Episode 31 – Addiction Vs Dependence
Dr. Ashish Bhatt ❘
The drugs of today can cause a physical dependency in 2 weeks. Dr. Bhatt explains the differences between addiction and dependency.
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Hayley: Hello, everyone. My name is Hayley and this is Straight Talk With The Doc. The podcast on all things addiction, mental health, and recovery. Our expert is addiction medicine specialist, Dr. Bhatt. How are you doing today?
Dr. Bhatt: I’m doing well Hayley. How are you?
Hayley: Doing fantastic. I think we can all agree that 2021 has been an unusual and challenging year for many of us. But, 2021 also marks 50 years since the War on Drugs campaign began in 1971. The campaign’s goal is to reduce the illegal drug trade in the US by increasing the size of federal drug control agencies, like the creation of the D.E.A. in 1973 and requiring mandatory prison sentencing for drug crimes among other factors that were put in place. But after 50 years, people are looking at this campaign and recognizing that drug use in our country is still very prevalent and the War on Drugs may have had an ulterior motive. Before we get into that, let’s talk about the beginning of the War on Drugs and how it all got started. Dr. Bhatt, how did this begin? What acts did President Nixon take?
Dr. Bhatt: Wow Hayley, you gave a really good background there and it is hard to believe 50 years has gone by and where we are right now in society given that we still have a War on Drugs. If anything, it’s one of the biggest problems that we have in society, especially with the Opioid epidemic. From the 70’s, Nixon recognized that drug abuse- he identified it as public enemy number one. I know there must have been some controversy and I think people speculated that he had an ulterior motive on creating that. Because maybe those who were using substances at the time, or he proclaimed to using substances, were not really in sync with his political agenda. Something that he did put together was The Controlled Substances Act which was introduced during his time and that really is what we have today: the recognition of understanding how drugs are scheduled into different classes based on their abuse potential or medical use, as well as The Controlled Substances Act evolution, or lack thereof, since then. He initially added the D.E.A., from what I recall, was created under him. And we’ve seen that become a full-fledged robust side of our government, and rightfully so. Drugs are a huge problem. Trafficking’s a huge problem, not only in the United States, but around the world. The D.E.A. is involved in not just what we do here in our country, but how drugs are brought into our country. But those are the two main things that I know that have come out of that as it relates to him: the D.E.A.’s creation and The Controlled Substances Act.
Hayley: With scheduling the drugs and the different classifications, how was it before the 70’s? Was it just kind of an unlabeled, free for all?
Dr. Bhatt: Well, no. I think when you look back in history, there has been some incremental changes with how drugs are used from recreational perspective, or a medicinal perspective. And drugs were used- Marijuana has been used for centuries for everything from religious to medicinal purposes, and Cocaine, similarly, and by different cultures. But we did see in the late 1800’s-early 1900’s different things trying to put regulations in place, as we’ve seen even with prohibition and with alcohol. But the point is, no, there were regulations that were coming in and taxations that were being imposed over the previous hundred and some years prior to the 1970’s. We did see that evolve. It didn’t just all of a sudden come about. I just think it was more robust, though, in the 1970’s
Hayley: Okay, that makes sense. Thank you for explaining that. When I was researching this topic, something that I saw was the sentencing for the possession of different drugs. And one of them was the difference between crack-cocaine and powdered cocaine. Crack cocaine triggered an automatic 5-year sentence if you were found with 5 grams of it, but if you were found with 500 grams of powdered cocaine, it meant the same sentence. Why was that controversial?
Dr. Bhatt: I think the biggest reason that’s controversial is because it shows a double standard and also who was using crack and who was using powdered cocaine. If we look back retrospectively, crack-cocaine was often identified and used by people with lower socioeconomic status, the African-American black community, Latin-American communities. Where powdered cocaine was often associated with glamor and partying, and more affluent people. If you’re going to penalize drugs in an unequal way and have a higher threshold for stuff that’s specific to a certain socioeconomic or demographic group, well it’s definitely going to be called out and it’s going to be seen as unfair. I believe that’s what we’ve seen for many, many years. The laws behind the War on Drugs and people who have been prosecuted, it has not been reflected equally. And unfortunately, where we are 50 years later, there’s still a lot of reform that’s needed. Many people are being sentenced to have a substance abuse problem or have underlying issues within their culture or communities that have played them and have contributed to the disease of addiction. And those things aren’t getting addressed. There’s so many factors involved in why certain people or groups or individuals develop an addiction. And one thing the government cannot do is have a double standard on how people are penalized for this, and unfortunately that was happening in the example you just gave.
Hayley: Expanding on that unequal reflection a little bit, Nixon’s domestic chief policy stated that Nixon was after the anti-war left and black people. Anti-war left kind of means people who identified as “hippies.” Did enforcing drug laws actually attack these groups?
