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.  

      

Thinking of alcohol as different...

Thinking of alcohol as different from other drugs has caused a great many addicts to relapse. Before we came to N.A. many of us viewed alcohol separately, but we cannot afford to be confused about this. Alcohol is a drug. We are people with the disease of addiction who must abstain from all drugs in order to recover.

~ from the N.A. Recovery Text reproduced on-line at  home.mchsi.com/~ciana/NA_Basic_Text_Fifth_Edition.doc

A close friend of mine recently decided to drink again after more than a decade of being abstinent from all drugs.  Art's justifications [not his real first name] for drinking were many and varied.  At the top of the list was the disclaimer, "I never really had a problem with alcohol.  I could take it or leave it."  But marijuana, he told me, was an entirely different story.  He had been unable to moderate his use of pot back in the days of active addiction.  He decided three weeks ago to take up drinking again.

"How's that working for you?" I asked.  [N.B.  I did not ask with a snarky tone of voice].  "Great!" he replied.  Art assured me that he was not overdoing the drinking, that so far he wasn't having a problem with it, that he was enjoying a social drink when out at the bar with a few buddies.  He told me that "no one wants to hang out with" someone who doesn't drink.  He said if he starts to develop a problem with alcohol, then he will "cut back."

Art was not asking for my help in this his latest endeavor.  I had to accept that.  In many ways, I would be the worst person for him to ask for assistance.  We've known each other since high school days, although we ran in different crowds and consequently never used together. 

There is a problem with thinking that an addict can return to using one drug safely, or can pick up a new drug and use that safely.  What we do is what we become.  If we've done it before, we will get in trouble with it again.  If we haven't done it before, we will get in trouble with it for the first time. 

"Trouble" does not necessarily indicate legal involvement or loss of income or relationships or stuff.  Trouble at the most basic level indicates being in trouble with oneself.  We can lie to others as much as we care to about anything.  [Most of] us do not get away with lying to ourselves.

Alcohol is a drug.  It is a chemical with a specific chemical formula.  It is physically addictive.  The addict who has never drank ought to endeavor to stay clear of alcohol.  Similarly, the alcoholic who has never used marijuana [or another street drug] ought to strive to not go out and experiment. 

A high percentage of people [90% is the commonly quoted number, but the number may actually be higher than that] are not addicts.  They don't experience any consequences from social drinking or social drug-taking.  That's great news!

A minority of people [10% is the commonly quoted number, but the number may actually be lower than that] cannot drink or use safely.  Bad things happen to them and around them when they do.  The addicts among us-- including those who are addicted to the drug alcohol-- may repeatedly endeavor to do it differently with or without excuses, justifications, or rationalization.  And just because addicts [including this one] cannot use safely, it does not follow that no one should.  I am not a prohibitionist.

To be honest, I also do not believe that addiction is a "disease."  I understand the sort of thinking behind this claim but I do not agree with it.  Labeling addiction, obesity, co-dependency, and other conditions as a "disease" is a legal and dimly medical argument to get insurance companies to pay for treatments.  I think that there are some numbers of etiologies underneath addiction.  I prefer to think of addictions as being conditions rather than disease entities. 

I am vaguely aware that some work has been done [in Canada, after being run out of the United States] by the Sobels in re-educating known alcoholics to healthy patterns of drinking.  I don't know enough about it to proffer an opinion about harm reduction in general.  I do know enough to know that I am myself beyond the point of being able to return to social usage.  My social use period was over with almost immediately after I first picked up.  I almost died and I am not willing to risk my life or my health on something that might kill me this time.

I am an addict.  I cannot control my usage once I've begun using.  There are drugs out there today that were not out there when I was using-- crack, beer with lime flavoring, hard lemonade, certain "designer" drugs-- but the bottom line for this addict is that what I do is what I become.  So I don't even flirt with the idea of trying them.  The powerlessness over my addiction for me specifies that now that I am an addict, I personally cannot go back to a state of being a non-addict.  I cannot use safely.

That is not to say that I am powerless over "everything."  I certainly am not.  I have a lot of personal power [N.B. power is not the same thing as control] and I intend to use it to my benefit and probably to the benefit of some other people around me.  Systems-change work involves the use of personal power of many members of a community of activists and stakeholders in order to challenge an archaic system.  I have hope today that justice can be had by people who have been and are being denied justice.  I have hope today that a closed system which demands compliance in order not to suffer set consequences can be mediated to include the freedom of individuality and self-expression.  I have hope today that we can create change.  I've considered the possibilities and I have picked my battles.  We need to change the systems that stifle us.

I wish the best for Art.  I really do.  I hope that his flirtation with drinking proves that he can drink safely or I hope that he is able to stop drinking [again] if he needs to.  And I hope he does not return to street drugs or to the abuse of legally prescribed drugs.  Meanwhile, I have some living to do.

                             Where's the coffee?