Opioid Addiction In Focus: Tackling The Opioid Crisis Requires A Better Understanding Of All Addiction

​Opioid addiction is an important social issue that continues to impact more and more people.  Not only has Melania Trump taken up the cause as part of her duties as First Lady, there is a growing desire across the political spectrum and across the United States to tackle opioid addiction.  The Trump Administration’s effort to confront the opioid crisis is one of the few initiatives of the US President that everyone can support.  Although more must be done to prevent opioid addiction by finding less addictive alternatives to treatment options that rely on painkillers and more must be done to treat victims of opioid addiction, Congress has managed to pass legislation that will help better control who gains access to opioids.  While hospital visits by the First Lady grabs headlines and the use of an opioid overdose to kill off the Roseanne character in the rebooted Roseanne series demonstrates the concerns of television executives and writers, the viral obituary of a mother who died of opioid addiction shows the empathy Americans feel toward victims of opioid addiction, which is an important step forward.

​Unfortunately, our culture often embraces perverse incentives while those in positions of authority too often forget they are given their power to serve, not to discriminate.  Instead of arresting drug addicts to help them, we cruelly inflict ineffective punishments on them.  This writer remembers a childhood field trip to a local police station where the holding cells lacked mattresses.  An officer explained, “if people want to act like animals, we’re going to treat them like animals.”  Viewing drug addicts as animals demonstrates a thorough failure to understand the impacts of drugs on certain people.  Criminalizing drug addiction only adds a greater burden to the hopelessness that drug addicts often face, thereby encouraging them to seek relief from their discomfort with drugs.  Instead of addressing the underlying social need to help drug addicts overcome their self-destructive behavior, our authorities too often treat addicts as inferiors in need of authoritative correction, thus they mistreat addicts.  Certainly, society cannot tolerate the misconduct of addicts, but we must also remember all addicts are people in need of help.
 
Unlike the broader drug epidemic, however, the victims of the opioid crisis, for the most part, are not addicts whose lives spiraled out of control, because they decided to utilize drugs for recreational use.  A large portion of opioid addicts become addicts, because they had addictive traits, pain that needed treatment, and healthcare professionals willing to prescribe them the strongest painkillers possible.  It is why most people see opioid addicts as victims of opioid addiction instead of just drug addicts.  To boot, a growing number of victims are not simple “street junkies” or troubled individuals.  They are fully functional members of society who happened to find themselves unable to function without a toxic that was given to them by the very medical professionals who were supposed to heal them.  Victims of opioid addiction are seen as more human than regular addicts, because they were doing what they were supposed to do when they became addicts, i.e. take their medicine.
 
With that in mind, it may be easier for people to sympathize with opioid addicts and relate to their struggles, but opioid addiction is no different than any other kind of addiction.  Dealing with opioid addiction in terms of treating addicts and tackling the social issue of opioid addiction is no different than the struggle to confront any other kind of addiction.  Clearly, addiction has a physiological-psychological component.  Although this hints at how to medically treat those whose biology makes them more susceptible to the reinforcing nature of addictive substances, no one truly understands how to treat addiction as a society.  It is why the so-called “war on drugs” has largely failed  A disease of this nature is difficult to treat, because it is rooted in our basic psychological response to appetitive stimuli.  Drugs affect the natural response that all humans have to any given chemical that makes us “feel good,” thus addiction is not a disease that can be cured by fixing something in the body.
 
Some addicts may be retrained to find certain drugs too aversive for consumption, but the best option typically available is deprivation, which can be terribly stressful on the addict and ineffective.  That said, drug addicts will often substitute one drug for another.  In many respects, the same is true for almost all people, whether they are reasonably healthy or dysfunctional.  Looking specifically at people who battle with severe dysfunctions, i.e. psychological and behavioral disorders that prevent such individuals from properly functioning in their communities without assistance, there is a pattern of avoiding necessary decisions and tasks that healthy people engaged in on a regular basis.  The fundamental reason why dysfunctional people avoid critical decisions, or make outright self-destructive choices, stems from how the dysfunctions of these individuals' skew their ability to tolerate potentially uncomfortable situations.  Because all people exhibit some dysfunctional behavior from time to time, understanding how our tolerance levels for necessary discomforts affects what we do, can help reasonably healthy and unhealthy people alike identify, as well as understand, their dysfunctional traits.
 
