what do we do about drug addiction today? pt.2

As I stated in the previous segment there are many problems with the world of drug addiction treatment. But a lot of people out there would say that despite its deficiencies, these programs are making a difference. They are better than nothing in other words. The twelve step programs and rehab centers have helped unknown numbers of alcoholics and addicts (emphasis on unknown.) Ultimately there is no way to determine how effective these programs really are. A group of recovering addicts in a given institution will "graduate" from the program with however many days of sobriety the program lasts. Say its 48. Usually a group will graduate at the same time. Then it is up to each of them to continue some kind of program. There will be "aftercare" programs, but the support lessens the longer it is from graduation time. Usually a few will fall off right away, but a lot of counselors will base their success on the number of people who make it to a year of sobriety. This is a way to measure, for after a year, sobriety becomes easier according to the medical world. Still I have only really seen a fraction of addicts make it that long. More often then not a new patient to a program will have already been through one or more of them. From my experiences at MPI and CDRP, I would guess out of the group of 15 to 20 that graduated at or around the time I did, only two would make it to a year.

1 out of ten is probably being generous, but lets say that is it. This is not a good recovery rate. I started noticing how bad my odds were when I was nearing the end of my treatment program. It seemed to me at first that rehab was like a cure, and these people around me, strangers, have been so forthcoming with their deficiencies and worked so hard that most of them would stay sober for a long time. But as they left, fewer and fewer would come back for aftercare. I would ask about some and hear that nobody had heard from them since they left. Some had relapses and came back to admit it. That was a hard thing to do, but even for them the prospect of starting over, not to mention the costs of a place like MPI, are too much to deal with. Even a few came around secretly asking other patients if they knew where they could get drugs. It paints a pretty dismal picture.

Another issue people who like to think might have with drug rehab methods is that everybody, no matter what their substance of choice, is grouped together. And yet there are strange exceptions to the rule. For one, not a lot of facilities will disallow tobacco. The twelve step programs are abstinence based yet they never make mention of tobacco. Of course you cold say that I would rather have a pilot have 5 cigarettes before flying than to have five drinks. Sure, but we are not all pilots and we are not all facing the same standards. The truth is cigarettes are the most deadly and most addictive substance by far. But they are legal, and our society accepts that they need not be part of abstinence from substance use. So what is the actual criteria for being sober. The programs will include abstaining from cocaine, heroin, marijuana, meth amphetamine, prescription medications, alcohol (of course), and any other substance that gets you high besides caffeine and tobacco. Now alcohol is a good one to have on the list for in terms of health it is the worst. Second only to tobacco. The others have very different effects in terms of health and physical addiction. Heroin is very physically addicting and one will feel withdrawal symptoms if trying to quit after two weeks straight of usage. Cocaine though obviously affecting ones physiology does not have clear withdrawal symptoms and is usually not treated with medication like heroin is. Same goes for meth, but I cannot say much about that other than serious meth addicts have trouble staying awake in early recovery. Marijuana is the weakest link in this list of abstention. It is the least damaging to your health and though it is hard to quit, there is no list of symptoms associated with withdrawal. The voters of California along with many other states have decided that it is actually helpful in treating certain illnesses. There is much debate about the potency of "today's" weed, but even strong weed is relatively harmless to humans. Each of these types of substance users have different experiences and I would say different odds for success.

What do we do about drug addiction today?

It is my belief that drug and alcohol addiction (or drug usage as the Canadians would more accurately call it) is at a high point. It must be if the cartels in Mexico find the sales of drugs in the US and world wide worth going to war over. And of course we are still at war with drugs themselves, something that did not seem necessary until the eighties ( though there was a fair amount of build up.) So what is actually going on in America and around the world when it comes to drugs? Why is it such big business and why are so many people willing to risk breaking the law, jail time, and even death in order to get high?

