Having found a very good deal on hosting services, I have taken the step of getting a new domain (a couple actually) and am in the process of building an addiction web site with forums. The domain is talkingaddiction.org and I have rather ambitious plans for the site. I would like to utilize the main page as a clearing house for information and have (ideally original) articles by addiction professionals, doctors and researchers posted a couple times a week.
I will also be creating a forum for people whose lives are affected by substance use disorders and people who suspect their lives are affected by substance use disorders - their own or someone else's. This is where I could possibly use a little help. I am committed to making this a space that is completely safe for people who are afraid of others finding out they are spending time at an addiction forum. This means that rather than just making it possible for users to post anon to the outside world, I want to provide assurance that administrators and moderator don't even have access to information that could identify forum members. This means not only providing means for creating accounts that hide all personal identifiers from everyone, but also hides their ip address and such.
I am honestly not to sure about how to make that happen, though I will be talking to the tech people who work for the host about it. I am using Drupal content manager, running on an apache server. I will also need to be able to keep track of the amount of traffic, even if I cannot keep track of any identifying information about the traffic.
The other thing that I am hoping to accomplish is the development of a forum for addiction professionals, researchers who study substances of abuse and MDs. Possibly even creating a whole different front page - or at least a feed (possibly keyword filtered for user preference) that identifies recent items. I know that this is less likely to come together - at the very least I expect it to be rather difficult to get people who are as busy as everyone who fits the requirements to actually take the time to make it happen. But I have long felt that communication between people doing relevant research and the people who actually deal with people with substance use disorders could be exceedingly valuable. And I think that MDs - especially those who work ERs, could also get a lot out of communication with addiction professionals. For that matter, it might be appropriate to invite emergency service providers into the discussion.
The other thing I am hoping someone might be able to help me with - or even possibly just create, is a news feeder for picking up addiction related news. Something that can be set to filter content from sites that turn out to provide inaccurate information.
Finally, I am also looking for people who have a bit of spare time, who could help as moderators. I have the tentative commitment of one person and would like to shore things up rather solidly. As the site isn't even up yet, I don't expect to need much help initially. But I am hoping to build things up rather quickly and would like to make sure that everything is covered. It really shouldn't be all that complicated. There are few enough restrictions that there really shouldn't be too much trouble. I am trying to set things up so that users can kill file other forum members if they run into conflict and also will be asking users to self flag posts that contain profanity, so that users who wish to avoid that can do so easily. Basically moderators would mainly deal with posts that should have been self flagged and weren't and personal threats. The only other issue that may be very complicated is users who set up multiple accounts so as to continue harassing users who have killfiled them - or who have been banned for refusing to respect the very few rules that will be in place.
Other than that, I expect to open the site within the next ten days. It will probably need some tweaking here and there - I have never set up a site before and have little help. But we will be ready to start talking by May 2nd at the latest. And unlike my last, rather blundered attempt at creating an addiction community (for smokers), I think this will work out much better. I think the biggest problem with that was the attempt to create what should have been a forum in a blog format.
I will also note that there will be no advertising on the site - I am rather up in the air about a donation button. I would like to recoup my costs if possible, but I am not terribly comfortable with creating any pressure for anyone who wants to use the site. I am going to keep the site as politically neutral as possible, not offering any "official" Talking Addiction position on anything except for the advocacy for more humane treatment of people dealing with addiction or addictive behaviors and people with other mental problems. I want this site to be a very comfortable and safe place for people to come and talk - including people who have yet to admit or who aren't really sure if they really have a problem.
Finally - a couple more important points; Sobriety is not a requirement for membership - or even for posting. And membership is not restricted to substance based addictions. There are all manner of behaviors that qualify as addictions and Talking Addiction will not discriminate. This is to be a site for people who are suffering from addictions and/or substance use disorders and anyone who either has (or thinks they might) those sorts of problems or knows someone who does will be welcome.
Showing posts with label substance use issues. Show all posts
Showing posts with label substance use issues. Show all posts
Thursday, April 22, 2010
Saturday, December 12, 2009
Talking to Kids about Substance Use and Abuse: Who and When
After mentioning some very disturbing statistics a couple posts ago, I would like to address ways that discussion might go and when it might be a good time to have it. Contrary to comments on that post, I am not suggesting you have it with the infants. But depending on various risk factors, I would suggest that it is hard to start too early. I have discussed this before and will probably do so again. The big difference between the last time I discussed this and now, is not the content of the discussion but that I now have evidence to support assertions I will make. I am only going to start this now, because I would like to post the paper I just wrote before I go into too much depth and I am waiting until I know it was graded to do that.
I think the first and most important issue to discuss, is that of what it is appropriate to talk about, with whom and when. I will start with who.
There are a remarkable number of parents out there who believe that they don't need to have this discussion with their child, because their child would never dream of using drugs. I am not engaging in hyperbole when I suggest that there are a lot of parents out there who have buried children they thought would never use drugs. While there are factors that elevate the risk that specific children are more likely to engage in substance use at a rather young age, that doesn't mean children who do not have those risk factors are immune. More importantly, there are risk factors you may not be aware your child has.
There are a lot of neurological issues that come up, that you may not be aware your child has. Your child may have friends who use drugs that you aren't aware of - your child might not even be aware of yet. A particular substance may be making the rounds at you child's school - this happens from time to time. A drug becomes particularly prevalent and is available at a very low price. It is there and because so many kids are using it, it becomes vogue to do so. It is also quite possible that your child is not nearly as open with you as you think s/he is. Your child may be something of a social outcast and you don't even know it - and that is a significant risk factor.
