The issue of substance abuse along with other mental illnesses has been a policy issue in Massachusetts and other health policy advocate groups such as the Massachusetts Public Health Association. These advocacy groups can lobby state legislators and the Massachusetts Public Health Department to take action to protect those who have substance abuse disorder as well as other mental illnesses and provide treatment and the proper health services and resources to give access to under-served communities in Massachusetts.
Addiction or in favor of reducing stigma now called substance abuse disorder, has been a continuous fight not only in Massachusetts but also at the federal level in Congress. Initially, addiction was only reserved for those about drugs or alcohol, but it was highlighted during President Richard Nixon’s term and continued during President Regan’s term as a high priority and there were huge strides taken to create policies that would curb the “War on Drugs”. These policies focused mainly on halting or stopping the production, supply, and sale of such substances in the United States looking at countries like those in South America and Mexico as probable grounds for the DEA to target; now however, the world is looking at stopping the new war on drugs and other harmful addictive substances in a new way; through stigma. Stigma or the perceptions and assumptions that a certain individual takes upon when looking at another person’s circumstances plays a heavy role in the effects of treatment and the compliance of these treatments. In Massachusetts especially with a growing rate of individuals dying from opioids, the social view of people who have suffered from substance abuse disorder hinders those same individuals from seeking treatment or being able to access the necessary resources to recover. Now, in a new change of policy, addiction or substance abuse disorder is labeled as a mental illness by the DSM-V by specific criteria some of which include substances taken in larger amounts, cravings or strong desires, and recurrent use of substances in physically hazardous situations (DSM-5, 2019). Certain policies have already been put in place to help those who are suffering from this mental illness. In Massachusetts, the public health department has created the Bureau of Substance Addiction Services, or BSAS to help provide treatment and recovery for those who are dealing with addiction (BSAS,2019).
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Such action is taken to prevent addiction and provide treatment for those who have addiction whether it be drugs, alcohol, or gambling, these groups advocate for laws and policies that help those who are suffering from addiction. Specifically, in Massachusetts, MOAR, or Massachusetts Organization for Addiction Recovery deals with helping those who struggle with obtaining as well as maintaining treatment plans. Other NGOs also deal with addiction recovery such as The Amy Winehouse Foundation which like famous singer and songwriter Amy Winehouse died from an overdose and provides resources and guides people who are suffering from substance abuse disorder to find the right help and treatment. However, there are some ways that not only individuals, but legislators can act against substance abuse disorder.
One prominent and already proven method is having addiction treatment centers in each state funded by the federal government then over time, the task of funding the addiction centers falls to the states. These treatment centers provide access to high-risk and low-income communities that do not easily have access to or can afford life-saving treatment. Another way is through the legal system by looking at sentencing laws for possessing alcohol, substance abuse, or gambling addiction require that they attend AA or another type of addiction treatment instead of going to jail for first and second-time offenders. Now that substance abuse disorder is categorized as a mental illness in the DSM-V, there can be a real medical argument for allowing people who are suffering from this illness to get the proper treatment instead of letting it get worse by sitting in a jail cell. Finally, the one policy that can potentially have the power to incite real and effective change is reducing overprescribing painkillers. All over the United States, doctors and other medical professionals prescribe medications that have the potential to be addictive like Oxycodone and Fentanyl, and educating them about other less addictive medications then it will go a long way in preventing people from having this illness.
Access is an important tool to provide people of low income with the necessary resources to fight against substance abuse disorder. By giving those who do not have access or transportation an opportunity to come and be helped as well as be given the resources needed to fight addiction. Being within these low-income communities allows for the health centers to be closer to their target groups. The manpower to run the addiction health and recovery centers as well as the money required to help them run and be able to provide the necessary resources to those vulnerable populations. The other disadvantage is that most of these new costs will come from the taxpayer and therefore taxes will increase to help pay for these initiatives and programs.
In the United States alone, we incarcerate more people per capita than any other nation in the world and a majority of those are due to drug possession. However, being able to treat addiction as a disease rather than a crime allows for those who are suffering to benefit from the treatment plans as well as the exposure to many hardworking people who are dedicated to helping them recover from addiction. It will also keep them out of jail and leave room for those in jail who committed a crime making the prisons less overcrowded and easing the burden of the taxpayer. There are also issues with this new method of sentencing laws regarding drug-related cases. In most trials dealing with DUIs, gambling, and substance-related crimes can now be claimed to be a disease, and therefore most lawyers will use that to keep their clients out of jail even though they may not have an addiction but can get out of jail time by “faking” that they do.
