How is it possible that we so rarely seem to hear these stories, certainly at the level of public debate? 

Propaganda from vested interests in the US recovery industry is one factor. The political demonization of drugs in order to attack certain groups of people who use them is another. But a third is that natural recovery is so normal, we don’t think anything about it.  

For instance, more 20-somethings get into problems with drugs (and other addiction involvements) than do 50-somethings—who have more life experience, and often, more life responsibilities than their younger counterparts. Everyone knows and accepts this. Yet we too rarely ask what these 50-somethings’ lives looked like when they were younger. 

People whose lives have evolved in this way, typically with an element of finding purpose, often don’t feel the need to tell a public story about it. It’s just something that happened—part of their prologue. But a fear of offending received wisdom, of setting the “wrong” example by showing that drug addictions are usually temporary, also informs this reticence. Offering a holistic, nuanced view about drugs and addiction is a risky thing to do in public, socially and legally. 

In contrast, the US-rooted recovery movement encourages—indeed, admonishes—people who previously experienced addiction to refer to themselves as being “in recovery,” and to make that the continuing focus of their identity. 

Celebrities constantly share narratives about the lows of their addictions and the revelation of their abstinence-based recovery identities, and are widely praised for doing so. That’s not to say that they are necessarily being dishonest about their own experiences; just that telling stories that cast drugs in the worst light is encouraged in our culture.

The drugs-are-bad narrative—to which the notion of addiction as a permanent state of being is central—deflects attention from real culprits

Strong pressures therefore amplify one kind of recovery narrative while suppressing another. Among countless manifestations, consider host of Armchair Expert Dax Shepard’s recent drug addiction and recovery story. Or Nic Sheff’s Tweak, about his tumultuous relationship with meth, as one example of a host of recovery memoirs. Or the way that Kurt Anderson once theorized in New York magazine that George W. Bush’s decision to invade Iraq and other failures were due, in part, to his side-stepping AA in his recovery from alcohol addiction. 

Stories of this kind often share some false assumptions: Drugs are bad; they hijack the brain chemistry of people who use them; and once people become addicted, their only hope is to practice a recovery program forever to keep their addiction “at bay.” Such myths sustain the lucrative, ineffective US rehab racket.

Clearly, resisting efforts to exaggerate drug harms does not mean we should ignore them—nobody thinks that. People do suffer and do lose their lives around excessive, compulsive or chaotic drug use. But the likelihood of harmful or fatal substance use is driven by societal pressures and injustices—and by drug policies that foster stigmatization, adulteration and other risk factors. 

The drugs-are-bad narrative—to which the notion of addiction as a permanent state of being is central—deflects attention from real culprits.

Luckily, some thought-leaders make a point of pushing back. Among them is Dr. Carl Hart, the Columbia University psychology professor. Hart attacks our culture’s misinformation campaign in his books High Price, and now Drug Use For Grown-Ups. (recently excerpted in Filter). 

Hart accepts, of course, that addiction occurs (one chapter of Grown Ups is titled “Addiction is not a Brain Disease”). But his primary focus is taking on the anti-drug propaganda that so many of us have consumed since birth. His simple message is, “drugs aren’t the problem.” That is, drugs, by themselves, don’t cause distress as we’ve been conditioned to believe (think “crack epidemic” and “opioid epidemic”). Instead, policies and attitudes create the bulk of harms. 

Hart consumes drugs—including heroin and cocaine—intentionally and for the betterment of his life, while taking care of his adult responsibilities, as his new book describes. He hopes that his honesty about his own drug use, along with his messaging about drugs’ potential benefits, will help steer our society towards the understanding and honesty that might save lives. 

Asked what others can do to help, Hart told Filter, “Get out of the closet. Just get out of the closet and be responsible. When people who respect you see that you use drugs, it may conflict with their view of what a drug user looks like. Just doing that will be so helpful.” 

Highlighting natural recovery fits this mission. Here are two examples of people whose complex journeys reflect the silent majority who recover on their own. 

Keri: A Story That Busts All Manner of Myths

Keri Ballweber, who’s in her late 30s, consumes cannabis regularly in a way that benefits her. Likewise, her occasional use of psychedelics such as psilocybin, LSD and ketamine is always positive. She also uses cocaine once or twice a year with friends: again a positive experience, conducted in a way that avoids harms.

Keri, who is the director of peer advocacy for an Illinois-based harm reduction organization called Point to Point Kane County, says that she thrives on her mature identity—including, but obviously not limited to, her healthy relationship with psychoactive substances—and would never let anything interrupt her good life and purposeful career. But according to our standard model of addiction and recovery, this shouldn’t be possible—especially because Keri once had a problematic relationship with heroin.

“My heroin use was more of a tightrope walk but I’ve been using harm reduction strategies since before I knew there was a word for it,” she told Filter. “Once I discovered buprenorphine when I was 22 in 2005, I was able to maintain a relatively stable life.” After that, “I never used heroin more than a couple days in a row, pretty much since 2005.”

Keri says she turned to buprenorphine as a safer and reliable alternative to her drug-of-choice—one she could obtain without fear of a poisoned drug supply—not because she was a diseased person who needed medication. She also recognizes that heroin brought her some positives, as well as negatives. “There have even been times that I felt I was using heroin in a therapeutic way,” she said. “My partner and I would get high and be able to calmly and lovingly talk about painful topics in our relationship that when not intoxicated would devolve into fights.”

“I think most of the pain I experienced with my heroin use was directly related to the feelings of shame, stigma and rejection I felt.”

Since that period of her life, Keri has become a mother. She fears that her son might be taken from her if she were ever caught using heroin. One of the few times she used heroin as a parent, she used with a friend. When the friend’s partner found out that they’d used together, he threatened to call child welfare and tell them that Keri was using in front of her baby. It’s a classic example of how the harms of drug policy transcend those of drugs themselves (with which they are often, wrongly, conflated).

“It doesn’t matter that my son was with a grandparent when I was high,” Keri explained. “The second I failed a drug test, child protective services would be able to snatch him away. To be honest, I think most of the pain I experienced with my heroin use was directly related to the feelings of shame, stigma and rejection I felt, simply because of the types of drugs I was consuming.”

For all of these reasons, Keri now uses methadone, legally, instead of heroin. This works for her, and she feels fortunate to have thereby side-stepped the stigma and risk produced by misguided societal attitudes.

But she wants to emphasize that not everybody has that opportunity. “I recognize that a big part of how I’ve been able to exist like this is because I’m a white woman in the suburbs and have no police record. My privilege has meant that I’ve been able to be shielded from many injustices of the drug war.”

