Remove the Moral Aspects of Addiction Treatment?

Aug 26 2020

Medication Assisted Treatment for Substance Abuse

Addiction, Rehabilitation Process, Yeshaia Blakeney

Overcoming addiction isn’t easy. Those struggling with addiction often require a comprehensive approach addressing substance abuse and underlying causes. Addiction professionals use a variety of tools and evidence-based treatments to guide an individual towards a successful recovery.

Counseling and behavioral therapy can be effective for addressing underlying issues and triggers. Also, developing a strong support network is crucial for helping an individual through hard times and preventing relapse.

Can medications help with addiction?

Evidence says medications can be extremely helpful for some types of substance use disorders.

Medication assisted treatment (MAT) is one of the many tools addiction professionals may use to help those with chronic and/or severe addiction. MAT can save lives and help get individuals focused on their recovery.

Addiction is a disease affecting the brain and body. Without proper treatment, it only gets worse–destroying relationships, families, careers, physical & mental health, and life itself. Those diagnosed with cancer or diabetes wouldn’t think twice about taking medications to treat their conditions. Why should treating addiction be any different?

It shouldn’t. In fact, agencies like the American Academy of Addiction Psychiatry, The National Institute on Drug Abuse, and the Centers for Disease Control all recommend MAT as a first line treatment for opioid and other substance use disorders.

What is Medication Assisted Treatment?

Medication assisted treatment (MAT) uses a combination of behavioral therapy and FDA-approved medications in the treatment process. Studies have shown MAT is effective in helping those struggling with opioid, alcohol, and other addictions.

MAT helps to relieve withdrawal symptoms and psychological cravings. These medications also help to safely restore chemical imbalances caused by substance abuse.

But isn’t that just substituting one drug for another?

This is a common misconception of medication assisted treatment. As you probably know, substance abuse can destroy your physical, mental, and emotional health. The medications used to treat opioid and other addictions are provided at safe doses that do not affect a person’s mental, physical, and daily functioning.

In short: MAT replaces drugs that can destroy your life–and kill you–with safer medications that ultimately help you.

MAT gives those struggling with opioid or alcohol addiction a chance to release the suffocating hold these substances create. Combining MAT with behavioral therapy allows a person to refocus on a life that is free from the dangerous substances taking control of the body and mind.

Doctors prescribing these medications closely monitor individuals to ensure they are given safe, therapeutic doses.

What Medications are Used for MAT?

For those struggling with addiction to opioids like heroin, oxycodone, codeine, morphine and hydrocodone, the following drugs may be used in different situations:

Methadone
Buprenorphine
Naltrexone
Naloxone

Drugs like methadone and buprenorphine activate opioid receptors to help suppress cravings. Naltrexone, on the other hand, blocks the sedative and euphoric effects of opioids. In fact, naltrexone prevents a person from getting that “high” feeling from opioids or even alcohol.

Naloxone (Narcon) serves a different purpose. It rapidly reverses the effects of an opioid overdose. It’s been used by first responders, police, and addiction professionals to save lives of those overdosing on opioids.

MAT may also help those with alcohol addiction by using:

Acamprosate
Naltrexone
Disulfiram

Acamprosate, for example, helps to restore the disrupted changes in the brain caused by chronic alcohol abuse. This safe, well-tolerated drug has been used to treat over 1.5 million patients throughout the world. In fact, acamprosate is safe even when a person suffers a brief relapse.

As with any drug, you want to make sure the doctor reviews your complete medical history and current medications. Discuss any potential side effects and risks of using MAT drugs. Also, be sure to consult with your doctor or treatment team before stopping any medications.

Medications used to treat addiction are not “magic bullets” that quickly make your addiction go away. You still have to do the personal work to address causes, triggers, and moving forward. MAT does, however, provide an opportunity to counteract some of the physical and neurobiological effects of abstaining from your drug of choice.

