Dilemmas of a broken substance abuse system

With rising health care expenses, we are all trying to solve the paradoxical dilemma of finding ways to develop better, more comprehensive health care systems at an affordable cost. To be successful, we need to tackle one of the most expensive health problems we face, alcohol and drug abuse, which costs us approximately $428 billion annually. Comparatively, the expenses of health care services, medications, and lost productivity for heart disease costs $316 billion per year. In addition to economic costs, none of us are spared the ravages of this disease, due to addictions among our friends, family, workers or co-workers. Addictions are the most prevalent mental health disorders, afflicting about 8-9% of the US population. Yet the vast majority—an estimated 90% of those with a substance use disorder—do not receive any formal treatment services. In addition, the majority of those 10% who do receive formal services for substance abuse have been treated previously, and therefore, even those who do get treated for their addiction often do not attain recovery. Something has to change, as our current substance abuse health care system is both expensive and ineffective.

The fact is that millions of Americans are not receiving help for their substance use problems, nor are the current treatment programs consistently producing long term successes. We as a nation need to overcome our denial of our country’s high levels of problematic alcohol and drug use. Simplistic solutions of just saying “no” have been unsuccessful and unwittingly wrecked havoc on our citizens. Rather, we endorse a comprehensive campaign to highlight the extent of our nations’ addiction to mind altering substances, a movement to develop norms that increase an awareness when self-management of occasional use fails, an undertaking to overcome barriers in seeking the help that is needed, and critical efforts to increase the effectiveness of treatment and after-care programs.

Bold new initiatives will be needed to solve these problems on a more systemic and sustainable basis, and below are a few of our thoughts for change.

Aligned with more universal efforts of facilitating self-awareness of problem behaviors, efforts should be made to identify and reduce risks with settings that promote use. This especially includes settings that perpetuate self-defeating and destructive influences on our youth and young adults, for example, college freshman binge drinking.

As a universal prevention effort, all citizens can be responsible for helping those at risk for substance use disorders. The majority of people who use legal substances like alcohol and prescription drugs do so without endangering their health or that of their family members and friends. Early prevention efforts should focus on the trajectory of problematic use and building awareness for self-screening and use management. For some individuals, however, self-management fails, and their alcohol and drug use can become harmful. Collectively, we should promote acting early to prevent addictions, and begin a dialogue with loved ones when such patterns are observed. Family members, friends, and work associates must recognize and change often unconscious subtle actions that unwittingly promote and enable harmful use of substances by their loved ones. Rather than condoning or even encouraging reckless drinking or drugging, and waiting until problems are more entrenched and less resistant to change, loved ones have a responsibility to take action (e.g., changing social activities from bar hopping to art gallery hopping) before a more formal treatment is necessary. Other activities might involve attending self-help groups, making referrals, and searching for appropriate resources in a proactive way.

We all have a role in abolishing barriers for someone seeking help and this includes reducing the stigma of substance use disorder. Taking the first recovery step is emotionally difficult for those troubled with addictions. Often, those who have recognized the need to refrain from patterns of damaging addictive behaviors all too frequently have encountered insurmountable obstacles to obtaining help, such as risk to employment, lack of resources, needs of dependents, etc. We should be promoting personal change rather than erecting barriers, like stigma, against it. Like promoting help-seeking, all of us can help re-integrate those with addictions back into our communities. Rather than stigmatizing those coming out of the criminal justice system or addiction treatment programs, we need to welcome them back into our society following treatment, with needed housing, jobs, supports, and resources.

To achieve lower total costs and greater effectiveness, we as a society are responsible for ensuring adequate funding that provides appropriate and timely access to a choice of addiction treatments. Today, treatment completion rates hover around 50%. By providing high quality treatment programs that are adequately staffed, we also support treatment completion, which is critical for long term successful outcomes. Ultimately, this might involve social actions at the local levels, including legislative and government efforts (e.g., Substance Abuse & Mental Health Services Administration) to provide needed resources across a spectrum of relevant care.

The recent presidential campaign and the media have graphically illustrated the epidemic problem of opiate deaths and more broadly, the Surgeon General’s report of addiction highlight the need for more attention and resources to solve this problem. What is now needed is more than good intentions, but rather a new agenda, a new way of thinking about systems that involve us all as responsible agents for setting the stage that leads our loved ones to healthy and addiction-free choices. We need to sponsor incubators of innovation, just as in the business world, to imaginatively and creatively find safer options and new ways of identifying those who are at risk and ultimately, treating and providing them the treatment and environmental supports to overcome their addictions.

Featured image credit: Medical Drugs for Pharmacy by epSos.de. CC0 Public Domain via Wikimedia Commons.