Two Congressmen Talk Addiction With The Fix

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Two Congressmen Talk Addiction With The Fix

By Hunter R. Slaton 05/03/13

In an exclusive interview, we grill the co-chairs of the Congressional Addiction, Treatment and Recovery Caucus about what the US is getting right and wrong.

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Congressional Addiction, Treatment and Recovery Caucus co-chairs Ryan (left)
and Fleming.
Photo via and via

It’s been said that addiction and recovery don’t get enough attention in Washington, DC—a result of the stigma attached to the disease, as well as the reluctance of some sober people to speak out about what they and their families have been through. And the latter is precisely what is needed to push forward a positive legislative agenda on addiction and recovery, according to Rep. Tim Ryan, Democrat of Ohio, who co-chairs the 62-member Congressional Addiction, Treatment and Recovery Caucus alongside Rep. John Fleming, Republican of Louisiana, who is a physician.

“Stories drive politics,” Ryan tells The Fix. “When you think about somebody who has really been to the depths of hell in some instances, and you make it out of that—that is a story of redemption, a story that needs to be told and can help move the needle when you're talking about raising awareness and fixing the gaping holes in addiction treatment.”

Our exclusive interview with the two congressmen covers the caucus itself, attitudes to addicts and ex-addicts on the Hill, and the effects of US drug policy.

What led each of you to become involved in the Congressional Addiction Treatment and Recovery Caucus?

Ryan: Knowing what was going on with a lot of our troops was one of my original interests in seeing how addiction treatment and recovery were a cycle that a lot of our troops were going through. They didn't have enough access to care with the trauma they were dealing with, and they were covering it up with drugs and alcohol. And I have an interest in the practice of mindfulness within the addiction community, and had met some people who were using this particular technique and having success with recovery. 

Fleming: My pathway is longer and more sinuous. I grew up in a family that had—in my extended family—alcoholism. My grandfather was a terrible alcoholic, he was violent and abusive and eventually died of his alcoholism. [I had] uncles and aunts who were alcoholic and cousins who eventually transitioned to a poly-pharmacy addiction syndrome involving drugs.

I was certainly impressed with all of the carnage that I saw from that. When I was in the Navy doing my training as a resident in family practice, we were all required to go to an [addiction] treatment facility [for] two weeks. Then I ended up on two occasions being an alcohol and drug rehab physician part-time at two different facilities. From there I became interested as a parent in some of the causes and eventually wrote a book on that very subject.

Fleming: "What does concern me is that there's many in this country that somewhat want to destigmatize the dangers of drug use—particularly, right now, marijuana."

Do you feel there's a bipartisan consensus on what needs to be done with addiction treatment in America?

Ryan: I think this could really be one of the areas where we can start to get a little momentum with other pieces of legislation, if we recognize that this issue of [treating addiction] can be a very positive thing—and part of it’s because small investments that we make in this area yield dividends down the line. You're talking about prevention, you're talking about saving money down the line of someone with a major addiction, what happens to their healthcare costs, what happens with their car accidents, longer-term jail and prison terms that cost the taxpayer a lot more money.

I've heard talk of the possibility of an Americans in Recovery Act bill. If such a piece of legislation were written, what sort of provisions do you think it should contain?

Fleming: Well, I don't know anything about that bill. I can tell you that from my perspective—in dealing with many different diseases as a physician over the years—the growing aspect of each disease is prevention and early diagnosis. That's the one thing we don't see in the area of addiction, yet there's plenty of data that shows there’s plenty of low-hanging fruit there. We know that early intervention—let's say teenagers who've begun experimenting with drugs—can yield tremendous dividends.

Do you feel individuals in recovery should be more open in order to break the stigma associated with their disease?

Ryan: Absolutely. And we want to utilize the caucus to raise awareness. When you think about somebody who has really been to the depths of hell in some instances, and their family has suffered significantly because of an addiction and you make it out of that—that is a story of redemption and resiliency, and needs to be told. I think it can help move the needle when you're talking about raising awareness and fixing the gaping holes [in addiction treatment].

Do you think there's any stigma on Capitol Hill about being associated with addicts or people in recovery?

Fleming: From my perspective, again it's defined as a disease or disorder, and as a physician it should be treated and considered as such. But unfortunately, like many diseases we treat, it is not curable. We know that addiction leads to permanent changes in the brain. So we have to think of it in terms of a management of a disease such as you would manage diabetes—and I think there's no reason to have any stigma apart from that.