Dr. Bhatt: I believe they did. Again, if it’s serving somebody’s political agenda by identifying or creating certain laws or regulations that eliminate people who don’t think like you do, well then, definitely the underlying motive being called out there can be questioned. And I believe that came from somebody who was an insider and who was well aware. Now, I didn’t exist, I wasn’t around at that time so that would be a lot of speculation on my part but I don’t necessarily disagree with that being a potential perspective and a potential agenda that he had.
Hayley: Let’s jump forward a little bit to today. It’s been 50 years, has there been a reduction in substance abuse during the 50-year War on Drugs?
Dr. Bhatt: The short answer is no, I don’t believe that there has been a reduction. If we look at the statistics that have come out and maybe there’s even more statistics and more groups that are keeping track of this, maybe there’s certain types of drugs that are a little bit more antiquated and in less circulation. But overall, no, the prevalence of substance abuse and substance dependence and addiction is super high. And I do believe if we look at it as a whole, when the War on Drugs was created it was just basically a punitive thing. When you call it a public enemy number one, when you view it as something that needs to be penalized, well it created a multi-tiered effect. If you’re going to arrest people, well what are you going to do once you arrest them? You’re going to impose some sort of sentence. If you’re going to impose some sort of sentence, you’re going to have to put them in jail. And if you put them in jail or in prison, we need to have space for these individuals. It became a domino effect of utilizing resources to take care of people that at that time was looked at as a moral deficit, because they use drugs or something or moral turpitude. Now I think that being the background of substance abuse and people who use substances who are not trafficking it or using for distribution, but personally possession or secondary to an addiction. And now it being recognized as a disease, I think it does change the whole entire dynamic of what we are doing as a country in helping to solve the problem. It is just being punitive. I believe a lot of lawmakers, regulatory individuals, and bodies, as well as physicians and scientists are tending to disagree with that approach. Fast forwarding from then to now, has that War on Drugs been effective? I don’t think it has.
Hayley: It’s funny that you mention that it was kind of seen as a moral failing. That reminds me of the “Just Say No” drugs campaign that was in the 80’s started by Nancy Raegan. It’s “just say no”, like it’s that easy.
Dr. Bhatt: Yeah, I know. It’s ironic actually because the views on substance use disorders and addiction- we, because this is a medical and a scientific type of podcast that we’re trying to get out there in terms of the background as to why we’re educating individuals. But at that time, to simplify it and just say no really speaks to their lack of understanding or awareness of all of the different influences and factors that go into somebody using drugs. Exactly like you said, to just say no. I wish it was that easy. If you speak to somebody who’s suffering from a significant addiction, I believe in their heart they would love to say no. But we know it’s a lot deeper than that and I wish Nancy Raegan’s initiative there in Just Say No could’ve worked if it was that simple. But unfortunately, we know that it’s really a multi-factorial disease and there are so many different things that we need to address in terms of solving this issue of substance abuse throughout our country.
Hayley: In terms of attempts to solve this issue, today, what’s the goal with certain states decriminalizing some drugs? Does this encourage people to use drugs or is it an attempt to stop a cycle of incarceration and addiction?
Dr. Bhatt: Both things are going to happen. There’s going to be people who have an ulterior motive who are looking to legalize and decriminalize cannabis because they want to use it and they want to use it because they don’t think it causes as much harm as other things. They like to get high and they enjoy it recreationally. At the same time, there are many people who may look at it as a business opportunity. They might look at it as if we can somehow legitimize this and decriminalize this and allow it to be used. It’s going to help benefit somebody’s pocket book. But at the same time, the recognition of the people who are using it that might have an addiction: are we really helping them by sending them to jail and incarcerating them? That understanding and looking for alternative ways to help these individuals through treatment programs, diversion programs, well, decriminalizing it definitely can support those endeavors. I think there’s going to be a lot of fallout to this. There’s going to be a lot of different ways people are going to look at it and depending on what perspective you’re coming from or looking at. I think you can see it in multiple different ways. But decriminalizing for those people who do have an addiction and getting them help, that’s a huge step to address the underlying substance use problem that they may have.
Hayley: I know one of the groups that was really affected by the War on Drugs back in the 70’s was low-income communities. I wanted to talk about why low-income communities are affected by addiction back then and today.
