By Carl Mueller
Under Massachusetts law, all ailments – whether physical or mental – are created equal. So they should be treated alike. But the law and reality are quite different when it comes to addiction. Experts agreed the road to recovery requires a level of individual attention and therapy that is often lacking. The problem lies in accessibility of care and patient transition to each stage of treatment. Recovering addicts get lost in the system.
Marisa Hebble, director of the Franklin County Opioid Task Force, said even a broken bone gets more attention than an overdose. “If I walk into the emergency room with a broken hip, the hospital will hold on to me for two, three days while they find me a rehab. They’ll do the calling. They’ll help me figure out the insurance. They’ll find the bed in an appropriate place,” Hebble said.
“But if I walk into the emergency department and say I need detox from opioid addiction, the hospital is not going to hold me for more than a few hours,” she explained. “If the hospital would keep me medically stable, help me find a bed, help me figure out my insurance just as if I broke my hip… that’s one of the ways parity laws are not working the right way in Massachusetts.”
Dr. Monica Bharel, commissioner of the Massachusetts Department of Public Health, said the first step in addressing the lack of parity begins at changing the stigma associated with those suffering from an addiction. “Think of friends or family members you have. If somebody has a cancer, people all talk about it, they come together: ‘Oh, she has breast cancer. Oh, he has prostate cancer. Let me bring him meals. Let me bring him to rehab, radiation.’ A whole support group often will come around that person,” Bharel said.
In contrast, Bharel said society often turns a blind eye to mental illness and addiction. “When I think about people I know in the community, friends, family who suffer from two things, any mental illness, depression psychosis, schizophrenia or are struggling with an addiction, people don’t talk about it.”
Matt Ganem, outreach coordinator at Wicked Sober, a free consultation service for those suffering from addiction, said this stigma not only affects the way in which society views addiction, it directly affects the quality of treatment and lessens the level of urgency the epidemic demands.
Ganem recalled when a close friend overdosed after two years of sobriety. Drooling from the corners of his mouth and a burn wound on his arm from an attempt by his cousin to wake him, the last thing he wanted to do was go in front of a doctor. He was ashamed. In the emergency room, the doctor kept his distance, “Because they don’t want to touch him. They don’t want to do anything with him because he’s like a leper. And even when you go into the emergency room they stick you in the corner away from everybody else because they don’t want to deal with you,” Ganem said. “You’re just a scumbag junkie in their eyes. And it’s really a shame.”
Addicts’ dread of such degradation may prevent them from seeking help. In fact, Ganem said, exposure to such treatment can create a sense of shame that can only be reduced by using again.
The solution, he said, requires we treat addition like the disease it is; a disease that requires years of recovery treatment.
Addiction: A disease
Drug addiction relapses occur at a rate of 40-60 percent; similar to the relapse rate for those suffering from other chronic illnesses, according to the National Institute of Health. In fact, withdrawal recovery techniques to treat symptoms of chronic illnesses — nausea, difficulty breathing, hallucinations, depression — are often successful for addiction recovery. Yet, despite these similarities, addiction is often looked upon differently.
Dr. Alejandro Mendoza, an addiction psychiatrist at Beth Israel Deaconess Hospital of Plymouth, said that although addicts deliberately decide to try opiates in the first place, they usually do so in their early, developmental years; years that often include neglect and abuse.
Substance abusers also often share a family history of addiction. Addiction has been scientifically proven to have an inherited component with many genes playing a role. For example, scientists have found that the A1 allele of the dopamine receptor gene DRD2 is more common in people addicted to alcohol, according to the University of Utah Genetic Science Learning Center.
Chris Shine, 31, of Haverhill, is a recovering heroin addict. And although he takes responsibility for trying in the first place, he feels his genetics predisposed him to an addictive personality.
“You can call addiction what you want, but the best word for it is a disease. Some people say ‘you had that first choice, you could have made the choice not to do it.’ In my eyes this can be due to a lot of different factors, genetics. My father suffered from alcoholism, my grandfather, my other grandfather, my grandmother all died from the disease of alcoholism. I had it in my body before I even knew it,” Shine said.
According Bharel, the state public health commissioner, the first step in removing unequal treatment for substance abusers is to see addiction as a disease. As of now, enough negative stigma exists to contribute to a lack of effective treatment.
Mendoza believes that in order to treat addiction effectively, a cohesive, collaborative effort between primary care physicians, psychiatrists and peers must exist. Today, the problem begins with a fragmentation of treatment options, which results from inadequate attention to mental health and addiction issues. “Things have changed dramatically in the delivery of health care… especially in mental health,” he said. “But we still don’t have parity in terms of mental health. What’s happened is that mental health has been chopped off from basic health care,” Mendoza said.
Outside providers or agencies — Mendoza calls them “carve outs” — are responsible for the delivery of mental health care. “These ‘carve outs’ attempt to save money by providing less care. It’s crude, but it’s actually what’s happening,” he said.
Changing the stigma
The first step in reaching parity for substance addiction treatment is addressing the stigma. This begins at prevention, Bharel said.
“I think all of us in society have a stereotype of what a quote, unquote addicted person looks like and the stigma related to it. To me, prevention is about how this can affect any one of us and how do we understand it before it happens,” she said.
Currently, the state has developed programs like the Massachusetts Opioid Abuse Prevention Collaborative (MOAPC) Grant, Massachusetts Technical Assistance Partnership for Prevention (MassTAPP), and the Prescription Monitoring Program. The Bureau of Substance Abuse has also developed educational materials as part of the response by former Gov. Deval Patrick’s Opioid Working Group.
The 2015 Opioid Task Force is set to provide their prevention recommendations by late May.
Furthermore, laws are being developed to prevent the stigma of addiction from getting in the way of getting help. For example, the Good Samaritan Law allows an individual to call 911 for overdose help without the risk of prosecution.
Yet, to fully combat stigma and promote prevention, Dr. Mendoza said preventative programs or handouts aren’t necessarily going to help. “This battle has to start at home, in grade school. Do something with your kids. Have dinner with them every single night. Have those candid conversations, those difficult conversations,”Mendoza said. “Make sure you understand that they will be angry. Make sure you understand they will not thank you for another 10-15 years. Be a parent.”