The Challenge of Addiction Treatment Today

 What help really works for hard core drug abusers? 

By DAVID KERR

Maia Szalavitz[1] is a thoughtful, respected and long-time writer in the field of addiction and I support most of her 8 points as listed below and seen in her article in the Huffington Post; “The Rehab Industry Needs to Clean Up Its Act. Here's How.” Here’s the link:
CLICK HERE. 

Though I disagree (in blue below) with some of her points, she presents a concise summary of what she sees needing to change in our field and she knows from her own personal history using heroin and cocaine.  Here is part of what she has to say:

“I have covered addiction as a journalist for nearly three decades, and also have my own history of heroin and cocaine addiction, and of receiving treatment. With the input of longtime leaders in and critics of the field, here are my views on what needs to change.

1. Remove 12-step-related content from treatment — or at least, stop charging for it

2. Ensure access to maintenance treatment for opioid addiction

3. Fight corruption and unethical practices

4. End the reliance on criminal justice system referrals

5. End humiliation and confrontation

6. De-emphasize residential treatment

7. Create truly independent accrediting bodies that are consumer-friendly—and national standards of care

8. Expand harm reduction”

I have a problem with three of her eight points but she missed a major point as described below.  Also I would add to her eighth point: “Expand all treatment.”

I disagree with her points #1, #4 and #6.

 #1.  The AA 12 step approach is a marvelous group process where recovering substance abusers are accepted by their peers, finding a mentor and/or coach who guides the new candidate for years through the process of recovery.  Why would we want to end a process that has clearly helped many addicts for years and years?

#4.  I don’t think that treatment programs in New Jersey, for example, rely on criminal justice referrals.  Rather they see the desperate need of those addicts caught in the criminal justice system who need treatment rather than incarceration.  According to the Human Rights Watchreport, 10-17-16, “ every 25 seconds someone in America is arrested for possessing drugs for personal use.”

To make matters worse, many of those failing to meet bail requirements are incarcerated since treatment beds are usually full with a waiting list.

What’s the alternative?  Recovery help and treatment must be available to all people in all cultures.  Should we just bypass the treatment of addicts whose disease causes illegal drug use and associated crime?  In New Jersey, residential treatment programs have contracts with Corrections and Parole and they are showing positive results over years with the legally supervised treatment and follow up support of hard core criminal addicts.  Many studies have shown that this treatment enhances the likelihood of continued recovery with fewer relapses over time.  It makes no sense to arrest and incarcerate but provide no treatment to some addicts just because of their background and previous record while offering treatment for the same crime to others with little or no criminal record.  Many of these “others” are those who are part of the growing heroin epidemic in the suburbs.  Punish some and help others based on their skin color, criminal background and/or lack of bail money?  Not the right direction.

#6. Residential treatment is part of the continuum of help for many if not most hard core addicts.  Very, few of the thousands of addicts I’ve known could ever begin to put their life back together without removing themselves from the temptations of “the streets” and their neighborhood i.e. “the hood”. 

Here is an alternative model for Treatment and Recovery, call it the

Long Term Continuing Care Recovery Model

Help and caring for hardcore long-term addicts must be long-term (years.)  Also, the life supporting connections between treatment and the community neighborhoods to which recovering addicts re-enter after treatment, must be strengthened. 

The full recovery model of help for hard core criminal addicts often looks like this:  The detoxification phase followed by the residential phase followed by the reentry phase {followed sometimes by the out-patient phase} and then the most critical, the follow up coaching phase.  These are all part of the essential many year recovery continuum of care for hard core addicts.  I emphasize the word “caring” in this continuum. 

