Supporting Addicted Populations Through Advocacy

When people hear the word “advocacy” they often think of lobbying on Capitol Hill or writing to senators. These actions certainly play a part in advocacy efforts, but the construct entails much more, and it is something we can all do.

For example, we can all advocate for individuals with addiction by making simple changes (like not asking people why they aren’t drinking at a social event) or engaging in larger efforts (like supporting the development of a local recovery high school). Advocacy is defined as, “breaking down barriers to wellness, acting to dismantle systems of privilege and oppression, and working for and with marginalized populations to effect change and promote development” (O’Hara et al., 2016, p. 2). Therefore, to advocate is to recognize and actively work to remove obstacles faced by a person or a group of people (particularly marginalized groups), and this includes those with addiction.

Barriers and Obstacles Faced by Those with Addiction

Individuals with addiction are often marginalized in society by stigma, stereotypes, discrimination, and aspects of culture that are counter to living in long-term recovery (e.g., attending a college surrounded by bars). These individuals face a myriad of barriers to their wellness such as:

• The pervasiveness of stigma: Stigma refers to undesirable labels placed on individuals as a result of particular traits or behaviors (Link & Phelan, 2001). The stigma faced by those with addiction stems from the moral model of addiction (the perspective that addiction is a choice resulting from a character flaw or moral failing) rather than the biopsychosocial model of addiction (the perspective that addiction results from biological, psychological, and social factors). Despite being defined as a disease by the American Medical Association in 1956, a person with addiction is often still perceived as selfish, lazy, immoral, untrustworthy, or criminal by many members of society. Stigma, stereotypes, and discrimination often are fueled by misinformation about the etiology, progression, and treatment of addiction. In essence, stigma suggests that those with addiction are bad rather than sick, resulting in many barriers faced by these individuals.
• Cultural norms that are counter to sobriety: If you are a person who consumes alcohol, consider abstaining for two weeks and, while doing so, pay attention to the number of alcohol cues and reminders that you encounter. From advertisements, commercials, billboards, song lyrics, and aisles of wine and beer at the grocery store; to societal expectations of drinking at certain events like weddings, tailgates, or on holidays, alcohol and drug use permeates American society. Cultural norms do not assist individuals in abstaining from alcohol (and some other drugs); on the contrary, they often actively promote it and shame those who try to abstain.
• Limited treatment access: According to the National Survey on Drug Use and Health (SAMHSA, 2017), 8.1% of U.S. adults in 2016 needed treatment for a substance use disorder, but only 1.5% received any form of treatment in the previous year. Thus, a large portion of those who need treatment are not getting it. Some barriers to treatment include the affordability, availability, and quality of treatment programs specific to substance use disorders. Treatment programs vary in length, location, and effectiveness, which may preclude some individuals from accessing quality care. Additionally, many people with addiction may not be able to afford treatment, may be forced to wait long periods of time before treatment in their area becomes available, or may face difficulties finding childcare while pursuing treatment.
• The popularity of acute care models: Rather than treating addiction like other chronic illnesses that require long-term care and follow-up appointments, substance use disorders often are addressed using a very short-term (i.e., acute care) model (White, 2014). For example, a 28-day stint in rehab may be all the services an individual with addiction receives, despite the knowledge that addiction is a chronic disease and often accompanied by relapse. The lack of aftercare, step-down treatment planning, and follow-up programming is a significant barrier to those with addiction.

Acts of Advocacy

In light of all these barriers, there is ample opportunity for advocacy efforts to promote the wellness and success of individuals with addiction—and many people have been doing just that. For decades, grass-roots organizations, medical and mental health professionals, and communities have been advocating for those with addiction and making great gains.

For example, advocacy efforts include supporting and pushing through legislation such as the Wellstone and Domenici Mental Health Parity and Addiction Equality Act (MHPAEA), which requires that insurance benefits for mental health and addiction treatment be comparable to those for medical treatment. Additionally, the 2016 Comprehensive Addiction Recovery Act is robust legislation that addresses the opioid epidemic by providing support for treatment and medication access, prevention programs, and grants.

