Stop Saying Addiction Disease is “Invisible.” It’s Killing People.

Addiction disease is just as visible as a heart attack. We need to open our eyes to actually look and listen.

Two Emergency Room Case Vignettes

Below are two different scenarios which describe the experience of two different people before, during, and after their visit to an emergency room. When you read the case vignettes, what do you notice? What is different, why is it different, and should it be different?

Vignette 1: Heart Attack Response

I begin to feel horrible chest pain that spreads to other parts of my body. I’m short of breath. There’s this pressure and squeezing feeling in the left part of my chest that’s coming and going. I’m becoming more anxious and worried. The more I worry, the worse the pain gets. There is something wrong and I need medical attention. I go to the emergency room, described my symptoms and told them that I think I’m having a heart attack. I am immediately seen by a nurse and doctor who explore my health history and evaluate my pain. I feel the nurse and doctor are being really attentive and respectful towards me. This puts me at ease.

The examining doctor thinks it could be a heart attack and I get admitted. I go to the ICU where I am observed and monitored. I am indeed experiencing a heart attack, and need surgery. I wake up. Luckily, I live through my heart attack. I am now given all types of information and resources for my aftercare; diet changes and restrictions, medications, caregiver information, and more. While I struggled at first with the changes, I get better over time. Even after a few years, my family and healthcare providers continue to check-in and make sure I’m doing well. I feel supported.

Vignette 2: Addiction Disease Relapse Response

I begin to feel horrible anxiety and distress. I can’t stop my mind from thinking in circles. I’m short of breath and there’s this pressure and pain in my chest. I normally would use heroin to ease my panic attacks, but I stopped using heroin a couple of weeks ago. This time it’s different though. This anxiety is more than I can handle. I’m thinking about getting high again to help ease this pain. I could make a call right now and in just a few minutes it would be here. But, I’ve put so much work into my recovery. Instead, I go to the emergency room to see if they can help me and keep me safe. I tell them about my distress, anxiety, and pain. No one asks me about my substance use history, so I disclose that I suffer from addiction disease and used to use heroin. I tell them that I do not want to relapse and so I came here to get help.

Things immediately change. I feel judged by the language the nurse is using. They ask me if I really stopped using because based on what I’m telling them, it sounds like I’m in withdrawal from recent usage. Hours pass and I have not been seen again. The nurse and doctor eventually come back and I can hear them saying things like “malingering” and “drug-seeking.” They do a brief evaluation. They say that they don’t see anything wrong with me. That this is all just in my head and that I’m fine. They give me a sheet of paper with what appears to be a list of walk-in clinics. They don’t give any other resources or helpful information.

At this point, I’m even more anxious and feel completely alone. I leave the emergency room and immediately place a call to an old connection. I go get that lockbox with all the tools I use to use to help me get some relief. Alone in my apartment, I take the amount I normally would before I stopped using. The pain and anxiety go away. Though the high feels different and more intense than I remember. Then the whole world disappears into darkness.

When we call something “invisible” it makes it much easier to ignore and disregard. If it can’t be seen, then why bother attending to it? Nothing can be done if it is invisible, right? That’s the mentality that gets created when we call mental health and addiction diseases invisible.

Did you spot the differences?

It’s not difficult to see how different these experiences are. One was treated with empathy and respect during their experience. They felt more comfortable and supported. Ultimately, this led to surviving the heart attack and living for years afterward. The other was judged for their illness. They were left alone and not given any support. This resulted in a relapse of their addiction disease and we’re not sure what may have happened to them.

Did you see anything that was the same?

There was something in common with these scenarios that cannot be overlooked. Both of these experiences were medical emergencies. A heart attack and an addiction disease relapse both require the same amount of attention, priority, concern, and empathy. Both affect the body physically and if not attended to appropriately can result in further damage or death. So why is it that the responses to both of these serious medical emergencies were treated so differently? It’s because we recognize a heart attack as a medical and physical condition that needs treatment. Addiction disease, however, is still often viewed as a moral failure, with those experiencing symptoms met with stigma and judgment.

“…the fact of the matter is that when someone in distress walks through the doors of any healthcare facility they deserve to be treated with respect, compassion, and empathy for whatever they are experiencing.”

Invisibility Kills

Mental illness and addiction disease are often labeled as “invisible” diseases. This suggests that as opposed to a physical condition like a heart attack which we can “see,” mental health conditions are not apparent physically. This is simply not true. Re-read the addiction disease relapse section again in case you missed it. The person was experiencing distress, anxiety, chest pain. Symptoms that were very similar to the person experiencing the heart attack.

All of those symptoms are physically visible. We just have to look and listen closer for signs of anxiety and distress. When we call something “invisible” it makes it much easier to ignore and disregard. If it can’t be seen, then why bother attending to it because we won’t be able to anything about it? That’s the mentality that gets created when we call mental health and addiction diseases invisible. We must stop saying these diseases are invisible. The pain is real. The distress is real. The disease is real.

The fact of the matter is that when someone in distress walks through the doors of any healthcare facility they deserve to be treated with respect, compassion, and empathy for whatever they are experiencing. They are humans in need of support and we must treat them as such. The consequences of not doing so are deadly.