Chapter 2: Different Pathways to Recovery

Everybody’s path to recovery is different. It seems like common sense to me now, but for a long time I was led to believe otherwise.

As I’ve mentioned before, I first started trying to quit heroin within four months of starting. I went to a doctor, which was a total failure. This was the same doctor who less than a year earlier had offered me a “free sample” box of Wellbutrin for what was obviously more than just a case of mild depression.

Most of my attempts at quitting heroin for the next two  years involved buying various different types of prescription painkillers to ‘taper down.’ When the withdrawal symptoms disappeared, I imagined I was cured. Then, I convinced myself, if I just cut back to using once every 2 or 3 days I’d be good. You can guess how well that turned out.

Eventually my habit became so expensive I gave up on my well-paying software job and developed a fairly lucrative career as a petty thief. At one point I was bringing in over $500, almost all of which went toward drugs, and the occasional ‘Debbie Cake’ for nutritional sustenance.

When you’re stealing all day, every day, even when you’re really great at it, statistics are bound to catch up with you. And so began my many run-ins with the law.

My first offenses were met with probation and suggestions I go to twelve step meetings. As I racked up more offenses, the 12-step meetings became mandatory.

The mere fact that I was being forced to attend made me less-than-receptive to their message. I just went to get my sheet signed to keep from going to jail.

But eventually I started listening. And I wanted to try. But their message just didn’t click. “Try a different meeting,” folks would tell me. And so I did. Didn’t work. None of them spoke to me. And, given that I had a crippling fear of talking with strangers when I wasn’t taking drugs, there’s no way I was going to get a sponsor.

Twelve-step programs work for some people, but the number is substantially smaller than advocates have led us to believe. Their response is that, well, they just weren’t working their program. They haven’t hit their bottom. And so on. The logical fallacies in this approach–and that so many people blindly accept them–are mind boggling. To me, those meetings just seemed like a place to gossip and share stories about our awful pasts, not the hope we had for a brighter future.

Before I was ever introduced to twelve step programs, I’d heard about methadone. And almost everything was negative. “Liquid handcuffs.” “Worse than heroin.” “The withdrawals last for months.” “Trading one drug for another.”

More than six years after I first started using I entered a methadone program. Within a few I discovered much of what I’d been told were myths. For me, methadone was a miracle. By that point I’d given up hope of ever quitting. I was simply counting the days away until it was all over; me dead in some gutter, lost and forgotten, and missed by no one. Methadone turned my life around.

Methadone won’t work for everyone–and that’s OK. For me, a long-time heroin user ready for a change, it did. After about three years I switched to Suboxone. The great thing about Suboxone, and I won’t get too scientific here, is that it binds to your brain’s opioid receptors more strongly than just about any other opioid. For me, that was great. It meant when I was on Suboxone and I did a shot of dope I felt nothing–NOTHING! If I wanted even a little buzz I had to skip my dose for a day or two. Eventually I decided it wasn’t worth the hassle. My love affair with heroin quietly faded away. I don’t count my non-using days because I don’t even remember the last time I used. It was unremarkable in every way, although it was a major milestone in my life.

Once I was on Suboxone I was finally able to get treatment for everything I’d been self-medicating with heroin: anxiety disorders, bipolar disorder, PTSD, emotional trauma, the list goes on. The unbelievable thing is that through all my tries at recovery, getting proper mental health care (not just handfuls of useless antidepressants) rarely came up. It never came up at twelve step meetings, although my SMART facilitator did gently suggest I consider it more than once.

My story is packed with twists and turns, as are most stories of those struggling with substance use disorders (SUDs). Most of us try to stop using when we’re ready, but unless we have the proper support and guidance, it’s just like Sisyphus, pushing an unbearable load up a mountain we’ll never scale.

