Will Unite to Face Addiction Reverberate?

There were a lot of different kinds of people at the Unite to Face Addiction rally on October 4. I tried to capture some of the variety with my camera, so the world could see how many sorts of folks care about this issue.

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I think all of us were delighted to see each other. No matter who we were, we were so pleased to commune with others who cared enough about these issues to schlep out to DC on an unusually chilly weekend.

The air was particularly potent, I thought, because of the lives lost and gained to addiction and recovery. Many of us had gotten our lives back. It’s a grateful atmosphere, surrounded by so many people in recovery who remember the suffering of addiction. “My life was a hurricane,” said one of the speakers, explaining why he wasn’t worried about bad weather on rally day.

But the crowd had also sustained many losses. I couldn’t count the number of t-shirts I saw with photos of fresh faces, dates of birth in the eighties or even nineties, dates of death two months ago, six months ago.

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This tension was apparent on the event’s message board, a huge tent where people scrawled signatures and thoughts. “Recovery Works,” said one message. “Peace to you, Steve. We miss you…” said another.

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I really like what Kim Johnson wrote about the people she was surrounded by at Unite to Face Addiction. It rings true for me:

Parents are angry. I spoke with parents who wanted to know why no one had told them about Vivitrol or buprenorphine…We heard from parents who had lost children, some more than one, to overdose deaths. In addition to their grief, they felt rage at their inability to get help…

We heard from young people who are unwilling to accept the status quo. They are unwilling to feel shame, unwilling to accept that the system works the way it does–with access to treatment only via the criminal justice system, if at all. They talked about mutual support, but did not necessarily accept the standard format under which it has been provided. They talked about many paths to recovery, and they really meant it.

So yeah, it was potent. I use this word too much–but it was awesome.

How Does It Matter?

And what next? Kim (and many others) have mulled over that question. What does it matter that we gathered for a day in Washington D.C.?

Lately, I’ve seen some fairly damning examinations of the “raising awareness” phenomenon. It probably comes as no surprise to you that there are over 200 health awareness days, weeks and months. And at this rate, there’ll be a thousand before we know it. I grew up in the trophy generation–everyone gets one–and that ethos seems to have extended to health awareness days.

This summer, two public health researchers tried to figure out if awareness days were effective and…couldn’t come up with much. In a peer-reviewed commentary, they wrote, “The craze of awareness days observed in the United States has not been driven by evidence of their effectiveness.”

And of course, even if awareness gets successfully raised, there’s not a lot of reason to think that it creates change. Reporting on national suicide prevention efforts in 2013, Time‘s Josh Sanburn wrote:

“A 2009 study in the journal Psychiatric Services looked at 200 publications between 1987 and 2007 describing depression and suicide awareness programs targeted to the public and found that the programs ‘contributed to modest improvement in public knowledge of and attitudes toward depression or suicide,’ but could not find that the campaigns actually helped increase care seeking or decrease suicidal behavior.”

And worse: “A similar study in 2010 in the journal Crisis actually found that billboard ads had negative effects on adolescents, making them ‘less likely to endorse help-seeking strategies.'”

However, as Julie Beck wrote in The Atlantic about awareness-raising, “Lip service is not nothing–if enough people do it, it could help shift cultural norms.”

Lip service is not nothing. But it’s also not very well supported by research.

Beck cites Melanie Tannenbaum, who wrote in Scientific American, “Based on everything that we know about our brains and their bafflingly strong desires to fit in with the crowd, the best way to convince people that they should care about an issue and get involved in its advocacy isn’t to tell people what they should do—it’s to tell them what other people actually do.”

ONDCP Director Michael Botticelli is a huge proponent of honest communication to change social norms. At the Unite to Face Addiction rally, he quoted former San Francisco mayor and gay rights advocate Harvey Milk: “Once they realize that we are indeed their children, that we are indeed everywhere, every myth, every lie, every innuendo will be destroyed once and all.”

There’s undoubtedly truth in that statement. Lip service is not nothing. But it’s also not very well supported by research.

There’s nothing wrong with doing things that aren’t evidence-based. Most of what I do every day isn’t evidence-based. But as advocates fighting to reduce the incidence of addiction and its related harms, we ought to consider what’s evidence-based in addition to what feels right or what seems good.

The organizers of Unite to Face Addiction know that (The Path Forward section of their website emphasizes evidence-based practices and policies). The organizers behind October 5th’s Advocacy Day know that. The researchers who wrote this excellent guide for high impact philanthropy to address substance use know that.

As all of us support measures to better prevent risky substance use, to face addiction or to support recovery, let us consider the evidence behind them. That goes for policy change, prevention programs, communication campaigns, and everything in between. There’s no need to pour all of our energy into vague efforts when there are a number of concrete strategies that work.

Resources

Lifting the Burden of Addiction: Philanthropic opportunities to address substance use disorders in the United States