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JUly 15th, 2019

Substance Use Disorder versus Substance Abuser

Why do we demonize people with addictions? Because we hate what they represent? Because we are afraid of them?

There are many reasons that we stigmatize substance users. What we need to do is look at the issue in modern terms.

At a conference in San Antonio on substance use and treatment, Dr. John Kelly discussed the reality that when people abuse food, we do not call them food abusers. They have an eating disorder of too much or too little. All abuse issues are problems of psychology and epigenetics based on life experiences that have occurred to shape one's psyche predisposing them to self-medication with drugs, alcohol or other substance to numb the psychological pain. We are very clear that substance abuse is not a choice for most people.

As soon as an at-risk individual tries a narcotic drug for the first time, the part of the brain that deals with empathy, social behavior, decision making and complex task organization is turned off leaving a primitive system called the limbic system in place. This is not good and explains why addiction is such a perpetuating issue. The limbic system's primary role is regulating emotion and memory, but also is critical for survival and procreation. You can imagine how when one loses the ability to think clearly and empathically with drug use that they would try to find pleasure at all costs as the limbic system drives the brain's activity. Thus, sex, drugs, alcohol and food become the primary motivators for life.

If the main driver of first drug use is physical, emotional or sexual abuse, would it not make more sense as a society to put more energy into treating the psychological underpinnings of cause? Would we not be better served helping people deal with the life experiences that are damaging their sense of self? The answer is clearly, yes. Fighting the drug war from the police and government punitive side has yet to show effectiveness. We need to, as a society, help people that have psychological abuse scars.

I encourage everyone to identify and help any child with abuse concerns. Whether you are a family member, friend, coach or scout leader you have an opportunity to intervene in a non-judgmental kind of way. Encourage them to seek counseling. Encourage them to never take the first pill or drug. If a child's behavior has acutely changed for the worse, think of bullying or abuse. Don't wait to intervene until they have tried the first drug or start drinking. Remember that prevention is always and will always be the best and most effective way to keep a society healthy whether it is with drugs or other concern.

Dr. M