I’m attending the annual meeting of the American Society of Addiction Medicine. I’m seeing a lot of old friends and catching up. As people normally do when they haven’t seen each other in a while, they are asking what I’m doing. I’m getting interesting responses to the answer, that I’m spending the year looking for partners to build an addiction treatment system that makes all others irrelevant.
A few have asked where they need to go to sign up, but most just nod, as if to say, “everyone says that’s what they’re doing.” Some look at me in horror as if I’m going to take their job from them. There are those who figuratively pat me on the head saying, “Good luck with that.” Most of these negative or dismissive reactions are because most of my colleagues don’t realize we have created the problem. They think because addiction has always been treated this way that it always should be treated this way and always will be. They don’t understand that it isn’t that addiction is so hard to treat, but it’s the system of care we’ve built in this country that makes it so hard to treat.
To give you an idea of what I mean, let’s imagine if we treated heart disease the way we treat addiction. The patient would probably arrive late in the illness, after a heart attack for instance. We’d tell him that the heart attack was his fault, because, after all, he had been eating a bad diet and wasn’t exercising regularly. We’d put him in a bed and give him a book to read about heart attacks. We’d tell him there’s medicine we could give him, but we want to make sure he’s serious first, so we won’t give it to him until he’s seen a nutritionist and a trainer. On his way out the door we’d give him a piece of paper with the phone number to a catheter lab and tell him he should call to get himself an angiogram. And finally, with his hand on the doorknob on the way out, we’d remind him sternly to not do this again, “No more heart attacks. You hear me? I’m serious.” After he left, we’d go home and tell our spouses what a hard patient we had today. I mean, some people, right?
How well would such a system impact heart disease in this country? What would be the response of the paying public to a system that treated heart disease that way? They’d probably avoid it, they’d belittle it, they wouldn’t trust it, and they certainly wouldn’t consult it for problems with people they loved. Is there any surprise that the addiction treatment system in this country doesn’t work?
Addiction effects up to 20% of the population. In America, that would be over 60 million people. If we’re going to get 60 million people into recovery, we’re going to need a system to attract them to care. It will have to be a system that attracts people early in the illness, before the heart attack so to speak. It will need to be welcoming and caring. It will have to understand that the primary problem with addiction is low midbrain dopamine tone, and when we treat people as if they are less than others, we actually lower that tone and make the illness worse.
I’ve met a few colleagues here who frankly don’t believe I can design such a system. But I’ve done it before, and I can do it again. Those who are knowledgeable about TOC know that any problem can be solved, any situation can be made better. We just have to look at how we’re making it worse with our assumptions. Treat addiction like the illness it is in nature, and it’s not hard at all.
