And you should be ashamed of yourself for even suggesting it.

There's no justification for any pain I caused to others, but it genuinely was not my intention. I'm coming off of the very recent loss of a very important person to me, and looking at a society that would largely say he had no value. There are people around me assuming he didn't fight and didn't want help when I know firsthand how desperately untrue that is. I know I'm not the only one in the world for whom that's true and you shouldn't inconsiderately cause pain to others just because you yourself are in pain. All I'm saying is that if I overstated my case in my despair and frustration, I hope that's forgivable, and that we can continue to emphasize that life has value, and that matters of public health deserve compassion and evidence-based medicine rather than stigma and punishment.

unfathomable to me that things have changed so much from when I was young. It was unheard of here then, and I don't understand why it's now so common.

My best to you.

terrible disease. I could not agree more with your OP.

Thank you for writing it.

We HAVE to make adequate access to modern, effective, evidence based treatment a national goal.

The way I see it is as follows:

People with what comes down to a medical condition are stigmatized and ostracized when treatment could save their lives.

The crisis is growing at an alarming rate but is largely being ignored and minimized by those in positions of power to change it.


I am coming from a place of pain right now as I have lost the latest in a string of young friends. I can rattle off about ten who have died as a result of substance abuse. I perceive this as a hideous crisis that is being addressed with callous judgment and stigmatization that overlaps with oppression (racial and class oppression) rather than effective research and treatment.

I don't mean to imply that the two situations are identical. Just that there are parallels. If you would like me to reword I will do so.

addiction/overdose to AIDS.

Likewise I am thirty years old and can count off the top of my head ten people my age or younger who died because of what is demonstrably a treatable chronic disease, who were inadequately treated because the operating philosophy is to stigmatize and dehumanize them. I do not think they are identical, but I think there are parallels in the fact that the lives of many matter less than the moral outrage of a few.

I think those lives mattered. I apologize if I overstepped my bounds in language. I don't think they deserve to have their memories puked on because others choose to stigmatize *them.*

I cannot count how many friends I have lost because there are to fucking many including my life partner

and a friend of 30 years in hospice house as we speak who is not going to make it through the night.

I don't think I have to justify a goddamn thing to you.

I did reword the title of the post, and I am not trying to compete with your sorrow or anyone else's. But drug addiction does currently kill about 200,000 a year, and effective, science-based treatment could save most of those lives--80% in France. My main point is that any time we choose stigma and judgment over compassion--and fucking medical evidence--it's a shitty tragedy and the judgmental assholes should be held accountable.

Sorry that this is what you are dealing with right now. The AIDS epidemic is by no means over. Note from another thread, it is growing in South America:

The impact of reduced access to contraceptives is far graver than frustration over failed hookups. Venezuela has one of South America’s highest rates of HIV infection and teenage pregnancy. Abortion is illegal...

Venezuela had the third-fastest rate of HIV infections per capita in South America, after Paraguay and Brazil in 2013, United Nations data shows. The country also has the highest rate of teenage pregnancies on the continent after Guyana, at 83 per 1,000, according to 2012 data from the World Bank. This compares to just 4 per 1,000 in Germany and 31 in the U.S...

Supplies of birth control and emergency contraceptive pills as well as anti-retroviral drugs for HIV patients are also at critically low levels, according to IPPF and StopVIH...

http://www.bloomberg.com/news/articles/2015-02-04/the-755-condom-is-the-latest-indignity-in-venezuela

AIDS is a disease that respects no gender, sexual orientation, age or border. No doubt AIDS is expanding in other nations. It is a heart breaker, destroying families and entire communities worldwide.

While I understand that HIV is not always going to result in AIDS, the last I heard it is part of it. Thanks for the statistics showing this is a continuing epidemic that requires attention. It doesn't make the news very often, does it?

But homophobes cite it as their justification for genocide of gays. Like that guy Putin put in charge of all Russian media. I won't even repeat it here, you've had more than enough this week, William.

But, I don't think there are parallels, either.

I've known some, too. Friends and family members. You can't help them if they don't want to be helped. You can't treat them if they don't want to be treated. It's a very hard situation for them and their family/friends.

Those lives do matter. All lives matter. And, I wasn't puking on "their" memories, but you know that. Only the comparison you chose to make.

Perhaps unintentionally. Addiction is demonstrably a chronic neurological disease. "Willpower" is not a factor, and the idea that addicts are hopeless (which wasn't exactly what you expressed, but which I think finds some support in the sentiment you expressed) is erroneous. The fact is that addiction relapse rates are pretty much the same as for any other chronic condition with a behavioral component, including hypertension, diabetes, or asthma. The fact is that good, medical-science based interventions are not available for millions of people in the United States--and the number of people who need treatment is currently in the millions.

