Can Empathy Boost a Public Health Approach to Addiction? | Healthiest Communities Health News

The first federal harm reduction grant program from the Substance Abuse and Mental Health Services Administration at $30 million signifies significant momentum for efforts to take a public health approach to treating addiction. The funding aims to make services such as syringe exchanges and the distribution of overdose-reversal medication more widely available.

This new program demonstrates the urgent need to approach the national addiction crisis with a broader view undergirded by empathy. It is necessary for all players in this public health crisis to better recognize, understand and even share the feelings and experiences of others who are deep into dangerous addictions.

As a licensed clinical social worker and community mental health registered nurse in Chicago, I serve individuals struggling with a range of addictions. My research and experience has taught me that addictions are shaped by biology, psychology, life circumstances and societal factors. The impact of addiction varies, often according to the cultural and political landscape. But while each addiction has unique elements, it is important to first consider the common underlying mechanism: the human brain.

The human brain is wired for addiction. Reward circuits work with learning and memory circuits to fire off dopamine in response to (and in anticipation of) things that bring pleasure. While this mechanism has served important survival purposes in the past, it has the potential to become hijacked and create complex and sometimes dangerous relationships between us and a variety of substances and behaviors.

In other words, each person has the innate potential to become addicted to something, and many are already affected.

The 2020 National Survey on Drug Use and Health reports that an estimated 58.7% of people 12 and older had used alcohol, tobacco, or an illicit drug during the previous month. The same survey said 40.3 million people 12 and older in the United States had a substance use disorder in the past year. That’s approximately 12% of the population.

To cultivate empathy for those struggling with addiction, it is important to remember that some addictions have nothing to do with illegal drugs. Addictions to things as sugar, processed foods, caffeine, cellphones and shopping are tolerated in their ubiquity and often are such encouraged in profit-driven capitalist growth.

Further along the addiction spectrum are alcohol, nicotine products, marijuana and gambling. These are widely legalized and available, while simultaneously prone to political and interpersonal control.

At the far end of the addiction spectrum are the substances that are most often criminalized and mired in stigma. These include heroin, cocaine, crack and other drugs produced either illegally or legally and used recreationally or as part of an addictive pattern.

Yet each of the above may cause harm to body, mind, family or community.

Shopping addiction, also known as compulsive buying, has been tied to debt, guilt and legal problems. And on a social level, compulsive buying – especially of cheap things – can fuel the exploitation of human workers.

Finally, many experts understand the extremely harmful health effects of cigarette smoking and vaping.

Criminalization of these substances shatters families and further controls people of color through disproportionate incarceration rates. When the opioid epidemic heavily impacted white and affluent families, attitudes and policies began to change, but neither sympathy nor similar resources were channeled toward communities of color. In 2020, the fatal overdose rate among Black people in the US eclipsed the rate among whites for the first time since 1999.

As the opioid epidemic rages on, the United States’ Commission on Combating Synthetic Opioid Trafficking has stressed the importance of disrupting supply chains that enable illegal manufacturing of substances like fentanyl, while also working to curb demand. At the same time, pharmaceutical companies are starting to be held legally accountable for their role in the proliferation of highly addictive painkillers that ignited the opioid epidemic in its early years.

Native American tribes, for example, reached a $590 million dollar settlement with Johnson & Johnson and three drug distributors. A similar $26 billion settlement plan involving the four companies and state and local governments across the US also was recently finalized.

Yet as settlement money and other efforts to combat the country’s drug epidemic grow, it’s important to remember: To be addicted is to be human.

Accepting that statement can lead to compassionate and creative solutions to addiction, especially for those suffering from the more dangerous and deadly ones.

Several strategies are worth trying or expanding upon. Harm reduction, for instance, is an evidenced-based approach aimed at minimizing the negative impact of drug use without unrealistically demanding abstinence. Paving the way for a new era of this approach in the US, New York City recently became the first city in the country to open authorized safe consumption sites where individuals can go to use previously obtained drugs in an environment of support.

Clean needles and other supplies are available at such sites, and naloxone is on hand to reverse an overdose and prevent death. Case management and other recovery-oriented services can be part of safe consumption programs, and there is a push to adopt this type of initiative in other states such as Illinois.

Decriminalizing drugs is another strategy that can reduce harms associated with addiction. In 2001, Portugal – where 1% of the population was addicted to heroin – decriminalized all drugs and aimed to treat drug use more as a medical issue instead of a crime.

The program is very popular, and the country – where harm reduction has also been part of the approach – has enjoyed a drop in stigma as well as in injection-related HIV infections. Using the Portugal model as a guide, Oregon has similarly shifted toward decriminalization, though the state has faced concern that it needs a more robust treatment system.

Legalization is also a tool for reform. In states where it is legalized, marijuana sales contribute significant tax dollars to the economy. And though regulations vary by state, testing for contaminants is generally part of the regulatory process to ensure the drug is safer than something purchased on the street. During the COVID-19 pandemic, cannabis retailers often were considered essential businesses like grocery stores and pharmacies.

As we all work to curb addiction and its harmful impacts, it is important to combat stigma and ditch judgment in favor of empathy. Recovery doesn’t happen overnight, and adopting a public health approach to treatment is complex and will take time.

The time to start is now.


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