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The Disease of Addiction is on Trial

by Steven Kassels, MD | December 12, 2014

The recent Ebola “crisis” and some of our politicians’ knee jerk reactions unfortunately only serve to reinforce the notion that when we base decisions on fear, not fact; when we allow emotions and not science to dictate responses; or when we ignore reality for perceived political or financial gain, we do a disservice to our family, our friends, our neighbors, our communities and to the fabric of our society.

These types of reactions have been prevalent in our overall approach to the treatment of the disease of addiction for longer than I wish to remember. As a physician who spent his earlier years practicing emergency medicine, it became clear that during many ER shifts a large minority, if not a majority of the patients I treated in the emergency department presented with illnesses related to the disease of addiction. Sure there were the “drunks” who had fallen off the bar stools or been battered in an altercation, the PCP psychotic hypertensive crisis, the automobile accidents related to drugs or alcohol abuse, the opioid-addicted patient feigning hematuria. But when you add the children with asthma due to secondhand smoking, the unwanted teenage pregnancies from intoxication, cardiac arrhythmias or infarction or cerebral vascular accidents due to nicotine or cocaine, diabetes exacerbated by excessive food consumption, etc., etc., one begins to understand the magnitude of the relationship between medical, psychiatric and surgical illnesses and underlying addiction.

So I decided I would change attitudes - that I could make a difference. My first approach was a cerebral one—through science and logic. I expanded my medical life to include addiction medicine when it was still in its embryonic stages. And I gave lectures and presentations and round table discussions to police departments, to PTAs, to medical students and residents, and to just about anyone who would listen. But, there was a problem – who came to listen? It was like preaching to the choir! So nothing really changed – NIMBYism (“Not In My Back Yard”) continued and I was not making a difference.

We will not significantly change public opinion through traditional means. Put up an announcement at a local library for a talk about addiction and see how many people attend. Ask your patients to invite family members to discuss how and why addiction is a disease and do they come? Go talk to a group of local politicians and do you really change their minds? Sure they may “yes” you to death, but how do they vote; and how many politicians, even if they understand the disease of addiction, are willing to risk their political capital like Vermont’s Governor Shumlin and make a real difference?

So when I entered my more formative years, I decided on a new approach. I would enter the lion’s den – but not through the front door. We can change public opinion and help our patients by educating through the back door; by engaging on Twitter and on Facebook and on Instagram, and by illustrating the consequences of denial as it relates to the financial and societal costs of not more aggressively funding and treating the disease.

Addiction on Trial Book CoverI then went one step further and wrote Addiction on Trial: Tragedy in Downeast Maine (which could be entitled, Addiction on Trial: Tragedy Anywhere USA) as a murder mystery/legal thriller based on medical and legal truths to reach a wider audience and to change hearts and minds by destigmatizing and demystifying the disease of addiction. I believe I am making significant inroads by morphing my book readings into educational lectures about addiction as I travel around the country: educating by entertaining can make a difference. I have also expanded this approach by offering to Skype in to book club meetings to discuss the book’s characters, the community’s pain and whether Jimmy, the relapsed heroin addict from away really did murder Annette Fiorno. I hope others will join me in trying new ways to change opinions about a disease that has become the scourge of our cities and towns.

Steve KasselSteven Kassels has been Board Certified in Emergency Medicine and Addiction Medicine. He is a Co-Founder and Medical Director of Community Substance Abuse Centers, with treatment facilities located throughout New England. He has served as the Chair of the Massachusetts ASAM Public Policy Committee; a member of the ASAM Medical Specialty Advisory Group; and as CARF Expert Medical Consultant for Opioid Treatment Programs. When giving talks, he frequently donates his author proceeds to local treatment centers and he has personally subsidized the publishing costs to keep the price affordable. “Medicine has been very good to me and it is my way of trying to give back.” Steve will Skype into book groups and they can be scheduled through his website. The book is available at Amazon, iBooks and Barnes and Noble online.

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