It isn't idealism to suggest that adequate, modern treatments work. France saw an 80% reduction in heroin overdose death with the introduction of a medical model to addiction treatment. But we are stuck in the stone ages, and in a mindset that prefers to judge people--ultimately condemning many to death--rather than offer them the medical support they need.

probably most effectively by the Reagan Administration (Remember "Just Say No!" and "Don't be User Friendly!&quot .

At one time, addiction was treated as a health concern. Rehabilitation was the objective. That all changed after Nixon, and addiction was thenceforth treated as a moral failing. Incarceration became the objective.

I'd prefer we approached the problem differently. Compare our "Drug War" with the way Portugal cleaned up it's horrendous drug problem by eschewing punishment and focusing on therapy:

http://www.forbes.com/sites/erikkain/2011/07/05/ten-years-after-decriminalization-drug-abuse-down-by-half-in-portugal/

http://www.spiegel.de/international/europe/evaluating-drug-decriminalization-in-portugal-12-years-later-a-891060.html

http://content.time.com/time/health/article/0,8599,1893946,00.html

Adequate help wasn't available and instead he was made to feel guilty for failing, when he was fighting as hard as he could. Now he's dead, and a lot of people would view him as being solely responsible for his own death. No one would blame an asthmatic for their death if they tried to get an inhaler and were denied one.

Once they are addicted, they are fighting against their biology, not their preference. You want to help but they have to help themselves - as though they are able to make a free choice. And even when they are ready to try and stop, it's so hard to get real or meaningful help for them. What would work is three months in a rehab with lots of therapy. What they get is 5 days in a rehab - or out-patient with a prescription for suboxone!

It's heartbreaking to be unable to change the trajectory.

I'm so sorry about your loss. And I understand what you are trying to express. There is no compassion for an addict (unless you love one). Society does not care about addict deaths. I wonder if that will change, as more people have a loved one sucked up along this tragic course. I hope so, because this problem is only getting worse.

And so much of the problem (not all by a long shot) has to do with the lack of opportunity or hope I see around me. I come from a hideously poor and unhealthy part of the country, and the kids get stereotyped and ostracized on top of the barriers they are already trying to overcome. When young dreams die (or never form to start with) what is there except escape? Then you add a record to all of that, and whatever sliver of hope they may have had to make something of themselves is gone, maybe forever.

I don't mean to say that all addiction is related to poverty and oppression, because I know sometimes it isn't, and a wealthy addict is still someone who deserves compassion and individualized treatment. But there's definitely a link. When everything in someone's life confirms that they are worthless and there is no chance for them, of course they are going to engage in temporarily pleasurable self-destruction. What else is there?

And I can't help but think, if all these kids had jobs, they would feel like they had a purpose, a future, hope for a better life, and a sense of self worth.

But there are no jobs - and lots of addiction.

like mine.

and sometimes I think it's by design.

"Survival of the fittest," "no one to blame but themselves," "society is better off without them," "you can't help poeple who won't help themselves," "worthless leeches."

My friends. People that I laughed and cried with. People that at their best would have given me the shirt off their back (and did so a time or two). People who want to participate productively in society. People who grew up without food or fathers or decent shelter or dreams. People trying to defy their pasts. People that I have buried.

it is one of least understood diseases. Mainly due to the fact that while it is referred to as a disease, it is not treated as a disease, ie, there is very little funding for research to find out what causes it.

In Europe more has been done to try to get to the bottom of the causes of alcoholism, and several doctors have stated that it should have a Clinical Name, it should not be called 'alcoholism'. Alcohol itself is merely the medication that is self administered in order to try to alleviate the symptoms

It would take too long to list some of the findings so far. But considering the awful effect of addiction on society, imo, an effort should be made to find the causes and hopefully some day a cure.

I agree with you that it is one of the least understood diseases. I didn't mean to come across harsh about it; but I've been very close to addiction several times with relatives and a very close friend.

Maybe I should have said that until the person is ready to get help, you can't make them. Some are not even aware that they have a problem.

destroying themselves and those who love them. But even if they are ready to get help, and I know that many have tried, there is really nothing that works for real addicts.

I remember reading that the statistics on success, even for AA, the most successful program, are only 12%. That led some researchers to believe that actual addicts cannot be 'talked' out of their illness. That the 12% are 'problem drinkers' which is not the same thing.

I was interested to read that as it was so puzzling to me that while people try to get help, it doesn't seem to work.

IF there is an underlying physical reason, no one yet knows what it is. Fatty liver in infants has been looked at, but there isn't enough research to determine whether that is a result of a family history of alcoholism, the effects passed on to the next generation, or a cause in itself.

