You’d think after all these years of talking about how alcoholism is a disease – the AMA declared it so in 1956 — the stigma of being an alcoholic would go away… or at least recede significantly. But no, it hasn’t. A study just released showed that most alcoholics won’t seek treatment because of stigma. And the problem is worse among men, people of color and people with lower income and less education.
Stigma has long been recognized as one of the biggest impediments for addicts seeking help. The National Institute on Drug Abuse (NIDA) has tried for years to confront stigma by telling anybody who would listen the facts about how addiction is a disease that responds as well to treatment and has about the same relapse rates as diabetes, hypertension and asthma. Basically, addiction has the same properties as other chronic illnesses.
People certainly have heard about this, but it hasn’t really sunken in.
Maybe the problem is that medical science says one thing but does another. Medicine says that addiction is a chronic disease but keeps acting like it’s a social disorder, i.e., somebody else’s problem. Most health systems today have little or no capacity to treat addiction. So what do you expect people will think?
The answer will be to truly integrate addiction treatment into primary health care, which a lot of people are talking about these days, though it hasn’t begun in any systematic way. Screening for addiction and substance use disorders needs to become an everyday occurrence at the offices of physicians, nurse practitioners, and other health care providers, and in emergency rooms, trauma centers and community clinics. Referrals for addiction need to become as routine as referrals for X-rays. And treatment for addiction needs to be like treatment for diabetes or any other chronic illness – you keep treating the condition until it’s under control.
NIDA Director Dr. Nora Volkow once said that stigma “arises when we do not understand the true nature of a health condition.” But I don’t think we can convince people that addiction is a treatable disease by simply telling them over and over. What we need to do is to show them. Once addiction treatment begins in every primary care doctor’s office, once every health plan covers substance use disorders at parity with other conditions, and once treatment for addiction is delivered the same way as treatment for diabetes, only then will stigma disappear.