“Be careful judging that addict so harshly. They may just recover and be the one who can show your very own child a way out one day.”
–Anonymous
Imagine you are in grad school studying for your doctorate in clinical pharmacy. You walk into the main lecture hall for the very first lecture on the pharmacotherapy (prescription treatment) for mental illness. This lecture is on schizophrenia, the beginning of your psychiatry series, which also includes depression, bipolar disease, anxiety, and insomnia. Take note – it unfortunately does not include addiction.
Blasting loudly enough to get your attention, you hear Linkin Park’s “Papercut.” The big screen at the front of the room is playing the video containing the lyrics. Your teacher waits till the video is over so all the words can be read: “It’s like I’m paranoid lookin’ over my back, it’s like a whirlwind inside of my head, it’s like I can’t stop what I’m hearing within, it’s like the face inside is right beneath my skin.”
She turns off the music and transitions to the first slide containing a picture of a painting and the words, “Do not ask why people are crazy, ask why they are not.” Holding a prize made of chocolate, the teacher speaks her first words, “Deliciousness and 3 free points on your next exam if you know the author of this quote.”
I was the teacher, and that is how I began my student’s introduction to the world of mental illness. I chose to start with a quote by my favorite artist, Salvador Dali, for two reasons. One was to highlight the pervasiveness of not just mental illness but the chronic stress of modern day living that almost everyone experiences. “If a person isn’t living a healthy happy life, they have a reason to talk to someone.” – Dr. D
The second was to begin a conversation about the stigma of mental illness. “Crazy” is not a word to use. It is a pejorative, non-medical term that only perpetuates the misunderstanding of these psychiatric conditions. The medical term would be psychotic, which requires specific features for diagnosis, such as delusions and hallucinations.
“Strength. Willpower. Intelligence.” These have nothing to do with mental illness, most especially addiction. Mental illness is a disease, end of story, no different than cancer, heart disease, and so forth. To quote one of my favorite comedians, Mitch Hedberg, “Dammit Lewis, you have Lupus. Dammit Lewis, you’re an alcoholic. One of these does not sound right.” Neither should be an acceptable label.
Although mental illnesses such as depression, anxiety and insomnia are some of the most common conditions in today’s modern world, I want to finish this article by focusing specifically on addiction. Addiction is a disease, and the basic disease process is the same, whether the addiction is to alcohol, drugs, nicotine, food, social media, gaming or sex, to name just a few. Given the current opioid epidemic and my personal history with alcohol, I focus on these two types of addiction. Just know that the recovery information offered on this site can be applicable to anyone suffering from this disease – no matter the drug of choice.
Drug overdose is the leading cause of accidental death in the United States. In 2015, there were more than 33,000 opioid overdose deaths, with almost half involving prescription opioids. In 2014, almost 2 million Americans abused or were dependent on prescription opioids. With respect to new heroin users, 75% started by misusing legal prescription opioids. This is sadly unsurprising considering 10% of the U.S. population is prescribed controlled substance pain relievers in any one quarter, according to 2013 data from the RADARS systems. To further put this crisis into perspective, a heartbeat is lost due to opioid overdose every 8 minutes. In 2016 alone, more fatal overdoses occurred than there were deaths in the Vietnam War.
According to the 2017 National Survey on Drug Use and Health (NSDUH), more than 14 million adults 18 and older had alcohol use disorder (AUD). AUD is defined as a chronic relapsing brain disease characterized by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences, and can range from mild to severe. Within the definition, it is noted that recovery is possible regardless of disease severity. I will talk more in future articles about how we should be looking at the definition of “consequences” with respect to AUD. To decrease stigma, it must be understood that addiction is an equal opportunity destroyer. It crosses all boundaries of socioeconomic status, all walks of life, and is not limited to the classic alcoholic stereotype of the homeless person who lost everything and is drinking themselves to death.
Despite the prevalence of AUD, only 6.5% received treatment in the past year. In youths aged 12-17, 443,000 had AUD, with only 5.2% receiving treatment. Roughly 88,000 people die from alcohol-related causes each year, rendering alcohol the third leading preventable cause of death in the United States after tobacco and poor diet/physical inactivity.
Even if someone doesn’t have AUD, there is the danger of binge drinking, which is defined by drinking patterns that bring the blood alcohol concentration levels to 0.08 or more. This typically occurs after 4 and 5 drinks for women and men, respectively. According the the 2017 NSDUH survey over 50% of college students reported binge drinking in the past month alone. Whether it is binge drinking or full blown AUD, the health consequences are grave, including liver disease such as cirrhosis, the need for liver transplant, cancers such as mouth, esophagus, pharynx, liver, and breast, and of course… death.
If YOU are not directly struggling with mental illness, specifically addiction, then you know someone who is. Mental illness is another Me Too movement, and we need to work together to help those suffering to heal. Hopefully by sharing my experience, strength and hope, the community at DrDWellnessAddict.com can increase awareness, dispel the myths, and improve knowledge of and access to treatment for one of the biggest unmet needs of our time.
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