Thank you so much Dr. Nora for this article. And for understanding people like me. I'm currently on 11 months clean from alcohol, marijuana and crack cocaine addiction. I have struggled with substance abuse for 30 years. I'm am glad that I found subscribed to your blog to learn more about my illness.

I understand the devastating effects that stigma has on someone suffering addiction. I myself have substance abuse issues and my step daughter committed suicide in 2013 at the age of 20 because she was so ashamed of her heroin addiction. It is great to see information about changing the way society views this condition finally being published publicly.

As always, Dr. Volkow does a wonderful job of highlighting the challenges individuals face when they seek help for substance use disorders. It is critically important that those of us in the healthcare field continue to advocate for our patients and combat stigma on a daily basis. Effective treatment is out there, but not enough people are able to or wiling to access it (in part because of stigma). We need to change that! Thanks again to Dr. Volkow for her outstanding leadership in this area.

Of course and resoundingly so, we should show impartial compassion toward anyone who is addicted to drugs or alcohol, medically treat their conditions, avoid the stigma and apply all we can for positive outcomes. Society needs to fully understand that there are conducive hereditary and environmental components that lead to addiction.

On the other hand, why can't we shame and stigmatize the widespread, popular drug culture that condones and promotes substance abuse to begin with? The lure and appeal to be a part of it, to be 'cool' so-to-speak, the 'sex appeal', while knowing the risks, is indeed a sign of flawed character and moral weakness. Celebrity lifestyles (sports, music, Hollywood) for instance are very often replete with illegal and addictive drugs. Yet much our society respects, adores, adulates and mimics them and their lifestyles as though they are doing nothing wrong. We basically have a 'behavioral disease' so-to-speak that also needs to be addressed.

Addiction is not some kind of 'communicable disease', so let's now act like it is and pretend nobody is to blame. Basically, our country played with fire, and now we are getting burned.

Please stop blocking research on the benefits of Cannabis. I shrank my terminal ovarian cancer on cannabis. After 4 years of fighting with 2 major surgeries, 12 rounds of Taxol, 6 rounds of Doxorubicin and 21 rounds of Carbo have no more options. I will not reach my 50th birthday. But Cannabis shrank my tumor. I am trying to cure/manage my cancer despite you. You have NO excuse, the first paper to show anti tumor effects was published back in 1973. Activists have been begging you for decades. And the pre-clinical data is pouring from labs around the world. If I die- I die from the stonewalling of science and the immoral DEA policy that suppress medicine. schedule1movie.com

The stigma associated with TREATING OUD, while perhaps not as personal for patients, affects those who step up to support recovery and get viewed askance by distributors who are wary of regulatory consequences and a fear that regulators will shut them down for supplying MAT meds to pharmacies for chronic use. When pharmacies get rationed or cut off on their orders for MAT, the risk to patients is real. Pharmacies MUST adhere to best practices and be open to inspection or audit. Yet, we need an active dialogue around how to promote increased use of MAT rather than an environment of fear and suspicion.

This summer, we celebrate 30 years of the passage of the Americans with Disabilities Act (ADA). Over the years, much has changed for people with disabilities to improve equal access to employment, and state and local government and public accommodations such as health care, while very little has changed for people with addiction recovery in these same areas. Today, thousands of people in recovery are unaware of their civil rights under the law. The part of the ADA that addresses Alcohol Use Disorder (AUD) and Substance Use Disorder (SUD) is the most underutilized part of the law. Knowing one’s rights can have a transformative effect on how we treat and care for one another in this country. Civil rights are a guiding force in combating discrimination often misidentified as stigma for people with AUD and SUD. Turning people away from emergency rooms and health care treatment because a person is under the influence of alcohol or drugs is a violation of the ADA.