Keri Ballweber’s experience with drugs busts all manner of myths. She uses drugs, including illicit ones, responsibly. She does so despite having had a problematic relationship with drugs in the past—one that was significantly caused and exacerbated by societal attitudes, rather than the inherent properties of drugs. And she moved beyond that problematic relationship without entering or maintaining an abstinence-based recovery program.  

Aurora: Cocaine a Lifesaver, Though It’s No Fairytale

Aurora*, a transgender woman in her early 50s, has a complicated relationship with cocaine. “Cocaine simultaneously ruined and saved my life,” she told Filter.

Aurora says she went through childhood and adolescence constantly feeling that something was terribly wrong—she didn’t feel like or want to be a man. But growing up in the ‘70s and ‘80s in New York, gender identity was a taboo subject, and she was left without support.

“I was so depressed and confused and scared, and many times I was suicidal,” she told Filter. “I didn’t see any reason to live for such a long time and the older I got and the harder I tried to suppress my feelings—by expressing myself with a purpose to be the strongest opposite of anything feminine—the stronger my self-loathing and self-hatred and self-destructive behavior became. Then I discovered cocaine.”

Aurora says that cocaine helped her to remove the fear and inhibitions that kept her from accepting her authentic self. Discovering the drug in early adulthood was a boon.

Unfortunately, she then came to rely on the drug to produce those confident and positive experiences—so much that she became obsessed with cocaine, she says, and developed a problematic relationship with it.

The recovery-movement hegemony would at this point have urged that Aurora check herself into a treatment program and join a 12-step fellowship. But her basis for using cocaine—even obsessively—was complicated. Although she became enmeshed in the drug as a perceived solution to problems it could never solve, she still credits her use as a stepping-stone toward a healthier, positive self-image. “Even though cocaine nearly ended my life, it also became a new beginning.”

Gradually, Aurora found herself able to overcome the destructive side of her drug use on her own. Over the next few years, while she continued to use cocaine, she found herself no longer needing it in order to feel comfortable as herself. She started talk therapy and hormone therapy in order to address some issues and embrace her gender identity. She eventually decided to stop using cocaine. Then, last year, she had gender affirmation surgery.

Aurora therefore sees her drug use, despite some significant road-bumps, as a major factor in her self-actualization process. As she embraced her identity, helped by cocaine, she was able to develop other beneficial areas of her life, such as her skilled career and volunteer harm reduction work. And when she experienced those cocaine-related challenges, rather than joining a recovery program or surrendering to a higher power, she instead found a way to preserve the benefits of drug use while sorting out some unwanted consequences.

“I’m certain I would have taken my life had I not learned to love myself through cocaine.”

Aurora’s story is a real one, however, not a fairytale (unlike how recovery stories are often presented). Following her surgery, she experienced some life-threatening health complications. Those are now behind her, but she says she’s still struggling to adapt to the changes to her body. “I’ve actually felt less like a woman than I ever have,” she said, “and so I’ve recently found myself using [cocaine] again.”

Some recovery advocates would instantly pronounce, “relapse!” But Aurora doesn’t see it that way, and says that her obsessive past relationship with cocaine has not resurfaced. Recalling how cocaine previously helped her to become more confident and self-aware, she says it helps her now as well. “I haven’t had a single sexual thought or tingle since my surgery. I don’t feel giddy about my femininity anymore. But a big hit of freebase and I’m humming pretty well.”

Aurora now also enjoys a robust social network and employment that is meaningful to her—life benefits that she says largely remained dormant while she was struggling to resolve issues around her gender identity, but which now serve to protect her from addictive involvements.

It’s always possible that people’s relationships with drugs will produce negative experiences, but that’s a risk that Aurora feels she can assess realistically—after all, it’s something she’s dealt with in the past. Right now, she finds her cocaine use, once again, to be life-preserving. “I’m certain I would have taken my life had I not learned to love myself through cocaine.”

Aurora’s story, like Keri’s, reflects a level of nuance and personal agency rarely found in recovery narratives in mainstream media. Yet the developmental process at the heart of each story is at root typical, as epidemiological studies show.

While people’s life parabolas and chance encounters vary all over the map, most people outgrow addiction. They do so because of values, purpose, relationships, responsibilities and ideas about themselves that addiction does not remove. This is such welcome news. But it’s news that is habitually withheld from the public, continuing a deadly feedback loop.

The author and Stanton Peele conduct a weekly podcast, “Sundays with Stories,” where they highlight (with Dr. Carl Hart in one recent episode) stories that don’t replicate standard “Temperance Tales.” 

*Name changed to protect privacy.

Photo by Simon Launay on Unsplash

The post Most People With Addiction Outgrow It Naturally. We Need to Hear Them. appeared first on Filter.

In 2018, drug-related fatalities declined ever so slightly (the first dip since 1990). Yet drug fatalities remain unacceptably high, and have actually increased in some areas and populations.

I was a member of one such coalition in Burlington, Vermont in 2017. Its partners were politicians, police departments, schools and nonprofit organizations; its members were clinicians, teachers, parents and other community stakeholders. To my dismay, our regular meetings centered around the questions of, “How do we stop people from taking drugs?” and, “What will it take to convince people that they need treatment?”

Note that these questions smuggle in an assumption that cutting drug supply and swaying drug users to seek treatment will solve our problems. It is seemingly subtle assumptions like these that leave us spinning our wheels, limiting our ability to follow strategies that improve and sustain lives—perhaps making matters worse than they were originally.

Take, for example, the recent strategy of deploying “post-overdose response teams” (PORTs) to the homes of people who have overdosed. PORTs have been used in several states, including Pennsylvania, Illinois, Ohio, Vermont and most recently, North Carolina. They sound good and mean well, but are often associated with negative consequences for the people they’re meant to help.

Post-overdose response teams are groups of professionals—typically a social worker, an EMT, a peer-worker, and either a police officer or a firefighter—tasked with visiting overdose survivors at their homes once they’ve returned home from receiving medical care. The hope, according to SAMHSA,  is that this group of compassionate professionals will create an “opportunity to direct people to harm reduction services for active drug users and treatment/detox services for drug users looking to reduce or stop using.” It may sound reasonable, but the devil is in the details.

A surprise visit from a team of professionals, however well-intentioned, is not respectful or person-centered.

One problem is that it puts vulnerable overdose survivors further on the back foot. Visiting a patient at home without warning is a system of care unique to drug users. It tacitly suggests that the patient in question isn’t worth notifying ahead of time, that they’re better off being surprised.

