Continuing Moralistic Tones About Addiction
On June 5th while President Trump and Elon Musk carried on a very public and vituperative feud the President made a reference to reported drug abuse by Mr. Musk. “I'm not even thinking about Elon. He's got a problem. The poor guy's got a problem," Trump told CNN, according to reporter Dana Bash. This is not the first time the President has done this as we may recall from the Presidential Debates in 2020 and his intimations about Hunter Biden. The New York Times had previously reported on abusive use of ketamine by Mr. Musk. The Times reported that Mr. Musk used ketamine as well as Ecstasy and psychedelic mushrooms while on the campaign trail with Mr. Trump. Mr. Musk has denied that reported drug use and abuse.
Ketamine was developed decades ago as a less toxic alternative to other anesthetics. Esketamine is a ketamine derivative, approved by the U.S. Food and Drug Administration for treatment-resistant depression in adults. There is also illicitly manufactured ketamine known by the street names Special K, K, Super K, or Vitamin K. Like other pharmaceuticals for medical use, ketamine can be a godsend to people who suffer medical conditions but can also develop into an addiction or dependence which leads also to illegal manufacture and sale. Repeating, for emphasis, Mr. Musk has denied the Times report.
As is often the case with the President, these offhand remarks may be a legitimate expression of concern, or a purposeful statement designed to demean another or advance himself. Mr. Trump is no stranger to the ravages of addiction seen in his immediate family and might be sensitive and empathetic to these issues. It could also be a slur targeted at improving the President’s position in the argument by demeaning Mr. Musk and explaining his behavior as an addict. Either explanation works for our point here.
These references to clouded judgment are noted throughout human history. The Old Testament strongly cautions against persistent drunkenness. The Book of Proverbs (memorialized at least five centuries before the common era) details the misery, sorrow and confusion associated with a life dominated by alcohol. Proverbs passages illustrate that addiction leads to a compromised ability to make wise choices and maintain healthy relationships.
We have previously documented that America treated addiction as a moral failing for the first 200 or so years of the nation. Temperance societies existed all over America throughout the 19th century and well into the 20th. Although these organizations emerged as political action groups over time, they began as mostly Christian movements designed to encourage salvation through moral rectitude. Temperance became abstinence for many which led these groups to advocate successfully for Prohibition that failed miserably in the U.S. and much of Europe.
In American history it is very common that people have been accused of drug abuse and often as a way to induce disrepute or pity. Benjamin Franklin (laudanum), Thomas Edison (cocaine), Edgar Allen Poe (opium), Robin Williams (alcohol and cocaine), Sylvia Plath (antidepressants), and Marilyn Monroe (barbiturates) have all been cited publicly by others.
This public calling out, too often in the context of improving one’s position or calling for pity, has the unfortunate effect of perpetuating a stigma around a disease. The American Medical Association listed alcoholism (and later drugs) as a disease in 1956. The controversy about that definition at that time lingers although few physicians would consider addiction as a moral failure.
Stigma surrounding behavioral health conditions was exacerbated by the separation of physical health and mental health in the 19th century. Stigma is often based on cultural expectations that may vary from society to society and over time in one society. It may be based on fact, fiction, or oftentimes some of each. Employers are often the perpetuators of stigma as they refuse to hire whole classes of people based on risk to the company in cost, failure and public perception. Stigma results in unequal treatment in housing, poverty, criminal justice and healthcare. Violence against people with stigmatized conditions occurs on a regular basis. Perhaps the most pernicious aspect of stigma is when it becomes a barrier to treatment. An unhealthy cycle sets in where the person with a stigmatized condition, in this case behavioral health including substance use disorder, does not seek treatment thus minimizing their chances to escape the stigma. This individual does not seek treatment because they fear discovery or, worse, they internalize the belief they do not deserve to be well as they have failed at a moral level. It can also make it difficult for family, friends, co-workers or others to understand the condition.
We can all reduce stigma through our day-to-day actions. A few suggestions:
Talk openly about mental health as we would any other disease and share orally and on social media
Educate ourselves through credible sources such as the National Institutes for Health, the National Institute for Addiction, and the Centers for Disease Control
Armed with this knowledge, weigh in gently but meaningfully to misperceptions or negative comments
Be conscious of language. Words matter; we know what to say and what not to say
Promote treatment and normalize mental health treatment just like other health care treatment
Encourage equality between physical and mental illness perhaps by drawing comparisons to how we treat other diseases such as cancer or diabetes
Show compassion for those with all mental illness, not pity or disdain
Choose empowerment over shame when interacting with someone in recovery or still in the madness of active addiction
Never refer to someone with an addiction in moralistic or pitying terms
We are not here to criticize the President but to use that rather public behavior as example. Similarly, President Biden’s response during those debates is instructive in the opposite, “I am proud of my son for his recovery”. After 200 years of moralistic approaches it is well time to treat substance use disorder as a disease and discuss SUD in clinical terms. We can all participate in persistent, matter of fact, ways. One may think that we have already overcome that stigma. These public responses from the most public of people tell us that we would be incorrect.
Gene Gilchrist
Louisville, Kentucky
June 2025
