We use to think the world was flat. We use to think the sun revolved around the earth. We even use to think that the size of one’s cranium or even their feet, was a measure of intelligence. And we still believe that punishing, shaming, banishing people from our lives and community will somehow “inspire” people not to use certain drugs; when all of the research we now have points in the opposite direction.
Funny how we humans shun change. Actually, most of us suck at accepting new ideas. Sometimes decades or even centuries go by before proven ideas become recognised as truths. Often, people proposing new ideas use to be thrown into prison or even executed for daring to make us think. Now we just ignore them or still shun or openly denigrate people – even when what they say is backed up with evidence-based science. Somehow, we hold on to the old familiar kitchen table beliefs of all sorts of things – often leading to harmful consequences.
From my experience as someone who has struggled with substances, and as a clinician for most of my life, I know that the science and tools to address the complex layers of addiction are evolving. What I knew forty years ago is only a small portion of what I know now and much of what I knew then is also irrelevant.
Study and research has brought us through the Oxford program’s fundamental Christian approach through to AA and the “disease concept” of addiction, the “decade of the brain” in the 1990’s and the “brain disease concept”, “Substance Use Disorders”, the role of Neuroplasticity in repairing, adaptation and learning in the brain, the impact of prohibition on individuals and society, the role of social health determinants on substance use and addiction, medical model solutions including opiate agonist, opiate replacements, medicinal treatment for alcohol, stimulants and on and on. What we are still learning will change communal knowledge of substance use and substance use issues in the future. Yet we insist to continue to see addiction as the disease.
We still fund and practice treatment methods and promote programs that are dated from 1935, 88 years ago as of when this is written. In those times even the creators of AA talk about addiction as something baffling and cunning. They knew what they knew based on the science and social and moral norms of that time. Almost a century ago! Have we not learned anything more since then?
And we continue to promote treatment based on this dated information as a silver bullet, often at the cost of life saving harm reduction approaches. We do this in reaction to the mounting deaths from overdose due to the toxic supply of illicit substances. And we say more treatment, not harm reduction will fix this horrific problem. We must stop this disease from spreading. It is the disease of addiction that must be treated. Harm reduction will only enable the disease to spread. Makes sense in a way. If this were only true.
Yet today, substance use and addiction rates continue to climb. Despite more access to treatment programs. We are finding increased rates of addiction more now amongst those who are at risk of or are actually disconnected and displaced in our communities. We find that certain population groups have always suffered disproportionately more from the negative criminal and yes, medical restrictions we have imposed on people who use substances. And fatality rates are skyrocketing from an increasingly toxic cocktail of illicit substances that the vast majority of people who use are not even aware they are taking. This despite slowly increasing access to residential treatment programs that are thought to be the silver bullet of “fixing” those who are addicted. Treatment programs that still focus on the “shortcomings” and pathology of the individual and almost completely ignore every other aspect and development in the science of substance use; The social health determinants in society that should be readily accessible to everyone, but are not.
It is not the tools or the developing knowledge that is flawed, it is our collective resistance to change. It is the insistence that there is only this way or that way. It is our fragmented system founded on policies created decades ago, in the last century. It is the resistance to look outside the box, at the bigger picture. It is the denial that systems exist to perpetuate themselves and not the objectives in which they were created for.
We operate from ideas based on moral and pious religious judgment; Ideas that are based on economic factors rather than humane factors. These old concepts stand in the way of flexible and human-centred attitudes and policies that would best address substance use and disorders. It is actually carrying the attitude and belief that the tools that are being developed are not part of the original one (religious) way and anyone using these tools is somehow in denial of their addiction.
We desperately need flexible responsive and accessible options for those who use substances and for those who suffer with addiction. We desperately need to expand on our own definitions of what substance use and treatment is now. We need to learn and accept that not everyone needs treatment as we currently understand it but rather a better and more educational component at the front end of our personal development; transparently and without the moral judgement that has colored our views of substance use. Each of us needs to catch up to the current theories and models and be open to expanding on and introducing new evidence-based proven ideology and methods.
But we stay right where we are. We scapegoat drugs as the disease rotting the core of society when indeed, the evidence, that is avoided at all costs, including the deaths of hundreds of thousands, suggests that it is something else far more insidious. We must address this elephant in the room. We must look beyond our comfortable little cages and find what exactly this disease is. Is it addiction or is it something else? We only need look at where it is happening the most. We need to face the elephant.
I continue this in the next part of the Elephant in the Room series.
Written by Ben Goerner, Edited by Ron Merk
Bibliography:
https://www.cato.org/blog/prohibition-theater-iron-law-prohibition-unpublished-letter-editor-wall-street-journal
Lewis Marc Dr, (2015) The Biology of Desire, Public Affairs Perseus Books New York
Boyd Susan et al (2016) More Harm Than Good: Drug Policy in Canada, Fernwood Publishing Nova Scotia.
Mate Gabor M.D., (2008) In the Realm of Hungry Ghosts, Vintage Canada Toronto.
Alexander Bruce Dr, (2008) The Globalization of Addiction, Oxford University Press
Fisher, Carl Dr, (2022) The Urge: Our History of Addiction, Allen Lane, Penguin Random House Canada.