The simple answer is that addiction is a disease. Once somebody becomes addicted to a substance they are unable to beat it without treatment. Will power alone cannot break an addiction and there is no cure but rather a path to "recovery". This path is best summed up as abstinence and it is achieved most of the time with help from God. I say most of the time because a person in recovery currently has a few choices however narrow they may be. There is a common sense of sorts concerning how the twelve step programs were formed. At the time Bill W. received a message from God, the country was still very Christian and more importantly the amount of secularism was just beginning to threaten the dominance of the church. Indeed Bill W and the doctor from Dayton made a program that was not attached to any particular religion and was open to anybody who wanted to stop drinking. But once the system of the "steps" was introduced, and I am not sure when that was but would love to find out, it solidified the importance of embracing and accepting God or as it is now termed a "higher power". So it fit that any religious person be they Christian, Buddhist, or Scientologist could find help for their drinking problem at AA. This structure has maintained and remains intact today. The anonimous aspect has allowed many drunks return to mainstream society without shame.

So it there it is. A system that works and can be applied world wide to the scurge of addiction. Forget geo-political issues or the fairness of laws, if you have a problem with drugs send it on up to the higher power and he will give you the solution. I hope at this point my sarcasm is being detected. I am not going to go over all the politics behind the drug war (right now), and I am not denouncing AA as a viable option. The twelve step programs have undoubtedly helped many intelligent people whom I know personally. What I have a problem with however, stems from the fact that since the inception of the twelve step program it has become the de-facto method for rehabilitating drug addicts. Every major insurance plan has substance abuse programs that more or less rely on the twelve step program as their model for recovery. No rehab would openly admit to it, and here in the bay area counselors will point to Life Ring, a "secular" recovery program as an alternative influence. As an agnostic I most certainly would take this program over AA. But Life Ring is essentially AA without God. And more problematic is the fact that there are very few meetings for this group and most recovering addicts find that AA and NA are just more convenient. A meeting is a meeting, and recovery programs stress the importance of outside meetings over anything else. I truly hope Life Ring grows and flourishes, but in our current state the God system rules. The problem with this in my mind is that along with its dominance in recovery, since the inception of AA drug use and probably alcohol use to have most certainly gone up. At the time of Bill W.'s miracle, columbia and mexico were at worst involved in smuggling marajuana over the border. It was in terms of the drug market, a simpler time.

The problems with how society deals with drug addiction today are too numerous to list. To start with, there is the fact that drug use is disproportionately affecting the poor worse than the rich. Rehab fascilites become more comfortable and better staffed the more a person is willing to pay. We all know about famous people going to the Betty Ford clinic. From there anybody with a good insurance plan, usually through work, can go to a decent rehab facility and expect a fairly cushy environment. (I d have to say that one evolved policy we do have is that an employer cannot fire an employee because they have a drug problem unless they get caught using on company property.) From there it just gets worse. There are detox house where if you check in you have to stay a mandatory 72 hours and cannot receive a medical detox ( unless it is life threatening.) There is also the Salvation army where as a patient you have to work unloading trucks of appliances for the stores. Both of these programs will put you up in a room of eight or more people as opposed to MPI, an expensive program if you don't have insurance, that at worst will make you share with one other person. Since the insured patients usually have jobs, they have not fallen as low as the people out on the street who get money for drugs doing any number of illegal or degrading activity. After treatment a lot of these people have no option but to live in highly priced sober living where again they share a room and in some cases have to work for the owner of the fascility. Some of these houses are fairly clean and descent, but others are run down and the rent is highly inflated. The alternative for many of these people is to go back to the drug infested place where they lived and try and tough it out. I remember a guy once testifying that the manger of his house would make the residents, who were all formerly homeless, eat oatmeal for diner while he ate a steak right in front of them. The residents were forced to work in his car wash for below minimum wage and almost all of their money went to rent. When the guy complained and asked the manager why he was torturing them like this, the manger replied," Because I have been sober a long time, and you need to get some time before you get to eat steak. I am just trying to show you what you can get when you remain sober." Obviously this is an extreme case, but it shows how vulnerable these newly sober people who have nothing are, and how predators will take advantage.