At The White House, Learning How Not To Talk About Addiction

Gil Kerlikowske, director of the U.S office of National Drug Control Policy. (THE CANADIAN PRESS/Pawel Dwulit Via AP)

Gil Kerlikowske, director of the U.S office of National Drug Control Policy. (The Canadian Press/Pawel Dwulit Via AP)

We don’t refer to someone who has anorexia or bulimia as having a “food abuse” problem. We say they have an eating disorder. So why do we refer to someone who is addicted to alcohol or pain pills as having a “substance abuse” problem?

Harvard’s John Kelly, director of the new Recovery Research Institute at Massachusetts General Hospital, made that point this week at what was billed as the first-ever White House summit on drug policy reform. The Obama administration has moved far from the old “war on drugs” model. The current federal drug czar, Gil Kerlikowske, wrote in his email invitation to the summit: “Drug policy reform should be rooted in neuroscience, not political science.” And “it should be a public health issue, not just a criminal justice issue. That’s what a 21st-century approach to drug policy looks like.”

Dr. Kelly, an associate professor of psychiatry, spoke to the summit-goers about the stigma around addiction — so pervasive it can even be seen in language. I asked him to elaborate; our conversation, edited:

It seems clear that addiction is not a good thing. It can cause people many problems, even kill them. But you’re saying that the trouble with addiction stigma is that it goes beyond seeing addiction as bad, to actually blaming the addict?

Yes. The degree of stigma is influenced by two main factors: cause — ‘Did they cause it?’ — and controllability — ‘Can they control it?’ We now know that about half the risk of addiction is conferred by genetics – what you’re born with. On controllability, neuroscience has also taught us that alcohol and other drugs cause profound changes in the structure and function of the brain that radically impair individuals’ ability to stop, despite often severe consequences.

Okay, but what about the other half? There is some element of choice in addiction, at least initially, isn’t there?

Addiction is like many other medical illnesses, in that there’s an interaction between the genetics and the environment. This makes some people more susceptible. For example, a lot of people are exposed to alcohol in our culture, but not everybody becomes addicted to alcohol. The genes may mediate the liking and wanting of that particular substance. For some people, alcohol is aversive for others, it’s kind of okay; for other people, it becomes everything.

So genetics is related to the cause. Brain damage — the toxicity and profound alteration in neurochemical function and structure produced by these abnormally potent reinforcers — alcohol, heroin, cocaine — which causes brain damage — that’s the controllability part. And the language we use directly maps on to that issue of cause and controllability. The rhetoric and language of ‘the war on drugs’ talks about ‘abuse’ and ‘abusers’ and the new movement, toward smarter criminal justice and a more public health approach, needs to look at it as a medical condition and talk about it as ‘substance use disorder,’ which is more accurate medical terminology.

Why does it matter what we call it?

The language we use to describe these problems may perpetuate stigma, and that can potentially harm patients and continue the suffering among families.

New evidence indicates that the commonly used “abuse” and “drug abuser” terms, for example, are conceptually linked to the notion that individuals are at fault for their addiction and therefore should be blamed and punished. These terms fitted well with the “war on drugs” policy approach. In contrast, use of the more medical and scientifically accurate “substance use disorder” terminology is linked more to a public health approach that conveys the notion of a medical malfunction.

We tested the effect of using these terms experimentally. We randomly assigned a paragraph vignette describing an individual in legal trouble due to alcohol and drugs; in half the vignettes the individual was described as “a substance abuser” in the other half he was described as “having a substance use disorder”; otherwise, the scenarios were identical.

(Courtesy J. Kelly)

(Courtesy J. Kelly)

These were randomly distributed to more then 500 doctoral level mental health clinicians, many of whom were addiction specialists. They were asked to read the brief description and then answer some questions about their judgments on whether the individual described was more to blame for his violation and should be punished.

Those clinicians exposed to the “substance abuser” term were significantly more likely to judge the person as more to blame and more deserving of punishment than the exact same individual described as having a substance use disorder. We tested these terms in a general population sample and found even larger differences with more negative and punitive judgments strongly associated with the “abuser” term.

These findings indicate that, even among well-trained doctoral level mental health clinicians and addiction specialists, exposure to certain language may create an implicit bias that may result in harsher punitive judgments that perpetuate stigmatizing attitudes toward individuals and families suffering from addiction. These may create barriers to honest self-disclosure and seeking treatment for alcohol or drug problems. This is important as only about 10 percent of affected individuals seek addiction treatment each year and they site stigma as a major barrier.

John Kelly (Courtesy)

John Kelly (Courtesy)

Does this language effect, which you found makes mental health professionals more judgmental of people with substance use disorders, actually translate into problematic behavior? Like withholding care or benefits?

We don’t know that for sure. That would be very hard to figure out. But what this research is suggesting is that it does produce a kind of implicit cognitive bias toward more punitive attitudes. We do know that attitudes predict behavioral response, however, and we’ve shown that language influences attitudes. So while we can’t prove it, there is a strong basis to believe that it could influence decisions such as withholding benefits or other things from individuals trying to recover from these problems.

You pointed out at the drug reform summit that other mental health fields don’t use the term ‘abuse.’

Right. Individuals with ‘eating-related problems’, are uniformly described as ‘having an eating disorder,’ not as ‘food abusers.’ We need to do the same in the addiction field.

Because the term ‘abuse’ gives rise to the ‘abuser’ term, it is better to use the term ‘misuse.’ Furthermore, given the lack of scientific specificity associated with the ‘abuse’ and ‘abuser’ terms, its nonuse would not result in any loss of scientific accuracy.

When you spoke at the White House, did you explicitly propose that the nation’s drug czar and his staffs and law enforcement more broadly change their language?

Yes, because while rhetoric around language has persisted for years, we now have good evidence that such terms may perpetuate stigma, and stigma is a huge barrier to seeking help.

We need to adopt new language which is more consistent with a public health approach, more accurate and more consistent as opposed to the rhetoric and language of the past — the abuse terminology, which is more strongly associated with a war on drugs approach. One very inexpensive way we can start to alleviate this terrible burden of stigma, which prevents people from seeking treatment, is to drop the old language.

Well, you’ll be up against some very ingrained linguistic habits — I mean, isn’t the federal addiction research agency called the National Institute On Drug Abuse? And you find it at drugabuse.gov. It could be quite an uphill battle to change this language.

If I’d thought of it at the time, I would have said that we do need to change the names of these federal institutions, so they don’t perpetuate this old language. I think it can be an uphill battle, but a battle that is not that difficult to win if we’re really serious about making changes that have an effect on the prevalence of substance use disorders and their impact in the United States. It would reflect a shift toward smarter evidence-based policies. It’ll just be a matter of if we decide finally to let go of that language and adopt new language more fitting, more accurate, and more conducive to the new game in town as opposed to the older war on drugs.

Please spell it out for me: You’re saying that whenever I would have said ‘substance abuse’ I now say ‘substance use disorder’ and for the person, I call them someone ‘with a substance use disorder’?

For example, when we’re talking about it generically, instead of using the term ‘substance abuse,’ many have adopted the term ‘substance misuse.’ And instead of describing someone as a substance abuser or alcohol abuser or drug abuser, you talk about a person who has a substance use disorder or is suffering from a substance use disorder. More broadly, it’s the ‘substance use disorder’ field.

It seems a bit odd when we’re not used to saying these things now; new terms can feel somewhat awkward and strange and foreign at first. But people adapt remarkably quickly; start using the new terms and they become second nature. Human beings are kind of resistant to change and our language is somewhat habitual, so it’s hard to shift our language, but we want to create a stigma against using stigmatizing language.

Is there a new term for the drug policy that has succeeded ‘the war on drugs’? The medical model? The public health approach?

Not formally yet. We could think of one — one that captures a public health and recovery orientation would be good.

Readers, suggestions? And will you consider shifting to Dr. Kelly’s terminology? Why or why not?

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  • LaPortaMA

    Those Harvard guys are VERY sneaky. Caveat addict.
    This article is about RHETORIC — look up the definition — not about health or wholeness.

    • LaPortaMA

      PS>> CZAR? In a Democracy. Very telling.

  • Karen Hanneman

    I completely agree. This is the only way to ease people in need, into recovery with dignity. People with substance use disorders are often already “hurting” from some sort of emotional trauma; and are too embarrassed to seek help because of the way we “label” them. THANK YOU DR. KELLY…

  • http://guineveregetssober.com/ Guinevere

    Thank goodness. I’ve long been saying “substance abuse” is inadequate terminology to describe what happens in addiction. We ought to call addiction by its right name.

    As far the concerns some readers express below about “recreational” drug-use, why not just call it what it is: “drug-use”?

    Finally, it’s beyond sad that the hatred of some commenters is given the power to dominate a compassionate discussion about human beings afflicted with this illness. No one sets out to contract the disease of addiction. No one chooses it, the same as no red-meat-eater chooses to contract high blood pressure or cancer and no sugar-eater chooses to come down with diabetes. Being in long-term recovery from addiction and from growing up with addiction, I’ve had to accept that I can’t change other people’s attitudes, no matter how offensive and pernicious they are to my moral code and to society in general.

