I used to believe that addiction was a character flaw, and that the drug fiends I treated on the streets of Hartford were there due to their own poor choices.Â That doesnâ€™t mean I treated them badly. I have always tried to treat all my patients as if I were treating members of my own family.Â That said, like anyone I have good days and bad days, and donâ€™t always live up to my expectations.
The older I get the less judgmental I am.Â I guess I have seen people go through hard times over the years, and am more sympathetic.Â I view the drug fiends, as I called them, differently now for two reasons.
One, I know people can stumble, they can make mistakes and they can have bad luck.Â Not all roads traveled lead to good ends.
Two, science now makes a compelling case that addiction is a brain disease. Â Hard core addicts are crippled in their thinking in much the same way that people with heart disease have diminished cardiac capacity or diabetics have problems regulating their sugar.
I advise all to read the chapter on THE NEUROBIOLOGY OF SUBSTANCE USE, MISUSE, AND ADDICTIONÂ from the just published Surgeon General’s reportÂ Facing Addiction in America.
Hereâ€™s the jist:
Use of opiates causes neuroadaptations in the brainâ€™s structure and function that impair logical thought and breed abnormal behaviors.Â These neuroadaptations can persist long after a patient has gotten clean and cause them to relapse.Â People with substance addiction are damaged in the same was as people with heart disease, COPD or diabetes have damaged hearts, lungs, and endocrine functions.Â People with opiateÂ addiction have damaged brains.Â This can be seen on MRIs.Â We canâ€™t expect them all to sudden act rationally in the same way we canâ€™t expect someone with a heart transplant to run a marathon, a COPDer to climb Mount Everest or a diabetic to live without insulin.
This from the Surgeon Generalâ€™s report:
* Well-supported: when evidence is derived from multiple rigorous human and nonhuman studies; Supported: when evidence is derived from rigorous but fewer human and nonhuman studies.
Our job in EMS it to keep these people alive and help steer them toward recovery.Â We can do it by reversing their overdoses, by guiding them to treatment and treating them like fellow human beings. Â We are all in this human journey together. Â Let’s help each other out.
Peace to all.
Graphic from Facing Addiction in America.