The Drug Holocaust part 2

The Drug Holocaust 2

 

A year ago I tried to make the argument that the attempts to control the supply of illegal intoxicants led primarily by the U.S. Government for the last 100 years has been incorrectly characterized as a "drug war" and should and perhaps someday will more accurately be characterized as an "addict holocaust." After all doesn't a war require that both sides fight to some extent? The war on drugs while sold as a war on suppliers has been a war on minorities and on the poor. While pictures of sad and unkempt dealers on the news followed by pictures of cellophane wrapped products sitting on a table with uniformed law enforcement standing at attention behind continue to be commonplace we never see videos of captured cops standing next to armed addicts being forced to read a manifesto denouncing their role in the war. It is the government that attacks and the poor who suffer, the poor and addicted who suffer most of all. Sometimes it seems like we are finally ready to try something else. There are programs popping up here and there attempting to replace the ineffective punitive models of the past and present that were effective enough to lead us to what might be the worst addiction epidemic ever. Everyone knows that heroin use has increased dramatically but few know so has alcohol use as has death from alcohol related diseases. Hard to blame that on pain pills. But even as these new encouraging models appear the dehumanizing effects of the old (and current) way are so powerful that progress may be impossible.

Consider this headline from npr.com 

Doctors Consider Ethics Of Costly Heart Surgery For People Addicted To Opioids

You may have to cut and paste the link to read the article and if that doesn't work there's a link to it on the Grey's Recovery Facebook page.

http://www.npr.org/sections/health-shots/2017/03/21/520830183/doctors-consider-ethics-of-costly-heart-surgery-for-people-addicted-to-opioids?utm_source=facebook.com&utm_medium=social&utm_campaign=npr&utm_term=nprnews&utm_content=20170321

The article is not as terrible as the headline makes it sound. The ethical guidelines discussed are more about connecting a patient with drug treatment than leaving them to die because they continue to shoot heroin.

"Daly says that the guidelines are not some kind of moral test. Instead, they are meant to help doctors connect patients with a primary care physician or set them up with addiction counseling."

"This is not the patient proving to the medical team that they are worthy of a new valve, that they are worthy of the surgery," Daly says. "We wanted to make sure that that could not happen."

But it could happen. It does happen, it will continue to happen. For those of you working in the field ask your clients what their last emergency room visit was like. If you work in a traditional abstinence based program the treatment your clients receive will shock you. If you work in a methadone clinic you will be appalled. See you can't wage a war on a substance. A substance can't be your enemy. You can only wage a war on the people who use that substance and the enemy in any war must be less than human.

Why isn't the answer to the question "How many times should you replace the same heart valve?" as simple as saying "as many times as you can"? Why isn't a cheaper more effective solution to the problem even discussed? The cardiac problems of IV opiate users aren't caused by the drug they are caused by the "war" on the drug. Impure products and dirty needles cause the infections mentioned in the article. A cheap solution that would be more effective than any surgery would be to make needles free and easily accessible and to provide a safe supply of opiates.

The new administration has made it clear that not only do they plan to continue the failure of the drug Holocaust and plan to make matters worse by resuming the prosecution of cannabis users. I expect minimal resistance by those affected with the addiction disorder as the sit in the recovery group I run and argue for even harsher drug policy. The holocaust has not only devastated individuals, families, and communities across the globe, it has produced Hitler's willing executed and the end no longer appears to be in sight.

What are you selling?

The the practice of using half truths and outright scare tactics over science has left an indelible scar on the credibility of anyone in the recovery profession.  In the defense of myself and colleagues in the field our profession was started by faith healers, not scientists and these mystics have passed their trade from one generation to the next shouting down many attempts by the scientific and medical community to turn substance abuse treatment into anything like real medicine. While the mystics have been historically hostile to the legitimate researchers of the world they have been by comparison very welcoming to the snake oil salesman, and why not? They are the ones who sign our paychecks* and the close proximity with them has transformed many of us into a hybrid of the two. There are some promising changes happening right now which may lead us to better treatment for those who come to us for help but the first step is to stop pretending we know more than we do.

I started writing Grey's Recovery not to be a guru but with the hope of starting a conversation about things like this and in that spirit I'm going to start a list of things I learned both in treatment and while training to be a drug and alcohol counselor that turned out not to be true and I invite anyone who is still reading or happens to stumble upon this blog to add to the list. In the same spirit, if you see something that you think doesn't belong on the list please say so, and why.