    • Fit_to_be_tied

      I know people who became addicted to opiates after major traumatic events. One car accident victim was hooked quickly on pain meds and is sentenced to a lifetime of them.

  • windancr

    Stigma such a universal problem in our country. Thank you Dr. Kelly!
    Great beginning to how we describe human beings who have so much more to them than being a substance abuer/addict/alcohol. Now if we can apply the same to the “homeless” as individuals who lack housing, the same to he’s “mentally ill” versus he has a Mental Health Disorder, instead of felon/convict vs he has a legal history that includes ________In our country we are labeled negatively and often do not get a chance at a job, an open minded MD, housing etc….time to change that

  • Cocoaspal

    Hate the disease not the addict.

  • Alexander Dukas

    I agree with the Language and Conceptual Diagnostic Upgrades but what I disagree with is that no one is looking at the fact that the Unsustainable + Miserable Lives and Ego-Forms and Imbalanced Emotional Systems that many Substance Users and Other Disordered Folk have are contributing to their psychopathology. It’s as ridiculous as those Anti-Depressant Ads where the implied message is that people become mentally ill or addicted as if they caught a cold or flu and it’s so much more complicated an issue in terms of build-up, crisis, breakdown, and resolution than is being presented.

  • HowNow

    There are so many things wrong with this man’s logic that it
    is surreal.

    Societal taboos are established when the behavior of individuals reach beyond the individual and endangers the public as a whole.

    First, if you tell someone that their behavior is not their fault and that it is the result of factors beyond their control, you are an enabler. And to make matters worse, you are removing social stigmas that are in place to prevent future generation from embracing the ways of those who failed before them. Why do think there are
    anti-drug campaigns and education programs in place to combat the use of controlled substances? It is to instill that this type of behavior is destructive and shameful, preventing future users from making decisions that will initiating addiction in the first place.

    Second, the basic foundation of addiction recovery requires that the person with the problem recognizes their issue and seeks help. The argument that drug addiction should be viewed as a disorder and not a self-inflicted dilemma removes the motivation for recovery in the first place.

    I think you will find that the driving factor in successful recovery is the fear of returning to addiction. After all, it was behavioral reward that got them hooked to begin with. Addiction is not an issue that positive reinforcement can remedy.

    • raymond hagermann

      Fully concur.

  • Jonathan E. Schwartz

    I whole heartedly agree with Dr. Kelly. The bias even with highly trained clinicians is very telling and I believe is just the tip of the iceberg. In my opinion there subtle (and sometimes not so subtle) stigmatization going on all the time even from very caring, well intentioned clinicians in the mental health field and not just with substance misuse. Language is very important, much more so than many (if not all) of us realize and an area that I feel needs to be addressed.

  • Bill Williams

    Mu son died of an accidental heroin overdose a year ago. I’m sure the Raymond’s of the world find this just and appropriate. It is not. Raymond is a “Typhoid Mary” of hate that perpetuates the stigma we desperately need to overcome. We do every addict a great disservice when we continue to engage Raymond in discourse. Dr. Kelly is absolutely correct. Not only do we have to change the language. We need to change to whom and when we use it. That means, ALL, detaching ourselves from fruitless and angry discourse with Raymond. Think of him as having a compassion disorder over which he obviously has no control. We cannot control Raymond or his ilk. We can control our behavior – both in regard to those afflicted with substance use disorders and the Raymonds of the world.

    • raymond hagermann

      Oh I have plenty of compassion. I rescue animals, assist vets and their families, seek to improve my community…..I simply will not tolerate addicts. They are liars and pariahs. They destroy whatever they can to get their fix. You, I can feel some type of remorse for your pain. I feel nothing but contempt for your son. No one put the needle to his arm except him. Was he escaping from pain? Maybe. Was he self medicating from the horrors of this world? More than likely. Was it absolutely selfish to hurt you like he did? Very much so.

      • Bill Williams

        Our discourse is over Raymond. Try it on someone else, but not me.

        • raymond hagermann

          Try what? Saying what should be said? What should have been said? Your son killed himself knowing full well his addiction could kill him. I will show no measure of sympathy to a selfish addict like that. Easy to accept? No. Not even close. However it is the truth. Addicts are selfish and don’t care who they hurt.

          • pac08

            Ever been shown grace?

  • Lesley

    Is there ANYTHING left in this world for which we are responsible? I understand that some people might get addicted to legally prescribed pain medication but everyone who takes illegal drugs, knows they are doing something that is against the law and will get them addicted. Anyone with half a brain knows how addictive nicotine is yet they still make the choice to smoke that first cigarette. I’m not unsympathetic, I would want them to get help but this culture of never accepting responsibility for anything is going too far. There is no shame or embarrassment any more. People can do the most socially unacceptable things and feel no compunction to apologise or withdraw from public life. If people are not naturally good or moral and no longer fear divine retribution, then we need something to make them toe the line!!

    • raymond hagermann

      Now we can’t say that! We might hurt someone’s feelings. “Boo hoo, I destroyed my body by taking in poisons I knew were harmful. Pity me.” No pity for self inflicted wounds.

  • Higher Power Enlightened

    It seems Raymond is a psychopath and needs to be executed like the cancer he is. The kkk and the nazis used the same rhetoric he does. Don’t argue w the troll Vito. He’s just serving as the symbol of ignorance. I’m shocked that someone still thinks like the church during the inquisition though. “Kill first anything you don’t understand”

    • raymond hagermann

      Oh no. Thats the thing you fools don’t seem to understand. I do understand this issue very well. I want addicts to suffer. Suffer all the pain they inflict on their patsies….I mean “loved ones.” I lived this nightmare chaos too long and seen the selfishness of addicts first hand. They aren’t looking out for anyone else but themselves. Why should ANYONE look out for them?

      • Recovering Addict

        Raymond… I hope that someone one day shows you grace and mercy that many recovering drug addicts are so fortunate to have found. I am sorry that somewhere in the past you have had something happen to you (presumably by an addict) which you have not had the opportunity to forgive. I have been clean for over three years now. I am working on cleaning up a very long list of amends caused by the self-centered behavior I refer to as the wreckage of my past. Some of that wreckage is financial, some emotional, some very spiritual and self-inflicted. I remember many times wanting to stop, but compulsively not being able to. That being said.. today I have finished my master’s degree, work with an international company in the marketing department, and give back as unselfishly as possible as many times as possible. I did many wrong things, but I am not an entirely bad person. I am very grateful that I found grace and mercy at the hands of the legal system and that they saw past charges to the core of my problem which I truly believe is a disease (aka medical problem). I got treatment and realized that a bachelor’s degree, good job, and church membership in the past didn’t make me superwoman. I couldn’t do everything on my own. I now voluntarily continue to do the things for my own continued recovery that helped me get clean to start with. I will suffer from this disease for the rest of my life. Many addicts never get the opportunity to find recovery because they are two scared of the stigma and shame: Wall Street executives, nurses, lawyers, the guy who delivers your mail. Many addicts won’t take it when they are offered because they are just as addicted to the chaos as the dope. Many addicts die. But many of us are tax paying law abiding citizens today, who were given grace by someone, somewhere who believed that we could and DO recover.

  • Mindy Sikel Greenwood

    I currently own a Drug and Alcohol Treatment agency. I am very happy with the direction that we are taking in reducing stigma. I have been going out into our community for the last 15 years working on this very issue. If a diabetic continues to “choose” to eat unhealthy and just gives themselves insulin, we don’t give up on helping them. Why should we give up on someone that has a substance use disorder? They need to have continual support in the community and their immediate support system has to be a healthy one. Thank you Dr. Kelly for helping with the message.

  • William Abbott

    I have already shifted because its a good idea and why not. Ive slipped a few times but Ill get it soon. . It sure makes sense to me- right in line with other stuff we teach in Smart REcovery .

  • metrobark

    In the world of prevention, the intent is to reduce problems resulting from misuse of alcohol/drugs. Some projections indicate that “addicts” are responsible for only a fraction of all the alcohol/drug related problems in society. Limiting NIDA or NIAAA to the study of “addictions” would thus shut down important avenues of research inquiry, and focusing public attention solely on “addictions” could make it even harder to implement public policies designed to reduce the harms resulting from misuse or abuse.

  • CodeJingle

    Right, but Raymond you are not giving credit to the people who start out as addicts who end up being strong enough to stop before they kill themselves or someone else. I’m sorry your addict wasn’t strong enough, most aren’t, but some are strong enough, and even for those who are strong enough to get over their addiction they usually can’t get over it completely on their own. Mostly though you are just trolling and have taken over the entire comments section of this article, imposing everyone to have your perspective instead of intellectual equivalence. You offer no relevance to the article as it is written. How many other articles and forums are you trolling? Changing the language is the scientifically accurate approach.

    • raymond hagermann

      Trolling? None. What would you like to know Bellsy? I don’t care if you escaped your addictions. I don’t care if your sister died. What I care about is the fact that addicts are selfish and only care about feeding their addiction. They are drug users. They abuse drugs. It’s euphemismistic to simply say it’s (just) substance abuse.

      • vito33

        “The future’s uncertain and the end is always near.”
        Get yourself some help, pal.

