Substance Use Disorder is a Family Affair

For many who struggle with Substance Use Disorder (SUD), this can be one of the most difficult times of year. Holiday parties at work or with friends invite overindulgence in the name of celebration. Family gatherings, so often an emotional minefield, can reopen old inner wounds, and inflict new pain as well. The arrival of a new year can be just another reminder of time and opportunity wasted, and the start of another round of despair and desperation.

A hidden epidemic

With the repercussions of decades of over-prescription of opioids dominating the headlines, it’s important to remember that substance abuse is far more widespread than most people might realize. In the most recent figures available from the Surgeon General (2015), more than 27 million people in the United States reported current use of illicit drugs or misuse of prescription drugs, and over 66 million people (that’s shockingly close to a quarter of the adult and adolescent population) reported binge drinking in the previous month.[1] In short, if substance abuse were a virus, the headlines would rightly call this an epidemic. It’s nothing less than an undercover emergency.

The tragedy of misplaced blame

Even though SUD is so widespread that nearly every family is affected, there’s a persistent – and counterproductive – public perception that the substance abuser is to blame for their problem. They got themselves into the mess, goes the thinking, and they alone are responsible for the consequences and the solution to their addiction.

Travis Rieder, who does research on America’s problems with pain and drugs at the Johns Hopkins Berman Institute of Bioethics – and who has personal experience with opioid addiction and recovery – wrote this in a USA Today opinion essay: “Some people are and will become addicted despite their best efforts, and they are at risk of dying until we can help them recover.”[2] Rieder goes on to make the point that if a speeding driver is injured in an accident, we wouldn’t refuse a life-saving operation.

Still, as the Surgeon General’s report says, society treats addiction and misuse of alcohol and drugs as symptoms of moral weakness, and in many cases prefers the criminal justice system to deal with them. Further, while more than 40 percent of people with a substance abuse disorder also have a mental health condition, fewer than half receive treatment for either disorder.

The influence of childhood experience

The 2019 film “Rocketman” offers a clear-eyed look at the family drama that marked Elton John’s childhood, and helps the audience grasp the paramount influence of that early trauma in Elton’s later struggles with addiction.

The contribution of childhood experience to later substance abuse is far more than just an excuse. It’s a factor supported by a considerable body of research and recognized by the Centers for Disease Control as Adverse Childhood Experience.

Adverse Childhood Experiences (abbreviated as ACEs) are described by the CDC as potentially traumatic events, including “experiencing violence, abuse, or neglect; witnessing violence in the home; and having a family member attempt or die by suicide.” Other contributing factors can include aspects of the child’s environment that undermine their sense of safety, stability, and bonding: growing up in a household with substance use disorder, mental health problems, or instability due to parental separation or incarceration of a close family member.[3]

A paper published in the journal Depression and Anxiety concludes that ” . . . the link between trauma exposure and substance abuse has been well-established. For example, in the National Survey of Adolescents, teens who had experienced physical or sexual abuse/assault were three times more likely to report past or current substance abuse than those without a history of trauma. In surveys of adolescents receiving treatment for substance abuse, more than 70% of patients had a history of trauma exposure.”[4]

The most humane, and most effective approach to substance use treatment takes into account the patient’s experiences from childhood onward and helps them learn to deal with the emotional and social triggers that underlie their medical addiction. The formal name for this is the Biopsychosocial Approach; it acknowledges biological, psychological, and social factors and their complex interactions in understanding health and illness, and it inspires the delivery of compassionate healthcare delivery.[5]

Self-care and peer support

For the patient, self-regard and self-care may be difficult to believe in at first, but with professional help and a solid support network of recovering peers backed by committed friends or family, it is possible to break free from addiction and pursue the journey of recovery.

As for friends, family and associates, Travis Rieder writes, “If we see people who use drugs as people we know and love, people who deserve respect and health care, we can save many of them. But we have to replace our instinct to punish what we see as bad behavior with an instinct to care.”

About CHESS Health

CHESS Health is the developer of the leading, evidence-based technology platform for the addiction management life cycle. The platform facilitates digital handoffs for getting more patients into treatment (eIntervention); improves outcomes through digital CBT (eTherapy) and reduces relapse and supports long term recovery (eRecovery)For providers, the CHESS platform grows patient volume through more successful referrals, improves treatment delivery, and measure better outcomes, including reduced relapse. Health plans and governments also benefit from more individuals in treatment and better outcomes; with the CHESS platform, they also gain analytic insights into provider performance. CHESS Health has received recognition from the Substance Abuse and Mental Health Services Administration’s National Registry of Evidence-based Programs and Practices (NREPP), the Journal of Substance Abuse and the Surgeon General. For more information, visit www.chess.health.

 

[1] Surgeon General’s Report on Alcohol, Drugs, and Health

https://addiction.surgeongeneral.gov/executive-summary#1

[2] To fight opioid epidemic, treat drug use with compassion, not judgment

Travis Rieder, opinion contributor, USA Today, July 9, 2019

https://www.usatoday.com/story/opinion/2019/07/09/treat-opioid-users-with-compassion-not-judgment-column/1668946001/

[3] CDC: About Adverse Childhood Experiences

https://www.cdc.gov/violenceprevention/childabuseandneglect/acestudy/aboutace.html

[4] Substance use, childhood traumatic experience, and Posttraumatic Stress Disorder in an urban civilian population

Lamya Khoury, et al, Depression and Anxiety 2010 Dec; 27(12): 1077–108

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3051362/

[5] University of Rochester Medical Center The Biopsychosocial Approach

https://www.urmc.rochester.edu/MediaLibraries/URMCMedia/education/md/documents/biopsychosocial-model-approach.pdf