Rethinking What it Means to Recover from Addiction

rethinking-what-it-means-to-recover-from-addiction




When I quit using cocaine and heroin in 1988, I was informed there was only one way to get better: abstain from all psychoactive narcotics for the rest of my life, including alcohol, and follow the 12 steps of Alcoholics Anonymous. “Jails, institutions, or death,” counselors and group members stated were the only options.

My addiction had progressed to the point that I was injecting dozens of times each day towards the end. So I grasped the lifeline that had been handed to me and went to the hospital’s suggested typical 12-step rehab program, where I went through withdrawal.

But as I dug deeper into the scientific evidence on addiction, I discovered that these claims were false. In fact, studies show that most people who meet the full diagnostic criteria for alcohol or other drug addiction recover without the need for treatment or self-help groups—and that many of them do so not by quitting completely, but by modifying their use so that it no longer interferes with their productivity or relationships.

There is no “one true way” to overcome addiction, and the concept of “one size fits all” can be dangerous and even fatal in some situations. September’s National Recovery Month and similar attempts to encourage healing will fail to reach millions of people who could benefit unless we understand this and appreciate the diversity of recovery experiences. During an overdose crisis that is expected to kill over 90,000 people by 2020, a greater knowledge of how people actually overcome addiction is critical.

Regrettably, rehab hasn’t progressed much since I was a patient in the late twentieth century. At least two-thirds of addiction treatment programs in the United States still emphasize teaching the 12 steps and pushing lifetime abstinence and meeting attendance as the sole way to heal. (The phases involve recognizing powerlessness over the problem, seeking a higher power, making atonement for wrongdoings, attempting to improve “character defects,” and praying—a moral program unlike any other in medicine.)

Moreover, despite the fact that the only treatment proven to reduce the death rate from opioid addiction by 50% or more is long-term use of methadone or buprenorphine, only about a third of residential programs allow them, and only about half of outpatient facilities use them, usually for a short time.

Worse, when medicine is allowed, most treatment institutions also require persons with opioid use disorder to attend Narcotics Anonymous, a 12-step program. This creates potentially fatal pressure to stop taking the medications. According to the group’s official literature, persons using methadone or buprenorphine are not “clean” and have simply replaced one addiction with another.

More than one family has contacted me after a loved one died of an overdose as a result of their relative’s rejection or premature discontinuation of medication based on this viewpoint. We are denying hope and healing to individuals who benefit from techniques other than the stages if we do not begin to view recovery in a more inclusive manner.

So, how might a more accurate and comprehensive perspective of recovery look? The Chicago Recovery Alliance (CRA), which created the Windy City’s first needle exchange, came up with one of the most useful descriptions for me.

CRA was also the first organization in the world to widely distribute naloxone, an overdose reversal medicine, and to teach drug users how to use it to save each other’s lives. Naloxone (commonly known as Narcan) is an opioid antidote that restores the desire to breathe in overdose patients. However, it must be administered quickly in order to be successful. (It is safe if used incorrectly: it will not harm persons with other medical problems and will usually work even if opioids are taken with other medications.)

Harm reduction is the CRA’s approach, and recovery is defined as “any beneficial improvement.” This means that everything counts, from using clean needles to staying entirely abstinent. If someone quits smoking crack, obtains a job, and reconciles with her family, she is considered to be in recovery, even if she continues to take marijuana on a regular basis.

Similarly, going from a bottle of Scotch a day to a daily glass of wine—or from daily drinking to bingeing only on weekends—are also beneficial developments, not just “active addiction.” Recovery is a process, not an event, in this case. It’s impossible to master a new skill without making mistakes, and building coping skills to manage or stop drug use is no exception. Big adjustments take time for most people, especially with activities that aren’t addictive.

People who take addiction drugs are clearly included in this broad description. This is a favorable shift because it reduces the risk of mortality considerably, even for people who continue to use other drugs.

Furthermore, those who stop nonmedical usage and stabilize on an adequate dose of these medications can drive, communicate, and work just like anyone else. They are not inebriated or numb, as those who take other psychiatric medications as recommended are not.

Patients taking methadone or buprenorphine are no longer addicted since they are physically dependent on the drug to avoid withdrawal. Addiction, according to the Diagnostic and Statistical Manual of Psychiatry and the National Institute on Drug Abuse, must entail obsessive behavior despite negative consequences—it is not simply a need for something to operate.

Of course, for some who are used to traditional abstinence-based recovery, the CRA’s “any good change” criteria can be difficult to accept. Members of the 12-step program who have abstained from alcohol and other drugs for a long period are venerated in the 12-step community; the longer they have been sober, the higher their standing tends to be. The allure of such public adulation aids some people in avoiding relapse. From this perspective, granting the title of “recovery” to individuals who have not completely quit appears unfair.

However, it has the potential to save lives. People who break their continuous abstinence—even for only one day after 20 years—are considered as going back to square one in 12-step groups, and their “sober time” and associated status are completely obliterated. According to research, taking such a black-and-white approach to recovery can actually make relapses more harmful. This is because many believe that because they’ve already blown it, their tiny blunder might as well turn into a gigantic spree.

Since the majority of people relapse at some point, shifting away from the belief that only continuous abstinence matters—rather than quality of life, ability to sustain relationships, and ability to contribute to society—would likely be healthier for everyone.

However, there is another method to reconcile divergent perspectives on recovery that keeps conventional notions alive for those who like them. Simply put, define it for yourself and let others do the same. If you’ve ever heard someone declare, “I’m a person in long-term recovery, and for me, that means abstinence,” you’ve witnessed this concept in action.

My personal viewpoint has evolved through time. I was completely free of substances other than caffeine, including alcohol, from 1988 until 2001. Since then, I’ve had no trouble using booze and cannabis responsibly. However, I have no illusions that I could reduce cocaine or heroin use, so I continue to abstain from these substances and count myself among the sober.

However, I now believe that my recovery began before my abstinence, when I was taught to clean my needles with bleach in 1986 and began fighting for HIV prevention information and equipment for other injectors. That positive adjustment most certainly helped me prepare for a more significant transformation, such as going to rehab. It probably certainly prevented me from contracting AIDS.

It doesn’t matter if someone recovers through medicine, moderation, 12-step programs, or anything else. It’s the fact that, like me, most people improve. We can help even more people if we identify and support the various paths to recovery.




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