1. What We Believe About Addiction Matters: A Public Health Perspective
Dr. John Dyben
DHSc, MA, MS, MCAP, CMHP
Clinical Director, Hanley Center at Origins

2. What Do We Believe About...

3. Crime? War? Poverty?

4. Diabetes? Cancer? Dracunculiasis?

5. 14th century problem: The Plague Belief: Punishment from God.
Result: Expel or kill those deemed sinful in order to earn God’s favor.

6. 16th century problem: Mental Illness
Belief: Demon possession or moral defect.
Result: Attempt exorcism and lock up in terrible conditions when that failed.

7. Society, to a large degree, came to understand Plague and Mental Illness as diseases that:
Can be better understood through research
Not of supernatural design
Not a matter of moral failing
Treatable

8. Diabetes Cancer Dracunculiasis

9. Resources for treatment and research
Facilities to care for the afflicted
Demand high standards of care
Walks and fundraisers
Ribbons and special days
Public awareness campaigns
Apply epidemiological triad

10. Epidemiological Triad

11. Dracunculiasis (Guiney Worm Disease)
Affected multiple millions every year in dozens of countries
No cure, only palliation
Today, almost completely eradicated

12. What is Addiction?
“…a primary, chronic, neurobiological disease with genetic, psychosocial, and environmental factors influencing its development and manifestations.” AAPM, APS, ASAM Liaison Committee on Pain and Addiction (2001)
Heit, H. A. (2003). Addiction, physical dependence, and tolerance: precise definitions to help clinicians evaluate and treat chronic pain patients. Journal Of Pain & Palliative Care Pharmacotherapy, 17(1),

13. Epidemiological Triad

14. How do we deal with Addiction?
More than 95,000 federal prisoners are serving time for drug-related offenses—up from fewer than 5,000 in (2015)
Health insurance rarely pays for treatment beyond acute medical care or lower than necessary levels of care.
“People are significantly more likely to have negative attitudes toward those suffering from drug addiction than those with mental illness, and don’t support insurance, housing, and employment policies that benefit those dependent on drugs” (2014)
Pew Charitable Trusts (2015). Federal Drug Sentencing Laws Bring High Cost, Low Return.
Join Together Staff. (2014, March 11). Substance Abuse Treatment Centers Report Problems with Insurance Coverage.
Barry, C. L., McGinty, E. E., Pescosolido, B. A., & Goldman, H. H. (2014). Stigma, discrimination, treatment effectiveness, and policy: public views about drug addiction and mental illness. Psychiatric Services, 65(10),

15. How do we deal with Addiction?
Incarceration instead of Treatment
Punishment instead of Care
Arrests instead of Research
Result:
More people are addicted, more drugs are in the country, and drug overdose is now the leading cause of accidental death in the US.
Center for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics
System, Mortality File. (2015). Number and Age-Adjusted Rates of Drug-poisoning Deaths Involving
Opioid Analgesics and Heroin: United States, 2000–2014. Atlanta, GA: Center for Disease Control and
Prevention.

16. Epidemiological Triad

17. Agent Naloxone availability Non-addictive anti-craving medications
Realistic controls
Medical education
Continued medical research into vaccines
???
Sifferlin, A. (January 9, 2015). Why you’ve never heard of the vaccine for heroin addiction. Time.

18. Host Longer-term treatment that is driven by research and outcomes
Funding for academic research and neutral investigation of outcome data
Social support systems such as AA/NA
Prevention efforts supported by long-term outcomes-based research
???

19. Environment Educate the public (cannot be overstated)
Support treatment rather than incarceration for non-violent, non- trafficking drug offenders
Turn war on drugs into war on addiction
???

20. References
Barry, C. L., McGinty, E. E., Pescosolido, B. A., & Goldman, H. H. (2014). Stigma, discrimination, treatment effectiveness, and policy: public views about drug addiction and mental illness. Psychiatric Services, 65(10),
Center for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System, Mortality File. (2015). Number and Age-Adjusted Rates of Drug-poisoning Deaths Involving Opioid Analgesics and Heroin: United States, 2000–2014. Atlanta, GA: Center for Disease Control and Prevention.
Heit, H. A. (2003). Addiction, physical dependence, and tolerance: precise definitions to help clinicians evaluate and treat chronic pain patients. Journal Of Pain & Palliative Care Pharmacotherapy, 17(1),

21. References
Join Together Staff. (2014, March 11). Substance Abuse Treatment Centers Report Problems with Insurance Coverage.
Pew Charitable Trusts (2015). Federal Drug Sentencing Laws Bring High Cost, Low Return. analysis/issue-briefs/2015/08/federal-drug-sentencing-laws-bring-high- cost-low-return
Sifferlin, A. (January 9, 2015). Why you’ve never heard of the vaccine for heroin addiction. Time. heard-of-the-vaccine-for-heroin-addiction/

22. Questions?

23. Dr. John Dyben
Hanley Center at Origins originsrecovery.com