Dr. Constance Scharff, Senior Addiction Research Fellow at the renowned Cliffside Malibu

Stigma of Addiction Interview – Ending Addiction for Good

Charles:

I would like to welcome with us today: Dr. Constance Scharff, Senior Addiction Research Fellow at the renowned Cliffside Malibu Treatment Center and co-author with Richard Taite of the Amazon.com #1 book bestselling book “Ending Addiction for Good,” who will be discussing The Stigma of Addiction with us today. Welcome Dr. Scharff, how are you?

Dr. Constance Scharff:

I’m very well. Thank you for having me.

Charles:

It is our pleasure especially to have such a well known voice on such an important subject. I would like our readers to get to know a little more about you, I understand you have worked in the field for many years; can you tell us a little about what you do?/

Dr. Constance Scharff:

Sure.
First, I should say that I have been sober for more than 17 years. And one of the things that I saw when I was getting sober myself was that the treatments we had for addiction fifteen or twenty years ago, didn’t really address trauma. I had trauma in my background and was miserable in my recovery. I also met many veterans returning from Iraq and Afghanistan who had trauma in their history and were having difficulty staying sober. This caused me to believe that there had to be better answers out there with regard to how we treat addiction.

To find those answers, I went to graduate school and learned that addiction is not at all the genetic disease we were once taught that it was, and it certainly is not a moral failing. Now, I work with leading scientists around the world to better understand addiction and to bring treatments/therapies to addicts that improve the addiction recovery success rate.

This is very important, because 12-step programs on their own only have a recovery rate of about 5-8% at the end of one year. Cliffside Malibu has a recovery rate of 70% for the same period — so we know there is good treatment available.

Charles:

First of all congratulations on your 17 years of sobriety it is no easy feat and at the same time a testament to the fact that recovery is not only possible but sustainable. From conversations with a number of addicts as well as specialists in the field; many have brought up the Stigma of Addiction even to some extent claiming that they find themselves treated as black sheep in the community. In your experience how does the stigma of addiction complicate recovery?

Dr. Constance Scharff:

Absolutely!
There are very few places even in the current day where being an addict — even in recovery — is not stigmatizing. You can be openly in recovery in the field of addiction research/treatment and in entertainment. That’s about it.

The biggest problem with stigma is that it misunderstands addiction. Stigma is applied to people who are seen as deviant, who are in some way “bad.” Criminals are stigmatized, but diabetes patients are not. Culturally, we misunderstand addiction and think of it as a moral problem because one of the major signs of addiction is that the addict hurts the people around him/her.

Because of this, we want to ostracize the addict, keep him/her away from us (which is sometimes appropriate) and that makes funding treatment difficult.

Who wants to fund treatment for people who could just “do better”? — This inaccuracy is at the root of why there are not enough treatment beds available to addicts. “Stop hurting your mother!” is a more common line than, “Let me help you get the care you need.”

Charles:

If I am understanding correctly part of the stigma revolves heavily around a lack of understanding when it comes to disease that is addiction. So I will play devil’s advocate for a moment here. How is addiction not a choice?

Dr. Constance Scharff:

The answer lies in what we are only now learning from neuroscientists.
The brain is changed by the behaviors we engage in frequently. There is a saying in neuroscience that “what fires together, wires together.” In other words, your brain builds physical bridges to make behaviors easier to do over time.

Let me give you a positive example of this. If you exercise regularly, and then for some reason you cannot exercise — you’re on a trip, sick, etc. — your mind and body send you messages saying, “Hey, you need to exercise!” and you miss it.

Now, imagine that you engage in drug seeking all day every day, and you pour the chemicals on top of that. Your brain will not allow you to just stop. You are in essence on a hamster wheel that you will not likely get off of unaided.

In that situation, you don’t show up at your daughter’s wedding drunk or fail to show up at all because you want to — you have to seek your drugs/alcohol and because you love your daughter, you try to fit her in too.

This is what we are learning about addiciton.

Charles:

I want to dig deeper and learn a little more, in a sense if I understand correctly we are talking about habit building that alters the way the brain operates. How extensive is the damage and is it repairable?

Dr. Constance Scharff:

This is not the same as brain “damage.” That’s a different situation that can also occur. But yes, addiction changes the structure and function of the brain.

We do not believe that this can be un-done. That’s where the idea “once an addict, always an addict” is probably true and why I support abstinence based addiction treatment whenever possible.

BUT — and this is a big caveat — we can develop healthier behavioral patterns in the brain — make a new loop if you like — and this is what recovery is in a broad sense — building a new pattern of functioning in the brain.

