It’s a mistake to think you are better than a person who is addicted to drugs or alcohol. But it can be very hard to fix that mistake. It’s easy to think of persistent addiction as a choice (why don’t they go to treatment?) or as a moral failure – a failure of personal responsibility, loyalty to family, and will power. That mistaken thinking is the foundation of a crippling stigma.
Medical science about addiction – which has advanced dramatically in the last decade or so – plainly says that addiction is a brain disease that sneaks up on people. It most often afflicts those who are desperate for relief from persistent misery, mental illness, trauma or despair. Yet it can also ensnare people whose lives are humming along nicely until a doctor writes them an ill-advised prescription, or until a fondness for good wine inexplicably turns into a compulsion.
In today’s world of addiction science, “substance use disorder” is itself defined as a mental illness – a treatable brain disease that nonetheless lingers long after people quit using or drinking, making them susceptible to relapses for many years.
This relatively recent understanding of how addiction works has been slow to change the popular understanding of this disease, but it has caused a dramatic rethinking of how to treat it.
After many years of over-reliance on the Alcoholics Anonymous 12-step model, practitioners now recognize that no single treatment approach works for everyone, and that many people with this disease have other medical and mental illnesses that require simultaneous treatment.
For people with opiate addictions, resistance to medication-assisted treatment is finally crumbling, as new opiate substitutes are developed, and as evidence mounts that for some people, medication can mean the difference between life and death.
The National Institute on Drug Abuse principles of effective treatment specify that treatment must address “any associated medical, psychological, social, vocational, and legal problems.” They also note that “It is also important that treatment be appropriate to the individual’s age, gender, ethnicity, and culture.”
The standards also state quite clearly that “Treatment needs to be readily available.”
These are standards that are only being partly met in our community. The gap between “readily available” and reality has narrowed, but not by nearly enough. There is more funding for treatment, more local control of how that funding is used, and wait times to get into treatment have shrunk.
The Thurston Mason Behavioral Health Organization has taken on management of what used to be state funding for mental health and addiction treatment, which has allowed it to increase reimbursement rates to treatment providers, especially for treatment for special populations, such as those who are pregnant or parenting.
But the ideal of readily available treatment that addresses the needs of the whole person is still largely unrealized. And so is the understanding that multiple episodes of treatment and long-term support may be needed to successfully treat this chronic brain disease.
Moreover, our treatment system is still full of bumps. Many people need to be in a medically assisted detox facility for a few days before they can move to inpatient treatment, but lining those bed dates up is not a perfect process. When there is a gap, things often go very wrong. And though more detox beds are on the horizon, there is still a shortage.
There is also still a very long way to go before integrated, simultaneous care for addiction and other mental illnesses is universally available, culturally competent, and appropriate for women, people of color, and people who are LGBTQ.
Progress is stymied by a big and persistent shortage of trained professionals in both mental health and addiction treatment, and by lingering problems in communication between the two fields. Mark Freedman, CEO of the Thurston Mason Behavior Health Organization, estimates that 20 percent of available positions are currently unfilled. And while funding for both mental health and addiction treatment has grown in the last few years, it is still far from enough to meet the need.
It’s well worth celebrating the progress that is being made, and offering thanks to the providers, government leaders, advocates, and outreach workers who have made it possible. And of course it is wonderful to witness the joy of recovery for friends and loved ones who have struggled to reclaim sobriety and rebuild their lives. But it’s equally important to grieve for all the lives lost to this disease, and to open ourselves to empathy for all those whose addictions have contributed to the catastrophe of homelessness.
To be clear, it’s the lack of affordable housing – not addiction – that is the primary driver for the growth of homelessness. But it’s undeniable that this brain disease affects a significant portion of our homeless neighbors, and that they need less stigma, more compassion, and better access to effective long-term treatment.