FSDP Blog

Reflections on Stigma’s Insidiousness in the Addiction Treatment Community

A therapist colleague of mine who doesn’t work within a harm reduction framework has a nephew who is struggling with problematic substance use and she shared with me last week that she finds herself being more sympathetic to her clients than her nephew about their drug use.

fsdp-our-missionI had the same reaction as her when I was involved as a family member in my own family’s therapy experience when my nephew was working on his substance misuse issues. It was before I was a harm reduction therapist and my incongruent reaction to this opened my eyes to my own perceptions of my substance using clients and I realized just how pervasive the judgments about people using substances are in our culture.

fsdp-donateThe judgments were so ingrained for me, it took me several years to shed these stereotypes, but as family members we don’t have the luxury of time and such an opportunity for this awareness. These judgments are damaging to individuals and families in treatment–damage that makes healing that much more difficult. It reinforces, and sometimes adds to, the trauma that many people enter treatment wanting to address.I’ll be exploring the effects of stigma on our families in future posts and would love to include your reactions on how it has affected you and your relationhip with your loved one, and what have you done, or do, to adjust…

I’m curious about people’s reactions to this from the perspective of a family member, a person using substances, or a treatment provider?

Any suggestions for reducing the treatment-inducing stigma that can can be such a barrier to good care? Email me at barry@fsdp.org with your experiences and I’ll share them in future blog posts.

An FSDP Advocate Planting Seeds of Harm Reduction in the South

FSDP is proud of our team of advocates and we’re pleased to share the latest blog post from our  Community Outreach Advocate Janet Goree and how she is planting seeds of harm reduction in the Georgia state corrections system…

As Community Outreach Advocate for Families for Sensible Drug Policy,  I take every opportunity to embrace and share our mission of empowering families to increase access to effective substance use disorder treatment and reduce the harmful consequences of oppressive drug policies.

After my youngest child was sentenced to a very long prison sentence I looked for a support and advocacy group where I could make a difference, an organization that was doing work that I could believe in. I found FSDP and knew I was home, especially because of the focus on families.

One of my regular outreach activities is visiting the Mitchell County Correctional Institute, a medium/minimum security facility housing 135 state inmates as well as 24 county offenders. The facility sits just on the outskirts of the tiny town of Camilla Georgia where I live.  Every other month I arrive at the facility on a Friday morning to speak to a roomful of inmates whose release dates are in sight.

The facility is run by Warden Bill Terry and is an exception in Georgia because of the commitment of the warden and his programs manager Kim Hatcher. They want to make sure the men leaving their facility have as many tools possible to make sure they never return.

My background is in child abuse prevention, which I became involved in after the shaking death of my granddaughter Kimberlin. I became involved in prison reform after my son Bobby was sentenced to thirty years in prison for robbing a drugstore.

Janet G blogI have just started to introduce harm reduction into the presentation. The first part of my presentation to the inmates is about the stressors they will be facing when they get out and some ways they can cope with them. I do an exercise with them called ” match the crime to the time”. The two crimes are 1) shaking a six week old child causing her death, and 2) robbing a drugstore while being improperly withdrawn from methadone at the hands of a professional. No one was physically injured.

The two sentences are 1) five years probation and 2) thirty years mandatory minimum. While most on the outside not involved with theJanet G blog1he work we do would guess that the murder of the child would certainly be the more severe sentence, the guys on the inside all get it. You see there is no money in locking up murderers but hundreds of millions of dollars have been made behind the war on drugs. Both of these crimes and sentences have impacted my family as my son Bobby is the one serving thirty years.

Just before I leave I tell them about FSDP and assure them that there are people out working very hard to change things, people that care about them. I look each and every one of them in the eye and wish them luck. Then I quietly say a little prayer as I walk out the doors they are locked behind.

FSDP and Our Global Partners Bring a New Paradigm of Family Drug Support to the United States

Our heartfelt presence at The International Harm Reduction Conference #HR17 in May 2017 was a springboard for a dynamic and thought provoking weekend: A celebration of family empowerment that filled attendees with enthusiasm and hope, while offering enlightened strategies, tools, and opportunities for advocacy.