There are some tools in particular that help with this, such as meditation.

Charles:

I am really going to step out of my comfort zone here especially as a recovered addict but I feel have to ask the question many people might. Could one make the argument that addiction is in many cases a self-inflicted disease; comparable to diabetes(some varieties) brought on by eating the wrong foods on a regular basis or cancer brought on by smoking?

Dr. Constance Scharff:

Obviously, there are people who do make that argument. But here’s the difference — we don’t have the same level of stigma attached to smokers or diabetics as we do to addicts — because those behaviors mostly hurt the user. We don’t deny smokers cancer treatment because they “brought it on themselves.” At the same time, like all diseases or disorders, it’s a crap shoot as to whether you get it or not. There are some people who drink or smoke or eat junk with impunity and never get sick. Then there are others, like veterans, who come home with intractable PTSD or women who have C-sections and are given pain meds by their doctor and because of their particular bio-chemistry and psychological makeup, are off to the races with addiction. So no, I think it is very dangerous to place blame for illness on those who are sick.

Charles:

I fully agree with you. Taking this into consideration, I want to move to a very damaging Stigma which might be even worse than community directed stigma. Self directed stigma, do you find this to be common among people you work with and what do you find is the best solution to it?

Dr. Constance Scharff:

As we start to treat more and more people who have no history of addiction in their families — particularly due to the over-prescribing of opioid pain medications and the inadequate treatment for too many veterans — we see not only the self-hating that is common to addiction, but a lot more confusion about how “I” became an addict in the first place.

Addicts in general hate themselves — because they don’t like how they treat others, how they treat themselves, and what they often have to do to get the drugs/alcohol they need.

The only solution to this is a lot of really good psychotherapy and day after day of positive action in the world. In 12 step programs, the emphasis is on service — doing good in the world. That and counseling are super important to get back on track and see ourselves in a real way — neither wonderful nor terrible, just us.

Charles:

Do I understand correctly that given the opportunity to be of service and to change both the way a substance abuser sees themselves and the way they are seen by the community is probably a very powerful tool in breaking the addiction itself?

Dr. Constance Scharff:

It is certainly a major part of the solution. But there is more to it than that. Remember, we have to deal with the brain — and that doesn’t get better through counseling or service. That takes a different kind of action….so the answer to your question is YES, AND…

Charles:

So part of the stigma we need to get over is that it is more than just a choice; we need to understand that it is also a disease that needs treatment?

Dr. Constance Scharff:
Yes.
I have to say something more here.

Addiction is sinister. Most people who have a hard day and come home and have a drink feel better for it. It relaxes them and helps them unwind. But for a few of us, about ten percent of the American population, that same action that 90% of the population takes with impunity, has a different effect on us. So in a way, it’s like Russian roulette. We all make the same choice and some of us get a negative consequence.

It’s not a lot different than ten people going out jogging and one falling and twisting his ankle. Would you blame him and say he was foolish and “asked for it” because he went jogging?!

Charles:

In some circles the saying as you mentioned is once an addict, always an addict. Based on your own experience, is this an accurate depiction?

Dr. Constance Scharff:

The brain science is confirming this. Now, there are all sorts of “exceptions” that people point out — like the number of people who in war zones like Vietnam used drugs, were in every way addicts — but then come home and cold turkey stop. The answer is not totally clear yet, but again, that’s the direction the science is leading us.

Charles:

So the statement is inaccurate?

Dr. Constance Scharff:

No, the saying, “once an addict, always an addict” is probably true, though we don’t yet understand why there seem to be some exceptions.

You see — in the last few years, scientists have been able to do brain scans (fMRI) that we never had access to before, and for the first time, we can actually see how addiction changes the structure and function of the brain. …but we don’t have access to brain scans of vets before and after they went to Vietnam, so we can’t explain some of the anneccdotal reports people have.

In my experience, if you go into recovery and you try after years of abstinence to go out and use “moderately” — you’re playing with fire and likely to be burned.

Charles:

Playing devil’s advocate again: Based on this how can an employer feel confident in hiring an addict into their organisation without fear that at any point in time they could relapse?

Dr. Constance Scharff:

We know a few things about addiction:

1. Don’t ever hire an addict you know is using, no matter how talented they may be.

2. If you have an employee you find out is using, offer them high quality treatment of sufficient duration to give a good foundation for recovery. Don’t expect them to get better on 12 steps and good wishes. However, if you give this access to care, you will develop an employee who will be an asset to your organization, will be loyal, and will be of value to you in years to come. Why? Because quality treatment works.

