Governor's Health Bowl Week 5

Avoiding Addictions

By: Greg Vigdor, Washington Health Foundation President & CEO

Addiction. It is a frightening word and with good reason. Most of us know someone who has battled (or continues to battle) an addiction and we often witness firsthand the toll it takes it takes on them and their family.

Addictions are one of the greatest threats to our health, both individually and collectively. They are also a driving force behind some of our most adverse health consequences. For example, smoking is one of the leading causes of death through its association to cancer, heart disease and stroke. And then there’s alcohol and drug abuse – each with its own myriad of poor outcomes, from failing livers to motor vehicle deaths to accidental overdoses and more. It’s hard to overstate the extent to which addictions can affect our lives. Here at the Washington Health Foundation – we fully realize that addictions create a major barrier to our vision of making Washington the Healthiest State in the Nation.  

This is why "Avoiding Addictions" is one of the six key action areas of our Healthiest State Campaign.   It is not just that smoking, excessive drinking and drug abuse is bad for us in terms of health outcomes; for many people, the addiction is one that carries psychological or physiological qualities that form habits that cannot be easily broken. Many find themselves powerless to stop their behavior, and the impact on their lives and others spins out of control.  

So, the best thing to do, as our action area suggests, is to avoid the addiction altogether. We understand that is often easier said than done, but there are strategies we can use to help battle this ever-growing problem. Whether it’s through health education, disincentives, policy, or by engaging potential users to take control of their own lives through our suite of Health HoME tools  – there are things that can and should be done to help people avoid dangerous addictions. These strategies can be successful, if they are applied correctly. Rarely are addiction strategies easy to implement and often they can be controversial. Witness the war on drugs, and the serious social question of whether incarcerating huge numbers of people for marijuana possession is the right way to limit drug use in American society.

However - the larger issue seems to be that so many people are already addicted.  Do we just focus on those who are not yet addicted, or try to intervene (from a health standpoint) on behalf of those who are already under the spell of these behaviors? Recent history would indicate that we often choose to intervene for many addictions that are already rampant in our society. Tobacco cessation is one of the major health strategies of the past forty years. Similarly, alcohol and drug abuse programs are all around us. 

One of the important attributes that we believe is necessary for a program to be ‘successful’, is to make sure it addresses the unique and often individual qualities that make the behavior "addictive" to so many. The truth is - not everyone is affected by tobacco, alcohol, or drugs in the same way. I vividly remember my mom quit smoking many years ago. It didn’t seem to have a huge effect on her, so I have concluded she was not ‘addicted.’ Meanwhile, I have many friends who have been unable to quit smoking. They often find themselves "jonesing" for nicotine and needing a cigarette so bad that they just couldn't stop.

Advances are being made, technologically and in terms of health policies across the nation.  For example, drugs are now available that are able to intervene and help ease a smoker’s cravings. One of our major Healthiest State efforts was to get employers, insurers and the state government (through its Medicaid program) to include easy access to these drugs as part of their cessation programs. The reason is simple – these types of interventions can and do make a difference. Especially for those people who would otherwise struggle to find success when they attempt to quit smoking.

So we need to figure out how to treat those already addicted, while trying to stem the tide of new people who might find themselves susceptible to addiction. How well we do this moving forward will be one of the critical issues for our personal health and the health of those around us.

But, perhaps even more challenging is to understand the breadth of health risks, and which should fit under the tent of addiction.  An online search of potential addictions is a wide array of common vulnerabilities in our society- gambling, sex, sugar, food, love, desire, prescription drugs, illegal drugs, and smoking, just to name a few. Are we compelled to determine who is actually addicted to any of these things, or is it better to allow social mores to dictate which of these indulgences should be branded with the addictive label and which should not? Think of when a famous person is caught with their pants down, and then ends up being treated for sex addiction.  How many of us scoff at the notion that their behavior can be excused in the world of public opinion by this alleged addiction?

Perhaps it is totally accurate that this is what is going on.  And perhaps many of our other questionable behaviors are explained by real addiction.  After all, psychological dependence is part of addiction, and our new age is all about trying to influence our behaviors through billions of dollars in marketing.  Buy products. Behave in certain ways.  Vote for certain people and support specific causes.  Would it be any shock that the net impact of these multiple stimuli has left us in great danger of succumbing to things that tickle our marketing fancies and are beyond our control to stop without some trauma to ourselves?

Maybe.  And maybe it is just that we need to take greater personal responsibility for our decisions and our bad behaviors…..at least some of them.  

Most likely, we need to do both - take greater responsibility and know when we are under the spell of something so we can seek help to break that spell.  Our health improvement strategies need to recognize the importance of both of these factors. It is particularly important if we are to somehow improve our health as individuals, and not just continue to invest trillions of dollars in treating the consequences of our bad behaviors through the medical care system (or think that we can merely legislate bad behavior until it goes away).  Not easy stuff to figure out. But it is a key front in the ongoing battle to build and cultivate real health in American society. Maybe we should get addicted to THAT!