More importantly, as I mentioned in my last drug use post, there are substances that transcend normative risk factors. Pharmaceuticals are huge these days and kids don't necessarily have to raid the medicine cabinet at home. With a lot of children on psych meds (most commonly abused, more than a percentage point or two over pain killers) they can just quit taking their pills, save them up and trade some with another kid who has done the same and take some of both - or more, if they let another kids or so join the fun. I will grant that they usually get a little older before they add alcohol to the mix, but this is behavior that more than 5% of children age 12-13 have at least tried. At least 3% of kids in that age range are abusing pharmaceuticals. What the National Survey on Drug use and Health doesn't say, is that a significant percentage of 9-10 year olds are also trying this. By the time they are old enough that they are more likely to use alcohol, the percentage of kids playing with pharmaceuticals is above the 40% mark.
To be totally clear and rather harsh about it, it is critically important that you discuss pharmaceuticals with your kids. The wrong combination can cause serious problems, even death. Throw some alcohol into the mix and there is an even stronger likelihood that you will go to wake up your child, only to find them stiff and cold and very, very dead. I doubt the thought that this child was a very good kid is going to be much comfort at that point. And no, the fact that your child might well engage in really stupid drug use doesn't make them any less a good kid. It just might make them dead though...
The next question, now that I hope we are clear that all kids should have this conversation with their parents, is when. My own attitude is to start young and never stop. Latch onto opportunities as they present themselves. Don't be preachy and don't be too intense or regular with it. When they are very small, just use their own insatiable curiosity. If you are a drinker, tell them about what you are doing. See something on tee vee, use that as a starting point. As they get a little older, make a point of sitting down with them once in a while, specifically to talk about drugs and drug use. When they get towards 11, 12, 13 - ask them about it. Let them guide the conversation. Talk about it a little bit more often, but not too often.
Most importantly, make sure they know that they can ask you anything they want to know about. Make it clear to them that you would be happy to honestly and openly discuss topics that are important to them - sex, drugs, relationships. Encourage them to develop a habit of talking to you about things that are bothering them when they are young, because that will make it infinitely more likely that when they are confronted with choices like using drugs, they will be inclined to talk to you about it. Also keep in mind that the best time to talk about drugs initially, is before they ever start. Don't assume that they will wait to talk to you - make it clear that there are dangers and that they need to understand those dangers. Also, accept that they may come to you and tell you someone offered them something or another - you can ask, but don't push them for a name. Yes, it would be ideal to know - but they aren't going to tell you if they aren't going to tell you and pushing them will be a detriment to the development of that trust.
As they become teens, make sure you have laid the groundwork already. If you have done your part early on, trust them to come to you with questions. Make sure that you have discussed the specifics - the dangers of various substances and the like - I am going to write another post about how those discussions might sound. If they seem to be depressed, ask them how they are feeling - is there anything wrong that they might want to talk about. If not with you, then with someone else that you trust and they trust. It may well be that they aren't going to be as interested or comfortable talking to you at that point - let it go and encourage them to talk to someone who is trustworthy. About the best you can do is to make it clear you are available and open to them.
Whatever you do, do not lie - we will go into this more tomorrow, but this one is important. Never. Never ever lie to them. If they ask you something about your past that you aren't comfortable talking about (assuming it is age appropriate), my first suggestion would be to get over it and just tell them what they want to know. But shy of that, if you aren't willing to answer, then honestly tell them that. Don't tell them you never did something you did - just tell them that you aren't comfortable talking about that.
Unless of course you have or have had a substance use disorder. At that point all bets are off. Your child has a major risk factor and you absolutely have to make that clear to them. Forget about your pride and all that bullshit. Suck it up and spill it, because your child absolutely must know that you have a problem and that because of that, they are far more likely to have similar problems if they engage in drug use. The thing is, you have an almost magical power at your disposal, one that makes it exponentially less likely your child will have this problem. You tell them they have an elevated risk and you tell them why. Do that and it is exponentially less likely that your child will initiate drug use. This applies to most risk factors, but is considerably more poignant when it comes to owning up to your own issues with substance use.
I am not just pushing shit in your general direction, that I am afraid to do myself. I have had myriad substance abuse problems and will be dealing with them until the day I die. My oldest son has a lot of very significant risk factors besides the substance abuse issues of his dad. My youngest will probably not be too far off his brother's risk factors. We have talked about it before and we will continue to talk about it, my soon to be eight year old son and I.
No, it isn't easy. It is just critically necessary, because I love my boys.
I think the first and most important issue to discuss, is that of what it is appropriate to talk about, with whom and when. I will start with who.
There are a remarkable number of parents out there who believe that they don't need to have this discussion with their child, because their child would never dream of using drugs. I am not engaging in hyperbole when I suggest that there are a lot of parents out there who have buried children they thought would never use drugs. While there are factors that elevate the risk that specific children are more likely to engage in substance use at a rather young age, that doesn't mean children who do not have those risk factors are immune. More importantly, there are risk factors you may not be aware your child has.
There are a lot of neurological issues that come up, that you may not be aware your child has. Your child may have friends who use drugs that you aren't aware of - your child might not even be aware of yet. A particular substance may be making the rounds at you child's school - this happens from time to time. A drug becomes particularly prevalent and is available at a very low price. It is there and because so many kids are using it, it becomes vogue to do so. It is also quite possible that your child is not nearly as open with you as you think s/he is. Your child may be something of a social outcast and you don't even know it - and that is a significant risk factor.
