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Rethinking How We Approach Substance Misuse

February 26, 2020

Substance use disorders and the misuse of opioids, methamphetamine, alcohol, and cocaine continue to present major challenges to the wellbeing of society. Public health approaches to the prevention, treatment, and recovery of these conditions require shifting focus to “upstream” factors such as housing instability, that mediate risks for diseases in the first place. Here, we propose three ways of re-thinking prevention and treatment for substance misuse and use disorders:

1. Thinking intersectionally: Understanding the intersections among substance misuse/substance use disorders (SUDs) and housing, employment, access to quality and affordable treatment, and ongoing support is crucial in addressing prevention. Prevention efforts for substance misuse and use disorders, like such efforts for any other chronic disease, work best when people experience well-being in other aspects of their lives. Unstable housing, unemployment, and lack of social support are all associated with higher rates of substance use. Prevention efforts must address the numerous intersectional barriers to wellbeing.

2. Thinking person-centered: Prevention and treatment efforts must focus on people as people, with various struggles, fears, and strengths. Criminalizing and stigmatizing substance use and misuse as personal failures ignores the fact that SUDs are chronic diseases. A holistic, person-centered approach to prevention and treatment means framing the disease as one of many components of a person’s experience, not the defining characteristic of the people themselves, and encourages providers to be compassionate and refrain from being judgmental.


3. Thinking about the continuum of care: Intersectional, person-centered approaches to substance misuse and use disorders must apply to each step of the care continuum. The continuum of care for substance use and misuse disorders begins with enhancing health and wellness in general. It then moves to primary prevention tactics, including strategies to lessen environmental and individual risk factors and early intervention methods such as screening and referrals. Treatment comes next. And finally it moves to ongoing recovery. This continuum of care rarely looks like a straight line, and one’s primary and ancillary needs—meaningful relationships, housing, employment, etc.—must be kept in focus throughout the process.

Without this mindset, some traditional approaches to substance misuse and use disorders may miss potential avenues for prevention and treatment, either by focusing only on the disease and ignoring intersecting factors at play or by criminalizing and stigmatizing those with the disease. Legislation at the federal and state level should incorporate intersectional and person-centered thinking to create strategies for each stage of the care continuum

Re-focusing preventive efforts “upstream” will lead to a reduction in the number of people experiencing these conditions. Working together, researchers, policy-makers, service providers, and other stakeholders can rethink the way we talk about substance use and incorporate holistic approaches to preventing, treating, and helping people recover.

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