Those Dirty Addicts

Dr. Kenneth Davis, of Galena Clinic, a substance abuse and mental health clinic, often says “No one sets out to be an addict.” These words reflect compassion for the people who suffer from a substance abuse problem that spiraled out of control. Yet our society, in general, lacks the understanding for the people whose lives are held hostage by an addiction. This population of people suffers a stigma from a disease that other medical diseases do not. And as such, they are not afforded the help that other medical conditions get.

I interviewed Dr. Mary Wenzel regarding the treatment of people who are dependent upon illicit substances. She is the Medical Director of Galena Clinic who’s primary responsibility is the health of opiate addicts, utilizing Methadone and Buprenorphine. Opiate addicts are people who are dependent upon pain killers or heroin. She reminds us that any addiction to substances is a chronic medical illness. Therefore, you always have to do something about it, just like any other chronic condition such as diabetes, high blood pressure and arthritis. The condition is not going away and its course needs to be managed. It will always need attention of some sort, whether that attention is in the form of medication, recovery support groups, psychotherapy or addiction treatment. Otherwise, if left untreated, alcohol and drug abuse may ruin your life by destroying relationships, causing loss of employment, cause incarceration and will very likely kill you. It may kill you through an overdose, but more likely cause irreparable damage to the body.

So why do some people develop these addictions? She believes that it is a common human desire to have a different experience – an experience that shifts us out of our everyday existence and stimulates us. She gave an example of a three-year old who turns in circles until they nearly pass out or fall. Some people seek stimulation through sports and travel. Some people get stimulation through risky behaviors such as substances, gambling, racing, or sexual encounters. There are numerous ways that people seek stimulation, some healthy and some not. This desire may be genetic or not, but it is a common human desire.

The goal of addiction medicine is to assist the sufferer to function normally to achieve a satisfying life. Evidence-based treatment for opiate addicts is long-term medication assisted treatment in the form of either Methadone or Buprenorphine. Methadone has been in use for 78 years and is well researched. As a comparison, it was developed within two years of antibiotics. And yet, there is a stigma associated with Methadone. People who suffer from an addiction are thought to be poor, uneducated, dirty, and are commonly perceived to be people of color. These assumptions are not true and are unfounded. Addictions cut across every socio-economic and geographic group and there have always been more Caucasian addicts than black.

This stigma exists within the medical community. Dr. Wenzel was trained as a general internist and noted that while in medical school, she had no training in drug addiction and very little training regarding alcohol problems. She worked as an internist but became interested in the field of addiction medicine through a fellow student who found work in a Methadone clinic. She increased her knowledge base at professional conferences and now works for four different Methadone clinics. Opiate addicts receive substandard medical care. She believes that the stigma against medication assisted treatment for opiate addicts continue because there is still no training for physicians in this field. Physicians, as well as most of the general population, believe that addiction is a failure of will and a moral failing. They also believe that people who suffer from an addiction are bad people who commit crimes. Additionally, as a result of a lack of addiction training, physicians tend to believe they will not be required to treat people with addictions in their practices – someone else will treat them. And yet in every medical specialty, from pediatrics to gerontology, oncology, neurology, etc., physicians will treat people who are addicted to something. Or their patients will develop an addiction to something. Some physicians believe that Methadone is just another addiction, rather than a medicine to treat an addiction.

There is a heroin epidemic in the US areas because it is cheap and available. The use of heroin among women doubled between 2002-2013 according to a New York Times article. This is especially true of young women of child-bearing age. Neonatal units are seeing more mothers who are receiving Methadone-based treatment but they may not understand how to treat Neonatal Abstinence Syndrome.

When Dr. Wenzel was licensed, there was no board addiction specialty. The American Board of Addiction Medicine was founded in 2007 and administers the exam to become certified. The good news is that medical students can now be certified in addiction medicine.

For more information, I recommend a documentary, “The Anonymous People,” that highlights the shame and secrecy of recovery from addictions to alcohol and drugs. It is time to stop the stigma associated with this chronic medical condition.