In recent weeks, I’ve had the privilege of shadowing in the IU Emergency Department, allowing me to witness firsthand the casualties of a drug abuse epidemic that has been plaguing Bloomington’s homeless population for several weeks. I watched paramedics wheel in victim after victim, some of them twice in one day. Some had overdosed on heroin while others on a toxic concoction of “spice” (synthetic THC) laced with rat poison. It was a harrowing situation from the perspective of a bystander, but from the perspectives of some healthcare workers, it was downright frustrating; they just could not fathom how anyone could bring so much suffering upon themselves. Some even complained of these patients draining the last of their empathy. Surrounded by this sentiment, I could not help but recall the words of Odyssey writer Brianna Lyman, who wrote, “I can't express how much it infuriates me when drug addicts have the audacity to play the ‘oh poor me’ role, blaming their choices on a disease that they brought on themselves.”
This attitude of disdain toward those who suffer from addiction is fairly widespread; The Bloomberg School of Public Health at Johns Hopkins released a report that examined societal views toward people suffering from drug addiction. It found that most people surveyed viewed drug addiction as a moral failing and even expressed opposition to policies that would help them. The stigma against those who have abused drugs is very present in our society, and based on my own observations, it is clear this stigma even exists in medical settings that deal with such patients.
When one is frequently exposed to the ramifications of drug abuse, it is easy to convince one’s self that the harms outweigh any short-lived high brought on by a drug, but there are still addicts. Despite the widespread implementation of programs like D.A.R.E., which seek to educate people about the consequences of drug abuse, people still choose intoxication and everything that comes with it. Why?
Well, I’d like to challenge the common notion that drug addiction is just a choice. Sure, there is decision making involved when one takes a drug for the first time, but it generally isn’t a choice made lightly. Most people don’t just wake up one day with a burning desire to try heroin. Often times, what ends as a debilitating dependence on an controlled substance began as something we can all relate to: a desire for a better state of being. My purpose isn’t to justify drug use, but rather to shed light on the fact that many people who end up as drug abusers started out as people undergoing significant emotional or physical pain looking for some form of relief that they could not find elsewhere.
For some, drugs offer relief from the emotional toil brought on by physical or sexual abuse. Numerous studies in recent years have examined the relationship between trauma and drug abuse. One such study, conducted by Khoury, Tang, et al, examined more than 500 participants and found that PTSD was moderately correlated with drug abuse. Another study published by Tomnyr and Shield in The International Journal of Child Abuse & Neglect concluded that even when controlling for factors such as mental illness, there was a significant association between childhood sexual abuse and drug use. The euphoric high brought on by opioids or cocaine can offer victims of trauma sanctuary from their emotional pain. Before long, panacea becomes pain, bringing the user an even greater degree of pain than what they had in the first place.
While many patients of drug abuse are victims of trauma, not all of them are. Some of them also began as patients of physical and mental disease. Patients suffering from neuropathic pain and cancer, for example, are frequently prescribed opioids as painkillers. A report published by Cicero et al in the Journal of the American Medical Association found that as much as 75% of opioid abusers were introduced to the drug as a prescription. These were just patients following the doctor’s orders to reduce their pain, but as time went on, the drugs changed the brain’s chemistry, making the patients physically dependent on their medicine. Furthermore, there is a great degree of comorbidity of mental illness and substance abuse. The National Institute of Drug Abuse noted that some patients of mental illness attempt to self-medicate using illicit drugs. These reports suggest that a considerable number of people who eventually become addicts are just people trying to make it through the strife caused by their diseases.
There is an overarching theme for these reasons: a desire to reduce suffering. Of course, it does not take much to see that the damage incurred in the form of physical dependence, withdrawal, isolation from friends and family, and the limitations on careers greatly outweigh any short-lived ecstasy or numbing caused by controlled substances. But as I mentioned before, there are still addicts. While education is a step in the right direction, and though the methods used in such programs are well intentioned, I think it doesn’t quite reach the target audience. If I were asked to describe the archetypal drug addict in high school, I would imagine someone who was pressured into doing drugs by their peers, or someone just looking to get high. Someone facing a life crisis in need of relief is not what would have come to mind. We were reminded to never do drugs and shown pictures of disfigured addicts, but I don’t recall there being much talk of the reasons why people choose to do drugs other than it “being cool.” I think we need to extend the conversation past automatically saying no when offered drugs. I think we need to expand the intended audiences for these programs by informing those who are most susceptible people to abusing drugs about the resources that are available to them and convincing them that these are much better solutions to their physical and emotional problems than turning to illicit drugs. And for goodness sake, we need to stop making addicts feel stupid or selfish. Stigma clearly has not done much to prevent people from becoming addicts; perhaps compassion and support will.
