It is time to change the narrative on substance use disorder.
I have often wondered what it would be like if individuals in recovery from substance use disorders (SUDs) were genuinely welcomed in their communities.
Until 2023, the national average of opioid overdose deaths has been 100,000 per year. Since then, the national average has decreased, while the numbers in New York State have increased. This might sound like we are winning the war. But, the number of methamphetamine and cocaine overdoses increased during the same time period. Many of them attributed to fentanyl contamination.
In 2021, over 100,000 people in the US died from an opioid overdose. And while that number has declined slightly over the years, it’s appalling that this stark reality never hit the news cycle. Our culture perpetuates the belief that opioid use disorder is a choice. That individuals who misuse opioids are responsible for their circumstances and deserve the consequences.
It’s time for that narrative to change.
The old narrative ignores the role of chronic pain or trauma in the development of SUD, particularly for those prescribed pain medications that initially aimed to ease their suffering. Even these individuals—many of whom sought relief through medical channels—are caught up in the pervasive stigma surrounding SUD.
In many cases, doctors, wary of the potential for dependence, stop prescribing these medications. Patients whose pain tolerance has diminished due to regular opioid use are then left with untreated pain. It is no surprise that some of these individuals turn to illicit substances like heroin or street opioids for relief.
How long could anyone endure relentless, unmanageable pain? Many who find themselves in this position faced a life-altering injury, illness, or condition that introduced daily suffering. When these individuals seek illegal drugs, they are often treated as criminals, ostracized, and stigmatized.
The old narrative also disregards the complex drivers of substance use disorder. It disregards unresolved trauma, family dysfunction, and criminal justice. It disregards the role Big Pharma played in creating the SUD crisis we face.
The old narrative imposes a stigma that’s hard to overcome, making successful treatment difficult and sometimes impossible.
Society’s response frequently involves punishment rather than addressing the root causes of SUD.
Why do we persist in punishing people instead of improving treatment and outcomes? Why do family members, employers, and friends still perceive substance use disorder as a moral failing, believing those affected are inherently inferior?
The media shares part of the blame.
Despite the staggering toll of over one million lives lost to opioid overdoses, the coverage remains sparse. Compare this to the Vietnam War, when nightly news reports tracked casualty numbers daily, reminding the public of the ongoing crisis.
Imagine if opioid-related deaths were similarly reported in every community.
Substance use disorder awareness through widespread education could help dismantle the misconception of substance use disorder as a moral issue, reframing it instead as a complex condition. A medical disease with measurable brain changes. A psychological coping mechanism often rooted in trauma. A societal problem that drives people into isolation.
Until now, the narrative has been one of treating the individual. Those involved in SUD treatment and care often feel the family is the problem, and they discourage including family members in the treatment process.
In my 30+ years of working with substance use disorder, I have rarely seen someone not return to their family of origin. When we accept this, perhaps we can open ourselves to the need to look at substance use disorder treatment from a family and societal perspective.
The impact of SUD on families is one of the missing links. Family members often feel overwhelmed and may inadvertently hinder recovery. However, they can become vital allies with proper education, supporting treatment engagement and long-term recovery.
Although we offer medical treatment for SUD, the stigma persists. This stigma often pushes individuals into isolated recovery efforts, limiting their support networks to others with SUD.
What if recovery-friendly communities embraced these individuals and their families? These communities would be non-judgmental, supportive, and welcoming environments that reduce triggers and encourage recovery.
At the 2024 NAADAC Conference, Dr. David Best introduced the CHIME framework for facilitating recovery change:
- C: Connectedness
- H: Hope
- I: Identity
- M: Meaning
- E: Empowerment
He also outlined the concept of an Inclusive Recovery City (IRC), a model designed to make cities better for everyone by focusing on education, employment, events, training, recovery communities, and service provision. Recovery Dublin and BRIM are already implementing IRC principles.
Expanding this model could encourage innovative approaches to address the medical, social, and economic costs of SUD, from first-responder expenses to hospital and insurance costs. More importantly, it could save lives and alleviate the immeasurable emotional toll of these losses.
We are already beginning to see recovery-friendly communities with the addition of recovery centers. Unfortunately, they are usually exclusive to those in recovery and don’t often include families. They fill a gap but need further expansion and connection with recovery-friendly organizations in the community. When someone in recovery feels safe, they also feel welcome to attend a community event, take an art class, or join an organization without feeling stigmatized.
At Authentic Trainings LLC, we are committed to improving the quality of care and combating stigma for individuals with SUD and their families.
We provide training to clinicians, peers, and other support personnel, emphasizing Motivational Interviewing for SUD, an evidence-based communication style proven effective for SUD, mental health challenges, and family engagement.
Additionally, we encourage treatment centers to involve family members in the recovery process. We also provide critical training on embracing families to prepare staff to integrate families into treatment and care effectively.
We also address the social aspect of recovery through programs like Creating Connections and Community, which integrates expressive arts, mindfulness, and rhythm. Presented at the 2024 NAADAC Conference, this program equips clinicians, peers, and family members with tools to foster deep, non-verbal connections. Feedback from the conference highlighted its value in creating transformative experiences.
The inclusion of Peer support in SUD recovery is another key component in developing recovery-friendly communities. Peers working in the community can hold out a hand to those in active use. They then act as the bridge to recovery.
Peers are critical bridges between the isolation of early recovery and embracing a full life in the community.
If we truly want to address the opioid crisis, it is time to think beyond traditional approaches. By fostering recovery-friendly communities and empowering families, we can create a supportive framework that promotes healing, reduces stigma, and saves lives.
This is how we change the narrative on substance use disorder.
References
- Best, D. (2024). CHIME framework and Inclusive Recovery Cities. Presentation at the 2024 NAADAC Conference.
- Substance Abuse and Mental Health Services Administration (SAMHSA). (n.d.). The science of addiction and recovery. https://www.samhsa.gov.
- National Institute on Drug Abuse (NIDA). (2023). Opioid overdose crisis. https://www.drugabuse.gov