      • GetALifeLoser

        “I don’t care if you escaped your addictions. I don’t care if your sister died.” Wow, you are an uncaring, unsympathetic asshole. Either get some professional help for all your psychological issues or actually, just go to hell.

        • raymond hagermann

          Who caused them to go and feed their addictions? No one. They really do DO IT TO THEMSELVES. I don’t feel bad for the guy who gets cancer chain smoking a pack of cigarettes in an hour or the woman who gets cirrhosis drinking a fifth before 10am. I do feel for the people who are hurt by the addicts selfish self destruction. But not the addict.

      • CodeJingle

        To take over a forum or the comments section of a article would be sort of the definition of someone trolling, and that is my perspective on what you are doing, so I feel it is reasonable for me to say that, after reading such a well written article and then all I see is off-topic derailment when I look to the comments for feedback, even if your comments are so thought out.

        None of my siblings are dead, neither of my parents are dead, so that was a bizarre comment to make towards me.

        You want to place all the blame on the person who is abusing a substance, even if the substance being abused is specifically designed for addiction.  I might say they were stupid enough for trying it the first time, but even saying that depends on context.  Addiction itself is not illegal.  If the substance being abused was obtained legally and is legal for that person to possess (like for alcohol), then they have committed no crime.  So I don’t know what to make of your comment to execute all people who actively engage in substance abuse.  The point of the article was that by changing the wording to be scientifically accurate it may make it easier for people to get help once they decide on their own to do so – I don’t expect such change in wording would make people feel better about their addictions neither to convince others to start new addictions.

        My actual point though to you is you seem blind-sided to the other side of your own argument.  That if the blame is solely to be placed on the specific individual engaging in substance abuse then the fact of substance abuse is no longer relevant.  In other words, someone who is a terrible person will always remain so, whether or not they are ‘on drugs’.  A person who is trying to ‘escape’ their reality, if they hate themselves and their life so much, will find some other way, and even without substance abuse the experience they put themselves and others through may be just as bad.  If someone is willing to destroy the lives of everyone around them just to feed an addiction then they would be willing to destroy the lives of others for any other purpose.

        For example, a mom or dad who decides they don’t like their partner and children and abandons their family to find a new partner and make new children, to the lifelong resentment of their previous family, isn’t much more noble or ethical than the parent who stays and instead destoys the lives of their family by engaging in increasingly active substance abuse and doesn’t stop until someone dies.

        As a personal preference – if a family member is putting me through years of heartache and suffering – I might even prefer them to do it while not of sound mind and body – such as with heavy substance abuse – than to know they did such terrible things completely sober with all their wits about them.

        If your addict truly didn’t care then even if they hadn’t been an addict it would have just been some other thing they did to hurt you and they may have put you through the same hell on earth regardless.

        Well it was nice to get some contextual feedback from you on the article.  Yes I agree the change in wording is euphemistic.  That is purposeful, and I don’t see anything wrong with that.  When my kids do something bad I have to make the distinction that the action was bad, not them.  My kids are never bad, only sometimes the things they do.  This is standard psychology.  My kids are more likely to take responsibility for what they did and to learn and grow from the experience just by that simple distinction.  If one of my kids does something ‘bad’ I sometimes punish both of them, that way there is no concept of blame, and they learn to work together and look out for each other.  Making them feel bad isn’t nearly as effective, if at all.  Fear and pain has its place but it is more of a last resort.  Adults are the same way.

        Someone with an addiction isn’t going to stop because you make them feel bad, in fact it may feed their addiction, and in the US you can’t execute someone just because they have an addiction, so using ‘abuser’ or ‘addict’ instead of ‘abuse’ or ‘addiction’ serves no purpose.

  • jenny

    I usually do not comment , but feel so strongly about this article….the pejorative language used around addiction should be changed because it is rooted in judgement and does act as one of the many barriers for treatment. Shaming is unhelpful. And as far as raymond hagerman is concerned, I can recommend really informative books about the neuroscience of drug addiction….at least then, your opinion might have some relevance. But as it reads, you sound like a young man with residual issues from his upbringing….anger, bitterness, vitriol are outward displays of pain, sadness, disappointment….often times, it is easier to feel anger than to acknowledge the hurt.

    • raymond hagermann

      Oh no, Jenny. I’m very honest about what pisses me off. Thanks for the concern sweetie. As far as your assertion that I am somehow just not “informed” about the neuroscience? False. I’m am well read on the subject. I’m simply not going to let an addict have ANY comfort. No excuse. No reasons to rationalize away their flaws.

      • LaPortaMA

        There is a path out of it, when they are ready. You know that story about cutting the cocoon and letting the butterfly out too early? On the other hand, I think that the sister programs to AA/NA recommend against being the CAUSE of the addict’s consequnces; rather to stay out of the way and let him/her deal with it. No one does ANYTHING without some “reward” in mind. Even if it’s a delusion.

  • beth simmons

    I wish them well in all of this. The Pharma and FDA are largely responsible for prescription drug dangers and abuse. Let’s clean that up!

    • raymond hagermann

      I agree on the pharmaceutical portion. I loathe the new breed of addicts thinking (oxy)contin is any safer than heroin. More pain, more families broken for a cheap fix.

      • Teddy Luben

        Maybe you should try not to hate addicts…

        • raymond hagermann

          No. Because in the end, they chose their addictions.

  • Joe P

    A note to anyone responding to raymond…

    You can’t argue a point with a narcissist. Their needs always outweigh any others. Let him have his tantrum and we’ll disregard him. He deserves no sympathy.

    • raymond hagermann

      Narcissist? No. Simply tired of people treating addicts like they arent what they are: weak and selfish.

      • Joe P

        Yes, you’re a narcissist. Get out of your own head for a sec and think about what you’re saying. Addiction is no where near as simple as you’d like to think it is. Simply judging people that you don’t understand and being done with them doesn’t solve anything. Based on your comments you’d just as soon see them all dead. Let’s hope none of your family or god forbid a child of yours falls victim to addiction. Sadly though, that might be the only way you’d ever see the error in your thinking.

        Anyway, here I am breaking my own rule. Good day.

        • raymond hagermann

          Don’t understand? I understand very well. You choose your addiction or to break free of it. You choose the people you are destroying or the drug you crave. My family already is riddled with addictions. I’ve watched it disintegrate for the craving of a drug. Why do you think I hate them. They lie, cheat and steal to feed a “habit.” As I’ve told my own addict parent “Be useful and die. You weren’t there as a parent, go feed the worms.”

          • Joe P

            Sounds like you’ve had a rough time of things. It’s a lot of work to hate people though. If you’re at the end of your rope with them, that’s understandable, but it doesn’t mean that every other addict should be shunned.

            If it were really as simple as your suggesting, that people can choose their addiction or to break free of it, why on earth would so many people choose the addiction? Even the most hardened addict understands that things were once better.

          • raymond hagermann

            Easy? No. The path is not easy. But you choose x or y here. There is no third way.

    • vito33

      Narcissist? OK.
      Pathetic troll, provocateur, possible sociopath.
      He or she needs to get some help.

  • Will S.

    I wonder abbout the term addiction and addict in the vein of the below discussions. Is the preferred term a person with a substance abuse disorder (for addict)? But how do we replace the term addiction as many believe that addiction is a biopsychosocial condition of which substance use disorder is but a symptom? The term addiction in and of itself is pretty stigmatizing. I have always that that the terms addiction and addict are way more stigmatizing than drug abuse and drug abuser? How are we to term the broader pattern of addiction (obsessive compulsive pattern) that oftern includes symptoms related to food, gambling, sex, drugs, alcohol, shopping, hoarding, codependency, etc.? How do we replace addiction and addict in the evidence based scientific public health model?

    Will S.

  • cccampbell38
  • Terry Cooper

    I was recently in the hospital for a stent. I had had this procedure before, and it had been no big deal. This time, however, it was extraordinarily painful during and after the procedure. The doctor ordered that I could have morphine every hour if I wanted it. Since the pain was ongoing for about 12 or so hours, I requested the morphine. At least two nurses made remarks about becoming addicted, etc. I was livid about “addiction” even being mentioned under the circumstances. The pain began to abate some by the time I went home the next day, however, the doctor refused to give me any medication to relieve it at all. Every doctor’s office here in this area now has signs saying they do not prescribe pain meds, don’t ask.lol… I ended up calling the patient advocate at the hospital and the Director of nursing concerning the reference to addiction, etc. while I was a patient, etc. I asked them both, what happens if you do get a patient who is having pain and that person also happens to actually have a substance problem? “do you refuse to give them pain medication to relieve legitimate pain because they are “addicts”? The entire episode was very disturbing to me. The same holds true for the doctors who are now refusing to write prescriptions for pain meds for people who do have pain, etc. It’s scary to think that I might have to deal with this kind of scenario again in the future, and there will be no one there to help me when I am virtually defenseless, and at the mercy of doctors and nurses who are more concerned about the potential of addiction as opposed to treatment for the current and most pressing problem.

  • cccampbell38

    In the book “Licit and Illicit Drugs” Edward M. Brecher outlines very clearly how we came to treat addiction as a legal problem and just why the so called “War on Drugs” was doomed to failure. He goes on the explain why a public health/mental health approach to addiction was the only approach that could actually have a real chance at addressing the problem.

