Great Antidote Archive: Sally Satel on Addiction

Juliette Sellgren and Sally Satel

Sellgren talks with guest Sally Satel about painkillers, addiction, public misconceptions, and possible solutions

Great Antidote host Juliette Sellgren is on vacation so we're digging into the archives during her absence.

By Paul Hargitt

In this episode of the Great Antidote, host Juliette Sellgren talks with guest Sally Satel about painkillers, addiction, public misconceptions, and possible solutions. Sally Satel is a psychiatrist who lectures at Yale University School of Medicine, a visiting professor of psychiatry at Columbia University, a senior fellow at the American Enterprise Institute, and the author of six books.

Satel begins in the early '90s. There was an increase in prescribed painkillers (specifically Oxycontin) because it was a long-acting pill. A long-acting pill means that the medication lasts for a long time, in Oxycontin's case, for about twelve hours. This quickly became a popular drug, especially in Southern Ohio, where miners worked in the Appalachian Mountains. Because miners have a taxing job, painkillers helped deal with not taking days off due to minor injuries or bodily pain.

In 1995, the National Institute on Drug Abuse “came up with the idea that addiction is a chronic and relapsing brain disease”. Satel disagrees with this and expresses that making addiction a disease will seem as if it's involuntary and less likely for people to blame those who are addicted. Additionally, many people have started to call addiction a brain disease, which Satel also thinks is a problem, mainly because it's too shallow of an umbrella term. She says that the psychological level of analysis for addiction is crucial, but it gets ignored if it's called a brain disease. Furthermore, the more you describe a condition as neurological or genetic, the more pessimistic the public will be that you'll get better.

Interestingly, Satel claims that very few people actually get addicted when taking painkillers for injuries, the exception being if you have past alcohol or drug abuse. Yet, an unintended consequence of this painkiller addiction is affecting the public's perception. Doctors are more suspicious of giving out painkillers, even to those who genuinely need them. And not only doctors but parents as well are refusing their kids to take painkillers because of their lack of trust in doctors. In addition, Satel claims that some psychiatrists have too much power and refuse to give people painkillers based on how the person presents themselves.

However, the public health community is fighting against painkiller addiction. They're advocating for an antidote for overdoses, Narcan, which reverses the overdose and will throw you into an intense withdrawal, yet it's better than dying. There are stands for Narcan in areas high in painkiller overdoses and a push to get people into drug treatment with opioids. A drug treatment, specifically for opioid addiction, is through an opioid replacement, in this case, methadone and buprenorphine, FDA-approved opioids to stop people from going through withdrawal. Going through withdrawal is one of the reasons to continue taking painkillers, according to Satel, since it makes you feel awful, so you take more to feel better.

Key Quotes

“It wasn’t unusual for doctors, especially for small rural towns, where coal mining was the sole job, to give these medications out very freely….if the guys didn’t work they didn’t get paid and they could get fired. So, there’s enormous pressure to take the medications, plus the doctors who were prescribing those pills were employed by the mining companies. So, there was a great familiarity with taking these drugs from these areas. So, when oxycontin was available, it was really no big deal, in a way, to change doctors minds...Doctors didn’t have opioid phobia because they’ve been prescribing it for so long.”

“Obviously drugs affect the brain, why else would people take them otherwise? I just feel like it is not the most productive level, the most explanatory level on which to think about addiction…there are other explanatory levels that give us insight…and those are the psychological and environmental levels.”

As always listeners will hear from the guest about one thing your people should know and something the guest has changed their mind about. For Satel it's how important it is to find your intellectual niche and to remember that even experts are fallible.

Listen to this episode
Sally Satel on Addiction

About the podcast
Introducing The Great Antidote Podcast with Juliette Sellgren

The guest

Personal website; Professional website

Articles
The Truth About Painkillers

Additional work

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Trevor Burrus on the Drug War

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