IMPORTANT THINGS I LEARNED ABOUT RECOVERY THAT TURNED OUT TO BE UNTRUE 

1) Addiction has been proven to be a brain disease 

why not drop the big bomb first. Addiction has not been "proven" to be a brain or any other kind of disease. It has been "recognized" as a disease by several powerful medical organizations but this is a fairly recent development and it's my understanding this was done largely for billing purposes. It's hard enough to get an insurance company to pay to treat anything, even harder if what is being treated isn't an official disease. 

The truth is whether or not addiction is a disease is still very controversial. I personally feel the Learning Disorder model advocated by Maia Szalavitz in her book "The Unbroken Brain" does a better job of explaining the symptoms of addiction than any other to date.  The truth is the Brain Disease model explains very little. If drugs alter the brain in a specific way that causes addictive behaviors then why doesn't everyone who uses the drug become addicted? Why do compulsive gamblers and "sex addicts" have almost identical behaviors sometimes with no drugs at all? The Learning Disorder model explains this, the disease model doesn't. 

I feel I must tip my hat to Stanton Peele who has been arguing against the disease model since the70s. He has been a pariah in recovery circles for 40 years and I highly recommend people both in and out of the field read his work.

2) Addiction is ALWAYS progressive and ALWAYS fatal

This came right from an instructor in my first month of training said with braveheartian passion and made me feel an exquisite mix of fear and righteousness! I was very disappointed when I first read the watered down version in my text book replacing "always" with "sometimes," implying that addiction was often neither progressive or fatal. The truth is someone with any type of substance use disorder can remain stable indefinitely, and trying to force a change too soon is at least as likely to make the behavior worse than it is to bring about recovery. I've heard people who know better reply this myth as the truth in an attempt to get a resistant client to engage more in treatment which I see as nothing short of malpractice.

To my knowledge there is no reason for an otherwise healthy person to rush into treatment as long as there are no physical or psychological problems which combined with continued use might put the person's life at risk. If the person is stable, they will likely remain so at least for the near future and if left to their own devices may even recover on their own.  

3) The 12 Steps of recovery are the only "proven" treatment for addiction 

As a person who attended AA regularly for over 7 years it's hard for me to admit that this one is wrong. Many of us in recovery have a strong emotional attachment for the way we recovered and in this I am no different. But the truth is there is very little evidence either for or against 12 Step work. What evidence does exist is highly suspect and even the little that supports 12 Step involvement doesn't support it very well. I do feel being in AA was helpful to me, I found a good meeting where people respected the fact I am an atheist, and a good sponsor who did the same. I needed friends in early recovery and I found them in AA. But after moving to Rhode Island I just couldn't find an AA meeting that felt right so I found SMART recovery. 

SMART unlike 12 Step organizations is very open to scientific scrutiny. There is still the issue of anonymity and SMART attendees are not required to participate in studies or even give their names but in spite of this there is some very promising data that speaks to its effectiveness. I'm not saying that SMART is a cure all, I only mention it because most people in the recovery field have no idea that SMART Recovery exists and that it is at least as effective (and possibly more effective) as the 12 step alternative, but it wasn't mentioned once that I can remember in either my treatment or my training.

4) If you have a problem with ___________ you will never be able to use it normally again.

The watered down version of this is that some people are able to moderate use again but that the number is so small that it is statistically insignificant. Unlike the other things on this list it is possible that this is true, but I doubt it. The truth is we have little idea how many people are able to moderate use after showing addictive behaviors for a substance. What little data there is show that of people who had diagnosable alcohol dependency the percentage of people who may be able to someday drink with moderation is between less than 5, or slightly above 50 percent. I wouldn't stand behind either number, the truth is I just don't know. As hard as it is to count addicts it is even more difficult to count those who return to moderate drinking. In the field we only meet with those who try and fail, so it looks to us like a %100 failure rate, but the ones who achieve moderation don't come back to visit us. If they do they don't tell us they are drinking moderately. If they did we would treat them with suspicion. So we don't see them at all. Many of those who have achieved sustained abstinence may be able to return to moderation but don't try, because we tell them it's impossible. 

The few times a client has felt comfortable enough to share with me that they are thinking about returning to use I tell them I have no idea what their odds are. I do know that people who attempt lifelong abstinence often experience relapse so even that is no guarantee of success. So I tell them to be careful and to come back and visit sometime, even if they are successful.

