Mike Thinks: NIDA Director Nora Volkow: How Health Communicators and Journalists Can Help Replace Stigma with Science

Drug addiction affects us either indirectly or directly in some way. To say that it does not, is not really looking at the whole picture. Statistics of death and addiction from drugs are all over the news along with stories which stigmatize people who suffer from drug addiction. These actions are not only not helpful, but actually can result in greater drug use and distortion of the problem at large. Director Nora Volkow is very familiar with these distortions on behalf of the news. She wrote a letter as director of the National Institute of Drug Abuse (NIDA) to spell out the issue at large:

Director, NIH's National Institute on Drug Abuse (NIDA)

No matter how much progress we make in understanding addiction and how to treat it, my colleagues and I in the field of addiction science keep running into the same obstacle: There are still people who believe addiction is a moral failing that could be solved if the person had more willpower. In fact, the science is clear: Addiction is a chronic, relapsing neurobiological disorder caused by changes in the brain that make controlling drug use extremely difficult, even when an individual knows it has terrible consequences for his or her life and health and wants to stop. It goes well beyond willpower.

Sadly, the drug seeking and related behaviors that typify this disease—which can include lying and failing to meet work and family responsibilities—can make it challenging for loved ones or care providers to have compassion or empathy, and this reinforces the misconceptions. The resulting social stigma can make it difficult for those suffering with addiction to ask for help and can make them less likely to get the help they need when they do summon the courage to ask.

Indeed, only a fraction of people with substance use disorders seek out or receive treatment. For example, in 2015, an estimated 21.7 million people aged 12 or older needed substance use disorder treatment, but only 2.3 million received treatment at a specialty facility. Even those who can access affordable treatment often find themselves in a rehab facility that does not use evidence-supported treatments, such as buprenorphine or methadone for opioid addiction.

I have imaged the brain of addicted individuals for decades, and through these studies I have seen how drug use and addiction changes activity in the brain. Though drugs act by activation of brain reward circuits, which generates the high and the euphoria, their repeated use leads to adaptations that makes them increasingly less sensitive to both natural and drug rewards. The result is that the person no longer experiences pleasure in response to natural rewards—such as food, sex, or positive social interactions—and loses the motivation for achieving these rewards. In parallel, drug use renders brain circuits that control stress responses more reactive, making the person more vulnerable to stress and negative moods while also impairing frontal cortical areas of the brain that enable self-control and decision-making. These changes make it harder for someone with an addiction to manage stress, control impulses, and make the healthy choice to stop drug use.

How Communicators Can Help

Many science journalists go to great lengths to report the science behind addiction, but others do not, perhaps because they believe they have a commonsense understanding of substance use and addiction. But we are often misguided when we assume that our own experiences translate to someone else’s. Most people who use alcohol or drugs never become addicted, and there are many individual biological, social, and psychological factors that influence one’s risk.

Journalists can help reduce the stigma toward addiction by providing information that helps the reader understand the person suffering from addiction rather than writing stories that generate anger and disgust. Increasing the public understanding of the underlying pathology and cultural reinforcers of addiction is a critical first step for improving the way our society addresses addiction. Journalists can now dig deeper and ask how we can facilitate a more compassionate public health-based approach to those suffering from addiction.

There is no immediate solution to solve the ongoing problem of drug abuse and addiction. As I said in a previous post, I am a member of Alcoholics Anonymous (AA). I say this because there are routes which are not highly publicized which lead to viable solutions. One of the best solutions is one drug/alcohol addict talking to another. Just like one person casually asks a network of friends what are the best solutions to issues at hand, an addict can get help from another addict in AA.

The power behind the AA program is that there will always be an 'ear' available to listen and help you when in need. There are a whole host of AA meetings throughout the United States (and world for that matter) to give a person an ample change to get help. What AA will not do for you is provide a solution which is 'effort free'. Sobriety is great but work too. Living life on the straight and narrow as is said takes work and dedication. The framework behind AA gives a person the opportunity to live a wonderful life. I highly recommend trying the program if in need.

With that being said about treatment, there is a lot of room for improvement on the Journalism front. What is reported in the news is highly stigmatized -- which upon entry is counter to what you learn about the program. Further, alcohol addiction is not very much different from any other addiction. As indicated by Director Nora above in the letter -- activating the brain 'rewarding circuits' can be achieved by a number of 'vices' - which can lead easily to addiction. Traditionally, drug/alcohol addiction is stigmatized the greatest in the news and society.

In closing, I will provide an example. Think of a person riding their bicycle around town -- an adult. At first sight, if the cyclist is not wearing lycra (spandex pants), a common perception is that person got a DUI - driving under the influence of alcohol. That designation stigmatizes the person into a negative category. Instead, maybe the person just wants to incorporate a little exercise into his/her commute by riding a bicycle around town. Instead, a potentially good situation has now been perceived (and quite possibly reported) as a negative situation.

Further, reporting on the negative stigma might persuade a person (separate person from the cyclist) not to pursue riding a bicycle -- making a better change for their health. That is one example which serves as evidence of a need to change how reporting on society could link drug/alcohol addiction to a problem which does not exist. That is one example - perception. What about science?

The science behind addiction treatment has been changing over the last couple of decades. Medicines do exist to curb addiction to alcohol along with other drugs. The efficacy of these treatments by themselves is severely under reported. Treatments only can take an addict so far. Common treatments (drugs, short term treatment) are usually coupled with other treatment methods from the medical community -- psychiatry and psychology. More could be reported on this front to provide solutions to people.

Other medications are being developed to treat people with addiction on a long term basis. These medications are still being developed or are in clinical trials. Why not report on these medications? Society needs to understand where each field is at presently. Otherwise, why should anyone expect viable treatments to be funded in the future. Journalists could change how they portray situations and drug/alcohol abuse in general. Maybe then, more people might find the help that they are in great need of.

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