What are the Benefits of Medication Assisted Treatment?

As a part of a holistic drug treatment program, MAT medications are safe, cost effective ways to help manage addiction. They can also:

Reduce the risk of potentially fatal overdoses
Keep you engaged in treatment
Reduce cravings
Help stabilize your mood and emotions
Prevent engaging in dangerous or criminal behavior
Help with your social and occupational functioning
Reduce risk of contracting HIV or hepatitis C due to unsafe needle use
Improve birth outcomes among pregnant women with substance use disorders

Common Medication Assisted Treatment Myths

MAT research and data proves better outcomes and significant reductions in relapse. Still, some individuals–and even practitioners–are reluctant to embrace MAT.

But why?

For some, they may not have the correct information. Others may feel completely abstaining from any drugs is the best method of recovery. The Substance Abuse and Mental Health Services Administration (SAMHSA) states that MAT is “greatly undersused.”

We already talked about why medication assisted treatment is more than replacing one drug for another. Here are a few other MAT myths that need to be debunked:

MAT only provides short term results. Individuals using MAT for up to 2 years have the greatest rates of long-term success.
MAT is only for those with a chronic, severe substance use disorder. MAT uses a variety of medications that can be modified to fit the unique needs of most patients–especially those struggling with opioids.
MAT makes overdose more likely. MAT helps to prevent overdoses. Once someone detoxes from opioids, even one brief relapse can cause a fatal overdose. MAT helps reduce cravings and gives those struggling with opioids a safer alternative.
MAT keeps a person from experiencing a full recovery. MAT allows a person to function better and enjoy a better quality of life so they can focus on the personal issues contributing to their addictive behaviors.

Is Medication Assisted Treatment Right for You?

Looking for addiction treatment in a values-based program that emphasizes dignity, respect, and compassion? Recover Integrity gives men dealing with life-threatening addiction a chance to refocus and recenter their lives on what is truly important.

When appropriate, Recover Integrity uses the latest, evidence-based medication assisted treatment as part of their holistic recovery program.

Tried 30-day programs with little or no success? Our exclusive, extended care addiction treatment for men offers an opportunity to comfortably address your issues and move past the dark tunnel of addiction.

Call (310) 294-9030 to get help now.

Aug 21 2020

Do You Need to Dumb it Down in Treatment?

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Do You Need to Dumb it Down in Treatment?

One of the things that’s common in some therapeutic communities, when it comes to recovery is telling people to dump it down. And I understand what they mean, but I don’t like it. Because I like to think.

If you learn to reason well, which is not about coming to the conclusion that I had before I started reasoning, that you’re actually trying to figure out the truth of the situation. That has been an incredible asset.

Recovery is cognitive

In my recovery, in many ways, a lot of my recovery was cognitive. It was an intellectual endeavor. I was trying to reason whether or not this made sense to do. Now reason alone won’t do it.

I have to have some foundation, some axiom there. And my axioms are to live is better than to die and to be healthy is better than to be sick. I don’t know why that is. I can’t tell you why that is. It’s a choice that I make. It’s the foundation for the rest of my reasoning.

Once I start there I could build up reasons to get clean, that makes sense to me, reasons to do things I don’t want to do, reasons that I can transcend my ego desires.

A part of what I do when I work with people, is I try to harness that.

If you ask questions, and you’d like to learn, instead of telling people like, “Hey, dump it down. Don’t think. Just show up.”

You can actually harness that asset that people have and use it.

Now, the reason why people don’t like it is because people have the capacity to reason their way into what they want. But just means you’re not reasoning, good enough, well enough. It doesn’t mean don’t use your reason. It means use your reason better. Right? And that’s a huge part of recovery.

If you know, I need to make reasonable decisions to have a healthy life and if I don’t know how to think well, I can’t do it and there are techniques and ways to think well.