Day 1: Workshop on Peer-Led Family Support Model18664623_1720713967945235_3219150813966158127_n

The two-part weekend that followed was an expansion of our global partnership including Liz Evans and Mark Townsend (not pictured) of New York Harm Reduction Educators (NYHRE) and Washington Heights Corner Project which featured a workshop introducing Tony Trimingham’s Family Drug Support (FDS) model (in center at right with Barry Lessin and me) and an international panel discussing the life-saving value of Supervised Injecting Facilities (SIFs).

Our families have a vital role in the development and resolution of how substance use impacts their home—for far too long our families have not been afforded the opportunity to engage as active participants and problem-solvers. The weekend offered a new paradigm of support for families impacted by substance use.

18581706_10102491791666402_8890817018380267324_n-3The weekend events, highly lauded by a passionate gathering of family members and clinicians, were a milestone for FSDP, allowing us to offer our vision of tangible support for families, based on what families need, expect and experience. This model of support helps families better understand and strengthen the connection between ourselves and loved ones who use substances. The peer-led support groups present viable alternatives for families to explore potential solutions and coping strategies.

Day 2: International Panel about a Public Health Response Proven to Save Lives: Supervised Injection Sites (SIFs)

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We were delighted to have CNN political commentator Symone Sanders (at right, between Liz and Tony) emcee the gathering at the Malcom X and Dr. Betty Shabazz Memorial and Education Center in Harlem. It was a moving interactive presentation before a diverse and engaged audience. The featured presentations were delivered by harm reduction pioneers Tony and Liz, who poignantly shared their own personal stories reflecting the inspiration that led them to do their groundbreaking work that included establishing successful SIFS in Sydney and Vancouver, respectively.

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Evidence from years of research is conclusive that SIFs reduce HIV and hepatitis transmission risks, prevent overdose deaths, reduce public injections, reduce discarded syringes, and increase the number of people who enter drug treatment. Across the globe, there have been no reported fatalities from an overdose in an SIF.

Personal Relevance

My own personal journey as a parent and healthcare advocate was inspired by the compelling and relatable perspectives shared during the presentations, as I too am a mother who is devastated by the recent loss of my precious son and student of the world, Bryan.

Bryan’s life parallels many young lives who, despite a loving relationship with a beautiful new wife, a supportive family in his corner and an amazing circle of friends who believed that laughter was the best medicine, his valiant attempts with sustainable periods of time in and around “recovery” were ultimately circumvented by much of what does not work about a ‘one size fits all’ model. Far too many young lives are tragically being lost to an accidental and fatal overdose that is preventable!  

My own perspectives and belief system came full circle from the early days when our families were first indoctrinated to the mantra of the addiction professionals champing for ‘hitting bottom’ and ‘detaching with love’ as the remedy. Despite a decade-plus of extensive and ongoing attempts by my own family to embrace the recommendations of the traditional treatment industry, our personal situation continued to implode on a downward spiral of pricey interventions, therapeutic wilderness programs, and exorbitant rehabs that over promised and under delivered.

Myths like encouraging us to use the criminal justice system, or advising us that advocating for our child’s well-being essentially reduces us to ‘enablers’ and ‘codependents’, only exacerbated the family issues and compromised health rather than supported it. If only we had the opportunity to turn our focus to empowerment and safeguard our loved ones with viable medical models during those times that they were in active addiction. Many people with problematic substance use have little or no access to evidenced-based care, or simply were not ready or able to embrace a path that was limited to abstinence-based recovery.

Our families deserve person-centered screenings and alternative solutions that meet them where they are with the goal of optimal health and wellness based on individual needs and unique circumstance.

Stay tuned to learn about more of our upcoming events as our momentum moves forward towards the Fall, where we will be representing the voice of the family at the 2017 Drug Policy Alliance Reform Conference.