Needless to say, surviving an overdose is already plenty to endure, with societal stigma often producing feelings of shame or embarrassment. A surprise visit from a team of professionals, however well-intentioned, is not respectful or person-centered. Many PORT team members I have spoken with admit that they don’t always receive a warm welcome.

Such problems are amplified by the involvement of law-enforcement officers, as harm reductionists and drug policy experts widely note. Maia Szalavitz, an addiction expert and author, told Filter that there is no reason for law enforcement “to be involved or present when people who have overdosed are followed up.” She added that “follow-up by social workers or qualified peer recovery specialists is fine and may help some—but police are not social workers or addiction experts, and people with addiction tend to have long, negative histories with law enforcement.”

This rings true to me. I nearly died after taking a toxic fentanyl/heroin mixture when I was still in my twenties. Luckily, after a 911 call, I was revived with the opioid overdose reversal drug naloxone.

The following day, a local police officer—obviously aware of the incident—called my home and left a message, asking me to visit the police station and speak with her. Then she followed-up with an email version of her request. I wished to decline but I felt vulnerable. Out of fear, I decided that it was in my best interest to speak to the officer.

But this wasn’t a check on my well-being. Instead, the officer lectured me: She told me that my (drug-taking) behavior was dangerous and that I was lucky to still be alive. Then she asked if I would be willing to turn in my drug dealer. I declined.

Diane, a harm reduction advocate from Illinois who asked that her last name not be used, has direct experience with police officers in the context of post-overdose response teams. Unfortunately, she’s had more than one encounter with these teams following her adult son’s drug-related emergencies.

“It felt like an invasion of my privacy. They asked me some questions that made me uncomfortable.”

Diane told Filter that she still remembers the awful feeling she experienced in her latest encounter with a post-overdose response team in 2019. It happened “three days after my son’s last overdose,” she said. “I heard a knock on my door and when I opened it there were two detectives standing there. I almost fell to my knees. In that split second I thought this was the knock I have been dreading for 15 years.”

She waited, painfully, to be told that her son had died.

“The detective realized what I was thinking and said that this was just a follow-up visit,” she continued. “It felt like an invasion of my privacy. They asked me some questions that made me uncomfortable, so I told them that they needed to talk to my son.”

The response team offered Diane’s son a few different options: to be placed in detox and/or to enroll in the nearest methadone clinic and outpatient treatment service; or to be assessed for immediate placement at an inpatient rehab.

But Diane and her son, whose experiences with such services have not always been positive, asked if there was anything more practical and accessible on offer. Diane, for example, asked if the officers could provide them with harm reduction supplies such as naloxone. The officer told her that the county didn’t have the resources to provide such things.

Diane believes that the response team meant well, but that their intervention was not worth the fear and trouble they put her and her son through. She doesn’t see how this process has anything to do with harm reduction.

“I pretty much shut down when they told me they weren’t providing Narcan to people,” she said. “Maybe there are people who appreciate these home visits and take advantage of what they offer, but I am not one of them.”

In fact, the most common reason people don’t seek medical attention for an overdose in the first place is because of fear of law enforcement. If a person associates their ability to access harm-reduction resources with the police, that’s an obvious barrier for many. 

Harm Reduction Versus Coercion  

It should be noted that although Diane’s response team did not offer harm reduction resources,  PORTs in most states do. But showing up at a person’s doorstep, unannounced and often with law enforcement present, is a uniquely intimidating way to deliver such resources.

James, a carpenter from North Carolina who asked that his last name not be used, recalls his own visit from a post-overdose response team, also in 2019. “I remember getting back home after my OD and just feeling utterly embarrassed,” he told Filter. “I was thinking, ‘Damn, I need to rethink what I’m putting in my body’ and I really wanted to do that thinking alone.”

But James’s independent self-reflection the day after his overdose was interrupted by a paramedic and a social worker knocking at his door. Thankfully, there was no police officer. However, “I didn’t want to see anyone really, but the last person I wanted to see was another paramedic,” said James. “They weren’t mean or anything like that, but the whole thing was pretty intrusive. They kept talking about treatment options but I just wanted them to go away. I didn’t need treatment; I needed time alone.”

The resources offered are tied to a set of assumptions about drugs and the people who use them.

“I kinda wonder,” he continued, “if I went to the hospital for any other condition, like a broken leg, would I be getting an unannounced visit to my home to tell me about my physical therapy options?”

The pressure inherent to these visits marks the distinction between harm reduction and coercion.

The stated aims of post-overdose response team programs similarly cross that line. The resources offered by PORTs—however helpful in themselves—are tied to a set of assumptions about drugs and the people who use them: that overdose survivors ought not be left alone; that they will require treatment; that if they won’t admit to needing treatment now, they will hopefully come around. A few examples:

* Vermont’s PORTs are designed “to persuade drug users to get help“

* A PORT in Pittsburgh hoped to “nudge overdose survivors toward treatment”

* PORTs  in Ohio want to be sure that they link patients to treatment, “which would prevent them from doing it again”

When NPR reported on PORT efforts in West Virginia, it titled the piece “Knocking on Doors to Get Opioid Overdose Survivors Into Treatment.” One of the PORT nurses reinforced NPR’s narrative when she told the interviewer, “It can take time to convince people who have overdosed that they need help.”

This treatment-driven mentality strips overdose survivors of their agency by failing to center what they want.

Drugs, Addiction and the Disease Model

If a person takes drugs, even if they’ve overdosed, it doesn’t necessarily follow that they are addicted. (Most are not.) If they are addicted, it doesn’t necessarily follow that treatment will be the best course of action. (Most people recover without treatment.)

PORTs—and drug task forces nationwide—are operating under the opposite assumption: that drug users require treatment to better their lives.

The current fentanyl-adulterated illicit drug landscape means that even people who use occasionally are at increased risk. In other words, many people who may be at risk of overdose are not people who will benefit from treatment services; they are people who will benefit from harm reduction services.

I once asked my fellow Filter contributor Stanton Peele, (whose Life Process Program I work for) to define harm reduction. I will forever remember his answer: “Harm reduction is helping people, non-judgmentally, to live their best lives—starting with surviving—no matter where they start, or what hole they’re currently in. Meanwhile, the helper wants to convey his or her confidence, without criticism, that this hole is not their permanent resting place.”

Harm reduction is also not primarily something that can be manufactured by authorities and deployed in a community from the top-down. Harm reduction is a bottom-up, organic process, instigated and primarily driven by impacted people.

