Daniel Hall   – -BBN Times – 24/08/2025

Outdated views of addiction hurt patients. Dr. Roger Starner Jones, Jr. and others are working to change that.

Despite decades of medical research, public awareness campaigns, and growing national concern, many people still see addiction through a distorted lens. “Addict” remains a pejorative label. Misconceptions persist that addiction is a choice, a character flaw, or the result of bad parenting. These outdated ideas don’t just misinform—they actively harm. They delay care, deepen stigma, and make recovery even more complicated to reach.

But addiction is not a moral failing. It is a complex brain disease, and understanding it as such is crucial to saving lives.

A Medical Diagnosis, Not a Personal Weakness

Addiction, clinically known as substance use disorder (SUD), alters brain chemistry in ways that impact decision-making, impulse control, and the experience of pleasure and reward. According to the National Institute on Drug Abuse (NIDA), addiction is a chronic, relapsing disorder characterized by compulsive drug seeking, continued use despite harmful consequences, and long-lasting changes in the brain.

Yet societal attitudes lag behind the science. More than three-quarters of Americans surveyed believe that substance use disorder (SUD) is not a chronic medical illness, and more than half said they believe SUD is caused by bad character or lack of moral strength, according to findings from the 2024 Shatterproof Addiction Stigma Index Report. This belief system creates barriers to treatment by fueling shame, encouraging secrecy, and often leading families and employers to distance themselves rather than lean in with support.

The Real Risks of Misunderstanding

Misconceptions don’t just alienate people—they endanger them. Fear of judgment keeps many individuals from seeking help until their condition worsens. Delayed treatment can lead to job loss, relationship breakdowns, homelessness, overdose, and even death.

“Shame is one of the biggest enemies of recovery,” says Dr. Roger Starner Jones, Jr., a board-certified emergency and addiction medicine physician based in Nashville. “When patients think they’ll be judged instead of treated, they wait too long. They spiral. By the time they reach us, their situation is often much more severe than it needed to be.”

Dr. Jones has seen this pattern play out thousands of times. After a decade in emergency medicine, he pursued a fellowship in addiction medicine at Vanderbilt University Medical Center, driven by both clinical experience and personal history. Starner Jones’ father, who once faced 11 DUIs in seven years, found lasting sobriety after being committed to a state hospital and undergoing physician-led detox. That experience changed the course of both their lives—and led Dr. Jones to dedicate his career to compassionate, customized addiction care.

Rewriting the Narrative: Care That Meets Patients Where They Are

Through his practices—Nashville Addiction Recovery and Belle Meade AMP—Starner Jones delivers concierge-level, judgment-free care. His model includes in-home detox, private hotel suite treatment, and office-based services designed to remove as many barriers as possible between a patient and their recovery. His focus is on meeting patients where they are, not where the system dictates they should be.

“There’s no one-size-fits-all in addiction treatment,” Dr. Jones says. “Some people need a quiet, safe space to detox privately. Others need a highly structured plan for relapse prevention. What they don’t need is bureaucracy or blame.”

Starner Jones’s approach is part of a broader shift happening in the addiction medicine field. More physicians are advocating for low-threshold treatment models—services that reduce wait times, eliminate unnecessary paperwork, and avoid rigid abstinence requirements. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), these models have been shown to increase engagement and retention in care, particularly among people with co-occurring mental health conditions.

While not a clinician in the traditional sense today, Dr. Gabor Maté is one of the most influential voices advocating for a trauma-informed approach to addiction. His book, In the Realm of Hungry Ghosts, explores how early childhood trauma, not moral weakness, underpins most substance use. He argues that addiction is not the problem itself, but rather a misguided attempt to solve internal pain. His philosophy underpins many treatment programs worldwide.

The Hazelden Betty Ford Foundation is one of the most established names in addiction treatment and has evolved to embrace an integrated model that combines medical detox, medication-assisted treatment (MAT), therapy, and mental health services. They openly reject the idea of addiction as a character flaw and emphasize long-term support and relapse prevention, rooted in compassion, not control.

