Opioids and Substance Abuse: What Can We Do?

JUN. 25, 2018

By Lloyd I. Sederer, MD


Opioids and other substances that alter how we feel, think and act have overtaken our culture, and have been declared a public health epidemic. We are losing our loved ones, friends, co-workers and neighbors to these substances. But we have yet to implement the solutions that will beat back this epidemic, as we have so many others, like HIV/AIDS, polio, smallpox and tobacco. 

Substance use and abuse—of opioids, heroin, cannabis, stimulants, alcohol, etc.—is universal and the casualties of drug addiction affect all classes, races and regions of the U.S. These substances are too frequently used as an answer to pain, mental and physical, and have become a cure-all for people who’ve fallen on hard times. That’s why so many people use them and that’s why so many people become addicted.

Substance use disorders commonly co-occur with mental health conditions, especially serious mental illness like schizophrenia, bipolar disorder, depression, eating disorders, PTSD and other forms of trauma. People with mental illnesses often turn to drugs and alcohol to quiet their symptoms, and drugs and alcohol can adversely affect our nervous system and increase risk for mental illness.

The Solution

We are failing with this epidemic because of this country's dogged attachment to policies and programs that have never worked for addiction. Vast sums of money continue to be wasted on campaigns of drug control and on public messages, especially for youth, that rely on scare tactics. We can and must do better. We can beat this epidemic with three public health approaches.

  1. Prevention. This includes school-based programs that provide youth with decision-making skills and methods of controlling their moods and impulses. One proven program is called the Life Skills Training. Prevention also extends to the family, such as “positive parenting,” or actively modeling and teaching children about positive behaviors. Big Brother/Big Sister programs—where an older youth of the same background takes on a younger, high-risk child—is also highly protective. These prevention programs work, and we have hardly started to apply them.
  1. Screening. Early identification of a problem means early intervention, before the substance use disorder becomes more firmly rooted. We have good screening instruments, (such as the Alcohol, Smoking and Substance Involvement Screening Test), and need to make them standard practice in schools, pediatric and family medicine offices.
  1. Treatment. Families and people affected by addiction should advocate for the strong, comprehensive treatment approach they need. Effective treatment means first detecting the presence of a co-occurring mental (or physical) condition and assuring it's also treated. Treatment for a substance use disorder should then combine:
  • Cognitive therapy that focuses on reducing the triggers of relapse
  • 12-Step programs like Alcoholics Anonymous and Narcotics Anonymous 
  • Family education and support 
  • Medications

This public health epidemic that is seizing our country can be beaten. And by following these steps, we save lives, help families and restore communities.


Dr. Sederer is a psychiatrist, public health doctor and medical journalist. His new book is The Addiction Solution: Treating Our Dependence on Opioids and Other Drugs(Scribner, 2018). www.askdrlloyd.com.


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SEP, 20, 2018 02:27:16 PM
Celia Guglielmi
I have heard various thoughts and experiences regarding treating bipolar symptoms with cannabis. Is there any credible information available that shows whether or not cannabis helps?

JUL, 09, 2018 06:23:32 PM
Lizanne Corbit
This is such an important read. There is so much overuse and misunderstanding surrounding opioid usage. Conversations like these are so beneficial to increasing awareness and decreasing stigma. Thank you for sharing this.

JUL, 04, 2018 11:38:14 AM
Blanche Dingle
My nephew was seriously hurt when he was hit and run over by a car. Praise the Lord, he survived, but he sustained a serious hip, leg and foot injury which is leaving him in great pain. At times, the pain can be unbearable for him. When he was hospitalized, he was given very strong pain meds intra697venously along with meds in pill form. Now that he's home from the hospital, the pain doesn't seem to be as severe as before, nevertheless, it still gets pretty bad for him. My concern is that he may want to get additional pain meds take to along with the prescribed meds he's already taking. Besides all of this, he has nightmares of the accident and he's a little fearful of cars coming too close to him, understandably. Could he be experiencing PTSD? And if so, what can we as family members do to help him get through a long period of healing and therapy to get him back on his feet, again. Just to let you know the extent of his injuries, his femur was snapped in half, he had to get a rod into that bone, pins in his hip, his foot was crushed and every bone was broken so he has pins and metal plates in his foot, and he has small fractures in his arm. Again, I thank God for sparing his life and his limbs because I believe that He wants my nephew's full attention. My nephew needs healing on all fronts, physically, mentally, emotionally and spiritually. He is not used to being incapacitated like this and he still has a long road to being fully healed. I am afraid the drugs could be a detriment to him in the long run.

JUN, 28, 2018 03:27:33 PM
James Georgeeo Wahmah
Great piece, well taken. On behalf of DAPE Liberia I like to commend you. DAPE Liberia , stand for Drug Abuse Prevention Education Liberia . We are a local NGO working in Liberia with school and community groups in combating this Drug epidemic. Undeniably, drug smuggling and substance abuse serve as a source and breeding ground for so many crimes and violent acts in the Liberian society. They are detrimental to peaceful coexistence among peoples and to human survival. After 14 years of civil war we are struggling some the negative impact the war left behind, addiction is a serious challenge in our society.
In Liberia these days dozens of young adults doing drug, sleep in tombs that they have emptied by hands,many of them can't live without snuffing in or injecting themselves with those substances, and they can do anything, even if it means taking away lives, to get the stuff.
DAPE doesn't have sponsors or support from any organization yet , we are striving to get there .
In our efforts to get sponsor or support from individuals who we believe are in the position to help have yielded no good, because most of them are themselves allegedly involved in doing drugs or have connections to it.

As an organization we are asking for your support /partnership to enable us deliver our massage about and against Drug Abuse. You can follow our facebook page,
Drug Abuse Prevention Education Liberia

Don't hesitate to contact us if there's any training/ partnership opportunity with your organization to enable us deliver the matter and save lives.

Sincerely :

J. Georgeeo Wahmah


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