Because if someone is suffering from a disease over which they have no control … then surely the compassionate thing to do is to treat them, whether they say they want it or not?

But the disease model of addiction—championed by the National Institute on Drug Abuse in its “brain disease” framing, but related in its implication of powerlessness to the 12-step ideology that has long been embedded in American culture—has led us down a different road altogether.

Our national acceptance of the disease theory directly harms people who use drugs by teaching us that we are powerless over some process in our brains (or souls)—a belief that becomes self-fulfilling.

And at a policy level, it provides the impetus (and funding) for interventions like PORTs that deny drug users agency. Because if someone is suffering from a disease over which they have no control—as opposed to engaging in chaotic drug use as a comprehensible response to their social and/or psychological circumstances—then surely the compassionate thing to do is to treat them, whether they say they want it or not?

As a result, the community-oriented strategies that receive federal funding ultimately serve an ideology rather than human beings.

Could a version of PORTs that truly entails harm reduction be imagined? Probably. But it would depend upon, and only operate according to, the wishes of impacted people. It would rule out law enforcement involvement and surprise visits. And ideally, it would operate within a framework that supports people in using drugs safely (and therefore legally) and addresses the suffering and inequalities that foster chaotic drug use.

Detail of photo by Staff Sgt. Nicholas Rau via US Air Force/Public Domain.

The post The Problems With Post-Overdose Response Teams appeared first on Filter.

The first-of-its-kind program, which offers methadone, buprenorphine and naltrexone among other services, is located in North Phoenix near I-17—an area where drug fatality rates are among the highest in the state.

CMS hoped that 24-hour availability in this strategic location would help reach people who need its services the most—people who may not have sought help otherwise. In addition to MAT, the site also offers counseling and community resources.

Setting it up wasn’t easy. Arizona drug laws are notoriously harsh and unyielding, and general attitudes toward people who use drugs are similar. Indeed, many community-members, politicians and local business-owners voiced opposition when rumors surfaced that the existing clinic would go 24/7.

I wondered what CMS has learned from its experience of operating a 24/7 clinic for over a year and a half, in a country where MAT access is typically restricted. And I wanted to know what, if anything, about the CMS model is worth replicating, as other agencies begin expanding hours nationwide (there is now also a 24-hour clinic in Tucson and one in Wisconsin). So I visited Phoenix to ask these questions and more.

Community Medical Services has been providing addiction treatment since 1983, when it opened a relatively small program, I learned at its headquarters in Scottsdale. It’s now the largest OTP (opioid treatment program, licensed to dispense methadone) in Arizona.

Having expanded rapidly, CMS is no longer exclusive to Arizona. The agency currently operates 32 OTP sites in nine states, said CEO Nick Savros, serving a current total of 10,600 clients. The large majority take methadone; a small minority—those who ask for it—take Vivitrol (naltrexone).  

While CMS primarily treats people with opioid use disorder, it takes the approach that drugs are only one part of a person’s addiction experience.

“It’s not about treating patients; it’s about treating the community—treating humanity,” Stavros told Filter. And he frames the idea to open a 24/7 clinic as a response to a community need.

Launching the 24-hour Program

CMS had been discussing going 24/7 even before it looked like a realistic possibility—it just seemed practical for many reasons. For one, it was clear that opening hours were a major barrier for some people.

“Construction workers work long hours, beginning early in the morning. Many are unable to get to a facility during normal hours.”

Tina Braham, CMS’s regional operations director, explained that many local people who wanted help with substance use issues were working long hours. Their availability just didn’t match the typical 9-to-5 window of most clinics.

“One example: There are many construction workers in our community looking for help,” Braham told Filter. “Construction workers in the area work long hours, beginning early in the morning. Many are unable to get to a facility during normal hours of operation without missing work.”

All-day availability also facilitates initiation. For some, the decision to seek help occurs spontaneously—perhaps in the middle of the night—and motivation may be fleeting. What if the only barrier to seeking MAT at a crucial moment is the fact that a clinic is closed?

This concept is more than just a thought experiment to John Koch*, the CMS community impact manager.

Koch began using opioids as a teenager, when he found that the drugs provided a sense of serenity. His opioid and heroin use became gradually more habitual. “They shut my big head down for a little while,” he said.

He became absorbed in destructive, cyclical behavior, and shut out other once-meaningful dimensions of his life: his family, his job, his health and his sense of purpose.  

“I let my family down, I didn’t graduate from high school, couldn’t hold a relationship,” he said. “I had done awful things to people. I wanted to forget about all of this for a little bit … heroin would do that for me.”

Late one night, just over five years ago, he was pulled over. He was sure he’d be taken to jail: The car he was driving was not his; he had an outstanding warrant; he was high; and there were 20 bags of heroin on the seat next to him, which he didn’t even bother to hide. Homeless at the time, he had been in and out of jail several times already. He had no support or meaningful human connection; jail, he said, was at least a community in which he could contextualize himself.

But the officer made an unlikely decision. Instead of arresting him, he handed him the phone number of a (non-MAT) treatment facility, whose intake operators were available 24 hours, seven days a week, and told him to ask for help.

That was the moment when Koch began to change his life. He said he doesn’t know what might have happened were it not for the around-the-clock accessibility of that program.  

CMS experienced its own transformative moment in September 2017, when the state of Arizona announced the allocation of funds from an OTP-access expansion grant made available under the federal 21st Century Cures Act.

The money was swiftly put to use. Going 24/7 didn’t require a new building; it was simply a question of extending hours and staffing at an existing location—CMS’s largest, which was already serving just under 1,000 people.

“CMS opened the 24-hour clinic in our northernmost location only 30 days after receiving funding,” said Braham. Over 6,000 people have come through its doors since, many of them accessing services after finding that insurance complications or long waiting lists were barriers elsewhere. “It’s been amazing; we’ve just seen lives change across the board.”

Help for People Who Are Homeless or Incarcerated

Beneficiaries have included some of the most marginalized people of all. A CMS street team works to engage people who are homeless, and in a county with around 26,000 unhoused people—at least 59 percent of Arizona’s homeless population—this is critical.

“We spend a lot of time talking about our ‘opioid epidemic,’ said Koch. “Well here in Arizona, we have a homelessness epidemic.” And of the many variables associated with long-term addiction to drugs, homelessness is the greatest contributor.  

