You Really Have to Want it to Get Better

Over the years I have found myself becoming increasingly careful in how I answer the question, "What do you do for a living?" That may seem like a simple question that carries with it an equally simple answer, but for me, the answer to that question is full of possible trip wires and booby traps. You see, when I tell someone, "I work with people who have alcohol and drug problems," I get back everything from an awkward, "Oh, that's nice" to "My mother died of alcoholism last year." Others try to defend why they drink or use certain drugs. Some launch into the "I know this guy..." scenario.

In reality, everyone has been exposed to alcoholism and/or drug addiction through a family member, friend, co-worker, or neighbor. Because of that, everyone has experiences, thoughts, and usually opinions about the issue. Probably the most common response I get is, "Isn't it true that a person has to really want it in order to get better?" Of course, that's not really a question as much as it is a declarative statement. Then the "you-have-to-want-it-to-get-better" comment is followed up with something like, "I have an uncle that's been to treatment six times and he's still drinking and using drugs. He just isn't motivated."

These comments and questions are all understandable because each person that has an experience with someone else's addiction has often had a heartbreaking and emotionally painful time with that person. It seems as if that person struggling with alcohol or other drugs should just be able to quit. "Come on, if you love your kids, you'll quit. I would."

That last phrase is really the key. Unless you've had a substance use problem it's difficult to understand how this condition defies logic. A normally intelligent, motivated, skilled, well brought up, successful person shouldn't have this problem and if she does, she should be able to climb out whenever she wants. Right? Wrong.

To quote a cliche, "This is an equal opportunity disease" and anyone can get it. In addition, for those that do get it, making it back to sobriety and recovery is often a long road full of frustration and relapse. But it's not because the addicted person is weak. It's because the addicted person, if truly addicted, has a brain disease. That means that the drug "hijacks" the brain by changing the brain chemistry. In other words, that altered brain is in some ways not the same brain that started using years or even months ago. The addicted brain says, "You don't have a problem." It says, "You don't need help." It says, "You need more drugs."

This is why an addicted person can't just stop by force of their own will. That's not an excuse but it is a reason that must be understood in order to better understand the addictive process and how people get better.

The War on Drugs

In 1989, the first President Bush declared "war" on drugs. It didn't require Congressional approval but everyone seemed to agree that declaring a state of war on a drug was the right thing to do. We were facing a very ugly cocaine epidemic (not that any drug epidemic is pleasant) and the popular opinion of the day was that we needed to take decisive action against this enemy that was attacking our very way of life and taking hostage many that we know and love. Good reason for a war.

Unfortunately, when we are feeling threatened and upset, a declaration of"war" actually feels kind of empowering and that it will solve the issues at hand. In fact, if you listen to people talk about our society's ever constant problem with drugs you hear language that is spoken like a combat leader who wants to rally the troops to the cause. We talk about "beating"drugs or the drug problem. We talk about "deploying" agents and delivering a "significant blow" to "the bad guys." We talk about drugs as a "scourge"that needs to be eliminated.

It's not that this language is totally off the mark but it's the "war room"mentality behind it that is at issue here. Here are my reasons for not wanting to call our effort to address drugs and addiction a "war."

1. This isn't a real war. Last time I checked, a war has a beginning, a number of battles, and an outcome that usually has a winner and a loser. Other than the 100 Years War several centuries ago, most declared wars don't last more than 4 or 5 years because nobody can last that long. This one has been going on for 20 years and with no end in sight.

2. Using the term "war" makes people who use drugs the enemy. We already have enough trouble trying to figure out who's who in this mess. The addicted people in our country may do crime and sometimes they deserve to be punished by society but the majority of those who are addicted need to be treated for their condition so they can get the help they need and not re-offend. Those addicted people who are locked up, only, have a very high rate of re-offending while those that get help have a more positive outcome.

3. Prevention and treatment work. Study after study have shown that for every dollar spent on prevention and every dollar spent on treatment saves many times that amount in savings to society. We can't arrest or fight our way out of this "war" but we can make significant progress through prevention and treatment, in concert with the juvenile and criminal justice systems.

4. Finally, science has shown us in the last 10 or so years that chemical addiction (including alcoholism) is a brain disease. Simply stated, this means that those who are addicted have a disease that requires treatment and that leaving that condition to run its course is about as effective as telling a diabetic that needs medical care to try harder next time.

Instead of waging war on drugs and, ultimately, on the drug user, let's develop a full approach that includes treatment, education, prevention, and law enforcement. The time for emotional responses that follows our intuition and our need to "attack" the problem is over. We need to combine all efforts to address strategically and intelligently the ever present problem of drug abuse and addiction in our country and in our society.

Methamphetamine - "Haven't we already dealt with that?

Methamphetamine or "Meth" as we more affectionately call it has been in our collective consciousness in northern Nevada for at least the last 5 or 6 years. We've been exposed to stories of thin, unkempt young people with scab and pock marked faces, dental issues that defy description (and that are a major gross out), and an insatiable compulsion to use the drug despite the inevitable consequences. We have been shown people who give up spouses, careers, and even their children to use this scourge of a drug.

Beginning in about 2005, the Washoe County community rose up in heroic fashion to face this menace to our children and to our very way of life. So much has been done, including millions of state dollars allocated by the Legislature in 2007 to increase prevention and treatment efforts, formation of the Washoe County based Meth Community Response Alliance in 2005, media campaigns such as "Crystal Darkness" beginning in early 2007, the "Break Free, Live Free" video produced by the Washoe County School District and shown to thousands of students in 2005 and 2006, the statewide "Most of Us" media campaign, a full spread in the Reno Gazette Journal in 2005, community trainings, and so much more. For quite some time, Meth was the "talk of the town." To our credit as a community, we rose up and met the challenge and, in my opinion, we have been successful.

We can see that lifetime use and use in the last 30 days of Meth by Washoe County students has gone down. Meth related admissions to treatment facilities skyrocketed in 2004-08 but now have evened out. Many youth report that they think of Meth as a "dirty" and dangerous drug. Meth labs, those iconic symbols of all that is wrong with Meth use, have all but disappeared in Washoe County and in Nevada. All of this is cause for celebration. I believe we could build a great case based on the information I just provided that the Meth problem has been significantly impacted by all of our efforts.

But has Meth really gone away? I think if you ask the average person, they'll say, "Sure, it's on the way out." In fact, I really think that many people not only think that Meth is becoming passe but they also are a little tired of talking about Meth as a topic. You might say that it's old
hat.

However, if you are of the opinion that Meth has been "whipped," consider this:

1. In January of this year, the Reno Police Department confiscated 15 pounds of Meth in one arrest. That's really a lot of dope! They've had at least one other large bust this year and others which I'm not aware. Check the police blotter in your local paper and see if Meth is mentioned in any of the arrests.
2. Treatment centers in Washoe County and northern Nevada are still treating people with a primary diagnosis of amphetamine abuse or amphetamine dependence, meaning that there are still people out there using the drug and having trouble with it.
3. Anecdotally, I still hear almost daily about people that have a current Meth problem.

Despite these facts, I still say that what we all have been doing to address Meth has helped but the real issue is not whether we are going to win this "War on Meth." I don't even like to call it a war because this is something that has been with us off and on since amphetamine was first developed in the 1880s. We aren't going to totally conquer it but we are going to cause use to go down and we are going to help people get the help they need to address their problems with the drug.

With the emerging prescription drug trend, it's easy to forget about Meth. It's easy to be tired of talking about it. "Haven't we already dealt with that?" But while we begin to address prescription drug use, we need to keep our eyes on Meth to make sure that the gains we've
made stay there and that we can make even more progress in that arena.