Teach-Out: Solving the Opioid Crisis

 

Teach-Out: Solving the Opioid Crisis

I am always reading about and following up on the latest research for the opioid crisis, especially as it regards the treatment. High profile people like Michael Jackson and Prince who die from the misuse of these drugs makes the problem even more public.

My experience is with a young woman that I was trying to help in the program. I go to AA and I think addicts should be allowed there, as well, but that's another issue. This young woman had been to detox and was living in a halfway house. She was attending meetings, working, and trying to stay clean. She was also taking Suboxone to help her to recover. What she said was that the other women in the halfway house -- what is supposed to be a refuge and a home -- were stealing her and everyone else's medications. If that is your recovery environment, a place of active addiction in a home for recovering addicts, you have a very hard road ahead of you. And, even in the best of circumstances, we all know that recovery from drugs and alcohol is "trudging the road of happy destiny."

This course addressed the multi-faceted nature of drug abuse and recovery and is a welcome discovery.

The presenters:

Michael Smith, PharmD
Pooja Lagisetty, MD
Dan Clauw, MD
Jay Lee, MD
Amy Bohnert, PhD
Rebecca Haffajee, JD, PharmD
Romesh Nalliah, DDS
Larry Gant, PhD
Rachel Janzen, RN
Vicki Ellingrod, PharmD

Young People Especially at Risk

What I find so disconcerting as I read about the myriad of issues with drug and alcohol treatment is that young people are so much more vulnerable to these flaws. It is a serious failure of our health care system.

This essay, Radical Transformation of Treatment,  reminds me that Gary's son is not alone in having been failed by our treatment programs. During my experience with one of the marginal treatment centers of the 90's, a young teenager from private school in St. Louis came to this treatment community. After a few days, she left because it was, well, really weird -- EST Lite. Where we were usually charged with supervising our fellow recovering addicts, this time the leader said to just let her go. She was dead within a few days.

A friend's son was a successful graduate of a recovery boarding school, but the after care for these kids or young adults is so inadequate. Only one high school in the large metropolitan area where I live has an addictions coordinator for their 1000 students. A few high schools have recovery meetings on the premises, but most have no support at all. One of the critical pieces of my recovery story is that I had access to "young people" meetings. My friend's son died after a return to drinking.

The ranches and boarding schools, hospitals and recovery communities, all have broadly good intentions. They are certified or licensed at a minimal level, like daycare centers, and many other allied educational and therapeutic organizations, but there is a lot of room for fraud, incompetence, and abuse. They must be better regulated, run based on evidence-based therapies and sound medical care.

AA is not a Cure-all

Chester Bennington should not have died

Mike Shinoda has created some beautiful songs to understand and communicate the loss of his friend and bandmate, Chester Bennington, to suicide.

When someone who has struggled with addiction commits suicide, I feel that it is not a failure of that individual so much as a failure of our institutions, whether our mental health system, the 12-step programs, the medical and pharmaceutical systems.

I know the 12-step philosophy that many espouse would say: He didn't surrender enough or He didn't work a good recovery program or He didn't work all 12 steps and 12 traditions perfectly on a daily basis. But I believe that it is a failing of the program. Alcoholics Anonymous saved my life. I was taking the elevator all the way to the bottom when my friends took me to my first AA meeting. And it took a while to accept that I needed a program of recovery. It didn't take the first time. But there have been obstacles all along the way, some even well-respected sponsors and therapists who, I feel, misrepresent the program. The masterful playwright Stephen Adly Guirgis is one of the only artists I know publicly addressing this problem in a meaningful way. Much dogma and pop psychology has made its way into the 12 steps that can be a deterrence more than a help.  

Some peer-reviewed research has shown what I have experienced, that AA can help people achieve continuous sobriety. John F. Kelly has been at the forefront with his research but the popular press often presents findings that disprove the effectiveness of AA. I contend that it is never the program that fails individuals but often a single person or a sect of AA that misrepresent the steps and traditions of Alcoholics Anonymous. When we can finally start to evaluate what kinds of treatments work and which do not, we will be making strides to gain a scientific understanding of how to effectively treat people. All of this is a reckoning we need to address in AA and the recovery community at large.

The program of AA is clear: "The only requirement for membership is a desire to stop drinking." In one of my meetings, an old guy used to tell his story that included picking up "enough white chips to tile my bathroom." He would say that he'd go to a meeting in the morning and be drunk that night. But he kept coming back to the meeting and picking up that chip. And the only shame would involve some supposedly sober member telling this guy he wasn't surrendering enough. 

No doubt Chester was prescribed many different medications over the years as so many of us are. And yet, they didn't do the single most important thing they are supposed to do and that is keep someone's depression at bay enough to keep them alive. No one expects Nirvana or pure bliss. We all know that these medications take a long time to work properly or it takes a while to determine the best cocktail for each particular individual. Again, it's better but in this case, a real failure of this technology. 

There is at once, more and more qualifications to become certified to practice in the mental health field and then sometimes seemingly less reliability of the practitioners. If you are lucky enough to have the best mental health care near you or you have access to resources to bring yourself to the best addiction hospitals, your chances are improved greatly. I know of many people with long-term sobriety who owe their lives to these well-known treatment centers. But such a small population really has access to this kind of care. When you do receive good care, the after care system is based on finding excellent recovery groups. The damage that one misguided or ineffective sponsor or therapist can do is remarkable. I was 15 years sober when I encountered one of these people and lucky to have years of sobriety to be able to see through and survive this experience.

So, let us all admit how we failed this individual. RIP Chester, Chris, Kurt, Philip, Scott, Mary Kennedy, my dear friend Irene, my brother-in-law Dan, and so many of our friends and family in and out of the rooms along the way...