When U.S. Surgeon General Vivek Murthy, M.D., MBA, released his 400-plus page report on addiction last November, what was prominently featured in the press headlines in the days afterward weren’t the opioid overdose statistics or the addiction research studies the report had cited, but rather a comment Murthy had made in the report’s preface. In a direct address to both U.S. medical professionals and the American population at large, Murthy called for an end to the long-held social stigma surrounding addiction.
“For far too long, too many in our country have viewed addiction as a moral failing,” Murthy wrote in the report. “This unfortunate stigma has created an added burden of shame that has made people with substance use disorders less likely to come forward and seek help.”
Murthy went on to state, “We must help everyone see that addiction is not a character flaw—it is a chronic illness that we must approach with the same skill and compassion with which we approach heart disease, diabetes, and cancer.”
Coming from the nation’s highest-ranking doctor, this plea for a cultural shift was indeed a potentially powerful one. But was it enough to help Americans see addiction in a new, more compassionate light?
We’ve Come A Long Way
Throughout U.S. history, Americans have taken a Darwinian approach to addiction—and mental illness in general—exhibiting a “shape up or ship out” attitude and frequently turning a cold shoulder to anyone lacking the motivation to “pull themselves up by their bootstraps” and take the necessary steps to save themselves. In fact, it wasn’t until 1956 that the American Medical Association (AMA) recognized alcoholism as a disease. Prior to that, victims of addiction were frequently shuttered away in insane asylums and even made to undergo forced sterilization.
More recent examples of discrimination and bias exist, as well. In a 2002 testimony before Join Together’s Policy Panel on Discrimination against Individuals in Treatment and Recovery, former First Lady Betty Ford testified that when the Betty Ford Center attempted to establish a residential treatment program for medical professionals, community residents lead protests. “They threatened to videotape our patients going to and from the homes and make public their tapes,” Ford said of the incident. “The ignorance and hate were surreal.”
And as recently as 2010, it was common practice for health insurance companies to refuse coverage for those seeking treatment for addiction. Addiction sufferers were told that if they wanted their treatment to be covered, they either needed to wait until their disease became life threatening or until the symptoms of the disease caused significant enough damage to warrant classification as a disability.
This changed, however, with the passing of the Affordable Care Act, when it became illegal to deny treatment to those with a substance use disorder. Then in 2016, several states—including Nevada—made it illegal to ban people with drug possession convictions from receiving benefits from the Supplemental Nutrition Assistance Program (SNAP). Prior to that, those who had served time for drug possession were denied access to food stamps, even if the crimes they had committed had occurred several decades prior.
Today, recent research has shown that Americans’ attitudes toward addiction and mental health may be changing. For example, the results of a recent study found that 90 percent of Americans view mental health as being equally important as physical health.
Much Work Still Needs To Be Done
Although attitudes toward mental health issues have been changing, the fight for unbiased treatment is far from over. A past survey from California, for instance, found that 59 percent of employers claimed they would never hire a job applicant with a felony drug conviction. This survey and others suggest that an addiction bias is still pervasive, even as laws continue to be enacted to counteract it. And this bias, says the surgeon general, may be contributing to why so many Americans with substance use disorders are not getting help. Indeed, according to the report, 20.9 million people in America have a substance use disorder, yet 90 percent are not receiving treatment for it.
Steven M. Altig, Esq., a criminal defense attorney in Las Vegas, believes that addiction is particularly misunderstood in Southern Nevada due to the “prolific use of alcohol and other vices within this state.”
“People see more people drinking or using without becoming addicted,” says Altig of Las Vegans’ perception of addiction. “As a result, it is easier for society to look at addicts and simply say addiction is the result of a lack of will power. Anyone who is educated on addiction knows that supposition isn’t accurate; however, it is easy for people to take on that mindset when you see so much use going on around you without a good portion of that use turning into addiction.”
Why The Stigma Persists
Addiction is not a “pretty disease”
People in the throes of active addiction are not pleasant to be around and, unfortunately, their behavior does little to inspire empathy. The disease of addiction is unique in that it turns those suffering from it into self-centered and secretive shells of their former selves—people who are capable of committing horrendous acts in order to feed the cravings of their disease. The stories told on the news of drug-addicted parents selling their children for crack or drunks murdering their neighbors in a blackout certainly don’t help refute the stereotypes.
Judge Cedric Kerns of the Las Vegas Municipal Court believes that this is one of the major reasons why addiction stigma continues to exist in Nevada and elsewhere.
“Addiction is one of the very few diseases that the symptoms are behavioral in nature,” says Kerns. “Other diseases have physical symptoms like sneezing, fevers, headaches, and dizziness. With addiction there is a hijacking of the frontal lobe, which then leads to manipulation, stealing, lying, prostitution, violence (all considered moral in nature). Because of this, people in active addiction are considered immoral or bad—not ‘sick’.
Thus, the stigma.”
Old stereotypes die hard, even among those in the medical community
For decades, the medical community mistakenly deemed addiction “untreatable.” Thus, patients presenting with substance use disorders were treated for their symptoms and sent away or else directed to 12-step programs. Now that the medical community has come under fire for contributing to the rise in prescription pain medication overdose rates, this has begun to change, yet more training needs to be provided so that healthcare workers may recognize the symptoms of addiction and intervene earlier.
