FIGHTING THE STIGMA LINKED TO ADDICTION

DURHAM -- Though most Durham area residents aren't likely to call people
sinners because they suffer from hypertension or diabetes, many aren't so
sure how to categorize addiction.

But alcohol and drug addiction must be understood as a disease, according
to scientists and activists who led discussions with more than 125 local
political, health, welfare and religious leaders last Monday at the
Washington Duke Inn. Addiction is associated with negatives like crime and
trauma, but fighting it will require positive action and lifting stigmas,
they said.

It was the third annual Durham Health Summit. And by the end of the daylong
event, leaders agreed that addiction was costing way too many marriages,
careers, dollars and lives in Durham County. They called for a
communitywide effort involving treatment-focused, agency-integrated systems
of care that could deal with the problems of addiction more efficiently and
more humanely than the fragmented, punishment-oriented approach
traditionally embraced.

Summit coordinator MaryAnn Black, Duke University Health System associate
vice president for community relations, and Victor Dzau, president and
chief executive officer of the health system, said Duke was committed to
helping the community seek ways to fight addiction and its collateral
damage, without abandoning support for last year's summit focus on Durham's
obesity and fitness problems.

The lineup of speakers included local people who were recovering from
addiction. Durham County Commissioner Lewis Cheek was among them, as was
Herald-Sun columnist the Rev. Carl Kenney, Carl Watkins of the Durham
Council on Alcohol and Drugs Inc., Roxanne Ellington, a counselor at the
Community Guidance Clinic, N.C. Central University student Johnny Rutt and
Randy Garcia, house manager at TROSA.

One plenary speaker, Thomas McLellan of Philadelphia, noted that
hypertension, diabetes and asthma shared several major characteristics with
chronic addictive disease. All had genetic, metabolic and behavioral
components, he said. He also cited research that showed parallels among all
those chronic diseases -- failure to comply with prescribed treatments.

McLellan, director of the Treatment Research Institute, said fewer than 60
percent of people with high blood pressure took even half the medicine
their doctors prescribed for them, and fewer than 30 percent adhered to
prescribed diet and exercise regimens. That led to re-treatment after
relapses within 12 months for 50 to 60 percent of hypertension patients,
noted McLellan.

Similarly, less than 50 percent of the diabetes population takes
medications as prescribed, and fewer than 30 percent adhere to prescribed
diet and exercise routines to prevent blindness and amputations, leading to
re-treatment rates of 30 to 50 percent. Fewer than 30 percent of asthma
patients adhere to their medications as prescribed, leaving 60 to 80
percent returning to doctors or hospitals for therapy.

"This reminds me of addiction therapy," he said. "The same things are at
play, but the public perception is different."

William Moyers, vice president for external affairs with the Hazelden
Foundation, an expanding Minnesota-based addiction treatment organization,
said he had to "hit bottom" with 20 years of drug and alcohol addiction
before he started recovery. "This is a disease that has no cure, but it has
a solution," he said.

He noted that the federal government was spending $20 billion a year on the
"war on drugs," but only 18 percent of that for prevention and treatment.
One recent survey showed that Americans felt the war on drugs had failed,
but most also didn't believe treatment worked, he said.

"There are 13 to 15 million people in the U.S. who need our help," he said,
"but only 25 percent of them will ever find it." The stigma of addiction is
allowing people to die, he said. "HIV, asthma, cystic fibrosis, every
disease has a face, a voice of people who care and contact legislators and
Congress and the press. There's the Walk for the Cure for breast cancer.
But where are the faces and voices of people like us? The stigma of
addiction is allowing people to die in this community. It's our
responsibility to smash that stigma, to make recovery our business."

He said part of the problem was that too few of those finding success in
recovery were willing to reveal themselves as the local panelists did at
the session. "So the public only sees those who don't get well." For that
reason, he called the requirement for anonymity in 12-step programs such as
Alcoholics Anonymous "bull."

Paul Nagy, director of Duke's addictions program, said research showed that
every dollar invested in treating addiction saves $5 to $7 lost by not
treating it. Keeping someone in jail, for example, generally costs around
$30,000 a year. But if that same person can remain a taxpaying worker while
being treated for his disease, everybody wins.

Nagy said 30 years of substance abuse research had resulted in 10 key findings:

- -- Earlier treatment produces better outcomes. A simple example: keeping
someone from falling down stairs while drunk.

- -- Multiple approaches can work. Often several must be tried. They can
include 12-step programs, cognitive behavior therapy, medicines and many
other treatments.

- -- Withdrawal alone doesn't lead to change. It's only a start. It doesn't
restore normal brain and social functioning.

- -- Time matters. True treatment requires a minimum of 90 days, though best
outcomes require at least a year. Anything less is a waste of money.

- -- Treatment requires a holistic approach. It doesn't work to treat
addiction in isolation when the patient also suffers from mental illness,
unemployment, tuberculosis or other significant problems.

- -- Medicines can help. There are several medicines available to treat
addictions, including some new ones and others likely to be approved in the
next year or so. "But even at Duke we don't readily offer those options,"
said Nagy.

- -- Leverage works. It's generally believed that people with addictive
diseases must make up their own minds to get help. But research shows
similar outcomes for people choosing to enter treatment and those pushed
into the same treatment programs by family, employers or the courts.

- -- The patient must be involved in the therapy decisions.

- -- Recovery is a process, not an event.

- -- Black said she and other organizers of the event intended to follow up
with volunteers throughout the community to find better ways to approach
addiction illnesses.