More importantly, as I mentioned in my last drug use post, there are substances that transcend normative risk factors. Pharmaceuticals are huge these days and kids don't necessarily have to raid the medicine cabinet at home. With a lot of children on psych meds (most commonly abused, more than a percentage point or two over pain killers) they can just quit taking their pills, save them up and trade some with another kid who has done the same and take some of both - or more, if they let another kids or so join the fun. I will grant that they usually get a little older before they add alcohol to the mix, but this is behavior that more than 5% of children age 12-13 have at least tried. At least 3% of kids in that age range are abusing pharmaceuticals. What the National Survey on Drug use and Health doesn't say, is that a significant percentage of 9-10 year olds are also trying this. By the time they are old enough that they are more likely to use alcohol, the percentage of kids playing with pharmaceuticals is above the 40% mark.
To be totally clear and rather harsh about it, it is critically important that you discuss pharmaceuticals with your kids. The wrong combination can cause serious problems, even death. Throw some alcohol into the mix and there is an even stronger likelihood that you will go to wake up your child, only to find them stiff and cold and very, very dead. I doubt the thought that this child was a very good kid is going to be much comfort at that point. And no, the fact that your child might well engage in really stupid drug use doesn't make them any less a good kid. It just might make them dead though...
The next question, now that I hope we are clear that all kids should have this conversation with their parents, is when. My own attitude is to start young and never stop. Latch onto opportunities as they present themselves. Don't be preachy and don't be too intense or regular with it. When they are very small, just use their own insatiable curiosity. If you are a drinker, tell them about what you are doing. See something on tee vee, use that as a starting point. As they get a little older, make a point of sitting down with them once in a while, specifically to talk about drugs and drug use. When they get towards 11, 12, 13 - ask them about it. Let them guide the conversation. Talk about it a little bit more often, but not too often.
Most importantly, make sure they know that they can ask you anything they want to know about. Make it clear to them that you would be happy to honestly and openly discuss topics that are important to them - sex, drugs, relationships. Encourage them to develop a habit of talking to you about things that are bothering them when they are young, because that will make it infinitely more likely that when they are confronted with choices like using drugs, they will be inclined to talk to you about it. Also keep in mind that the best time to talk about drugs initially, is before they ever start. Don't assume that they will wait to talk to you - make it clear that there are dangers and that they need to understand those dangers. Also, accept that they may come to you and tell you someone offered them something or another - you can ask, but don't push them for a name. Yes, it would be ideal to know - but they aren't going to tell you if they aren't going to tell you and pushing them will be a detriment to the development of that trust.
As they become teens, make sure you have laid the groundwork already. If you have done your part early on, trust them to come to you with questions. Make sure that you have discussed the specifics - the dangers of various substances and the like - I am going to write another post about how those discussions might sound. If they seem to be depressed, ask them how they are feeling - is there anything wrong that they might want to talk about. If not with you, then with someone else that you trust and they trust. It may well be that they aren't going to be as interested or comfortable talking to you at that point - let it go and encourage them to talk to someone who is trustworthy. About the best you can do is to make it clear you are available and open to them.
Whatever you do, do not lie - we will go into this more tomorrow, but this one is important. Never. Never ever lie to them. If they ask you something about your past that you aren't comfortable talking about (assuming it is age appropriate), my first suggestion would be to get over it and just tell them what they want to know. But shy of that, if you aren't willing to answer, then honestly tell them that. Don't tell them you never did something you did - just tell them that you aren't comfortable talking about that.
Unless of course you have or have had a substance use disorder. At that point all bets are off. Your child has a major risk factor and you absolutely have to make that clear to them. Forget about your pride and all that bullshit. Suck it up and spill it, because your child absolutely must know that you have a problem and that because of that, they are far more likely to have similar problems if they engage in drug use. The thing is, you have an almost magical power at your disposal, one that makes it exponentially less likely your child will have this problem. You tell them they have an elevated risk and you tell them why. Do that and it is exponentially less likely that your child will initiate drug use. This applies to most risk factors, but is considerably more poignant when it comes to owning up to your own issues with substance use.
I am not just pushing shit in your general direction, that I am afraid to do myself. I have had myriad substance abuse problems and will be dealing with them until the day I die. My oldest son has a lot of very significant risk factors besides the substance abuse issues of his dad. My youngest will probably not be too far off his brother's risk factors. We have talked about it before and we will continue to talk about it, my soon to be eight year old son and I.
No, it isn't easy. It is just critically necessary, because I love my boys.
Friday, February 13, 2009
Why I am pursuing a education for a career dealing with addiction
I am now busy as all hell. I have a lot of writing to do in the next week and posting may get sparse, though I may throw some more up as I get into the nuts and bolts of my paper. For now, I just wanted to mention the abysmally poor record of the dominant substance abuse paradigm.
There is very little information available about recidivism, but what there is is chilling. I suspect that the figures we have, strongly contribute to why we don't have more. This is a link to Comments On AA's Triennial Survey, from 1989. This is analysis of survey compilations performed by AA. Of particular interest, is the graph on page twelve, showing that of those who start attending AA, only five percent are there after a year. Other studies (scroll up a couple pages) have shown a slightly better picture, but there is little question that twelve step programs are not for everyone.
Meanwhile, American taxpayers are pumping out two hundred billion a year for substance abuse issues. Add to that the loss of production and other factors, substance abuse costs us more than five hundred billion every damned year.
There is very little information available about recidivism, but what there is is chilling. I suspect that the figures we have, strongly contribute to why we don't have more. This is a link to Comments On AA's Triennial Survey, from 1989. This is analysis of survey compilations performed by AA. Of particular interest, is the graph on page twelve, showing that of those who start attending AA, only five percent are there after a year. Other studies (scroll up a couple pages) have shown a slightly better picture, but there is little question that twelve step programs are not for everyone.