They don’t teach you that in school. You memorize a lot of facts in order to figure out how am I supposed to be in my relationship with this person when I’m in a moral conflict between using drugs and my parents, you know, coming into town next weekend. How do I weigh those competing claims and come to a decision, you know. We don’t teach people how to do that, but we can.

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Aug 01 2020

Mindfulness in Treatment: Getting to Know Yourself

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Addiction, Recovery Blog, Rehabilitation Process, The Field of Treatment, Therapy, Video, Yeshaia Blakeney

Mindfulness in Treatment: Getting to Know Yourself

The other area that’s important that’s come into the treatment field, when we’re looking at kind of how to recover and become whole and become healthy, is what I would say the Eastern practices and I’ll lose the categorize them as mindfulness and of yoga.

Mindfulness is around intention and attention.

If I meet somebody who’s suffering from addiction, demoralized, who’s ashamed, has some traumas in their background, often they’ll be sitting in my office, and you can kind of tell the level of trauma by body posture, and eye contact, and their ability to stay connected and intentional and paying attention in the interpersonal relationship.

The first thing that I have to do with this person is I’ve got to figure out how to help them feel safe.

That’s the beginning. You build on that a little at a time in relationship with them and groups and individual work in casual kind of covert, nurturing and caring in the hallway, this kind of thing.

Then eventually, when somebody is kind of here and they’re awake, that can take two, three months to blossom and start to change.

This is a great sign when their affect changes.

Then work on the directing people’s attention and having people being mindful of the things that they’re engaged in that’s right in front of them.

That goes to a very subtle level, eye contact, of focus, of being aware of what’s happening in my face and my shoulders, my neck and my back and that’s an endless route, both recovery and growth and wellness.

You can move deeper and deeper into the mindfulness attention and intention, by knowing what’s happening inside of your mind.

Not just of what’s happening outside of me, but what’s happening in the dark, creepy recesses of my unconscious mind. The whole thing about recovery to me is to help people to move deeper into a process and become deeper people.

Get addicted to getting to know myself and working on myself

Not just me, but working on myself in relationship to all the people that I care about, to understand myself in the context of my work.

That’s the “Wow. How can I be a better husband? How can I be a better father? How can I have a meaningful role in my work? How can I make a difference?”

That kind of thing and when you get a little bit obsessed and curious about that, then recovery is not that hard.

Then it’s this endless journey of getting to understand yourself, getting to understand the world, and interfacing with your reality in a way that’s meaningful, where you wake up and you look forward to it.

Those are like the deeper realms of recovery.

Getting to understand yourself schematically. How you process stress and all that stuff. And actually, it becomes fun. It doesn’t become this chore. Then it’s not about, you know, when can I leave treatment,. Then it’s about what are the other ways I can get to know myself and I can get to grow learn to change.

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Jul 15 2020

The Spiritual Element of Recovery

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The Spiritual Element of Recovery

In many programs, that you would go to, to engage in recovery from addiction, there’s a spiritual element to that program. So we have a spiritual program or something like this. And the most common spiritual traditions that they drawn are these Eastern traditions, Buddhism, the yoga, the mindfulness, meditation, these kinds of things. And honestly, I don’t think one can put into words the benefits of those practices.

Spiritual Psychology

There’s another spiritual tradition that’s more Western that I think is underutilized, which is spiritual psychology and it has to do with how the psyche works and it has to do with virtues. It’s sort of this mix of Greek thought, and philosophy and psychology.

That element is crucial because one of the things we’re addressing when we’re looking at recovery is who we are in the moral sphere. Because when you’re in your addiction, you feel demoralized and often ashamed of how you behave.

One of the things to try and figure out is how do I get in contact with my, let’s call it authentic self? And how can I be a better person? Which is a huge antidote against shame. If I feel like I’m being a good person over a period of time consistently, I usually don’t feel that a shame might take a while to get there. But we have to understand what it means to be a good person and that’s challenging. It’s a really complex philosophical issue and something that spiritual psychology looks at a lot.