If you have a loved one struggling with substance misuse, here are a few pointers, based on my experience and the stories I’ve gleaned from others. These aren’t hard and fast rules, but I think they do deserve consideration:

  • We need a loving, non-judgmental support system. Too often parents and loved ones impose their own thoughts or preferences, with the best of intentions, which only pushes us further away. We need someone to support us, someone we can lean on, someone who loves us unconditionally. It’s maybe the most important factor to successful recovery. (Community Reinforcement and Family Training [CRAFT] is great at teaching family members these skills)
  • Sometimes we’re not ready to stop using, but that doesn’t mean we haven’t thought about it. Until we’re ready to stop, harm reduction approaches can keep us alive. Harm reduction approaches look to engage more people in treatment by taking judgment out of the equation, acknowledging that people move through stages of change, they meet us ‘where we’re at’, and encourage small positive steps. I wasn’t exposed to harm reduction until after I stopped using–and I ended up with hepatitis C because I was sharing needles. I still have scars on my hands, arms, and feet from reusing the same needle–sometimes for as long as a month. Harm reduction keeps us alive and more healthy, but it also makes us think about our using in a different (safer) way. Harm reduction practices can break down barriers we often don’t even notice.
  • The Internet is packed with myths and misinformation about drugs and drug treatment. You might be amazed what getting the right information into the hands of a loved one with an SUD can accomplish. If I’d known the truth about methadone when I was first exposed, I might have been spared that two year prison sentence. If I’d known where to get clean syringes, I might not have contracted HCV or have to wear long sleeves in the summer to hide the reminders of my dark dance with heroin.

There’s no shortage of alternatives to abstinence-based approaches out there. Here are just a few treatment and support options, but it’s by no means comprehensive. Feel free to chime in with comments with on what’s worked for you:

  • Methadone-maintenance treatment (MMT)t: sometimes patients can come off opiates entirely this way, but sometimes they’ll need methadone the rest of their lives. And that’s OK. The decision should be up to them and their doctor. The CDC has declared the most effective treatment for heroin use, but the stigma around treatment remains a critical barrier to treatment.
  • Suboxone treatment: similar to MMT. It’s recommended long-time opiate users stay on suboxone at least a year before trying to taper off. Some of us might need suboxone the rest of our lives. I’m one of those people and, while I’m cool with that now, it took a long time to accept it because of the stigma.
  • SMART Recovery: Self Management and Recovery Treatment (SMART) is an evidence-based recovery recovery program that uses cognitive-behavioral therapy and other proven methods. Most importantly for me, they accept medication-assisted treatment (MAT), like methadone, suboxone, and anxiety medications. That’s something many twelve step groups look down on, marginalizing some attendees to the point they take their medicine (even antidepressants and antipsychotics) in secret.The SMART terminology helped reduce much of the stigma I’d internalized and helped me realize I wasn’t using because I had character defects, but because I had mental health issues that weren’t being addressed.
  • Moderation Management (MM): For decades the dominant position in the recovery community was that total abstinence from drugs and alcohol was the only way to recover. “One is too many and a thousand is never enough,” the old saying goes. We’re powerless over our addictions and even one drink or hit of weed constitutes a relapse. Recent research suggests that, for some people, this isn’t necessarily the case. Some people can reduce their drinking to healthy levels. With drugs, the case is a little cloudier. Can one use moderate amounts of heroin, cocaine, or methamphetamine successfully? I’ve know a handful who can, but I can’t say for sure.

One thing is certain: The old mantras the rehab industry and much of the recovery community have propagated for decades are being called into question. There are no hard and fast rules when it comes to recovery.

Now, what can we do from a policy perspective to insert these alternatives into a justice system and rehab industry that are slow to adapt? Many drug courts won’t even consider allowing clients to participate in MAT or twelve-step alternatives. That’s slowly changing, but not nearly fast enough. The abstinence-only position of many rehabs and drug courts are not only likely to fail, they can be fatal. When opiate users leave a 30-day program, get kicked out of rehab, or leave drug court, they’ve lost their tolerance for opiates. When they go back out and use, they’re at a significantly higher risk of overdose. This has to change.

The evidence is out there that we’re all different and, as such, all our needs are different. With that in mind, what will it take to find people with SUDs the treatment that’s most effective for them? What steps are we willing to take to make sure rehabs and courts don’t treat our loved ones as just another statistic, or a cardboard cutout capable of being “cured” by a one-size-fits-all approach?

These are important questions, and how we respond to them will determine the course of substance misuse treatment–and the lives of our loved ones–for years to come.

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