Changing the language of addiction

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{***NOAH***}

COMING UP ON HARVARD CHAN THIS WEEK IN HEALTH…

CHANGING THE LANGUAGE OF ADDICTION.

{***HOWARD KOH SOT***}

HOW STIGMA AFFECTS THE TREATMENT THAT PEOPLE RECEIVE AND THE NEW PUSH TO CHANGE THAT…

PLUS—THE NEW STUDY RAISING CONCERNS ABOUT THE PSYCHIATRIC CARE THAT VETERANS MAY BE RECEIVING…

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HELLO AND WELCOME TO HARVARD CHAN: THIS WEEK IN HEALTH…IT’S THURSDAY, JULY 20, 2017.

I’M NOAH LEAVITT.

THIS WEEK WE’RE REBROADCASTING TWO STORIES FOCUSING ON IMPORTANT MENTAL HEALTH ISSUES.

COMING UP IN ABOUT SEVEN MINUTES—WE’LL TELL YOU ABOUT A NEW PUSH TO ASSES THE PSYCHIATRIC CARE THAT VETERANS MAY BE RECEIVING.

BUT FIRST YOU’LL HEAR A STORY ABOUT THE IMPORTANCE OF LANGUAGE WHEN DISCUSSING ADDICTION.

IT’S A TIMELY TOPIC TO REVISIT AS THE UNITED STATES GRAPPLES WITH AN ESCALATING OPIOID EPIDEMIC.

LAST MONTH A NEW YORK TIMES ANALYSIS OF CDC DATA ESTIMATED THAT NEARLY 60-THOUSAND AMERICANS DIED OF DRUG OVERDOSES IN 2016.

DRUG OVERDOSES ARE NOW THE LEADING CAUSE OF DEATH AMONG AMERICANS UNDER 50.

COMING UP IN THE STORY YOU’RE ABOUT TO HEAR, HOW THE WORDS WE USE TO DESCRIBE ADDICTION CAN AFFECT THE TREATMENT PEOPLE RECEIVE—AND WHY CHANGING LANGUAGE IS CRITICAL TO REDUCING THE STIGMA SURROUNDING SUBSTANCE USE DISORDERS.

TAKE A LISTEN.

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JUNKIE. CRACKHEAD. SUBSTANCE ABUSER.

THOSE ARE THE WORDS OFTEN USED TO DESCRIBE THOSE WRESTLING WITH ADDICTION.

{***AMIE***}

AND THAT LANGUAGE CAN INCREASE STIGMA—MAKING IT HARDER FOR PEOPLE TO SEEK AND RECEIVE TREATMENT.

BUT THERE’S A NEW PUSH TO CHANGE THE LANGUAGE SURROUNDING ADDICTION.

{***NOAH***}

WRITING IN THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, HOWARD KOH, HARVEY V. FINEBERG PROFESSOR OF THE PRACTICE OF PUBLIC HEALTH AT THE HARVARD CHAN SCHOOL, AND MICHAEL BOTTICELLI, DIRECTOR OF THE WHITE HOUSE OFFICE OF NATIONAL DRUG CONTROL POLICY ARE SHINING A LIGHT ON THE EFFECTS OF STIGMATIZING LANGUAGE.

KOH SAYS THAT STIGMA CAN MAKE PEOPLE EMBARASSED OR AFRAID TO SEEK CARE.

{***HOWARD KOH SOT***}

(Well, we know that stigma isolates people. It prevents people from coming forward to seeking treatment. There have been national studies saying that some 22 million people in this country need specialty treatment for alcohol or other illicit drug disorders. But 90% of those people do not get the treatment they need and deserve, and many of them are held back, because of the fear of stigma from family, from neighbors, from employers. So they have to suffer alone, when good and effective treatment is available to them.)

{***NOAH***}

THERE’S ALSO A SUBSTANTIAL BODY OF RESEARCH SHOWING HOW STIGMATIZING LANGUAGE CAN AFFECT THE CARE THAT DOCTORS PROVIDE.

{***AMIE***}

MICHAEL BOTTICELLI TOLD US ABOUT RESEARCH CONDUCTED BY JOHN KELLY OF HARVARD MEDICAL SCHOOL AND MASS GENERAL HOSPITAL THAT ILLUSTRATED EXACTLY HOW LANGUAGE INFLUENCES PERCEPTION OF ADDICTION.