However what does concern me is that there's many in this country that somewhat want to de-stigmatize the dangers of drug use. We just had pot day or marijuana day in Colorado, where people were openly using it because it was the first day, I think, it could be used legally.

What worries me about that is addiction virtually always begins in youth, even pre-teens. And the more available, the more acceptable that drug experimentation is, the higher rate of addiction will occur downstream. Those who promote marijuana say that it's perfectly harmless—and yet those who are in the industry of drug treatment tell me that the most common diagnosis for people entering into treatment is primarily for marijuana addiction.

Despite what either of you may feel about the Affordable Care Act as a whole, do you in general support requiring insurance companies to cover treatment for substance use disorders?

Ryan: I do. [With] caucuses like this, we try to stay focused on the things that we can move on together and provide a little bit of an example.

Fleming: My belief in terms of what insurance companies [should] cover or not cover is that insurance companies, like any insurer, should be in the free marketplace and that you pick and choose what kind of coverage you want.

What do you hear from your constituents about friends or loved ones who struggle with addiction?

Ryan: You see a lot of suffering there; you see a lot of pain with the families that have had to deal with this. And it's not always a story that ripples throughout the community. Unless you're directly connected, you may not know the extent of the trials that the family has been through, because a lot of people don't share that—there's a stigma there.

We continue to hear these stories related to the veterans, where clinicians are identifying 20% of active and 42% of reserve component soldiers as requiring some kind of mental health treatment. Drugs and alcohol frequently accompany these problems and were involved in 30% of the Army suicide deaths in 2003 to 2009.

So it's civilians, it's military and ultimately for us I think it's, “How do we get these folks back into society? How do we get them back to work as small business people or as entrepreneurs or as people in the work force?” That's ultimately a wasted human resource if we allow them to go without treatment and early intervention.

Ryan: "I think drug courts have been extremely effective in carving out an alternative path for addicts and not to just lock them up but to make sure they get the kind of treatment that they need."

Does current US drug policy—including incarceration for possession, aggressively going after drug traffickers and spending lots of money to do that—contribute positively or negatively to addiction rates and the availability and efficacy of treatment?

Fleming: If you go back to the numbers, the age at which children actually experiment first with alcohol or similar substances is age 11. They get it in their own homes or their neighbors', and the risk of addiction in a person's life is five-fold increased if they experiment before age 15. So obviously early exposure is a critical piece of this.

What that says to me is that we should do everything we possibly can do to keep drugs, even alcohol, out of the hands of minors. That includes everything from educating parents to be sure they know the dangers of early experimentation with alcohol and other drugs [to] watching both their drug cabinets and alcohol cabinets, [as well as] what [their kids] do when they leave the home and who they're with.

These are all things we monitored with our four kids and it ended up paying off very well for us. But I worry that again, the more relaxed drug enforcement policies become—such as what you see happen in Colorado—that just means drugs are more available, they're in more homes, they're more flaunted, and I think all we're going to see is even higher addiction rates.

Congressman Ryan, do you feel the same or do you have a slightly different view?

Ryan: I probably have a slightly different view. I certainly agree there needs to be a tremendous amount of emphasis on parents and the role of good parenting to make sure that they're keeping an eye on their kids. Another issue I think that needs to be promoted is drug courts. I think drug courts have been extremely effective in the way that they deal with this, and carving out an alternative path for addicts and not to just lock them up but to make sure they get the kind of treatment that they need. So I think there needs to be consequences, there needs to be discipline, but shifting that through a drug court over to treatment instead of locking people up and throwing away the key [is preferable].

I think in our schools there are programs that begin to address and teach the social and emotional learning that's needed to deal with peer pressure, whether it's drugs and alcohol, whether its teenage sex, whether its bullying. There are skill sets that need to be developed because many times these kids get a tremendous amount of peer pressure, especially today when they see [drinking and drug use] on their computer screens, on their iPhones, on TV, on the radio, in the lyrics of songs.

Fleming: One of the big things you hear about in schools is the DARE program—and unfortunately the results have been actually, if anything, to the negative. The reason I think that that's happening is that they're not really teaching it to the right people. The right people are the parents. Parents have some really interesting beliefs. For instance, you hear about how parents [say], “Well look, you should teach children how to drink properly and they will grow up to be responsible drinkers.”

I think we should focus on the parents just like we taught parents that children should have seat belts. We taught parents that tobacco is a very bad idea for kids. I think we should do that with drugs and alcohol, but we just haven't gotten to that yet.

Hunter R. Slaton is The Fix's Rehab Review Editor.

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