Addressing America’s addiction crisis requires an evidence-based public health response, not discrimination and alienation of people with substance use disorders (SUD).
“Whether it is the rapid rise of prescription opioid addiction or the longstanding challenge of alcohol dependence, substance misuse, and substance use disorders can—and do—prevent people from living healthy and productive lives. And, just as importantly, they have profound effects on families, friends, and entire communities,” wrote former Surgeon General Vivek Murthy in his groundbreaking report on addiction in America.
Because addiction is a disease, Murthy recommends a public health approach that is firmly grounded in the best available science. “Recognizing that we all have a role to play, the Report contains suggested actions that are intended for parents, families, educators, health care professionals, public policymakers, researchers, and all community members.”
However, many of the stakeholders who play essential parts in supporting recovery, don’t understand how the disease of addiction works. “They may mistakenly think that those who use drugs lack moral principles or willpower and that they could stop their drug use simply by choosing to,” explains the National Institute on Drug Abuse (NIDA). The reality is different: drug addiction is a complex disease, often driven by co-occurring mental health conditions and sustaining recovery takes more than good intentions and willpower.
Unfortunately, stigma based on misconceptions about addiction continues to affect people even when they are living in recovery.
In a recent study, researchers from the Harvard Medical School (HMS) and Recovery Research Institute and Center for Addiction Medicine at Massachusetts General Hospital (MGH) found that many adults in recovery from substance use disorder still experienced “micro” and “macro” forms of discrimination as they navigate their life in recovery. Micro types of discrimination include personal slights, while macro discrimination refers to the violation of personal rights.
Discrimination Creates Recovery Barriers
Skepticism, low expectations, and discrimination against people in recovery make it more difficult for them to access important resources and opportunities that help to sustain recovery. “…greater micro and macro discrimination were associated with higher psychological distress,” the authors of the study found—stress has been identified as an important relapse trigger. Almost half of the study participants reported that other people assumed they would relapse, 18.5 percent said unfair treatment by the police, and more than 16 percent could not get a job.
“These findings have social and policy implications,” says lead author Corrie Vilsaint, a research fellow at MGH. “It is tough enough struggling with the physical and psychological demands of recovery without having to contend with the kinds of discrimination reported fairly frequently here. Some of these residual tolls that you see in these people’s lives from past drug history or past criminal history related to their drug use can block them from seeking addiction recovery, block them from seeking treatment and block them from disclosing that they need help.”
All of which will only perpetuate the problem instead of helping people get better. The study revealed that discrimination has a discernible impact on the quality of life and recovery capital of SUD patients—recovery capital they urgently need.
People living in recovery need support from family, friends, and the community; they need access to stable employment and sober living; they need job training and social integration. Access to these recovery resources is as important as medical care and psychotherapy. The Substance Abuse and Mental Health Administration’s stated four dimensions of recovery — health, home, community, and purpose — highlight the importance of extra-therapeutic recovery supports.
To provide this kind of comprehensive approach to treating addiction and its underlying conditions, NUWAY introduced its Recovery In Supportive Environments (R.I.S.E.) model in 2013. This modern approach helps clients access a full continuum of care, including evidence-based addiction and mental health treatment, high-quality recovery housing, peer support services, and easier access to other community recovery resources.
Many NUWAY clients assessed for admission to intensive-outpatient are vulnerable in several clinical categories including environment security (i.e. housing) and low recovery capital (ASAM – Dimension 6). A lack of safe, secure, and supportive housing or stressful living arrangements do not readily support long-term recovery. Being able to go to the stable environment of a well-run recovery residence following initial addiction treatment significantly increases the chances of sustained recovery from addiction.
NUWAY, one of Minnesota’s largest nonprofit addiction treatment providers, regularly encounters dated thinking, stereotypes, and stigmas about the disease of addiction and people suffering its effects. “Although 20 million Americans suffer from substance use disorder and the opioid epidemic has raised awareness of addiction, many people are still unaware that addiction is a disease and not the result of poor choices,” says Monique Bourgeois, NUWAY Chief Community Relations Officer. “Even family members, friends, and colleagues of people who suffer from addiction can hold outdated and damaging ideas about what causes addiction. These antiquated notions make it hard for people to get the help and resources they need, and that can lead to higher rates of relapse.”
NUWAY is taking action to help its clients, and the recovery community overcome cultural barriers. One example is NUWAY’s practice of partnering with recovery housing that meets high-quality standards. Owners and operators of recovery housing are improving properties, increasing supervision, connecting residents to community resources, and providing peer support services. “Working closely with recovery housing providers is making a real difference for our clients and our communities. Additionally, the utilization of trained peer support specialists as a bridge to these housing partners is helping people stay in recovery and get the services they need,” says Kenneth Roberts, NUWAY Chief Clinical Officer. As NUWAY expands, recovery housing providers respond. This year, the program opened outpatient counseling centers in Rochester and Duluth. NUWAY is connecting with recovery residences in these cities to ensure a supply of safe, secure housing its clients need.
NUWAY also works to raise awareness and reduce the stigma of addiction and mental illness through sponsorships and community relations. “The more people become aware of the prevalence of addiction, the fact that it is a treatable brain disease, and what it takes to effectively sustain recovery, the less afraid we will become and, perhaps, the more welcoming of people who need our support and help,” says Bourgeois.