 

Representing the Voice of the Family at the 2017 International Harm Reduction Conference #HR17

C_DNaZxXgAAUhpMRepresenting our family voices in the global harm reduction community, FSDP Co-Founder Barry Lessin and I enthusiastically attended the 2017 International Harm Reduction Conference #HR17 in Montreal, Canada, May 14-17, 2017.

The theme of this year’s conference was ‘At the Heart of the Response’ and addressed “innovative harm reduction services, new or groundbreaking research, effective or successful advocacy campaigns and key policy discussions or debates. With delegates from more than 70 countries the programme not only reflects the truly global nature of our movement but also addresses key international issues”

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We had the opportunity to meet with our global partners Australian Family Drug Support (FDS) powerhouse Tony Trimingham (right) and Shaun Shelly (below) to identify the issues that are unique to families and bringing the family voice into our home communities. The inspirational and motivational moments were continued with a dynamic and thought provoking celebration of family empowerment that culminated in New York City May 20-21, 2017 with an extraordinary weekend filled with enlightenment and hope. Barry and I are energized and privileged to bring the FDS model of family support to our cherished friends here in the United States. We remain humbled and honored to serve our growing network of families who are asking for non judgmental alternatives to support optimal health and well being for their loved ones impacted by substance use while managing their own needs and self care in the process.

FSDP AC_9Zk_UUwAAB1qWdvisory Board member Shaun Shelly (whom we got to meet in person for the first time!) explaining the challenges and successes in his groundbreaking work in harm reduction service delivery to his native South Africa.

One of the highlights of #HR17 for many of the attendees was the dynamic presentation given by Andrew Tatarsky (right) on “The Scientific Revolution of Addiction Treatment”, exploring how his model os Integrative Harm Reduction Psychotherapy 18558570_1716762775007021_2210259828598535816_o(IHRP) can enhance harm reduction services and make addiction/substance misuse treatment relevant to the majority of problematic drug users who have been turned off or hurt by traditional abstinence-only treatment.

18527769_1714581398558492_4107739766811187219_nPausing to honor the dedication and commitment of our global partners, appreciating the connection and spirit of compassion shared among cherished friends like Zeeshan Ayyaz Shani, who sadly could not attend because of visa related obstacles. Paying tribute to his courageous advocacy and extraordinary efforts on behalf of drug users in Pakistan through his exemplary work with Middle East and North Africa Harm Reduction Association (MENAHRA).

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Barry and Tony discussed the new collaboration of Tony’s Family Drug Support model of family support and FDSP’s commitment to bring strategies and solutions into the homes of our families!. Below, Tony joins me, Deborah Peterson Small, who spoke at a morning plenary on the global priorities of drug policy, and Ernie Drucker, valued mentor to FSDP and author of “A Plague of Prisons”. 
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Stay tuned for more about FSDP’s next steps in our collaboration with Tony’s Family Drug Support to empower families, restore health and save lives…

FSDP to Address Aspiring Medical Professionals in Philadelphia, PA

14731154_10154153120499195_2687285408442853763_n - Version 2Families for Sensible Drug Policy (FSDP) Co-Founder Barry Lessin and FSDP members Brooke Feldman and Kenneth Anderson will be on a panel to discuss “The Culture and Misperceptions of Addiction” with medical students at the Philadelphia College of Osteopathic Medicine on Thursday, January 5, 2017, 5:30 to 7:30pm this Thursday.   This is an amazing opportunity to reach healthcare providers at the beginning of their careers with a message about harm reduction and compassionate, evidence-based care for substance use problems.  

Said Barry, “I spent most of my career as an abstinence-only, one-size-fits-all psychologist until I became aware of the War on Drugs five years ago and began viewing drug use and people who use them through a human rights and public health lens. I realize now that using this model was doing more harm than good by reinforcing stigma and shame by blaming my clients for the lack of success in treatment. I now embrace a harm reduction, client-centric approach and feel it’s important to share my harm reduction knowledge and experience with people who will have an important impact in providing care.”

