I like to think that we are making great progress in the fight against the stigma of mental illness -- a fight that is necessary to ensure that people of any age with psychiatric or learning disorders feel comfortable getting the care they need. Once-taboo issues like depression, bipolar disorder, PTSD and dyslexia are now out in the open, and everyone from pop stars and movie stars, to soldiers and professional athletes, are comfortable admitting their problems and seeking help. We've come a long way.
But we still have a long way to go. Even those who are kind, caring and non-judgmental when it comes to most psychiatric disorders, from selective mutism to schizophrenia, may change their tune when talk turns to drug abuse and addiction. "Drunks," "junkies," "stoners" -- we look down on them because they "chose" to become addicted to drugs. They "chose" to ruin families and relationships. They made a "choice" that cost them their lives in an overdose.
This "choice" is a false one. Drug abuse and addiction are tragic things, but they are not character traits. Just as depression is a no-fault mental illness, so is addiction. And just as depression can tragically lead to suicide, so addiction can lead to self-inflicted death by overdose. They are both mistakes -- profound mistakes -- that the illness makes people more likely to make. But we can, should and must help suffering young people avoid them. This means tackling addiction, which takes the lives of people every year. But how?
A recent New York Times article tells the sobering story of an Ohio county in the grip of a prescription drug abuse epidemic that has taken the lives of many young people. In the article, Sabrina Tavernise lays out some devastating statistics: In Scioto County, almost 1 in 10 babies test positive for drugs at birth. In Ohio as a whole, overdoses have long since outpaced car accidents as a cause of death. Prescription drug addiction across the nation is "now killing more people than crack cocaine in the 1980s and heroin in the 1970s combined."
I don't have to say that the drugs abused tend not to be medications for diabetes or high blood pressure, depression or schizophrenia. They tend to be habit-forming pain medications, like the OxyContin that has claimed dozens of lives in the town of Portsmouth, Ohio.
The suggestion is that the declining economy -- locally and nationally -- has brought on this tragedy, and urban decay and loss of industry are certainly at play. But the article fails to recognize that the root of much prescription drug misuse is untreated mental illness, which not only can lead to drug abuse but can also be exacerbated by environmental factors, like poverty. Anxiety and depression can come unbidden, but can also be triggered by adverse experiences.
It's the same way with addiction, which is just as much a problem of the mind. Self-medicating with prescription painkillers in stressful situations -- what we call a maladaptive coping mechanism -- starts many drug abusers on the road to serious problems. In the community Sabrina Tavernise writes about, the abuse is so ubiquitous it is surely a law enforcement issue. But behind the law enforcement issue and tangled with the economic issue is a mental health issue. Tavernise notes that Ohio's governor has pledged $36 million to address the drug problem through prevention and rehabilitation, which I applaud, but what constitutes prevention? Locals want more direct police intervention, shutting down clinics that (perhaps unlawfully) dispense pain medication and the like. But the problem is more deeply ingrained in the people, nuanced and immune to the number of cops on the street.
"We're raising third and fourth generations of prescription drug abusers now," the Portsmouth police chief tells Tavernise. These problems are deeply rooted in families -- just as some other psychiatric disorders can be -- and the only way to reliably prevent them is to both intervene early with kids and treat the whole family in order to mitigate the influence of a potentially corrupting disease. The goal is to make the family what it should be -- a nurturing, positive force.
Not everyone who commits suicide is mentally ill, but mental illnesses, like depression and bipolar disorder, make people feel hopeless and therefore much more likely to commit suicide. Likewise, not everyone who overdoses is addicted, but addiction greatly increases the likelihood of overdose. The bottom line is that addiction is an illness that we are able to treat and manage, if not cure, provided that we focus on the person with the addiction, the family and the community -- a holistic approach to a sprawling problem.
"I miss her so much," says the mother of an addict who was murdered by a home invader looking for pills. "If you had 100 kids, you'll never replace the one you've lost."
For this mother, I think the crime might as well have been an overdose or suicide. Her child is gone because of addiction. Let's help make sure no more children are lost to this disease.
Harold S. Koplewicz, M.D. is a leading child and adolescent psychiatrist and the president of the Child Mind Institute. For more on depression, substance abuse, and how the two can go hand in hand, go to our website, which offers parenting advice and a wealth of information on childhood psychiatric and learning disorders.
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