Dispelling Common Myths

Several deeply ingrained myths continue to distort how addiction is viewed and treated. Let’s set the record straight:

• Myth: Addiction is a choice.
  Reality: While the initial decision to use a substance may be voluntary, the progression to addiction is driven by changes in brain circuitry, not moral weakness.

• Myth: You have to hit “rock bottom” to recover.
  Reality: Early intervention improves outcomes. Waiting for someone to “bottom out” can be fatal, especially in the era of fentanyl-laced street drugs.

• Myth: Medication-assisted treatment is trading one addiction for another.
  Reality: FDA-approved medications like buprenorphine and methadone reduce cravings and withdrawal, allowing patients to stabilize their lives. They’re widely considered best practice in treating opioid use disorder.

• Myth: Recovery is rare.
  Reality: Millions of Americans are living in recovery today. In the United States, 9.1%, or 22.35 million adults have reported resolving a substance use problem.

Compassion Is Evidence-Based

What ultimately works in addiction care isn’t punishment or shame—it’s connection. “When you treat addiction like the disease it is, you empower people to get better,” Dr. Starner Jones says. “You stop asking ‘What’s wrong with you?’ and start asking ‘What happened to you?’”

At Nashville Addiction Recovery, the ethos of compassion is baked into every interaction. From discreet intake to 24/7 physician supervision, the patient experience is defined by dignity and respect. Many of the patients Dr. Jones sees are high-profile professionals—athletes, musicians, executives—whose careers demand confidentiality. But the underlying need is universal: to be seen, respected, and supported through one of the most complex challenges a person can face.

A Call for Better Understanding

Changing how society views addiction won’t happen overnight, but it starts with how we talk about it. Swapping judgment for empathy, punishment for treatment, and generalizations for science can change not just conversations—but lives.

Source: https://www.bbntimes.com/science/what-most-people-get-wrong-about-addiction

by Jan Hoffman – Published Aug. 25, 2025

Jan Hoffman is a health reporter for The New York Times covering drug addiction and health law.

San Francisco, Philadelphia and others are retreating from “harm reduction” strategies that have helped reduce deaths but which critics, including Trump, say have contributed to pervasive public drug use.

Safe drug-consumption materials distributed in the Tenderloin district of San Francisco, including naloxone, pipes and plastic straws.Credit…Mike Kai Chen for The New York Times

As fentanyl propelled overdose deaths to ever more alarming numbers several years ago, public health officials throughout the United States stepped up a blunt, pragmatic response. Desperate to save lives, they tried making drug use safer.

To prevent life-threatening infections, more states authorized needle exchanges, where drug users could get sterile syringes as well as alcohol wipes, rubber ties and cookers. Dipsticks that test drugs for fentanyl were distributed to college campuses and music festivals. Millions of overdose reversal nasal sprays went to homeless encampments, schools, libraries and businesses. And in 2021, for the first time, the federal government dedicated funds to many of the tactics, collectively known as harm reduction.

The strategy helped. By mid-2023, overdose deaths began dropping. Last year, there were an estimated 80,391 drug overdose deaths in the United States, down from 110,037 in 2023, according to provisional data from the Centers for Disease Control and Prevention.

Now, across the country, states and communities are turning away from harm reduction strategies.

Last month, President Trump, vowing to end “crime and disorder on America’s streets,” issued a far-flung executive order that included a blast at harm reduction programs which, he said, “only facilitate illegal drug use and its attendant harm.”

But his words, implicitly linking harm reduction to unsafe streets, echoed a sentiment that had already been building in many places, including some of the country’s most liberal cities.

San Francisco’s new mayor, Daniel Lurie, a Democrat who campaigned on a pledge to tackle addiction and street chaos, announced this spring that the city would step away from harm reduction as its drug policy and instead embrace “recovery first,” aspiring to get more people into treatment and long-term recovery. He banned city-funded distribution of safe-use smoking supplies such as pipes and foil in public places like parks. A year earlier, San Francisco voters had signaled their restiveness with pervasive drug use by approving a measure stipulating that some recipients of public assistance who repeatedly refused drug treatment could lose cash benefits.