Brooke Feldman, an outspoken recovery advocate and Huffington Post columnist [link], as well as FSDP member, said, “It is imperative that all medical professionals understand substance use and its related impact on whole health and wellness.  Only through truly understanding the delicate interplay between mental and physical health, including alcohol and other drug use, medical professionals can be best positioned to practice the holistic, integrated care that is the future of quality healthcare in this country.”

Kenneth Anderson, Executive Director and Founder of Harm Reduction, Abstinence and Moderation Support (HAMS) and long time FSDP member, broke down the myths and facts he plans to address at the session:

Myths and facts about substance use disorders

Myth: Everyone with an addiction dies from it unless they get addiction treatment.

Fact: 90% of people with alcohol dependence recover whether they get treatment or not. For drug dependence the rates are even higher; 98-99%.

Myth: Lifetime abstinence from all mood altering substances except caffeine and nicotine is necessary for recovery from addiction. 

Fact: Half of all people with alcohol dependence recover via controlled drinking. Marijuana is frequently an exit drug from more harmful substances.

Myth: Addiction treatment is effective.

Fact: Most treatment centers do not use evidence based treatment even if they claim to do so for the sake of collecting insurance payments. The odds of dying of heroin overdose after graduating from a 28 day inpatient program are 3,000% higher than if one continues to use heroin with no treatment.

Myth: Patients must be confronted and forced against their will into AA because they are in denial and only the 12 step program is effective.

Fact: The more people are confronted the more they will drink. Actually listening to what the client wants is the most effective approach here as it is everywhere else. Although some people benefit from the AA fellowship, others, including myself, are greatly harmed by it. I nearly drank myself to death before I left AA.

FSDP continues to be the voice of families affected by the cruel and ineffective drug war, everywhere from the meetings where policy is made to the institutions where new healthcare professionals are trained.  Stay tuned for an update after the event!  

 

FSDP at the Southern Opioid Epidemic Symposium

FSDP’s Co-Founders Barry Lessin and Carol Katz Beyer, and our Harm Reduction Coordinator Jeremy Galloway represented us at the Southern Opioid Epidemic Symposium held at Emory University’s Rollins School of Public Health this past week.

The symposium convened academic, medical, research, policy, and government stakeholders to identify and develop strategies to advance a comprehensive response to the opioid epidemic in the South and beyond.

Barry Lessin was invited to speak, and here’s the text of of his talk “The Significance of the Family in Developing Harm Reduction Strategies and Practices in the Southeast and Beyond:

15541250_1393299694023257_4760824146094682188_n“I’m an aging hippie from the VietNam war protest days when I came of age, during the drugs, sex, and rock and roll era and as a result developed an ingrained distrust of the federal government.

When FSDP was invited to join the Southern Collaborative on Opioid Harm Reduction , my initial thought was ‘Oh my God, I’m going to meet with the government to talk about drug use. I hope they don’t ask me too many questions about my past’. My worry and disbelief quickly dissolved when we got to the meeting and saw how serious the government is about attacking the opioid problem with comprehensive harm reduction …

We’re again a very divided nation, even more so in some ways, but I have optimism because of our ability to convene forums like this to tap into the brilliant minds gathered here to identify life-saving solutions to this public health epidemic.

So being here is an exciting and encouraging moment for myself, co-founder Carol Beyer, Jeremy Galloway and the 1000s of families and diverse stakeholders we represent because it’s an opportunity to be a part of process of an ongoing collaboration with this esteemed community to address the needs of the millions of families who have suffered the direct consequences and collateral damage of substance use and the existing harmful drug policies.

FSDP is a global coalition of families, professionals, organizations and drug policy reform advocates who view substance use through a human rights and public health lens. Viewed this way, Harm reduction interventions, are a natural fit for managing substance use, but have rarely found their way into family settings.

We have listened to our families, parents and users alike, sharing their lived experiences of being harmed by a broken treatment system that uses ineffective, often unregulated treatment methods, that treat people more like commodities to fill beds than patients being provided effective care.