Meanwhile, American taxpayers are pumping out two hundred billion a year for substance abuse issues. Add to that the loss of production and other factors, substance abuse costs us more than five hundred billion every damned year.
Monday, February 2, 2009
Harm Reduction Part 2: How do we Define Success?
The dominant addiction paradigm makes some very strong assumptions about the nature of addiction. It assumes a one size fits all approach, stating categorically that the only measure of successful treatment is complete abstinence from psychoactive drugs. And it assumes that the best method for achieving abstinence is a confrontational model that forces the addict to accept that they are powerless to deal with their addiction. That only through dependence on a higher power, can their addiction be brought under control. This is the basis for the twelve step program for treatment of addictions.
What is truly remarkable about this paradigm, is that it encompasses over ninety percent of addiction treatment in the United States today. It is a multi-billion dollar industry and firmly entrenched in our educational system. Go to med school and you're quite likely to be taught that this is pretty much the end all of addiction treatment. Public policy is based firmly on these ideas. This is remarkable to me, because not only is there no evidence to support this confront/depend on higher power paradigm, there is a lot of evidence that it simply doesn't work for the vast majority of people. Because of the lack of reporting on the part of most twelve step programs, it's hard to come up with very definitive figures, but the estimates range anywheres from a five to thirty percent success rate. Most science based research tends to assume the low end of the spectrum.
This is absolutely insane. At the high end estimates, this means we are failing seventy percent of the addicts who seek treatment. And yet this is the treatment paradigm that we allow to dominate our society and public policy. Don't get me wrong, I don't believe there's some vast conspiracy out there, propping up a failed system for profit. There's very little profit to be had in all this. At it's heart, I think it has to do with the Us/Them dichotomy that makes non-addicts, and especially addicts who haven't accepted what they are, feel better at night. This dichotomy is also very conducive to reinforcing addicts who are sober, because they've beat tremendous odds and manage to stay clean. This makes it really easy to just say; "Screw the other seventy to ninety-five percent."
"They're weak." "They just don't really want it." "They just haven't hit bottom yet." And underlying it all; "I'm better than them." Which isn't to say there isn't a lot of "we failed them," intermixed in all that. But which is more likely to keep this failed system propped up, "I'm better than them," or "we're failing them?"
At the core of this are some important questions to be asked. The same sort of stark, realistic assessments, very much like the self assessments that are an integral part of any addicts quest for control over their own lives. For this post, I am going to focus on one of them; How should we define success in one's battle with addiction? To try to answer this, I am going to ask you to try for a moment to ignore that nagging voice in the back of your mind that insists that success can only be defined as abstinence. Please, just try to pretend you've never heard of AA and other twelve step programs. Open your mind to the understanding that black and white is a flawed, simplistic dichotomy - that life exists in the shades of gray.
Meet Steve. Steve is an alcoholic who drinks from the time he gets out of bed, until he passes out, later in the day. Catch Steve in a rare moment of lucidity and you'll discover that the man is absolutely brilliant, rife with penetrating insight into human nature and it's interplay with the people around him. Steve first got high when he was eight years old. His drinking was out of control by the time he was thirteen years old. Not surprisingly, he never graduated high school, though he did manage a GED. He managed to stay sober in the Marines, at least when he was on duty. Steve spent several years in LA as a gangster, existing in a very ugly frame of reference. When I met him, he had left LA to get away from it all - but the memories of what he had seen, the things that he's done, drove him into the absolute depths of alcohol abuse.
Now meet Allen. Allen is an alcoholic who drinks in the evenings. Allen has, over the years, built a great business. He's also raised one of the very least dysfunctional families I've ever met. He has four fantastic kids, who absolutely adore their parents and who all have the foundation for great success in life. Allen has wonderful friends and is a very well respected, highly regarded member of his community. Not that he or his business are perfect, but his failings are the human failings that everyone can fall victim to, rather than being the result of his drinking. And make no mistake, Allen can drink. He proves that nearly every day of his life. As often as not, he proves it by getting fairly drunk. And it is quite likely that ultimately, Allen's drinking is going to foreshorten his life, though probably by very little.
So lets explore these two people, both men addicted to alcohol, but with very different lives, very different relationships to their drug of choice. According to the dominant paradigm, the only measure by which either of them can be successful, is for them both to abstain from the use of alcohol and other psychoactive drugs. But I would argue that success is in the eye of the beholder, that rather than searching for absolutes, success is very much a relative concept.
If Allen stopped drinking altogether, stayed absolutely clean and sober, what benefit would he gain? Certainly, his health would be positively impacted, though I should be clear that his health is very reasonable for a man his age. As such, this can really be counted as a minor benefit. It won't improve his family life, which is already quite rich and fulfilling. It isn't going to do anything for business, which while less than perfect, is that way because of the economy, not because of Allen's substance abuse. It certainly wouldn't improve his social life, which is largely focused around his brewing of great beers and appreciation for the. To be sure, he does have more to his social life than these, but a lot of his social activities are centered on his appreciation of fine drink.
Ultimately, we need to take into account Allen's relationship with alcoholic beverages. Why he drinks, what he drinks and the circumstances in which he drinks. Allen is a beer hobbyist. He belongs to beer a couple of beer clubs and has even taken classes for judging beer. He and his wife both take part in these activities together. He's taught his son to brew beer, along with a number of friends. He doesn't drink alcoholic beverages that aren't pretty much top of the line. And he never seems to drink alone. For Allen to quit drinking altogether, would require a major shift in how he lives and how he interacts with his friends and family. Since his drinking causes minimal harm to himself and no harm to others, I would argue that there is simply no reason for him to change.
