The EMTs would come, quickly rolling a gurney through the foyer, pulling back the casters to get it up the stairs. “Ma’am? Hi ma’am, can you hear me?” They’d try to rouse her with blue, rubber-gloved hands and a small flashlight. Holding open her eyelid, they’d shine the light into her pupil, forcing it to retract. But, she would never blink.
The attending police officer would ask the usual questions: “Could you spell your mother’s name? Date of birth? Is she on any kind of medication? Can you describe to me what happened?” Always matter-of-fact, always impersonal.
There were many nights like this: clipped talks with the police, emergency trips to the hospital, blood, booze, and pills.
My entire life, I’ve felt a sense of anger toward my parents; my father also developed alcoholism while I was in my teens, though he was the quieter drunk, falling asleep at the kitchen table or taking a six-pack to the parking lot of the local bank and drinking until he stumbled home. They made my life a living hell, and I told them so all the time.
But, their addiction wasn’t their fault — not just because addiction is a disease, which it is, but because we’ve never treated addiction like a disease, either culturally or in our health care system.
"That’s like taking people with diabetes today, not giving them insulin, not giving them any counseling for behavioral change, and telling them to go meet with a support group,” says Foster.
Addiction further detached from the health care system in the 1980s during the crack epidemic, when incarceration became the "method" of choice for dealing with substance abuse of any kind. So, addiction treatment started to look like this: A person dealing or taking drugs would get arrested, convicted, and sentenced. The government would pay for the inmate’s treatment, either while in prison or at an outside institution. As a result, addiction facilities developed a dependence on government dollars and a fee-for-service payment system. Instead of becoming a component of the health care system, addiction treatment became its own institution with its own set of standards — none of them medical.
Both of my parents frequented these kinds of programs. Not just rehabs, but also detoxes, psychiatric wards, and Alcoholics Anonymous meetings. (There was a time when “detox” referred to a facility where you'd go to get sober — not a juice cleanse.)
Maddeningly, I watched my mother stay clean for 18 months, only to watch her relapse after a job interview and retreat back to the depths of addiction for another 10 years. I shamed both my parents for not getting sober and, in doing so, probably made the problem a lot worse.
Before one of his many visits to rehab, my father went to a detox center where doctors monitored him while the alcohol worked its way out of his system. Detox is meant to be the place you go before “real” rehab, but some people simply cycle in and out, never quite making it to the next step. When my father did get to rehab, he was there for 30 days. Little did I know then that the “rehabilitation” he was receiving amounted to little more than a 12-step program; most activities were limited to group therapy, religious ceremonies, and counseling. Some drug rehabilitation centers keep a social worker on call, but often they simply employ addiction counselors and are not required to have a physician on staff.
“The minimum requirement for an addiction counselor in most states is a GED or a high school diploma,” says Foster. These individuals can’t prescribe medication, and chances are they’re not required to keep up-to-date on the latest addiction studies or behavioral therapies. “You have largely a group of people who, while most are incredibly hard-working and very well-motivated, are struggling with limited resources and no medical training to provide care for people with a complex disease.”
According to the National Institute on Drug Abuse, roughly 23 million Americans in 2012 needed treatment for addiction, but only 10% received it. Though the Diagnostic Statistical Manual classifies addiction as a chronic medical problem, it's still most commonly treated with group therapy and conventional wisdom.
There’s also a long-held belief that you have to let an addict “hit rock-bottom” in order for him or her to recover. This myth reflects the influence of a non-medical, anecdotal approach to addiction recovery. It’s especially problematic because many addicts aren't just addicts; they suffer from co-occurring mental health issues, too. Could you imagine letting someone with depression hit “rock-bottom”?
“There are actually some states that don’t allow an addiction treatment provider to hold a license to provide mental health treatment simultaneously...[it's] really hard to understand why that is allowed to continue,” says Foster.
Both NIDA and CASA are trying to change the way people think about and treat addiction. In some ways, this is as much about changing public perception as it is about changing the health care system. “We have to go through the same process as we do for every other disease. Let’s do the diagnosis, let's do the assessment, let's do the treatment plan. That is a routine part of health care practice, but it is not a routine part of addressing addiction,” says Foster. The Affordable Care Act is also making progress by requiring health insurers to cover addiction treatment, which encourages providers to amp up services and increase access.
My dad is coming out of another round of rehab this year. I have a lot of hope that he’ll stay sober this time, because it seems like he’s developing some good habits. But, he could relapse just as he has 100 times before. This time, however, he might actually get medical treatment if he relapses — and maybe even some acknowledgement that his problem is a disease and not a character flaw.