Philadelphia stopped funding syringe services programs, which the C.D.C. has called “proven and effective” in protecting the public and first-responders as well as drug users. The city put restrictions on mobile medical teams that distribute overdose reversal kits and provide wound care for people who inject drugs, and stepped up police sweeps in Kensington, a neighborhood long known for its open-air drug markets and a focal point of the city’s harm reduction efforts.

Santa Ana, Calif., shut down its syringe exchanges; Pueblo, Colo., tried to do the same but a judge blocked enforcement of the ordinance.

Mayor Daniel Lurie of San Francisco, center, often walks through the Tenderloin district, where people experiencing addiction, mental illness and homelessness gather.Credit…Mike Kai Chen for The New York Times

Republican-dominated states have also been retreating from the approaches. In 2021, West Virginia legislators said that needle exchange programs had to limit distribution to one sterile syringe for each used one turned in and could only serve clients with state IDs. Last year, Nebraska lawmakers voted against permitting local governments to establish exchanges.

“Harm reduction” is a decades-old concept, grounded in the reality that many people cannot or will not stop using drugs. Since the 1980s, when AIDS activists began distributing sterile syringes to drug users to slow the spread of diseases, the expression has moved to the mainstream of addiction medicine and public health.

Over time, it has become shorthand for a wide range of approaches. Some are broadly popular and will certainly continue. In April, the White House’s office of drug control policy released priorities reaffirming support for drug test strips and naloxone, the overdose reversal medication that has become an essential item in first-aid kits in homes, restaurants and school nurse offices.

But critics contend that making drug use safer, with distribution of supplies and pamphlets directing how to use them, normalizes drug use and undercuts people’s motivation to quit and seek abstinence.

“The more you’re sort of funding and feeding the addiction, you’re going to get more addiction,” Art Kleinschmidt, now the head of the federal agency that oversees grants for substance abuse, said on a podcast last year. Such programs, he said, “definitely are breeding dependency.”

Others argue for nuance.

“Harm reduction is neither the singular solution to the overdose crisis nor a primary cause of public drug use and disorder,” said Dr. Aaron Fox, president of the New York Society of Addiction Medicine. “It’s one component of a spectrum of services necessary to prevent overdose deaths and improve the health of people who use drugs. But if communities want long-term solutions to homelessness, they need to work on expanding access to housing.”

Harm reduction supporters reject the notion that protecting people from the worst consequences of drugs encourages use.

“I don’t think the availability of sterile supplies really makes a difference about whether someone is going to start or continue using drugs,” said Chelsea L. Shover, an epidemiologist at the University of California, Los Angeles, who oversees Drug Checking Los Angeles, which tests the contents of drugs for individuals and public health agencies. “But I do think it will make a difference in terms of whether that person is going to be alive in a week or a month or a year, during which time they might get into recovery, whatever that may mean for them.”

Some addiction experts fear that a retreat from harm reduction will reverse the falloff in deaths from injection-related diseases.

“Hepatitis C and H.I.V. numbers will go up, and more people are going to die,” said Dr. Kelly Ramsey, a harm reduction consultant who practices addiction medicine at a South Bronx clinic.

While overdose deaths have fallen, it is unclear whether drug use itself has also slowed. In neighborhoods across the country, from Portland, Maine, to Portland, Ore., many residents complain that the harm to them from drug use, including crime and syringe street litter, has not been reduced.

Mr. Trump particularly called out a type of harm reduction known as “safe consumption sites” — sometimes labeled “overdose prevention centers.” They are supervised locations where people can inject drugs without fatally overdosing, found in Europe, Canada and Mexico. Often drug users can test their supplies right away and staff members can quickly administer overdose reversal medication if needed.

There are only three in the United States, and they make for easy political targets. In addition to many Republicans, prominent Democratic governors, including Gavin Newsom of California, Kathy Hochul of New York and Josh Shapiro of Pennsylvania, oppose them. The Pennsylvania senate voted to ban them. One, in Rhode Island, is protected by state and local law. But the other two, in New York City, which provide treatment referrals and support services, operate in a legal gray zone and could face federal scrutiny.

