On the surface, they couldn’t be more different. A lawyer and son of the current United States president. A high school athlete and father whose life gained national attention because of the gut-wrenching way it ended. And a multiplatinum rapper and actor who is currently on a ventilator, fighting for his life. The common thread among these individuals was the illness they battled throughout their lives for which they were shamed and judged: substance use disorder (SUD) or addiction.
Today is the release date of Beautiful Things, a memoir by Hunter Biden. In it, the oldest surviving son of President Joe Biden describes the pain of losing his mother, baby sister and big brother; the dissolution of his marriage; as well as his decades-long addiction to – and ultimate recovery from – alcohol and crack cocaine. Like most people with an SUD, Biden went to extraordinary lengths to score his next hit, from staying in cheap motels to being held at gunpoint. His ordeals with addiction-induced indignities are not unique.
“Combine [grief] with addiction and it is a really hard thing to overcome,” said Hunter Biden. “I was basically drinking myself to death.”
The reality is that alcoholism is common … and it’s tough to treat. “Alcohol use disorder is more common than all other substance use disorders combined (except for tobacco),” according to Richard Saitz, MD, MPH, DFASAM, Professor, Boston University School of Public Health. “Yet because drinking is legal and socially acceptable, it gets less attention and concern.” There is hope: “Although no single treatment leads to improvement in the majority, long-term, comprehensive treatment with multiple modalities including medications constitute the best approach,” according to Dr. Saitz, Senior Editor of the Journal of Addiction Medicine.
George Floyd Shapes the Addiction and Race Narrative
The ongoing murder trial of former Minneapolis police officer, Derek Chauvin, is shining the spotlight on the opioid epidemic. Courteney Ross, girlfriend of George Floyd, tearfully described their mutual struggle with chronic pain which led to an opioid use disorder (OUD), a.k.a. opioid addiction. Floyd was in recovery but then returned to using when he lost his job as a security guard due to the pandemic. He had overdosed, became hospitalized and was diagnosed with Covid-19. On the day he died, his airway crushed by Chauvin’s knee, a toxicology screen was positive for the potent opioid, fentanyl, as well as methamphetamine.
“Addiction,” testified Ross, “is a lifelong struggle.”
While inappropriate use of opioids can lead to overdose, it should be noted that the vast majority of people with chronic pain who are prescribed opioids (e.g. oxycodone, Percocet, Vicodin) take them as prescribed. In fact, people with chronic pain continue to be misunderstood and undertreated – particularly among Black patients.
Rapper DMX Isn’t the Only Artist with Addiction
Born as Earl Simmons, the 50-year-old singer-songwriter and groundbreaker in the rap community had always been open about his struggles with drug use, which started with crack cocaine at age 14. While the scientific basis of his treatment is not known (other than multiple stints in rehab), like fellow Black American Floyd, DMX faced criminal consequences for his drug possession and use. As of this writing, Simmons remains in a vegetative state. Sadly, many other musicians have succumbed to their SUD, including Juice WRLD, Prince, Whitney Houston, Chris Cornell, Tom Petty and a long list of other talented artists lost to a treatable disease. Stigma, shame and fame collided and contributed these preventable deaths.
Addiction Transcends All
The reality is that SUD transcends age, race, ethnicity, gender, national borders, socioeconomic status. According to the American Society of Addiction Medicine (ASAM), addiction is a chronic, relapsing and remitting disease of the brain that causes compulsive drug-seeking and use despite harm to the person using or to those around him or her. Addiction is NOT a sign of moral weakness or failure. In fact, most people with an SUD, once connected to the appropriate treatment and recovery services, get better. Just like people who are successfully treated for other chronic diseases such as diabetes, lupus and kidney disease. And you certainly don’t have to wait to hit rock-bottom before getting help. We don’t wait for people with high blood pressure to suffer a debilitating stroke before we decide to treat them.
“Science has given us the tools necessary to understand addiction as a disease and provide effective, often life-saving treatments for people with substance use disorders (SUD),” explains Yngvild Olsen, MD, MPH, DFASAM, Medical Director of the Institutes for Behavior Resources, Inc. “Yet, society too often still thinks of people who use drugs as moral failures who deserve punishment, not compassion. We need, and can, do better. Shame and stigma have no place in science, and certainly no place when it comes to treating people with SUD.”
The Racial Divide
Black Americans are disproportionately punished and criminalized for their drug use versus their white counterparts who are more likely receive treatment and care. Prior to the current opioid epidemic which often portrayed white Americans as falling prey to highly addictive pills leading to a chronic illness, Black Americans addicted to crack cocaine were shamed, arrested, incarcerated and killed. Compassionate, evidence-based treatment was rarely an option. This archaic and racist approach must change.
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I believe we have reached a focal point. Just as Floyd’s death sparked a global civil rights movement over racial injustice, my hope is that the trial over his unlawful death along with Biden’s experience and DMX’s critical condition, will prompt a national dialog about drug and alcohol addiction including progressive, evidence-based drug policies and treatment rooted in science, empathy and harm reduction approaches. There are several measures we need to take:
We need to reframe the way we view people who use drugs. They are not criminals.
We need to stop using stigmatizing language such as “addict,” “drug abuser,” “dirty,” “clean,” “junkie” and a laundry list of other harmful, derogatory terms used to describe people with a chronic disease.
We need to deregulate and increase access to lifesaving medications, methadone and buprenorphine (a.k.a. “Suboxone”).
We need to de-schedule marijuana as a Schedule I Controlled Substance.
We need to integrate addiction treatment with general medical care.
We need to improve treatment for chronic pain and mental illness.
We need to address structural racism head-on in every sector from government and law enforcement to medicine and social services.
Let’s follow data-driven guidance from the National Academy of Medicine which proposed the 4 C’s as a solution to the addiction treatment landscape: Capacity, Competency, Consistency and Compensation. As an internal medicine and addiction medicine doctor who’s been on the front lines of both the drug overdose and coronavirus pandemics, I am hopeful that society is moving in the right direction. But we need to be faster and better.
