In the midst of the present coronavirus pandemic, one hears regular reports of people who exhibit no symptoms of COVID-19, but who are capable of spreading the coronavirus infection to others. Asymptomatic (presymptomatic) carriers pose a major obstacle to public health responses to COVID-19—an obstacle underscoring the need for mass testing, tracking, isolation of virus carriers, and quarantine of those exposed to the virus.
Asymptomatic transmission can play a parallel role in surges in substance use and related disorders. This occurs when people in the honeymoon phase of initial drug use who do not exhibit signs of a substance use disorder initiate others into the social world and rituals of drug use.
Those who possess high addiction vulnerability often experience profound euphoria in their earliest drug experiences. This is not just pleasure induced by the drug but a radically new sense of self—one liberated from distress and one imbued with the promise of a new purpose in life. Falling in love or a world suddenly transformed from black and white to technicolor are apt analogies. The desire to share the newfound joy of this magic elixir with others is not surprising.
Drug honeymooners are a key mechanism of drug transmission within local communities. Some will later experience horrendous consequences from their drug use while others will decelerate or cease drug use from boredom, maturation, or discovery of more fulfilling activities. At these later points, members of both groups may discourage drug use to others or cease being addiction carriers, but that does not alter their earlier contagious influence.
Asymptomatic transmission of drug use and addiction has both personal and systems implications.
At a personal level, recovery is a liberation often portrayed via the images of breaking chains and slaying the dragon or demon that possessed one’s soul. This emphasis on freedom misses the subsequent assumption of responsibility for the injuries and harm one’s addiction inflicted upon others. Included within such harms are the seduction of others into the world of intoxicants—some of whom progressed to lives of self-destruction or lost their lives in that world. Asymptomatic transmission encompasses modeling drug use, actively initiating others into drug use, selling or supplying drugs to others, and protecting others from the consequences of their drug use.
This is all a way of saying that addiction can be socially contagious and that addicted people have often served as carriers of this vector. Facing that reality in recovery requires taking responsibility for such actions, making amends via direct expressions of regret, acts of restitution, and acts of service to other individuals and the larger community—all to balance, as much as is possible, the karmic scales.
This is not an easy process. Some of those we influenced with no malicious intent may have later lost their lives to addiction. How does one face having participated, even unconsciously and without harmful intent, in the death of another person? How many lives must one save to balance the life or lives taken by one’s earlier actions or inactions? Fortunately, there are communities of recovery with members whose decades of recovery experience can guide us through such efforts.
At a systems level, surges in drug use and addiction can be prevented and mitigated. This occurs when the cultural density and visibility of addiction and recovery stories match or exceed social interactions that intentionally or inadvertently promote drug use. Responsible decision-making related to psychoactive drug use, including the decision to use no such substances by those for whom such use is contraindicated, is also a socially influenced process.
People in recovery have long reached out individually to others who are suffering from addiction, but in elevating their stories at a public level, a vanguard of people in recovery have the potential to influence people before such suffering begins. In this way, the pool of asymptomatic carriers of addiction shrinks or their voices quieted and the public health of local communities is elevated.
People in recovery have the potential to serve as both wounded healers to those seeking escape from addiction and the potential to serve as agents of prevention at a community level. Recovery communities have longed served the former function; they are now awakening to their potential role as community recovery carriers. It is time national, state, and local drug policy leaders fully capitalized on this potential.