Based on 50yrs. of clinical experience in BHC here are some of my observations. Persons who experience addictions is widely seen as persons who exhibit very low Perceived Social Value (PSV) and perceive it as self-inflicted. And a # of primary care physicians are not sufficiently trained and thus reluctant to treat what they see as a high risk condition that is also illegal.
This is a significant hurdle to overcome.
Rich

I grew up here and my daughter is the third generation of women abused and neglected by this county as policy. Starting with being left alone as a child with a severely mentally ill mother; to being demonized and watching my child slice her arm on front of her father and losing my home trying to protect her and a $900 a MONTH share of cost because I WORKED! Unable to obtain detoxification services. This place has damaged us and not once has anyone even suggested trauma services....I am broke, devastated and my child...She is only 20 and already had a break. We are your mothers, children, a ROP Instructor and Mental Health Case Manager and I wouldn't believe it but my story is sadly not unique!

I faced drug problems all my young life. I quit in November '16. On 4 May, when restrictions were lifted and wine shops reopened I started day drinking. Doctors were recommending drinking in moderation and people all over the world were drinking. I made me miserable. I have sought help from the local chapter of AA. I don't want to spend the rest of my life as an alcoholic. Brilliant blog.

Please we the African need help regarding Addiction, drug and alcohol use is causing a lot of death in African more than poverty, mostly Nigeria and Ghana, and the government if not doing anything to help this. Please can the world come to out aid??

Thanks,
Miracle Ojo.

I am a retired Pharmacist from Lincoln, Nebraska.
I feel that the opioid/APAP combination should be removed from the market. I have appealed to the DEA, CDC and FDA with little to no response. The following is what I have sent to them.
Contributing risk factors for patients could be:
• Decreased weight and fatty tissues.
• Dehydration
• Alcohol consumption, current and historic
• Decreased Liver Enzyme function
• Potential renal failure
• Comorbidities (hepatitis, alcoholism and gastroenteritis)
• Quantities of medication consumed, especially as a result of diversion.
The Acetaminophen alone may be a factor causing death in some drug abusers, due to the large number of pills being taken. If not the direct cause, it could be a factor contributing to the increases in opiate toxicity and/or death, by compromising the metabolic, plasma distribution and renal excretion of the opiate. The diversion of these meds can lead to a cascade of effects, that would not be at the same level of Risk if they were only to be allowed to be made of their individual ingredients and not in combination.
THESE ARE REASONS THAT I FEEL SUPPORT THE REMOVAL OF THESE PRODUCTS AS A COMBINATION FROM CIRCULATION IN THE MEDICAL COMMUNITY.

Dwayne Wilson R.P.
Lincoln, NE

"There must be wider recognition that susceptibility to the brain changes in addiction are substantially influenced by factors outside an individual’s control, such as genetics or the environment in which one is born and raised..."

Indeed! Accepting that there is a full and complete causal story behind the genesis of someone's addiction and their addictive behavior - even their voluntary choices - can help to reduce stigma. An open access paper in Neuroethics, "Determinism and destigmatization: mitigating blame for addiction" argues as much in the context of the ongoing debate about the disease model. doi: 10.1007/s12152-020-09440-w

Yes, it IS reassuring as you say, "The annual Monitoring the Future survey has shown consistent declines in most forms of drug, alcohol, and tobacco use by teens—suggesting that increased education about the dangers of drugs can have an impact." And with certain caveats, of course.

Thanks in large part to efforts from organizations such as NIDA, I'm sure, but also I imagine that an older generation that went through the primary 'drug movement' of mainstream America some 50 years ago has passed on hard-earned wisdom to their offspring.

In fact, I recall how much of this happened while as a teenager visiting the modern illegal drug movement's ground-zero- San Francisco's Haight/Ashbury in 1967. Not as a participant, but as a visitor to see relatives.

Utterly shocking was the degree of drug abuse, addiction clinics and so forth. When I returned home, I thought I would tell others about the disaster there. But instead of being appalled, many found the movement entertaining and something to be exalted. The media sold it to our society as the "Summer of Love", carefreeness, music and free-love.