The Ego- Self

In the moral sphere, the way that I think about that, is to think about a person as having a lower self, or you could call it -my great teacher, Dr. Rabbi Mordecai Finley calls it the ego-self- which is the, it’s a perfectly healthy part of the self for quick, unimportant decisions.

It’s the part of me that’s driving the car. That’s in chit chat on the elevator, that’s all ego-self. “Oh, would you like me to push this floor for you? Let me open the door.” You know, etiquette and basic memorized, mechanized ways of responding in the world. Ego self is great at that.

However, we needed to function. I don’t want to be looking at a doorknob thinking what do I do here? How do I go through this door? What does this mean, right? Ego-self is great with that kind of interaction that we have.

The ego-self is terrible, a complex interpersonal reaction.

And any deep relational interaction is complex. It’s going to be reactive, impulsive.So, one of the core parts of spiritual psychology is this question of being able to identify when I’m in my ego self and when that’s appropriate. And when I’m in my higher self.

The really tricky part about addiction is that you become confused about the difference between those two ways of thinking and you use inconsistent rational thought to rationalize and justify ego desires, if that makes sense.

An ego thought does not stand up to scrutiny.

If you ask your ego deep questions, it cannot give you deep answer. It doesn’t have deep answers. To figure out how to respond in accordance with the situation so that you can continue to build on the most important thing.

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Mar 17 2020

The Physical Aspects of Recovery

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One of the things I don’t talk about as much–but it’s so important–is the physical aspects of treating addiction.

Now this doesn’t necessarily pertain to people who are already “fitness freaks”. There’s a whole group of people that come into treatment and their primary coping tool is the gym and eating well. For those people, they’re not gonna get the same kind of relief from the gym beyond what they’ve already got. They’ve already dealt with the nutritional and physical aspects of their neurophysiology.

But there’s another huge group of people who have never paid attention to their body. And sometimes it shows.

Huge Amounts of Information Are Stored in the Body

And we know that traumas are stored in the body. Memories are stored in the body. We know you can tell a lot about how a person is doing based on their body language, energy, posture, and eye contact.

In order to have a full recovery, you have to take care of the body. Meaning: you have to be mindful and intentional about what you’re bringing into your body, what you’re eating, and what you’re drinking.

And you have to be mindful and intentional of the physical activity you’re engaging in to help the body reach close to a peak performance.

Of Course, Exercise Is Healthy, But Did You Know…

There are meditative exercises that exist. I think particularly swimming, biking, and running. Real rhythmic, physical activities, that open up different emotional spaces. When we’re in a deep depression emotions get locked in.

I’ve told a story about when I picked up bike riding. On my first long bike ride, I just broke out in tears. There was so much emotion that was stored in my body. Until my body was moving in a rhythmic way, I couldn’t get to it.

One of the big ways to relieve that stress and anxiety is to start to take care of your body more. The way to do that well is to find an exercise routine that actually works for you. I do biking, it’s really hard for me to lift weights in the morning, and frankly I don’t enjoy it. And I don’t like gyms. I like to be outside. So, biking is great for me.

I wake up early in the morning and I jump on a bicycle. And it’s an automatic warm up; I kind of ease into that exercise. And, for me, it’s great because I’m kind of like, rusty in the morning. Biking, to me, brings this rhythmic, meditative thinking that just blows the thoughts and anxieties right out of my mind.

Of course, you have to find the exercise that’s right for you.

The physical components of recovery cannot be understated. It’s not my area of expertise. There are people who know much more about it than me, but it’s definitely worth talking about.

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Feb 21 2020

The Desire to Move Forward

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Addiction, Recovery Blog, Rehabilitation Process, The Field of Treatment, Therapy, Video, Yeshaia Blakeney

When I’m working as an addiction or spiritual counselor, clients want to climb the ladder of treatment. They want to move forward in their lives, which is understandable. We all want that direction.