I have a feeling that if there ever is enough research to determine the causes, there will be many different causes, depending on the addiction. Much like we have different kinds of cancer.

No problem btw, it is extremely frustrating for those having to deal with addiction, especially when the person seems to be intelligent, and often creative and in other ways, in possession of all that SHOULD cause them to turn their lives around.

I am sorry you have had to deal with it. It is a terrible disease for everyone concerned

I'm sure most people have had to deal with it one way or another in their life; so I wasn't trying to gain support or sympathy more than anyone else (although I'm not saying you are doing that because I'm sure you're not).

Best to you!

people who have not been affected by addiction one way or another. Another good reason to put more effort into finding out as much as possible about it and hopefully, one day, finding a cure.

Please inform yourself. Psychotherapy/cbt and medication yield the best results empirically, and without the religious/ higher power nonsense and with no moral degradation. It's not the 1950s anymore.

successful based on the huge % of failure, as the stats show.

Not into discussing people's 'beliefs', that's none of my business.

I believe I stated that the program may be a complete failure, since the 12% have been referred to as NOT actual addicts, but 'problem drinkers'. Which would mean as I said, that you cannot TALK people out of the disease of addiction.

Not sure what your point was, it is not me you need to argue with.

but recovery is possible. I also think the key is to work on prevention and try to change society's acceptance of drug and alcohol misuse. We know the binge drinking and early consumption common in teen and college years makes one more susceptible to addiction yet most accept this as a right of passage.

We glorify and reward this stuff. Moreover, there's a lot of evidence that teens are way more susceptible to addiction because of where they are in brain development.

drugs. Heroin, which you seem to single out, according to your link was just over 6000 of the 43,000 deaths. The rest were from prescription and over the counter drugs.
Last year alone over 40,000 people were admitted to the hospital due to acetaminophen overdoses. Yeah, Tylenol.

I have been through generations of drug use. I have had 2 friends die from drug use in my 40 years of getting high. I've lost way more people to car accidents, stupidity, and illness, than to drug use.

Sorry, while I agree that the stigma needs to be removed, drugs should be legal and regulated, and addiction should be considered a disease, I'm not gonna freak out over these numbers.

I referred to the story because it just came out yesterday and it discusses some of the points that have been on my mind lately. Being admitted to the hospital is not the same as dying. It seems we have had different experiences, and your life has been longer than mine. I'll tell you how many friends of mine die from substance-abuse related causes when I get there. I still think the statistics make clear that we have a serious public health crisis on our hands that is being addressed in completely inadequate ways.

the cause of about 22K overdose deaths in 2013, and responsible for more deaths than AIDS. These ODs are mostly the result of drug abuse and addiction, not prescribed use.

http://www.cdc.gov/homeandrecreationalsafety/overdose/facts.html
http://www.cdc.gov/hiv/statistics/basics/ataglance.html

I'm not trying to win a contest, but I think people who live in good neighborhoods don't really understand how prevalent the problem is. Where I live, hard drugs are everywhere. You can't avoid seeing it. And its very, very depressing to live in this environment.

I have a handful of friends who have made it out...a handful. The rest are falling apart and/or dying, and I've been watching it get worse for ten years.

No one to Aids that I know of. I won't conflate the two out of respect for either. All I know is we can do better

I was an alcoholic for years and smoking a lot of weed and during that time I'd wonder what my brothers and sisters who did neither did for entertainment. Now that I no longer drink and only occasionally toke I can see real clear what they do. Same things I do now. Family and friends same as before but now there isn't a drug involved. Guess what, I like me much better now that I've finally woke up to the facts of life and that is if I'd kept on the path I was on I'd be in much worse shape or more than likely dead now.

Education is the cure for this drug problem we have today. I strongly believe that.

The drug that claims most lives in this part of the country is not opiates or alcohol but meth. I thank my lucky stars that I never liked the stuff and stayed away from it but due to my toking I was around a lot of people who did because we were all lumped together. The same person where I got my weed also sold the meth too. If I'd not been forced to deal with the dealers in my life and had a chance to procure pot without the dealer being in the mix I do think that I'd never have have got to know as many meth heads as I did. As it is I can't count the number of people who I've known that have died because of meth mostly on both hands. I've only known a couple who od on opiates who were actually addicts. I've known a couple who chose that way to end it but it was a method not an accident.

Meth has been a huge problem where I live as well. I don't know anyone (that I'm aware of) who has fallen into meth addiction, but across the board, we need research and implementation of treatment strategies that are effective for specific drugs, and individualized for each person's circumstances.