When people relapse with other complex problems similar to addiction that require lifestyle changes like cancer, heart disease, and diabetes, we don’t blame the person for treatment failures, we don’t tell them they’re in denial, or they ‘need to ready’ or they must ‘hit bottom, we don’t throw them in jail, or kick them out of schools.

With other conditions, we respond with scientific, commonsense, and compassionate approaches and we look at the treatment methods that are failing them and do more research to provide better treatments.

Families are in a unique position to directly influence the development or resolution of substance use problems because substance use doesn’t take place in a vacuum but in the normal context of family life and relationships as well as the wider culture that the family resides in.

We know that problematic substance use is a complex interaction of psychological, biological and socio-cultural variables. Prohibition-based drug policies directly contribute to a cultural narrative that views the substance as the primary problem, ignoring the uniqueness of each family, the culture it exists in, as well as the family’s strengths and resources.

We don’t have to reinvent the wheel–harm reduction approaches are already in place for other conditions. We can use this knowledge to extend these benefits to implement family-friendly strategies and practices in combatting the opioid problem.

FSDP bring diverse communities together to embrace enlightened drug policies—empowering families, restoring health, saving lives. We are dedicated to identify a vision and approach that will provide solutions and pathways forward…

Our meeting here offers us an opportunity for us to engage with the communities brought together here who share the public health lens of substance use, to be catalysts for change by tapping into your knowledge as scientists, educators, and healthcare providers to eventually develop the necessary strategies and practices and the hands-on tools to offer our families to restore our health to the level we deserve.”

Families for Sensible Drug Policy (FSDP) Team Reflects on the 11th National Harm Reduction Conference

IMG_2911In early November, Team FSDP went to San Diego to represent the voice of families affected  by the Drug War at the 11th National Harm Reduction Conference. The conference is a gathering of over 1,200 activists, treatment professionals and policy makers working to reduce the harms of substance use. We gave poster presentations, spoke on panels, and staffed a very busy table in the Exhibition Hall.

It seemed like everywhere we went, people sought us out for our perspective on the latest in policy, treatment, and activism. It was clear to me that we are respected as the organization that represents families fighting for change.

Some reflections from our team:

“My life was enriched by attending the HRC conference. I encountered so many dedicated professionals in the field. The movement has grown since I got involved with the organization to a level that will make harm reduction standard for drug treatment.” – Beth Herman, FSDP Nurse Advocate

“My experience at the HR Conference gave me great hope that intelligent, hard working and insightful people are working to bring science, empathy, compassion and proven results to the Harm Reduction movements. After my experience in prison, I was not hopeful that there were efforts at work to lessen the harms caused by incarceration on people that use substances. After meeting people like FSDP’s Corrections Health Advocate Julie Apperson I now can see that there are many intelligent hard working people, both inside and outside the system, trying to lessen the harms of incarceration.” – Dale Schafer, FSDP Legal Advocate and Sentencing Reform Specialist

“The HRC conference was an affirmation for me that a society grappling with complex challenges can still find compassion, innovation and humanity under one roof.”– Carol Katz Beyer, FSDP Co-founder and Vice President

“Being at the HR conference is like a homecoming for me. It’s where I got a new lease on my professional career as a harm reduction psychologist and where I can re-connect with a supportive community and learn about the latest developments in the public health and harm reduction world.” – Barry Lessin, FSDP Co-founder and President

I personally found it to be a life-changing event. I’ve never felt so surrounded by unconditional love, and so united in purpose with hundreds of people I’ve never met. I wrote more about the opening panel here.

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In the day to day struggles we all face as we try to fight against the cruel and deadly Drug War, it’s easy to feel alone and powerless. Being a part of Team FSDP at the Harm Reduction Conference made me realize that we are never alone – we are surrounded by friends worldwide who know exactly what we are going through and support us every step of the way. Together, as FSDP, we make our voice heard!

Families for Sensible Drug Policy at the 11th National Harm Reduction Conference in San Diego!