People fear the “addict” label
Although the mental health profession has moved away from labels like “addict” or “alcoholic” in favor of “individual with a substance use disorder,” the addict-as-identity mindset (and all the shame and guilt that goes with it) continues to persist. This causes people to refuse to seek treatment: the fear of their friends, family and work colleagues learning their “dirty little secret” is so great, they would rather die than live with the shame of acquaintances discovering the truth.
Addiction is treated separately from other mental health disorders
Addiction continues to be treated separately from other co-occurring disorders, which often only serves to further fuel feelings of ostracization. If someone with a history of substance abuse seeks out counseling for his or her anxiety, for example, it’s not uncommon for a counselor to refuse treatment unless the person “gets clean and sober” first. It’s a common belief that a person’s other mental health concerns—such as depression or anxiety—cannot be treated until the substance use disorder is addressed first. Can you imagine a psychologist telling a client that he can’t help him with his depression until he overcomes his eating disorder? And yet, with substance addiction, that’s often exactly what happens.
Medical illness receives more funding and positive PR than mental illness
Breast cancer victims receive colorful ribbons and parades. Brain cancer survivors are championed and lauded for their strength, courage and perseverance. ALS research receives millions of donation dollars. Those struggling with addiction, on the other hand, mostly suffer in silence; their causes of death mysteriously left out of obituaries and no “she bravely lost her battle to addiction” accolades on social media. The same often holds true for victims of other mental illnesses as well.
People are being sent to jail for addiction-related charges instead of receiving the help they need
Experts in the addiction field have long emphasized the need to focus on prevention and treatment rather punishment. Although Nevada has recently made an attempt to shift the focus in that direction, with more federal dollars being spent on programs that help inmates imprisoned on drug charges or who have a history of drug abuse, for example, the fact remains that we still have a long way to go with this. According to statistics provided by the Bureau of Prisons, of the 189,130 people incarcerated in federal prisons, 46.6 percent are serving time for drug offenses. A diabetic would never be imprisoned for buying a carton of ice cream, yet we imprison a drug addict for buying a bag of heroin. If society can have compassion for those suffering from physical illnesses, we should be able to extend that same compassion toward those suffering from mental illnesses.
Altig hopes more of his colleagues in the legal community will work toward getting their clients help in treating the “underlying issue of addiction.”
“It appears that many lawyers feel they are doing what is best for their clients by getting them an outcome that does not require the addict to treat their issues,” Altig explains. “This creates a revolving door for that client, and keeps them entrenched in addictive behavior that will result in their return to the criminal justice system.”
While Altig acknowledges that attorneys may be fulfilling an obligation to their clients when they attempt to limit his or her punishment, he also suggests that removing consequences may not always be what is best for a client’s mental health. Altig, who himself is in recovery from addiction, notes that addicts are different.
“With addicts, they need to have some sort of treatment to help address the addiction issue otherwise their return into the criminal justice system is imminent.”
Judge Kerns expressed a similar sentiment, stating that “the jails and prisons are full of people due to their addiction,” but he also pointed out that this isn’t always a negative.
“In many cases, it is absolutely appropriate. Judges are sworn to follow the law and in turn protect the community. The community includes the public as well as the defendant. When people in their active addiction rise to levels of violence and dangerousness, incarceration may be the only answer.”
Judge Kerns, however, added that “each case is different” and that “rehabilitation and recovery is an answer for many, too.” The ‘rehabilitation vs. incarceration’ debate is an issue frequently argued in front of judges, explained Kerns, and it can be difficult for judges to “know exactly the most appropriate sentence.” This is why Kerns advocates for addiction education for everyone, including judges.
What Can Be Done
Educate yourself and others
Southern Nevada offers several free addiction education programs for kids, teens, and adults. Las Vegas Recovery Center, for example, an alcohol and drug addiction treatment program in northwest Las Vegas, offers a Family Renewal Program for members in the community looking to learn more about the disease of addiction and what they can do to help those afflicted with it. The program includes a free education and support meeting, every Monday at 6 p.m.
Help spread awareness that addiction is a disease
The American Society of Addiction Medicine defines addiction as a “primary, chronic disease of brain reward, motivation, memory, and related circuitry.” The more people who understand that addiction is a disease that affects the circuitry of the brain, the more likely it will be that with time, our culture will stop seeing addiction as a “moral failing” and start seeing it for what it is: a potentially deadly illness.
Be a source of support for friends, family and neighbors who are suffering from or are in recovery from this disease
Become an advocate for those in your community who are suffering from addiction. There are several organizations that work with local communities to help raise awareness and host educational and fundraising events, including Faces and Voices of Recovery, Join Together Nevada, and Foundation for Recovery. Visit their websites for upcoming event information.
Las Vegas Recovery Center (LVRC) also offers help to those wishing to seek recovery from an opioid use disorder. With campuses in northwest Las Vegas and Henderson, LVRC is equipped to help chronic pain and addiction sufferers across the Las Vegas Valley. Visit www.lasvegasrecovery.com or call 702-515-1373 to learn more.