People involved in the criminal justice system are another area of focus. CMS’s correctional health program, led by Marlayna Anderson, provides educational opportunities and resources to people who are incarcerated. It sends a peer support mentor to speak with incarcerated people about post-incarceration treatment options, working with jail staff to coordinate services including MAT (whether from CMS or another agency) from the moment of a person’s release.

This can be lifesaving for people who used heroin before going to jail and are likely to use again when released. Resumption of opioid use after enforced abstinence carries an increased risk of death due to lowered tolerance, and of course fentanyl is present in the heroin supply.

As Filter has reported, incarcerated people are scandalously underprovided with MAT across the US, with the CDC noting evidence that around 10 percent of opioid-involved overdose deaths are of people who were released from institutions in the month prior. MAT can provide stability, and even if patients return to using illicit opioids, they will do so having once again increased their tolerance.

“There is no ‘right way’ of treatment. They don’t need us to tell them what they can and can’t do.”

Employing peer support workers is an important way for CMS to foster personal connections for clients. Those I interviewed were notably practical, down-to-earth and passionate⁠—seeing their role as showing clients, through meaningful conversations, that they can be themselves without fear of judgement.

“There is no ‘right way’ of treatment,” said worker Anthony Dunkerly. “Everyone is going to have slips and falls in recovery. They don’t need us to tell them what they can and can’t do.”

“When clients come here, we tell them we are a harm reduction-based program,” said Jessika Miller, a supervisor at the 24-hour clinic. Yet she also explained that state laws make harm reduction difficult to pursue. For instance, fentanyl test strips are considered illegal “drug paraphernalia” under Arizona law, and syringe exchange programs are forbidden. The clinic is therefore limited in its ability to provide essential harm reduction services.

But that doesn’t stop it from thinking creatively. CMS works closely with Sonoran Prevention Works, a grassroots organization that provides harm reduction services, training and education in Maricopa County. The group is the brainchild of Haley Coles, a hero of Arizona harm reduction, who also operates an unsanctioned syringe program called Shot In The Dark.

These harm reduction programs regularly refer people to the 24-hour clinic if they want MAT. In turn, when the clinic’s clients seek harm reduction help that it is unable to provide, it will refer them to outside services like those Coles operates. The law creates many shortfalls, but the clinic strives to reduce risk in any way possible.

Being Good Neighbors

The program’s expansion sparked mixed emotions among locals. While many were intuitively supportive of the program’s objectives, Braham described “a lot of community pushback.”

Some concerns were practical, like complaints of traffic congestion and increased competition for parking after the influx of new clientele. Others included philosophical objections to MAT and harm-reduction—like the notion that MAT enables people to pursue their addictions legally. A few locals, including business-owners, have also expressed fears that crime, public disturbances and decreased property values may stem from inviting people with addictions to their area.

The clinic has been diligent about responding to these concerns—even those that are based in prejudice or completely unfounded.

CMS collaborated with the state to provide a 24-hour taxi service, covered by Medicaid, to and from the clinic to reduce traffic, and hired folks to direct traffic. It also hired off-duty police officers to reassure the community about public order—albeit this is an unsatisfactory concession to local opinion.

CMS employees also attend and host community forums, hoping to facilitate communication and find common ground when possible. When it’s not, they try to work through disagreements and solve problems collaboratively. Koch said that CMS takes criticism seriously and responds respectfully, taking feedback as an opportunity to learn about improving community involvement.

Although I was unable, for privacy reasons, to have on-the-record conversations with CMS clients when I toured the 24-hour facility, many of them find that positive community involvement is key to their journey.  

CMS clients engage, for example, at an independent living retirement community, where they tend a garden, prepare and serve meals to residents using the vegetables they’ve grown, and conduct arts and crafts activities. Clients are also involved in monthly “community cleanups,” picking up trash and syringes (most of which are not associated with CMS clients).  

Disease Concepts and Common-Sense Compassion

The work of the 24/7 clinic is overwhelmingly valuable, lifesaving and rooted in common sense and compassion. If I were to find fault, it would be with the theoretical basis of its approach.

“We are evangelists for practices grounded in science and evidence,” states one of the agency’s declared values. When I asked Nick Stavros, via email, whether science and evangelism can go hand-in-hand, he responded:

When I speak about evangelizing, it is definitely not in a religious sense but is indeed in an effort to gain converts to a few simple points:

*Addiction is a disease, not a moral failing and the stigma associated with addiction being a moral failing is what keeps people from getting into treatment and also prevents treatment from expanding to keep up with the growing need;

*Thus, to succeed in eliminating the consequence of SUD in our communities (that’s CMS’ vision statement) we need to treat addiction from a place of compassion, not from a punitive perspective;

*And, in spite of all of the doom and gloom we hear about the opioid crisis, there is hope in the fact that we have a highly effective modality of treatment that works for 92% of the population.

Of course, Stavros is coming from a place of caring about people who use drugs in a state where negative judgements against them are pervasive. He also has plenty of support in his views: NIDA, the organization that funds 90 percent of America’s drug research, defines addiction as a “chronic brain disease,” emphasizing that drugs cause long-lasting brain changes that embed addiction for the individual.

“Anyone who remembers what Maricopa County was like under the jurisdiction of Sheriff Joe Arpaio should marvel at how productive CMS has been.” 

This is where I personally pause. My own work as a counselor is non-labeling, and oriented around skills and values. My own journey of recovery from heroin addiction reflected the expansion of other areas of my life through building skills and relationships.

While I certainly agree that addiction is not a moral failing, I do not agree that it is a disease. This distinction matters—even when you’re engaged in providing life-preserving MAT, as I have argued in Filter—because a disease/”addict” identity can become self-fulfilling, holding people back from positive life transformations and exposing them to further risk.

Addiction is far better conceived, I believe, as a relationship that people form—to drugs or to something else—which they rely on to provide experiences they can’t achieve on their own. A relationship which, given normal developmental opportunities and improved life circumstances, most people will grow beyond. The non-judgemental attitudes of the CMS peer support workers I spoke with allowed for this.

None of this is in any way to disparage or deny the fundamentally valuable work of CMS. Anyone who remembers what Maricopa County was like under the jurisdiction of Sheriff Joe Arpaio should marvel at how productive Nick Stavros, CMS and its compassionate, intelligent and industrious staff members have been in so little time.

The 24/7 clinic is special in many ways. The staff here believe in their clients; they believe in human beings. They treat them as people who deserve dignity and respect, who are worth helping—and going out of their way to help, as 24/7 availability reflects. This practical, common-sense compassion is what’s worth evangelizing for.

*Zach Rhoads’ full interview with John Koch will feature in an episode of The Social Exchcange Podcast.

