15 Tips for Smart Reporting on Drug Addiction and Treatment

Do you want to better report on drug addiction and treatment? Avoid having Slate's Jack Shafer feature your work in his Stupid Drug Story of the Week feature? Then follow these smart tips from veteran journalist Maia Szalavitz, who specializes in neuroscience, mental health and addiction. Many thanks to Maia for graciously sharing them with ReportingonHealth.

1. Maintenance. Whether with methadone, buprenorphine (Suboxone, Subutex) or even heroin itself according to several studies now, maintenance is actually the most effective treatment for opioid addiction (if we're talking about keeping people alive and cutting disease), regardless of what you hear in the media. See Institute of Medicine and World Health Organization.

2. Don't ever write about a treatment center's "new" approach without Googling.   Chances are, it's already been tried and failed or had the same results as other treatments. Googling can also discover if the program operator has had regulatory problems in previous states.

3. Widely used "tough love" approaches are not effective and are actually counterproductive. This includes confrontational "interventions," like the ones on TV, boot camps, and any kind of humiliating or "attack" therapy. Not a single study has ever found a confrontational approach to be superior to an empathetic, supportive one. 

Consider this when you consider the need for coercion to get people into care:   avoiding treatment may not be due to "denial" or having fun while high: it may be because of fear of these widely used and traumatizing tactics.

4. Don't ever write about a new treatment for addiction-especially one that is harsh or invasive-without consulting academic experts and ethicists. For example, when brain surgery for addiction was touted in Russia and China and picked up by U.S. media, there was no reason to believe what they proposed would help anyone (taking out your pleasure center!). It carries great risks of disability and death and the one study done found it was inferior to accepted treatments.

5. Don't ever take seriously claims of success rates that are not from peer-reviewed published research. Never make the false equivalence of contrasting a program director's self-interested and unsupported claim with findings from peer reviewed literature. 

A common ruse is to claim an "80%" success rate-that's typically 80% of the 15% who actually completed the 18 month program. By the way, that's about the same abstinence rate as untreated addicts.

6. Twelve-step programs are not superior to other approaches and are absolutely not the only way to recover. In Project Match, the biggest study done on this, Alcoholics Anonymous was equivalent to cognitive behavioral therapy and motivational enhancement therapy in one arm and slightly superior on one outcome only for those with lower psychiatric problems in the other. 

Just because 90% of American treatment providers use it does not mean it's right for everyone, and many addicts lose hope when told that it's the only way. It helps some:  that doesn't mean everyone should be forced into it.  Research shows providing options for addicts to choose from increases success of all options.

7. Having recovered from addiction doesn't make you an expert on addiction.  You're an expert on your own experience, which counts, but unless you've studied the research, you're not an expert on addiction.

8. Police are not good sources of information about drug effects or pharmacology or addiction.  Nor, typically are drug counselors, who are often not even required to have a high school education. Universities and the National Institute on Drug Abuse (NIDA) have experts who actually know the literature:  use them!

9. Don't ever say that a drug is instantly addictive or addicts everyone who tries it.  The most addictive drug is actually nicotine and that only captures around 30 percent of those who try it.  Crack, heroin, and methamphetamine addict around 10 to 15 percent of users; marijuana, about 5 to 6 percent.

10. Addiction is compulsive use of a substance despite negative consequences. It is not physically needing a drug to function, despite the fact that the Diagnostic and Statistical Manual of Mental Disorders (DSM) calls this condition substance dependence (this should change in the DSM-V).

 You can be physically dependent on non-addictive drugs-blood pressure meds, antidepressants-which are not addictive. You can be addicted to drugs that don't cause physical dependence:  crack and methamphetamine, for example.

This is critical for pain patients who may be physically dependent on opioids but are not addicts: the drugs improve their lives and they aren't taken compulsively.  The same is true for addicts on maintenance: a steady, regular dose does not produce mental, physical or emotional impairment and relieves craving.

11. That "new worst drug ever" probably isn't new or worse.  Learn the (extremely racist) history of drug laws and the cyclic nature of drug scares.  Media hype over infinitely increasing addiction never pans out.

12. Always, always, always think critically.  If editors had done this, a Pulitzer would never have been given to a woman who claimed that an 8-year-old addict was being supplied by his junkie parents.  Why would they waste their drugs? What 8 year old likes shots? Another myth that should never have been promoted by media:  "addicts like to share needles."  So why don't they do peace, love and sharing with drugs?

13. If you are covering the "prescription drug epidemic," never write a story that does not include the perspective of a pain patient or pain patient advocate.  Virtually all coverage of this issue focuses exclusively on the risks to people from exposure to drugs-not the risks to patients from losing access or from requirements like weekly doctor visits that can be prohibitively expensive to patients and the system and can interfere with the ability to hold a job. 

Consider what it would be like to be in agony and dismissed as a drug addict and whether we want our doctors' first impulse to be to disbelieve claims of pain.

14. Drug diversion is not always bad. If a safer drug like buprenorphine is being sold on the street rather than heroin, it's not a full win but it will reduce risk of overdose death.

15. The relationship between drugs and crime is complicated. Contrary to popular belief, most people who steal to get drugs stole before they got hooked, most prostitutes who support their habit that way were prostitutes before they became addicts and were sexually abused before that.  Most violent drug addicts were violent before they got hooked and were abuse victims before that.  Drugs exacerbate but do not create most of the problems with which they are associated-at least 50% of all addicts have an underlying psychiatric problem and unemployment doubles the risk of addiction.

Maia Szalavitz is willing to provide references and further information "on request." Email her at maiasz@gmail.com or contact her through her ReportingonHealth profile.  

Photo credit: brains the head via Flickr