I debated a bit before using the word “fucked,” but face it. No one is going to read a scholarly dissertation on the subject. Instead, we need some straight talk (no pun intended) because there are too many people dying, too many families suffering, too many people are lost. Show of hands, folks. How many people know an addict, have lost someone to addiction, have struggled with it personally? If there is even one person on my list who doesn’t know someone for whom treatment has failed, and failed multiple times, they are either lying or dead. I shall presume the former since the latter would be a bit unsettling.
Now most of you will not listen to William White’s youtube presentation on Recovery Oriented Systems of Care because it sounds dull and it takes about three days to listen to the entire series. But you should. If you are an addict, you should listen to it. If you are a family member, you should listen to it. If you are a certified professional, you damn straight should listen to it. Let me give you a quick synopsis of why addicts don’t recover and I can do it in one word: treatment.
Here’s what happens in today’s enlightened age of addiction treatment. Addict comes in. Addict is de-toxed. Addict has thirty days to get his shit together. Addict has graduation celebration. Addict is released from treatment. Addict goes back to old neighborhood and scores before he takes his first shit as a free man. Why?
We know that addiction is a chronic condition, but in our culture, addiction is treated as if it were an acute disease, sort of like the flu plus or minus a felony charge. White puts it like this. It is like taking a dying tree, uprooting it, planting it in good soil and nourishing it, and the minute it starts to bloom, we say, “Awesome. This tree has recovered.” And we dig it up, put it back where it came from, ignore it, and it dies.
Do we use this model with diabetics? Lupus? High blood pressure? Fuck no. How about cancer? Nope. HIV? Nope. Statistics show that alcoholics stand a good chance of remaining sober if they’ve reached their fifth year of sobriety. So how long should we provide follow up care (at minimum)? Hint: If you have to think about that one too long, you’ve got the wrong answer. Opiod addicts take even longer. Just like with any other chronic disease, addiction has a point where it is stable and the patient is able to manage it, for the most part, by themselves. And just like any other chronic disease, there are periods of remission and a potential for relapse. Notice I said “potential.” Not everyone does, but you don’t hear about them. Why? Because a large majority of people who recover don’t ever go into treatment. We can’t identify them, so we can’t study them.
And why can’t we identify them? Stigma. Who in their right mind is going to risk their job or their friendships or their family by telling a well-meaning researcher, “Oh hell yes. Man, I spent a whole year of my life pawning everything I owned, pawning stuff other people owned, crawling through the rose bushes at 3AM vomiting my guts out, and every once in a while, wetting the bed. I was just lucky I never got caught. And dude, that describes about half the guys in my college dorm.” Even more salient, what former addict who never got caught is going to lead the civil rights movement against the stigmatization of addicts? If you can go public with your addiction it is because you are in one of two positions: either you’ve got nothing to lose because you’ve already lost it all, or you are Betty-freakin’-Ford. Either way, someone who is looking for hope is not finding a role model who looks like them.
If you’ve been in treatment, you’ve got yourself one serious case of stigma. You have to lie on job applications. You’ve got to sweep your former self under the carpet and pray to God that one of your old dealers or drinking buddies doesn’t recognize you when you are on a family outing with your kids. And you sure aren’t going to stand up at the Rotary club and be an advocate for the ones that didn’t make it lest someone sees the ex-addict in you and decides its time your membership expired.
But back to the acute treatment model. We’ve got other problems in our thirty day, instant recovery plan besides simply the duration of treatment. Here’s the biggie. Administrative discharge. If you’ve not been around people in a program, let me define this for you. The client enters treatment straight out of jail or off the street and we are SHOCKED – simply SHOCKED – that he does not even have rudimentary social skills. He breaks a rule, which may or may not involve using. What happens? He’s kicked out of the program. Now I’m going to paraphrase White again but “in what other chronic illness do we find patients kicked out when they become symptomatic?” He uses this as an example: You go into a hospital for a heart condition. On Day 2 of your stay, you have a heart attack. In other words, you have become symptomatic for the condition that brought you to the hospital. Does anyone come to your room and kick you out of the hospital for being “non-compliant?” No. They move you to ICU because you need more care, not less. Do you see the problem here? The guy that really needs the help, who is seriously a danger to himself or others, is kicked out of a program for exhibiting symptoms of his disease. If you are his counselor, you will see him again. And again. And again. That is provided that your facility allows him back in your program and many do not, thereby causing another problem in that the person who knows your case better than anyone can no longer treat you and you have to start over in a brand new environment with a brand new counselor.
But there’s more. Counselors who really care are actually leaving formal treatment facilities because they feel they can do more good as a volunteer. Why? First of all, they spend more time doing mandatory paperwork than treating clients. Second, there are “boundary issues.” Ethically, if your client walks out of treatment and disappears, you are not permitted to go looking for him. You can’t go to his house, his shelter, his street corner and say, “Hey what’s up? Let’s go have a cup of coffee and talk about what’s going on with you.” If you do that, you will be fired. You can’t interact with the client’s family and invite them over for one blessed afternoon of normalcy doing a backyard barbeque or having a picnic. In the facility, you can’t hug the client or pat him on the shoulder or have any contact whatsoever. Presumably this excludes CPR, but I am guessing that most counselors would even feel uncomfortable about that. It is such a pervasive concept that I had one instructor at school who said she will not even offer a distraught client a tissue, although of course they are free to reach for one themselves – or use their sleeves.
In one class, we were given the hypothetical situation of running into a client in a shopping mall. The client is doing well and is happy to see you. Bubbling with enthusiasm and gratitude, he or she rushes over to give you a hug. The instructor’s advice? Extricate yourself from the client’s embrace and gracefully slide into a politically correct handshake. Play that scene out in real life and think about how it feels to be a client who has just been stiff-armed by their therapist. To make matters worse, you cannot disclose the identity of this person to your stunned family members. “Who is that?” your hubby asks, narrowing his eyes suspiciously. “Uh…just..ummm…you know…some guy.” This does not exactly model functional social interactions, ya know?
You owe it to yourself, and to those you know who struggle with addiction, to understand the limitations of the current addiction treatment health care model in the United States. You need to understand why treatment is often a revolving door. You need to understand that there is a vision out there that could work and it needs advocates. Most of all, you need to know recovery is possible even for the most hard-core addict you know. Maybe that person is you. Don’t give up. Take action.