Photo by Chuttersnap on Unsplash

The post What Can We Learn From the Nation’s First 24/7 Methadone Clinic? appeared first on Filter.

This is not to downplay the many daunting threats, injustices and stressors we face. Sociopolitical strife has always been been part of human history, but many current political situations are extremely fraught and many egregious inequalities persist. By some long-term measures, equality is improving, but if so, it’s happening far too slowly. And while technology has helped generate equality on a global scale, it may ultimately widen the class gap.

One thing that’s clear: Despite people worldwide becoming more comfortable materially, they are no happier. (In fact, some evidence suggests that humans in richer countries are more depressed than those in poorer ones.) One could infer that people are even less happy than in times past, when subsistence living was the norm. This premise is supported by rising rates—both worldwide and in the US—of depression, anxiety and suicide.

What accounts for this?

British journalist and author Johann Hari investigated this question in his best-selling book Lost Connections (Bloomsbury, 2018). He believes that cultural disconnect is to blame for a pervasive drift toward depression in the West. He insists that our modern understanding of depression is short-sighted. If we are to deal with depression and anxiety in a practical way, he argues, our methods of treatment are in need of a 21st-century upgrade.

In Lost Connections, Hari writes that we’ve become overly reliant on a biological explanation of the causes of depression—that depression is primarily a brain imbalance people are born with, to be treated with chemical antidepressants. As a result, he considers, many are left with an incomplete story about their distress; and these people are not accessing—nor are they even aware of—the best help available.

Photo via Johann Hari’s website

A Personal Tale

The book begins by describing Hari’s own struggles with depression. He recounts the story his doctor offered him about why he was depressed—and then the moment he realized the doctor’s story was incomplete.

“Being given a story for your pain is a tremendous relief.”

“When I went to the doctor as a teenager, I told him I had this feeling; sort of like pain was leaking out of me, and I couldn’t regulate it, and I didn’t know what to do,” Hari related in an interview for my podcast. “He told me a story: ‘There is a chemical called serotonin that makes people feel good. Some people are naturally lacking that chemical; you’re clearly one of them. I’m going to give you these drugs and you’re going to feel normal again.’”

“I felt a tremendous amount of relief and joy when I was told that, because being given a story for your pain is a tremendous relief, especially if it has a solution.”

Hari began taking the antidepressants his doctor prescribed. He felt significantly better for a few months, but then the depression resurfaced. He returned to the doctor, who prescribed him a higher dose of the same medication. This pattern continued until eventually his pain out-competed the drug’s maximum dose. Depression followed him into adulthood.  

Challenging the Narrative

Hari had no reason to distrust his doctor; prescribing chemical antidepressants for depression was standard medical practice. Still, he wondered why—insofar as his common medical illness was being treated with commonplace medicine—he was still so depressed. Was there something uniquely broken about him?

He discovered years later that this tedious experience was actually quite common. “Far from being freakish, my experience was absolutely the standard experience of [people on] chemical antidepressants. Between 65–80 percent of people—depending on which study you look at—on chemical antidepressants are depressed again within a year.”

Hari suspected that depression and anxiety had causes and solutions beyond the scope of medical practice, and decided to investigate.

And more people are taking antidepressants today than ever before. “In fact,” Hari told me, “one in five Americans is taking a psychiatric drug; one in three women is taking a chemical antidepressant; one in eleven people around you are on chemical antidepressants at any given time.” Hari recalled, “It seemed to me it could not be that just all of us, individually, were having our brain chemistries gone awry, mysteriously, at the same time.”

His suspicions are well founded. Increased prescribing does not seem to have curbed population-level mental health problems in this country. An estimated 15.5 million Americans have been taking antidepressants for over five years, a number that has tripled since the year 2000). Yet, a recent CDC report reveals, “The US suicide rate increased 25 percent from 1999 to 2016, even though the rates of psychiatric diagnosis and treatment also greatly increased.” Why hasn’t expansion of treatment made a dent in suicide trends?

To be clear, neither Hari’s book nor this article argue against use of antidepressants—many of which are reliably demonstrated to be helpful, and do help many struggling people. The thrust, instead, is that we also need to adopt a far more holistic view of depression and try to change our society accordingly.

Hari suspected that depression and anxiety had causes and solutions beyond the scope of medical practice, and decided to investigate. He traveled 40,000 miles around the world in an effort to better understand the causes of depression. He met people in many different communities and cultures along the way: people living with depression; people who have overcome depression; and many of the world’s researchers in the field. Hari elegantly communicates his encounters and his research in the remaining pages of Lost Connections.

The Real Causes of Depression

Hari concluded that, rather than having primarily biological causes and solutions, depression is largely related to the way we live. It’s psychological, social, political and woven into the fabric of culture. Moreover, people’s innate psychological needs are decreasingly being met by our culture, which accounts for higher rates of depression.

In Lost Connections, he lists nine primary causes of depression, emphasizing the ways in which people have become “disconnected.” He spoke with me about a few of them.

“For example if you are disconnected from other people—if you’re profoundly lonely—there is evidence that’s one of the big drivers of depression around us. If you feel your work is meaningless, there’s a lot of evidence that will make you depressed and anxious in a lot of cases.”

“We need to feel we belong to a group; we need to feel we have a stable future; we need to feel that we are valued; we need to feel we have meaning and purpose in our lives.”

“Everyone knows human beings have natural physical needs,” he added. “Well, there’s equally good evidence that we have innate psychological needs. We need to feel we belong to a group; we need to feel we have a stable future; we need to feel that we are valued; we need to feel we have meaning and purpose in our lives.”  

This is consistent with wider evidence of distress in the US and around the world. The US Rust Belt serves as an example. This area was once rich with manufacturing work. But the collapse of the steel industry has left many in the region unemployed, in poverty, or—if slightly luckier—forced to pursue tedious work to make ends meet. There are considerable rates of depression in these areas. One could also assert that there are likely many non-diagnosed people who are feeling isolated, disconnected, and hopeless. These people, and others in similar socioeconomic brackets in many places, are in dire need of support.

But it doesn’t stop there. Even the financially secure are less happy than in times past. One reason is that people are less engaged in their work than ever, perhaps due to monotonous work days over which they have little control.

This may seem strange on the surface when people work fewer hours worldwide than previously. But it turns out, per Hari’s research (and that of many others), human needs go far beyond comfort. Satisfying these needs is to a large extent about feeling in control of one’s life.

