Too many people are talking about addictions these days. It’s almost impossible to read a newspaper, listen to the radio, watch a television newscast, or scan the internet without finding yet another article or segment on addiction. The “opioid crisis,” as the journalists have called it, has provided a platform for government officials, politicians, police, families, and the public to talk about chronic drug use and what we should do about it.
It’s not that the topic shouldn’t be discussed. It is very important. The problem is that most of those who are doing the talking are not particularly well versed on the subject. We know from a lot of research that addiction is the result of a very complicated interaction of biological, psychological, and social factors. But we still don’t understand the details of factors or how they all come together to create the problem. It’s curious that few people doing the talking in the media are willing to admit that we’re still trying to understand what this thing we call “addiction” is. In fact, most seem convinced that they’ve got the answers and are happy to share them.
And we hear lots of talk about addiction treatment as if all it would take is to get those addicted people into proper treatment. Everyone seems to assume that treating someone with an addiction is the same as treating someone for a heart condition or for depression. In all the media talk, we don’t hear from experts such as addiction psychologists Warren Bickel and Marc Potenza who ask, “Why is addiction so difficult to treat?”
It’s also a bit disconcerting to hear the media talk about addiction the same way they’ve been talking about it for decades. It’s as if we’re stuck rehashing the same thinking we heard about during the heroin crisis of the 1970s or crystal meth crisis of a decade ago: Those who are addicted are not like us regular people, abstinence versus harm reduction, compulsion versus choice, drug users are self-medicating some condition, more police are needed, and so on.
The Media Shows Medical Doctors as Addiction Experts
It’s curious that journalists typically interview medical doctors certified to practice addiction medicine as the clinical experts. This is good information, but it leaves readers and listeners with the impression that the medical professionals are universally recognized as the experts.
The reality is that field of addiction is remarkably complicated. There are many theories of what this thing we call “addiction” is and what we should do about it. Some of the more famous theories interpret addiction as a disease, consumer behaviour, faulty thinking, self-medication, or a lack of connection with others.
Medical professionals are typically versed in one of these theories, known as the biomedical model (popularly known as the disease theory). It’s an important theory, but it’s only one of many scientifically-based theories.
The biomedical model offers treatment based on a theory that addiction is a problem in the physical brain and, for many, in the body. Medications, for example, are a key feature of the biomedical model. We’ve even been hearing about vaccines for drugs. Some of those who accept the biomedical model of addiction believe that non-medical therapies, such as family counselling, are basically a waste of time. What does family counselling have to do with a disease?
But if we take a big picture perspective of the field of addiction treatment, we find that there are dozens of scientifically based ways to treat the problem. The reason for this is that a treatment is based on a theory of addiction. So different theories offer different treatments. The biomedical theory offers one way, but there are lots of other ways that are equally valid. It depends on which theory you believe is correct.
The Media’s Tendency to Blame the Person for Addiction
When the media report on the opioid crisis, we hear a tendency, often unspoken, to blame addiction on the addicted person. Journalists in BC, where the opioid crisis is at its worst in Canada, hasten to Vancouver’s infamous drug-infested Downtown Eastside. The Downtown Eastside has become famous, in no small part because of the commercial film industry, which uses it as a metaphor for the dark side of life.
Media stories present opioid-addicted residents as underprivileged, undereducated, and underemployed. Journalists interview opioid users, who have endured lives of abuse, to explain why these underprivileged men and women fall victim to the drug, while healthy-minded people do not.
But when an overdose victim does not fit this stereotype, the journalists seem confused. One example was the story of a respected vice-president at a university, who overdosed on fentanyl (the opioid of greatest concern). Little was reported, other than to respect the family’s request for privacy. And it’s not just BC. When newspaper headlines in Connecticut and New Hampshire stated that white, middle-class adults were overdosing, the media reports offered little explanation of how these “regular” people could be addicted.
The Media Maintains the Addiction Stigma
It’s well known from research studies that the social stigma of addiction is a huge problem in trying to get help to those suffering from substance use disorders. Among other things, the stigma is a barrier to asking for help.
The stigma is so powerful that many medical professionals, who are taught that addiction is a medical condition, fall victim to it. Even Terry Lake, who was in charge of the BC Ministry of Health during the initial fentanyl crisis, inadvertently stigmatized addiction. When he went to the nation’s capital to lobby the federal government for more help, he emphasized that fentanyl is an especially pernicious drug because even non-addicted people were dying of overdoses.
He told reporters, “I don’t want to sound alarmist, but these are everyday people that are dying because of fentanyl …. They’re not what we would consider criminals, they’re high-functioning regular people in many cases, and they’re dying.” If we follow Lake’s logic, then those who are addicted are criminals, low-functioning, and not like us. In fairness to Lake, this comment was unusual for him, but it shows how easy it is even for a provincial minister of health to slip into the stigma.
Unproductive Debates on Addiction in the Media
The constant reporting on the opioid crisis has sparked debates that are not helpful to either understanding addiction or dealing with it.
We keep reading about “abstinence” versus “harm reduction” as the goal of treatment. This distinction is particularly scientific. It arose when the principles of harm reduction were introduced into Canada and the United States from Europe in the 1980s. North Americans had typically defined addiction as chronic drug use and recovery as abstinence from mood-altering drugs. This approach was trumpeted in 12-step programs and by many older addiction doctors.
The new harm reduction approach was far different. For example, research indicated that methadone—an opioid drug prescribed to help those addicted to opioids—was valuable. Abstinence experts disagreed. How could prescribing an opioid drug be a solution for someone whose very problem was using opioids? But harm reduction made sense of the problem differently. One of its key features is that abstinence is not the defining feature of recovery. In fact, abstinence, say many harm reductionists, evolved from an ideology (a prohibitionist ideology), not science.
With the introduction of medications in treatment, the term abstinence has become so muddied that it’s almost meaningless. Say a psychiatrist, assessing a client in treatment for cocaine, discovers that the client is also clinically depressed. He prescribes an anti-depressant. Is the client abstinent from mood-altering substances?
Scientific research has shown the value of prescribing psychotropic medications. If an addiction therapist fully embraces abstinence for all mood-altering drugs, including medications, is this sound practice in healthcare? Professionals are taught to base treatment on scientific research, not personal ideology.