Now lets look more closely at Steve. At first glance, Steve seems to be the typical, at the bottom alcoholic. It would be easy to make the assumption that Steve simply must either quit drinking altogether, or die an alcoholic. Honestly, that may well be the reality of things. The question becomes; Is abstinence from any psychoactive drugs the only measure of success we can use on Steve? What if Steve quit the destructive drinking, but took up smoking pot in the evenings and on weekends? How about if Steve was able to get help from a therapist and get a handle on the problems that have pushed him to drink to such destructive excess and started drinking only in the evenings? Could it not be said that some level of success has been achieved, if Steve is able to functionally work and take care of his family - even if he isn't completely abstinent from alcohol?
While I think it is safe to assume that in Steve's case, abstinence is the underlying ideal, helping him reduce his drinking and become more functional can be considered a success. This is not to say that when he's reduced his drinking and become more functional, that the work is done. Steve has goals that will ultimately require he quit drinking altogether at some point. Taking the step of reducing the drinking would be huge for him and more importantly, his family. Being able to hold down a job and support his family would also make a major difference. But ultimately, Steve wants to be in a position to ensure that he never gets this bad again.
Steve runs into a few problems with our dominant paradigm. One, it requires that he get sober now, instead of letting him take steps to get there. With the exception of his stint in the Marines, Steve hasn't managed to get to sleep without alcohol in almost twenty seven years, since he was thirteen years old. And even in the Marines, it was tough for him to sleep without it. After busting ass all day in training and maneuvers, he was still having trouble with sleeping. And the haunting memories of being a gang banger are still there, even if he gets the drinking to settle into a more functional pattern. But if he can manage to reduce his drinking and work with his therapist to deal with the underlying issues that push the hard drinking, it is likely that he will get there in the end. The other problem that Steve faces in the current paradigm, is that he simply cannot contend with the notion of a higher power. He believes that either god doesn't exist, of if he does, hes "one evil motherfucker," as he put it to me.
It is really easy to stick with the status quo. It doesn't take any work to assume that people who use drugs are out of control and simply cannot get through it on there own. To paint addicts as powerless to deal with their addictions. It's also very easy to create an us/them dichotomy. To assume that "us" are somehow better people, even as we recognize that addiction is a disease and not necessarily the fault of the addict. We all have a mix of feelings about addiction and addicts that just make it really easy to denigrate substance abusers. From equating the worse of substance abuse behaviors, such as driving while intoxicated, or destroying one's family, with everyone who has substance use issues.
Harm reduction, on the other hand, is a good way to get past the black and white and embrace the gray areas. Because most addicts and people with substance use issues live in the gray. Simplistic dichotomies rarely apply. But even harm reduction isn't the end all that some would assume, or at least hope it would be. There is balance that must be struck and there needs to be a tacit understanding that while it fails most people, the current paradigm has it's place as well. In the next post, I will be exploring this, as well as the shortcomings that I see in the harm reduction approach to substance use and abuse. I will be trying to get back into this and posting links to various sources of information, but I am mostly using these posts to try to lay down the information I want to put into my paper. That way I will have all the information in front of me and ready to organize.
I am also thinking on discussing some of my other friends with substance abuse issues, from time to time. Having been a very voracious abuser of substances, I spent a lot of time around abusers of substances and there are several I want to write about. In every case, I am renaming the people involved and trying to change as many details as possible to protect their identities. I am more than happy to post stories with the actual name of the person and more pertinent details about their situations, but will only be doing so with their permission. The thing about harm reduction, as I mentioned in my last post on this topic, is that it is very natural for some people to engage in it. The problem is that the current paradigm assumes that if they don't abstain, they are just deluding themselves. More to go in; Harm Reduction Part 3: Where I Digress or Harm Reduction Falls Short
What is truly remarkable about this paradigm, is that it encompasses over ninety percent of addiction treatment in the United States today. It is a multi-billion dollar industry and firmly entrenched in our educational system. Go to med school and you're quite likely to be taught that this is pretty much the end all of addiction treatment. Public policy is based firmly on these ideas. This is remarkable to me, because not only is there no evidence to support this confront/depend on higher power paradigm, there is a lot of evidence that it simply doesn't work for the vast majority of people. Because of the lack of reporting on the part of most twelve step programs, it's hard to come up with very definitive figures, but the estimates range anywheres from a five to thirty percent success rate. Most science based research tends to assume the low end of the spectrum.
This is absolutely insane. At the high end estimates, this means we are failing seventy percent of the addicts who seek treatment. And yet this is the treatment paradigm that we allow to dominate our society and public policy. Don't get me wrong, I don't believe there's some vast conspiracy out there, propping up a failed system for profit. There's very little profit to be had in all this. At it's heart, I think it has to do with the Us/Them dichotomy that makes non-addicts, and especially addicts who haven't accepted what they are, feel better at night. This dichotomy is also very conducive to reinforcing addicts who are sober, because they've beat tremendous odds and manage to stay clean. This makes it really easy to just say; "Screw the other seventy to ninety-five percent."
"They're weak." "They just don't really want it." "They just haven't hit bottom yet." And underlying it all; "I'm better than them." Which isn't to say there isn't a lot of "we failed them," intermixed in all that. But which is more likely to keep this failed system propped up, "I'm better than them," or "we're failing them?"