Opponents of harm reduction offer few specifics about how to get more people to stop using drugs and into treatment. Mr. Trump’s order directs the health secretary and the attorney general to explore laws to civilly commit addicted people who cannot care for themselves into residential treatment “or other appropriate facilities.” But it is silent about how such programs would be paid for.

The administration has already made major cuts to the Substance Abuse and Mental Health Services Administration, the federal agency that awards grants for prevention, treatment and recovery. It has slashed the agency’s staff and the grants it gives for a wide variety of prevention, intervention and treatment services.

Cuts to Medicaid included in the sweeping domestic policy bill enacted this summer are also likely to affect many people’s access to treatment and states’ ability to cover it. Robert F. Kennedy Jr., the health secretary, who is in recovery from a substance use disorder, has focused on nutrition, chronic disease and vaccines during his first six months in office and has said little about plans to address the drug crisis.

The battle over whether harm reduction should remain a primary goal or be secondary to getting users into treatment and restoring order to public streets has been joined most intensively in San Francisco.

There, ample social services and ferociously expensive housing had contributed to a large population living on the streets, many struggling with mental illness and addiction. Then, by 2020, fentanyl and Covid had slammed into the city.

At public meetings this spring, angry residents brandished signs, some reading “Harm Reduction Saves Lives” and others “Drug Enablism Kills.”

Although the city has adhered to regulations for state-funded Housing First programs, which offer permanent housing for homeless people without requiring them to be drug-free, Mr. Lurie recently presided over the opening of the city’s first transitional sober living residence, with 54 units for adults committed to abstinence.

The drive to adjust the city’s drug policy to recovery first has been led by Matt Dorsey, a member of the San Francisco Board of Supervisors, who is in recovery from a substance use disorder.

In an interview, Mr. Dorsey said he supports aspects of harm reduction, including the distribution of safe supplies. But he sees the strategy as more of a floor than a ceiling. “We need to make clear that the objective of our drug policy is a healthy, self-directed life free of illicit drug use,” he said.

The difficult challenge, he said, was how to attend to the rights of pedestrians who daily confront drug use, while also trying to “help people addicted to life-threatening drugs.”

To pay for additional treatment and services, he said, city officials are working on ballot measures to redirect tax revenue.

“Part of what gives me confidence that we will ultimately find the funding,” Mr. Dorsey added, “is that the alternative is unthinkable.”

 

Source: https://www.nytimes.com/2025/08/25/health/harm-reduction-san-francisco-trump.html

Marijuana is one of the most widely used drugs globally. Rising legalization has fueled greater social acceptance and lowered perceptions of risk even as research continues to highlight its harms. A recent study published in Pediatric Research reviewed years of evidence from both animal models and human studies, examining how marijuana impacts pregnant women and their babies.

How marijuana affects the body during pregnancy

One of the critical human body systems is the Endocannabinoid System (ECS), which helps regulate memory, appetite, emotions, and even fetal development. During pregnancy, the ECS is especially active, influencing hormonal signaling, fetus brain development, and placental development.

When marijuana is used, cannabinoids such as THC enter and interfere with the ECS, disrupting its natural processes. Because THC is lipophilic, meaning it binds strongly to fat, THC crosses into fatty tissues and can be stored there for weeks. This is especially concerning during pregnancy because the membrane of the placenta, which is the critical organ that supplies the developing baby with nutrients and oxygen, is mostly made of fatty molecules enabling THC to enter with ease. About one-third of the THC in the mother’s body reaches the fetus and once there, it can accumulate in the developing brain and other fatty tissues. Animal studies show that even after marijuana use stops, the developing fetus continues to be exposed to THC, potentially altering how organs and systems grow.

