The Opioid Scourge and the Disease Metaphor for Addiction

The "opioid scourge" and government intervention: full of sound and fury (and sound bites, empty gestures, and taxpayer dollars) destined to accomplish nothing.

The “opioid scourge” has become the disease du jour in the media and in statehouses and courthouses nationwide (See Vermont, Pennsylvania, New Jersey, Baltimore et al.).                   

In 2014 Vermont Gov. Peter Shumlin devoted his annual address to Vermont’s opioid epidemic. State lawmakers appropriated $760,000 to fund his initiatives to steer low-level lawbreakers with drug addictions into treatment rather than jail. 

These diversionary programs differ in minor details but generally people committing crimes indicative of drug addiction are encouraged to enroll in a substance abuse program in lieu of prosecution.

The assumed benefits are to reduce the stigma associated with addiction and a criminal record, the availability of counseling, housing and employment support services, and lowered costs of prosecution, incarceration and probation.

Some prosecutors are not enamored of what they consider to be a soft-on-crime approach, voicing concerns about recidivism and public safety.

Geoffrey Norman, in an August Wall Street Journal op-ed, painted a less than buoyant portrait of Vermont’s initiative. “There is no sense that the crisis has passed, or even eased. One hears talk of the need, always, for more education, more treatment, more enforcement. Cynics -- and there are many -- say that Vermont’s biggest growth industry is methadone clinics.”

A Facebook friend’s Jan. 5 post recounts her experience as an alcoholic (one type of addict) and multiple DUI offender. Five years to the day earlier she was sentenced to 20 days’ incarceration, 70 days’ house arrest, and five years’ probation for her second DUI offense.

“My addiction turned me into a broken, horrible person who did amazingly stupid things. Maybe if my sentence for my first DUI had been a bit harsher I would have stopped being drunk behind the wheel when I was blacked out drunk... maybe not though.”

Her narrative is a compelling argument for abandoning the pretext that substance abuse is an illness and “struggling” and “troubled” addicts its hapless victims. “Struggling” and “troubled” do not describe addicts I have known. 

Rather, their purported “disease” bears a striking resemblance to a bad habit forged by a lifetime of self-centered, impulsive, and damaging choices.

This well-intentioned but scientifically suspect shifting of personal responsibility from an individual’s choice to a “disease” inadvertently delays recovery and metastasizes the problem.

As my Facebook friend learned (“maybe if my sentence for my first DUI had been a bit harsher”), rather than immediately suffer the consequences of her poor choices, both the active user and the embryonic adolescent get a “get-out-of-jail free” pass for their excesses, putting both the addict and the public at risk. 

Of greater concern is the danger that the “disease” model has contributed to the deaths of more addicts than died in pre-enlightenment days when substance abuse was widely considered a character flaw. 

The disease model delays (often fatally) the moment of truth that every addict that hopes to recover must face: the realization that he alone is responsible for his situation and that he alone must choose to do something about it. Many, perhaps most, don’t, but practically every recovering addict can recall that fateful moment. 

My friend continues,” I know my experience has shaped me and taught me valuable lessons in humility, acceptance, faith, accountability, and above all gratitude.”

“I know there is an easier way and a lot of pain can be avoided if we’re willing to surrender sooner. I wish I had.”

“But I got through these last 5 years. More than that… I LIVED!

“I know change and recovery are both possible. I know I couldn’t do it -- and never will be able to -- on my own."

She credits God, her twelve-step program, and her family and friends as the post-incarceration underpinnings of her sobriety. 

I predict that two years hence, the nation’s opioid epidemic will continue unabated, millions of taxpayers “treatment” dollars will have vanished, and lawmakers like Governors Shumlin and Wolf in Pennsylvania will be pleading for more education, more treatment, more dollars for the “disease.”

While the body count continues to soar among its “victims.”

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