I've had a painful shoulder injury/replacement and suffer from a few disabling and painful diseases and will never use opiates again. After my shoulder surgery I missed about a month due to painkillers.

Cannabis is so much better. I've ditched valium and have cut my muscle relaxer use to a couple in a month (mainly when I cant get to my cannabis).

But in a situation where people are being prescribed drugs that are known to have addictive capacity, we need to be proactive about acknowledging that addiction is going to occur for some people who are susceptible, and we need to make sure that those people are enabled to get effective treatment when that happens.

I think this is an important topic and I am so sorry for your loss(es).

I don't have a ton of time but I'd like to do a series of posts on the different aspects of addiction--treatment gaps (especially ostracism by medical professionals), criminal justice, how various oppressions based on class, race, gender/gender expression/sexuality, etc.) play a role, new developments and understandings, and strategies for improving the situation and saving lives. I see advocacy for effective addiction treatment as a critical part of a larger social movement, one whose time has definitely come.

12 Step treatment is so ubiquitous, but it doesn't work for everyone. There has to more support out there for addicts and alcoholics.

But still, from what research I have done (and I am in the very early stages of understanding the problem, motivated by grief as I am), even hypothetically newer strategies still often involve 12 step principles in disguise, largely due to the high number of addiction professionals who have arrived at their current positions through that approach.

Don't get me wrong, I am thankful to the bottom of my heart for every single person who has been saved through 12-step programs. Certain aspects of the programs have some scientific validity, and I would not want to see them taken away as one potential strategy that works. But there are good reasons that they legitimately do not work for a lot of people, and other approaches might be better.

I would really recommend listening to/reading the transcript of the Fresh Air episode I linked to. Beyond that, NPR Morning Edition has done some great stories on opioid/heroin treatment recently, including one on Vermont's newly implemented "Hub and Spokes" program, which I think is particularly compelling. I have also found a lot of useful information on "The Fix," a website which focuses on addiction and recovery. I have also actually gotten some really enlightening information from the drugabuse.gov website that helps define the crisis, break down the stigma, and provide evidence for good treatments that work.

As I see it, the main areas for advocacy are: 1) eliminating the incarceration/criminal justice aspect of drug abuse; 2) demanding that substance abuse treatment be incorporated into standard medical care; 3) demanding that substance abuse treatment programs adopt evidence-based approaches that include long-term, comprehensive care and management; 4) making a host of legal changes that can save lives, most importantly making naloxone widely available, and guaranteeing that those calling for emergency services in the event of an overdose don't face the risk of arrest or jail time (which will be moot if point 1 is addressed)

But I also agree w/ your idea of advocacy for a multi-faceted approach. Above all, I think that the stigma needs to be eliminated and we need to see addicts and alcoholics as people in need of help and treatment instead of people who need to be shamed and punished. Again, thanks for bringing up the topic. I feel that there is too little that is discussed around this subject.

Silence engenders complacency. Complacency engenders suffering and often death.

Unless someone is an addict*, or has been a close to one, it may be difficult to see how insidious a disease it is.

Nobody chooses addiction.

*In recovery 26 years.

Thank you for your kind words.

However. Look at this.

I apologized as well. In addition, to be honest, I dislike using the word "addict" or "alcoholic," although I do in some cases for brevity. Such words can so easily be used pejoratively, and imply that some are more deserving of affliction than others. I reject that assumption and find it unscientific and callous.

I take your point about NPR. Elsewhere in the thread I have offered other resources that combat misinformation and victim blaming when it comes to addiction. However, I feel that this particular episode of Fresh Air contained an important perspective and information that needs to be broadcast from the rooftops, and more now than ever.

Edited to add I am also very sorry for your losses, past and present.

It simply illuminates the stigma of addiction, that people are so outraged that a comparison would be drawn between addiction as an epidemic and other diseases.

Bigotry against LGBT folks is also a huge factor. While addiction stigma has its own associated bigotries when it comes to class, ethnicity, gender expression, and orientation, I think that aspect of the Reagan AIDS response was still really extreme, painful, and unique. I also acknowledge that talking about the AIDS crisis as if it is a past-tense thing downplays the fact that AIDS is a global scourge that is still terribly out of control in many countries. Making the comparison the way I did was a mistake.

At the same time, I don't know if everyone is really experiencing the on-the-ground reality of opiate addiction the way that I have. I can't say my experience is representative, but personally it feels like I'm seeing a whole generation of a whole social class be consumed with nowhere to turn, and in fact a society that ostracizes them for struggling and even at times rejoices in their deaths. If I could do it again I might just say that there were important lessons to be learned from the past.

By using person-first language imo.

I would have preferred not to use the word "addict" in the OP, but length limits made it my only option.