One advantage of re-educating doctors and other prescribers on other forms of pain relief is that it will reduce their patient’s dependence on addictive painkillers as well as reduce the number of individuals with substance abuse disorder. However, one major obstacle that gets in the way of such a policy is big pharma or the pharmaceutical industry. Big Pharma spends billions of dollars on R&D as well as lobbying Congress and pouring money into their campaigns to make sure the legislative system works in their favor. Prominent politicians like Bernie Sanders and Elizabeth Warren want to take on Big Pharma to reduce medication costs and provide people with better alternatives than just using medications to feel better.
Policy Issue #1, which is the implantation of counseling and other departments that deal with substance abuse in high-risk communities, due to its reasonability and possible feasibility, and lack of political backlash, potential financial gains over potential financial burdens, but Policy Issue #2 which is changing the justice system to see substance abuse disorders as an illness rather than a crime is also a possibility because of the savings it can have on the taxpayer, reducing the number of people the United States incarcerates, giving those who suffer from this diseases an opportunity to get better rather than have worse symptoms before it’s too late, and it also separates those who do deserve to be in jail like murderers, robbers, and rapists from those who need medical help. However, other challenges and obstacles are more difficult when it comes to implementing Policy #2 such as political backlash from those who are supported by private prisons, as well as whether there is a viable and accurate way to determine the difference between those that need medical assistance versus those who may be faking it just to get out of jail and into a rehab facility.
It is wiser to act on policy issue #1 which implements health centers in low-income community neighborhoods since it will bring resources directly to at-risk populations as well as provide them with the resources necessary to combat this illness. Hospitals like Boston Medical Center (BMC) have a whole department dedicated to preventing substance abuse. Their Grayken Center for Addiction continues to work tirelessly to help their community and reduce substance abuse overdoses. However, it is also important to continue to look for ways to change our justice system as well as reeducate our medical professionals because it may not work now but it can be a viable and effective policy in the future.
Substance abuse disorder continues to affect millions of Americans as well as their families. We must find a way to reduce the number of people dying from overdoses as well as find a solution to reduce the political red tape that often hinders laws that can have a meaningful impact on this new war on drugs. Although there have been significant strides in fighting addiction from the days of Nixon and Ronald Reagan, there is still much to do to reduce the number of people labeled as having this devastating mental illness.
References
- American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.)
- Bureau of Substance Addiction Services https://www.mass.gov/orgs/bureau-of-substance-addiction-services
- Carise, Deni. McLellan, Thomas. A. Kleber, Herbert. D. (2003). Can the National Addiction Treatment Infrastructure Support the Public’s Demand for Quality Care? Journal of Substance Abuse Treatment, Vol. 25(1), Pages 117-121. Retrieved from https://s3.amazonaws.com/academia.edu.documents/42451026/Can_the_National_Addiction_Treatment_Inf20160208-29210-hp9wpc.pdf?response-content-disposition=inline%3B%20filename%3DCan_the_National_Addiction_Treatment_Inf.pdf&X-Amz-Algorithm=AWS4-HMAC-SHA256&X-Amz-Credential=AKIAIWOWYYGZ2Y53UL3A%2F20191021%2Fus-east-1%2Fs3%2Faws4_request&X-Amz-Date=20191021T000557Z&X-Amz-Expires=3600&X-Amz-SignedHeaders=host&X-Amz-Signature=9d5ab96ca723d10e28e282b8449f717175e719a716e7b7af97609bdfcd07a245
- Hawke, L. D., Cleverley, K., Settipani, C., Rice, M., & Henderson, J. (2017). Youth friendliness in mental health and addiction services: protocol for a scoping review. BMJ open, 7(9), e017555. doi:10.1136/bmjopen-2017-017555
- Sharareh, N., Sabounchi, S. S., McFarland, M., & Hess, R. (2019). Evidence of Modeling Impact in Development of Policies for Controlling the Opioid Epidemic and Improving Public Health: A Scoping Review. Substance abuse: research and treatment, 13, 1178221819866211. doi:10.1177/1178221819866211
- Incarceration, Substance Abuse, and Addiction. Retrieved from https://www.prisonerhealth.org/educational-resources/factsheets-2/incarceration-substance-abuse-and-addiction/
- Wheeler, P., Stevens-Watkins, D., Knighton, J. S., Mahaffey, C., & Lewis, D. (2018). Pre-Incarceration Rates of Nonmedical Use of Prescription Drugs among Black Men from Urban Counties. Journal of urban health: bulletin of the New York Academy of Medicine, 95(4), 444–453. doi:10.1007/s11524-018-0258-2
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