Name: Natalie Lawson
From: Ann Arbor, Michigan
Reflections on Addiction from a Former Social Worker
Reflections on Addiction from a Former Social Worker
Seasons in Malibu Addiction Awareness Scholarship Essay 2020
Applicant: Natalie Lawson
Like most issues facing the nation, addiction is complicated. As a community mental health social worker in Chicago, I saw some of the effects of addiction up close, but I am getting ahead of myself. My work in direct service, and my continuing technical assistance work, has always been informed by history, research, public policy, and basic humanism. As such, I know that each addictive substance has its own story to tell. Alcoholism is frequently brushed under the carpet of societal norms. The histories of cocaine and crack cocaine are laden with racial inequality and biased national policies during the era of the War on Drugs. However, I believe the current Opioid Epidemic tells a poignant and vivid story representative of the various substance addictions in the United States to date.
The dream-like effects of the opium poppy have plagued humanity for centuries. In the last 30 years, Opioid Use Disorder (OUD) has been bolstered by aggressive and deceptive marketing by American pharmaceutical companies for painkillers, such as OxyContin and Vicodin.1 Concurrently, the medical community began taking patients’ claims of pain more seriously in the 1990s, urged by the president of the American Pain Society to treat pain as the “fifth vital sign.”2 Combine deceptive marketing with a shifting perception of patients’ pain, add in innovative heroin dealing tactics, and the Unites States is the scene of an epidemic that cuts across class, race, and party lines.
However, I believe one prevailing factor most highly influences the Opioid Epidemic in the United States: isolation. Almost every person I worked with as a social worker had very limited income, lived alone, and relied on my team of fellow case managers for social support.
Several factors contribute to isolation. AARP reports that the number of American adults reporting loneliness has doubled from 20 to 40 percent since the 1980s.3 The rise in the use of social media also contributes to feelings of isolation, notably among young adults.4 When feeling socially isolated, people often turn to alcohol or other drugs to feel better and substitute for social connectedness. Then, once using drugs or alcohol, a person may engage in behaviors that cause conflict or further isolate them from others. On top of that, risk of fatal overdose increases in isolation.5
Rural communities are some of the hardest hit by the Opioid Epidemic, and there is no denying that increasing economic inequality and lack of economic opportunity are major factors in opioid use. Research has shown that there was marked increase in mortality of middle-aged white non-Hispanic working class men and women from 1999 to 2013.6 This increase in mortality is unique to the United States, and similarly wealthy countries have not seen such a change. Anne Case and Angus Deaton coined the term “deaths of despair” to describe this phenomenon of a working class who bears an increasingly heavy societal burden and sees no opportunities for an improved future.
Sadly, I believe isolation is the crisis behind the crisis, so to speak. The current COVID-19 pandemic is likely to make matters worse. While necessary to slow the spread of COVID-19, public health measures such as social distancing, shelter in place orders, and school and workplace closures lead to financial stress and social isolation. Additionally, concern about the pandemic itself can increase mental health symptoms, as 47% of Americans say that the pandemic has negatively affected their mental health.7 While telehealth services are becoming more widely used and accessible, those already in recovery from substance use disorders, including OUD, may no longer be able to access in-person recovery groups or other in-person recovery services.
The consequences of addiction are enormous. In 2016, the Surgeon General estimated that addictions for all substances costs the Unites States $442 billion annually, primarily from loss of productivity and premature death.8 However, a dollar amount neither tells of the struggles endured by people with substance addictions nor expresses the heartbreak and pain felt by loved ones of people struggling with addiction.
As a community social worker, I watched people cycle in and out of recovery programs and struggle daily to get to methadone clinics. I listened to a client still suffering from the trauma, agony, and guilt of losing a girlfriend to overdose when they used heroin together almost a decade ago. I saw the shame and guilt of a young father who was only allowed to see his daughter a few hours each week due to his addiction to cocaine. I can still hear the sound of paramedics kicking down the apartment door of a client who we feared had taken an entire bottle of powerful painkillers.
So, what can be done? On a societal level, we need to invest in recovery treatment services and make those services accessible to all who need them. The cost of providing recovery treatment to all Americans with substance use disorders would actually save this country money.8 In other words, the cost of doing nothing is higher than the cost of treatment. Substance use treatment is evolving, but still faces challenges like stigma, low reimbursement rates for services, lack of providers, and provider burnout. I myself experienced burnout, and believe we can do better by mental health and substance use treatment professionals.
On an individual level, we need to change the way we think about addiction. People with substance use disorders have long been stigmatized and marginalized, labeled “addicts,” and deemed to have moral failings that explain destructive habits. This could not be further from the truth, as biology and neuroscience research shows that addictive substances can destroy key emotional centers of the brain, as well as decision-making centers in the prefrontal cortex.9
In addition to familiarizing ourselves with relevant research, we can also start by changing seemingly small things like our language. We need to talk about addiction in a way that recognizes the human being, often referred to as person-first language. As opposed to using the word “addict,” encourage use of the phrase “person who is struggling with substance use.” This shift recognizes that there is a person who is facing difficulties, rather than giving a damaging label that assumes lack of ability to change. I did not work with “addicts”; I worked with Bob, Michael, and Jan [names changed for privacy].
Again, addiction is complicated. While I do not have personal experience with addiction, I have seen its impacts up close in my work. My research and experiences tell me this about addiction: isolation is the cause, lives are the cost, and treatment access and humanism are the answers.
Kaiser Health News. (2018). Purdue and the OxyContin Files. https://khn.org/news/purdue-and-the-oxycontin-files/
Quinones, S. (2015). Dreamland. New York: Bloomsbury Press.
AARP. (2010). Loneliness in Older Adults: A National Survey of Adults 45+. https://assets.aarp.org/rgcenter/general/loneliness_2010.pdf
Primack, B.A., et al. (2017). Social media use and perceived social isolation among young adults in the U.S. America Journal of Preventative Medicine, 53(1): 1–8. doi: 10.1016/j.amepre.2017.01.010.
Bebinger, M. (2020). Addiction is a Disease of Isolation – So Pandemic Puts Recovery at Risk. Kaiser Health News. https://khn.org/news/addiction-is-a-disease-of-isolation-so-pandemic-puts-recovery-at-risk/
Case, A. & Deaton, A. (2015). Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century. Proceedings of the National Academy of Sciences, 112(49).
Panchal, N., Kamal, R., Orgera, K., et al. (2020). The Implications of COVID-19 for Mental Health and Substance Use. Kaiser Family Foundation. https://www.kff.org/coronavirus-covid-19/issue-brief/the-implications-of-covid-19-for-mental-health-and-substance-use/
Recovery Centers of America. (2017). Economic Cost of Substance Use in the United States. https://recoverycentersofamerica.com/economic-cost-substance-abuse/
National Institutes of Health. (2015). Biology of Addiction: Drugs and Alcohol Can Hijack Your Brain. https://newsinhealth.nih.gov/2015/10/biology-addiction