Hear we go again.

I had a most interesting and frustrating telephone conversation today. A representative of a local nursing program contacted me with questions about the workshops I'm providing with LaTonia Wright, RN, BSN, JD. Our topics focus on substance abuse/chemical dependence and legal issues (related to addiction as well as other legal issues) facing the nurse and nursing profession. Since we've just started these workshops, attendance hasn't been what we hoped for, but we realize it takes time to get the word out. I digress...back to the phone call.

As I explained why I started my company and my mission, I discussed the obstacles we face when dealing with the disease of chemical dependence, such as:
- addiction isn't accepted as a disease (it's a lack of willpower or lack of morals)
- "they" did this to themselves
- if they loved their family, they would stop doing this
- how could they let this happen? After all, they are health care professionals, they should know better!
- treatment doesn't work, so why bother

The caller's response was almost textbook, as if reading from a script or a "FAQ" brochure.

Caller: Nurses receive education about the disease in training, don't they?
Me: Yes, but the focus is mainly on "caring" for the addict (talk about an oxymoron!). Even more likely is a focus on the consequences of the actions of the addict's use of an addictive chemical or participating in an addictive behavior. Things like cirrhosis, gastritis, gastric ulcers, pancreatitis, infections (including sexually transmitted diseases, hepatitis, etc.), accidents, crime, violence (domestic and otherwise), loss of job, income, divorce, etc.

Caller: Nurses know this is a disease.
Me: No they don't. They may pay lip service to the disease concept, but their attitudes and actions speak loudly...gossip, rejection, hostility, etc.

Caller: The incidence of addiction in nurses and doctors is less than the general public. After all, they are trained health care providers.

Me: Actually, the incidence is the same in health care professionals, even higher if you practice in certain specialties such as anesthesia, emergency room and other critical care areas. Training about addiction provides no more "resistance" than training in oncology prevents cancer, or training in endocrinology prevents diabetes. Education MAY help early recognition and treatment, but it doesn't prevent the possibility of disease.

Caller: The relapse rate is so high. Doesn't this mean treatment isn't as successful as treating other diseases?

Me: No, because we don't approach addiction in the same manner we approach other chronic diseases. For all chronic, potentially fatal diseases we all know early recognition, treatment, and continued follow-up provides the best chance for remission. Is that the approach used for addiction? No. We wait until the addict hits "rock bottom", treat them with outpatient therapy (when research clearly shows increased effectiveness of long term inpatient/residential treatment), with little, if any, follow up.

If we waited until the person with cancer had signs that could no longer be ignored, provided treatment with inadequate doses of chemotherapy for too short a time, with little or no follow-up, how many remissions would we see? Not many!

There-in lies the problem. Addiction is not accepted as a "legitimate" disease. Research has identified the areas of the brain where addiction takes place. It has determined the brain chemicals (neurotransmitters) involved, how "cues" can trigger activity in those areas of the brain even after documented decades of abstinence. There is a very specific set of signs and symptoms associated with addiction. It occurs in all cultures and all socio-economic classes. Yet we continue to approach the person with addiction in the same ineffective manner used since addiction was described thousands of years ago (China and Middle East cultures have described substance abuse as early as 5,000 years ago). We continue to base our decisions on the three "M's" of addiction...Myth, Misbelief, and Misinformation. This the way we approach any situation where we have no factual understanding. Look at diseases such as Hansen's Disease (Leprosy), congenital blindness, seizure disorders and HIV. The first three were almost universally accepted as a punishment from God (in the case of congenital blindness the punishement was a result of the parent's sin), or demon possession. Then, when science began to discover the pathology of disease(s), those misbeliefs were eliminated. Yes, there are still some who continue to believe the myths, but generally it's from a lack of education. Because the topic is skirted or ignored, there has been little progress in treating addiction.

No one wants to talk about it. Ignore it and it will go away. The disease won't go away, but the addict will...either to prison, or to the morgue. Certainly not an acceptable outcome in the 21st century.