If you had a magic wand what is one myth or misconception about addiction treatment that you would make disappear? >> I think I said mine already moral- >> Say it again. >> Failing that it would be considered that someone has no willpower or that it's a moral failing. >> What I'd like to see disappears recovery. You recover from acute problem, you recover from the flu, you recover from a broken wrist. You can even recover from a bruise nose, but you don't recover from chronic diseases, you manage them. And if you're lucky and you have good care attentive care, you can be in remission. But recovery implies that somehow the problem and the biological changes that occur that underlie the problem have disappeared. And for many people they don't and they never will, I think one of the things that distinguishes substance use disorders from other chronic diseases. Is that it's a chronic disease that appears in adolescence or early adulthood, but can with time disappear. That some people just aged out of their substance use problems without medical intervention even. That doesn't happen all that often with things like type II diabetes or hypertension. So, A chronic disease recovery is a terrible word to describe how to approach a chronic disease. But that doesn't mean that people can't recover, they can but while they're in the throes of that disease to think about recovery as an immediate objective. Really puts a huge onus on the patient or on the individual to succeed and when he fails as is often the case in a relapsing chronic disease. They then a shoe further care, and put themselves at risk of all sorts of things like opioid overdoses, or liver disease. Or any number of things that are the sequelae of an untreated substance use disorder >> Robert I like that, I think that's knew we might use the term recovery in this course, and so I think you've given us something to think about there. And when we do think about chronic diseases, you're right we think about remission. And maybe that's a much better term when we think about people who no longer have signs of active substance use disorder they're in remission, rather than recovery. >> I think the ICD-10 actually look at grades people as opioid use disorder, mild moderate severe in remission in controlled environments etc, so they may be ahead of us, believe it or not. >> Thank you for. Other myths? >> That it's easy to stop like why don't they just stop? Like they're causing themselves, what we perceive as harm, they're not showing up to their job, they get abscesses from injection, why you don't they just stop? I think that's a myth that's just so easy, because I don't have an addiction so I can look at someone else and say why don't you just stop? It's just causing so much pain in your life or failings in relationships or other things. >> And it's a lack of acknowledgement that the disease itself is a loss of control. >> Right. >> Or inability to stop or cut down or control use. >> Right. >> But a magic wand I think I would in addition to the things I've heard already. I would kind of get rid of the exclusively individual focus we have about thi, and the problem is always within their corpus the body of this individual person. And we take it out of the wider social political and, Policy context that so deeply affects who ends up having these kinds of problems. There have been a number of different studies that have shown that people have in from disenfranchised backgrounds are more likely for various reasons to to need the dopamine reinforcement that happens within many of the substance use disorder. And they're more susceptible to that, there's all these other things which when we only focus on it in our very clinical perspective to help this individual person. We ignore that other stuff that contributes to it greatly. >> It also kind of takes the burden off the healthcare system. It's the problem of the person and then we don't have to take a look at our own our own contribution or as a society. >> Yeah. >> All of a sudden. >> But these aren't even things that the health care system can necessarily mitigate. And so the question is what is our role as in various parts of the healthcare system not just to advocate for better patient care, but to advocate for better structural things poverty elimination? Earlier attention to, Social inequalities that that create within certain people the preconditions that contribute to when they experiment with drugs in adolescence or early adulthood? They're the ones that develop a problems whereas many of us who may have used drugs at an earlier stage of their lives, have never developed those problems. >> Housing first is one of the things that have shown that for homeless persons who are at risk for substance use, providing housing first. Is a more effective model than trying to help them with their substance use, and then help them find housing. That if you have instable housing you're much more likely to have difficulty getting over your substances than you are if you provide that first, very social thing. >> So work on housing or work on the constructs around the person. >> Yeah. >> So for me, it kind of I think relates to everything that y'all is said, these are wonderful myths. I think there's an idea that people don't get better or that treatment doesn't work for me if I've tried it once and it failed. Or, I know that I could teach it and so therefore it's not going to work for me, and I think that probably my myth would just be some optimism. Around the fact that treatment can work, and just like a chronic relapsing remitting disease. Sometimes it takes multiple treatment episodes over time and that that's an expectation or a realistic outcome of treatment. >> This idea of the person, that a person needs to hit rock bottom before they can effectively manage treatment. They delouse everything they need to kind of have this the bottom fallout for them to be able to engage appropriately in treatment. And I think that that's a really unfortunate perpetuated myth that is out there. The other is about the family members, this idea of enabling right? If I allow my son daughter brother sister to come into my home and they use drugs there, I'm just enabling them and enabling their condition. I think we as addiction providers and people who are really passionate about dispelling myths really need to help families come to terms with this idea of enabling, right? They're going to use substances whether they're in your home or not, let's do our best to keep them safe. >> Thank you for that, I think that also brings up the fact that this is such a stigmatizing condition. That there's not many medical conditions that when a loved one has the condition the family member also feel shame or guilt or as you put it an enabler. I mean, they have their own stigmatizing terms and just by being a family member of somebody who's struggling with substance use disorders. It speaks to the layers of stigma that are seen. >> And they were also structural issues there, I mean, there are whole elements of public housing for instance where if your child is caught using drugs you are thrown out of your home. I mean, social problems like that go well beyond what the medical community can manage. But I think medical providers and public health providers have to speak up against those kind of insane policies. >> [LAUGH] >> I also think just as we're on the topic of stigma and that's something I happen to be pretty passionate about. It's not even just the disease or the person that stigmatized the treatment is stigmatized itself, take methadone for instance, no one wants to tell their neighbor their son or daughter. We have a success story our son's on methadone, doesn't tend to come across in that way. And we even have terms and we address this in some parts of the course, terms that perpetuate stigma about the treatment. Opioid substitution therapy, we're substituting one opioid for another, we really need to be careful as agents of change to avoid perpetuating that stigma with our language. And really being the people who can help dispel myths around them. >> It's right, we don't talk about insulin substitution therapy. >> Right.
