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Stigma is defined as “a mark of disgrace that sets a person apart from others.” Ample time and resources have been expended in explaining the proper language to use when talking to and about those with substance use disorders, mental illness, and all those other-isms, but stigma is still inescapable. Why? How long before we need to understand that the language we use is killing people?

Only one in twelve people with substance use disorders gets treatment because stigma is one of the key barriers for seeking treatment. Further, treatment decisions are influenced by how addiction is talked about. So society continues to call people “addicts” and “alcoholics,” and people continue to die without treatment.

But who is “society” exactly? To steal a phrase from Pogo, “We have met the enemy and he is us.” The stigma that is killing those with substance use disorders is far too often coming from those with substance use disorders, their family members, and the people who serve them.

I thankfully have not had much occasion to walk around a hospital that specifically serves those who have cancer, but I can’t imagine that I’d hear such things from patients as “I’m not as bad as THAT woman.” Or “I don’t have cancer; my DAD had cancer, and I know what that looked like. That’s not what I have.” Or how about, to the doctor, “It’s just YOUR OPINION that I have cancer. I disagree.”

But, where I work, at my pseudo-hospital that specifically serves those with substance use disorders, that’s what I hear day in and day out. “I’m not an addict; I’m nowhere near as bad as my friends.” Or “My DAD was a drunk. I’m nothing like him!” Or, despite my many years and expertise doing this work, “It’s just YOUR OPINION that I have a substance use disorder. I disagree.”

And so those with SUDs continue to die from their disease because the enemy is us. We spend far too much time pretending that we don’t see a problem or pretending that the problem will simply disappear on its own. It won’t. It’s a DISEASE. The American Society of Addiction Medicine defines it this way: “Addiction is a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences. People with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences.”

Our society has a problem remedying stigma so we try to ignore it…which brings on more stigma. Maybe you don’t feel comfortable pointing out someone’s substance use disorder; not many people do. That’s fine! Start talking instead about the harmful consequences you see. “I love you, and I’m scared that your being late to work will cause you to lose your job.” “I love you, and I’m worried that your drinking at the bar so often will cause you to have a car crash.” “I love you, and I’m scared to death that I’ll walk in here and find you dead one day.” It’s OK to talk about the elephant in the living room. In fact, if you really care about someone, it’s pretty much obligatory to do so. And human nature is that the person we say something to will lash out; get mad; deny, deny, deny. It’s pretty much obligatory to do so.

In the context of my work, I’ve been called a “drunk” – loudly – by someone who was mad because her boyfriend was being held accountable for his continued substance use despite an abstinence order to the contrary; I’ve been called stupid more times than I can count because people disagree with my qualified opinion; I’ve been told I’m being judgmental because I’m doing my job assessing a person’s use. And guess what! I didn’t stop doing any of these things. I continue holding people accountable; I keep offering my qualified opinion; I keep assessing and judging.

Until we understand that the enemy is us, our loved ones will continue to die from the treatable disease of addiction.

I catch myself saying, “He’s addicted to X,” and then I remember that addiction is addiction. A person isn’t addicted to any one substance. He may PREFER one substance over another, but that’s a slippery slope. A person I love once told me that he had a slip and used heroin. “Oh, what happened?” I asked. Then I knew, before he ever said a word. I said, “Never mind. I know what happened. You were drinking.” He said, “Yup. I was drinking, I got drunk, and I figured, ‘Eh, might as well use heroin.’” The slippery slope.

We often refer to certain drugs as “gateway drugs” because they are a gateway to using other drugs. This isn’t true for everyone, but it is true for the 12% of the population or so who have addictions. They can’t safely use one substance but stay away from others. That first substance is a gateway to all other drugs.

So, when you love a person with an addiction, show that love while in her presence by abstaining from mood-altering substances; show that love by modeling a healthy relationship with alcohol or other drugs; show that love by seeing the disease he has and not making it worse.