Dr. Bhatt: That’s a complex question and there’s a lot of reasons why people are using. When you don’t have money, you don’t have educational infrastructure. A lot of the times, as a community, is a reflection of multiple things that are a part of a culture, part of a city and a system. That’s part of a state that might not be supporting that specific group. And unfortunately, when you’ve trickled down that socioeconomic ladder and you are breeding within each other and you’ve failed to find jobs and you’ve failed to have support, the risk factors for other things increase. At the end of the day, when you’re trying to look for alternative ways to get out and find a way to be successful, these are risk factors for anybody to seek ways to escape from that difficulty from that duress that you’re under all the time. These people in these communities are more susceptible to substance use just due to that multi-factorial financial, educational, health, all of those lack of opportunities that exist and substance use, unfortunately, can become a way to survive, to deal, to cope, and putting these individuals in jail is not necessarily the solution. Now, of course I’m not saying to not penalize those who are drug trafficking and those people who are part of a bigger crime incident. And anybody can argue that anybody using is ultimately the target as the end user and they’re contributing to the financial part of this whole thing. Yes, but at the same time as a society we are responsible for supporting and taking care of each other, and that’s part of living amongst one another, and that’s why part of our attempts to solve these issues cannot just be putting one in jail, because it’s just going to keep going and going and going. And, unfortunately, we’ve got to get to the underlying roots of these issues.
Hayley: In terms of that with treatment and stopping the cycle, how are low-income communities limited in their access to treatment?
Dr. Bhatt: When you have a low-income, it’s often because you don’t have a good job. If you don’t have a good job, you often don’t have health insurance. And if you don’t have health insurance, you don’t have access to treating anything. It’s really- again, it’s a domino effect. When you are put into a situation where you may not have good role models, you might not be educating yourself. You might not be able to support yourself. It’s just the multi-factorial component of all of this that ultimately renders somebody vulnerable to using drugs and alcohol. And how do they get out of this? It is a vicious cycle. Unfortunately, it really is a vicious cycle. And that’s where we hope that people can step in. The government on a city and state federal level can come in and help out to provide resources, even if it’s as much as primary preventions and educations and creating alternative programming for individuals to find jobs, and not being incarcerated but getting educated, or not being incarcerated and getting treatment. These are some of the things that can help people re-enter society and be positive contributors to not only themselves, to other people who they might support, and people as a whole. But, again, it’s so complicated. And unfortunately, when you’re in that situation, it’s very hard to get out and you do need help from a bigger system.
Hayley: Outside of this system though, how can people, like me, general society, how can we help people with addiction instead of demonizing them? Is it a mindset?
Dr. Bhatt: This is where outreach and messaging really is important. Because, again, there’s so much going on in terms of how we communicate. Just look at what we were talking about like in the 70’s when we made it look like if you use drugs you are evil, or drugs if it’s sense are evil. Yes, they’re bad for you. But without explaining or educating or understanding the disease of addiction, that might be contributing to somebody’s drug use. And so this is where we need to have multi-tiered interventions. And again, it goes back to public health models or primary, secondary, and tertiary preventions. And it really starts at the beginning, and it starts with education- educating people on addiction and what that manifests like. Educating people on prevention of substance use in the first place starting out in the schools, starting out at primary care with your physicians, and making sure people are getting checks and educating people in schools. In the medical community, where people are going to be interfacing. Even in churches, where people in community and people of influence are interacting with one another. But it has to be a national campaign of understanding substance use and the more surface area that messaging can get out to the better. But If we demonize it and we look at it that people who use drugs are bad people, well, we’re not going to change this whole thing and we’re always going to have that negative stigma associated with substance use disorders and people who use them. Getting help to them is always going to be limited if it’s looked at that way.
Hayley: Awesome, thank you so much. Dr. Bhatt, is there anything else on this topic that you think people should know?
Dr. Bhatt: I think we’ve fought a long time to change the way people who use substances are viewed. But I think the most important thing is education on addiction to ensure that people are getting tools at the right moment in their lives starting as early as possible. When people can cognitively understand staying away from drugs so they are not using in the first place, but then those who end up using it aren’t automatically penalized or incarcerated when they could have diversion programs available for people who might have a true problem and maybe have a first offense. And these things are starting to gain traction, we do see this starting to get more prevalent throughout the country. But again, it’s going to take all of us to consistently provide messaging of support and getting the resources to the right place. There’s a lot of money that’s been spent on the criminal justice system and on our department of corrections and putting people in jail. I’m sure that if some of that money was used in alternative ways we can get people who need the help, the help that they need.
Hayley: Definitely. For anyone listening who has a loved one struggling with addiction or is struggling themselves, addictioncenter.com has free resources and information, so check that out. Thank you to our listeners and Dr. Bhatt for being here today, we hope to have you next time for another episode of Straight Talk With The Doc.
Dr. Ashish Bhatt
Dr. Ashish Bhatt, MD, MRO is an accomplished physician, addiction medicine specialist, and psychiatrist with over 20 years of medical and administrative leadership.