The vital missing parts of drug treatment

via Obama Administration Offers Desperately Needed Help For People Addicted To Opioids

When I grew up in the 80s, drugs were no less than a demon scourge come to take your soul away if you so much as got a contact high. Nancy Reagan went a long way to make a lot of people really miserable. But the guiding philosophy on drug abuse was that it’s  up to you to kick it’s ass – anything less than total sobriety is a moral failure on your part. You didn’t try hard enough. The AA Big Book famously states

“Our description of the alcoholic . . . makes clear three pertinent ideas. . . (b) That probably no human power could have relieved our alcoholism.”

-AA Big Book, pg. 60 (right after the 12 steps)

confession-of-an-alcoholic-mom
It also has one chapter called “Women Suffer Too”

It goes on to say that the only way to recover from alcohol addiction is through a spiritual awakening. Presumably, you come to realize you are a terrible sinner and it magically cures toxic shame, trauma, and mental illness. But heroin is the end boss of addictions. It directly rewires the reward centers of the brain and can condition a sufferer’s mind to obsess over everything about the habit (including the gross parts). It turns lovely, brilliant people into cringing thieves, serial liars, and corpses. I’ve seen it first hand and I’ve had terrible run-ins with opiate addicts. Never, ever take one in out of pity if you value your valuables.

pawnshop
You can buy them back cheap though.

I’ve also been to court ordered rehab myself. I was there for booze issues, and I know I didn’t envy all the women who came in addicted to needles and pills. They were quickly put on suboxone and just as quickly weaned off of it. They seemed fine, but most relapsed when returned to the compromising living situations they wanted to escape.

Obama is trying to get money to states for MAT, or medically assisted treatment, for opiate addicts. Almost all treatment facilities use faith-based methods and 12-step principles (which are also faith-based). However, there is zero evidence that these programs are any more effective than trying to quit on your own. Medication is changing the way heroin addicts are treated though. Suboxone is a maintenance opiate that prevents dope-sickness and can be controlled to wean the brain off of the changes in dopamine production that make getting clean so vexing and, frequently, otherwise impossible.

And there were a lot of sufferers, especially among the women I encountered. In fact there was a triad of opiates, alcohol, and eating disorders I kept noticing. All of us had problems with at least two. I’m sure it bears better investigation. Anyway, I’ve been sober for three years and dealing with the criminal justice system and state rehab was the hardest thing I’ve ever done. Staying sober has been a breeze, by comparison.

A female addict’s real problems are seldom addressed.

One class we had in rehab was a revelation to me. It was oddly called “gender,” just “gender” class and it means the men and the women (insultingly labeled by staff as males and females like we are on in a Mutual of Omaha special and not adult humans) were split up to discuss our unique issues. I figured out it was especially important for the ladies to go into a safe place to discuss aspects of our addictions, and what they’d done to us and made us do, that we would hardly bring up in court-ordered mixed company. Once the floodgates open in a counseling environment where problems related to relationships with men, LBTQ struggles, and our difficulties in society can be explored, it is apparent that any one of us would naturally turn to chemical solutions to deal with what we had survived. Experiences such as domestic violence, sexual abuse in childhood and adulthood, work discrimination, heart-breaking childcare challenges, the effects of rape and rape culture, neglect, financial morasses, and our submerged status start to tumble out.

By the end of the short class (which usually went on long after the men were done) I knew that more of this type of consciousness raising was absolutely a seldom-used tool for getting to the underlying trauma and powerlessness that leads women (and many men) to relapse. A female addict’s real problems are seldom addressed. 12-step programs focus overly on how relapse and the initial drug experimentation that led to addiction are our fault. It is clear that most of these women were not receiving the kind of educational awakening and support services that would profoundly improve their chances of staying clean and avoiding more contact with the criminal justice system.

The focus typical of modern treatment programs is on “triggers” and how to deal with them. But quickly one realizes in the program that life is a trigger and the majority of women there will not be able to escape the “people, places, and things” that remind them of using. What they really couldn’t escape were the life circumstances that led to addiction in the first place. They would be returning their small towns with no employment opportunities or community centers, their abusive domestic situations, their untreated (unacknowledged) traumas, their grief over the custodial loss of their children, and their very poor financial prospects.

I hope that we can come to see addiction and relapse also as failings of society. I hope we can change treatment to include medications for addiction maintenance and mental health problems. I hope we can tell women that life isn’t always hard because they are failures. It’s because life is hard for a lot of women and not enough, not nearly enough, is being done to improve their circumstances.

Author: scidoll5000

Female genius and American essayist.

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