We Don’t Understand The Problem of Substance Abuse
Gene Gilchrist
Louisville, KY
Here is our premise – one reason that so few Americans overcome substance use, abuse and addiction is that we, as a nation, don’t understand the problem. Until we have a better, more informed awareness, too few people are motivated to find the support they need for themselves or their loved one. Let’s see if we can change that and let’s start here.
The seeming increase in reports from the press about alcohol and drug use and abuse is a double-edged sword. On the one hand, raising awareness of substance use and substance use disorder (a broader definition than addiction) creates opportunities for the person suffering the disease and/or their loved ones to act, and creates a greater imperative for public action. On the other hand, these same reports unintentionally reinforce long held attitudes about alcohol and drug use and abuse that create barriers to access to treatment or, worse, reinforce stereotypes that prevent the addict from seeking help.
We all have read these stories, but to make the point let us review one. Specifically, “Detroit drug pipeline targets North Dakota Native Americans. How they’re fighting back”; Story by Beth Warren, Photos by Alton Strupp, September 24, 2021, Louisville Courier Journal. This is an extraordinarily important and professionally written article. Ms. Warren reviews the story of a Native American woman introduced to fentanyl following an injury who subsequently developed an addiction. The article includes reports of the drug cartels that supply the reservation on which the woman lived and died. “The biggest problem we’re experiencing is the Detroit connection, Detroit gangs,” reports the Bismarck, ND police official.
An important and informative report. Fentanyl is a Schedule II narcotic, popular, increasingly supplied by secondary sellers, and is partially responsible for the increase in overdose deaths during Covid and afterward. However, are the other messages contained in the story familiar? The report,
· Involves a young female
· Describes a woman who is an ethnic minority
· Discusses the North Dakota reservation creating images of poverty
· Involves reports of drug cartels including Cártel Jalisco Nueva Generación
· Engages the Bismarck police department making this a “crime” story
· Involves the most recently popular drug in the American consciousness
· Reports about a fatal overdose
None of this is incorrect or problematic in itself. It is accurate, important, and promoting all of this is a service to the public. In the process, however, it also reinforces stereotypes about young, ethnic, poor people and drug cartels when the majority of drug use, abuse and addiction in America involves a much broader portion of the American public. Do these impressions paint a completely accurate picture of addiction in America? To the extent that they do not, do these skewed impressions create a barrier to the majority of substance abusers and addicts to seek and find treatment? Do these skewed impressions create a barrier to an effective, broad based approach to addiction and recovery?
Consider the 2015 member survey from Narcotics Anonymous. The report notes that the membership was :
Average age 48
59% male, 41% female
91% employed, enrolled in school, parenting or retired
Ethnicity: 74% Caucasian
11% African American
6% Hispanic
3% Asian American
1% Native American
Allowing that this is not a random sample of drug addicts but a report from among those in recovery, and the biases that attend, the report shows that NA members, self-described drug addicts, are not young, ethnic, unemployed and crime involved, but match the American population to a great extent. We do not focus on the over representation of whites in this survey as it may reflect unequal access to treatment and, therefore, to recovery.
Consider, too, the use of drugs among the working population. Our analysis suggests that if one tested a normalized sample of 100 employees on an average workday, 44 of them would be at risk of failing that random drug test. That is not to say that 44 would be drunk, high or hung over but that there would be the potential for them to be in that condition. Specifically, accounting for age at the point that risk taking behaviors begin to decline, and gender as women and men metabolize alcohol and drugs differently, of those 44
17 are binge drinkers who run the risk of intoxication or severe hangover
6 are heavy drinkers again the risk is intoxication or hangover
14 are marijuana users
7 are abusing prescription drugs
This is one of the underlying reasons that employers have abandoned random testing. A Forbes report from 2020 noted that only 1.47% of all job postings mentioned required testing after employment. According to Hire Right, pre-employment drug testing has declined to 63%. Our assumption is that pre-employment screening identifies schedule I narcotic users (excepting marijuana) and why we included alcohol, marijuana (a soon to be legal drug although currently a Schedule I narcotic) and Schedule II narcotics in our analysis.
Consider also a 2018 survey conducted by the National Institutes for Health that found that in the past month Americans reported that:
164.8 million used alcohol, tobacco or an illegal substance
139 million reported using alcohol
43.5 million reported using marijuana
3.6% reported abusing a subscription pain reliever
Given these data, the report from Narcotics Anonymous, behavior in the workplace, and knowing that 40 million Americans are suffering substance use disorder, it is highly unlikely that young, minority, poor females represent the majority of substance use, abuse and addiction in America. A 2020 study by the North Carolina Community Action Association sums it up well,
“There’s a misconception out there that drug addicts, regardless of whether it’s prescription drugs, illegal drugs or alcohol, are poor, uneducated and homeless. But the truth is, that’s just not true. Most people struggling with addition live in a home, have a job and have at least some level of education. What causes or leads someone to be addicted or use drugs has more to do with their genetics, environmental influences, mental health, education, stress and parental substance abuse.”
To be certain, this is not a critique of the commercial press. We understand their competition for readers and viewers. Further, reports like that of Ms. Warren are about very genuine issues, historic and inexcusable racism, illegal organizations loosely and not so loosely organized making profit at the expense of the lives of many, many people. They are to be applauded for surfacing these stories and promoting a national awareness of drug and alcohol addiction. Brava!
Our point is that this should not mask the breadth of drug addiction in America. Drug and alcohol use, abuse, and addiction is not only on the reservation or under the highway but in your neighborhood, in your church/synagogue/mosque, in your school, in your workplace, in your neighborhood, in your home. As the addict is advised in treating their disease, the first step in an effective national approach is admitting the problem ---- honestly.
Gene Gilchrist
