It’s all over the news and there have been countless articles and shows on the topic by now. You may even be tired of all of the stories, but here is one more to read if you desire. One of my favorite actors, Philip Seymour Hoffman, was found on Sunday with a needle in his arm, dead from a heroin overdose. He died well before his time due to the demons of drug addiction.
But these famous names are really just the tip of the iceberg. According to the United States Centers for Disease Control and Prevention, an estimated 105 people die from drug overdoses in this country each day. Although many of these deaths are from illicit drugs, such as heroin in Seymour’s case, a number of people actually die from legally prescribed drugs each year. ( In fact prescription opioid abuse is now one of the biggest growing sources of addiction in the country. Some say the recent rise in heroin use has been fueled by the high street costs of prescription drugs.) Most people get drugs legally from someone they know. About a third of Americans view drug abuse as a sign of weakness rather than a chronic health problem, however about 45% of people know someone with an addiction. Given these numbers, it is very likely that someone we know personally has at some point suffered from drug addiction. Philip Seymour Hoffman’s demons affect us all.
I debated writing about this topic on a blog that explores what we can learn from other countries to improve health. I did not want to be a downer on a blog that we generally try to keep positive and upbeat. At the same time I want to address health issues realistically. Since addiction is not a problem unique to the United States, I thought perhaps there were things we could learn from other countries about how to treat it.
The fact is, the world as a whole performs pretty poorly when it comes to drug addiction treatment. According to the World Health Organization, worldwide there are only 1.7 beds for every 100,000 people in the world who have a need for drug or alcohol detoxification services. Many countries have no addiction treatment programs whatsoever, focusing only on the criminal aspects of drug use.
There are a couple of things other countries do that may or may not have promise for the United States, but that are interesting nonetheless:
- Portugal, for example, has decriminalized drugs since 2000. People who are caught with drugs appear before a 3 person panel (a judge or lawyer, a social worker or psychologist and a doctor) who make a decision on whether to impose a fine, do nothing or recommend intensive treatment. As a result there has been a 20% increase in the population receiving treatment for addiction in the country. Some people argue though that there have been mixed effects, with no drop (and a slight increase) in the number of people who use drugs in the country. However the number of serious addicts has decreased.
- Several European countries such as Germany, Switzerland and Denmark have set up drug consumption rooms (DCR). Here users inject drugs with clean needles under direct supervision by a professional with medical and social work backup available. In these countries, the number of drug related deaths have decreased. One study in Vancouver, which also has DCRs, showed increased intake into detox facilities as a result of this program, since social workers are available on site for enrollment. However, again this is a controversial program with mixed results. Opponents argue that such models take the focus away from needed treatment programs.
- There are also other lessons we can learn from other culture’s approaches to treatment. There is some evidence that acupuncture and ayurvedic medicine may help with drug addiction symptoms. However to be effective, such therapies should be a part of a larger program.
It is not clear whether any of these approaches would work (or even be socially acceptable) in the U.S. (Our demographics are different and we have high rates of poverty that make us very different from the countries we described above.) According to the National Institute of Drug Abuse, an approach to drug addiction treatment should be multifactorial. Instead of brief interventions, longer-term therapy that targets not only the addiction, but other social, physical and behavioral needs as well is needed. Such treatment should be tailored to the individual and adjusted over time. Because many people with drug addictions have other mental health related issues, such as depression, it is important to treat these conditions as part of the treatment plan.
Having support of family and friends is also a critical part of effective drug therapy. Involvement in therapy not only helps someone have a better response to treatment, but also can provide loved ones counseling in coping with the addiction.
About 40 million people aged 12 and over in the United States have an addiction to drugs or alcohol. Another 80 million people engage in use that is considered risky, i.e. at levels that pose a danger to their health. Here are some facts about drug addiction:
- Drug addiction is a chronic disease, yet for the most part, the medical system does not treat it this way.
- Over a third of Americans view drug addiction as personal weakness rather than a public health problem. However, an estimated half of all Americans know someone with an addiction problem.
- Only about 1 in 10 people with drug or alcohol addiction get treatment, compared to 7 out of 10 people who get treatment for other chronic diseases, such as hypertension.
- Less than half of people who enter treatment programs complete treatment. Forty to sixty percent of people who do get treatment will later relapse.
- Many treatments are considered below recommended standard of medical care. Only 1% of health care dollars are spent on substance abuse treatment.
Centers for Disease Control. Drug Use in the United States. http://www.cdc.gov/homeandrecreationalsafety/overdose/facts.html
Denmark Fix Rooms Give Users a Safe Haven http://www.npr.org/blogs/parallels/2013/12/16/246606797/denmarks-fix-rooms-give-drug-users-a-safe-haven
Gifford S. Family Involvement is Important in Substance Abuse Treatment http://psychcentral.com/lib/family-involvement-is-important-in-substance-abuse-treatment/0006631
National Criminal Justice Reference Service. America’s drug abuse profile. https://www.ncjrs.gov/
The National Center on Addiction and Substance Abuse, Columbia University. Addiction Medicine: Closing the Gap between Science and Practice. May, 2012.
National Institute on Drug Abuse. Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition). December, 2012. http://www.drugabuse.gov/publications/principles-drug-addiction-treatment
National Institute on Drug Abuse. Addiction Science: From Molecules to Managed Care. http://www.drugabuse.gov/publications/addiction-science/relapse/relapse-rates-drug-addiction-are-similar-to-those-other-well-characterized-chronic-ill
Robert Wood Johnson Foundation. What does American think about Addiction Prevention and Treatment. Research Highlight. March 2007. https://folio.iupui.edu/bitstream/handle/10244/559/Research%20Highlight%2024%5B3%5D.pdf?sequence=2
Szalavitz M. Drugs in Portugal: Did decriminalization work? Time Magazine. http://content.time.com/time/health/article/0,8599,1893946,00.html
World Health Organization. http://www.who.int/substance_abuse/en/