I Had Cancer. My Treatment Was Eye-Opening About Addiction

Having just completed six months of radiation and chemotherapy for Stage 3B colorectal cancer, I'm thankful for an exceptional health care experience and the best possible outcome, which doctors cautiously call "no evidence of disease" (NED).

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Though I'll need anxiety-provoking scans every few months for the foreseeable future, my oncologist reviewed my recent results, congratulated me with all the usual caveats, and emphasized: "It's not every day I'm able to share such good news."

His declaration left me relieved but painfully aware of persistent disparities, not only in cancer care, but in the way we treat other diseases; namely, addiction.

I'm a white, middle-class, well-insured man who has worked in non-profit behavioral health services for more than 30 years, so my social determinants of health are admittedly different to others I met in the infusion room.

Cancer care is far from perfect, but the chasm between addiction and the rest of medicine was at once eye-opening and disheartening.

While substance use disorders—like most diseases—are more treatable than ever before, over a million Americans have died from overdoses during a twenty-year-long opioid crisis and illegally manufactured fentanyl has driven annual fatalities to record highs.

Alcohol still kills more people than any illicit drug, according to the National Institute on Alcohol Abuse and Alcoholism, and the NIH-reported surge in drinking during COVID that's been linked to social isolation, job loss, economic hardship and mental health problems has not yet subsided.

Cocaine and methamphetamine use have risen in the last decade, so much so that some experts are warning that stimulant use may become our nation's next drug epidemic.

Cancer and addiction are both serious illnesses that become more manageable and survivable with timely detection, front-line treatment, regular follow-ups, a robust support system, and a healthy dose of hope.

I've had two different types of cancer in two years and in both instances, I was screened, diagnosed early, and ushered into care. My cancers were identified, analyzed, staged, and a team of doctors designed an evidence-based treatment plan that commenced as soon as I consented.

That's not what usually happens with addiction. In fact, according to HHS estimates from 2022, only 6 percent of the more than 48 million Americans with a diagnosable substance use disorder (SUD) received treatment for their condition.

Most of those folks didn't think they had a problem, but others faced barriers to care or were reluctant to seek help. It's no wonder why.

I didn't hide my cancer diagnosis and I didn't need to sneak off to treatment. I never worried about losing my job, my housing, custody of my kids, or the support of friends and family.

Many people struggling with the disease of addiction, on the other hand, are also battling a deadly combination of private shame and public stigma, deeply rooted in the notion that addiction is a personal choice reflecting a lack of willpower and a moral failing.

My loved ones didn't have to spend hours combing the internet and calling dozens of facilities hoping they could at least get me on a waiting list. They didn't have to sift through "treatment brokers" who collect commissions from out-of-state rehabs that offer 1,000-thread count sheets but little in the way of evidence-based care.

Neither they, nor I had to battle my health insurance company to get the tumors removed from my nether regions. While each of my expensive treatments had to be pre-authorized and my doctors had to continually prove "medical necessity," I got what I needed without a fight.

Health insurers handle conditions above the neck very differently and getting them to pay for addiction treatment or mental health care in the right setting for an adequate amount of time is soul-sapping.

Insurers routinely require patients with severe substance use disorders (SUD) to "fail first" at outpatient addiction treatment centers that are better suited for more moderate cases before they'll pay for an inpatient stay that's been recommended by a licensed health care professional.

Those who don't die or wind up in jail while failing first are sometimes lucky enough to land in an inpatient rehab, but even then, insurers arbitrarily limit lengths of stay or abruptly cut reimbursements, forcing a premature discharge. Then they limit follow-up outpatient visits in a way that would be unacceptable for any other disease.

My tumor would probably still be there, insidiously growing by the day if my insurer had suddenly decided they would only pay for 11 radiation treatments instead of the 27 sessions my health care team prescribed.

Delaying my chemotherapy while doctors were forced to try something they knew probably wouldn't work would have also left me full of cancer and worry.

FDA-approved medications like methadone, buprenorphine, and naltrexone, used in combination with traditional counseling and behavioral therapies, are considered the "gold standard" for treating opioid use disorder (OUD).

Yet, those who use medication-assisted treatment (MAT) to cut their cravings, normalize their brain chemistry, and reduce their risk of a fatal overdose are often told by friends, family and even health care professionals that they're simply "trading one addiction for another" and are berated for needing a "crutch."

Nobody said that about my life-saving radiation, chemotherapy, or any of the drugs I was prescribed to manage some of the rough treatment side effects.

I got appointment text reminders, informational videos about what to expect during treatment, and my clinical notes were available in my patient portal instantaneously after each visit.

Social workers, a dietician and other members of the treatment team checked on me during chemo sessions. Case managers and patient navigators from both the hospital and my health insurer called me regularly.

I didn't need those services, but I took comfort in the fact that I wasn't battling cancer alone.

When I abruptly stopped taking anti-nausea medication that made me feel loopy, there was no judgement from medical staff, and I wasn't considered "non-compliant." My doctor simply asked me a few clarifying questions and prescribed an alternative.

My fiancé came with me to treatment, took notes, asked my doctors questions I forgot to ask and was an active participant in my care. Nobody lectured her about boundaries, the dangers of enabling me, or my need to "hit rock bottom" before I could get better.

I worry that my cancer could come back, but if it does, nobody will blame me for not "wanting it badly enough." My family, friends, and co-workers will be disappointed, but they'll blame cancer, not me.

Nobody will accuse me of "relapsing" or suggest that money spent on my treatment was wasted. It would simply be that my cancer returned, and I need more help.

I'd get supportive texts, calls, and emails, and maybe even meal chain deliveries, rides to appointments, and more F*ck Cancer gear. I wouldn't be thrown out of treatment or shunned in peer support groups but welcomed back with open arms.

With renewed hope and a revised treatment plan, I'd live to fight another day—just like the other 18 million other cancer survivors in the U.S.

If all else eventually failed, I'd know that my health care team did everything they could to save my life and that my family, friends, co-workers, and community not only rallied around me, but loved me with all their hearts.

People with addiction desperately want and deserve no less.

Jeffrey L. Reynolds, Ph.D is the President/CEO of Family And Children's Association, a New York-based nonprofit organization.

All views expressed are the author's own.

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