{***BOTTICELLI SOT***}

(He actually gave two almost identical vignettes to a number of trained mental health and substance use clinicians. And the only variation of the two vignettes was in one, he referred to the person as a substance abuser. And in the other, he referred to it as a person with a substance use disorder. And what he found was that, even among trained clinicians, when you were refer to someone as a substance abuser, it elicited a much more punitive response than a therapeutic response.)

{***AMIE***}

THERE HAVE ALREADY BEEN SOME CHANGES IN THE WAY ADDICTION IS TALKED ABOUT IN THE MEDICAL AND PUBLIC HEALTH COMMUNITIES.

FOR EXAMPLE, SUBSTANCE ABUSE DISORDER HAS BEEN REPLACED BY SUBSTANCE USE DISORDER.

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THE KEY GOAL IS MAKING IT CLEAR THAT ADDICTION IS A DISEASE—NOT A CHOICE OR A MORAL FAILING.

IT’S A PERSONAL ISSUE FOR BOTTICELLI—WHO IS IN RECOVERY—AND HAS GRAPPLED WITH THE FEAR AND EMBARRASMENT LINKED TO ADDICTION.

{***BOTTICELLI SOT***}

(I knew that I needed help with my alcohol use, that I had a significant problem. And I also recall that I was very embarrassed and ashamed to ask for help. And you go through this rationalization that I had a good job at Brandeis University. I had a couple degrees, that how can I be a person who has a substance use disorder? What will people think of me? Will they think that I am stupid, or that I’m weak willed? And I know that I am not alone in that experience. You start internalizing the messages and the language that you hear reflected at you. If we can in some way have people understand through the language that we use that they have a disease, we might see people asking for care earlier and being willing to step forward, that professionals are likely to treat people with more care and compassion, and that it enhances the probability that we’ll be making kind of good public policy based on how we perceive people with addiction.)

{***NOAH***}

CHANGING LANGUAGE IS ONE STEP TOWARD REDUCING STIGMA, BUT KOH AND BOTTICELLI SAY THERE IS WORK TO BE DONE IN OTHER AREAS.

{***AMIE***}

THE MENTAL HEALTH PARITY AND ADDICTION EQUITY ACT  OF  2008 REQUIRES THAT INSURERS COVER MENTAL HEALTH AND SUBSTANCE USE DISORDERS ON PAR WITH PHYSICAL CONDITIONS.

BUT A RECENT REPORT FROM THE DEPARTMENT OF LABOR FOUND THAT HEALTH CARE PLANS ARE STILL IMPOSING LIMITS ON THESE TREATMENTS—OFTEN MAKING PATIENTS ENDURING LESS EFFECTIVE THERAPIES BEFORE PROVIDING THE CARE RECOMMENDED BY THE FEDERAL GOVERNMENT.

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KOH SAYS THAT CHANGING LANGUAGE IS AN IMPORTANT FIRST STEP TO SHIFTING HOW ADDICTION IS VIEWED  BY NOT ONLY THE MEDICAL COMMUNITY, BUT THE PUBLIC IN GENERAL.

{***HOWARD KOH SOT***}

(For too long, this whole area has been dehumanized. And the criminal justice system has been the primary source for treatment and care. And we need more of a public health discussion here, more of a medical approach to these issues. And so we are hoping that over time, more and more people will view this as a health issue and treat it in collaboration with medical professionals, and that especially means mental health providers and the substance use disorder providers. We need to improve outreach and support for people who are wrestling with these issues. There are lots of families, I feel, so isolated. We should send the message that this is a medical condition, a brain disorder that can be treated, that people can enter recovery, that there are resources available. None of this is easy, but we have to start understanding that this is a medical condition and not a moral failing.)

{***NOAH***}

IF YOU’D LIKE TO READ THE PIECE WRITTEN BY HOWARD KOH AND MICHAEL BOTTICELLI, WE’LL HAVE A LINK ON OUR WEBSITE: HSPH-DOT-ME-SLASH THIS WEEK IN HEALTH.

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{***AMIE***}

NEW RESEARCH IS RAISING QUESTIONS ABOUT THE QUALITY OF PSYCHIATRIC THAT VETERANS MAY BE RECEIVING.