The reality was that event was the "Summer of Drugs". Ever since, unfortunately, much of mainstream America, mostly among progressives, developed a fascination with psychedelics, getting high and alternative states of reality.

And now look at all the problems we have because of it- drug-related crimes, murdered cops, ruined lives, some $750 billion lost yearly. The grandest stupidity ever. I do hope future historians get this right.

Obviously no one in Government has even tried Cannabis.Perhaps you can understand the correlation between products of different THC levels to alcohol.

Low-level flower at around 17% even up to 25% THC is equivalent to beer which ranges from 3.2% to 6% depending on the state. Concentrations, ie: wax, sugar, etc and vape oil at 50% and up is equivalent to liquor.

Both alcohol and cannabis affect people differently due to their individual chemical makeup and metabolism.

Adults should have a choice. I can kill myself drinking too much alcohol. Impossible to die from too much marijuana.

What, no research? People have been using cannabis for decades if there were such a danger don't you think we would have seen society's demise by now?

Your fear of whatever, losing your position, grant money, whatever is only keeping the illegal market going strong and they LOVE you for it.

Perhaps any alcoholic beverage over 6% should be banned and a limit to how much beer one could buy say 1 sixpack per purchase should be instated. This move alone would save families from domestic violence, financial ruin, health problems and death by drunk driver, gunshot, etc.

Remember that cancer patients need a very high dose of THC along with a full spectrum of other cannabinoids. Reducing limit to 5 mg of THC would be a death sentence to those that now have some hope of surviving. Please don't do this to patients that now have hope! Stop believing the lies of government and big pharma. They only care about the money in its own pockets. We care about society and its potential for survival.

I love the way you worded ADVERSE AND POTENTIALLY THERAPEUTIC when the opposite is reality.
Cannabis has been used for thousands of years for therapeutic purposes.
The “adverse” lies about it were created in 1937 when prohibition agents needed SOMETHING to prohibit!
Lucky they didn’t go after caffeine or you wouldn’t be sipping coffee while you read this comment!
Or rather you WOULD be, secretly, in spite of the NIDA warning about the “adverse” effects of caffeine!

They don’t care that they’re being hypocrites!
They want something to spend hundreds of millions of dollars “researching”.
(30 mg is standard dose for edibles, likely same for smoked or vaped).
There’s your answer.
Meanwhile everything the first comment or says is true.
What are the “therapeutic” uses for alcohol?
Does alcohol cause any harm? YA THINK?
It’s all about how much they can pay themselves.....

Mj itself exhibits a very high dose range. it is important to establish a therapeutic range/adverse dose range/lethal dose range. And we recognize that many clients consume multiple psychoactive substances. And by many, MJ is perceived as harmless.
Rich

Regarding the liberalization of marijuana, can we stop for a moment and look at what is happening to our country?
Marijuana use is infiltrating all walks of life and at all ages. Legalization was supposed to end violent crime, it didn't. Legalization ended none of the problems. Pot farms on national forests kill much of the wildlife from rodenticides, or water drainage, and occasionally lead to major forest fires. But we look away.

Nurse practitioners push this drug to vulnerable patients, some doctors prescribe it as medicine and in fact I know of incidents where young mothers gave this drug to their infants. Stop in a music hall, or any concert, and somebody invariably lights a joint and blows the smoke everywhere.

The major media tell one lie after another about so-called marijuana arrests or mass incarceration when the reality is always something else. Entertainers promote this drug, even its illegal use, and society just looks the other way.

With regards to the science of marijuana, every single warning that comes along is instantly rebutted by so-called "experts" who plaster the media with their own propaganda. One thing I have learned over many years is those who use this drug, legally or not, often say "Yes" to other drugs as well.

We are a country that is asleep at the switch. Nobody has the guts to take a national stand. Thus marijuana is now becoming more American than apple pie. Is that what we want? Apparently so.

I think the best move of the government is help the cannabis industry in regulating and providing standard unit dose for thc. At least, entrepreneurs and users are aware as to how much must be consumed.