    This book was first published in 1973. It’s amazing how terribly long it takes for us to even begin to think about trying to develop a rational framework within which to view addiction.

    I am 43 years into recovery and at least six members of my immediate family suffered from addiction. I was an addictions counselor for 30 years and taught a college degree program on addictions counseling for many years. I like to think that, from personal experience and professional training, I know a little about this subject.

    I am encouraged by the White House effort to begin to change the conversation. I am not optimistic, however, that it will gain much traction. There are still too many people who are unwilling or unable to change their moral judgement for a scientifically based medical view. In addition, and perhaps more important, the vast sums of money that are spent on this counterproductive “war” flow into too many pockets, creating a huge and powerful lobby that is dedicated to keeping things just as they are.

    Sad; we could do so much better and I fear that we will not.

  • Lucy Mae

    Your article quotes , “Does this language effect, which you found makes mental health professionals more judgmental of people with substance use disorders, actually translate into problematic behavior? Like withholding care or benefits?”
    as a health care provider, I have seen much prejudice against addicts/alcoholics…..the nurses have negative attitudes and make malicious comments justified by the “fact” that they did it to themselves

    • Dixie Thompson

      I agree. The health care providers have also been affected by the language, and yes, it leads to poor care and poor outcomes. But it isn’t just nurses!

    • Vicki

      Totally agree.. there needs to be a shift in the medical profession. My kids have been treated like dirt because of their illness. My kids are suffering and then when they ask for help they are looked down on and treated with no respect. This drives people further into addiction. HELP them for God sake!!

    • http://www.facebook.com/groups/OccupyDrugPolicy/ Lydia Heather Blumberg

      My friend, Anthony Galletta, died last year because he needed a kidney transplant due to years of struggling with the damage ravaged by diabetes. The hospital would not even consider putting him in line for a new kidney from a donor. Why? An obscure reference 20 years back in his medical notes stating that he was treated–successfully–for opiate addiction. Since then he’s had kids and grandkids, buried some of his kids and raised the grandkids himself. It sure sucked seeing those kids in fits of tears at his burial. He was a model citizen and a generous friend. The real kicker is that he didn’t even tell his family why he wasn’t on the list. I think I’m the only person he told, because he was ashamed. So, does judgemental language tangibly effect medical outcomes? For sure.

  • Michael

    Excellent article. There is way too little knowledge, information and understanding about addiction in this country. There is way too much stigma and uneducated views.

  • Aoede

    Why still, do we treat this as The Disease or Disorder, instead of the SYMPTOM of much greater problems? Addiction is a symptom. NOT the disorder itself. This act of treating only symptoms of any disease or disorder… and not treating the actual problem…is the biggest problem in this far too ignorant culture.

    • Justin Chapweske

      Mindfulness-based addiction interventions seem to be a big improvement on previous treatments. I would argue that Mindfulness Meditation starts to treat the root cause.

  • jayson

    If you go to AA or NA you have to say that you have been and always will be an addict, but you are “trying to change. If you go to Jenny Craig for an eating disorder you aren’t subject to that stigma. If you want to call it the same thing, treat it as if it were.

    • jayson

      You don’t see the newly thin people on jenny craig commercials admitting that they have an eating addiction while they are spinning and dancing. They don’t arrest the people at buffets for doing damage to their health by raising their risk of heart disease or diabetes.

  • Nancy

    I have a son who’s IQ is in the range of 45 ….due to his bio mothers use of drugs. I have another son who was offered oxyctin in school while suffering from a undiagnosed brain tumor….it took four years to find because he was given a mental health diagnosis by some doctor that never looked at the organ that was giving the problem! He is now a heroin addict fighting for his life by staying in prison! Our legal system CAN help if they provide treatment! Real treatment! And real structured support after prison. One son is mentally retarded….intellectually delayed…. Slow…special needs. The other is an addict, drug abuser, junkie, …..I don’t give a flip what you call them…..we need freakin help out here! REAL help! Quit giving us theory and start giving us staff and housing!

  • CT

    It starts at the top. Why is the name of the leading government research entity on this matter called the “National Institute on Drug Abuse” (NIDA) instead of the “National Institute on Drugs”? This name lends an automatic bias to the research of the scientists who work there. It automatically assumes that people who use drugs are always abusers to be fixed.

    • Guest

      Actually, no big political or social movements have ever starts from the top. Ever. And if you read the article, you would see that they did discuss the fact that the name of the federal addiction research group is problematic. But that’s down the line. First you create awareness, educate the public, and start with yourself and those around you. If you knew anything about history and progress, and the way life works, you’d understand that.

      • Lojiko

        Actually, you’re rather condescending.

      • You’resilly

        Go watch Lincoln. Then get back to me.

    • U.s. Hemp

      Also the ones who paid to develop Spice : (

  • raymond hagermann

    Let the addicts die. The world doesn’t need them.

    • Vicki

      Raymond.. come on.. stop. You are basically wishing my kids DEAD. I work with moms of kids who have died. Your statement causes them great pain. Hardly becoming behavior of an American Soldier. As a military wife, Im ashamed of your behavior! There are some really amazing parents who had really amazing kids who lost their lives due to drug addiction. I pray to God that if you ever have a child with an addiction that someone wont wish them dead. They are humans and they deserve help, not your hate. American soldiers are GUARDING THE POPPY fields in Afghanistan. Do I want YOU dead for working for a government that allows this. The poppy plants are being made into heroin and coming to American where our kids are getting their hands on it and dropping like flies. Why don’t you be part of the solution if you are so passionate about this instead of sitting back and flinging hate. A lot of us had a crappy childhood. I don’t look back.. I look forward and work to change things to make them better. Helping people with substance use disorders helps kids to have better lives than the one you had. Help us.. use your experience to help.. not spread hate.

      • raymond hagermann

        No. Addicts deserve death. The kid across from my great grandmother killed himself due to an od. What about HIS parents pain? Why should they have to suffer for HIS selfishness? If I have a child that dies to an OD, good. Their selfishness dies too. Get it through your skull lady: I’m not in service any longer. That pic was from Veteran’s Day. I’m not ignorant of the causes or mechanisms of addiction either…been studying it or have been “explained” it a hundred or more times. “But the world is disgusting! I can’t deal with that! Where’s my smack?” The world is hideous and ugly. Pain is very abundant. Medicating yourself won’t make it any better. “She couldn’t help it, the drugs were too much.” No, she was weak. Defend it all you want lady, your kids and addicts like them…are selfish. They want to feel better no matter what the cost to those around them.

        • Unabomberswife

          Raymond…. please direct your hatred to an enemy truly trying to destroy us. Re-enlist.
          By the way, do you smoke? Ever tried to quit? If not a smoker, do you have something else you are compelled to do frequently because you feel like you have to or want to? Any habit, even brushing your teeth daily? Stop doing it, never do it again. Ever!
          You have stated your point here too numerous a time for the rest of us to not know who and what you are.

          • raymond hagermann

            No. I like my lungs just like they are. Nice attempt to connect brushing your teeth with alcoholism or drug addiction. Not quite there slappy. Since you asked, no. No habits that I feel I must do frequently.

          • Unabomberswife

            No one takes a drug to become an addict. No one knows when they take that first prescribed pain pill if they are in the 20% that have the brain chemistry or the genetic makeup leading to an addiction. NO one wants to become an addict.
            Would you have wanted pain relief if you had been injured while serving, especially knowing addiction is in your genetic make up? Would you deprive a loved one pain relief if they are injured, knowing it may lead to an addiction? Got kids? Let them hurt?
            Habit, look it up then try to stop one of your habits, forever.
            Oh, that’s right… you have no habits you “must do frequently”. Bully for you. Make sure you remember to look both ways when you cross the street; that’s an acquired habit you may need to do frequently.

          • raymond hagermann

            How many times do you need to see people die from an od before you realize that next bullet can have your name it? Oh no, I forgot… “It won’t happen to me!”. I was injured in service. A few times. I’m not sensitive to pain meds so they don’t do shit for me…at most normal levels. Call it a “gift” from an addict. Not worth the risk. As I’ve told others: rather be in pain with my wits than be drugged and delusional without pain.

    • cccampbell38

      Mr. Hagermann,

      It’s pretty obvious from your comments that you have been deeply hurt by addiction, someone else’s, of course, but you were hurt as much or more that the addict or addicts in your life. The anger that you express is common in adult children of addicts and others whose lives have been effected like this. In the last few years treatment professionals have recognized that people like yourself can benefit from treatment aimed at resolving these issues. I hope that you might seek out professional help, not for the addict in your life but for yourself.

      Speaking again from personal experience, I have found that being able to put the experience of being a child of an addict behind me was at least as important in my own life as my own recovery from addiction.

      I do wish you well.

  • Lojiko

    Although the White House is taking a softer, gentler stance on the War on Drugs, it’s still a war, fought in our own streets against our own people.

