Opiate epidemic: it’s not the drug

Lately not a single day goes by here in Portland, Maine without an opiate related overdose. Working as a therapist and substance abuse counselor, not a single life I encounter is left untouched by this disease. Why now? Why the sudden increase? I have some thoughts. Working in community mental health I noticed, as I’m sure many others did, a steady increase years ago. In fact, it was predicted when Maine discontinued its medicaid coverage for medicated assisted treatment (Methadone, Suboxone) for those receiving treatment longer than two years. When this law passed it was retroactive. This meant that many people’s coverage for the medication that had helped many of them return to a life focused on their values was suddenly gone. Over the next few years pharmacy robberies increased, and heroin overdoses increased, dramatically. A strip of Suboxone on the street is $20 a dose, heroin can be $10 or less. Now there is a cheap and regular supply of heroin in Maine from increased demand due in part from state legislation.

But why use it in the first place? I will borrow ideas put forth in this Ted Talk (see link below). What most people understand about addiction and drug use is from early research with rats in cages with just two water bottles. One bottle has drugs in it, the other does not. The rats drink the drug water compulsively until they die.  Thus we draw the conclusion that if we go out and use addictive drugs enough times in a row we will become addicted. What’s really interesting is this is not at all true. Only a small percentage of people become dependent on drugs. “According to the Institute of Medicine of the National Academy of Science, 32 percent of people who try tobacco become dependent, as do 23 percent of those who try heroin, 17 percent who try cocaine, 15 percent who try alcohol and 9 percent who try marijuana” (see link below). Therefore, it’s not the drug.

Later rat experiments tried putting them not in empty cages, but with everything and anything a rat could possibly want, including other rats. Nobody overdosed, nobody became dependent, they hardly used. When one works with people dependent on drugs, none of them feel well connected, nor loved, nor understood. Another addiction specialist, Gabor Maté, said “we shouldn’t look at what is wrong with the addiction, but what is right about it.” That is to say, what is the problem it is fixing? If we are anything like rats in cages, which for a long time now scientists have felt it a reasonable model, than the problem is that of connection. People who are dependent and addicted are feeling disconnected when they start using. When we notice, how does society treat them,? With compassionate open arms, inviting them to return to the fold?

When trying to help those dependent on using substances to cope, it is important to understand this idea of connection. It is important to not judge, maintain a kind and compassionate disposition. A deer in the meadow will flee when approached head on. If a kind offer of an apple is left to be taken when wanted, than a connection becomes possible.

Be Well,

David Aronson LCSW

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Johann Hari: Everything we know about addiction is wrong https://www.ted.com/talks/johann_hari_everything_you_think_you_know_about_addiction_is_wrong?language=en

New York Times, Addiction: a brain ailment not a moral lapse http://www.nytimes.com/2003/09/30/health/personal-health-addiction-a-brain-ailment-not-a-moral-lapse.html