How the Perception of Addiction Affects Treatment and Recovery
PERCEPTION OF ADDICTION AND ITS Jana MacKercher Scaife FellowshipEFFECTS ON TREATMENT July 2012 AND RECOVERY
DISEASE AND TREATMENT To create and implement effective treatments, the course of a disease and its effects are studied and analyzed Most importantly, it is necessary that people, especially physicians, understand the intricacies of each disease But what happens to treatment efficacy when society does not view the disease as organic but a condition of personal choice?
People’s understanding of addiction is a function of its context and is a “cultural means of distinguishing people who perform an undesirable behavior from others who do not” Heim et al. 2001 Instead of viewing drug addiction as a medical condition, or a disease, society tends to associate addicts with moral weakness.
ADDICTION ACCORDING TO SOCIETY “Addiction as a Functional Representation” Heim et al. 2001 144 college students participated Given images and descriptions of actors (males and females) Each actor depicted as a member of the middle class (a) and a ‘junkie’ (b) in different scenarios
ADDICTION ACCORDING TO SOCIETY “Addiction as a Functional Representation” Heim et al. 2001 Results: Heroin was perceived to be more addictive for those in the ‘junkie’ condition, whereas cocaine was more addictive for the middle class ‘Junkies” were perceived to be more likely to use drugs than the middle class Middle class drug use was believed to be less problematic in nature This shows that people tend to apply their own biases towards addiction Perception of addiction is a “function of social conditions, personal circumstances and type of substance” Heim et al., 2001
ADDICTION ACCORDING TO SOCIETY “The Public Stigma of Mental Illness and Drug Addiction” Corrigan et al. 2009 Public stigma: “impact that members of the general population have when they endorse negative stereotypes” Randomized phone interviews, representative of American English- speaking adults Given a scenario about a person with either a mental, substance dependent, or physical disability Asked questions regarding his perception of the disabled person in terms of Responsibility for their condition Role of the community in helping them And level of dangerousness
ADDICTION ACCORDING TO SOCIETY “The Public Stigma of Mental Illness and Drug Addiction” Corrigan et al. 2009 Results: Disabled persons described as having a drug addiction were perceived to be more responsible for their health condition than those with a physical illness that required a wheelchair Participants were also less likely to be willing to offer help to the drug addicted person Psychiatric conditions were categorized as more dangerous, more likely to evoke fear, and more likely to be avoided Overall, participants reported that they tend to view mental illness more negatively than physical disabilities
ADDICTION AS A CHRONIC DISEASE Many clinicians trained in addiction and those in recovery believe it is a chronic disease that involves biomedical and psychosocial symptoms These people who subscribe to the “disease model” often compare addiction to other diseases that are more readily accepted and understood as chronic by the public Relapse is often a common part of addiction recovery but usually makes it more difficult to secure long-term funding that will support a lifetime of treatment This, however, is not typically the case when considering chronic illnesses deemed to be of a more biomedical origin in terms of life-long coverage of hospitalizations, doctor visits, medications as well as support from loved ones
ADDICTION VS OTHER CHRONIC DISEASES “Drug dependence: A Chronic Medical Illness” McLellan et al. 2000 Substance Abuse Abstinence in substance abuse patients, 1 year post-discharge 40-60% Additional 15-30% do not resume dependent use Other chronic diseases Full adherence to prescribed treatment plans Type 1 diabetes <60% Hypertension or asthma <40% Rates are even lower when patients asked to make behavioral changes Recurrence of symptoms requiring additional medical care Type 1 diabetes 30-50% Hypertension or asthma 50-70%
ADDICTION VS OTHER CHRONIC DISEASES Despite the fact that relapse rates for addicts are comparable to that of other chronic diseases, most private insurance “only covers detox or acute stabilization with no continuing care” (McLellan et al., 2009, p. 1693).
PHYSICIAN PERCEPTION OF ADDICTION “Physician Beliefs About Substance Misuse and Its Treatment: Findings from a U.S. Survey of Primary Care Practitioners” Johnson et al. 2005 648 primary care doctors (internal medicine, general practice, family practice, obstetrics-gynecology, and pediatrics) Survey on views towards various diseases, including addiction Results: Following percentages represent physicians who felt “very prepared” to identify each disease Hypertension (82.8%) Diabetes (82.3%) Depression (44.1%) Substance Abuse disorders (less than 33%)
PHYSICIAN PERCEPTION OF ADDICTION “Physician Beliefs About Substance Misuse and Its Treatment: Findings from a U.S. Survey of Primary Care Practitioners” Johnson et al. 2005 Results: Perceived treatment effectiveness for each disease “Very effective” Hypertension 85.7% Diabetes 69.0% “Not very effective/not effective at all” Illegal drug 62.7% Alcohol abuse 48.7%
PHYSICIAN PERCEPTION OF ADDICTION “Physician Beliefs About Substance Misuse and Its Treatment: Findings from a U.S. Survey of Primary Care Practitioners” Johnson et al. 2005 Perceived difficulty in discussing substance abuse > 1/3 felt uncomfortable talking about alcohol and prescription drug abuse with their patients “Very difficult” 40.7% “Somewhat difficult” 46.6% But only 17.9% felt uncomfortable with depression Both are sensitive subjects!
CONCLUSION Easy to see why millions of Americans face discrimination when it comes to addiction. Society believes if someone makes the initial choice to use a drug and becomes addicted, they are responsible for the negative outcomes resulting from this act. Like people suffering from chronic illnesses, addicts have the right to be regarded as patients with a disease that deserve treatment in a setting of respect, understanding, and hope. Above all else, physicians need to receive more training in addiction medicine so that they may help recognize the addicts that come into their office on a regular basis 5.7% of substance abuse treatment admissions are made by health professionals 44.3% are made by the criminal justice system “Addiction Medicine: Closing the Gap between Science and Practice” CASA, 2012