    The White House continues to ignore the fact that there is such a thing as responsible recreational drug use, lumping all use into abuse, failing to differentiate between someone having a good time and someone desperately in need of addiction therapy. Smoking a joint with friends on the weekend doesn’t make someone a pothead anymore than going to a cocktail party makes someone an alcoholic, but given the two scenarios, one person is going to have a good night’s sleep (providing he doesn’t kill anyone on his drive back from the cocktail party) and someone else is going to drug court. There’s no sense in a such a policy.

    • Guest

      Actually, marijuana has been highly decriminalized in many states so far and is still progressing, exactly for that reason that you stated. It really seems like you are just mad about something rather than understanding what’s actually going on. This is a great article–the whole purpose of changing the language is to not only rid of the stigma against drug users by their peers but also to eventually rid of that stigma among policy makers. Political progress doesn’t exist only exists when those affecting and implementing the policies fully understand the effects of their judgements and decisions and there is a real conversation about it.

  • Abby Dean

    It is good to hear that we are finally looking at a new approach to drug use in this country. Treatment works.

  • AmyGutman

    Really interesting! Thanks for writing this.

  • vito33

    Great, change the language.
    Now, let’s eliminate the rest of the cruel and stupid Mandatory Minimum Sentencing guidelines that have decimated poor black and brown neighborhoods, already suffering from substandard education and lack of employment. Let’s admit that the ‘war on drugs’ has been a ‘war on poor minorities’, and it’s greatest success has been to keep for-profit prisons stocked to the gills.
    We’re the most incarcerating nation on the planet, with millions of youth languishing in prison for decades over non-violent drug offences. It’s an embarrassment, it’s unjust, and it’s disgusting. We, as a society, should be ashamed.

    • raymond hagermann

      Even better. Let’s just execute you addicts. no sympathy for the selfish addicts. No mercy. They wanted to “feel good,” let them pay the consequences.

      • Guest

        It’s amazing how sympathetic and open minded you are.

        • raymond hagermann

          As the child of an addict? No. No sympathy. No mercy. No compassion. They put their selfishness first. Let them suffer.

          • Tom H

            I’m the child of two addicts and your attitude disgusts me. Grow up.

          • raymond hagermann

            Well aren’t you a better person. I’m not so forgiving. You live a life devoted to your next fix and ignore the greater good? You’re trash and worthless. Who put tg e crack pipe to their mouth? Who put the needle in their arm? Who put tge bottle to their lips? They did.

          • Lojiko

            I think it’s important to illustrate to someone with your background the difference between using drug responsibly and using drugs irresponsibly.

            Not everyone who uses drugs is an irresponsible addict, in much the same way that not everyone who goes to a bar is an alcoholic. In fact, the vast majority of users in both categories do so responsibly and in moderation.

            The test is the harm the behavior does to others. Behaviors that do harm to others deserve to be punished, but for behaviors that do harm only to oneself, the punishment should not be greater than the harm of the behavior.

          • raymond hagermann

            I don’t particularly care. It is a cancer. You don’t leave it to grow. You exterminate it.

          • Vicki

            Raymond.. just stop. Im sorry for your pain . I see that no one took the time to really educate you on your parents disease. I know that doesn’t make up for a crappy childhood. No one WANTS to be an addict. NO one. Im glad that you were able to come out of that and be a better person. But you are better than this name calling and hatefulness. Its hypocritical. I have three boys who have substance use disorders. I feel Ive been a pretty good mom. I watch my boys SUFFER from their addiction. I watch them SOB because they are so embarrassed and ashamed of what has happened to them . I have watched them lose every possession they have and every person they loved. I run an anti drug page with 50,000 people on it. If people could just STOP whenever they wanted… they WOULD and we would not need to have rehabs and drug summits and drugs that save people when they OD. Drug addiction is a disease and its complex. Its not black and white. Our kids are dying. As a mother it kills me to hear someone their same age wish my children death. Very painful.

          • Anand

            I feel the same way about Internet trolls. Bravo, you stirred it up expressed your contempt and got your chuckles. Move along.

          • raymond hagermann

            Chuckles? Who the hell can laugh at a topic this serious?

          • disgustedwithraymond

            If your parents hadn’t been subject to the war on drugs and the stigma, they might have had a chance of getting help.

            You can’t solve social problems by putting a boot on their neck. If that worked, the military that you’re a part of wouldn’t be around.

            What if the world your parents lived in when you were a child had HELPED them to overcome their problems, instead of telling them to hide their problems in your home (where they no doubt traumatized you), or else?

          • raymond hagermann

            No. It wasn’t hidden and my family addict could have gotten help a hundred times. Even when I as a child begged them to get help and after they almost killed me. They chose NOT to get help. Selfish addict.

          • Katherine Mitchell

            Every addict is not your parents. I think you need to deal with your ugly childhood yourself instead of projecting it onto strangers.

          • Gary Laney

            Raymond, if your addicted parent is truly as callous and you make him/her out to be, you are truly your parent’s child. You are as callous as he/she is. There are many, many addicts I have experienced in my life who have much greater character than you are displaying on this thread.

          • raymond hagermann

            Oh I’m callous. I am absolutely without remorse to those who would destroy their family for an addiction.

          • Brandon Miller

            You might want to look into attending some al-anon or ACOA meetings or reading some literature. Sounds like you might have some stuff in your past that’s making it difficult to grasp the nuances of the article.

          • raymond hagermann

            Been there. Done that. Got more than one t-shirt. No.I get the “nuances” of the article. I simple don’t care about “helping them” overcome the “stigma.” They wanted to be selfish and self indulge, they should take people’s judgements as a consequence.

          • Brandon Miller

            Well, if you’re really committed to the idea of (and I hope I’m not strawmanning your position,) sentencing first-time drug offenders to execution, and feel this passionately about it, I don’t know what to tell you. I can’t imagine killing people for having an untreated mental illness is an idea that’s going to gain much ground. Personally, I think we should focus more on phasing out the War on Drugs and start funding treatment, research, and education. I grew up with addict parents. I was mad for a long time, but I finally came to realize that they weren’t being selfish or self-indulgent, they had a neurological disorder. If they had a choice in the matter they would have chosen to do the responsible thing. But if they had a choice in the matter they wouldn’t have been addicts and it wouldn’t have come to that.

          • raymond hagermann

            Yes. They are selfish. The idea that (insert drug) is addictive. We know that anything that triggers the reward/pleasure centers of the brain, can lead to addiction. They don’t care what anyone else around gets hit with. Only how to get that next fix. They don’t care what the fall out of their death would be for those that give a damn about them. They just want another long suck on the pipe for a momentary fix….just to find the problems problems they ran from…are right there. They didn’t go anywhere. They are weak and selfish. I’m sick of this world being weak and soft and saying “That’s ok. You were just ill…” No. I want this world to finally say “You are screwed up and we won’t accept this.” and stand with some type of backbone. As the NA and AA books say: be honest and admit your character flaws. I know fully what mine are and freely admit them. Can addicts?

          • Christina

            Lol, getting upset? The misspellings give you away……

          • Gary Laney

            Tom is a better person than you Raymond. There is no doubt. I put you several notches below the worst addict.

          • raymond hagermann

            If being a better person meant being a coddler of an addict, I’ll take a first class ticket to hell.

          • Clint G.

            Your parents probably sucked anyway. They would have been shitty parents without using. If they were making these decisions about kids and drugs in the first place, it is doubtful that their decision making would have improved over time or in other aspects of life. Lots of people with crappy parents go on to have productive lives and not drag the baggage with them forever. Your parents sound like idiots, and it seems like they passed it on to you. How’s that for tough love?

          • raymond hagermann

            Not particularly bright there Clinty. I’ve been quite successful in what I’ve set out to do: avoid the mistakes of the past, get an education, prove I’m not just ” your mothers kid.” No kids running around wondering they’re going to eat or ask why they can’t get new shoes. No running away from a house where the threat of dying on any given day is considerable. I’m quite aware and familiar with the past and actively work against any and all mistakes from there. Both mine and others. I won’t feel for an addict regardless of what they say or do. They lie even when they tell the truth. They get exactly what their actions warrant.

          • Clint G.

            I don’t believe I am the one with the “brightness” problem, here “Raymond-ey”, or however one would cutesify Raymond, as you so eloquently did with my name. I realize when you are running behind everything seems like an affront, but I didn’t say anything about what you had or hadn’t done with your life (aside from carrying the parental baggage). I understand making it about you is the platform for your soapbox, but it is just so played out and boring. I like how you declared yourself better than these addicts that should be executed, then got all indignant with Tom H.’s comment and insinuated HE was the one acting superior.

          • raymond hagermann

            An affront? Nope. More of the coddling babble I’ve heard all my life to excuse the selfishness of addicts. Oh yes, Mr “I had two parents who were addicts”…as if I’m supposed to be impressed. Very well, Mr Tom H a better person. Let him heal his addicts. Addicts lie and cause immeasurable pain to feed to feed their addictions. They wanted their fixes and fun, they can take the costs.

          • Clint G.

            How was my statement about your running behind “coddling babble”?

          • Katherine Mitchell

            If addicts don’t care about who they hurt or getting better, why do millions of people around the world go to AA and NA? Why is the rehab industry so successful? You are obviously blinded to the realities of addiction because of your own negative experiences. Your anger at addicts is really misdirected.

