The addict's stigma: Perception of weakness hampers treatment: Editorial

By Star-Ledger Editorial BoardThe Star-Ledger
on February 24, 2013 at 7:10 AM, updated February 25, 2013 at 11:54 AM

 

The first time a person sips a drink, takes a painkiller or shoots heroin, there'™s no addiction. Over time, however, the substance takes hold and dependency develops. Hardliners say it'™s weak willpower; medicine says addicts no longer have a choice.File photo

If you’re diabetic and binge on birthday cake, you can go to the emergency room for treatment — and health insurance will pay for it. You get the same medical care for your third heart attack that you did for the first two, again, with full coverage.
But the underlying attitude in the United States, clouded by social and legal stigma, is that addicts get one shot. Get clean, but fall off the wagon, and you’re on your own.
And, as The Star-Ledger’s Dan Goldberg reported in last Sunday’s editions, many families find convincing their health insurers to cover addiction treatment is a life-and-death struggle. Some commit fraud, lying their way into inpatient rehab programs.
Diseases afflicting the body — diabetes, heart disease, cancer — have clear paths for treatment, as recommended by your physician. Depending on your policy, doctors and insurers might quibble over details, but care is typically covered.
Addiction, on the other hand, is stigmatized as a personality weakness. Just as marijuana’s medicinal value was ignored because pot’s illegal, the perception of people addicted to drugs such as heroin is clouded by law, too.
The first time a person sips a drink, takes a painkiller or shoots heroin, there’s no addiction. Over time, however, the substance takes hold and dependency develops. Hardliners say it’s weak willpower; medicine says addicts no longer have a choice.

Insurers told The Star-Ledger cost-benefit calls are made on all medical treatments, including addiction. They might cover less expensive outpatient rehab, even when doctors recommend costlier inpatient stays. In that respect, critics say, addiction is treated differently, and parity laws are needed to ensure addiction has equal access to care.

If a diabetic misses an insulin shot, doctors restore the blood-sugar balance. If an addict slips, we call it relapse and say treatment didn't work.

The Affordable Care Act requires addiction and mental health parity, but it’s still part of the law’s interim rules, and advocates worry there’s too much wiggle room for insurers to deny coverage.
In New Jersey, where heroin addiction is rising at double-digit rates, parity laws have failed to advance in past legislative sessions, though a bill mandating parity in state employee health plans is moving through the Legislature.
Like diabetes, addiction is chronic, forcing patients to make lifestyle changes. When a diabetic misses an insulin shot, doctors try to restore the blood-sugar balance. When an addict slips, we call it a “relapse” and say treatment didn’t work. Both patients need — and deserve — lifetime care to maintain balance.
The “addicts brought this on themselves” argument can be made about overeaters who get diabetes or smokers who get lung cancer. Addictions deserve the same access to insurance coverage. It’s the right path, medically and morally.

Intervention for High-Risk Teens Can Reduce Alcohol Abuse

By Rick Nauert PhDSenior News Editor
Reviewed by John M. Grohol, Psy.D. on January 25, 2013

Mental health interventions directed toward high-risk teenagers significantly reduces their drinking behavior and that of their schoolmates.

Results from the randomized study were so strong that UK researchers believe the intervention should be administered throughout the country to help prevent teenage alcohol abuse.
The study is published in JAMA Psychiatry.

The research effort, termed the “Adventure Trial,” involved 21 schools in London that were randomly allocated to either receive the intervention, or the UK statutory drug and alcohol education curriculum.

A total of 2,548 year-10 students (average age 13.8 years) were classed as high or low-risk of developing future alcohol dependency. Those classed as high-risk fit one of four personality risk profiles: anxiety, hopelessness, impulsivity or sensation-seeking.

Eleven students were monitored for their drinking behavior over two years. Four members of staff in each intervention school were trained to deliver group workshops targeting the different personality profiles. Eleven schools also received the intervention where 709 high-risk teenagers were invited to attend two workshops that guided them in learning cognitive-behavioral strategies for coping with their particular personality profiles.

Clinical psychologist Dr. Patricia Conrod, from King’s Institute of Psychiatry and lead author of the paper, said: “Through the workshops, the teenagers learn to better manage their personality traits and individual tendencies, helping them to make good decisions for themselves.
Researchers discovered cognitive-behavioral strategies helped some students better manage high levels of anxiety, reduce their tendency to have pessimistic reactions to certain situations, and helped to control their tendency to react impulsively or aggressively.

“Our study shows that this mental health approach to alcohol prevention is much more successful in reducing drinking behavior than giving teenagers general information on the dangers of alcohol.”
After two years, high-risk students in intervention schools were at a 29 percent reduced risk of drinking, 43 percent reduced risk of binge drinking and 29 percent reduced risk of problem drinking compared to high-risk students in control schools.

The intervention also significantly delayed the natural progression to more risky drinking behavior (such as frequent binge drinking, greater quantity of drinking, and severity of problem drinking) in the high-risk students over the two years.

Additionally, over the two year period, low-risk teenagers in the intervention schools, who did not receive the intervention, were at a 29 percent reduced risk of taking up drinking and 35 percent reduced risk of binge drinking compared to the low-risk group in the non-intervention schools, indicating a possible ‘herd effect’ in this population.

An excellent upside of the intervention is the carry-over effect reducing unhealthy behavior among friends and peers of the youth receiving the intensive counseling.

“This ‘herd effect’ is very important from a public health perspective as it suggests that the benefits of mental health interventions on drinking behaviour also extend to the general population, possibly by reducing the number of drinking occasions young people are exposed to in early adolescence.”
Said Conrod, “This intervention could be widely administered to schools: it is successful from a public health perspective, appreciated by students and staff, and because we train school staff rather than professional psychologists, the intervention remains relatively inexpensive to roll-out.”
Drinking is a significant issue in England as approximately 6 out of 10 people aged 11-15 in England drink and approximately 5,000 teenagers are admitted to hospital every year for alcohol related reasons.

Across the developed world, alcohol accounts for approximately 9 percent of all deaths of people aged 15-29, and so far, universal community or school-based interventions have proven difficult to implement and shown limited success.

Nick Barton, chief executive of Action on Addiction, said: “Dr. Conrod’s study, which helps young people reduce their chances of developing an addiction to alcohol and/or drugs in the future, is an exciting development for prevention work in the UK.

“This is generally recognized as inadequate, and as we see regularly in the media, currently fails to address binge drinking and drug taking among young people. We treat a large number of people who began misusing substances in their school years, and we welcome any evidence-based research which may help to reverse this trend.”

Source: King’s College London