Let’s use another disease, cancer, as an example, and let’s pretend that a person you love has cancer that is decidedly caused by grilled meat, a known carcinogen. Would you invite that person over and cook burgers on the grill in front of her? Would you give him a salad while you eat your big, juicy grilled steak? Would you have a cookout and expect that person to attend but not eat the grilled meat? And, if you would expect that person to eat around the grilled meat, enjoying potato salad and watermelon, would you post a picture on social media of yourself with a hunk of grilled meat and comment on how absolutely delicious it is, how you’ve missed it all day, how it’s going to get you through the night? Would you post your wonderfully staged pictures of your friend along with the grilled meat, knowing he shouldn’t be eating it but reveling in his looking on?

Kind, loving people wouldn’t do this. They don’t put their loved ones in harm’s way, and that’s exactly what this is: too often we care more about our comfort than we do about the comfort of those we love. That’s OK in some circumstances – such as overruling the movie to see on date night – but it’s not OK when we’re trying to mitigate the effects of a chronic, progressive, lethal disease.

This is a part of stigma we don’t talk about much because it’s really painful to see it. We want to believe that what we’re doing isn’t harming our loved ones and that we can continue to live our lives but expect those with addictions to change…but not to change too much because we certainly don’t want them to signify a mirror of ourselves and the fact that we, too, may have a problem with substances.

 

 

The Kenosha County Substance Abuse Coalition has spent a considerable amount of time working to reduce stigma around substance use disorders. Still, day in and day out I see reminders that we have a lot of work to do. Most recently I read about a truly kind woman who bought a meal for a woman who was homeless. The post ended this way: “So next time u judge a homeless person think twice…not all of them are homeless because of a drug addiction or because they are lazy.”

I really try not to be a social media troll, but I couldn’t stop myself from commenting: “I love the kindness shown toward the woman, but I think we’d all be hard-pressed to find a person who’s homeless due to laziness. Further, drug addiction is a DISEASE that NO ONE chooses. Let’s be kind to EVERYONE, even those we don’t understand.”

I realize that I’m not going to win everyone to my side, but I am going to give it my all trying!

Stigma is defined as an association of disgrace or public disapproval with something, such as an action or condition. By itself, that’s probably not a bad thing. We often disapprove of people who don’t follow rules, mores, or laws, right? Stigma around substance use disorders (SUDs), however, goes beyond that. Stigma regarding SUDs means that people disapprove of people with a DISEASE – a disease they had no choice in getting. That’s why we have to change how we think about those with SUDs and change our language to reflect our support of them.

I often hear that addiction is a choice, but no one would ever choose to have a substance use disorder. What we don’t know is why one person gets one and the other doesn’t, but here’s what we do know:

• There’s an inherited biological disposition – meaning, it runs in families. If a parent has a substance use disorder, the child is about 40% more likely to have a substance use disorder than the general population.
• A parent’s use – EITHER parent’s use – preconception may also play a role in a child developing a SUD. Give it a Google; it’s a FASCINATING new field of study!
• Early exposure also plays a significant role in SUDs. That is, the younger a person starts using substances, the more likely that person is to develop an addiction. Think about that for a moment: a young person whose brain isn’t fully formed starts making bad choices by using mood-altering substances. Can we really blame that child for then developing an addiction?
• Using a lot leads to a SUD, but, as I like to say, no one wakes up in the morning and says “I think I’ll inject heroin today.” No one PLANS to use a lot in order to develop an addiction in his life.

Which brings me to the next point: addiction is a chronic, progressive, lethal disease, and part of the problem with stigma is that people think it’s only “hard drugs” that cause problems. Until their lives or the lives of their loved ones spin out of control because of alcohol. Or marijuana…. cocaine…benzos. Or opioids. Because when someone is finally using meth or heroin, we all know that person has a significant substance use disorder, and that’s when we say “It’s his fault. If he hadn’t picked up, he wouldn’t be addicted.” Do you see how ridiculous that is? Again, no one wakes up in the morning to get ready for his job and says, “Today is the day I’ll try meth.”