“We’ve collectively told a story that encourages people to look overwhelmingly to brain-chemicals to explain their pain,” Hari told Filter, “while society crumbles beneath their feet, while people become much lonelier, while they’re made far more financially insecure, while they are taught life is all about spending and showing off, while they are ever more controlled and humiliated at work, while their sense of a stable future is stripped from them. We have not explained to people that these factors (and others) are major causes of depression—that they are, in fact, the key reasons why it is rising—and that there are solutions to these problems we can pursue together.”

It’s also likely that unfettered access to information, quick pleasure and convenience, while comforting us in the short-term, contribute to increased distress population-wide. For instance, most of us now live our lives through technology. Texting and social media have replaced more active and personal ways of interacting on a regular basis.

This has been a boon for our culture in some ways, as most of us are communicating with more people more often. But we often confuse this passive and fleeting form of communication with meaningful interaction with those we care for most. In effect, many of us have become estranged from the experiences and rewards of community values.

“Depression is a signal to people—a signal that their psychological needs are going unmet.”

It is not revolutionary to say that these circumstances—and the others listed in Lost Connections—contribute to increasing rates of depression and anxiety. Hari cops to that, calling his analysis both “radical and shockingly banal.”

Yet these phenomena are often deemphasized in favor of medical heuristics. Indeed, many of the organizations tasked with advising about mental health problems merely insist that we broaden access to chemical antidepressants.

While supporting unfettered access to antidepressants, Hari also worries that their dominance as a response to depression may affect people, on a population level, in the same way his own doctor’s conclusion affected him as a teenager, when he believed his depression was driven by abstract brain mechanisms over which he had no control.

“When in fact,” he explained, “depression is a signal to people—a signal that their psychological needs are going unmet.” He added, “What my doctor should have told me was not, ‘you’re a machine with broken parts’, but rather, ‘you’re a human being with unmet needs.’”

Unexpected Solutions

In the final section of Lost Connections, Hari chronicles a variety of successful approaches offered by the experts he interviewed, such as the psychiatrist Dr. Derek Summerfield, and demonstrated by communities he visited.

Hari tells one story about a Cambodian rice farmer who stepped on a landmine and lost his leg. His doctors gave him an artificial limb and he returned to his work. But it was painful for him to walk through flooded fields all day, and he no longer felt in control of his work and became depressed.

The man told his doctors of his physical pain and depression. They listened carefully. They understood that farming was his livelihood and that he was having difficulty engaging positively with his work; he needed a compromise. The doctors bought the man a cow and suggested he use his existing skills, resources and environment to become a dairy farmer instead. That way, he could still be a farmer but wouldn’t have to walk through the fields. After a few weeks with the cow, his depression went away.

Hari lists nine solutions to problems of cultural disconnection, all involving social and cultural reconnection. Reconnection with the mansions of life (like values, purpose, meaningful work); with each other (family, friends and the community) features extensively; as does our relationship with (and hopes for) the future.

Hari calls for a shift in our cultural mindset, reminding us that depression is a response to life experience which cannot be fully summarized by a mechanistic medical model. Hari is often criticized for blaming doctors for high rates of depression. Quite the contrary: He is urging us to stop leaning on medical professionals to do so much of the heavy lifting.

Hari believes that we should broaden the meaning of ‘antidepressant’ from chemical antidepressant to anything that makes people less depressed and anxious.

Hari acknowledges that chemical antidepressants are valuable tools that should be available to all who want them. “For something as devastating as depression—the worst thing I have ever been through—we need every strategy and tool on the table.”

There is a further key point. Hari believes that we should broaden the meaning of “antidepressant” from chemical antidepressant (FDA-approved medicines) to anything that makes people less depressed and anxious.

In the story about the Cambodian farmer, the doctors did prescribe an antidepressant to the farmer; they considered the cow an antidepressant in and of itself. They knew intuitively that the way to help the farmer become less depressed was to help him regain control of his life and reconnect with meaningful work.

Chemical antidepressants are a marvel of the new age. As is the case with all drugs, we need to strike a balance between using them to their full benefits versus over-relying on them. Hari notes on his book’s website, “If you feel helped by them, and the positives outweigh the side effects, you carry on. Some of the people I love most take chemical antidepressants, and I have never once urged them to stop.”  

As Filter contributor Stanton Peele and I wrote in our forthcoming book, Outgrowing Addiction, “Overarching everything in America is the loss of intimacy and community, a lack of connection to the world around us, and often a loss of connection to our own selves.” Drugs, alone, will not solve these human problems. Minimizing depression and anxiety will ultimately entail accessing the values, resources and communities needed to create a productive future.

Johann Hari encourages such solutions in Lost Connections. Following his suggestions may just help to bring stability to the most disadvantaged among us, and a purposeful future to all of us who have lost our way.

Main photo by Randy Jacob on Unsplash

The post Johann Hari’s Journey of Discovery About Depression appeared first on Filter.

Except in one regard: Much of the press and official response has glossed over critical elements that make Safe Recovery so precious, and instead used the move to promote an unhelpful way of viewing addiction.

“Recognize addiction as a chronic disease,” urged Burlington Police Chief Brandon del Pozo in a viral Facebook post that made many excellent suggestions, but also called on doctors to “Return the opioid prescribing rate to pre-epidemic levels.”

“Over the past few years, Vermont has built a “hub and spoke” system that has integrated addiction treatment into the broader health care system,” noted a Vox article. “… Things are much better now, [Safe Recovery’s Grace] Keller said, but Vermont’s work is far from done. Case in point: John Brooklyn, one of the architects of Vermont’s hub and spoke system, estimated that around 35 to 40 percent of people in the state who need care for an opioid use disorder have gotten into treatment. That leaves more than half without care they need.”

“With thousands of people now enrolled in Vermont’s “hub and spoke” program for opioid addiction, officials are increasingly focusing attention and resources on the thousands who aren’t,” announced the Vermont Digger. “A new $525,000 federal grant will allow a key opioid-dependence program–Burlington-based Safe Recovery–to directly help that ‘harder-to-reach’ population.” Which is great—except for the implication that Safe Recovery’s other services were not already providing invaluable help.

Such announcements emphasized—some subtly, others less so—a prioritization of narrowly medicalized responses to risky drug use over the broader continuum of harm reduction already exhibited by Safe Recovery.

What Safe Recovery Was Already Doing So Well

Safe Recovery (SR) has been a boon for Vermont’s public health since it opened in 2001. It operates from the purest harm reduction principles. Its doors are open to anyone. It preserves and improves life—including reducing overdose and HIV and hepatitis C transmissions—by providing clean drug injection equipment, medical assistance and naloxone. But it doesn’t stop there.