Obviously the list could go on much further but I'm getting tired of writing. My advice is to avoid speaking in absolutes as they are usually false and to research any "fact" you find yourself repeating more than once a week.

Please feel free to call me a madman or a genius in the comments, I will consider either a compliment.

* when referring to snake oil salespeople I am not referring to my current employer or anyone I have worked for in recent years. I have been lucky.

 

The Meeting Makers

The views express may not represent those of my employer or any other organization I am affiliated with.

I started this little project I call Grey's Recovery to fill what I felt was a void in my professional development. I want to share my development as a professional in the chemical dependency field but also share my development as a person in long term recovery. The two things often don't overlap but they do parallel each other. When I make a decision, take an ethical stance, or more importantly change my ethical stance I can't help but feel the effects of that change from both sides. A major change which started in my professional life and has moved to my personal recovery is the role of AA and the 12 Steps. 

"Meeting makers make it" is one of the countless platitudes you will hear around the tables. We all know that people who attend regular AA meetings can achieve sustainable abstinence and by doing so long enough a richer more satisfying existence follows but that's often not the message of the person who pulls out this gem. The intended message is often that the opposite is not only true but but an absolute certainty. The message is that while meeting attendance and specifically 12 Step meeting attendance can't guarantee sobriety and a better life, not going to meetings will doom you to jail, institutions, or death.

Is this true? The short answer is no, but like all answers about recovery it's not that simple. The truth is that there are "meeting makers" that have very successful recoveries that grow into rich satisfying lives and there are some that get stuck in a perpetual circle of abstince and relapse that spirals into the very same jails, institutions, and graveyards reserved for the non makers. Those who don't attend meetings have a similar range of experience, some make it, some don't, and of course it isn't either/or for either group but a vast sea of grey between one extreme and the other. 

Do meetings help at all? Should you recommend meetings to a friend, loved one, or a client you are counseling? Should you make meetings a staple of your own recovery? If meetings don't guarantee success do they at least increase the odds of it? Funny how recovery turns us all into gamblers. The answer to this question is a less satisfying maybe. There is data to suggest that 12 Step attendees do better in recovery than those who do not attend, there is some that might suggest that there is no difference at all. Some experts have said 12 Step work with its dogma of helplessness actually does more harm than good.  I am not one of those people who sees all data as equal but if you are looking for clear scientific research that proves 12 Step attendance is helpful or harmful it really doesn't exist. 12 Step members are anonymous and that makes them hard to count. So what do you do? The answer is easier than you might think. You ask your friend, loved one, or client something like "did you try a 12 Step meeting? Was it helpful?" and the answer you receive will be the best indicator you will get. 

I will say 12 Step meetings helped me, but the 12 Steps did not. Through 12 Step meetings I broke through the isolation I felt in the years leading up to my problem with alcohol. I learned that sharing my struggles with a group was a healthier coping skill than drinking my anxiety away and brought people closer to me. I learned that I could have close meaningful friendships with people who believed in a higher power though I myself did not. With the help of the fellowship I recovered, grew, became a better person, and found my career. But I never did the 12 Steps. I maybe took the first, but even that I've taken back. My sponsor advised me that if I wasn't comfortable with 12 Steps I should try 3. Don't drink, don't think, go to meetings, and that's what I did for almost 8 years. That's what I still do, though I now attend SMART Recovery instead of AA. While I don't see myself regularly attending AA meetings again I don't think anyone who knows me would doubt I am far better off for having done so.

I broke with AA professionally about a year before I did so personally. When I started as a counselor I tried to take my personal experience in recovery and apply it to those I worked with. Meetings had helped me, meeting attendance had been the turning point that brought me from abstinence to recovery and like many new counselors I assumed some version of that experience would work for everyone. I suppose it worked about as well as anyone who practices 12 Step recovery counseling. I had several ethical problems with professional 12 step work.

1) I was using clinical techniques that were developed a long time ago and had changed very little. It felt like we were practicing surgery with techniques developed in the 1930s.

2) I was using a technique that in its instruction manual required belief in a higher power, something which I did not myself believe. 

3) I was paid for my services when there when the same service was available for free.

4) I became more and more concerned that the people who appeared to succeed after working with me could have succeeded with anyone or with no help at all.