The trajectory is much more unsteady because addiction is not a choice. I once worked with an outstanding Recovery Coach who told about how she bargained with herself to determine if her addiction was, indeed, a problem. She’d say to herself, “As long as I’m not using cocaine, I’m OK.” Until she used cocaine. Then she’d say to herself, “As long as I’m not using heroin, I’m OK.” Until she used heroin. Then she said to herself, “As long as I’m not shooting up, I’m OK.” Until she shot up.

No one wants to have any disease, and the disease of addiction is no different. Let’s be kind to EVERYONE, even those we don’t understand.

Addiction is considered a family disease because of its wholly negative impact on the family and other loved ones.

Consider how, when a person receives a diagnosis of a different chronic, progressive, lethal disease…one that ISN’T the disease of addiction, the typical societal response is to offer support – bring over food, offer rides, provide child care – you support the entire family while they wrap their arms and minds around the new diagnosis.

Now, take a moment to contrast that response to the one when a loved one gets diagnosed with an addiction. If, and it’s a BIG IF, but IF the family is even willing to discuss the disease with others, the typical response is too often blaming, shaming, and stigma. And so this chronic, progressive, lethal disease that the entire family suffers from continues to wreak havoc.

What if we regarded this disease the same way we regard other diseases? From the family member’s/loved one’s perspective, what if we all stopped pretending the disease didn’t exist? When we saw the continued negative consequences of addiction in our loved ones’ lives, what if we actually started pointing it out to them as we would with any other disease? “Hey, I see you have a great big new discolored mole with irregular edges on your back. You may want to have that looked at” works reasonably well for suspected skin cancer. What if we said to loved ones we suspect suffer from addiction, “Hey, I see you have a great number of negative consequences from your substance use, including loss of income and loss of friendships. You may want to have that looked at.” Sure, someone may get mad, but as with every chronic, progressive, lethal disease, the lethal part is a given without intervention. Without intervention, death or incarceration – or incarceration (then death) – is the result. It doesn’t matter if the disease is cancer or addiction or something else. The inevitable outcome of a chronic, progressive, lethal disease that is ignored is death.

But, people who suffer from other diseases actually want to get better, and with addictions it’s different, right? Well, no, it’s really not, but it certainly does seem that way. The truth is that the “relapse” rate for chronic diseases is all about the same, but what’s different is the level of frustration we feel with the person who actually has the disease. Loving a person with an addiction is hard, and knowing where our responsibility for that person ends is hard to recognize. That’s why loved ones have to understand – and then mitigate – their role in helping the addiction to continue.

“Codependency” is said to be the idea that I will work harder on your problem and your life than you do. “Enabling” is doing for someone what that person can and should be doing. It’s helping avoid the natural consequences of behavior, and it’s one of the factors that allows people with addictions to ruin lives…their own lives and those of the people who love them.

The bottom line is that the loved ones of those with addictions are also victims of the disease. They need to learn to detach…to let the people with the addictions experience their own consequences rather than taking responsibility for them. Doing so is hard, but it can be done.

This is the one disease where we seem to believe that we can force someone to get better…where we seem to think that we can provide them all the information that they need, and then they’ll simply accept it and miraculously stop using with no future concerns. But, let’s compare this to heart disease. Heart disease is caused by diet and lack of exercise among other factors. So, when a loved one has heart disease, do we go to the doctor’s office for that person to find out how to “cure” it, then take the information back to the sufferer? Of course not! We expect THAT person to go to the doctor and then make the changes to put him- or herself on a healthy path. And, if that doesn’t happen, what do we do? Threaten? Cry? Curse? Maybe. But we don’t run out to find a new doctor to start the process all over because that first doctor “just didn’t know what he was talking about and that treatment just didn’t work.”

Addiction is a disease: a chronic, progressive, lethal disease. It is no better or worse than any other chronic, progressive, lethal diseases, but our reaction to it – societal, familial, fraternal, or sororal – has to change because our loved ones are dying.