A Softer View of Drug Addiction

by Michael Nguyen, PharmD, CPh
Director of Clinical Pharmacy

In a first report of its kind, the Office of the Surgeon General is providing a framework for addressing America’s crippling alcohol and drug addiction problem. The 428-page report, Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health, contains a chapter on neurobiology, which compares alcohol and substance addiction to other chronic diseases such as diabetes, asthma, and hypertension. The comparison is made to drive a change in the public’s thinking about addiction, a “cultural shift” as it was stated.

The Cultural Shift: Viewing Addiction as a Disease

Much in the same way that we do not blame people for having other chronic diseases, the Surgeon General asks that we not blame addicts for their addiction. The chapter explains that misuse of alcohol and other substances causes neuroadaptations to occur in the brain that compromise its function and drive the addiction forward. Addicts are not in control of their addiction once the brain’s structure and function has been compromised. This message is important because many people view addiction as a character flaw. To say that you have pain when you don’t or you can’t work when you can or that you need a medication when you don’t is viewed as morally wrong. Looking at addiction as a disease removes the stigma from addiction and allows us to see that an addict is no more able to control his cravings and subsequent behavior than a person with hypertension is able to simply will his blood pressure to go down.

In exercising this cultural shift, it is important to consider that the path to addiction treatment begins with one honest admission: The addict admitting to his addiction. This is the challenge that we deal with in our patient population. As long as the addict steadfastly holds on to the claim that his pain is real, and the medications are necessary, in many ways we are compelled to fund the addiction. The person with the most impact in this situation is the prescriber.

Prescribers Play a Key Role in Preventing Addiction

Much like with any other chronic disease, there is a two pronged medical approach: Prevention and treatment. The underlying message in this report is that people are more vulnerable to becoming addicts than we may think. Our hope is that prescribers will absorb this message and prescribe judiciously. To this regard, the report does recommend that prescribers use the CDC Guideline for Prescribing Opioids for Chronic Pain to reduce opioid misuse, but we believe that the prescriber’s role in prevention deserves more dedicated attention.

It is no secret that the road to drug abuse and addiction often originates from a legal–although inappropriate-prescription. Regardless of the fact that many physicians were misled by Big Pharma and others regarding the true addictive nature of opioids, we believe that these inappropriate prescribing practices are the root of the problem. No amount of drug abuse education in the world can prevent a doctor from giving oxycodone to a patient with a relatively minor affliction. Therefore, for these reasons, we as a society need to follow a similar path as that chartered by the Surgeon General with regard to addiction and call for a cultural shift in the treatment of pain to really drill down to the essence of prevention: Don’t start in the first place.