America Is Neglecting Its Addiction Problem

Addiction is America’s most neglected disease. According to a Columbia University study, “40 million Americans age 12 and over meet the clinical criteria for addiction involving nicotine, alcohol or other drugs.” That’s more Americans than those with heart disease, diabetes or cancer. An estimated additional 80 million people in this country are “risky substance users,” meaning that while not addicted, they “use tobacco, alcohol and other drugs in ways that threaten public health and safety.” The costs to government coffers alone (not including family, out of pocket and private insurance costs) exceed $468 billion annually.

Over 38,000 peopled died of drug overdoses in the U.S. in 2010, greater than the deaths attributed to motor vehicle accidents, homicides and suicides. Overdose deaths from opioids (narcotic pills like Oxycontin, Percodan and Methadone as well as heroin) have become the fastest growing drug problem throughout the U.S., and not just in large urban settings.

Family dysfunction adds to the list of tragic consequences of our neglect. Addiction brings financial and legal problems (property and violent crimes) and increases domestic violence, child abuse, unplanned pregnancies and motor vehicle accidents. Addiction is also highly prevalent among jail and prison inmates, and in many instances, played a role in their incarceration.

Yet, and perhaps this is the most important – if not troubling – finding of all, only one in 10 people with addiction to alcohol and/or drugs report receiving any treatment at all. Compare this to the fact that about 70 percent of people with hypertension or diabetes do receive treatment. Can you imagine accepting that degree of neglect if that were the case for heart or lung disease, cancer, asthma, diabetes, tuberculosis, stroke and other diseases of the brain?

And when a person with an addiction seeks treatment, odds are they will be directed to Alcoholics Anonymous, Narcotics Anonymous or another 12-step recovery program. AA is a spiritual approach to recovery, developed in the U.S. by Dr. Bob Smith and Bill Wilson in 1935. A 2006 Cochrane Review, internationally recognized for evidence-based treatment reviews, reported that between 1966 and 2005, studies examining AA and 12-step programs concluded that “no experimental studies unequivocally demonstrated the effectiveness of AA” in treating alcoholism.

The April 2015 issue of The Atlantic featured a story by Gabrielle Glaser titled “The Irrationality of Alcoholics Anonymous.” Glaser wrote that AA works for 5 to 8 percent of those who use it, citing an estimate by retired psychiatry professor Lance Dodes. Yet AA or 12-step programs remain the sole or core element in most private and recommended programs in this country. A forthcoming documentary, “The Business of Recovery,” exposes the private addiction treatment industry for it’s predomination of the 12-step approach – with fees in the tens of thousands of dollars per month.

What is missing from the vast predominance of private or 12-step-based services is a comprehensive approach to managing addiction. Treatments have been developed for addiction that go well beyond AA. These include motivational techniques and cognitive-behavioral therapies. For those who want a non-medicinal and group approach, there is SMART Recovery, which, unlike AA, does not accept that individuals are powerless and seeks to help participants find their strengths and use them.

Perhaps the most neglected interventions for addiction are medication-assisted treatments. Medications are available that reduce cravings, deter use and help prevent relapse. These include naltrexone, acamprosate, Antabuse and methadone. And among the most promising and underused medication-assisted treatment is buprenorphine (Suboxone), a medication taken sublingually that can be one answer to our national epidemic of pain pill and heroin addiction. Buprenorphine, for example, is prescribed at a doctor’s office for up to 30 days, and thus does not require attending a daily program where medication is dispensed, as it generally is in methadone programs. A bill was introduced in the Senate that would enable greater access to this medication.

Psychiatric News reported on a recent speech by National Institute of Drug Addiction Director Dr. Nora Volkow, in which she explained that we once thought “addicts sought out drugs or alcohol because they were especially sensitive to the pleasure-inducing effects of dopamine.” In fact, the opposite prevails. Volkow said that “addicts are actually less sensitive to the effects of dopamine,” they reported. “They seek out drugs because of the very potency with which they can increase dopamine in the brain, often at the expense of other pleasurable natural stimulants that do not increase dopamine so dramatically.”

This neurological discovery helps explain alcoholic or drug cravings as well, Volkow said, as addicts are vulnerable to environmental triggers, like the sight of alcohol or a bar, contact with friends who share a drug life and exposure to substances in media – even including reports of addict deaths. Cravings and the heightened response to triggers are part of why addiction pirates an addict’s behavior and renders them unlikely to pursue everyday life’s pleasures and responsibilities. Treatments that target cravings and reduce the power of triggers are among our best hopes for recovery – and they now exist.

America has turned a blind eye to addiction. No wonder so many people walk into walls when paths of recovery are possible. Criminal justice approaches and interdiction are ineffective; they have become prohibitively expensive because they don’t work and can make matters worse. It’s time to give treatment a chance. But treatment must incorporate modern medical and psychological approaches, not only adhering to a tradition of spiritual recovery. Until we do that, more Americans will die, societal costs will continue to escalate, families will be bankrupted and cast asunder and communities will remain at risk for the crime that untreated addiction spawns.