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A common saying is that “addiction doesn’t discriminate,” which means it can affect anyone in any area of life, ranging from coal miners and truck drivers to executives, doctors, and lawyers. I have personal experience with what can be a destroyer of equal opportunities for wellness and happiness addiction as I have 14 years of recovering from a vicious addiction to prescription painkillers. My addiction didn’t care about my education, medical degree, race, gender, religion (or lack thereof), social status, or health.
Social determinants of health and addiction
But in another critical sense, addiction discriminates between people, in an unfair and deadly way, and in a way that shines a focus on tears in the socioeconomic network that holds our society together. Clinicians have long observed that social determinants of health (SDoH) can tip the scales against people, in their already daunting quest to recover from any kind of addiction. According to the World Health Organization, SDoH is defined as “the conditions in which people are born, grow, live, work and age. These circumstances are formed by the distribution of money, power and resources globally, nationally and locally. levels “.
The profound effect SDoH has on people struggling with addictions is confirmed by the evidence. In a 2019 study on drug and alcohol dependence, it was found that “in 17 states between 2002 and 2014, opioid overdoses were concentrated in more economically disadvantaged zip codes, indicated by higher poverty rates. and unemployment, as well as lower education and an average income for families. “Other studies have shown that poverty is a risk factor for opioid overdose, unemployment as a risk factor for overdose of lethal heroin and a low level of education as a risk factor for prescription overdose and for overdose mortality. Homelessness has also been shown to be associated with overdose, especially among veterans. Terrible results are associated with imprisonment, especially the period just after release, when overdose deaths are triggered. Systemic racism contributes to all these problems.
Research on SDoH reflects what I see clinically in the clinic in the city where I practice as a primary care physician. A patient may be stable for years with buprenorphine or methadone (medicines to manage cravings and aid recovery), but if they abruptly lose their home because of it, they may lose access to the organization and security of their lives. It becomes much harder for them to care for their families, attend medical appointments or support groups, fill out prescriptions, or practice any of the cares that are so important to staying in recovery. As such, they become much more vulnerable to relapse.
Stigma plays a role in addiction
Stigma is defined as “a mark of misfortune associated with a particular quality, circumstance, or person.” The bad look with which so many people have seen for so long those who have suffered addiction and the fact that we have criminalized drug use in our increasingly unpopular war on drugs have contributed to an attitude of “punish, not treat “. . Fortunately, this destructive attitude has evolved recently, as more people have come to understand that addiction is, at least in part, a brain disease and not a moral failure on the part of the individual. However, it leaves a lot of stigma and provides an additional barrier to people asking for the help they need, as they suffer unnecessary guilt and shame. Many healthcare professionals do not want to deal with people who suffer from addiction due to stigma. In short, stigma can lead to unnecessary suffering and more overdose deaths.
SDoH are significant factors that contribute to addiction, but they are not the only factors
In the end, with my addiction, I was lucky enough to see him on the other side. I will never know to what extent this was due to my own capacity for internal resilience, my family support, work resources and the support of colleagues, genetics, luck or, in large part, my favorable SDoH putting a useful finger on the scales. Certainly not all doctors get it; several of my colleagues have overdosed and are no longer with us. At the same time, many seemingly baffled patients I’ve treated in the past lead a healthy, stable life in recovery, so SDoH isn’t everything.
But clearly, SDoH plays a huge role in framing the odds of whether people are able to deal with and survive their addictions. As a society and as doctors, we need to go far beyond simply seeing drugs as the problem. In order to give all people with addiction the best possible opportunity to get in and stay in recovery, we must urgently begin to pay attention to the broader issues that allow addiction to infection, such as housing, employment, poverty, systemic racism and the effects of imprisonment (to name just a few). By strengthening society’s safety net, so that we all have access to basic human rights to food, shelter, and health care, we not only help those who suffer from addiction, but we also help others.
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[ad_2]Source: https://www.health.harvard.edu/blog/poverty-homelessness-and-social-stigma-make-addiction-more-deadly-202109282602 [ad_2]
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