many other illnesses. Think of how often alcohol use disorder runs in families.
Psychological. Experiencing or witnessing violence and other types of traumas while growing up not only changes the brain, but also impacts DNA. Research on the children of Holocaust survivors has shown that trauma can be passed down to children even after the event through their genes. These are “epigenetic” changes: They don’t change the DNA sequences in your body, but they can alter the expression of a gene, making you more susceptible to stress and depression or more likely to be resilient, for example.
Environmental. Everything from your economic class and access to health care to whether the water in your neighborhood was safe to drink and how many liquor stores dotted your neighborhood can raise addiction risk.
Acquired risk factors
Biological. Your risk of addiction is tied to biological changes that happen after birth, such as illnesses like depression. Medications, like opioids, can go from being the solution to becoming the problem.
Psychological. Facing adversity and experiencing discrimination, which now affects so many different groups of people, are examples of acquired psychological risk.
Environmental. A drinking or drug use culture among people in your social or work circle is a significant source of environmental stress, as is living in a neighborhood where liquor stores rather than basketball courts or yoga studios are the primary stress relievers.
A more effective approach
The typical stay at an addiction treatment center is 30 days. One reason for the initial high rate of success at destination centers is that they remove environmental triggers. These triggers are responsible for up to 60 percent of relapse risk, so when you go back to your real life, you need a whole new level of coping skills and ongoing support to keep your illness in remission. It’s a mistake to think that 30 days away is the cure. It’s just the first step of an ongoing journey.
Also, the current standard addiction treatment system focuses on only one of the six risk factors: your acquired biological risk. It’s vital to address all six. That may mean getting help to remove barriers to recovery like finding affordable housing, dealing with financial stress, overcoming disconnection and, most important, developing life meaning and purpose.
For a better chance at recovery, you also have to think long term, just as if you have high blood pressure, for example. You might get it under control with medication, but you still have it. Stop those meds and your numbers will jump. Another example: If you have diabetes, you’re taught to know your triggers and your high (and low) blood sugar signs. The same approach works for addiction recovery with a three-step strategy: recognize, avoid, and plan.
Recognize your early warning signs, know and avoid things that trigger your illness, and have a plan for when you can’t sidestep a trigger situation.
This doesn’t mean you need to see your doctor every week for the rest of your life. It should be more frequently at first, and then as needed when your illness is stable. You might schedule a quarterly visit for prevention, just as you get your teeth cleaned regularly to avoid big oral problems. Or maybe you text your doctor once a month as a check-in, just as many women do a monthly breast exam to check for any lumps.
There is much more access to care now than ever before, thanks to virtual care, but you want to find a doctor who will meet your needs, including providing the right kind of ongoing support. Do your research on practitioners in your area, and read reviews—look for words like warm, compassionate, and caring, or keep searching.
Meaningful Conversations
Addiction is the epitome of disconnection. That’s why open conversations are so meaningful for both those at risk and their loved ones.
Talk about it. Silence about addiction teaches everyone else in the family that the subject is taboo. So if one of them becomes at risk, they will feel that they have to hide it, and that increases the danger. If a loved one already has a substance use disorder, show compassion and caring to increase your chances of being effective.
Self-Reflection. Reflect on how your environment impacted you when you were growing up and how it’s impacting you now. Try to understand the effects of the circumstances of your upbringing and see if you can take present-day steps to counterbalance them.
Talk to your doctor. Drug use is something many people hide from their doctors out of fear of being judged, but being open and honest can get you the help you need. Also, if you have risk factors for a substance use disorder, it’s essential to share this information with your doctor if he or she prescribes any medication with the potential to be addictive.
Find safety. Locate and become a part of a safe space—a place or group where you can talk about your experiences and validate the experiences of others. Challenge or step away from situations where substances are baked into the culture, rather than going along and putting yourself at risk.
