On May 14 of this year the National Institute on Drug Abuse (NIDA) celebrated 50 years in existence. Congress voted it into being and since then Americans have benefited from NIDA’s ongoing research. In NIDA’s own words, it has been: “shifting the mindset of medicine and the public from viewing addiction as deviance toward understanding it as a health condition that is preventable, treatable, and deserving of compassion and support.”

Indeed, kudos. As Dr. Nora Volkow reminds us, Congress took action to create this Institute at NIH shortly after President Nixon called drug abuse “public enemy number one.” We knew very little, especially about prevention and treatment. 

Dr. Volkow writes:

While disulfiram and methadone had been approved for treating alcohol and opioid addiction respectively, there were no other pharmacotherapies for drug use disorders, and there was little in the way of effective behavioral treatments or effective prevention programs.

Yet, 50 years is so long ago: Before Nancy Reagan’s “Just Say No” efforts, the violence was associated with the crack epidemic, or today’s much-discussed opioid crisis. Not to mention the perennial abuse of alcohol and other compulsive behaviors that cause suffering and even death.

Should society have any hope? Yes.

Societal Shifts Regarding Addiction

Addiction has always been part of the human condition. The suffering caused by addiction is borne first by the individual. Very rapidly an individual’s suffering can engulf others: first family and friends. Then the rippling negative effects continue, some of which infiltrate local communities through our diverse social ties (e.g. neighbors, worship, workplace) and random interactions (e.g. drunk driving fatalities). And yet…

As recently as 50 years ago much of this suffering was in silence and shame. Solutions, if any were to be believed, were commonly understood to involve The Big Book, 12 steps, and sheer luck because (the prevailing wisdom said) there was very little hope. 

In the intervening years there have been great strides in research, prevention, treatment, and recovery practices. There is reason for a lot of hope now. Access to peer-reviewed information about emerging topics in addiction science is (obviously) extraordinarily easier, too. 

Yet one of the best outcomes in the last 50 years is the ongoing normalization of addiction and recovery discussion. Addiction is so pervasive in our phone-addled, fast-food society that almost everyone knows someone somewhere on the sliding scale of addiction. Generally speaking, when someone asks for help they find a more sympathetic audience — and that’s a big social shift from years past. 

Not all is easy, of course. Surprisingly, social ties also help (or hinder) individual recovery. Take opioid addiction, for example.

A Social Disease With Social Solutions

“Social isolation may play a role in the development and exacerbation of opioid use disorder,” writes researcher Nina C. Christie when evaluating the role of social ties and opioid addiction.

She describes a common situation with spiraling effects:

A person’s motivation to use a substance erodes social ties over time as they begin to miss social obligations, behave in secrecy to obtain or use the substance, and become less invested in relationships that exist outside of the drug-use sphere — behaviors which physically and socially isolate the person from their family and friends (Volkow et al., 2011; Gili et al., 2017; Daley et al., 2018). This bidirectional relationship creates a cycle in which an individual may cope with feelings of isolation by engaging in drug use, which then further isolates them from society and their loved ones, leading them to engage in more drug use and so on.

The paper highlights other work on the impact of social ties and opioid use. Specifically, opioid users’ social networks are destabilized because opioid use changes a person’s social networks so dramatically and chaotically. By contrast, more stable social networks had protective effects on users of other substances, even if the people in those social networks also used drugs. A lot depends on the stigma associated with the substance.

Opioid abuse is particularly pernicious because of the stigma around it. “[Opioid users] are at high risk of being ostracized from the recovery community, as many peer group programs reject the use of opioid medications to treat opioid use disorders,” Christie writes.

Opioid abuse, and its reliance on medication to treat, is one area where stigma persists. Given the opioid crisis, it is one area our society should evaluate more closely.

Back now to Dr. Volkow’s conclusion, which calls for community engagement, especially from those impacted by addiction firsthand:

A half century after NIDA was founded, the science of addiction has ushered in an understanding that we can no longer view people who use drugs in oppositional and punitive terms. The failures of that mindset — the inefficacy of punishment at mitigating addiction and its consequences, its exacerbation of racial and other health disparities, and its creation of stress and trauma for communities — have been well documented. People who use drugs can be allies in the scientific search for solutions, and this must be recognized by addiction science. An important component of developing effective solutions must be a community-engaged approach to science that regards people with lived and living experience of drug use and addiction as research partners with valuable expertise. (Emphasis added.)

Written by Katie McCaskey. First published October 21, 2024.

Sources:

“50 years after founding, NIDA urges following science to move beyond stigma,” NIH NIDA, February 1, 2024.

“NIDA Has Supported Scientific Research on Drug Use and Addiction for 50 years,” NIH NIDA, undated.

“Drugs and Addiction Science: NIDA Celebrates 50 Years of Research and Looks to the Future,” The American Journal of Psychiatry, May 6, 2024.

“The Big Book,” Alcoholics Anonymous, April 10, 1939.

“The role of social isolation in opioid addiction, Social Cognitive and Affective Neuroscience, Volume 16, Issue 7, July 2021, Pages 645–656,” March 3, 2021.

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