          • Katherine Mitchell

            Oh yeah, totally successful, you are obviously so happy and well adjusted. I am so glad you could overcome your negative experiences without holding on to any negativity or bitterness. What a positive message for children of addicts! Just because your chilis rough doesn’t mean you can’t grow up to be a vindictive, vitriolic person with violent fantasies of taking out their anger at their parents on others by wishing for them to be mercilessly executed. You are so inspiring!

            I am sorry, but no matter what you have accomplished in lif, you obviously aren’t successful at letting go of your childhood demons. Nobody who would have such a dictatorial, unforgiving worldview is tri successful in my opinion. Success to me means stability, mental peace, amd happiness. There is no way anyone who would suggest executing all addicts, or executing any massive group of strangers, is a happy individual. Nobody can be happy with that much hate. I seriously hope you can find some peace someday. Life is short. Why spend it being so hateful and angry?

          • Hiddenballtrick

            Mr. Hagerman, I come in peace. It was difficult for me not to blame a mother with a mental disorder for her actions, but in truth I was wrong. Certainly she always had to be held to account for his misdeeds, but because of her disorder, her “choices” were not always her own or made in the presence of mental clarity. The article above suggests the same is true of the “addict” or the “alcoholic.” The more we learn about these disorders and what causes them the more we can work to prevent the damaging behaviors they drive.
            I worked for 35 years for an airline which had the BEST and most forward thinking alcohol and addiction programs, all based upon the “disorder” approach to the problems. The results of the programs were stunning and stunningly positive. Retribution was not the goal, recovery and managing the disorder were.
            You took a very positive path of service to our nation, for which you have my thanks. I only hope you will be able to someday look back and more completely understand the issues surrounding the addiction your were forced to live with and allow the anger to dissipate. Frankly, it appears the disorder of another member of your family with which you had to live with as an innocent child is still in control. In one of your comments, you referred to addiction as a cancer.
            I am a Stage 4 lymphoma survivor. The point you are missing here is I am no more to blame for my cancer than an addict is for their addiction. No one put the bottle or the pill into their hands, but once ingested, they were all but powerless to control their lives without proper medical treatment.
            Thanks again for your past service.
            Stay safe.

          • Guest

            Did you even read the article?! Your comments completely affirm the ignorance around this mental health problem and the sitgma attached to it. Your personal experience (addiction in your family) does not make you an expert on the subject. I’m sorry for your suffering but urge you to actually read the article and think about how inane your comments sound. With more compassion and a willingness to learn the science behind addiction, you could channel your anger in a more positive way, say, advocacy and education. You might find yourself healed in the process. Peace.

          • Katherine Mitchell

            Ahhh, this finally makes sense. Truamatic childhood. You can’t divorce your own reality from an objective one, and Lord knows that the marine aren’t known for helping one’s critical thinking skills. Has it never occurred to youthyou that your expectations with addiction isn’t universal? Or that growing up with an addict probably really skews your ability to rationally and objectively examin this issue? Or that your childhood experience doesn’t really give you any insight into the biochemical nature of addiction?

            Do you honestly believe it would have been better for your parent to be executed by the government than to have been assisted in reaching sobriety?

            Addiction runs in families by the way. It is likely your children will be addicts. I wonder if you will still think execution is better than treatment th3n. I wouldn’t be surprised if you did, you obviously aren’t a very compassionate or understanding guy.

          • Christina

            Ahh, there it is! Bitter, party of you. The ‘ole child of an addict. With all the hate and bitterness you spew, you should have your brain checked.

          • Gary Laney

            Oh, so here it is. You are your parents. You are a resentful SOB. That’s on you, not them.

        • U.s. Hemp

          Now we come to crux of Raymond’s problems-he did not get therapy or have a good friend to help him through his poor childhood.

      • Jester

        Go on GI Joe! How many of your Army Buddies are addicted to Pain Pills?

        • Lojiko

          SPC Hagermann probably sees no moral dilemma between wanting addicts executed and drinking excessively every weekend. The military has a HUGE alcohol problem.

          • raymond hagermann

            Incorrect. I see a big moral equivalence between them. Still, not sympathetic to the drunk driver or the high driver.

          • Lojiko

            Well, at least you’re not a hypocrite then. I can respect that.

            Of course, the article deals with addiction, not drugged driving. I don’t think you’ll find anyone in this thread sympathetic to drugged driving, regardless of their opinion of drug legalization.

            Legalization doesn’t mean anyone can do anything they want on drugs. It means responsible drug users aren’t treated like criminals, addicts get help rather than jail (which is cheaper too), and problem criminals who neglect their children or engage in irresponsible behaviors while under the influence of drugs are punished accordingly.

          • raymond hagermann

            Addicts deserve nothing. They want to be selfish, they can suffer. No. Not a hypocrite. Just extremely hateful and bitter. Better?

        • raymond hagermann

          I don’t particularly care. No one puts the drug or bottle to their lips except them. Their fault.

          • kittiesarenice

            That’s not always true. One of my cousins became an addict at just 8 years old. His older brothers, 11 and 13, got him started. Both of them were already addicts as well. I don’t know how they got started. I know of another case of a girl whose addict parents fed her LSD when she was 6. Many a woman (and possibly men too) has had Ecstasy or other drugs spiked into their drinks. It isn’t always the addict’s ‘choice’ to get started, and finding help to beat addiction isn’t easy.

          • raymond hagermann

            They know they costs of continuing their addict ways. Fight it or die. I could almost feel sorry for your cousin..if you weren’t blatant trying to bring in the exception. But hey, I’ll play ball. You always have a choice. You can choose to take the hard recovery path…or continue on the easy way to death. I’m not heartless…just cold blooded.

          • kittiesarenice

            My cousin paid for his addict ways by going to prison at 19 and was released at 30 and now taking the hard recovery path. The only good thing that came out of his prison time was going through a Drug/Alcohol Rehab Program, something we asked the judge to get him into. He’s starting over in his 30s now. Don’t feel sorry for him, just if you have to deal with an addict going clean try to give them a chance.

          • donius

            And those are edge cases. Statistical outliers. Which is why mandatory minimums and zero tolerance policies are flawed.

            Raymond might be hard hearted but he’s not emotional or insane or heartless. He just has a different view of personal responsibility than you do. Compassion for wrong behavior might well have public policy and rehabilitation value. But saying that it’s the only way to think about bad behavior is pretty naive.

          • Justin Chapweske

            Raymond – Thanks for being brave enough to share your story.

        • raymond hagermann

          More than should be. I don’t get their appeal since I’m not sensitive to analgesic type meds. Don’t take them myself.

      • Lojiko

        If you think drugs are so bad, why not let the addicts kill themselves with drugs? If you think drugs are so bad, why do you insist on executing a punishment against addicts than is arguably worse than drug addiction? Why not just let them “feel good”?

      • YouareNOsoldier.

        I’m emailing your CO a screenshot of this. You just suggested that american citizens be executed without just cause or mercy, and you did it while proudly representing the US military. I am researching you and emailing this screenshot to as many relevant email addresses as I can find.

        Serve with honor. This kind of behavior and public statement brings dishonor to your post and the organization that you represent. A member of the military suggesting that americans be executed without just cause and trial is HORRIFIC.

        • raymond hagermann

          No. You won’t. I’m not under UCMJ jurisdiction. Nice try though. This picture was from 03, quite sometime since I’ve worn that uniform. Yes. I did serve with honor. Proudly and with some distinction. Seen way too many families destroyed by drug addicts selfishness. So I’ll treat them like the cancer they are.

          • DAN

            You have a people abuse disorder! Hate, such as what you clearly display, is a horrible attribute. I hope you seek help.

          • raymond hagermann

            No. I am tired of the illusion many of you seem to think is reality. “If they only knew how hard it is on us…they’ll stop…”, “They just don’t know how it hurts…” “They don’t want to be addicts….they just can’t stop.” Evidently someone hasn’t enlightened these family members to the fact that the addicts know full well what they are doing and what it can cost the. They don’t care about those they hurt. I won’t waste a second caring about them.

          • Gary Laney

            Raymond, you are ignorant. Nothing more, nothing less. Thanks for your service.

          • raymond hagermann

            This has nothing to do with service. Also, I’m not ignorant. I’m very well versed in this topic. An addict is an addict. Nothing more nothing less. They are not to be trusted.

          • Gary Laney

            This is a statement of ignorance. An addict is an addict. I, like many, sought “to feel good” in my youth and suffered no consequence. Others get addicted doing much less. Your ignorance becomes stupidity when you fail to acknowledge it and hang on to your ignorance as fact.

          • Katherine Mitchell

            Did you read the article? I doubt you have even a slight grasp on neuroscience, or are capable of forming opinions based on empirical evidence as opposed to your own self righteous notions based on your own worldview, but there is very compelling evidence that addiction substantially alters brain chemistry. I am sure you haven’t actually read any studies or research, but before you call for mass executions, maybe look into that stuff?

            I can’t believe anyone would be so hateful, violent, and vitriolic. PTSD?

