The Conversation about Addiction Has Changed Since Maia Szalavitz Came to Town

One year ago today, author Maia Szalavitz came to town to talk about addiction.

The conversation hasn’t been the same since.

We speak differently about addiction than we did a year ago in our rural town in Southwest Virginia.

• Our conversations about addiction are increasingly informed by knowledge, not based on belief or theory, particularly with regard to opioid use disorder.
• We share our personal experience with addiction, either our own or what we’ve observed in loved ones or others, as our individual experience, not as “truth” that others should follow.
• We’re increasingly aware when we’re speaking uncertainly and say so.
• People can increasingly arrive at their primary care physician’s office and state they have a substance use problem and get help for it. As Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health recommends, we are finding that consulting primary care physicians for substance use disorders offers first-line, evidence-based care for addiction and optimizes use of the infrastructure we already have in place to take care of our people.
• Local addiction treatment providers are increasingly embracing evidence-based treatment for addiction and jettisoning the moral model that has dominated addiction treatment for nearly a century. The belief that addiction is a personal problem, rather than a medical one, has inadvertently provided non-treatment and ill-treatment to its sufferers, untold anguish to those with addiction and their loved ones, and needless, tragic deaths. Real care for real problems is making a real difference.

To further deepen our conversations about addiction, let’s talk courageously about these questions:

• Why is opioid use disorder declared a national public health crisis but we have wait lists for treatment?
• Why is the top, evidence-based treatment for opioid use disorder – the affordable, readily available medications methadone and buprenorphine – not affordable and not readily available, due to federal and state laws, insurance company policy, and medical board policy? (In my town, I could get you heroin faster than I could get you medical treatment for opioid use disorder.)
• Why is counseling required to receive buprenorphine for opioid use disorder when the data says counseling doesn’t improve outcomes?
• Why is opioid use disorder considered a national crisis when 6 times more people have alcohol use disorder?
• Why does the media report extensively on problematic use of prescription and illegal opioids and ignore, in terms of crime, lost work productivity and health care costs, the use of legal alcohol ($249 billion), which costs the nation 3 times more than opioid use ($73.5 billion), or the use of legal tobacco ($300 billion), which costs the nation nearly 4 times more than opioid use?
• Why in the world is marijuana – from which no one can, or has overdosed, ever – legal in some states, not in others, even though there is increasing evidence that it can substitute for far more dangerous opioids in both pain treatment and possibly in the treatment of addiction?
• Why do we send people to jail for having the illness of addiction?
• Why is a person’s driver’s license suspended for non-traffic-related drug offenses?
• Why are judges permitted to prescribe or deny medications?
• Why are consumers being pitched, via advertising, a potentially dangerous medication for opioid use disorder with limited efficacy studies when other proven medications are already on the market?
• Why is the central addiction policy question control-based – “What can we do to stop drug use?” – and not compassion-based: “Why do people use risky substances? What do they need that they don’t have? How can we help?”

We can continue to keep our conversations about addiction informed, and monitor hype vs. reality, by examining the data.

• 14 in 100 Americans are expected to develop a substance use disorder in their lifetimes. (Source)
• 1 in 100 Americans, 12 and older, met the diagnostic criteria for opioid use disorder in 2015 (0.2 percent for heroin use disorder, and 0.8 for pain reliever use disorder). (Source)
• Fewer than 2 in 100 Americans met the diagnostic criteria for marijuana use disorder in 2015 (1.5% for 12 and older, 1.3% for 18 and older.  (Source)
• 6 in 100 Americans, 12 and older, met the diagnostic criteria for alcohol use disorder in 2015. (Source)
• 15 in 100 Americans, 18 and older, smoked cigarettes in 2015. (Source)
• Nearly 35,000 opioid-related deaths in year 2015. (Source)
• About 88,000 alcohol-related deaths every year. (Source)
• Estimated 300,000 obesity-related deaths every year. (Source)
• Over 480,000 tobacco-related deaths every year. (Source)
• No overdose deaths from marijuana this year or ever. (Source)

Let’s keep defining terms to make sure we know what we’re saying. Let’s keep differentiating between correlation and causation.

• Babies are not born addicted to substances. They may be born dependent upon them.
• Marijuana is not a gateway drug. Many factors predispose people to problematic substance use.
• Most people with addiction to pain pills are not pain patients who got them from a doctor. They’re people with pre-existing challenges who got them from family members and friends.
• In the era of the Internet, focusing on the supply of anything is folly. Anybody can get anything they want, drugs included, through the Internet.
• Addiction is defined as compulsive behavior that persists despite negative consequences. No type or amount of negative consequences – jail time, losing a license, getting fired, losing custody of one’s children, being shouted at or admonished – will keep it from persisting. Addiction is a condition that requires evidence-based care.
• Abstinence is not treatment. Abstinence may be a desired outcome of substance use disorder treatment. But abstinence does not, in any way, untangle the Gordian knot of addiction for an individual, including opioid use disorder.

One year later, what’s author Maia Szalavitz talking about?

• If you like to read, here’s a first-rate, recent interview with Maia Szalavitz by Rachel M. Cohen.
• If you like to listen, here’s a bold, recent podcast interview with Maia Szalavitz by Chris Poff.
• If you like to watch, here’s Maia Szalavitz’s discussion of opioid use disorder with Dr. Jonathan Giftos and Kassandra Frederique on Facebook.
• If you like to read the author’s own words, here’s Maia Szalavitz’s latest writing on addiction and related subjects, published since the release of Unbroken Brain in April, 2016.
• If you’d like to learn in real-time what Maia’s talking about, follow her intrepid commentary on Twitter.

How am I doing since, a year ago, I dejectedly typed my woebegone search terms about how to survive alcoholism into Amazon’s search box and Maia Szalavitz’s newly-published Unbroken Brain: A Revolutionary New Way of Understanding Addiction, appeared in the search results?

• I now pursue evidence-based medical and professional care for alcohol use disorder and I engage in evidence-based self-care practices.
• I took to heart Maia’s advice to fall in love with my life. I realized one of my top loves is writing about my insights. I pitched an idea to The Fix and am delighted that they’re currently publishing my memoir as a serial. Here’s the memoir’s table of contents.

People throw around the phrase, “You saved my life.” I don’t want to go back in time and miss your visit to Blacksburg, Virginia to find out for sure, but I do believe you saved my life, Maia. I’m not sure what would have happened to me without you.

Thank you, beyond words, for visiting my town, Maia Szalavitz.

Laurel Sindewald contributed to the research for this post. Our reports on addiction treatment and addiction policy are here.

Updated 8/14/17