Substance abuse has become a mainstream topic and a national crisis. Deaths from overdoses are significantly higher today than in recent years. Over the past 15 years, the rate of heroin overdoses has quadrupled (CDC). This includes more than 16,000 deaths from opioid pain pill cases. In 2013 alone, more than 8,000 Americans died from abusing heroin (CDC). From 2002 to 2013 heroin abuse in the U.S. increase more than 60% (CDC). Unfortunately traditional rehabilitation therapies targeting drug addiction, especially heroin, are failing. However, chemical medications are showing effectiveness. The good news is that scientific explanations of drug addiction are becoming clearer, and medications are working. The consensus is that substance abuse is a chemical problem, not a character flaw, or cultural phenomenon that is intractable.
Statement : This collection of articles appears to justify the holistic approach for the effective treatment of addiction and substances abuse, which also integrates the disciplines of physical and mental health and supports public health concepts. This essay will follow the fictional character Bob to demonstrate the holistic approach.

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What causes substance abuse?
Bob is a 42-year-old father of two children with a full time job as a medical sales representative living in Atlanta, GA. He drinks alcohol occasionally socially with his wife and friends, and seems to be a normal American. But, Bob is different; his brain structure has some slight differences that predispose him to substance abuse and impulsive behavior. As a pharmaceutical sales rep, he has access to opioid drugs, and has begun stealing samples from physician offices and has discovered that heroin is a much high, and less risky to get caught stealing at work. Why would Bob behave this way when he has so much to lose?

Addiction appears to be a chemistry problem. According to Nora Volkow, the director of the National Institute on Drug Abuse, drug addiction is a behavioral malfunction, a learning disorder founded on imbalanced brain chemistry. In addicts, the focus of dysfunction occurs in the prefrontal cortex, where dysregulation of dopamine affects cognitive functions including emotional learning, memory processing, reward system, and motivation (May). Addiction is also very complicated, with factors from psychological, environmental, cultural, and genetic.

Cost to Society
Bob’s situation is getting worse, now he has called in sick and has take all of his vacation days from work. His boss is calling and is concerned. His wife has noticed a difference in his attitude and he is spending some of his family savings money to secretly get high. His actions are affecting his life with negative consequences. The impact of substance abuse and drug addiction on our society is massive. According to data from the National Institute on Drug Abuse, illicit drugs like heroin are costing our nation approximately $200 billion annually (NIDA). This includes loss of worker productivity, health care charges, and crime related incidences. In America, the largest illicit drug problem comes from prescription opioid drug abuse (May). About half of the economic burden comes from workplace issues. The number is staggering, approximately $26 B in workplace loss. This makes sense, given that most abusers are not the typical homeless crack heads most have idealized as the problem. Instead, it’s your neighbor, or your neighbor’s son, who are engaging in reckless behavior that is causing office problems. Given that most opioid abuse begins with prescription abuse, data show that problems are centered on working adults who have health insurance. Costs are primarily lost as workers are absent from the job due to health issues of overdose, or calling in sick; absenteeism. For the other half, medical costs are responsible for nearly $25B in substance abuse-related expenses. Most of which are spent on legal prescriptions and insurance payments. The criminal justice system accounts for a nice chunk at $5 B to cover jails, policing, and rehabilitation services (NIDA).

Effective Treatments
Bob has been fired from his job, his wife has moved out and taken their children to live with her parents. Bob is depressed and late on his bills and doesn’t know how to get his life turned around. A friend insists he see a therapist and attend drug counseling for help. Drug addiction is a treatable disease. However, it is notoriously difficult to treat. Nearly 50-90% of addicts relapse (Alcohol rehab). Opioid addiction is tough; it is chronic, with many relapse episodes, not an acute easily treatable condition. The best results come from combination therapy of medicine and behavioral modifications. One of the keys to effective treatment is considering addiction a disease like cancer or heart disease. When cancer patients go through relapse they are given appropriate treatment to deal with the challenge. However, drug addicts are treated as criminals when relapse occurs. We know relapse is going to happen in most cases, and dealing with the odds will help reduce economic issues in a responsible manner. For example, in cases where patients with relapse are either not treated appropriately, or referred to facilities connected with judicial consequences, the cycle addiction is perpetuated in 90% of cases (May). However, when patients of relapse are treated like cancer patients, the relapse triggers a process of higher-level treatment that addresses immediate needs and digs into underlying issues. This results in a much higher rate of successful recovery compared with traditional stigmatized strategies.

A great example of treating drug addiction with similar protocols and resources like established systems in cancer and heart disease, the state of Vermont has installed a nice system. They are looking at addiction from a public health perspective. One part is focused on prevention, trying to prevent the abuse from starting by removing drugs from circulation that would fall into abusive hands. And, they are supporting efforts to educate and empower primary care physicians that come across cases of opioid abuse. The goal is to shift the stigma from addict, to patient of disease. They are also supporting efforts to establish stronger recovery centers and 12 step facilities to enhance efforts on reducing relapse rates. Bob is lucky, he found a supportive group for recovery and has medical coverage for treating his outpatient visits. Bob is now recovering with support from mental health professionals and medications to reduce his cravings. And, he has begun exercising to improve his overall health and attitude.

However, a serious problem exists with treatment and preventable focus. Very few clinical trials exist that are focused on opioid treatment. In fact, compared with other common diseases like cancer and Parkinson’s, opioid addiction receives significantly less attention from drug companies. This is a serious matter, given that drug companies fund most of the clinical trials in our nation. It is frustrating to those that are seeking treatment. Nearly, 80% of individuals actively seeking treatment for opioid abuse go without help (NIDA). They are reaching for help with hands outstretched to empty space. A major concern comes from insurance coverage, where Medicaid or Medicare does not cover necessary treatment. Luckily, Bob’s insurance covers the necessary treatment plan, but not everyone is so lucky.

Overall, the incidence of opioid addiction and abuse is massive and growing. We are understanding how and why drug addiction occurs. However, our societal views are preventing us from accepting this situation as a treatable mainstream disease like cancer and Alzheimer’s. We have scientifically founded strategies to deal with these issues. However, we need to remove the social stigma. Addiction is clearly a disease. We have the disease explanation. Now, it’s time for a reasonable answer and strategy to deal with its consequences in a fair and responsible manner. Patick Kennedy, a former U.S. representative has much to say on this topic. He believes addiction is a biopsychosocial illness. Meaning that we need to incorporate biology, psychology and social. This holistic philosophy explain the success of Bob’s recovery, and thousands of other addicts that have successfully tackled recovery.

    References
  • Alcohol Rehab. http://alcoholrehab.com/addiction-recovery/beating-the-relapse-statistics/
  • May, M. 2016. It’s Chemistry, Not Character: transforming the treatment of opioid Addiction. Scientific American.
  • CDC. http://www.cdc.gov/vitalsigns/heroin/
  • NIDA. https://www.drugabuse.gov/related-topics/trends-statistics