At the core of this are some important questions to be asked. The same sort of stark, realistic assessments, very much like the self assessments that are an integral part of any addicts quest for control over their own lives. For this post, I am going to focus on one of them; How should we define success in one's battle with addiction? To try to answer this, I am going to ask you to try for a moment to ignore that nagging voice in the back of your mind that insists that success can only be defined as abstinence. Please, just try to pretend you've never heard of AA and other twelve step programs. Open your mind to the understanding that black and white is a flawed, simplistic dichotomy - that life exists in the shades of gray.
Meet Steve. Steve is an alcoholic who drinks from the time he gets out of bed, until he passes out, later in the day. Catch Steve in a rare moment of lucidity and you'll discover that the man is absolutely brilliant, rife with penetrating insight into human nature and it's interplay with the people around him. Steve first got high when he was eight years old. His drinking was out of control by the time he was thirteen years old. Not surprisingly, he never graduated high school, though he did manage a GED. He managed to stay sober in the Marines, at least when he was on duty. Steve spent several years in LA as a gangster, existing in a very ugly frame of reference. When I met him, he had left LA to get away from it all - but the memories of what he had seen, the things that he's done, drove him into the absolute depths of alcohol abuse.
Now meet Allen. Allen is an alcoholic who drinks in the evenings. Allen has, over the years, built a great business. He's also raised one of the very least dysfunctional families I've ever met. He has four fantastic kids, who absolutely adore their parents and who all have the foundation for great success in life. Allen has wonderful friends and is a very well respected, highly regarded member of his community. Not that he or his business are perfect, but his failings are the human failings that everyone can fall victim to, rather than being the result of his drinking. And make no mistake, Allen can drink. He proves that nearly every day of his life. As often as not, he proves it by getting fairly drunk. And it is quite likely that ultimately, Allen's drinking is going to foreshorten his life, though probably by very little.
So lets explore these two people, both men addicted to alcohol, but with very different lives, very different relationships to their drug of choice. According to the dominant paradigm, the only measure by which either of them can be successful, is for them both to abstain from the use of alcohol and other psychoactive drugs. But I would argue that success is in the eye of the beholder, that rather than searching for absolutes, success is very much a relative concept.
If Allen stopped drinking altogether, stayed absolutely clean and sober, what benefit would he gain? Certainly, his health would be positively impacted, though I should be clear that his health is very reasonable for a man his age. As such, this can really be counted as a minor benefit. It won't improve his family life, which is already quite rich and fulfilling. It isn't going to do anything for business, which while less than perfect, is that way because of the economy, not because of Allen's substance abuse. It certainly wouldn't improve his social life, which is largely focused around his brewing of great beers and appreciation for the. To be sure, he does have more to his social life than these, but a lot of his social activities are centered on his appreciation of fine drink.
Ultimately, we need to take into account Allen's relationship with alcoholic beverages. Why he drinks, what he drinks and the circumstances in which he drinks. Allen is a beer hobbyist. He belongs to beer a couple of beer clubs and has even taken classes for judging beer. He and his wife both take part in these activities together. He's taught his son to brew beer, along with a number of friends. He doesn't drink alcoholic beverages that aren't pretty much top of the line. And he never seems to drink alone. For Allen to quit drinking altogether, would require a major shift in how he lives and how he interacts with his friends and family. Since his drinking causes minimal harm to himself and no harm to others, I would argue that there is simply no reason for him to change.
Now lets look more closely at Steve. At first glance, Steve seems to be the typical, at the bottom alcoholic. It would be easy to make the assumption that Steve simply must either quit drinking altogether, or die an alcoholic. Honestly, that may well be the reality of things. The question becomes; Is abstinence from any psychoactive drugs the only measure of success we can use on Steve? What if Steve quit the destructive drinking, but took up smoking pot in the evenings and on weekends? How about if Steve was able to get help from a therapist and get a handle on the problems that have pushed him to drink to such destructive excess and started drinking only in the evenings? Could it not be said that some level of success has been achieved, if Steve is able to functionally work and take care of his family - even if he isn't completely abstinent from alcohol?
While I think it is safe to assume that in Steve's case, abstinence is the underlying ideal, helping him reduce his drinking and become more functional can be considered a success. This is not to say that when he's reduced his drinking and become more functional, that the work is done. Steve has goals that will ultimately require he quit drinking altogether at some point. Taking the step of reducing the drinking would be huge for him and more importantly, his family. Being able to hold down a job and support his family would also make a major difference. But ultimately, Steve wants to be in a position to ensure that he never gets this bad again.
Steve runs into a few problems with our dominant paradigm. One, it requires that he get sober now, instead of letting him take steps to get there. With the exception of his stint in the Marines, Steve hasn't managed to get to sleep without alcohol in almost twenty seven years, since he was thirteen years old. And even in the Marines, it was tough for him to sleep without it. After busting ass all day in training and maneuvers, he was still having trouble with sleeping. And the haunting memories of being a gang banger are still there, even if he gets the drinking to settle into a more functional pattern. But if he can manage to reduce his drinking and work with his therapist to deal with the underlying issues that push the hard drinking, it is likely that he will get there in the end. The other problem that Steve faces in the current paradigm, is that he simply cannot contend with the notion of a higher power. He believes that either god doesn't exist, of if he does, hes "one evil motherfucker," as he put it to me.
It is really easy to stick with the status quo. It doesn't take any work to assume that people who use drugs are out of control and simply cannot get through it on there own. To paint addicts as powerless to deal with their addictions. It's also very easy to create an us/them dichotomy. To assume that "us" are somehow better people, even as we recognize that addiction is a disease and not necessarily the fault of the addict. We all have a mix of feelings about addiction and addicts that just make it really easy to denigrate substance abusers. From equating the worse of substance abuse behaviors, such as driving while intoxicated, or destroying one's family, with everyone who has substance use issues.