Another form of advocacy that has been steadily growing is the development of recovery high schools and collegiate recovery programs. These schools and college organizations recognize the need for long-term care and support among individuals with addiction (beginning in adolescence). Recovery schools and collegiate recovery programs work to create spaces that are conducive to recovery so students with addiction can reach their educational and career goals. As of today, there are 43 recovery high schools (ARS, 2021) and 133 collegiate recovery programs (ARHE, 2019) across the nation.

What Everyone Can Do

So, what now? Given the obstacles faced by those with addiction, how can you join in the advocacy efforts to support this population? Here are a few concrete ideas:

• Don’t ask people why they aren’t drinking. According to SAMHSA (2020), 21.2 million people in the U.S. are in recovery from alcohol or other drug addiction. Thus, the odds are good that there will be people in recovery at most events abstaining from alcohol (and who likely are tired of being singled out for not drinking). No one should have to explain why they aren’t consuming alcohol—whether or not they are in recovery. Drinking doesn’t have to be a societal expectation, and if we stop asking people why they aren’t consuming alcohol, we can begin to change these norms.
• Correct misinformation about addiction when you hear it. Not everyone has been exposed to the neuroscience and current research related to addiction, and, as such, may believe some erroneous things. We all can stay informed about addiction-related research and share this information with others (e.g., when you hear someone talk about the selfishness of someone with addiction, you could respond with, “Actually, did you know that addiction impacts the brain in such a way that people think they need substances to survive? It’s as if their brains have been tricked by the drugs and it is really hard to “just stop” without professional help…”).
• When you plan events, be intentional about making them enjoyable and inclusive of all people, including those in recovery. If alcohol will be served, be sure to provide non-alcoholic options and make them just as prominent. Keep alcoholic beverages in one designated area rather than scattered throughout the event space. Avoid making drinking the focal point of the event.
• Use your platforms and spheres of influence to give voice to those in recovery. Allow people in recovery to tell their stories, demonstrate that long-term recovery is possible, and raise awareness about the realities of addiction.
• Support recovery efforts financially or by volunteering (e.g., get involved in recovery organizations and programs, celebrate recovery month each September, give to your local nonprofit organizations that serve those with addiction). When individuals without addiction partner with those with addiction, great changes can be made.
• Support legislation that seeks to improve addiction treatment, cultivate research related to addiction, develop prevention efforts, and increase treatment quality and access. Make issues related to addiction part of your deliberations when you cast your vote and take political action.

What Mental Health Practitioners Can Do

Along with the advocacy ideas mentioned above, there are a few additional ways practitioners can combat barriers faced by those with addiction:

• Assess all clients for addiction, regardless of your setting (addiction is pervasive and you sometimes cannot tell if a client has addiction merely by their appearance). Asking all clients about addictive behaviors destigmatizes the disorder. Ensure there are items on your intake form related to addiction and that you feel comfortable broaching the topic in session (if you don’t, ask yourself why).
• Stay current on your knowledge regarding addiction and evidence-based practices for substance use disorders. Seek out continuing education related to addiction to ensure you can recognize and respond to addictive behaviors in your clinical work.
• Support long-term care rather than acute-care models for addiction. Whether you are making a referral or providing services yourself, make sure clients with addiction have a long-term treatment plan (e.g., residential treatment, then intensive outpatient treatment, then standard outpatient treatment, then 12-step support and bi-monthly outpatient check-ins).
• Provide psychoeducation to clients and their families about the neuroscience of addiction, the biopsychosocial model of addiction, and correct misinformation leading to stigma and shame.
• Partner with researchers or engage in your own scholarship to continue advancing the field of addiction counseling. As clinicians become more informed about addiction, more effective treatment and prevention efforts can be developed.

In sum, we all have a part to play in advocating for individuals with addiction.

So, what will you do?