After criminal convictions, many people with substance use disorder are placed on probation with the condition they remain completely drug-free. They are often jailed when they relapse, setting back recovery and removing them from treatment that helps keep them clean. Is that fair, when relapse is a common symptom of their disease (and many others)? Addiction and legal experts discuss.
Lisa Newman-Polk, attorney and social worker, Ayer, MA
Michael Botticelli, Executive Director, Grayken Center for Addiction, Boston Medical Center and former Director, National Drug Control Policy
Dr. Barbara Herbert, Immediate Past President, Massachusetts Society of Addiction Medicine
Dr. Sally Satel, addiction psychiatrist and Lecturer, Yale University School of Medicine and Resident Scholar, American Enterprise Institute
America’s opioid epidemic has taken 64,000 lives in 2016. While many people support prosecution and strict punishment for drug users, Vancouver in British Columbia has taken a different approach with their drug use policy of harm reduction. Travis Lupick, author of Fighting for Space: How a Group of Drug Users Transformed One City’s Struggle with Addiction, explains more about how harm reduction works and where it came from.
Harm reduction seeks to solve the problems of drug addiction by alleviating the harms caused by the prohibition of drugs, rather than the drugs themselves. In Vancouver, a supervised injection facility, established based on the recommendation of the Vancouver Area Network of Drug Users (VANDU), provides a safe and clean place for drug use, without providing drugs. This has resulted in the reduction of diseases caused by unclean needles, for example, and has even provided many with a lifeline to abstinence and detox from drugs.
Although counterintuitive, harm reduction has been met with resistance within Vancouver and in several cities in the US, as well. But, the effects of this program have been undeniably positive and have been supported by medical research. By providing a space where drug users feel safe, the city is providing drug users with the chance to use drugs safely and also to eventually transition into a drug-free life. Lupick calls for more American cities to consider the benefits of this program, as well as encouraging more doctors to enter the field of addiction medicine, where they are sorely needed.
For more information about Harm Reduction or to purchase a copy of Lupick’s book, visit the links below.
Travis Lupick, author of Fighting for Space: How a Group of Drug Users Transformed One City’s Struggle With Addiction
In the past, healthcare has spent thousands of dollars on treating the homeless, and often times the hospitals are never paid for these treatments. Homelessness affects an individuals health and severely decreases their life expectancy. Stephen Brown, Director of Preventive Emergency Medicine at University of Illinois Hospital and Health Sciences, Chicago, explains that homeless people are admitted to the hospital more than the average person and on a more consistent basis. Yet, following these treatments, the homeless are often sent back to the streets and forced to fend for themselves again.
However, some hospitals around the nation are beginning to acknowledge their role in helping homelessness. In light of this growing problem, bigger cities around the nation have started to provide housing to the homeless. But, they have replaced the traditional model that required people to be clean of their addiction before they were provided with housing with a much more efficient model that has already shown higher success rates. Shannon Nazworth, President and CEO of Ability Housing in Jacksonville, Florida, explains that the new “housing first” model takes people straight from the street and provides them with shelter, and then gives them access to resources that help them get back on their feet. She explains that they have the responsibility to pay rent, but the program helps the individuals access funds through benefits. The end goal of this program is to help the person work toward a financial position in which they are able to to move from program housing to different community housing.
Since “housing first” programs began, they have shown a significant increase in getting homeless individuals off the streets and keeping them off the streets. But, the programs have still faced backlash. Nazworth explains that due to stigmas associated with mental health and homelessness there have been misconceptions about the individuals that would be allowed in these programs. In order to change this, Nazworth states that the program allows people to come in and observe the housing to acquire more knowledge on it. By providing homeless individuals with the opportunity to receive housing and aid, many of them are capable of redeeming their health and eventually no longer rely on the programs for help anymore.
