At a Standstill
Is the issue of stigma stymieing efforts to gain ground in the battle against opioid addiction?
by Bill Donahue

“Do I have to use my real name?”
So the interview begins, with a man named Brian Jones (not his real name, by request). The 28-year-old originally from Bucks County would like to share his story about his journey to hell and back. He wants others to know his trajectory is once again on the ascent after essentially losing the past four years of his life to an all-too-familiar foe: opioids. 
He’s just not ready yet.
Smith’s troubles with addiction began like many others. An athlete in high school and college, he was prescribed painkillers to assist in his recovery from a back injury during a casual football game with friends. When his allotment of painkillers ran out, the pain did not. Soon enough he sought other, more accessible means of relief, including heroin.
“I did things I didn’t think I’d ever do [in order to procure drugs],” he says, though he’s shy about saying exactly what. After a few false starts and an ultimatum from his family, he found a path to recovery through an inpatient treatment program in a facility in Boca Raton, Fla. Smith says he’s better now. He’s back living with Mom and Dad, at a new home in Montgomery County. He’s holding down a decent job and working toward leading “a normal life,” as he calls it. 
Even so, Smith has not shared his story with many people. Outside of his parents, most of his family members still don’t know what he went through. His situation underscores a curious phenomenon: The United States is struggling to scale a mountainous problem—an epidemic, as it’s been termed—that no one seems to want to talk about, to normalize, at least not in personal terms.

Over the Wall
In recent years, nationwide deaths resulting from drug overdose have been on an upward climb, according to The Centers for Disease Control and Prevention. In 2017, the number hit more than 70,000, including more than 47,000 from opioids. Nearly 5,400 of those deaths occurred in Pennsylvania—the third-highest rate of fatal overdoses in the nation. 
Even though opioid addiction has affected nearly every American family, in some way or another, many people who have dealt with addiction directly—people like Smith—are hesitant to openly share their stories. In fact, some choose to go without the care they need partly because of how they think others will perceive them, according to Thomas Franklin, M.D. 
“I run a residential treatment center, so I see lots of folks with psychiatric and substance-use disorders, and almost all of them delayed treatment because of stigma,” says Dr. Franklin, medical director of The Retreat at Sheppard Pratt in Baltimore. “They’re anxious about the future, worried that it will affect their relationships … or their job prospects. Perhaps the most damaging part of it is that they stigmatize themselves; they think they have brought it on themselves, which is not true at all.”
Dr. Franklin can understand the hesitation to seek treatment. He suffered from depression for many years, and the stigma attached to the condition prevented him from finding help. He recalls one “completely debilitating” depressive episode he had as an intern. He would drive to the office, close the door and turn off the lights, then lay on the floor all day. Eventually, he did seek treatment and has had a full recovery through the combination of intensive psychotherapy and medication.
“I suffered a lot longer than I should have,” he says. “I finally sought treatment because I knew I wanted to be fully present for my own patients, so in my head I was doing it for them. The wall I had to get over was me.”
He has been heartened by the fact that other classes of illness that were once stigmatized now have virtually no stigma attached to them. Decades ago, for example, there was a sense of shame in admitting that one had cancer. Another example: alcoholism.
“Much of it has to do with how brave and open people with alcoholism have been,” he says. “It’s about letting people know that it’s not your fault and that the treatment works. I expect that in time, the same thing will happen with other types of addiction. The more people who break their silence, the more [the stigma] will dissipate.”  
Change comes slowly, he says, one person at a time. To his point, he encourages residents of The Retreat to share their stories, to not keep their struggles a secret.
“Everybody worries what people will think of them,” he adds, “but I have yet to meet a patient whose worst fantasies have come true. …In most cases, the reaction [after sharing one’s story] tends to be, ‘It’s not as big a deal as I thought it was going to be.’”
Signs suggest the tide may already be turning. Earlier this year, for example, the U.S. House of Representatives overwhelmingly passed the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act to advance treatment and recovery initiatives, improve prevention, and protect communities from illicit drugs.  
“This is everybody’s problem, not just a problem for certain groups,” Dr. Franklin adds. “It’s a serious problem that needs to be addressed, and that’s something everybody can agree on.”
As for Smith, he’s getting closer to talking openly about his struggles with addiction, opening up to family members and friends. In the future, he might take an even bolder step.
“Part of me wants to post something about it to everyone I know on Facebook, so my name and my story are out there—good, bad, and ugly,” he says. “If someone needs help, they should get it. If sharing my story can give them the courage to get over that hump, then at least some good can come from what I had to go through.”

Reaching Out
For individuals in the Greater Philadelphia Area struggling with issues associated with substance use, professional resources may be necessary. A number of treatment centers with local ties, including those listed below, stand ready to help these individuals overcome their struggles and achieve their fullest potential. 

Caron Treatment Centers

Recovery Centers of America

The Retreat at Sheppard Pratt

Seabrook House

Serenity at Summit

Published (and copyrighted) in Suburban Life magazine, December 2018.  

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