We Set You Up For Failure
When people go to a detox facility, they’re not there because at some point they picked up a drink or a drug and thought to themselves “hey, I’d really love to start a lifelong habit that’s going to wreck my physical and mental health, destroy all of my relationships, make me lose my dignity and sense of self, maybe lose my car, maybe lose my house or marriage or children.” No one fucking thinks that addiction is going to happen to them.
No one thinks that this game is going to end up causing them to sell their body for drugs, or end up unhoused living on the streets, or living at a sober living home at the age of 45.
I’ve never met a patient who said “yeah, I definitely thought I’d get addicted to heroin and be at a methadone clinic at four a.m. every day so that I don’t use a needle.” Those conversations don’t happen. Not in my experience at least.
It usually goes something like this:
I was sexually abused by my family member at age 6
My whole family is addicted to something and that’s what I grew up thinking was normal
I have chronic pain and nothing else was working
I got raped in my 20’s
My boyfriend was violent
My mom died and she was my best friend
I found out my husband had another family
My son died
I had an accident and was prescribed Oxy and then moved on to heroin once I built a tolerance to Oxy
My dad beat the shit out of me as a child
It’s a list of pain. My patients were searching for a way to solve a problem and they used what was available to them. And when they’re detoxing and reviewing everything that the drugs or the drink cost them, I just listen and let them feel the weight of it all. Because if they don’t feel it, they’re not going to move forward. They’ll go right back to everything that numbed all of their pain. And I probably would too. So I let them feel it in a safe environment.
And I honestly don’t know which is the harder part for them: going through withdrawals and taking a look at everything they’ve lost in a controlled environment, or leaving the facility and trying not to go back to the habits of addiction. Both seem pretty miserable to me.
The thing about addiction treatment in America is that we as clinicians, doctors, nurses, program directors, and behavioral health technicians shove PHP, IOP, and 12 Step meetings down our patient’s throats. Yet 40-60% of people with substance abuse challenges relapse (the statistics vary but the common numbers are about 50-60%.) So we’re selling something that doesn’t work. And then we judge people when they inevitably relapse.
PHP and IOP are the recommended treatments after patients complete detox and some level of inpatient substance abuse treatment. PHP and IOP means that you do group therapy between 12-25 hours per week. You get drug tested. You usually live in a sober living home-which requires you to go to 12 step meetings ON TOP OF the IOP/PHP groups you are already doing. It’s a lot of therapy. And it’s a lot of 12 step meetings. And if you have a medical marijuana card-you’re not allowed to be in PHP/IOP because they require you to be 100% abstinent. Despite all of the evidence that has shown that marijuana has medicinal efficacy; it helps with sleep and anxiety-two things that most people in recovery have challenges with. But no marijuana if you’re going to do what the clinicians are recommending. Our society would rather your relapse on Fentanyl than smoke marijuana when you’re anxious. And if you’re on Medication-Assisted Treatment (Suboxone, Vivitrol, Methadone) then your options for what sober living home you can go to and what IOP/PHP program you choose are even more limited. Because still, even in 2024, the majority of us require 100% abstinence. Some facilities and 12 step programs and sober living homes view being on medications such as Suboxone or other forms of MAT as not being completely abstinent. So they think that using a medication being MANAGED AND PRESCRIBED BY A DOCTOR to reduce the cravings for a drug or a drink is equivalent to using a needle to inject heroin in your neck. We have this stigma about Suboxone and Vivitrol and other forms of MAT. Go to a pharmacy and ask for your Suboxone prescription and watch the pharmacy tech shift their attitude. It’s the “you’re a junkie” attitude. It’s the judgment for using a medication as a tool instead of using a needle or snorting a pill.
What we are asking of patients is not fucking realistic.
Where is the balance? Where is the consideration that JUST MAYBE what we have been doing is not working as evidenced by all of the research? Why do we continue to stay inside the stupid box that says a patient needs to give up everything and do exactly what WE THINK is best for them? Where is the self-efficacy here?
Why aren’t we encouraging people to MAKE THEIR RECOVERY LOOK THE WAY THEY WANT IT TO-however that may look for them. It’s different for EVERYONE. Not everyone needs group therapy 25 hours a week. Not everyone connects with AA/NA-not everyone’s higher power is God so that shit doesn’t work for everyone.
Some people can benefit from marijuana. Some people can benefit from a fucking exercise program. Some people can benefit from 1:1 therapy. Some people can benefit from getting connected to nature. Some can benefit from psychedelic therapy.
Not everyone is the same and we shouldn’t be prescribing the same shit for every patient.
IT JUST DOESN’T WORK.
Treatment and Recovery | National Institute on Drug Abuse (NIDA) (nih.gov)
