Substance use impacts many people in many different ways – and while studies show that it doesn’t always lead to addiction, experts agree that using substances can affect a person’s health and wellbeing and impact their lives – as well as the lives of the people around them.
Rachel Winograd is the director of the Addiction Science, Practice, Implementation, Research, & Education (ASPIRE) Lab at the University of Missouri St. Louis. She also leads the addiction science team within UMSL's Missouri Institute of Mental Health, and her research focuses on "substance use and the systems designed to address it".
Winograd spoke with KBIA's Alex Cox about her research and how approaching addiction from a place of understanding can help people who use drugs live the best lives they can.
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Alex Cox: How do you think people can bridge the gap between the scientific understanding and the public understanding of addiction and substance use?
Rachel Winograd: So we need to make change at a lot of different levels, I often talk about there being four key levels where we need to make inroads.
So the top level, so you know, our federal systems or state systems, those things need to change to be more conducive to this more recent approach.
The second level is the agency level. So thinking about your individual substance use treatment agencies and each individual agency, how are they set up to carry out this work most effectively?
Then the third level is the provider level, or like the individuals who are delivering services -what biases might they be coming in with?
And then the the fourth level is the the level of the person who uses drugs, and their family members and their friends, are they armed with the knowledge about what works and what doesn't? So we need to make change at all four of these levels.
Alex Cox: What are some ways you work to make changes at these four levels?
Rachel Winograd: You know, I think an important job we have is to funnel information up to decision makers and people with power at the agency level.
Our team designs and executes a ton of trainings, we work to help give best practice guidance about how to set things up at the provider level, our training fits into that category as well.
We try to improve knowledge and improve attitudes around things like harm reduction, which is a philosophy or a framework for how we work with people who engage in risky health behaviors, and encouraging providers to meet people where they're at and walk alongside them and the change process.
At the individual level, we distribute a ton of naloxone, the overdose antidote, we share a ton of information online and in paper pamphlets to try to get knowledge out there about what's true and what's not true about all this.
Alex Cox: What does your worst critic say about you and how do you think they came to that criticism?
Rachel Winograd: My team and I have gotten criticism that we are working to make it so easy to use drugs that people won't have a reason not to use, and that we're enabling continued drug use. And in doing so, we are making this overdose crisis worse.
I think some people more than others have grown up with a deep sense of what they feel is right and wrong.
And using illicit drugs is squarely in the camp of wrong and not playing by the rules to a lot of people. And for those who view the world in sort of black and white terms like that, there is very little room for this gray - for this argument that drug use can sometimes be okay.
