Final presentation for the Scaife Advanced Student Medical Seminar by Jana MacKercher

1. PERCEPTION OF
ADDICTION AND ITS Jana MacKercher
Scaife Fellowship
EFFECTS ON TREATMENT July 2012
AND RECOVERY

2. DISEASE AND TREATMENT
 To create and implement effective treatments, the course of a disease and
its effects are studied and analyzed
 Most importantly, it is necessary that people, especially physicians,
understand the intricacies of each disease
 But what happens to treatment efficacy when society does
not view the disease as organic but a condition of personal
choice?

3.  People’s understanding of addiction is a function of its context and is a
“cultural means of distinguishing people who perform an
undesirable behavior from others who do not”
 Heim et al. 2001
 Instead of viewing drug addiction as a medical condition, or a disease,
society tends to associate addicts with moral weakness.

4. ADDICTION ACCORDING TO SOCIETY
 “Addiction as a Functional Representation” Heim et al. 2001
 144 college students participated
 Given images and descriptions of actors (males and females)
 Each actor depicted as a member of the middle class (a) and a ‘junkie’ (b) in
different scenarios

5. ADDICTION ACCORDING TO SOCIETY
 “Addiction as a Functional Representation” Heim et al. 2001
 Results:
 Heroin was perceived to be more addictive for those in the ‘junkie’ condition,
whereas cocaine was more addictive for the middle class
 ‘Junkies” were perceived to be more likely to use drugs than the middle class
 Middle class drug use was believed to be less problematic in nature
 This shows that people tend to apply their own biases towards addiction
 Perception of addiction is a “function of social conditions, personal
circumstances and type of substance”
 Heim et al., 2001

6. ADDICTION ACCORDING TO SOCIETY
 “The Public Stigma of Mental Illness and Drug Addiction” Corrigan et al.
2009
 Public stigma: “impact that members of the general population have
when they endorse negative stereotypes”
 Randomized phone interviews, representative of American English-
speaking adults
 Given a scenario about a person with either a mental, substance
dependent, or physical disability
 Asked questions regarding his perception of the disabled person in terms
of
 Responsibility for their condition
 Role of the community in helping them
 And level of dangerousness

7. ADDICTION ACCORDING TO SOCIETY
 “The Public Stigma of Mental Illness and Drug Addiction” Corrigan et al.
2009
 Results:
 Disabled persons described as having a drug addiction were perceived to be
more responsible for their health condition than those with a physical illness
that required a wheelchair
 Participants were also less likely to be willing to offer help to the drug
addicted person
 Psychiatric conditions were categorized as more dangerous, more likely to
evoke fear, and more likely to be avoided
 Overall, participants reported that they tend to view mental illness more
negatively than physical disabilities

8. ADDICTION AS A CHRONIC DISEASE
 Many clinicians trained in addiction and those in recovery believe it is a
chronic disease that involves biomedical and psychosocial symptoms
 These people who subscribe to the “disease model” often compare addiction
to other diseases that are more readily accepted and understood as chronic
by the public
 Relapse is often a common part of addiction recovery but usually makes it
more difficult to secure long-term funding that will support a lifetime of
treatment
 This, however, is not typically the case when considering chronic illnesses
deemed to be of a more biomedical origin in terms of life-long coverage of
hospitalizations, doctor visits, medications as well as support from loved ones

9. ADDICTION VS OTHER CHRONIC DISEASES
 “Drug dependence: A Chronic Medical Illness” McLellan et al. 2000
 Substance Abuse
 Abstinence in substance abuse patients, 1 year post-discharge
 40-60%
 Additional 15-30% do not resume dependent use
 Other chronic diseases
 Full adherence to prescribed treatment plans
 Type 1 diabetes <60%
 Hypertension or asthma <40%
 Rates are even lower when patients asked to make behavioral changes
 Recurrence of symptoms requiring additional medical care
 Type 1 diabetes 30-50%
 Hypertension or asthma 50-70%

10. ADDICTION VS OTHER CHRONIC DISEASES
 Despite the fact that relapse rates for addicts
are comparable to that of other chronic
diseases, most private insurance “only covers detox or
acute stabilization with no continuing care”
 (McLellan et al., 2009, p. 1693).

11. PHYSICIAN PERCEPTION OF ADDICTION
 “Physician Beliefs About Substance Misuse and Its Treatment: Findings
from a U.S. Survey of Primary Care Practitioners” Johnson et al. 2005
 648 primary care doctors (internal medicine, general practice, family practice,
obstetrics-gynecology, and pediatrics)
 Survey on views towards various diseases, including addiction
 Results:
 Following percentages represent physicians who felt “very prepared” to identify
each disease
 Hypertension (82.8%)
 Diabetes (82.3%)
 Depression (44.1%)
 Substance Abuse disorders (less than 33%)

12. PHYSICIAN PERCEPTION OF ADDICTION
 “Physician Beliefs About Substance Misuse and Its Treatment: Findings
from a U.S. Survey of Primary Care Practitioners” Johnson et al. 2005
 Results:
 Perceived treatment effectiveness for each disease
 “Very effective”
 Hypertension 85.7%
 Diabetes 69.0%
 “Not very effective/not effective at all”
 Illegal drug 62.7%
 Alcohol abuse 48.7%

13. PHYSICIAN PERCEPTION OF ADDICTION
 “Physician Beliefs About Substance Misuse and Its Treatment: Findings
from a U.S. Survey of Primary Care Practitioners” Johnson et al. 2005
 Perceived difficulty in discussing substance abuse
 > 1/3 felt uncomfortable talking about alcohol and prescription drug
abuse with their patients
 “Very difficult” 40.7%
 “Somewhat difficult” 46.6%
 But only 17.9% felt uncomfortable with depression
 Both are sensitive subjects!

14. CONCLUSION
 Easy to see why millions of Americans face discrimination when it comes
to addiction.
 Society believes if someone makes the initial choice to use a drug and
becomes addicted, they are responsible for the negative outcomes
resulting from this act.
 Like people suffering from chronic illnesses, addicts have the right to be
regarded as patients with a disease that deserve treatment in a setting of
respect, understanding, and hope.
 Above all else, physicians need to receive more training in addiction
medicine so that they may help recognize the addicts that come into their
office on a regular basis
 5.7% of substance abuse treatment admissions are made by health
professionals
 44.3% are made by the criminal justice system
 “Addiction Medicine: Closing the Gap between Science and Practice” CASA, 2012