Long term effects extend beyond infancy

Research finds that marijuana use during pregnancy is associated with:

Fetal growth problems: Babies exposed to marijuana in the womb are more likely to be born small for their gestational age, be admitted to the NICU, and face a 75% increased risk of low birth weight. Even short-term exposure during early pregnancy can impact fetal growth.
Developmental delays: Long-term studies show that marijuana-exposed children may struggle with memory, attention, problem-solving, and emotional regulation.
Higher risk of metabolic and heart problems: Prenatal marijuana exposure may change how the body processes insulin and stores fat which could increase the risk of obesity, diabetes, and heart disease later in life.
Increased vulnerability to addiction: Prenatal marijuana exposure changes the brain pathways involved in reward and impulse control which may increase the risk of substance use and mental health challenges during adolescence and adulthood.
 

In some studies, girls’ exposure to marijuana in the womb showed more behavioral problems including aggression and attention issues, as early as 18 months of age.

With the marijuana industry falsely promoting products as “natural” and safe remedies for various health conditions, it is critical that women of childbearing age understand that marijuana use is not risk-free. Research consistently shows that marijuana can affect fetal development, leading to long-lasting consequences for a child’s physical and mental health.

For science-based resources on marijuana use during pregnancy, as well as tools for parents and fathers, click here to visit our dedicated webpage on this topic. If you are in Florida, our grant program allows us to provide and distribute these resources to you free of charge. Complete this request form to access materials ranging from Go-to-Guides to Fast Facts for Fathers.

Prevention starts with education, and staying informed can help protect future generations.

Source: Drug Free America Foundation | 333 3rd Ave N Suite 200 | St. Petersburg, FL 33701 US

Although I’ve been deeply concerned about this problem since my days in Sacramento, over the past nearly 8 years, I’ve focused mainly on education, on prevention, and on the need to change attitudes.

NANCY REAGAN
Remarks at the White House Conference for a Drug Free America Washington, D.C. 02/29/1988

The White House

People finally are facing up to drug abuse. They’re banding together, and they’re making real progress. And I just want to say a heartfelt ‘thank you’ to all those people out there who are working so hard to get drug abuse under control.

NANCY REAGAN
Radio Address to the Nation on Federal Drug Policy 10/02/1982

As First Lady, Nancy Reagan focused on fighting drug and alcohol abuse among youth. She expanded the drug awareness campaign to the international level when she invited First Ladies from around the world to the First Lady Conference on Drug Abuse April 24-25, 1985.

“Just Say No”

Thank you for being part of the first international ‘Just Say No’ walk. Look around at how many young people are walking with you today. And just think, there are groups as big as yours, or even bigger, doing the same thing all over the world! Can you imagine just how many children are saying ‘Just Say No’ today? Children everywhere are learning about drug abuse at an early age. And that’s a good thing.

NANCY REAGAN
Remarks at the Just Say No International Walk 05/22/1986

First Lady Nancy Reagan urged the nation’s youth to “just say no.” She appeared on television talk shows, attended rallies and sporting events, taped public service announcements, and wrote guest articles.

 

---

Signings

This legislation allows us to do even more. Nevertheless, today marks a major victory in our crusade against drugs – a victory for safer neighborhoods, a victory for the protection of the American family.

President Ronald Reagan
Remarks on Signing the Anti-Drug Abuse Act of 1986 10/27/1986

The United Nations

In your deliberations, I urge you not to be diplomatic for the sake of diplomacy, but to speak the truth about the effects of drugs on our peoples and our governments. I urge you to be tough and firm in the recommendations you make.

Nancy Reagan
Remarks to the Third Committee of the United Nations General Assembly 10/25/1988

On October 21, 1985, during the United Nation’s 40th anniversary, Nancy Reagan hosted a second international drug conference.

On October 25, 1988, she addressed the Third Committee of the United Nations General Assembly where she spoke about the illegal use of drugs and its impact on families.

Nancy Reagan and the Fight Against Drug Abuse: United Nations: Textual Records

---

The picture below shows the various trips Nancy Regan made in promoting her campaign.

Source: https://www.reaganlibrary.gov/exhibits/virtual-exhibits/nancy-reagan-and-fight-against-drug-abuse

---