Stephen Brown, Director of Preventive Emergency Medicine at University of Illinois Hospital and Health Sciences, Chicago
Shannon Nazworth, President/CEO of Ability Housing, Jacksonville, Florida
Dr. Robert Lustig, pediatric endocrinologist, Professor of Pediatrics in the Division of Endocrinology at University of California, San Francisco, President of Institute for Responsible Nutrition, and author of Fat Chance: Beating the Odds Against Sugar, Processed Food, Obesity and Disease explains that generally people believe that obesity is a calorie problem: people eat too much and exercise too little. But, he states that there is something else at play here–the enormous increase in the consumption of dietary sugar across the country.
However, it is hard to place the blame on a lack of self-responsibility. Dr. Lustig explains that evidence shows sugar is addictive and it is capable of exciting the brain in a similar way that other substances of abuse do, too. Dr. Lustig believes there are two reasons sugar has become so prevalent in the human diet: first, sugar became cheaper, and second, the food industry put an emphasis on “low-fat”and “fat-free” diets that encouraged people to eat these foods that are higher in sugar.
The negative effects of sugar are not only seen through the increase in obesity, but also in the rise of diabetes which is increasing at a far quicker pace. Dr. Lustig states that this growth in diabetes is not just affecting those who are obese, it is affecting all people who consume sugar at a high rate. He further explains that diabetes is not about obesity, but that it’s about how our bodies metabolize what enters it and the damages that these bad foods cause in the process. In order to decrease the number of people being affected by diabetes and obesity, sugar consumption must go down.
Dr. Robert Lustig, pediatric endocrinologist, Professor of Pediatrics in the Division of Endocrinology at University of California, San Francisco, President of Institute for Responsible Nutrition, and author of Fat Chance: Beating the Odds Against Sugar, Processed Food, Obesity and Disease
Addiction has become undoubtedly entangled in modern American society. Whether it’s gambling, food, sex, technology, alcohol or drugs, the deadly disease hijacks the human brain with severe ramifications. Recent eruptions in the number of opiate addicts and overdoses has shined an even brighter spotlight on this critical public health issue.
There is an inclination to equate addiction to a moral failing, lack of willpower, or simply bad judgment. Dr. Rita Goldstein, Professor of Psychiatry and Neuroscience at the Icahn School of Medicine at Mount Sinai, explains that due to our ‘evolutionary legacy,’ the reward center in the brain is designed to make us feel good when we do things like eat food or have sex. Yet, with prolonged addiction, a chemical imbalance occurs, and as a result, the reward center takes priority over rational thinking or the threat of negative consequence. When addictive behavior is continually reinforced, further imbalance occurs, weakening the part of the brain meant to counterbalance impulsive behavior.
The good news; Dr. Anna Rose Childress, Research Professor of Psychology in Psychiatry at the Pennsylvania School of Medicine, observes that with abstinence, with or without the use of medications for recovering addicts, the brain can begin rewiring pathways created in the midst of addiction. The road to recovery is not yet paved in the golden promise of a cure, but understanding the biology of addiction is a critical component of treating the disease.
Dr. Rita Goldstein, Professor of Psychiatry and Neuroscience, Icahn School of Medicine at Mt. Sinai, New York
Dr. Anna Rose Childress, Research Professor of Psychology in Psychiatry, University of Pennsylvania School of Medicine
Scientists are learning the specific workings of the brain when it is addicted to a substance or behavior, and showing that all addictions are similar. This gives hope of one day developing a drug to combat many addictions. However, the stigma of addictions—that they are a moral failing—still looms over the field.
Preparing for Disaster
Many people will have to deal with a natural disaster at some point in their lives. Two civil defense experts discuss how to be ready before it comes.
Americans consume 80 percent of the opioid painkillers prescribed worldwide, ultimately resulting in the deaths of more than 20,000 Americans each year of overdoses of these drugs. The crisis is making doctors look at alternative medicine therapies for a substitute for these drugs. Experts discuss modalities that have shown success.