We need “recovery” as part of a holistic approach to substance use health issues, mental health and other social determinants of health. In other words, there is much going on today that we have to recover from. I’ve never nor will I dispute that. What we need is to redefine recovery as it is currently being touted to the public by certain government parties and disappointingly through far too many “treatment” facilities.
I am particularly concerned about the current policies in Alberta under the UCP party. These policies are narrowly focused on a very restrictive view of what recovery is and are eliminating life saving harm reduction models and policies based in scienctific research and evidence.
From my lived experience and my experience as a counsellor and treatment provider, recovery is a fluid journey through life. It involves anything and everything that we experience and that we influence and or influences us. It is so much more than a state of abstinence from a substance.
Recovery is currently considered and being propagandized as complete abstinence from all substances. Period. This particular view makes no room for all of the natural and normal steps along this pathway. The return to this view of recovery comes from the original beliefs of substance use developed in and implemented in the late 1800’s and 1900’s. It is returning to the belief that the person who uses substances will either “just say no” or die.
We are seeing the devastating consequences of this return to old, moralistic, religious, unscientific ways that do not allow for any other approach other than surrendering to a religious concept and relinquishing the use of any type of substance. (Please note that I fully embrace spirituality as we understand it in our own lives. I’m just not so hot about organized religion).
Science has come so far in determining the physiological and neurological aspects of substance use and its impact on the person. Science has even shown multiple spiritual approaches as effective. Tenets from Buddhism for instance play a huge role in recovery models, proving that no one religion has the corner on recovery, and that spirituality indeed has a role in healing. As a result of that long drawn out work, strategies and interventions have been developed to address any disorder, disease, learning disability and mental health challenge. Of course, this in many cases involves medications.
In 1988 I was working at an entry level job at a 30 day “detox”, (what I considered to be a stabilization centre). Many detoxes were and continue today to be 7-10 day stays. The main rule for admission there was that you had to relinquish all medications that had anything to do with mental health or pain relief – at the door. We now know, as many negative health events, including death, occurred from that policy, that this was not best practice nor evidence based. It was based on the 12 step tenet that one had to be “clean” from all mind altering substances in order to be considered in recovery. This was in place as there was little fact based knowledge of concurrent disorders at the time.
This is still happening today though with a slightly slower approach. People are being quickly titrated off their medications once entering most treatment facilities. You see, most treatment facilities are still operating from the foundation created in the 1930’s and implemented in the 1950’s – informed by the very limited scientific guidance of that time. Only a belief that a higher power would magically guide people through their shortcomings and help make them productive and “good” people again seemed to be the universally accepted model; then and now.
Again, there are many that do benefit from the religiously based 12 step model. And that’s awesome! But it does not address the diverse needs of a diverse population of people and is rarely coming from a place of fact based current research. It certainly is not the silver bullet that people wish it to be as I learned very quickly in my career.
Fortunately, science has been able to influence current policies and facilities. So some flexibility and recognition of diversity has been implanted into treatment programs. But, as a recent treatment provider and clinician myself, there is still so far to go.
It is great that almost half of people who enter a treatment program of some sort, manage to maintain abstinence for at least 6 months to a year. That number by the way is suggestive and subjective rather than definitive. It is very difficult to get people who have completed a program to consistently respond to surveys. So it is really impossible to say with any accuracy what an abstinence success rate is with any treatment program.
The biggest indicator we do have is the recidivism rates in and out of residential and outpatient treatment programs and counselling. Again, there are studies out there that show that at least half of people who attend programs return multiple times before any kind of significant abstinence is reported.
To me and many in the field, this suggests that success and recovery be redefined to include progress. Everyone seems to understand that baby steps are little victories when one is trying to change something profound in their lives. The Big Book and 12 step program even recognizes “progress, not perfection”. My experience taught me this as well. Celebrating change was recovery. Abstinence is not the only measure of success. Staying alive was just as much cause for celebration as 24 hours abstinent or 24 years abstinent. That’s harder to do these days though, with the increasing number of deaths from illegal drug toxicity.
The current trend to eliminate harm reduction strategies from drug policy is proving fatal and will continue to contribute to even more deaths. This is because people do not automatically “just so no” because we believe and demand they should.
We are eliminating harm reduction because too many people still believe in the moralistic model of yesteryear. And now they are calling it evidence based – best practice. Medical approaches are again being taken off the treatment shelves of these archaic programs. A recent conversation with a fellow I knew who works at a faith based facility is still steadfast on not “replacing one drug with another”. This despite well proven, well studied medical interventions such as methadone and suboxone. Other opiate replacements are being studied as well with equally promising results in stabilizing people who use substances without requiring immediate abstinence. “One drug for another” is an outdated and misinformed judgment call that is still embraced by supposed accredited treatment programs.