12809723_996162890465550_5205762628852637136_nEvery two years, the leaders and the soldiers in the fight for sane and sensible drug policy gather together for three days of learning, laughing, sharing, and sometimes crying.  At the 11th National Harm Reduction Conference, people from all wings of the movement – needle exchange pioneers, treatment professionals, activists, and families who have fought a drug war in their own homes – join forces.

It was my first Harm Reduction Conference, yet I felt I was among friends.  Meeting FSDP Co-founder Carol Katz Beyer for the first time was like hugging a family member I hadn’t seen in years.  No one has to ask each other why they’re there – we all share a bond of feeling, very personally, the wreckage of the drug war and the impact it has had on those we love.  

The FSDP booth in the Exhibition Hall was buzzing.  We met AIDS educators, Students for Sensible Drug Policy (SSDP) members, needle exchange pioneers from states where needle exchange is still illegal, and marijuana legalization advocates.  I was especially excited with Jeannie Little, co-author of Over the Influence and one of my personal heroines, came by the table.   The heroes of harm reduction – people whose books decorate my coffee table and serve as references in my masters’ thesis – are so warm and accessible, happy to chat with a newbie and share a hug.  

Many of our members presented or spoke on panels:

“Missed Opportunities for Intervention in Correctional Facilities: Barriers to Harm Reduction Interventions and Solutions for Change”– Dale Schafer, FDSP Legal Advocate and Sentencing Reform Specialist, and Julie Apperson, FSDP Correctional Health Reform Advocate. 

“Nine Stories: The Experience of LGBT Individuals in 12 Step Rehab”– April Wilson Smith, FSDP Harm Reduction Epidemiologist 

“Red State Harm Reduction: Naloxone, Medical Amnesty and Drug Policy in the Bible Belt–Jeremy Galloway, FSDP Harm Reduction Coordinator 

IMG_3951One of the highlights of the conference was the panel on Health and Correctional issues, where FSDP Legal Advisor and Sentencing Reform Specialist Dale C. Schafer and FSDP Corrections Health Reform Advocate Julie Apperson spoke (pictured at right).  Dale talked about his experience spending 52 months in prison for growing a small amount of marijuana. It was hard to believe that such a distinguished attorney had actually spent time behind bars, and for nothing more than growing a medicinal plant to give to some friends who were sick.  

Julie spoke about her work to reform the prison health system, where inmates are routinely denied needed services. Medication is used as a weapon by guards who can arbitrarily deny inmates access to needed pills.  Psychiatric care is almost impossible to get, and even if a patient has insurance on the outside, they are not able to use that insurance to pay for needed care on the inside.  Julie’s passion for reforming prison health services led her to change her nursing career and go into the difficult world of behavioral health.  Her own son is currently in a correctional facility, and she fights for the rights of people like him every day.

The Harm Reduction Conference was such a big event that one post couldn’t hope to cover it, but one thing was clear: Families for Sensible Drug Policy is an internationally recognized voice for the families who have been affected by the senseless drug war.  Everywhere we went, leaders in the movement recognized us and sought us out.  We contribute a unique perspective to the conversation on drug policy – a conversation that all too often leaves our voices out.  

Being a part of team FSDP at the Harm Reduction Conference left me energized and ready to take on the fight!  Hope to see you there next time!  

— April Wilson Smith, FSDP Harm Reduction Epidemiologist

Chapter 7: Stigma, Harm Reduction, and the Future of Medication-Assisted Treatment

Killing Us with Stigma

At a time when heroin use and overdoses are exploding across the country, Tennessee just passed a law tightening restrictions on Suboxone (buprenorphine), one of the most effective treatment options available to opiate-dependent people.

Advocates for laws like this rely on the excuse that Suboxone is sometimes misused, which is true. But what’s missing from this equation is that its misuse can be an unintended consequence of restricting access to it. What’s also ignored is that, even when it’s misused, Suboxone is safer than unregulated street drugs like heroin or prescription pain medications.

Buprenorphine, the active ingredient in Suboxone, causes less respiratory depression (the usual cause of overdose) than other opioids because it only partially activates the brain’s opioid receptors. There are very few cases of overdose death by buprenorphine, and almost all those cases involved mixing with other drugs.

