With the opioid epidemic reaching into every corner of the U.S., more
people are talking about addiction as a chronic disease rather than a
moral failing.
For researcher A. Thomas McLellan, who has spent
his entire career studying substance abuse, the shift is a welcome one,
though it has come frustratingly late.
McLellan is co-founder of the Treatment Research Institute
in Philadelphia and former deputy director of the White House Office of
National Drug Control Policy. His work has focused on understanding
addiction as a disease and improving the ways it is treated, a mission
that took a personal turn midway through his career when he lost a son
to overdose.
NPR's Audie Cornish spoke with McLellan about how
addiction is viewed and how that view has shaped the treatment system we
have today. He also has suggestions on how to make it better.
Here are interview highlights, edited for length and clarity.
On why addiction has traditionally been seen as a criminal justice issue, not a health issue
Think
about it. If you didn't have brain science, which has just really
emerged in the last two or three decades, all you had to look at was the
behavior of addicted people. They are not pleasant people when they are
in full addiction. They steal, they lie, they swear they're going to do
something and they don't. It's quite easy to think of this as it has
been thought of for literally hundreds of years: as a character
disorder, as poor upbringing as a problem of parenting. And that's how
we approached it. It's not coincidence that the Justice Department has
played such a pivotal role. The emerging science shows this is a brain
disease. It's got the same genetic transmutability as a lot of chronic
illnesses. And the organ that it affects is the brain, and within the
brain it is motivation, inhibition, cognition, all those things that
produce the aberrant, unpleasant behaviors that are associated with
addiction.
On whether the drug treatment system is prepared to address the current opioid crisis
So
there are two ways you have to think of it. First, there's the
traditional addiction treatment system. It was purposely set up to be
separate from all of health care and that's the way it's been for four
decades. They've been doing heroic things, but they've been underfunded,
undertrained and they have been unable to provide the most contemporary
kinds of treatment and monitoring. So then you turn to the rest of
health care, mainstream health care. What we found is that less than 10
percent of American medical schools have a course in addiction. Ditto
nursing, ditto pharmacy schools. So, contemporary physicians are not
equipped to do it. Yet it's those same kind of services, medications,
behavioral therapies, monitoring and management, they now do routinely
for diabetes, hypertension, chronic pain.
On the idea that addiction has to be treated over the long haul, the way diabetes and other chronic diseases are
It's
a tough sell on two sides. No. 1, it's a tough sell for people who
suffer from addiction. It's tough to hear, "I'm sorry, we don't have a
cure. You can't get detoxed, go away for 30 days, get your head straight
and not be affected." Same is true for diabetes. There is no place that
I know of that gives you 30 days of insulin treatment and a hearty
handshake and sends you off to a church basement. It just won't work, so
that's tough.
It's been tough for medicine, too. These are
doctors who have never learned about addiction in school. Why in the
world, if they're already busy trying to treat other chronic illnesses,
why should they take this on? And here is actually the best answer. You
may say that expanding insurance options, providing more and better care
for addicts is a waste of money, or it's a gift to someone who doesn't
deserve it. The real gift is for the rest of health care, because it is
impossible to manage most chronic illnesses without some attention to
substance use disorders. They've been willfully ignored by medicine for
decades and it's costing them roughly $200 billion a year in wasted or
inappropriate medical care.
On what has changed for people whose families are affected by addiction
The
people that I know who have lost spouses, children, some of them are so
ashamed that they wouldn't even acknowledge it as a cause of death. And
one thing I've found is that in health care, you don't get the kind of
health care that science dictates or that is even economically prudent.
You get the health care that you negotiate and that is politically
motivated. So for most of my life, there has been no groundswell
demanding the kind of care that other illnesses have rightfully come to
expect. In my life, the best thing that has ever happened and given
people like me hope that your grandkids won't have the same illness is
the Affordable Care Act. It now mandates that the same kinds of care
that are available for other illnesses of the body are also available
for illnesses of the mind. We can do it. It's economically sensible to
do. We just haven't had the political will.
Sumber :http://www.npr.org
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