          • raymond hagermann

            Ahhh yes. The “did you read…” argument. Yes. I read and I do understand the science of addiction (both biological and psychological.) I even understand the interaction of the individual and their community that helps to reinforce the cycle of addiction. Oh, wait. You weren’t expecting that one were you? You expected me to simply just jump off the cuff and spew out my “vitriol” weren’t you? Yes. I know it alters neurological connections. It doesn’t stop you from forming thoughts. You can still see the costs to those who are harmed by your “fix.” You simply don’t care. I spent 12 years trying to “help” my addict. Nothing got through. Not leaving me with crack heads. Not nearly killing me with their coke on the bathroom mirror. Not being so high the house caught fire trying to boil water. Not having me go through two rooms and get slammed inside a wall. Not even nearly dying from pneumonia because they were out tricking to get money v or coke and having me be the parent. THIS is what I see. The real victims of this “harmless” activity. The families destroyed because one member wanted to self medicate. Mothers and fathers burying their children. Children burying their brother or sister after they went out “partying.” No. Call me all the hateful things you want. You’re probably right…. I will never coddle an addict.

          • Katherine Mitchell

            “Yes. I know it alters neurological connections. It doesn’t stop you from forming thoughts”

            Can you explain this? How does one think independently of their brain’s reward pathways. Explain how chemically alteredneuronal coconnections in the limbic system have absolutely nothing to do with choice? Find me one neurologist who says that higher level reasoning is independent of the limbic system and not directly influenced by our reward pathways. Seriously, I would be fascinated.

            You claim to know the neurophysiology behind addiction. And apparently you have some special insight into the brain’s functioning that all those scientists don’t. Can you explain the how? Explain how chemically, addiction doesn’t influence the brain’s ability to make choices? Can you cite a source. Forgive my skepticism, but you are telling me that you have independently reached verifiable conclusions that the best brain scientists in the world have missed?

            Because if you have discovered that the amygdala, limbic system, and association cortex have a fundamentally different function than the scientific concensus, you owe it tp tje world of medicine to publish these findings immediately.

            “ Mothers and fathers burying their children. Children burying their brother or sister after they went out “partying.”

            So we should solve this problem by EXECUTING their siblings and children before the drugs do!!!? That sounds like am arguments for treatment and understanding. Forgive me for doubting that somebody who’s thinks “we should kill these people before they kill themselves accidentally amd hurt their families” is logical solution doesn’t have the firmest grasp on neuroscience. The fact that you think we should murder people because when they hurt them sell it hurts their families suggest to me that you are speaking from personal pain, using every addict as a proxy for your parents.

            You are angry at your parents, I think the homicidal feelings sprout from that anger. We have all felt “so angry I could kill them” at somebody. But the fact that you acknowledge that untimely deaths caused by addiction bring families pain suggest to me that deep down, you actually wish your parents had gotten help amd been able to function the way parents are supposed to more than you wish they had been executed by the state.

            I’m willing bet that due to your parents obviously neglecting to raise you in an emotionally healthy environments, you don’t really have the copimg skills or emotional vocabulary to express your pain as anything but murderous anger. In your earlier post I thought you were just a jerk but your comment about the pain of burying a child suggests that you don’t actually think that killing these people is the best solution. Surely you are not so logically deficit that you think killing these children would be any easier on the parents. It looks like you are just angry at your parents for failing you,

          • Bum Deggy

            “I spent 12 years trying to ‘help’ my addict.” This right here is why you shouldn’t be making policy recommendations. You don’t have professional, objective experience with the general problem. You have personal experience with limited aspects of the problem through a handful of your close personal relationships. Even if it’s 50 personal relationships, you are still biased.

            No one policy will fit all, and you may even be right about what should’ve been done to “your addict[s]“…but you are too close to your personal demons to be unbiased in judging others. This resembles the meaning of being “unable to see the forest for the trees.” You should really give counseling a try; cold blood is not healthy, and there are alternatives to both hate and forgiveness that may work for you. The rest of the world isn’t half as bad as what it sounds like you’ve been through; you don’t have to forgive your demons to feel compassion for the rest of us.

            As for the “no one makes them” argument, this is not entirely invalid, but choosing to feed an addiction does not make a person worthless or deserving of execution. Furthermore, you say you’ve read this article, but you don’t seem to have understood the implications: disorders can erode a person’s control over actions to the point where they’re not really voluntary. They can also introduce such extreme consequences to choices that even your hateful, intolerant, hard-ass attitude would crack right open if it was the one thing standing between you and a fix. You clearly don’t have both the personal experience with addiction and the personal vulnerability to it that are necessary to truly rob a person of self-control, as this article considers. “Your addicts” may have made a lot of willfully psychopathic decisions, but you are perpetuating the harm they did to you if you let yourself continue to believe that all the world’s addicts are just like “yours.” Let it go, move on, and join us all back in the real world, where things aren’t always quite so grim.

          • Gary Laney

            Ah the “I’m more educated than you think,” argument. Sort of like “I’m not racist but…” No, you haven’t a clue. You think you do, but you haven’t a clue.

          • raymond hagermann

            And do enlighten me as to why you don’t think I “have a clue,” dear Gary. Is it because I’m not “sensitive” to the “plight of these poor souls?” Because I’m no longer willing to “give just a little more effort for them to get their lives back on track?” How about “if youknow what is happening to them …you’d be more understanding?” No. I understand. I simply don’t buy the coddling approach. So no. No compassion for them. No sympathy for them. No effort to save them from themselves.. Stand up and take responsibility for your wasted life, addicts. Quit simply blaming the target of their addiction. They have a choice.

          • Gary Laney

            Start by comprehending what the article says. Your comments willfully ignore anything that does not fit into your world view. Unfortunately for your point of view, it’s science, and not a “tolerant society” that has formed the policy around addiction.

            I am not an addict by a long shot, but I am in a situation where addiction has affected my life. If I chose to be bitter like you, I’d be a miserable SOB like you. But by coming to understand the disease, I have a peace of mind that you obviously do not have. I cannot control an addict’s behavior. I can, however, set my boundaries and, from that distance, have empathy for the addict in the same way I have empathy for those with any other disease.

            It could have been me, but it wasn’t and for that, I’m thankful.

          • raymond hagermann

            No. That’s what you all seem to fail at. I do understand the science. I don’t care. In the end addicts put their poison in themselves. They chose their drugs. They can die on them and they don’t care. So no. No empathy to waste on wastes of life. They know they hurt others and continue using and hurting. Enough is enough.

          • philb

            Addicts don’t have a choice until we are exposed to a solution, the problem with our society is that we spend millions of dollars to “cure” and find causal factors for all kinds of diseases and we never blame the patient who has cancer for being “sick”, why would you blame the person who has an addictive disorder for being “sick”, same mechanism of disease. I would like to suggest that we come together as a society and really seek and fund the solution to addiction, which I think science is getting closer to all the time. I have found the solution, sober 31 years, and during that time have have used “sobriety” to help thousands of others, including healing within my own family who are generational alcoholics and addicts and most clean and sober today.

            I heard a story once about a young girl who was walking along a beach after a huge storm, as she was walking she was bending over and picking things up and throwing them into the ocean, and older gentleman was watching her and asked her what she was doing, she replied “there are thousands of starfish washed up on the shore and i am saving them”, he looked at her in surprise and said, “But there are so many, you can’t possibly make a difference”, she picked up another star fish n threw it into the ocean and looked at the older man and said, “I made a difference to that one”. So not everybody that has a disease gets well, does that mean we should quit trying, isn’t it better to be part of the solution, rather than part of the problem, i understand that my disease hurt many people, my recovery has helped even more, my recovery has created huge ripples in the health and happiness of my family and friends and others I have met along the way. Phil

          • Edwin-Dale Clemons

            Dude, you are an idiot.

          • Katherine Mitchell

            Good idea, these families destroyed by drug abuse will be so much better off if the government has their loved ones executed.

            Your bloodthirst and complete lack of compassion is am embarrassment to all those who serve. You should be ashamed.

          • raymond hagermann

            Why not? Addicts dont care who they hurt. My lack of compassion isn’t like you think. I’m actually very compassionate. Just not to addicts. Was it fair for my neighbors to have to bury their son because he wanted to get high? Was it fair for me to get left in the care of meth and crackheads fo a parent to go get high? Is it fair for any child to have to grow up being their parents parent? No don’t harp on me about compassion for selfish addicts. They’ll get none. I feel for their families. That’s it.

          • vito33

            Unless you’re just a simple troll, you need to see a psychiatrist. Your comments indicate that you are a danger to others, and possibly to yourself.
            Get some help.

          • raymond hagermann

            Troll? No. Hateful? Embittered against a culture that promotes the “if it feels good do it” mindset and then makes excuses for them to avoid responsibility? Yes.

          • Gary Laney

            Hateful would be accurate. You walk into the rooms of an AA meeting and you see people who have been sober 30 years or more and have led good lives. Yet, they know they are addicts and if they drank today it would be as if they never stopped. They are addicts. Yet, they stay sober and lead productive lives.

            Your lack of empathy is either because 1. Pure ignorance or 2. Having had a bad experience with a particular addict, so you carry resentment to the entire population of addicts.