Stigma contributes to the lack of accurate information available to the public on medication-assisted treatment (MAT) and its effectiveness. It also contributes to policies that severely restrict access to those who need it most, directly contributing to the likelihood of increased diversion of these medications.

Maine’s Governor Paul LePage is pushing to cut funding for methadone clinics in favor of suboxone, despite the fact that 98% of patients in MAT programs rely on methadone and methadone is still considered the “gold standard” for treatment by the CDC.

Methadone treatment has been controversial for decades, despite studies that indicate long-term success rates as high as 60-90%. We see and hear plenty of methadone horror stories, but the media rarely covers the lives of those who have been saved by MAT (props the Gainesville Times for being one of the few to take that bold step).

Lack of Availability

Because of laws restricting the number of methadone clinics in certain areas (like the one in Indiana, which was just eased after a wave of overdose deaths and an HIV/HCV outbreak) or the number of patients allowed by clinics and suboxone doctors, patients seeking treatment are often left on waiting lists or unable to find treatment where they live.

I live in rural North Georgia, about 70 miles north of Atlanta. There are no methadone clinics and one Suboxone doctor in my county. The nearest clinic is over 30 minutes away. In eastern Tennessee there are only two cities with methadone clinics. In Mississippi there is one clinic. North Dakota and Wyoming have none. (A methadone clinic directory is available here, and a list of Suboxone doctors here)

Even in large cities with multiple clinics the wait time can be weeks or months. Having been in that situation, I know I’m not the only heroin user who never made it to my intake appointment.

The art of quitting opiates and other drugs is delicate. It has to be done on the patient’s schedule. When someone is ready for treatment, that opportunity needs to be available immediately, because next week their mind might be somewhere else. (Once, I changed my mind after checking myself into a hospital, which led to an awkward showdown with an elderly security guard and enough ativan to put an elephant out for a week)

To become eligible to prescribe Suboxone, doctors must pass a special course, after which they’re eligible to prescribe to 30 patients at a time. This limit can eventually expand to 100. No other drug is administered or regulated in this way and it creates a barrier to treatment that not only makes getting an appointment difficult, but makes office visits nearly impossible to afford, on top of the cost for the medicine.

Many patients coming off years of misusing drugs don’t have insurance, or even a job, so that money comes out of pocket. Considering the low risk of overdose and abuse (some people do misuse Suboxone–I’ve tried and got absolutely nothing, so take that for what it’s worth), and the high cost of people dying from overdoses, spending time in jail or prison, and drug-related property crimes, increasing the patient limit is critical toward making suboxone a viable route for treatment.

Teaching Harm Reduction to Counselors

In my 3+ years in a methadone program, I had five different counselors. Not only did that complicate building a relationship with someone I could trust, it put me at a greater risk for relapse. The counselor had no idea why I was sitting in front of them, aside from the notes my previous counselor had typed into a computer.

During my time in that methadone program, I was never taught about or provided naloxone, instructed what to do if I witnessed an overdose, or any other harm reduction practices. The only thing we heard was not to take benzos (xanax, klonopin, etc) which is certainly good advice, but that didn’t stop it from happening.

Even when I failed a drug test, there was no discussion about why I failed, how dangerous it might have been, or how I could have at least made the situation less dangerous.

Fortunately, I discovered SMART Recovery not long after entering that program, and learned the skills there. But from what I’ve seen, and what evidence from other clinics indicates, there’s a desperate need for methadone counselors to be trained in harm reduction practices.

One of the groups I work with, Georgia Overdose Prevention, is visiting methadone clinics across the state to train counselors about naloxone and how to administer it. When we raise the idea of providing naloxone kits to patients, a group that often has direct access to the most at-risk drug using communities, the issue is tabled until later; which boggles my mind. It seems that, even if they have to absorb the cost, their legal obligation of patient overdosing would be greatly reduced.