Substitution involves an attempt to avoid the consequences of one choice by embracing the less uncomfortable consequences of another choice.  A drug addict, for example, will often substitute food, cigarettes, cutting, suicide, and/or sex for narcotics.  Ignoring the impulse to use drugs is extremely uncomfortable to these people, thus substitutes, which might be healthy or unhealthy, help ease that discomfort.  Similarly, someone with OCD will use excessive cleaning to overcompensate for insecurities while the mother of a deceased child might seek to distract herself from the emotional deficit by "mothering" other children or adults.  In reality, these substitutes are being used to avoid something far more uncomfortable, such as emotional pain; therefore, treatment for those using substitutes hinges upon the ability of such individuals, with the proper assistance of a support network, to move beyond the substitutes in order to address their underlying issues.
 
Given that the most fundamental mechanism behind all self-destructive behaviors is the avoidance of discomfort, substitution does not necessarily have to be harmful.  Only when a substitute prevents an individual from addressing underlying issues does a substitute inhibit the healing process.  Someone suffering from depression, who uses a string of superficial relationships to avoid the emotional pain of past intimacy, is engaging in a form of unhealthy substitution, because the sex is simply another means of avoiding the need to confront past feelings and the potential pain of real intimacy.  Conversely, a smoker drinking a glass of water when in need of a cigarette is healthy as the act allows the smoker a chance to avoid the intense discomfort of not smoking until the smoker learns to cope with the lack of nicotine.  Consequently, healthy substitution affords damaged individuals the ability to function and live functional lives as they heal.   
 
Understanding the difference between healthy and unhealthy substitutes can empower individuals to overcome emotional and psychological roadblocks.  Although it is essential to avoid over-intellectualizing emotional issues, i.e. emotions cannot be reasoned away, this is especially important for people in crisis.  Life-altering changes, such as prolonged unemployment, i.e. financial insecurity, or heartbreak, i.e. emotional insecurity, can lead to the need for individuals to adapt; however, that change sometimes requires too much discomfort.  Suddenly, once functional individuals are unable to function in their new circumstances.  Instead of dealing with the necessary discomfort of addressing unmanageable situations, people in crisis will seek to occupy their time with seemingly nonsensical activities.  Such individuals will either become locked into old routines or seek substitutes to avoid the discomfort of dwelling on distressing circumstances.  
 
All people tend to avoid what they find uncomfortable, yet most individuals find little to no significant discomfort in what must be done to establish and/or maintain a healthy lifestyle.  When people cannot tolerate the discomfort of doing what they must, or cannot do what they need to do because of exasperating factors such as financial insecurities, substitution allows these individuals some comfort.  In more dire circumstances, thoughtful, well-tailored interventions from family, friends, community, and/or trained professionals, can be used to funnel and harness the untapped potential of someone in need of a healthy substitute.  When substitution leads to the resolution of underlying issues, such as the creation of a new job or improved relationships, it can be healthy.  When substitution distracts individuals from dealing with their issues, it is unhealthy.  As such, substitution can be a healthy or unhealthy mechanism, but understanding its role in our decision-making process affords us a powerful tool in our efforts to overcome everything from minor quirks to disabling mental health issues.  For drug addicts, it is particularly easy for their aversion to discomfort and the distressing circumstances their addictions create to overwhelm their ability to cope.  
 
Taking a punitive approach to drug use does nothing to prevent drug abuse; it only marginalizes drug addicts and somewhat lessens the negative impact of drug abuse on our communities.  Instead of self-righteously condemning our drug addicts and finding ways of throwing them away, we need to find ways of serving them, so they overcome their addictions and our society can reap the benefits of a society safe from drug abuse.  In the case of the opioid crisis, there is far less stigma and far less of an attempt to criminalize the use of opioids.  What needs to be criminalized is the over-prescribing of opioids, which is the driver of the opioid crisis.  Medical professionals need to be more proactive in confronting the crisis that they had a major hand in creating.  For users of opioids, family, friends, and communities need to be aware of how easily opioid use can transform into opioid addiction.  From there, we as a society need to understand the mechanisms of addiction and treatment.  Recognizing drug abuse as a form of substitution and substitution as an important part of treatment is a significant step forward in combating the opioid crisis and the drug epidemic.