Harm reduction, on the other hand, is a good way to get past the black and white and embrace the gray areas. Because most addicts and people with substance use issues live in the gray. Simplistic dichotomies rarely apply. But even harm reduction isn't the end all that some would assume, or at least hope it would be. There is balance that must be struck and there needs to be a tacit understanding that while it fails most people, the current paradigm has it's place as well. In the next post, I will be exploring this, as well as the shortcomings that I see in the harm reduction approach to substance use and abuse. I will be trying to get back into this and posting links to various sources of information, but I am mostly using these posts to try to lay down the information I want to put into my paper. That way I will have all the information in front of me and ready to organize.
I am also thinking on discussing some of my other friends with substance abuse issues, from time to time. Having been a very voracious abuser of substances, I spent a lot of time around abusers of substances and there are several I want to write about. In every case, I am renaming the people involved and trying to change as many details as possible to protect their identities. I am more than happy to post stories with the actual name of the person and more pertinent details about their situations, but will only be doing so with their permission. The thing about harm reduction, as I mentioned in my last post on this topic, is that it is very natural for some people to engage in it. The problem is that the current paradigm assumes that if they don't abstain, they are just deluding themselves. More to go in; Harm Reduction Part 3: Where I Digress or Harm Reduction Falls Short
Friday, January 30, 2009
Harm Reduction Part 1: Addiction, Substance Abuse and Therapy
If you haven't already, I would like to strongly recommend that you listen to this podcast, or read through some of the transcript here. It will provide a very solid introduction to the Harm Reduction approach to addiction treatment. And please, do not take anything said in this post as an excuse for addictive patterns that lend themselves to self-abuse. This is something ideally discussed with a therapist. Short of that, discerning what any individual is really dealing with in their substance use requires a great deal of honest self assessment.
I am having some trouble with pushing on through this discussion. I want to warn you that one, I am using some strong language in this post and two, I am going to take a while to tie it all together. I expect to put two more posts into this discussion. I really am going somewhere with this and am arrogant enough to say that it's a point worth getting to. I really hope you will understand that while I am not afraid to discuss whats going into this, what I am talking about is rather painful - pain that I am dealing with right now. Bear with me, I like to think it will be worth it.
More...I am really glad that I decided to relax last night, instead of pushing through and finishing the post I was working on. Not only do I feel better now, I have a somewhat altered perspective to talk about. I had a rather busy morning and really have a fair amount to get done this evening and into tomorrow. But I think I need to take the time for this right now.
I just had a very intense session with my therapist. On top of my general neurological proclivities, on top of being in school for the first time in sixteen years, I am trying to muddle through the very worse experience of my life. And it's been fucking brutal. Not one to deal with stress and anxiety very well in the best of times, it takes a lot for me to simply stave off meltdown. Add to that, that I have been abstaining from cannabis, traditionally my warm comfort in times of extreme anxiety. For the first time in years, I'm really having the urge to drink and get trashed (as apposed to simply wanting a beer or good bourbon, because I enjoy them).
To make things worse, I have been trying to get in to see the doctor so I can get on meds. I set an appointment for the 20th, back in early December - only to have them call and cancel because they made a mistake. So I tried to reset, twice they've set then canceled, again, due to mistakes. This has not helped with my anxiety issues. All together it's everything I can do not to curl up in a corner and descend into fucking hysterics. The upshot, is that I have an appointment Monday, to see the doctor I grew up with. It will cost money I really don't have, but it will also help me succeed in school and make it easier to avoid losing it.
What the hell does any if this have to do with addiction you ask?
I am an addict, an abuser of substances. By most measures I'm an alcoholic, in spite of being capable of the occasional drink without falling into a binge. It wouldn't be inaccurate to call me a marijuana addict. No question I'm thoroughly addicted to cigarettes. I could go on, but I think you get the picture. I'm an addict, an addict who has a fairly high degree of success at manging his addictions - excepting the cigarettes. But according to the dominant addiction paradigm, I am an abysmal failure.
My measure of success is not that of the dominant addiction paradigm. I am not abstinent. Even though I am not drinking, it's because I know that if I have a drink right now, I could well lose it and fall into self-abusive behaviors. A year from now, hell maybe in a few months, it will probably be perfectly safe for me to have a drink. I like good beer and I love good bourbon, but my fondness is limited to a single drink, two at the most. Beyond that I don't like to drink.
My reasons for abstaining from the weed are a little different and will probably be a very long-term, if not permanent decision. It was no longer performing the function I wanted it to and in some cases was actually increasing my anxiety instead of reducing it, as it traditionally has. Beyond that I have other motivations for quitting that far outweigh the desire to get stoned.
How did I get here?
Several years ago, I had a fortuitous encounter with a cognitive psychology professor who busted me, sitting in on one of his lectures. We ended up spending more than an hour talking in his office and one of the topics that came up was my ADHD and a theory that's been floating around for a long time about it. He explained that it seems likely that ADHD is in part a dopamine deficit. This was ultimately pretty earth shattering for me, because it ended up having a profound effect on how I looked at my use of psychoactive drugs and even some of the things I love to do, like writing and playing music.
Over the course of the weeks, months and years after that conversation, I began to formulate a whole new personal drug use paradigm. The initial concept was simple and not necessarily well affected - it's ok to get high, the problem is getting wasted all the time. As time passed, I began to take increasing ownership of my drug use. Never having heard the term, I had stumbled upon the harm reduction approach to substance abuse, or as Dr. Denning puts it, substance use issues. I am far from unique in this. I don't have some special knowledge or brilliant fucking insight that no one else can have. I figured this out because with a bit of introspection it just makes sense.
