How Did We Get Here? The Evolving Epidemic Of Addictive Disease In The United States

By Dr. Drew Edwards

The opioid crisis in the US is part of the larger epidemic of Substance Use Disorder, an equal opportunity brain disease, affecting over 40 million children, teens and adults. Addiction does not respect age, gender, ethnicity, income or zip code.

Addictive Disease

Through remarkable advances in neuroscience, neuroimaging and behavioral medicine we have demonstrated that addiction is a complex, multifaceted disease, resulting from the interplay of genetics and environmental risk factors. Drug and alcohol abuse cause significant neuroadaptations, of which some are permanent, and observable loss of behavioral control. Yet, large gaps remain between what science has revealed about this deadly disease and currently available treatment and prevention programs. Closing these gaps will not only save the lives of those suffering from this disease–but will also reduce crime, mental illness and improve the quality of life across our nation.

The recent enactment of new legislation signed by the President, to address the opioid crisis is welcome news. Policy makers must now forge new partnerships with addiction researchers, neuroscientists, treatment professionals and community and school leaders at every levels. Although addictive disease is debilitating and deadly — it is highly treatable when care is individualized, of appropriate duration and intensity, and delivered by highly trained professionals providing long term monitoring and life-long support. Unfortunately, only a handful of treatment centers meet this standard. Why? Money, of course. This also must change.

How We Got Here—The Last 50 Years

In the late 1960’s and 1970s, the widespread use of marijuana, LSD, and amphetamines among teens, college students and young adults was shocking. The images of stoned and “tripping” teens were seared upon our national consciousness– and life as we knew it in America would never be the same.

In the 1980s “recreational” use of cocaine by the young and the affluent was quickly supplanted by the crack epidemic that decimated our inner cities and gave birth to a national anti-drug movement known as “Just Say No”. As a result, drug use declined among high schoolers by over 30% in 8 years. The most successful prevention effort in our history.

By the 90’s, amateur chemists were producing dangerous analogues known as “designer drugs” including MDMA (Ecstasy), and a new, deadly form of methamphetamine, which became the latest national scourge. Rural America was hit particularly hard by the onslaught of meth.

As the new millennia dawned, attitudes about drugs softened, evidenced by the unprecedented rise of heroin abuse and addiction, first among young Hollywood celebrities and supermodels, and then upper- and middle-class teenagers. Dubbed “Heroin Chic,” this phenomenon crumbled the once formidable wall between so-called ““recreational drugs,” and heroin and other opioids. This set the stage for our current and evolving epidemic.

The non-medical abuse of addictive prescription opioids and benzodiazepines skyrocketed, as unscrupulous doctors opened “pill mills” across the nation. In response, aggressive legislation, the DEA and local law enforcement effectively prosecuted those involved and shut down the pill mills—thus doubling and tripling the street price for these drugs by the end of the decade. Concurrently, the legalization of marijuana was picking up states across the nation while the Mexican drug cartels flooded America with cheap heroin, adulterated with homemade fentanyl, a powerful and potentially lethal anesthetic. Heroin was now cheaper than prescription opioids and readily available.

Since 2015, mortality from overdose has increased dramatically among adolescents using heroin/fentanyl. Expert analysis of these data reveal that a shocking 22% of the overdose fatalities among 15 to19 year-old-females were due to suicide. Why does a 13-year old- girl decide to start shooting heroin and 2 years later kill herself? This is the deeper and more important question. Sadly, it has been largely ignored.

What has also been lost amid our intense focus on opioids, is the fact that 8000 Americans, mostly children and teens, will use their first intoxicating substance today—and 8000 more tomorrow, and so on, and so on…. This rate is unsustainable, yet none of these children choose heroin or an opioid as their first drug. In fact, 7,000 of the 8,000 choose highly potent marijuana, largely because they have been told its harmless and may actually cure diseases.

Early initiation to drug use is an established risk factor for addiction. In fact, 17-20 percent of the early initiates (children and teens) who start smoking marijuana today, will be addicted and using other intoxicants such as alcohol, heroin, in addition to their highly potent marijuana. Whereas for initiates age 18 or older, the addiction rate drops to 9%. Why? Marijuana causes neuroadaption and degradation of neural circuitry in the developing brain, thus increasing the risk for addiction, depression, psychosis, cognitive decline and suicide. Recent findings by the National Institute on Drug Abuse (2017) show that young marijuana users are 2.6 times more likely than nonusers to use opioids and more than twice as likely to become addicts. Yet, we allow states to legalize this highly toxic, addictive drug by the ballot box, and not through normal scientific scrutiny to evaluate its safety and efficacy. As a result, those who begin using heroin/fentanyl are already addicted.

There are nearly 23 million adult addicts in the US, most of whom started by smoking marijuana because they believed it is harmless. Until addiction experts are allowed to educate policy makers, 17-20 percent of children and teens who start using marijuana today, will become addicted– and many will soon be binge drinking and some will be shooting heroin.

What works?

The reason adolescent drug use declined so significantly in the 1980’s was due to a “parent movement” that pressured (perhaps even harassed) local government and school officials to do something. The oft criticized “Just Say No” program provided funding, expertise and structure for the local educational and prevention (not treatment) programs, and the result are unsurpassed.

We desperately need another parent movement if we are to ever stem the tide of addicted kids and all that comes with it. Today, a teen spends less than 3 minutes per day in any meaningful dialogue with a parent and spends on average, 11 hours per day plugged into media. Guess whose message and values are making the bigger impression? This is not to say that wonderful, loving and involved parents never have problems such as addiction in their children— they do. But these parents provide the best chance for their children to escape the allure and trap of social pressures to use drugs and alcohol when compared to uninvolved parents.

I have seen and evaluated hundreds of 14, 15 and 16 year old kids who are already addicted, depressed, have flunked or dropped out of school and are infected with an incurable sexually transmitted disease. Is it really surprising that many feel hopeless, unimportant, and want to die? Sadly, for most of these kids the outcome is largely determined—and it’s not good. Government policies and new laws can only encourage or punish. They will never spend quality time (and a lot of it) with a child, help them with homework, teach them right from wrong, love them unconditionally, tuck them in and kiss them goodnight. Only parents can do that…but only if they are willing.

Dr. Drew Edwards is the clinical consultant and medical educator for Lakeview Health in Jacksonville Florida. Formerly assistant professor and the Director of Psychiatry & Health Behavior at the Medical College of Georgia. Dr. Edwards also was the Associate Director of Psychiatry at the University of Florida where he worked Dr Mark Gold, providing clinical instruction for medical residents and postdoctoral fellows in the Division of Addiction Medicine. Additionally, Dr. Edwards has conducted and published original esearch on depression and chronic illness and over 250 peer reviewed and popular articles, CME’s, training manuals on addictive disease, behavioral medicine, parenting, and youth culture, as well books for parents on childhood depression and instilling self-esteem in children. www.drdrewedwards.org
References Provided Upon Request