Is Cancer A Moral Failing? What About Addiction?


June 24, 2018   Thomas G. Kimball, PhD

Published in The Doctor Weighs In, July 24, 2018. View the Article Here

Obviously, cancer is not a moral failing. No reasonable or rational person would make such a claim about a disease that today accounts for about 1 in every 7 deaths worldwide (American Cancer Society, 2018). Although different in many ways, cancer and addiction are both complex disease processes with biological, psychological, and social/environmental components.

However, unlike cancer, the disease of addiction carries with it massive stigma creating additional suffering for patients and their family members. This needs to stop. I believe that this massive stigma exists because we fail to categorize addiction properly as a chronic brain disease. Addiction as a chronic brain disease is not just conjecture but based on a body of excellent neurological research (NIDA, 2014).

The need for longitudinal outcomes research

The need for longitudinal outcomes research on the effectiveness of various models of treatment for addiction sufferers is still sorely needed. In addition, we also need to understand:


  • When the most effective models we have identified should be employed
  • What type of patient should utilize each model
  • What level of care should be employed for each patient

To accomplish this, society at large and professionals in the addiction recovery field can learn from cancer treatment protocols and how they have changed the face of cancer treatment.

Ongoing cancer research has occurred for decades across the U.S., which has refined and standardized incredibly effective treatment regimens (e.g., childhood cancers). This process has lead to increased survival rates and long-standing recovery for cancer patients. Utilizing this kind of strategy in the treatment and recovery from addiction has the potential to not only help us find more effective ways of helping those who suffer and their family members but also destigmatizing the disease of addiction itself.

Why, even in the face of the available research, do we, collectively, hold onto archaic and outdated views of addiction?

Typically, our society has blamed addiction and those who suffer from it on an individual’s poor choices, moral or ethical failings, and/or unhealthy family dynamics or interactions. We do know there are social/environmental factors and stressors that increase the risk for addiction disease formation such as:

  • Early attachment (Schindler & Broning, 2015)
  • Adverse childhood experiences (Dube, Anda, Felitti, Edwards, & Croft, 2002),
  • Parenting (Stone, Becker, Huber, & Catalano, 2012)
  • Peers (Piko & Kovacs, 2010)
  • Other environmental stressors

Choice can play a role in addiction as well, as is the case in most other disease processes like cancer or diabetes. However, there are also powerful genetic, psychological, and other social factors at play that have nothing to do with individual choice. Moving away from an archaic view of addiction, namely blaming individual choices and families, is so important to alleviate suffering and provide the most effective care.

The Case of Childhood Cancer

I am the father of five children, two girls and three boys. In 2001, just prior to his fourth birthday, my middle child Nathaniel (a.k.a., Nato) was diagnosed with acute lymphoblastic leukemia or ALL. Immediately, he was tested for his level of risk (e.g., mild, moderate, severe). We, as his parents, were asked if we wanted to be part of the ongoing research on childhood cancer treatment occurring at a host of sights across the nation. As we moved forward with his care, we learned this type of research was decades old. Brilliant doctors and courageous children had drastically improved the survival rate of children with cancer from 20% to 80% over the course of a few decades based on this research.

Learning about this incredible research, and the positive outcomes it had created, was a bright light in a troubling time for our family. Even when we were struggling, we could be part of this massive effort helping so many children with cancer not only live but also elevate their standard of living. We felt so much gratitude for those who had participated in this treatment research before and what had been learned to benefit our son now.

Upon agreeing to participate, Nathaniel was randomly assigned to one of three treatment protocols based on his risk level, his sex, and other factors related to his disease. The three different types of treatment pathways included the “standard” pathway and two experimental protocols. We understood that as data came in from all the child participants across the nation, the experimental protocols were found to be more effective long-term and immediately replaced the old “standard”. Thus, my son was diagnosed with acute lymphoblastic leukemia (ALL), moderate risk, standard treatment. I am happy to say that Nato moved through his three years of treatment well and is cancer free to this day.

Unfortunately, in the case of addiction, this type of comprehensive research and data, which can inform treatment protocols in real time and effectively produce better outcomes, is not available for patients.

Treatment Protocols Can Help Destigmatize Addiction

Imagine, instead of being labeled a heroin addict, a patient could be properly referred to as suffering from an Opioid Use Disorder, Severe, with best practice protocols of treatment and recovery outlined based on risk level, sex and gender, and other factors related to his/her disease. Instead of being an alcoholic, language such as Alcohol Use Disorder, Moderate, should always be used. The more clinical/medical terms themselves could help individuals, families, and communities understand the nature of the disease process, its seriousness, and the importance of following the protocol or pathway outlined.

Most diseases, including chronic diseases, follow the above type of categorization and treatment based on solid research. The power in applying this kind of structure and language to addiction treatment and recovery is obvious. If we could properly diagnose, categorize, and identify the most researched-based and effective forms of recovery pathway(s) for individuals and families, it would go a long way in standardizing treatment across providers, holding providers and payers accountable for care, and destigmatizing the disease.

When my son was diagnosed with childhood cancer, he was given a proper diagnosis, acute lymphoblastic leukemia, a risk level, moderate, and a 3-year treatment regime for us to follow. Because most everyone understands the serious nature of leukemia as a disease, our community rallied around us with tremendous support and help. Amidst the crisis that is addiction in our country, we must overcome the archaic views we have had about the disease of addiction and end the stigma associated with those who suffer and those who love them.

Addiction is a chronic brain disease.

Those who suffer deserve a proper medical/clinical label to destigmatize this life-threatening disease, and move forward toward effective forms of recovery. They need to understand the risks and be given clear pathways to recovery based on their individual factors that reach across treatment providers and are paid for by third-party payers. And finally, individuals, families, and communities need to rally together in support, understanding, and hope for those who suffer just like we do when people suffer from other diseases such as childhood cancer.

References:

American Cancer Society (2018). Cancer Facts & Figures 2018. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2018/cancer-facts-and-figures-2018.pdf

Dube S. R., Anda R. F., Felitti V. J., Edwards V. J., & Croft J. B. (2002). Adverse Childhood Experiences and personal alcohol abuse as an adult. Addictive Behaviors. 27(5):713–725.

National Institute On Drug Abuse (2014). Drugs, Brain, Behavior: The Science of Addiction. https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/preface

Piko, B.F., & Kovacs, E. (2010). Do parents and school matter? Protective factors for adolescent substance use. Addictive Behaviors, 35(1), 53-56.

Schindler, A., & Broning, S. (2015). A review on attachment and adolescent substance abuse: Empirical evidence and implications for prevention and treatment. Substance Abuse, 36(3), 304-313, DOI: 10.1080/08897077.2014.983586

Stone, A.l., Becker, L.G., Huber, A.M., & Catalano, R.F. (2012). Review of risk and protective factors of substance use and problem use in emerging adults. Addictive behaviors, 37(7), 747-775.


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