Most recently, a study, conducted without sanction but initially partly funded through an educational institution, actually demonstrated the impact of safer supply on a small number of people on the streets of Vancouver. While the number was small for a study, it was conducted over a one year period. In that year, substances were purchased by a compassion club model and tested for adulterants. This ensured the purity of the substances that were then sold at cost to the participants. In short, crime reduced by more than half, overdoses reduced by more than half, and no deaths occurred amongst the participants. This needs to be expanded on and replicated to solidify its findings. The findings were not surprising to those of us who are in the thick of clinical work with substance use. They are are promising and were expected based on our already too well informed experience every day.
What was our response to that one year study as a society? We were so mortified that drugs were being purchased to resell as safer supply that we arrested the proprietors and research leaders of the study. Then we proceeded to not talk about or bring the study up for unbiased appraisal. Fortunately the charges are being challenged in court.
Safer supply is a form of harm reduction that addresses the increasing toxicity of an illegal supply of street drugs that are solely responsible for the atmospheric rise in overdose deaths across our continent. Substances that are regulated such as prescribed pain killers, on their own, are not responsible for the overdose crisis. People are not going to drop dead from a pint of beer or a highball because it has been poisoned with other unexpected ingredients. And because there are safer places to use alcohol other than back alleys and dumpsters.
So a safer supply and other crucial harm reduction measures are necessary to end the tsunami of overdose deaths. No they won’t address opioid use disorder directly. No supply is considered absolutely safe for many reasons. That is why we call this safer supply and not safe supply. It will help give people a chance to reach out for help when they are in a position to do so.
A safer supply will also address the fact that at least half of those who die from toxic drug poisoning are not people struggling with addiction. They are using for whatever personal reasons they have that are nobody else’s business. Recreational, occasional, experimental and even medicinal use could lead to a disorder in about 15-20% of people who use. Regardless, there is a majority of our population that won’t reach out for “treatment” and will continue to use substances at various rates for various reasons. A safer supply will end the current death sentence for those good folks as well.
“Oh but you will encourage drug use by making it available”!
Well, that ship has already sailed. Prescription drugs are all over the street market already through “diversion”. They are being adulterated, altered to be more potent and less detectable. The supply out there is more poisonous than even 10 years ago because of this.
People use substances regardless as we have seen all along. Currently there is so little safer supply out there available, that the vast majority of people do not have access to it. And people are still using.
The current trend to end harm reduction is going to cause irreparable damage to individuals who use drugs and to their families. If we continue to be a pious society bent on just say no or die, more people will die. Good, bad, right, or wrong, that is who we are. And when you do the numbers, about half of those who get help will relapse. The majority of youth experiment with substances (usually alcohol cigarettes and pot at first), and some will experiment with “illegal” substances. Trades people will party after work. They will go home and use there sometimes. Sales people will use, professionals will use, overworked overwhelmed women with two full time jobs inside and outside of the home will use. And most of these people will not reach out for treatment based help. So by just investing in “just say no” treatment programs and eliminating harm reduction practices, we are actually missing a majority of people in society who continue to use substances legal or not, addicted or not.
So we are investing in a just say no type of recovery based treatment infrastructure anyway, without access to other evidence based, current and evolving practices. We are eliminating the safety nets that have been put into place to at least try to address the devastation that is occurring from toxic illegal drugs. We are essentially saying it is more important to treat addiction than it is to ensure that people are at least alive and safer from harm. We are in “denial” about the impact of prohibition and its role in the increasing toxicity of street drugs and it’s role in the waves of deaths that are occurring. We are saying that the deaths are only due to addiction, not a poisoned supply. We are saying that harm reduction is somehow the cause of this grief.
We are saying that treating addiction is more important than saving lives. We are saying “recover or die”.
Is this really what we want for our loved ones and our families? Really?
What we really need to recover from is old worn out judgments based in a moralistic. religious and now a very deadly foundation of misinformation being wantonly thrown about to rage farm and further a political agenda.
Recovery should resemble a truly spiritual foundation of diversity, compassion, empathy, empowerment as the foundation for facts and science.
Resources
https://www.canada.ca/en/health-canada/services/canadian-alcohol-drugs-survey/2019-summary.html
https://www2.gov.bc.ca/gov/content/life-events/death/coroners-service/statistical-reports
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5688890/
https://www.sciencedirect.com/science/article/pii/S095539592400015X
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4657309/