About 23 million people in the U.S.—about 9% of us—suffer direct physical, mental, and social harm from drug or alcohol overuse or addiction. Many millions more experience secondary consequences from a loved one’s illness, disability, imprisonment, or death. I’m among the millions who have watched as a dear family member gradually lost himself, his promise, and his life to substance abuse. It feels hopeless sitting beside a loved one dying of cirrhosis, or waiting for a child, parent, or friend to finally go too far, winding up dead alone. Lacking training, power, and resources, individuals usually are helpless to intervene. But at a society-wide level, our typical responses to substance abuse have let us avoid responsibility for what we could do.
Think of three common perspectives on addiction. There’s the AA-derived perspective: the addict has to hit bottom, take responsibility for herself, accept her own helplessness. There’s the common medical ethics worry that mandating treatment would override the addicted person’s autonomy. And there’s the perpetual observation that the effectiveness of substance abuse treatment is low.
The first two obviously give us reasons (excuses, I’m suggesting) to butt out. The rationale for turning aside is that although addicted people may need help from a treatment center, a sponsor, or a higher power, they are—and should be—responsible for seeking out and holding onto their own sobriety. In light of the first two perspectives, we have tended to blame addicted people for the third as well, again letting everyone else off the hook. In a recent shift, we now increasingly view addiction as disease. This reframes the low treatment efficacy as a treatment failure, not as the addict’s failure. But if it’s treatment failure, there’s obviously plenty of room for improvement: Much available treatment has a limited scientific basis, despite the ongoing illnesses, deaths, and widespread social consequences. And even if treatment were effective, access is sharply limited. At present, only 1 in 10 people harmed by substance use gets treatment. Forty percent of counties have no outpatient substance abuse facility that accepts Medicaid, thus abandoning many who are poor.