{***NOAH***}

THE STUDY, AUTHORED BY MORGAN SHIELDS, A 2016 HARVARD CHAN SCHOOL GRADUATE, AND CURRENT DOCTORAL STUDENT AT BRANDEIS UNIVERSITY, FOUND THAT HOSPITALS RUN BY THE DEPARTMENT OF VETERAN AFFAIRS ARE NOT PERFORMING AS WELL AS OTHER HOSPITALS WHEN IT COMES TO KEY MEASUREMENTS OF INPATIENT PSYCHIATRIC CARE.

{***AMIE***}

SHIELDS, ALONG WITH MEREDITH ROSENTHAL, PROFESSOR OF HEALTH ECONOMICS AND POLICY AT THE HARVARD CHAN SCHOOL, LOOKED AT HOW HOSPITALS PERFORMED IN SEVERAL CATEGORIES.

THAT INCLUDES ADMISSION SCREENINGS OF PATIENTS TO ASSESS RISK OF VIOLENCE, TRAUMA, SUBSTANCE USE, AND STRENGTH.

THE RATE OF RESTRAINT AND SECLUSION OF PATIENTS.

THE PERCENTAGE OF PATIENTS DISCHARGED ON MULTIPLE ANTI-PSYCHOTIC DRUGS

AND THE PERCENTAGE OF PATIENTS FOR WHOM A CONTINUING CARE PLAN WAS CREATED—AND TRANSFERRED TO THEIR NEXT LEVEL OF CARE.

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WHAT THEY FOUND WAS THAT V-A HOSPITALS CONSISTENTLY PERFORMED WORSE THAN PRIVATE FOR-PROFIT AND NON-PROFIT HOSPITALS…AND OTHER GOVERNMENT HOSPITALS… IN SEVERAL AREAS.

A STRIKING DIFFERENCE WAS FOUND WITH ADMISSIONS SCREENINGS.

THOSE WERE PERFORMED JUST 61-PERCENT OF THE TIME IN V-A HOSPITALS—COMPARED TO MORE THAN 90-PERCENT IN OTHER FACILITIES.

{***AMIE**}

SHIELDS SAYS MORE WORK IS NEEDED TO DETERMINE THE REASONS FOR THESE GAPS IN CARE, BUT SHE SAYS IT’S CONCERNING BECAUSE VETERANS ARE ALREADY A VULNERABLE POPULATION.

{***MORGAN SHIELDS SOT***}

(It’s really concerning, especially when we consider this patient population and the increase in suicide. And the no history of trauma– certainly, trauma is likely present in all contexts, but especially when it comes to veterans. I mean, this is something we know for sure and we talk about. And we’re not even screening for it. It’s very concerning when it comes to the care for veterans, of course. It’s concerning when it comes to the care for anyone, but especially a population that has potentially been very traumatized and could be re-traumatized by the care that they’re getting.)

{***AMIE***}

IN LIGHT OF HER RECENT RESEARCH, SHIELDS IS CALLING FOR A NATIONAL SURVEILLANCE SYSTEM FOR INPATIENT PSYCHIATRIC FACILITIES.

{***NOAH***}

RECENT LEGISLATION PASSED BY CONGRESS WOULD ESTABLISH THE CENTER FOR BEHAVIORAL HEALTH STATISTICS AND QUALITY.

THAT CENTER WOULD  MONITOR KEY OUTCOMES AND CONDITIONS, SUCH AS THE PREVALENCE OF PSYCHIATRIC DIAGNOSES, NUMBER OF HOSPITALIZATIONS OF PATIENTS, AND THE LEVEL OF CRIMINAL JUSTICE INVOLVEMENT.

{***AMIE***}

BUT SHIELDS SAYS THAT DOESN’T GO FAR ENOUGH.

WRITING IN THE JOURNAL HEALTH AFFAIRS—SHE ARGUES THAT THE SYSTEM SHOULD ALSO BE USED TO MONITOR EVIDENCE-BASED QUALITY INDICATORS, IN ADDITION TO INJURIES OR DEATHS IN PSYCHIATRIC FACILITIES.

IF YOU WANT TO READ THAT PIECE, WE’LL HAVE A LINK ON OUR WEBSITE—HSPH-DOT-ME-SLASH THIS WEEK IN HEALTH.

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THAT’S ALL FOR THIS EPISODE OF HARVARD CHAN: THIS WEEK IN HEALTH.

A REMINDER THAT YOU CAN ALWAYS LISTEN TO THIS PODCAST ON ITUNES, SOUNDCLOUD, OR STITCHER.