Wednesday, 21 May 2014

When "Treatment" Goes Wrong

     In my unasked for opinion, blaming the client/ customer/ participant/ patient for a failure of the system to treat that human being competently-- or at least adequately-- sucks. I've been alive long enough to know that this cookie cutter treatment that almost all of the newer folks in recovery are being subjected to is a sham. It is more than unfortunate that twelve step philosophy in general and A.A. in general [with a passing nod to N.A.] is presently dominating the addictions treatment industry.

     Now that we've all been edumacated into the disease concept-- alcoholism is a disease, drug addiction is a disease, gambling addiction is a disease, internet addiction is a disease, obesity is a disease...-- it is obvious to those profiteers of the misfortune of the addicted that a "disease" requires "treatment" that insurance companies ought to pay for. The identified addict is shuffled into counseling, drug courts, mental hell courts, detox, in-patient, out-patient, halfway houses, houses for people who have been identified as having both a mental problem and an addiction problem world without end amen. The identified addict is subject to inspection, psycho-socials, team meetings, social workers, case managers, and fishbowl living. Add on to all of that feelings groups, employment groups, recreation groups, spirituality groups, house meetings, and group groups. 

     I have been witness to more than several rather dramatic "treatment failures" through the years. Three people I knew committed suicide. Two were drunk and one was not drunk at the time of the taking of their lives. Shotgun [drunk], overdose of prescribed meds [drunk], jumping off of a bridge on purpose [sober]. Not easy ways to die for sure. The common reaction to the news of a suicide is something along the lines of "He or she wasn't working THE program." Countless people have left rehabs and day programs and halfway houses and other residences early and against the advice of the professionals and para-professionals. A few have opted for serving prison time rather than completing drug court. Some have been kicked out when it was determined that their addiction was complicated by more serious issues such as a rampant eating disorder or sexual abuse trauma.

     The drug court folks complain of fishbowl living. And that seems to be accurate. Anyone from the community can call the drug court staff in order to rat out a drug court defendant [NOT participant] for things like giving someone a ride home from a bar, being near a bar, bowling with a bowling team [hey, there's booze at the bowling alleys Jack]. What's even worse are past graduates of drug courts who have the ears of drug court staff. They report that one woman "looked" upset before a [12 step] meeting or that a guy "is not paying attention" during a [12 step] meeting. They should know better. So should the drug court staff.

     Folks who live in a residence with staff oversight have complained that staff have stolen their property, held back their checks, insisted that they attend a dance or other social event put on by the agency that runs the residence, treats them like children. They too are under constant surveillance.

     Groups conducted at the residences and those conducted at treatment facilities sponsor the viewpoint that all of the attendees are "sick" people with a "disease" who must rely on a "Higher Power" [supposedly of their choosing but commonly referred to in the literature as male and monotheistic] in order to halt the progress of their "disease." Atheists are pressured to find a "Higher Power" regardless of how sincerely an unbelief may be held. At the very least, an atheist should be encouraged to re-write the steps into something that is pertinent to him or her. Even better is a system that offers alternatives to twelve step meetings as a means to facilitate abstinence. Also [usually] missing is the opportunity to engage in treatment geared toward harm reduction. Some folks can cut back. Others may find that they are unable to cut back and then opt to go for total abstinence. 

     Twelve step meetings have helped some [very low] percentage of people to abstain from their addictions. Other folks may do better in a secular group or in harm reduction or gasp! on their own. [According to Harvard studies, approximately 77% of those people who themselves choose to quit drinking do so without any formal treatment or attendance at 12-step groups]. Some folks may opt for opioid replacement therapies for a time. [Others may have this option forced on them]. More research is needed on issues such as when treatment is needed and what kind is optimal to the individual. It is far too easy to assume that all identified addicts should be steered to a twelve step program. The real work is in helping a patient to determine what resources he or she want to access in order to mitigate or stop a given self-destructive behavior.

     Professionals and para-professionals do a grave disservice to their patients and drug court defendants by assuming that they know better than the individual being subjected to their knowledge does about what might truly help and heal. Until the system changes its operating premises that all of the clients are sick and diseased and too stupid to figure out what they need, there will be treatment failures. And these "treatment failures" are human beings. 

sapphoq itching for a coffee says: It is past the time when the dominance of a twelve step approach should be acceptable in treatment protocols for all identified addicts. Blaming the customer is bad practice. While there certainly are very dedicated professionals and para-professionals working in the addiction treatment industry, the overbearing system inhibits their ability to shine and to put the needs of their patients and drug court defendants first.