Despite the fact that 20.7 million Americans (roughly 8 percent of the U.S. population) are in need of substance use disorder (SUD) treatment, only 4 million people (or 19 percent of those with SUD) receive treatment. SUD is a widely misunderstood illness, shrouded in stigma and misinformation.

According to researchers at Johns Hopkins Bloomberg School of Public Health, Americans are more likely to have negative opinions of people with substance use disorders than they are of those with mental illnesses. Despite the fact both mental health and substance use disorders are more widely discussed and addressed than in years past, they are still not treated in the same way as physical ailments are. Plus, a significant number of people still reject the idea that SUD is an illness.

It is critical we break the stigma of SUD and we can start by talking openly and honestly about it. To that end, here are four questions, with answers, that you might be afraid to ask about substance use disorder.

  1. Isn’t SUD a weakness? No. SUD is an illness. In fact, it is both a physical and mental illness. According to the National Survey on Drug Use and Health, 9.2 million U.S. adults experienced both mental illness and a substance use disorder in 2018. The National Alliance on Mental Illness (NAMI) calls this a dual diagnosis and states, “People experiencing a mental health condition may turn to alcohol or other drugs as a form of self-medication to improve the mental health symptoms they experience.” The existence of co-occurring psychological disorders helps explain how many people who struggle with substance abuse get to the point of developing a chemical dependency or addiction. In addition to this psychological disorder, once a person’s brain is addicted to alcohol or other drugs, it also has a physical disease that must heal.
  2. Wouldn’t I know if my family member/friend/coworker had a problem with SUD? No, you won’t necessarily know if someone close to you is struggling with SUD. Many people with SUD do not seek treatment and appear to be managing their lives. Part of the reason people hide their SUD is because of the stigma attached to the illness.
  3. Is SUD a fireable offense at work? Actually, employees with SUDs are protected by two federal laws: the Americans with Disabilities Act (ADA); and the Family Medical Leave Act (FMLA). However, an employee can indeed be fired for using drugs or alcohol during work, or for lapses in work performance related to using drugs or alcohol. And at first glance, that seems reasonable. What manager doesn’t want the right to terminate an employee for poor job performance? But imagine for a moment that an employee had another illness, and then apply the same logic: that employee can’t be fired for getting treatment but they can be fired if the company discovers they are sick on the job. It wouldn’t happen. Well, the American Medical Association and American Society of Addiction Medicine define addiction as a disease.
  4. Isn’t SUD a personal/private issue? Why are we talking about it? Untreated SUD affects all of us.  For our healthcare system, people with untreated SUDs represent a substantial burden. That’s because people with untreated SUD are twice as likely to be admitted to emergency departments as people who do not have the disorder. Furthermore, untreated SUDs often lead to an occurrence of chronic health conditions and poorer health outcomes for individuals. For employers, the impact of lost productivity due to SUDs has been projected to be $180 billion annually and contributes to rising healthcare costs. And for society in general, alcohol played a role in 2.6% of all deaths in the United States in 2017.

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