It’s 2017, but there’s still plenty of ignorance to go around. Namely, when it comes to discussing and understanding substance use disorders, long-held beliefs about these issues often come from a place of fear and prejudice.
In a new report by the Cincinnati Enquirer, experts in the field of substance use disorder and mental health take on four common myths about addiction:
Myth 1: Addiction is not a disease.
“Addiction is a brain disease, and you’ve got to treat it with a disease model,” says Betty Tai, director of the Center for Clinical Trials Network for the National Institute on Drug Abuse. Tai was the keynote speaker at “Tackling the Ohio Opioid Crisis: Harnessing the Power of Science to Break the Cycle” on Monday (Nov 27).
Dr. Howard C. Wetsman, chief medical officer of the Townsend Addiction Treatment Centers in Louisiana, agrees. He pointed out the disconnect in the way we talk about and treat substance use disorder in an article featured in The Fix (February 2015). If we truly applied a disease model to treating addiction, long-term medication-assisted treatment (MAT) would be universally accepted.
But the idea of relying on a maintenance drug long-term does not sit well with people who stick to one definition of recovery: pure abstinence. Wetsman disagrees with this thinking: “The mindset… is that addiction is really just a long-lasting intoxication that will eventually go away, leaving the person normal again,” he writes. “This is not a true understanding of addiction as a disease.”
Myth 2: If someone addicted to heroin wants to stop using, they should just detox.
In fact, relying on detox alone to treat a substance use disorder is not enough to sustain recovery. “With just detox, and not providing additional treatment, the relapse is almost instantaneous,” says Tai. The success rates of this method are low. Theresa Winhusen, professor and director of the Addiction Sciences Division, of the department of psychiatry and behavioral neuroscience at UC College of Medicine, notes that just 5-10% of people who detox and do nothing else are able to stay abstinent.
Not only that, quitting cold turkey in the absence of other forms of recovery support increases the risk of overdose if the person were to relapse, as Kenneth Anderson, CEO of Harm Reduction for Alcohol (HAMS) explained in The Fix (January 2017). Detox lowers a person’s tolerance. If they use again, they will likely use the same amount they had before, raising the risk that they will overdose. The tapering approach of MAT is regarded as safer and more sustainable.
Myth 3: Using methadone or buprenorphine is just trading a drug for a drug.
Rather than achieving the same effect as the person’s opioid of choice, MAT drugs like methadone and buprenorphine, when administered in the proper dosage, only serve to help the patient “regain normal functioning,” Tai explains.
The idea is to “normalize” the person so they can get back to daily life—Anderson likens this to “people with diabetes stabilized on insulin.”
Myth 4: It’s their fault, or their parents’ fault, that they are addicted to heroin.
“Nobody is to be blamed,” says Tai. This also applies to individuals who repeatedly try and fail to stay sober. As Thaddeus Camlin, PsyD writes in The Fix (November 2016), “Substance use is the only area I’m aware of that blames treatment failure on a client.” Again, revealing the discrepancy between the mantra that “addiction is a disease” and how people with addiction are perceived.
Rather than assigning blame, Camlin, a substance use therapist based in San Diego, says we should recognize that failure is part of the process for some. “Behavior change is an imperfect process,” he writes. “The lie that perfect, 100% abstinence is the only success in substance use is an undeniable and unethical dilemma that helps perpetuate the lie that most people fail in recovery.”
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