By Janice F. Booth
In mortal combat, one must know one’s enemy. Throughout the country and in our own region specifically, we are fighting for the lives of fellow citizens—friends and neighbors, children and adults who are addicts. So, what is addiction and how do we halt the dangerous overuse of drugs and other addictive substances and activities?
There are no simple answers to those questions.
Addictions to alcohol, marijuana, tobacco, gambling, and chemicals were considered moral failings in the 1800s; addicts lacked the fortitude to resist these temptations asserted members of the Temperance Movement, a worldwide force in the later part of the 19th century. In the United States, the repeal of the 18th Amendment and the failed policies of Prohibition marked the fall-from-favor of the “moral high ground” view of addiction.
In the 20th century, America’s em ace of Alcoholics Anonymous (AA) and the publication of The Big Book in 1939 redefined addiction. While the social stigma remained, AA reasserted and cultivated the moral integrity of addicts. Addiction became a battle not fought alone, but with the support and respect of others dealing with similar issues.
Then, in the first decade of the 21st century, with ain imaging, PETs (Positron Emmision Temography), and MRIs, (Magnetic Resonance Imaging) sweeping the diagnosis and treatment landscape, medical researchers redefined addiction as an illness of the ain—a condition that had to be observed, pinpointed, treated, and monitored, but was likely incurable. Interestingly, business publications such as Forbes magazine published articles on the disease of addiction, applying terms like “relapse” and “remission.” Addiction moved into the realm of socially acknowledged conditions; one’s family and friends could discuss the addict’s treatment and prognosis. The World Health Organization replaced the term “addiction” with “dependence.”
Professionals—business men and women—could sign themselves into chic facilities for treatment, not unlike the tuberculosis sanitariums of the late 1800s.
Now, with the current epidemic of drug abuse and overdose fatalities, a struggle is underway to wrench drug addiction out of the medical treatment landscape.
On one side, the National Institute on Drug Abuse (NIDA), a member of the National Institutes of Health, maintains that addiction is a “chronic disease similar to other chronic diseases such as type II diabetes, cancer, and cardiovascular disease.”
On the other side, or perhaps moving toward a mid-point, a growing number of social workers, therapists, and other professionals treating addicts assert that addiction is the norm; everyone engages in addictive behavior. Eating, drinking, and sex are addictive, points out G. Alan Marlatt, director of the Addictive Behaviors Research Center at the University of Washington.
In a recent article in Psychology Today, Joann Ellison Rodgers of Johns Hopkins Univ. Bloomberg School of Public Health, quotes physiologist Steven Childs, “The inescapable fact is that nature gave us the ability to become hooked because the ain has evolved a reward system, just as it has a pain system…What we now call ‘addictions’ are cases of good and useful phenomenon taken hostage, with terrible social and medical consequences.”
Society cannot tolerate the characteristics associated with addiction—behaviors that are disruptive, even destructive to the addict, the family, and the community. Addicts exhibit repeated behavioral problems, costly in time and energy for the addict and those with whom he or she engages: family, friends, employers, police, hospital personnel, and the legal system.
Paradoxically, these characteristics of addiction may be triggered by society’s disruption and the collapse of society’s support systems—such as occurred during the economic meltdown of 2007–2014, which led to unemployment, deep poverty, and dislocation across the nation.
Illustrative of this “whole-person in a fractured-environment” definition of drug dependence or addiction, author Johann Han described a study of U.S. soldiers returning from the Vietnam War. Twenty percent of those soldiers were addicted to heroin while in Vietnam. Americans feared that these veterans would return to the States with violent, addictive habits. But, 95 percent of the addicted soldiers simply stopped using drugs when they returned from the horrors of war to simpler, family life. Researchers argue that this ability to give up the addictive behavior supports the position that overuse of drugs and other addictive behaviors are adaptations to an individual’s isolation and fear, alone in the crowd. If we acknowledge addiction as both a desperate search for relief from suffering and gratification through pleasurable experiences, then we can develop treatments that relieve the causes of addiction—loneliness, fear, hopelessness, abuse.
The statistics in our state and adjacent counties are staggering. Three-hundred-eighty-three Maryland residents died of overdoses within the first three months of 2016, according to the Department of Health and Mental Hygiene. Forty-five of those deaths were in Anne Arundel County, compared with 27 county overdose-related deaths during those same three months in 2015. By August of 2016, Anne Arundel County recorded more than 500 heroin and opioid overdoses in seven months, 75 of which were fatal.
Fatal overdoses, primarily from opioids and heroin, more than tripled in Anne Arundel County from 2014 to 2015. Anne Arundel County ranked third in the state for opioid fatalities in 2014— with Baltimore and Baltimore County being first and second. Statewide, 2015 drug deaths increased by 10 percent over the previous year. (Figures for 2016 and 2017 are not yet available.)
In response, the forces were martialed; the plan to combat the deepening addiction/abuse crisis accelerated.
In 2016, Governor Larry Hogan responded to the crisis, awarding $3 million in grants to fight the drug-abuse health crisis. Anne Arundel County’s Executive, Steve Schuh also responded, redirecting county funds to address the expanding problem. Baltimore’s Chase Brexton Health Care opened a facility in the county, in part, to provide more services to combat this epidemic of substance abuse. And, Anne Arundel County opened two substance abuse treatment clinics, Annapolis Addiction Center and Gaudenzia. Arundel Lodge, the county’s premier behavioral health facility, opened First Recovery, an agency established to serve children and adolescents and their families dealing with co-occurring mental illness and drug abuse. The county also began offering training to residents and public service workers on the administering of Naloxone, commonly known as Norcan, to reverse the effects of an opioid overdose.
Psychotherapist Heidi Waltos, in a July 2016, editorial in The Baltimore Sun, addressed treatments for addiction, particularly for co-occurring patients (those struggling with both mental illness and addiction.) “…a recent review focused on different modalities [of treatment] for adolescent substance use, including 12-step Alcoholics Anonymous models, cognitive behavioral therapy, motivation-based therapy, family-based intervention, and other approaches. A consistent pattern emerged where family-based intervention and cognitive and motivational enhancement therapy had the best outcomes. After all, addiction is much more a psychological response than a disease, as addiction researcher Lance Dodes has pointed out, rooted in denial of one’s personal power and uniqueness…We need to educate and re-educate people regarding addiction and the central issue of powerlessness, and refrain from further marginalizing those with addictions from the ‘family of man’ into a segregated family of ‘addicts.’
The Governor, other influential political leaders, therapeutic professionals, and medical and social workers are trying to help stamp out this plague of addiction. Our intentions are honorable and sincere. Perhaps those expressions of concern and offers of helping hands in clinics, hospitals, and elsewhere will make a difference. In this society we tend to “follow the money.” Where we spend our money points to what we truly value. Perhaps these concrete actions will focus our attention and aid in the recoveries of those struggling with addictions in our county, our state, and our nation.
