Over the past 20 years, our use of the word ”addict” has changed dramatically. Whereas it was once a term reserved for people prostrate in the gutter, now we all claim to be addicted to something – iPhones, MasterChef, pilates, Twitter – even lemon myrtle hand sanitiser.
And yet we are still careful to distinguish between our ”addictions” and real addicts. After all, we news junkies and caffeine fiends are not the same as those people hanging out for their next snort of cocaine or ice. We haven’t deliberately destroyed our lives chasing the next hit. We might be addicted but we are not real addicts.
”Nice People Take Drugs” was the central message in a 2009 advertising campaign in London aimed at challenging popular attitudes towards drug users. But these four simple words that appeared in big red letters on the side of London buses were quickly removed. It was considered that the public wasn’t ready for such a suggestion. Our view of addicts as villains, as criminals, as deviants, as representative of the dark side of human nature is deeply ingrained. Some philosophers have even suggested that we need deviants for civilisation to function – because they mark the boundaries between the civilised and the uncivilised. And yet, how real is that division?
”I believe that we are all potentially addicts,” says Professor Michael Farrell, director of the National Drug and Alcohol Research Centre, who has more than 30 years of experience in addiction medicine. ”The idea that addicts are a little group of people over there that are fundamentally different from us is wrong.”
Despite its wrongness, that idea has driven drug and alcohol policies, drug laws, and the funding of drug treatment services for decades. The idea that addicts are fundamentally different – deeply other – has resulted in a nihilism that is exemplified in a common two-sided attitude: a) drug treatment doesn’t work and b) addicts are not worth it.
Only those of us who have been close to somebody with addiction can really know what it feels like to turn up at an emergency department and find that our loved one, after hours of waiting, has been left last in the queue or even told to stop wasting precious ED space and leave. In my experience, the desperately ill drug-user was directed to the drug and alcohol unit across the road where she was told to call a number in order to get on a waiting list for a public detox unit. Despite repeated calls, the number never answered. The thousands of people seeking treatment far outnumber the beds available. This is the concrete outcome of the popular attitude that drug addicts aren’t worthy of attention and that medical professionals have better things to do. ”I didn’t come into psychiatry to deal with these sort of people,” commented one psychiatrist.
But after an extraordinary year when we have become accustomed to making health decisions based on science and evidence rather than assumptions or popular misconceptions, maybe it’s time to look more rationally at how the treatment of addiction actually operates.
The evidence shows that a third of the people with alcohol and other drugs (AOD) problems who have contact with the treatment system will get better. The other two-thirds won’t, largely because of what the rehabs call ”lack of compliance”. Perhaps a third doesn’t sound like a huge success but if you compare that with diabetes, blood pressure problems and asthma – where at least half of the people don’t comply with treatment – it’s pretty good. And just because half of the people suffering from diabetes, high blood pressure and asthma don’t follow doctor’s orders, doesn’t mean we automatically consider that a reason not to treat those conditions.
The other reason for the nihilism around drug treatment is the belief that addicts aren’t worthy of medical investment because their condition is ”self-inflicted”. This ignores the fact that other life-threatening conditions such as obesity and heart disease are also largely ”self- inflicted” through bad habits such as over-eating and lack of exercise. This is the very reason why they are called ”lifestyle” diseases.
On considering the problem further, it becomes clear that our confused attitude towards addiction and addiction medicine is actually a philosophical one. The Judeo-Christian world view is deeply committed to the concept of free will, a concept usually left for discussion among professional philosophers. Free will means that we are all responsible for our actions. If individuals over-eat or fail to exercise or indulge in illegal drugs, it is because they have chosen to do so. And yet social science teaches us that individual choices can be nudged, manipulated, coerced, press-ganged, peer-group pressured and modified by million-dollar government advertising campaigns – in essence, that individual choices are often not, in the end, as individual as we would like to believe. Can we really afford to stick to our stubborn ideas around free will in the face of the suffering that addiction causes, not only to the addict, but to their spouses, brothers, sisters and children?
”When we do the calculations – referred to as the Global Burden of Disease – where we calculate the contribution AOD addiction makes to overall ill-health, we find that it accounts for 15 per cent of all disease,” says Professor Farrell. ”The first thing that society has to grasp is that money spent on dealing with these problems is money well spent. If we spent 10 per cent of what we spend on cancer and cardiovascular disease, we would revolutionise the outcomes for addicts and their families.”
Over the past 20 years, our attitude towards the mentally ill has changed dramatically due to a combination of public health initiatives and brave individuals ”coming out” and telling their stories. And yet our enlightened approach towards mental illness is not mirrored by our approach towards addiction. Research shows that approximately 50 per cent of people suffering from addiction are also suffering from a mental illness. Nobody knows which came first and maybe that isn’t the point. Both are treatable conditions and both deserve to be treated.
Gabrielle Carey is a non-fiction writer. Her most recent book is Only Happiness Here (UQP).
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