And that idea of moving forward in treatment–that’s a therapeutic issue. I don’t mean that as an evasion. Our conception of what it means to move forward is a therapeutic issue.

How do I answer clients when they ask, “When is it time to go? When am I ready to leave?”

I used to say, “When you’re willing to stay.”

Considering Your Desire to Finish Treatment

My answer wasn’t cruel or a joke. I answered the question sincerely.

I wanted them to ponder:

What happens when you come into treatment?
What is this urge to move out?
What do you think is at the end of this journey?
Is there an illusion that when you leave treatment you get your freedom back?

Many expect leaving treatment restores the freedom to do, “What I want, when I want, and how I want.” That it’s some kind of promised land. That life is going to feel better–everything’s back to normal.

But your life wasn’t normal before you got there. You had an addiction problem and were suffering. And, in fact, when you leave treatment, life is more complex and difficult with less support.

So it’s actually harder.

I had a counselor that told me–when I was in treatment–the only thing that should change when you leave is your address. And what he meant by that was all of the tools and support that you’ve created while in addiction treatment–the kinds of choices you make and the things you have and haven’t been doing–all of that should stay the same.

Treatment is the First Step of Your Recovery

Don’t think because you move forward in treatment that it’s going to relieve your stress and anxiety. That, actually, may be what’s driving this idea of moving forward.

We all want to move forward in our lives, which is a complicated thing to even define. There’s a stress and anxiety that exists inside us all at times. If you’re active in addiction, stress and anxiety has a powerful pull. Yet we think, “If I can just get through these obstacles and move forward that will relieve the stress and anxiety.”

But actually what relieves the stress and anxiety is dealing with the underlying conditions of the emotions. What relieves the stress and anxiety in my interpersonal relationships is not getting away from them. Then I’m just guilty because I’m not around. Right?

I have to work through the emotions. And that’s what we’re actually doing in treatment. So it’s really a reframe. You’ve got to reframe your idea of moving forward. You’ve got to reframe your idea of stress and anxiety.

Another thing I used to say: that feeling you have–that restlessness and boredom–that’s your ism. That underlying cluster of feelings exists inside of you and drives you to use drugs and alcohol. So every time you have that feeling, it’s a signal for you something is up. That is the ism you have to address.

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Adam Mindel Interventionist with patient

Jan 17 2020

Realistically individuals with high levels of sociopathy do not generally enter treatment without being compelled by the fear of consequences. Click To Tweet

Interventions and Recovery: a Process | part 3

Adam Mindel

Adam Mindel, Addiction, Recovery Blog, Rehabilitation Process

As I look back over the last several months of working with individuals and families towards recovery, I promise I am terribly understating when I describe interventions as a process versus an event. All interventions are a process, I promise you, and I promise you so is recovery. Firsthand, I reflect on my nearly 17-year journey of recovery and recognize the years I spent in my addiction leading up to my current sobriety as all part of the process that produced the recovery that I have today.

Research shows that individuals must often go through a process of preparation before they are ready for permanent sobriety. The Transtheoretical Mode of Change by Prochaska & DiClemente is a model which describes sobriety as a movement from Denial to Contemplation to Preparation and ultimately Action and Maintenance.

Two Predominant Methods to Move Individuals from Denial to Motivated States of Change

If the above is true, then realistically how do I utilize interventions to move individuals from states of denial to more motivated states of change? I suggest there are two predominant ways:

1. Utilizing leverage to engage individuals in treatment, with ultimately, treatment itself as the vehicle which provides the process of resolving ambiguity and resistance to change
2. Meeting individuals “where they are at”, by finding levels of care that can begin to engage individuals in a process of change.