One of the most effective ways to measure quality in a program is to notice the level of concern and caring shown by all staff, not just counselors.  Assuring a caring staff must be the first step to assuring a quality staff and a quality program.  The best measure of a caring staff often comes from comments by the residents.[2]

The reentry phase of this continuum can be very challenging and it is not always the recovering person’s fault.  If we think of the cause of addiction as much from an addiction seeking culture as from a disease, we can begin to understand how difficult it can be to help people who must return after treatment to their home environment that is loaded with temptation.  Yes I know and believe the studies supported by Nora Volkow, NIDA, demonstrating that addiction is a brain disease.[3]  However, I attribute the present day growing problem of heroin addiction in the suburbs more from copy-cat and cultural behavior rather than so many people suddenly developing a “disease.”  AA talks about changing “people, places and things,” to stay clean and sober but this is often not possible in a drug seeking culture and as a result, addiction spreads.  Today, if you want to help and coach an addict towards recovery sometimes your most formidable enemy is our present day growing feeling that “heroin is ok.”  Some are saying under their breath; “yeah right, now that white people are using heroin, it’s ok;” and this has a ring of truth to it.

Peer support is often critical for hardcore criminal addict recovery

I founded a TC in Newark in 1968 called Integrity House. I retired from this work in March, 2012.  The TC concept has come a long way since the early 1960's.  We recognize the impact of the recovering peer, clean and sober for years, as a role model for change in our residential and out-patient programs.  We recognize the need for changing our system of care from long-term residential help to long-term support and coaching so that self-realization and the new drug free lifestyle has a chance to become internalized and practiced over years.  I have not found much long-term recovery success for hard core criminal "lifestyle addicts" without years of interaction with positive peers, and without support and coaching[4].

That said, most hardcore criminal addicts that I have worked with need to start and become part of a culture of safe, clean and sober living in a residential setting.  Each participant has a role in helping him/herself and others while learning, practicing and finally internalizing a new positive and ethical lifestyle. In my experience, the Therapeutic Community is the most effective tool, demonstrating a positive culture of right living for many months in treatment and for years thereafter following the long-term recovery continuum model.  

I have found that they must give help to others to get the full measure of help for themselves. 

A properly functioning TC must be sensitive to others needs and wants and what will help and what will hurt.  I've found that those addicts I have worked with over the years need a combination of understanding, love and straight honest talk and finally the role modeling of others like them, clean and sober for many years.  What I didn't expect to find, as I began to know them in the mid-1960’s, was a deep understanding of their own motives and behavior to help themselves as well as their strong need for help and guidance from others in long-term recovery. Finally I have found that they must give help to others to get the full measure of help for themselves.  Addicts in recovery for years make some of the best counselors I’ve ever met and this is with or without a degree! 

Let’s not mandate a degree since the bi-product may be to eliminate the recovering peer from our system of treatment.[5]

My experience supports the idea that a durable recovery is best insured by a counselor and/or peer who can feel a deep understanding and sincere sense of love and caring for others.  I have seen that recovering addicts who attain a degree are seen as role models to others in recovery!  On the other hand, I have found that the most effective people to inspire change are often former addict role models with a strong history of recovery, with or without a degree.

Growing addiction in the mainstream society is setting a bad example for our children

It is difficult today to help someone in a residential or outpatient treatment program to pursue a lasting recovery, when they leave treatment to return to our present drug consuming culture.  Addiction today is part of our culture whether it be from middle class in more affluent suburbs or ghetto pockets in the inner-city. If we want to make a serious impact on this personal and cultural malaise, we have to look at our own addictive behaviors and negative role modeling!  It's what we as parents do that is having a noticeable impact on the behavior of our children.  Growing addiction in mainstream society is setting a bad example for our children.  As a result, many have fallen into the deep hole that takes “adolescent recreational use and abuse” down the path of lifetime addiction.

Let's work together and with the media to develop more effective prevention plans that will be part of our culture and that will help our children grow up healthy.  These plans must start with changing our own habits and negative role modeling and personal substance abuse that will be mimicked by our children!

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 [1] Maia Szalavitz is a columnist for The Influence. She has written for Time, The New York Times, Scientific American Mind, the Washington Post and many other publications.

[2] Be careful though not to base staff evaluations on resident comments!

[3]  http://www.memoirsofanaddictedbrain.com/connect/nora-volkow-the-disease-model-and-moi/

 [4] While I never used drugs, I lived with active addicts in Newark while starting Integrity House and learned much from what they said and how they lived.

[5] Most addicts in recovery owe fines and are just beginning a stable life in the workforce.  They will not be able to afford to pay for a degree for years if not decades!