          • raymond hagermann

            My attitude? Yes. I hate them for their weakness. I hate their selfishness. I hate their “need”. It isn’t one or two experiences….it’s many experiences. It’s watching many lives ruined to selfishness. It’s wasting time and effort on wastes of human life when others who were more worthy floundered. It’s watching decent people bury their waste of a relation due to their “habit” and end up needlessly hurting. Yes. I hate them and their addiction.

          • Gary Laney

            That hate is on you, not any addict. If you took time to understand, as opposed to build resentment, you wouldn’t find a need to lash out on message boards or admit to hating anybody. If you had ANY understanding of addiction, you wouldn’t dismiss it as “selfishness.”

          • raymond hagermann

            No. It’s on the addict and their selfishness. I don’t care about their pain. They deserve it. Also understanding does not mean acceptance. The two are not synonymous. They want their fix and damn anyone or anything that gets between them. Pure selfishness.

          • gurlgeek

            Raymond, I’m sad this has all become about you. I understand your frustration, and more your pain. However, I’m an alcoholic, and was incapable of making a clear decision as a parent without alcohol being the primary driver in all those decisions. I’m extremely lucky and didn’t care about stigma and managed to get sober while my children were still young. I watched one of them repeat the cycle but because she knew how to get help, and she watched others recover and be loved in spite of their additions, she doesn’t have to suffer the same consequences I did. For that I’m grateful. As for your situation, is it even slightly possible that if your parents knew how to get help and were given access without social stigma that perhaps your chances of having a different story today would be a tiny bit improved?

            No child should have to suffer as you did. If we look at all of this in a different way as this interview suggests perhaps there will be fewer children with your story. I do fully understand your feelings and have often wondered why some of us recover and others don’t. More over why there is such a disproportionate number of practicing addicts compared to recovering ones.

            Raymond, thank you for your honesty and your service.

          • Stan N

            Good insights, the part I think Raymond is really missing is how important it Is to break the cycle. I get the impression that he thinks he’s above addiction problems, but my guess is that with all the resentment and hatred he carries he has a boat load of personal issues that get played out in relationships with either loved ones kids or a spouse.
            He wrote that he spent 12 years dealing with the behavior.
            I doubt Raymond takes my suggestion but if I were him I would visit Alanon or some 12 step support group.
            Thank you Raymond for your service I do appreciate it…good luck,buddy.

          • scrantongirlx

            i’m sorry that you had to grow up too fast and didn’t get to enjoy the typical carefree aspects of childhood. that’s not fair for any child to endure. you are at an age now that you control you life. i hope you can put the past behind you enough to take full advantage of every joyous and beautiful thing that life has to offer. i know you can’t go back and relive your childhood, but i wish you double the blessings in your adult years to make up for lost time.

          • MamaG

            Cancer is a disease just like addiction! I became addicted to pain medicine after several bone injuries with surgeries and metal inserted into my body. I did not know I was addicted till I thought I shouldn’t need it anymore but couldn’t stop with out being in pain. My doctor called it a physical dependency since I took it as prescribed but the addicted feeling felt the same. Not everything is black and white there is a lot of grey areas, think before you speak. I’m sorry that someone hurt you with their addiction hopefully one day you can forgive them!

          • raymond hagermann

            And you eradicate cancer do you not? Congrats. You were dependent upon a prescription medication. You kicked your habit? Well good for you. You got yourself help. BRAVO. You weren’t an addict. Oh I have thought about what I say. Every word I’ve said has been intentional and deliberate. Forgive? No. My addict will burn in hellfire before I ever talk to them.

          • Christina

            Ten years ago and you still use this picture? Nice to have peaked then huh? You’re an idiot and you are taking your experiences and making generalizations.

          • raymond hagermann

            No. I pulled up this picture because my old plt reposted their in service photos for veterans day. I simply haven’t pulled mine back to one I don’t hate.

          • Gary Laney

            Raymond, you are as bad as — and probably worse than — the addict in your life, truly an apple falling off the tree. You have the choice to find compassion and peace with yourself even more so than the addict has the choice to stop medicating him/herself. Their choice is largely taken away from the addict for biological reasons that science understands (but you do not). You, however, CHOOSE to ignore what is known and you CHOOSE to carry resentment that eats away at your very soul. No addict has the power to make you carry resentment. You have that control over yourself. And by choosing resentment, you hurt yourself and others.

          • raymond hagermann

            Ob do tell me wise Gary…what have I ignored? I must hear this. Compassion? For addicts? No. Self inflicted wounds get no sympathy from me. I know that anytime I have to take something, anything really, that can fundamentally alter the way my body works (technical definition of the word drug), I run a very high chance of developing an addiction. I run an increased chance of destroying another set of lives. No. I’m not going to let bloodline traits continue to destroy because I was weak and fell to them.

          • Gary Laney

            You ignore the science. And you choose to carry resentment. Even if addicts were put on earth with the specific purpose of annoying Raymond Hagermann — which seems to be your attitude — it’s on you to carry resentment, period.

          • raymond hagermann

            No. Not ignoring the science. Who started the drug use? Who put that bottle/pipe/needle in their hand? Who ultimately said “This is good! I want more?” The addict.

          • U.s. Hemp

            Will this reply to vets as well and their pharmaceutical addicts?

          • raymond hagermann

            Will it APPLY to vets?…..You mean veterinarian or veteran?

          • PattiP

            I have never taken a drug in my life and I am now a senior citizen. I have only taken even prescribed meds (such as antibiotics) when absolutely necessary, so I have no vested interest in what this article supports. My hope is that you are not raising children with your belief system. Over the years, when hearing about horrible merciless acts, I have often wondered who would raise a person who would do such a thing. I think that I now have an answer. People with mind sets such as yours.

          • raymond hagermann

            And you think treating addicts with kid gloves is “merciful”? More like rewarding bad behaviour. You harm yourself? Sucks, but that’s your issue. Harm another for your selfish desires? No compassion or mercy.

          • Pat

            You are a complete ignorant moron

          • raymond hagermann

            Incorrect. I’m experienced in this and hateful. Slight difference.

          • windancr

            Who is the addict in your family who hurt you? Seriously? Grow up and get educated.

          • raymond hagermann

            Already am educated in this field. You see ms windy dancer, I’m educated both by studying the science and experientially. And yes, as you bleeding hearts are so quick to point out, I’m absolutely vile when it comes to dealing with those “poor, tortured wretches…merely needing an act of kindness and a gentle hand… to find salvation and deliverance” (yes, I’ve even heard that exact line.) You see, I truly don’t care WHY they turned to drugs. I don’t care that there are measurable and demonstrative changes in the cognition/decision making ability/ structure of the brain. I don’t care what predilections they had. I don’t care what forces lead them to think drugs are/were the answer. They took their drug and said “This is my answer. This is all that matters.” That is nothing more than selfishness and cowardly.

      • raymond hagermann

        Oh do enlighten me Jay. How am I ignorant? I fully admit I’m an ass…but I’m not ignorant.

  • guest

    NO!!!! If one is fat or obese, then they overeat; therefore, they are OBESE. What is this? Doctors who want to make more money but do not treat the patient? This is not a disease but a BAD HABIT of stuffing one’s face, instead of gardening or doing something positive. Do you really think these people care? Hey, right, PASS another Nacho. Ridiculous thinking.

    • BeH20

      And do you have data to back up your statements?

    • Shanna Gilkeson

      Bravo. Flawlessly spoken like someone who has absolutely idea how addiction works.

    • Kait

      Food disorder isn’t just over-eating. Its anorexia and bulemia too.
      Yet somehow when you over eat, or binge, and don’t make yourself vomit its just a “bad choice” not a real mental disorder like bulemia.
      What’s the difference? Its how people look, fat people make other uncomfy.
      So it muse be them with the problem, right?
      Ever been to an OEA meeting? You will see maybe 2 or 3 obese people.
      Others are either bulemic or also have an obsession with covering their food disorder with working out 5 hours a day.
      But please, keep your mind small. Food disorders are just fat people making bad choices.

    • Guest

      Wow, that’s possibly the dumbest thing I’ve ever heard. It’s obvious you’ve never known someone with an eating disorder or a drug problem who you’ve cared about. Your statements here are unjustified, indignified, and blatantly ignorant. Did you even read the article?

    • kCw

      Are you just being a troll? Did you even read the article…? Or just the headline?

  • Marty Harding

    I think this is a brilliantly stated article, and I loved hearing about the stigma research. Thank you!

  • Reid K Hester

    In God we trust. Everyone else has gotta show their data. And John has demonstrated with his research that words and labels matter.

    • Terry Cooper

      Absolutely “labels” matter. Just look at labels that are put on kids in schools, etc. by peers, teachers, or certain tests. Some labels are so bad that kids and their parents will give up before they even try to find the positive. I had numerous friends who have had problems with alcohol and or drugs. Some of them absolutely just gave in to the disorder once they were labeled. I also think that there is a huge genetic and environmental element involved in this problem. Once society understands the things that are triggered in a persons brain as soon as they introduce whatever substance they become addicted to, I think much of the stigma may be reduced. In fact, I’d go as far as to say that everybody has the potential to become “addicted” to something, and may well be addicted to something. Even common, everyday things have an addictive quality, i.e coffee, sugar, etc. but we don’t berate people who cannot get through a morning without a cup of coffee or because they put a spoonful of sugar in it.