People with Addiction Must Take Treatment Matters Into Their Own Hands

A lot of people with substance use disorder (SUD) – popularly termed “addiction” – stop using substances on their own, a few stop through 12-step recovery, and many successfully practice harm reduction. The rest of us have to scramble.

Before 2016, no research-backed guide to substance use disorder treatment existed. Once the Surgeon General’s report, Facing Addiction in America, was published in November, 2016, however, most* of the data about what works and what doesn’t is now available to the public. What that means, though, is that many people living with addiction today have been incorrectly treated, even maltreated, for decades, resulting in acute, seemingly intractable cases.

Based on my fierce and determined study of the 400+ pages of the Surgeon General’s report, research for our literature reviews, and secondary sources that cite research, I outlined an initial, evidence-informed treatment plan for substance use disorder. I expanded that outline for clinicians who assist people with alcohol use disorder.

Logically, then, if I have substance use disorder, and can receive evidence-informed treatment from medical professionals and other trained health care professionals, I should be able to abstain from problematic substances, be able to use legal and prescribed substances in non-problematic ways, or engage successfully in harm reduction, right?

Realities trump logic.

• Substance use disorder treatment is hard to find in America, especially in rural areas. If treatment is available, many people don’t have health insurance to cover it, or their policies have limited coverage for addiction treatment, including medications. Expenses can be beyond the means of many people.
• Evidence-informed substance use disorder treatment is hard to find in America, period. Many treatment facilities still use a 12-step model which does not, according to research, result in abstinence for most people, most of the time.
• Whether evidence-based or not, where affordable or subsidized addiction treatment is available, wait lists are long.
• Abstinence is required to remain in treatment for the illness of addiction, yet inability to abstain is the symptom of the illness.

Although addiction is a medical condition, it is considered a moral and criminal one. People with the medical condition of addiction have lost their jobs, lost their kids, lost their licenses, even lost their freedom through incarceration.

Society’s primary measure of achievement of recovery from substance use disorder is negative urine drug screens for illicit and non-prescribed substances. Secondarily, society requires reduced contact with 1) the criminal justice system, 2) emergency health care services, and 3) child protective services.

Achievement of legal negative urine drug screens requires abstaining from illicit and non-prescribed substances. However, the National Institute on Drug Abuse (NIDA), a division of the National Institutes of Health (NIH), states, “Addiction is a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences.”

If my survival instinct, willpower, abilities to choose or decide could have kicked in, they would have. I would be abstaining. I would “piss clean.” I have experienced extensive, significant, harmful consequences, as have others, as a result of my continued substance use. Continuing to use doesn’t make sense to me or to others. But according to the definition of addiction, my repeated behavior wouldn’t be about sense, logic, or reason. It is about malfunctions in the brain.

Let me see if I’ve got all this.

I have a medical illness of the organ of the brain. I can get limited or no medical care for it. The primary symptom of the illness is repeating a behavior. I am expected to, on demand, right now, not display the symptom of the illness in order to prove I’m healing from it.

That’s a diabolical, no-win, Catch-22, gaslighting, crazymaking, double bind.

And it’s a malfunctioning view of addiction. In the Philippines, they shoot their people with addiction. About that, our president said, “Great job.”

In the short-term, I just don’t see anything to do about society’s views, or about federal law, state law, insurance company policy, and/or medical board policy that restrict treatment for addiction.

Dogs put in horrible experiments where they couldn’t avoid electric shocks just laid down helplessly.

No! Not us!

If people with substance use disorder – of which I am one – want to get and keep jobs, stay out of jail, and get our kids back, the only solution I see is to take treatment matters into our own hands.

In my estimation, help is not on the way.

What we need is a guide to do-it-yourself, evidence-informed, addiction treatment.

The primary problem with that approach is this:

“A substance use disorder is a medical illness characterized by clinically significant impairments in health, social function, and voluntary control over substance use.”
– Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health, November, 2016, Page 4-1

Medical illnesses need medical care. Since most of us are not medical professionals, nor ethically able to treat ourselves if we were, our first priority needs to be to figure out how to get medical care for ourselves, or to get on wait lists to receive it.

In a modern, industrialized country, taking health care treatment matters into our own hands might seem radical and revolutionary. It should be unnecessary. But the current state of addiction treatment in the U.S. creates a third-world nation of deprivation, a post-apocalyptic, Stone Age realm in which people must use the tools at hand to fashion their own survival. Luckily, thanks to advocates like Maia, Vivek, and others, we don’t have to rely on word-of-mouth folk wisdom, rocks and twigs. Advanced, evidence-based tools are at hand.

In low-income countries, lay people help each other with health issues all the time. Nora Volkow, M.D., Director of NIDA, advocates for crowdsourcing addiction treatment. Virtual assistance (telemedicine) with addiction care is on the horizon.

All right, then. Let’s help each other. Let’s create a guide to evidence-informed, do-it-yourself, addiction treatment.

*most of the information in the Surgeon General’s report:

1. Our literature review concludes that Twelve-Step Facilitation, TSF, is not an evidence-based addiction treatment protocol.
2. We challenge ranking naltrexone with methadone and buprenorphine as first line treatment for opioid use disorder, rather than listing it as an alternative.
3. We assert that the evidence does not support rehab as an effective protocol for achieving abstinence.

Last updated 12/31/17

This post is part of a series.

The table of contents for the series is here and posts are published in the category entitled Guide.

The views expressed are mine alone and do not necessarily reflect the positions of my employers, co-workers, clients, family members or friends. This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.