Addiction: An Illness in Disguise by Dr. Janet Astle

Father Michael Decewicz - July 23, 2019

Anyone can get addicted to any substance. It strikes all races, genders, ethnicities, geographic areas, socioeconomic status, level of education, religious beliefs. A better understanding of addiction – is it disease or moral failing? Try to dispel the stigma – it is not a moral failing.

Life expectancy of US – declined over last 3 years due to losing young people in 20’s & 30’s bringing average down – over 70,000 drug overdose deaths in 2018 and 47,000 lost to suicide – significant overlap between groups. Substance abuse leads to loss of life due to accidental overdose and suicide.

WV, OH, PA – per capita rate based on population – lead the nation in deaths related to drug overdose

190 die accidental drug overdoses daily across the U.S.

Stigma about substance use disorders – it is illness, not moral failing

There is hope to get better

8-12% of population have disorder – may go as high as 20%

Most people either suffer from a SUD or know a family member, friend, or acquaintance who suffers from a SUD

Jump from 2015 to 2017 in number of overdose deaths in Allegheny County –

Good news! Latest trend that is falling from 2017 – attributable to NARCAN (Naloxone rescue) used for heroin, fentanyl overdose – knocks the opioid off receptor – reverses respiratory arrest – immediate withdrawal – saves lives – Increased awareness of its availability; many pharmacies stock it.

Compare SUD to diabetes – share characteristics

1. Genetics and heredity - not destiny, but an increased propensity to develop disorder

2. Diabetes – affected organ is the pancreas – not producing sufficient insulin; receptors are not adequately responsive

SUD – affected organ is the brain – dysfunction in neurotransmitter dopamine; receptors are downregulated and not adequately responsive

3. Environmental factors –

Diabetes – poor diet, obesity, lack of exercise

SUD – stress, anxiety, mental health, depression, pain, peer group influence

4. Chronic – can’t cure but can control

Relapse rates 40 to 60% for SUD

Diabetes is 30-50% relapse rate

5. If untreated, progressive end organ damage for both, and eventually lead to death

6. Treatment – Maintenance of Remission

Need to get down to the root cause. In diabetes if we treat just the symptoms (such as thirst, frequent urination) by providing more liquids, we do nothing to manage the illness.

In SUD, if we treat just the symptoms of bad behavior (such as lying, stealing) by punishment through prison time, we do nothing to manage the illness.

Need to treat root cause of illness

Midbrain or primitive brain (lizard brain) – not thinking about what we are doing – compulsive center – kept the human race alive for a lot of years. Hunger, thirst, procreation, survival.

VTA – pleasure or reward system – release of dopamine

dopamine attaches to receptors in the nucleus accumbens – gives boost – located close to midbrain

When using a substance of abuse – the memory of the euphoria is burned in the brain (hippocampus and amygdala) and wants to repeat without thinking – automatic response

Although initial use might be attached to euphoria, people continue to use to not feel awful or to avoid going through withdrawal.

Brain thinks it needs drugs to survive – addiction “continuing to use despite the negative consequences”

Manage SUD – people say just stop using – easier said than done – people who are doing well in recovery still have the disease just like people with well-managed diabetes still have the disease –– the underlying illness is still there – craving still exists; the disease is being managed and is in remission.

can be in sobriety for many years but still actively working on illness

PET scans of the brain show that when a video of the substance of choice, or the paraphernalia associated with the substance of use such as a syringe for a heroin user, is shown to a user in recovery – the emotional center of the brain lights up with memory center; the association still remains strong.

An experiment with rats demonstrates that rats will continue to self-administer cocaine by depressing a lever to the point that they will forego food and drink to the point of death.

Illustrates the illness. Rats did not have “bad parents” or hang out in “rat gangs.”

Stigma, guilt associated with SUD & mental health problems – no one wants to talk about it

afraid to talk about it – afraid to get help

people don’t know what to say, think it is a moral failing and are judgmental

raised awareness of SUD – affected everyone regardless of ethnicity, socio-economics

need to use the right type of language - avoid stereotypes; “words matter”

Enabling – doing for other people what they can or should be doing for themselves – not allowing sufferers to deal with the consequences

Anytime someone tells us not to do something, people will get defensive – people retreat; be careful to use “I” statements instead of “you” statements. Not “you need to get your act together” but rather “I am worried about you; I feel frightened when you use.”

Co-dependent people – may be more damaging than enablers – Co-dependents like playing the role of savior or victim – doesn’t help anyone to get into recovery

Co-dependents are as obsessed with person who is using as is the user with the substance –– also a disorder – the user becomes your drug of choice

no easy script or one way to help people to get to the point of wanting recovery

CRAFT technique (Community Reinforcement and Family Training) has been found to be an effective intervention; moves the user along a continuum towards acceptance of help and treatment

Crisis situation – need plan – have NARCAN (naloxone nasal spray) on hand to administer to give chance to survive for opioid users

In many emergency rooms – once the crisis is resolved, the patient is discharged – just given a list of phone numbers for help – not helped by any specialist or expert – need to do warm handoffs to health care professionals trained in behavioral health and addiction medicine

St. Clair has referral system with Gateway

AGH has a team to respond for SUD

Butler & UPMC McKeesport hospitals have people in place to help

Change of behavior can lead to user changing behavior – family and friends need to take care of themselves

Resources for Recovery

Self-Help Programs for Recovery

12 step: AA and NA

SMART Recovery Groups

Al-Anon, Nar-Anon, and Alateen for family/friends

Rehabilitation Centers – inpatient and outpatient

Look for those that are accredited

Medication Assisted Treatment for Opioid and Alcohol

Methadone – Opioid

Buprenorphine (Suboxone) – Opioid

Naltrexone (Revia/Vivitrol) – Opioid and Alcohol

Genes are not destiny; there is hope

Relapse does not mean treatment has failed

Relapse is associated with many chronic diseases

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