Two important qualities required for an intervention

First, let’s cover the basics in all models of interventions, most interventionist asses for two important qualities required for an intervention

A. Influence – The capacity to have an effect on the character, development, or behavior of someone.

B. Leverage – The power to create consequences, or require behavioral change by an individual that is addicted.

I additionally assess for Attachment, which -is a deep and enduring emotional bond that connects one person to another across time and space (Ainsworth, 1973; Bowlby, 1969). Put simply, I like to know how much individuals care for and are connected to the friends and family that love them. Realistically individuals with high levels of sociopathy do not generally enter treatment without being compelled by the fear of consequences. At the same time, addiction and neurochemical changes will often resemble anti-social behavior.

Individuals often enter treatment due to tensions in interpersonal relationships.

With over 15 years of experience working with families and individual in treatment, I can unequivocally inform you that individuals with deep attachments to friends and family have better outcomes from interventions and addiction treatment.

Having experience and understanding the quality of influence and leverage is vital to producing positive outcomes and creating the correct type of intervention. Quite frankly it is always easiest to intervene on loving individuals that care for their friends and family, and due to interdependent relationships, there are real consequences if the loved one does not enter treatment. For example, I recently intervened on a college student that had very close relationships with his parents and extended family. From the beginning, the initial assessment it was clear that this dutiful son would be entering treatment. In addition, he was dependent upon his parents to return to college. The intervention became high-level consultation, psychoeducation, and changing family dynamics while creating an accountable path back to university with the parent’s support post-treatment.

Unfortunately, not all interventions are high in relational influence or attachment, and not all interventions have real leverage. Click To Tweet

I describe “real leverage” as actual consequence that an individual would experience if they choose to not enter addiction treatment. These consequences may include the removal of financial support, parental or marital consequences.

“Adaptive models of interventions find ways to engage with individuals realistically in different stages of change” – Adam Mindel

Adaptive models of interventions find ways to engage with individuals realistically in different stages of change, different levels of care, and often must create processes that allow individuals to fail or provide them the dignity to try things “their way”, before accepting recommended courses of action.

For example, I recently Intervened on a successful businessman that was abusing both opiates and amphetamines. Though he loved his family, no individual in his family had any type of leverage, he was well able to finance/self-enable his own addiction. In addition, as a result of chronic amphetamine abuse, the client was dysregulated and unable to acquiesce to residential treatment, and insisted upon beginning outpatient treatment. An agreement was made between the client and his friends and family that included scheduled follow-up meetings to track his progress in outpatient. Ultimately, due to repeated relapses while attending outpatient treatment, the client became more intrinsically accepting of entering residential treatment of his own accord versus external coercion.

After the Intervention

Once in treatment a further process was created moving client through different levels of care which included residential treatment, sober living coupled with day treatment, intensive outpatient treatment, and ongoing continuing care which included week individual therapy for 6 months, psychiatric care, continued urine analysis monitoring, and of course the client’s agreement to attend self-help group throughout the recovery process. The client to this day continues in his own process of recovery and growth…the process continues.

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Things I Don’t Like About Contemporary Treatment: A Meditation From The Inside

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Recovery Blog, The Field of Treatment

Dr. Erich Fromm, one of my teachers, inspires the title, and much of the content here.

There is a huge shift transpiring in the field of drug and alcohol treatment, it is happening rapidly and systemically, it will be for the worst and difficult to reverse. Warning: the field of treatment is being infiltrated by people who are emotionally disconnected and un-empathetic towards the plight of the people they claim to serve.

What the treatment industry used to look like: A group of people who had an experience of transformation becoming missionaries and willing to do whatever it took to help addicts and alcoholics. Twelve step, spirituality, new clinical techniques, whatever helped people recover it was done with spirit, intention and legitimacy. I am not idealizing the past, there were always unscrupulous operators, but they were the exception rather than the rule (with some large scale exceptions in the 80’s treatment bubble).