5) Science, the lack of it.

I broke with the 12 Steps professionally after starting work at a medication assisted recovery center. While I could reconcile my discomfort in an abstinence only program I couldn't recommend AA and 12 Step work for clients on methadone and Suboxone. I couldn't recommend 12 Step meetings to my MAT clients because I didn't want them to have to lie about their type of recovery and I wasn't sure what reception they would get if they told the truth. There were "methadone safe" NA meetings in the area and some if my clients attended them. The center hosted a group called MARS which is a peer led support group for people in medication assisted recover that is not 12 step based. My office was across the hall from the MARS meeting and they were loud and proud of their recovery. I think MARS benefited my clients who attended but for the clients who went to NA it was a mixed bag. Some seemed to find healthy connections, others seemed to find more shame. The majority of my clients attended no meetings, and the majority of them did just fine.

As this post seems to be running away with itself I'm going to wrap it up. My point is I now treat meeting attendance much like I treat church. If a client tells me they are going to church and church is helping their recovery I assume that it is and tell them to continue. I make meeting information available to my clients but I make no judgment about the type of meeting they go to or how often they go. What the clients need is meaningful human connection, and while a meeting can be a place to make meaningful connections it isn't for everyone. I believe the client is the best judge of what will work.

Meeting makers make it and don't make it. What's more important is that one doesn't give up on positive change no matter how long it takes.

IT'S AN EPIDEMIC!!! (don't panic)

It's an Epidemic (don't panic)

The views expressed here are my own and are not necessarily shared by any employer or educational institution I may be affiliated with...but they probably should be.

Epidemic! Such an exciting word! Brings up images from history and horror movies of bodies in the street and society on the brink of collapse. Fingers have been pointing for years to find who to blame. Do we blame the doctors for filling medicine cabinets across the country with oxi and perc 30s? Or do we blame the drug companies who made billions supplying pill mills with unlimited product which then ended up on the streets? Do we blame the war in Afganistan for modernization of heroin production and distribution that has flooded the streets with so much heroin that some days it's cheaper than booze? We could always go back to blaming the addicts, but that thankfully is getting harder and harder to do. Now that heroin has found its way from poor inner city neighborhoods to wealthy suburbs and rural white comminuities it's harder for politicians to slap "other" status on the dealers and consumers of heroin and write it off as "somebody else's problem." Here on the east coast it's hard to find someone who hasn't lost a close friend or family member to heroin overdose, and some have lost more than one. In truth it doesn't matter who we blame. Blame has been as useful to a person fighting this epidemic as an anchor is to a person tryinging to swim the English Channel. It's something best left behind so we can focus on the task at hand.

Yes things are bad, it might even be that we haven't seen the worst of it, but this epidemic is treatable. We already have what we need to handle the situation. We just need to stop panicking. 

The war on drugs has lasted about 100 years. 100 years ago people panicked and decided to turn a small number of functioning addicts into criminals. Panic has driven drug policy since then to increasingly draconian measures on the mistaken belief that the problem is heroin itself or what ever drug du jour we are afraid of. Panic has driven us to wage was on cartels, arrest heads of state, and fill our jails so full that we now imprision more people than any other country in the world. Panic has driven us to treat an epidemic like an invading force rather than a disease and by doing so we've waged war against our fellow citizens. It's time to stop panicking. These panicked attempts to rid the world of heroin have brought us to where we are now. More people addicted to heroin, more people overdosing on heroin, more people dying from heroin than ever before.

We need to stop and take a breath. There are two medications with a proven track record in treating opiate addiction, Methadone and to a lesser extent Suboxone. We need to educate addiction professionals on the effectiveness of these treatments and stop acting as if they are as bad as heroin. We need to stop using prisons as the treatment option of choice for all addicts. We need to open our minds to any treatment modality that helps the addicted person return to the human experience rather than judge them for not recovering the way we want them to. We need to stop trying to punish the afflicted back to health.

For a history of the drug war and the damage its fear based policies have done to the world and to the treatment of addiction I recommend Chasing the Scream: The First and Last Days of the War on Drugs, by Johann Hari.

The author thanks you for taking the time to read Grey's Recovery. Feel free to give feedback on the ideas presented. Feedback on spelling, and grammar is not requested. Those who can't resist commenting on the author's spelling and grammar may be rewarded with a picture of the author's middle finger.