The Faces of Addiction
Addiction has many changing faces. Addiction can appear late at night in a busy city as a syringe under neon lights, sold on every street corner. Addiction can appear at your friend’s 15th birthday party, as a pill taken from his mother’s medicine cabinet. Addiction can appear as a liquid your 90 year old grandmother takes for a fall she had at the hospital a few weeks ago. Addiction can appear as a baby crying, weaning from narcotics that their mother used while in utero. As an inpatient registered nurse, I have taken care of infants who present with opioid withdrawal symptoms. As a nurse, it is my job to evaluate the severity of the withdrawal through the COWS or Clinical Opioid Withdrawal Scale. The individual or baby is ranked based upon clinical symptoms presenting such as elevated heart rate, sweating, restlessness, pupil size, runny noses or tearing, tremors, yawning and anxiousness or irritability. Infants going through withdrawal often do not sleep because symptoms can be so unsettling. They also have the risk of permanent physical and brain impairments. I have experienced addiction in adult and adolescent patients in the Urban Milwaukee area, where a large portion of my practice is located. The United States is dealing with an addiction crisis because of the prevalence of individuals or families who are impacted by the disease. Homelesness in the United States has continued to rise, largely related to improper services and resources for those who are encountering addiction. The face of what addiction looks like, many of us cannot recognize. When a patient or individual also does finally recognize their need for services, and elect to check into hospitalization, the services provided for them often end at discharge. Our nation is trained to see addiction as a choice, or a uniform consequence of bad circumstances. The overuse of opioids and the War on Drugs has perpetuated a criminal mentality on addiction, when in reality, someone who is suffering from addiction is suffering from disease. Withdrawal and addiction are physiologic conditions we as a nation are attempting to treat with isolation and deprivation of the substance. MRIs and CT scans of brain activity of someone who is addicted to a substance reflect deterioration and stimulation in the same regions of the brain as someone suffering from other white matter disorders such as psychiatric conditions. Lack of education on the topic has perpetuated misinformation and condemnation of those who experience addiction.
In 2020, the United States spent an estimated $34.6 billion dollars on fighting the War on Drugs.1 It is estimated that the annual per person hospital cost of those with substance use disorders is $2783. Although we are all interested in the economic aspect of any national issue, addiction has, in my opinion, more detrimental consequences. There are emotional, mental and physical impacts that addiction contributes to. 31.9 million Americans currently use illegal drugs. 22% of all American males misused Prescription drugs and 17% of all American Females misused prescription drugs.2 Although these statistics are startling, until you have seen a family torn apart by the impacts of addiction, they may not have as much emotional resonance. Until you witness a child taken away from their family due to substance use and addiction, the full emotional weight of addiction may not leave a mark. In 2016, the prevalence of parental alcohol or other dug use as a contributing factor for a child’s removal from the home increased by 16.8 %.3 Child welfare workers report that most children within this system have a parent with an alcohol or other substance use disorder.
The first step to remedying the addiction crisis within the United States is to provide further funding for addiction related resources in private and public settings. Public education in elementary and middle schools should incorporate education on addiction as a disease, and not solely as a consequence to criminal drug use. This education should be combined with Health Education programs. For those who are incarcerated for drug related offenses, medical services as well as classes should be provided to aid in treatment of illicit drug use and distribution. Once the individual has been released from the prison system, drug counseling and medical appointments should be arranged on a weekly basis. To address the medical aspect of addiction, prescribers of all hospitals should be mandated to take opioid and prescription drug safety courses. These providers should also be surveyed about situations in which prescription of narcotics was concerning or alarming and which patients triggered these reactions. These individuals should then be evaluated in an outpatient setting at follow up after prescription. Opioid and substance abuse drop boxes that are normally only available at pharmacies, should be made more widely accessible. Through these methods, we may make a dent in the addiction crisis in the United States. However, to make real, sustainable change, we must first change the lack of understanding and apathy that exists around the idea of addiction. If we exchange apathy, for empathy, and in turn treat addiction as a life-threatening disease, we may truly create a resolution for addiction in the United States.