What’s happening now is something different: salesmen, hustlers, and young wealthy kids who want to show their parents they can be successful, open treatment programs, for the wrong reasons and with no experience. Many Drs. And psychiatrists enter into the field as consultants or hired employees and get tempted by money and use their degrees as cache to become owners and operators of there own centers, these too tend not to be missionary healers, but more business savvy narcissists. What’s happening now in treatment is systemic, a result of the breakdown of ethics and spirit in the treatment field. All of this has come together in a near perfect storm to create an industry that seems to have lost its way. The new breed of treatment centers is looking at how to maximize profits, buy and sell addicts care, and become as large and efficient as possible. It is the wrong approach.

One of the contributing factors to this shift is the influx of narcissistic and egoistic personalities that own and operate treatment programs. Every day I hear about the shenanigans of the owners of large “successful” treatment programs. It is clear many of the owners of private rehabs have not done their own spiritual work. Many of these owners are pathological. They tend to have the psychological profile of compulsive gamblers: Mildly (or majorly) anti-social, grandiose, charismatic, addicted to the cycle of winning and loosing, self sabotaging, self-absorbed and lacking in empathy.

What makes this situation deeply troubling, as opposed to another unfortunate by-product of profit-centered capitalism, is that recovery once was a sacred field, largely due to Alcoholics Anonymous.

We have reached a moment in the field of treatment where events and industries have conspired to create the perfect storm. The issue is greed.

Treatment, when done correctly can be a profitable business, and treatment with a focus on profit (over care) can be insanely profitable. Treatment has now become an attractive field for those looking to make a quick buck. On some level what is happening is no different than what happened in the mortgage industry in the early 2000’s. The treatment bubble began to attract these characters (en masse) with the introduction of mental health coverage from insurance in conjunction with the capacity for huge online marketing efforts on Google.

How has this happened? There is a lot more money in the field than there was ten years ago. There is also, unfortunately, a growing customer base, as our country is in the midst of the worst heroin epidemic it has ever seen, and it is an epidemic affecting not only the lower, but also the middle and upper class that can afford to spend more on treatment. This has not gone unnoticed by venture capitalists, real estate investors, huge multinational corporations; they all see treatment as an industry they can capitalize on.

One of the reasons this works is that when families or clients choose to come to treatment all they know is the marketing, not the treatment itself. Unlike a restaurant, customers cannot just try the product and decide if they like it and go somewhere else. Rehab is a big investment. From the outside (or the website) there seems to be no difference between genuine experience legitimate treatment, and large commercial insurance farms. Financial success in this industry has little to do the quality of treatment and everything to do with marketing. The more one can focus their resources on marketing the more clients one will get. It has become a marketing game to fill beds. As a result you see the greediest operators achieving enormous success, putting marketing first (over care). The clients who don’t get the care they need don’t have a voice because they disappear back to where they came from, or sometimes, tragically, die. No one takes responsibility, and the most vulnerable among us are being exploited.

And, we now have the recovering community itself getting involved. Which in many ways is a great thing, but when a recovering person in the first couple years of recovery without much experience or know how opens a treatment center, the core of the treatment matches the core of the founder: shaky, compromised and not yet fully integrated.

So what does good treatment look like? A good treatment center is one that exemplifies healthy living, strong ethics, strong boundaries, expertise (through experience) and lots of love. The men and women in the trenches of their recovery, with an interest in transitioning into the field of recovery, become counselors, therapists, techs; they go back to school learn their crafts and 10 years later they have worked their way to positions of power, legitimately.

The best of us in the field are those who feel an obligation to our fellow person, see ourselves in the people we help, recognize our own limitations, can empathize deeply with suffering, and have the strength to help create a safe and sacred place for those in need to recover.