3. The idea that relapse is inevitable is UNtrue. Quality treatment and a commitment to recovery can and does allow individuals to remain sober long term. This idea that treatment simply prolongs the time between relapses is nonsense.

4. No addict in recovery needs to disclose that information. It’s illegal to ask. I share that I am in recovery because it is an asset to the work that I do, but I can’t imagine that anyone would fear after nearly 18 years clean that I’m a relapse risk. That needs to be true for all employees. There are reasons we have protections with regard to discrimination.

Charles: So part of the stigma which needs to be addressed is that relapse is inevitable?

Dr. Constance Scharff:

Absolutely.

One of the ways in which I feel for families is that they live in constant fear of relapse. Relapse generally happens because of inadequate treatment. I cannot emphasize enough that quality care makes all the difference. By quality I mean:

1. Treatment of sufficient duration to address the issues, including re-patterning the brain. This means in general terms 90-120 days in residential care with a full year of intensive follow-up/aftercare.

2. A host of activities that help to both get at the root cause of the addiction, why the person needed to use in the first place (intensive one-on-one psychotherapy) and a host of complementary therapies (mindfulness meditation, yoga, acupuncture, exercise, healthy diet, etc.) that rewire the brain toward more positive functioning.

If you’re living a healthy life, the odds of relapse diminish.
(2:07:55 PM) Charles: Treatment can be very expensive and not always attainable by those of lesser means. Do you believe that if we get past the stigma funding or more importantly loans for people with such an illness would be more likely to become available? What would their impact be on mitigating the costs of having a considerable part of America’s population suffering from untreated addiction?
(2:11:37 PM) Dr. Constance Scharff: I think it is a crime that treatment is not readily available and that addiction and mental health issues are not treated the same as physical disorders. The Mental Health Parity Act was adopted for a reason. Now, we need some teeth behind it so that EVERY addict has access to quality addiction treatment.

Let me give you some facts — it costs far less to treat an addict than it does to incarcerate them for possession or petty crime.

It costs far less to provide quality care than it does to have whole families lose out on livelihood trying to follow, track down, support and keep an addict alive.

And imagine if we helped addicts — which would mean that the vast majority would become productive, tax-paying members of society? This would be a boon to business, which loses BILLIONS of dollars to addiction each year.

We don’t treat because we don’t want to help “bad” people — and that costs us in every way imaginable.

Charles:

Dr. Constance Scharff you have been a phenomenal guest and I would like to thank you myself and behalf of the individuals that will read and learn from our interview. We have covered a lot of ground today and on that note I would like to ask you one final question.

Dr. Constance Scharff:

Sure.

Charles:

Of all The Stigma that follows addicts how much of it is due to a lack of understanding of the disease itself and what would you most like to see change in people’s perception of addiction?

Dr. Constance Scharff:

Thank you. That’s a good question.

In my opinion, nearly all the stigma associated with addiction comes from lack of understanding of the disorder. Stigma, by definition, is a mark of disgrace. It comes from judgement. Others judge addicts to be bad, sick, harmful, disrespectful, reproachful, etc.

What we now know is that addiction is a disorder in which the brain is co-opted. Normal people who make normal choices — like having a drink after work or taking pain meds prescribed by a doctor or even drinking a lot after the loss of a loved one — but have an abnormal brain reaction to that choice. Use of the substance “fixes” more than it should, at least initially. …and that is the root of addiction, not a choice.

We all have problems. Does anyone make it through life without at least one health issue? Mental health disorders, like depression, anxiety, and addiction, are no different than heart disease or broken bones. We have good treatment. Let’s give that care to those in need and put families back together.

Compassion is what healthcare — and life — need to be about.

Charles:

I have to follow up with a realization that might help others understand but I need to be sure on this and you are well versed to correct me if I am wrong. In a sense one could say that akin to an allergy some of us react differently to certain substances and that it is partly beyond our control however with good treatment we can avoid falling to an allergy again?

Dr. Constance Scharff:

That is a good analogy.

With treatment, the brain gets into a different pattern, so it’s like avoiding a bee sting or peanuts.

And if you do get near the allergen, whether you need pain medication after a surgery of have a brief slip, we get you right back into treatment — which is like using an epi-pen — to be sure that the reaction is as limited as possible.

This is a disorder — treatment is the key.

Charles:

Thank you so much for that and for joining us today; you have been wonderful and extremely helpful.