SR also offers information about available addiction services and makes referrals on request. It refers people in need to housing support and provides assistance with insurance and legal problems, too. Just as critically, SR provides friendly, non-judgmental people to talk to.

In short, Safe Recovery is special because its interventions are grounded in treating people whose drug use may be chaotic and harmful like important human beings with meaningful lives.

Last year, lawmakers—led by Vermont’s State’s Attorney Sarah George—proposed opening a safer consumption space (SCS) in Burlington. A survey indicated that 90 percent of SR’s current clients would utilize one. So Safe Recovery made itself (unofficially) available to host the program in its building. However, the proposal was sadly rejected by the Vermont Senate.

Then this summer, the Burlington City Council introduced an SCS measure. This measure was shelved “until the city council affirmatively votes to do so” (that’s a no), but the council voted 9-3 to promote Suboxone treatment, to be provided by Safe Recovery.

I absolutely support Suboxone access. Studies show that long-term methadone and buprenorphine use has cut mortality in some populations by half or more for people with opioid use disorders. At the same time, the widespread portrayal of SR’s new role carries serious negatives.

Of course, speaking equivocally about any aspect of Suboxone provision is liable to be challenged, and I’ll need to explain myself. So let me contextualize my perspective—as a specialist who works with struggling students and their families, as well as adults with addiction.

Vermont’s Mixed Picture

Vermont is home to many programs that provide strong social and community support. But despite our best intentions, we Vermonters can’t get a handle on our most serious problems. In schools, where I work, clinical diagnoses like depression and anxiety are rising. Meanwhile, drug poisonings and fatalities in Vermont remain at record high levels (the number of overall drug fatalities dropped slightly from 2016 to 2017, while rates of have increased in Chittenden County, where SR is located). Why is that?

One part of the answer is that Vermont policy-makers—and most Americans—believe in the disease model of addiction (i.e., that addiction is a chronic, relapsing brain disease). Different versions of the disease model posit that people with addictions must receive special kinds of help—either spiritual, or medical and biochemical. Many of Vermont’s newer policies are largely medical approaches, with an over-assumption that medical solutions are total.

In reality, when a therapeutic setting is helpful, it is nearly always the case that we see basic elements of social support, access to care and community in the setting, with encouragement and opportunities for people to expand their visions of themselves and their life options. There is nothing magical, medical, or out-of-the-ordinary in this—and that should be a source of incredible optimism.

The disease model on which many programs are founded fails to produce desired real-world results. The low success rate of Alcoholics Anonymous is the classic example when we take the spiritual version of the disease model.

Pain pill restriction policies cause unintended harms.

As for the medical/biochemical version, one of Vermont’s policies, aimed at curbing opioid addiction, has been the regulation of pain pill prescriptions—as advocated by Police Chief Brandon del Pozo. The idea that this solution would save lives hinges on the assumption that opioids are inherently addictive. Therefore, fewer drugs will lead to less drug use and fewer addictions.

This may seem logical. But this policy is not working. While national opioid prescribing rates have dramatically decreased since 2010, drug-involved deaths have dramatically increased.

Pain pill restriction policies cause unintended harms. Many chronic pain patients, taking their drugs as prescribed for pain, are now denied access to their medications and suffer with more severe pain than ever. Tragically, some of these patients have ended their lives: either accidentally, after seeking unreliable illicit drugs to replace their prescribed ones; or intentionally, out of despair. Limiting pain prescriptions remains popular in Vermont and throughout the country.

An alternative approach is exemplified by the Chittenden Clinic, which offers methadone and Suboxone, along with therapy and community resources, and is Vermont’s most famous program taking on addiction-related problems (I should disclose that my wife is a clinician there).

I support offering people these drugs, as I’ve said. I know that first, drugs themselves don’t make people addicted, and second, if people crave and seek opioids, it is safer to make them accessible in regulated forms. Many of the clinic’s clients and former clients credit the program and its clinicians for helping them stay alive and on the positive side of life’s balancing act.

The Chittenden Clinic saves lives, not only because it prescribes drugs, but because the clinic’s staff are trained to circumvent clients’ life-problems, including but not limited to addiction.

Harms of the Disease Model

Medications like Suboxone and methadone are effective at keeping people alive. Self-evidently, that’s hugely important. What they don’t do, on their own, is solve the life issues that clients face—we also need life-centered, human interventions to be available to help do that. And we shouldn’t allow our justified support for access to medications to obscure that.  

In addition to its negative influence on policies, the disease model carries direct dangers for people who believe in it.

One national illustration of this is that large cities—the areas where MAT is most readily available, are now showing the biggest surge in drug-related deaths, usually from heroin mixtures. That’s not an argument to reduce MAT provision in those places; it is an argument to add more of other kinds of care.

In addition to its negative influence on policies—like Vermont’s pain pill restrictions, or our nation’s perseverance with harshly punitive drug policies, often justified by the supposition that addictiveness is an inherent quality of certain drugs—the disease model carries direct dangers for people who believe in it.

Safe Recovery’s holistic harm reduction values are timeless. Their attention to the everchanging struggles and needs of deprived community members, and their indifference to single addiction models, has long served as a bulwark against failed assumptions and interventions.

While policy makers, public figures, and experts are constantly chasing the next revolutionary addiction “solution,” Safe Recovery is well poised to provide whatever assistance people need. On-the-spot Suboxone is the latest element of that.

A reasonable person could point out—and believe me, I argued with myself in circles about this—that if you agree the drugs ought to be available, who cares why they’re available? Isn’t it the same outcome? Isn’t this just theoretical quibbling?

But I don’t think it is. In addition to its negative influence on policies—like Vermont’s pain pill restrictions, or our nation’s perseverance with harshly punitive drug policies, often justified by the supposition that addictiveness is an inherent quality of certain drugs—the disease model carries direct dangers for people who believe in it.

One famous study, for example, (focused on alcohol) pointed to two factors as “optimally predictive” of relapse: “lack of coping skills and belief in the disease model.” In other words, the innate pessimism of the disease model is self-fulfilling.

In contrast, the services provided so admirably by places like Safe Recovery and the Chittenden Clinic can help people to develop both coping skills and self-empowerment. Safe Recovery’s value and potential is far greater than they have sometimes been credited for. People deserve to know the whole story.

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Photo via Wikimedia Commons

The post Let’s Support MAT Without Propping Up the Disease Model of Addiction appeared first on Filter.