The other day I was visiting with a young man who just opened a new treatment center. I was speaking with him and the clinical director for longer than I had anticipated. It was clear he was excited about his new business and also clear that he was excited to be helping those who need it. We talked about ethics, spirit and fighting the trends of our industry. Treatment programs like his and mine, are becoming the exception. We are people first, we’ve done our own work, we have experience, we are small, smart, and we are values based. I am having these conversations more and more (with colleagues, with parents, with clients, with peers); there is a small underground group of us forming, perhaps a specter is haunting the treatment field: the specter of integrity![/vc_column_text]

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The Human Side of Treatment Behind the Opioid Epidemic: Ryan’s Story

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Addiction, Recovery Blog, The Field of Treatment

I was working in residential treatment a few years back; one Friday night, a new resident, Ryan, approached me. He was a teenager, 5’6” with big, kind eyes, natural dark circles, and a face that turned red at every feeling or change in temperature. He asked, vulnerably, if he could speak with me. I took him to my office, we sat down and I asked, “What’s up?”

“I got out of Heroin detox two days ago. I’m 8 days sober. And I’m craving shooting heroin again.”

I could see that he was quite sincere and on the razors edge of going this way or that. I looked him in his eyes and asked him: “How are you going to use?” This question surprised him; I think he thought I was going to talk him out of it.

“I’ll smoke it,” he said dryly.

“Do you have Heroin on you now?”

“No,” he said.

I asked, “How will you get Heroin?”

“From my dealer” he responded, clearly getting impatient and annoyed.

I proceeded, “Do you have money?”

“Ten bucks” he answered.

I said “Give it to me,” and he did, and I put it in my pocket. “Do you have a cellphone?” I asked.

“No,” he was beginning to catch on to our game.

“How are you going to call him?” I pressed.

With some finality he said, “I’ll panhandle, get the money, I’ll call him from a payphone at the gas station, and get high.”

“So he will come drop it off and you’ll get high at the gas station?”

“No.” Ryan said, “my dealer doesn’t deliver, I’d have to take the bus to Inglewood and meet him.”

I continued, “After you meet him and get the dope where will you get high?”

“I’ll get some tinfoil and a straw from burger King and smoke it in the bathroom there.”

“And then what?” I asked accusingly.

“I’d be high,” he replied.

“And then what?” I asked.

“I’d go home,” he answered.

“To your parents?” I asked.

“ No, they kicked me out. I’d come back here,” he admitted.

“To rehab?” I asked, “and then what?”

“I’d get sober,” he answered.

“You’d get sober? But you’re sober now!” I replied, too loud, revealing my inner judgement.

“Yes but when I am High I really want to be sober,” he said.

Aha. “So let me get this right, in order for you to stay sober you have to get high?”

Two days later, Ryan was on the street getting high. Ryan wanted to be sober. But he wanted to be high, also. By the eighth day in treatment and sober, he had run out of motivation to stay sober. Why did Ryan need to get high in order to stay sober? When he went into his memory he realized that when he was high, he found the motivation to get sober; the crisis of addiction created an energy, a desire in him to get well. Ryan was cutoff, he was stuck in his own thinking, and his thinking was cut off from the world. He was stuck in a narcissistic bubble of addiction. Ryan was rational, but his reasoning was driven by an unconscious craving to get high. He didn’t want to get high, that’s why he asked to talk to me, but it was almost as if once he engaged me he was sleep talking, unable to wake up and stay where it was safe and welcoming. Underneath the mechanics of Ryan’s thinking there was something else going on. Ryan was numb, and underneath his numbness was pain, fear and sadness.

I wonder if I had been able to break out of my role in that moment: warm and clever counselor and instead become loving and vulnerable with him, would the effect have been different? If I had held his hand, been there with him 2 or 3 hours or however long was necessary, listened to his pain, given him a hug, could I have broken through to a different part of him and changed his trajectory? As it was, I believe we were both stuck in our roles at the time, him the out-of-control addict in need of saving and me the young-smart-(slightly)-distant counselor. Ryan recovered from his condition; I am still working on mine.

Ryan ended up in treatment two weeks later and has been sober ever since. So it turns out he was right, he had to get high in order to get sober.[/vc_column_text]

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