Guest Editorial: An Antiracist, Justice-Guided ASAM: It’s Who We Are

An Antiracist, Justice-Guided ASAM: It’s Who We Are

by Stephen M. Taylor, MD, MPH, DFAPA, DFASAM

ASAM Incoming 2023 President-Elect

(with helpful input from Drs. Mishka Terplan, Ricky Bluthenthal and Andrea Barthwell, who are also members of the ASAM Writing Subcommittee on Racial Justice.)

A patient recently said to me, “At this point in my life, recovery is not only how I live, it’s who I am.” Although I realize – and have helped him understand – that recurrences can occur in the course of the chronic disease that is addiction, I was able to celebrate with him that he is now “right where he needs to be.” It was a long, often painful journey to get there, and he will have to remain diligent to build on the gains he has made.

As ASAM prepares to release the third in a three-part series of Public Policy Statements on Racial Justice, our journey to become an antiracist[1], justice-guided organization in all that we do is akin to the journey of my patient – or any of our patients, who trod purposefully and tenaciously, if not always rapidly and unerringly, from the abyss of active addiction towards the oasis of long term, stable recovery and wellness. It is a journey fraught with challenges which, at least initially, often go unrecognized because they operate at an automatic and unconscious level and can lead to behavior and consequences that sometimes seem the exact opposite of everything we desired and intended.

Consider, for example, an issue that inspired a great deal of spirited discussion and debate among the members of the Racial Justice Writing Subcommittee, which I was honored to co-chair with Dr. Sharon Stancliff. We confronted the history of disproportionate – and clearly racist – emphasis on arresting and incarcerating people who use and/or possess drugs in communities of color, rather than on providing them adequate access to evidence-based prevention, treatment, and recovery support services. In the 1980s, many a well-intentioned community resident or leader endorsed, advocated for, and ultimately enacted or supported the harsh, punitive approach to people who use drugs and people with substance use disorder (SUD) that has plagued Black communities for decades. Indeed, policymakers who lived in and/or represented Black communities, and who were desperate to respond to widely held sentiments among their constituents that drug-related crime in communities of color must be addressed, were often the most vocal and aggressive proponents of such policies. Sadly, the mass incarceration and inequitable criminalization of people of color who use substances that resulted was devastating to those communities. Only years later, when the damage that was visited upon these communities was recognized, analyzed, understood, and widely discussed and condemned did many Americans come to appreciate the horrific racist toll such policies took on the people in these neighborhoods.

It has long been known that substance use disorders are medical and public health problems.  Recognizing this, it is difficult to accept the racist application of a heavy handed criminal legal approach to these problems among the people in Black communities. This dark – and sadly, ongoing – chapter in our history is one in which the desire to fight crime in a community of color is not accompanied, as it should be, by purposeful, planned, and committed effort to protect the people of the community from racism and racist policies. We, the representative members of ASAM who wrote the Racial Justice Public Policy Statement Series, are determined that we will not make similar mistakes, will call them out when we recognize them, and will work to correct them wherever they exist. 

In medical school, we’re taught that no matter how brilliant or knowledgeable a physician may be, “You can’t make the diagnosis (or treat the illness) you do not consider.” This holds true for issues of justice; it does not matter that I am not an active, intentional interpersonal racist. No matter my personal or individual history -- for I am an African-American physician from an impoverished inner city racially isolated community -- I can miss the mark. If I am not actively thinking about racial justice in everything I do, then I am at risk of endorsing, pursuing, supporting, or at least, passively failing to recognize and address policies and practices that produce racially unjust results, regardless of their intent.

As we go forward, ASAM must always make a conscious, purposeful, planned, committed, doggedly determined effort to ensure that racial justice and global justice concerns always guide, direct, and permeate anything and everything we do. Throughout all ASAM activities and projects, we must incorporate antiracism and the relentless pursuit of justice in all forms, for all people; applying “universal justice” in much the same way we apply “universal precautions” to combat infectious disease. “Universal justice” must be how we think and act, and ultimately has to become part of our “DNA.”

As we assess our commitment to this mandate, a review of our recent policies and practices is promising. ASAM’s Five-Year Strategic Plan includes a thoughtful roadmap for us to follow as we attempt to incorporate the recommendations of our own Public Policy Statements into actionable goals and objectives. Similarly, ASAM’s recent Public Policy Statement on Substance Use and Substance Use Disorder Among Pregnant and Postpartum People directly addresses the racist nature of the disproportionately punitive approach that has been taken to pregnant and postpartum people of color and makes dozens of clear, specific, bold-but-actionable recommendations that illuminate the path towards more just and equitable treatment of this patient population. When the least among us receives competent and thoughtful care, everyone is better off. And it’s good to see that we at ASAM are putting our money where our mouths are with the new Diversity Travel Scholarships that will provide $2,000 of funding to assist physicians or medical students who identify as a member of an underrepresented group to attend our 2023 Annual Conference. This start is just that -- a start that, as indicated above, must be followed up by the long-term work of solidifying and building on the initial progress. We can and we must continue to move forward. Ultimately, antiracism and a strict adherence to principles of “universal justice” must become for ASAM “not only how we live, but who we are.”