How to Help Someone With an Addiction: Compassion
Madelyn Ellen Linsenmeir was a mother of one with a beautiful singing voice, who loved swimming with her son and rarely met a person she couldn't befriend.
That's what her family wrote about her in a moving obituary that recently ran in Vermont's Seven Days newspaper. Linsenmeir died in October after a years-long battle with opioid addiction, according to the obituary. She was 30 years old.
"It is impossible to capture a person in an obituary, and especially someone whose adult life was largely defined by drug addiction," it reads. "To some, Maddie was just a junkie—when they saw her addiction, they stopped seeing her. And what a loss for them. Because Maddie was hilarious, and warm, and fearless, and resilient. ...
"In a system that seems to have hardened itself against addicts and is failing them every day, she befriended and delighted cops, social workers, public defenders and doctors, who advocated for and believed in her 'til the end."
Linsenmeir's family asked that anyone reading about her life "with judgment, educate yourself about this disease, because that is what it is. It is not a choice or a weakness. And chances are very good that someone you know is struggling with it, and that person needs and deserves your empathy and support."
Education is exactly what filmmaker Sarah Holt had in mind when she set out to produce the newest episode of PBS's "NOVA," simply titled "Addiction," that explains the science of opioid addiction, and what people who don't experience addiction can do to help people who do.
A crisis close to home
Substance use disorders related to opioid pain relievers are so common that the National Institutes of Health has called it "a public health crisis with devastating consequences." The National Institute on Drug Abuse reports that 115 people die every day in the U.S. from an opioid overdose. In fact, drug overdose is now the leading cause of death for Americans younger than 50, according to "Addiction."
"This is happening to many Americans across all walks of life," Holt said. Nearly half of all people in the country have either struggled with an opioid addiction themselves or watched a loved one struggle with one and "navigate a broken system of care," she said.
One goal of the film was to show that "people fall into addiction in many different ways," she said. To get to the heart of the issue, she spoke with 70 to 100 people who had experience with addiction. These people were bank executives, miners, teenagers, wealthy, poor and everything in between. They had depression, anxiety or another mental illness, a genetic predisposition for addiction or experienced a workplace injury. Some people were still using, some people were in recovery. Some were family of people who had been lost.
While "there are a lot of very powerful documentaries" about substance use disorder, many focus on the toll the crisis has taken on individuals and families, Holt said. She took the opportunity to "focus on some solutions and not just have it end in tragedy."
Why the most common treatment methods don't always work
In Holt's mind, by treating addiction for what it is—a serious illness and not a moral failing—the American health care system can "stop preventable death" by more readily providing treatments that already exist.
Part of that is moving away from "tough love," both in treatment and in the way we all treat people experiencing addiction.
"One of the tragedies of addiction is that families and friends get really upset with people they love," Holt said. "It further isolates people who are really sick and really need help. ...
"I really think in this epidemic, where every time you use you risk dying, the tough love is a deadly approach."
One of the stories in the "Addiction" documentary centers on Jonathan Winnefeld, a teenager whose military family often moved. To cope with misdiagnosed anxiety, he self-medicated with alcohol and, eventually, drugs. Fifty percent of teenagers who experience anxiety also experience drug addiction, according to the documentary.
Fearing they would lose their child to addiction, Winnefeld's parents placed him in an abstinence-based treatment center, meaning the treatment involved going "cold turkey." He completed his 15-month treatment and it seemed to have worked.
Just three days after he started college with a new outlook on life, his parents got a call. He was found unresponsive in his dorm room after relapsing.
Now, Winnefeld's parents believe that punishing him early on for his drug use and enrolling him in abstinence-based treatment, though common and understandable, were harmful.
If you've ever tried to quit smoking or drinking soda or using anything you have come to depend on, you know how hard it is to stop completely. In the case of opioids, imagine quitting something that overwhelms your brain with happy feelings—up to 10 times more than naturally rewarding experiences do—and never turning back to it, not even once.
"Abstinence-based programs for opioid use disorder are setting people up to fail or relapse," said Laura Kehoe, a doctor at Massachusetts General Hospital, in the documentary. "There's almost a 100 percent relapse rate. ... This should never be recommended as a primary intervention."
Despite this, most addiction treatment is abstinence-based, rather than medication-assisted, when people experiencing opioid use disorder are given other drugs, like methadone or bupenorphine, to help wean them off of the more destructive ones.
"Some people can manage their diabetes with lifestyle changes and diet, but some people need insulin, and the same is true with addiction," Holt said.
In Vancouver, Insite, first of its kind in North America, offers a safe place for users to inject drugs, as well as clean needles and access to life-saving treatment in an emergency. Since the facility opened in 2003, the rates of overdose and HIV in Vancouver has gone down, said Insite manager Darwin Fisher in the film.
Though establishing facilities like Insite in the U.S. would likely be highly controversial, Holt said, this kind of thinking is what we need to turn the opioid crisis around.
"It's really hard to watch someone you love do something incredibly destructive," she said. "I don’t think other diseases play out in the same way."
It's so difficult to remember that your loved one isn't consciously choosing to continue using drugs. But "there are a lot of things we can do to keep people safe until they’re ready" for recovery, including educating yourself on the science of addiction and making sure they're safe.
Even being mindful of the words you use—like avoiding the labels "addict," "dirty" and "clean"—can reduce stigma around drug use disorder and recovery.
"I hope this film will help people have compassion with people struggling with addiction," she said. "People need education and they need therapy, but they really need community. So many people shun people with addiction and leave them isolated.
"Try to reach out to those people that are struggling and not judge them and support them."