I will continue this discussion a little later, maybe tomorrow. It was a productive day and a very good session in therapy, but it has also been a fucking brutal day in many regards.
I am having some trouble with pushing on through this discussion. I want to warn you that one, I am using some strong language in this post and two, I am going to take a while to tie it all together. I expect to put two more posts into this discussion. I really am going somewhere with this and am arrogant enough to say that it's a point worth getting to. I really hope you will understand that while I am not afraid to discuss whats going into this, what I am talking about is rather painful - pain that I am dealing with right now. Bear with me, I like to think it will be worth it.
More...I am really glad that I decided to relax last night, instead of pushing through and finishing the post I was working on. Not only do I feel better now, I have a somewhat altered perspective to talk about. I had a rather busy morning and really have a fair amount to get done this evening and into tomorrow. But I think I need to take the time for this right now.
I just had a very intense session with my therapist. On top of my general neurological proclivities, on top of being in school for the first time in sixteen years, I am trying to muddle through the very worse experience of my life. And it's been fucking brutal. Not one to deal with stress and anxiety very well in the best of times, it takes a lot for me to simply stave off meltdown. Add to that, that I have been abstaining from cannabis, traditionally my warm comfort in times of extreme anxiety. For the first time in years, I'm really having the urge to drink and get trashed (as apposed to simply wanting a beer or good bourbon, because I enjoy them).
To make things worse, I have been trying to get in to see the doctor so I can get on meds. I set an appointment for the 20th, back in early December - only to have them call and cancel because they made a mistake. So I tried to reset, twice they've set then canceled, again, due to mistakes. This has not helped with my anxiety issues. All together it's everything I can do not to curl up in a corner and descend into fucking hysterics. The upshot, is that I have an appointment Monday, to see the doctor I grew up with. It will cost money I really don't have, but it will also help me succeed in school and make it easier to avoid losing it.
What the hell does any if this have to do with addiction you ask?
I am an addict, an abuser of substances. By most measures I'm an alcoholic, in spite of being capable of the occasional drink without falling into a binge. It wouldn't be inaccurate to call me a marijuana addict. No question I'm thoroughly addicted to cigarettes. I could go on, but I think you get the picture. I'm an addict, an addict who has a fairly high degree of success at manging his addictions - excepting the cigarettes. But according to the dominant addiction paradigm, I am an abysmal failure.
My measure of success is not that of the dominant addiction paradigm. I am not abstinent. Even though I am not drinking, it's because I know that if I have a drink right now, I could well lose it and fall into self-abusive behaviors. A year from now, hell maybe in a few months, it will probably be perfectly safe for me to have a drink. I like good beer and I love good bourbon, but my fondness is limited to a single drink, two at the most. Beyond that I don't like to drink.
My reasons for abstaining from the weed are a little different and will probably be a very long-term, if not permanent decision. It was no longer performing the function I wanted it to and in some cases was actually increasing my anxiety instead of reducing it, as it traditionally has. Beyond that I have other motivations for quitting that far outweigh the desire to get stoned.
How did I get here?
Several years ago, I had a fortuitous encounter with a cognitive psychology professor who busted me, sitting in on one of his lectures. We ended up spending more than an hour talking in his office and one of the topics that came up was my ADHD and a theory that's been floating around for a long time about it. He explained that it seems likely that ADHD is in part a dopamine deficit. This was ultimately pretty earth shattering for me, because it ended up having a profound effect on how I looked at my use of psychoactive drugs and even some of the things I love to do, like writing and playing music.
Over the course of the weeks, months and years after that conversation, I began to formulate a whole new personal drug use paradigm. The initial concept was simple and not necessarily well affected - it's ok to get high, the problem is getting wasted all the time. As time passed, I began to take increasing ownership of my drug use. Never having heard the term, I had stumbled upon the harm reduction approach to substance abuse, or as Dr. Denning puts it, substance use issues. I am far from unique in this. I don't have some special knowledge or brilliant fucking insight that no one else can have. I figured this out because with a bit of introspection it just makes sense.
I will continue this discussion a little later, maybe tomorrow. It was a productive day and a very good session in therapy, but it has also been a fucking brutal day in many regards.
Here I am, I am just a man
this is my life, starting all over again
nearing the end my last life was broken.....
this is my life, starting all over again
nearing the end my last life was broken.....
Thursday, January 29, 2009
In The Meantime.....
I am working on a post about the research I am doing for my first paper. It involves the harm reduction approach to addiction, or as Patt Denning Phd puts it, substance use issues. The post I am working on is actually a discussion of Dr. Denning's terminology, which I heard in this podcast. Wherein Dr. Denning is interviewed by Dr. David Van Nuys and provides a wonderful introduction to harm reduction.
Unfortunately, I don't think I'll be finishing that post tonight. Surprise, surprise, I've gotten a little distracted. In part, I am distracted by Over the Influence by Patt Denning, Jeanie Little and Adina Glickman, which I picked up for the paper. But I'm also a bit distracted by a headache and will probably be putting Over the Influence down before long and maybe picking up a little brain candy to feed the geek inside me.
Unfortunately, I don't think I'll be finishing that post tonight. Surprise, surprise, I've gotten a little distracted. In part, I am distracted by Over the Influence by Patt Denning, Jeanie Little and Adina Glickman, which I picked up for the paper. But I'm also a bit distracted by a headache and will probably be putting Over the Influence down before long and maybe picking up a little brain candy to feed the geek inside me.
Subscribe to:
Posts (Atom)