Editorial: Heroin is a disease, not a choice

Heroin addiction is not a choice; it is a disease.

Accepting that simple statement will change – for the better – how we respond to this worsening crisis. It will affect how police respond, what kind of laws we pass, how we fund treatment and how we help the addicted and their families recover their lives.

It’s an attitude shift that could result in a swifter, more coordinated response to an epidemic that is killing hundreds in our community each year and damaging the lives of many more.

With the help of a task force of experts, parents and others, WCPO is advocating for solutions to the crisis. Through the year, we'll look at addiction treatment, funding, legislation, enforcement and more, with a view toward potential solutions. An acknowledgement that addiction is a disease, and not a moral failing, is a first step. Taking that step can open the door to better answers and solutions that are effective yet at the same time compassionate. 

Professional medical organizations have actually acknowledged for years that any addiction -- including alcohol and crack cocaine -- is, in fact, a disease, one that rewires the brain, which then causes a compulsive drive for more drugs.

Addiction is defined as a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences. -- National Institute on Drug Abuse

Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. -- American Society of Addiction Medicine

The U.S. Centers for Disease Control and Prevention has called the heroin and the related prescription painkiller crisis an “epidemic,” a term reserved for a rapidly spreading disease.

But even still, some doctors, treatment professionals, law enforcement and certainly the general public have yet to recognize heroin addiction as a disease and one that requires medical treatment as surely as does heart disease, diabetes or asthma.

If the world treated addiction as a disease, change would happen. Look at how we view heart disease. Yes, people make bad choices, smoking and overeating, that contribute to heart problems. But once they have the disease, it's treated as a medical problem. Drugs are prescribed; surgeries performed; the patient is monitored regularly by doctors. If they keep getting sicker, efforts are redoubled to help them get better. We raise millions for research through walks, runs and other fundraising tactics. It is considered a public health issue.

But treating the disease of addiction is hindered by arrests, jail time, a lack of treatment, relapses that go unchecked. We don't view this complex disease through the same lens that we do other medical problems. In fact, our attitudes can be downright harsh. Take a look at the world of social media, which is filled with opinions about addicts.

This is a recent post on WCPO’s Facebook page:

Addiction is a CHOICE. Cancer is a disease, hepatitis is a disease, choosing to snort or shoot a substance is a choice. When are people going to own up to their consequences for their choices than blaming others? People who use don't think of the people it affects, just the 2 hour high.

We need a change in attitude, a change in our thinking. That will drive change among our elected officials, police and treatment professionals: a change that will free up money for treatment centers, create better laws, reform treatment methods and create a more supportive community for those suffering.

In this video, Erin Winstanley, a University of Cincinnati researcher and member of the WCPO task force, talks about how community attitudes are hampering addicts' efforts at recovery. "People make bad decisions. That doesn't mean they should pay with their lives," she says.   

The science of addiction disease is complex, but at its core, simple. For an in-depth analysis of it, read this Jan. 28 article published in the venerable New England Journal of Medicine. The conclusion: “Research guided by the brain disease model of addiction has led to the development of more effective methods of prevention and treatment and to more informed public health policies.” 

More informed public health policies. That's exactly what we need now.

The science of addiction has a lot to do with brain neurons, white matter, receptors and synapses.  But the essence of it is this: Doing heroin and painkillers changes the brain. That, in turn, changes how people behave so they lie, steal and even commit violence to keep getting the drug.

It is considered a brain disease because drugs change the brain; they change its structure and how it works. – National Institute on Drug Abuse

“When these (brain) changes happen, people’s motivation and values shift. In that sense, they become different people.”
-- Dr. Jeffrey Goldsmith, Cincinnati physician, president of the American Society of Addiction Medicine

Some argue that taking that first dose of heroin is a choice. But research shows that those who become addicted are already predisposed to addiction, either from genetics or the environment they live in.

"There are biological ways that you can inherit and pass on the vulnerability to addiction."
-- Dr. Goldsmith

Because this disease is so complex, successful treatment is extremely difficult. An addict can’t just take a pill every day to manage the disease. They can’t just undergo surgery and expect to live a healthy life again with a few checkups down the road.

This complex disease demands a complex treatment. Successful treatment (and success, unfortunately, is too rare) often includes a combination of medication, counseling, therapy, and support over a long period of time, maybe a lifetime.

That's expensive, time-consuming, frustrating and difficult. It’s very easy to give up. But we can’t quit or turn away as a community. There are methods and treatments available and laws that need to be passed that can help quell this crisis.

The effort will get the support, money and long-term dedication it needs if we can begin to see the addict not as a "good-for-nothing" but as someone who is suffering from a disease and needs help.