Executive Summary: This is the second of multiple Alerts exploring different facets of the ongoing opioid addiction crisis afflicting our country. Our June 12, 2023 Alert outlined the big-picture issues associated with this epidemic. Our September 7, 2023 Alert (Part 1) addressed how to identify a potential addiction issue and when and how to engage on the issue. This Alert focuses on some of the medical concerns related to addiction and why it is helpful for employers to better understand these concerns when navigating an addiction scenario with an employee.
Dependence Versus Addiction
With respect to drug and alcohol abuse, dependence and addiction are related but distinct concepts. Generally speaking, dependence is the body’s physical reaction to use of certain substances. For example, if someone regularly drinks alcohol or caffeinated products and then abruptly stops using them, their body will manifest well-known and generally unpleasant physical reactions to the absence of that substance – just ask a coffee lover what it is like to go without Joe for a week… The body has become dependent on the substance, but after a period of time without the substance, the body acclimates to its absence and the initial physical reactions cease. Addiction is different in that (generally speaking) the addicted person is compelled to pursue and use the substance in question without regard to consequences – no matter how dire they may be. In short, addiction is “continued use despite consequences.”
Interestingly, a person can be dependent on a substance but not addicted. Likewise, a person can be addicted to a substance but not dependent (e.g., a common phenomenon with the usage of methamphetamines). And a person can be both dependent and addicted to a substance – which is generally the case with alcohol and opioid addiction.
The distinction is important, both from a workplace safety perspective, as well as how an employer responds when a concern arises about an employee potentially having a drug or alcohol addiction issue. If an employee does not feel well and is unable to report to work because he/she has recently stopped drinking alcohol or using lawfully prescribed opioid medication (on which they are dependent but not addicted), the health concerns will normally be of a short duration and most likely can be managed with little disruption or impact on business operations (e.g., taking some time off work). On the other hand, addiction is a very different issue that will most likely entail an extended leave of absence for rehabilitation and a follow-up plan of action to navigate the return-to-work process over an extended time period (assuming that option is on the table).
Opioid Addiction’s Impact on Brain Chemistry
One of the most problematic aspects of opioid addiction is its impact on brain chemistry. Dr. Loyd refers to this impact as being akin to a “frontal lobotomy” in that the frontal lobe of our brain, which controls insight, judgment and empathy (reason and judgment), is essentially turned off, and the pleasure center of our brain takes total control of the addicted person with no braking process in play – hence the frequently devastating personal, professional, and legal consequences, including death. This phenomenon also accounts for denial of addiction and the need for treatment when confronted. Further, when someone suffering from opioid use disorder (i.e., they are addicted) starts the rehabilitation process (regardless of whether it is inpatient or outpatient), they are in for a long haul in terms of re-wiring their brain chemistry such that it returns to its pre-addiction state (if it ever does so) – on average two years.
In relatively short order, the person’s opioid dependence will subside, but the impact on brain chemistry is a much longer term issue. Generally speaking, when a person addicted to opioids stops using them, their brain chemistry will start the re-wiring process after two to three months of sobriety. If that person can maintain sobriety on an extended basis going forward, it can take the brain up to two full years to return to its pre-addiction stage. Unfortunately, most people suffering from opioid use disorder require multiple runs at sobriety (on average about five to six times) before they are successful, assuming they are ever successful. Consequently, for most people, the recovery process can last for a number of years.
Given the potent nature of the synthetic opioids flooding our country, coupled with the long-term struggle for the brain to recover from such addiction, it is not surprising that recovery is such a difficult road for most addicted people. When you factor into this equation the inevitable interplay between unresolved, underlying mental health issues and opioid addiction, it helps explain the enormous scope of the problem, including the fact that more than 109,000 people died from drug overdoses (with the vast majority involving opioids) in both 2021 and 2022 – with no end in sight.
Relevant Issues for Consideration
Some of the most problematic hurdles impeding our collective ability to more successfully navigate the opioid addiction epidemic are not clinical but social. One of the primary social issues is the long-standing stigma associated with both mental health and addiction issues. Addiction is not a moral failing. Nor is it a reflection of a weak constitution. Instead, it is a medical condition. However, as a society, we are still struggling to fully come to terms with this fact. Further, such stigma impacts access to care, as many people do not want rehabilitation facilities in their community, especially if it is a facility that utilizes medically assisted therapy (“MAT”) – which we will discuss in a subsequent Alert.
The good news is that because opioid addiction is a medical condition, it can be successfully treated. To be successful, a person addicted to opioids needs treatment that contemplates both the addiction itself and the corresponding mental health issues, as well as other social issues that directly impact the likelihood of a successful recovery (e.g., having a place to live, financial resources to navigate daily life expenses, transportation, employment, etc.). All of which we will explore in a subsequent Alert, as well as exploring the relevant employment laws that employers need to consider and navigate when dealing with an addiction issue.