The fact that such an important issue is treated with so little concern demonstrates not only the need for teaching harm reduction skills to counselors and clinic directors, but proving the value of harm reduction in those settings.

Alternative and Progressive Treatments
As we continue our struggle to de-stigmatize methadone and suboxone programs and patients, there are progressive treatments that reveal promising research–and are likely to make steam blow out of the ears of some US journalists and politicians.

Heroin-assisted treatment (HAT) has been used in parts of Switzerland, the UK, Germany, Spain, Denmark, Belgium, Luxembourg, and recently Vancouver, as a second-line treatment when methadone and suboxone treatments fail.

HAT patients are administered controlled amounts of pharmacological-grade heroin in a safe, clean setting with sterile equipment. Contrast this to sitting in a car, ducked down, seat-belt wrapped around your arm, trying to find a vein (with a needle you’ve been using since who-knows-when), praying the cops don’t roll up on you. Never mind there’s no telling how potent or what’s contained in the shot of dope you just put in your arm.

HAT can be effective for patients where other forms of MAT have failed. It has the benefits of reducing use of unregulated and unsafe street heroin, reducing crime, has better retention rates than other forms of MAT, and reduces demand for heroin on street markets–which leads to a reductions in violent and nonviolent crime. (More information on HAT from the Drug Policy Alliance, The Lancet, and the British Journal of Psychiatry)

Alternative treatments, such as ibogaine and other psychedelics, will require more research before they’re viable, but show promising results. Some long-time heroin users have reported being “instantly cured” after ibogaine treatment, but such treatment is illegal in the US, making research difficult and treatment (which might be administered by someone with no medical credentials) dangerous.

The Future of MAT and Saving Lives the Hard Way

We have decades of evidence demonstrating the success of MAT, yet stigma and legal restrictions around these treatments create barriers that are literally letting people die, suffer, and waste away in prison cells. Our nation’s ‘War on Drugs’ has literally become a ‘War on Drug Users.’

To end on a bright note, the medical and drug treatment communities are finally casting aside the old, failed methods of drug treatment in favor of evidence-based treatments–individual and family psychotherapy based on a biopsychosocial model that treats the whole person, MAT, and new alternative treatments that were unimaginable just a few years ago.

The future of drug treatment and life for those living with SUDs shows promise for improvement, but it’s going to take hard work, from many angles. Whether we’re out in the streets or in the halls of our legislative buildings we can, and with the right determination will, make it happen.

FSDP is dedicated to bringing together these resources and people to neutralize stigma, advocate for more common sense drug policies, and employ our collective power to stand up and “Just Say No” to the War on Drugs– and the stigma, pain, and death it leaves in its wake.

Chapter 6: Substance Use and Mental Illness

I first noticed signs of a mood disorder shortly after I turned 16. One month everything was awesome, life was grand. Then the next month I couldn’t even crawl out of bed for work or school. I remember hearing “Manic Depression” by Jimi Hendrix and thinking: That’s what I have!

I grew up with a stepdad who was physically and verbally abusive, used drugs (sometimes) and alcohol (almost always). When he was sober, my stepdad was a great guy. Sometimes I even wanted think of him as my dad–especially given that my biological father abandoned us. But in that environment, talking about my feelings wasn’t safe, and so, I bottled them up.

You can only pack so many feelings into your brain’s inner-bottle before something gives. In my mid-20s, when I found myself tossing and turning every night, butterflies kicking around in my stomach, and bad thoughts racing through my mind, I finally went looking for help.

I told my doctor what was going on: My anxiety was so bad I had physical symptoms. I hated being around people. It was impossible to form an emotional bond with anyone, even my kids. Sometime I couldn’t sleep, others I could work all night, non-stop.

She sent me home with a box of antidepressants, a sample dropped off, no doubt, by the latest pharmaceutical rep.

I tried the pills for a few weeks with no luck. I went back complaining that my symptoms were getting worse. So she wrote me a prescription for another antidepressant. This yielded the same result. After a few times of that, I gave up on doctors.

Within a few months of my last visit, I was injecting heroin every day.

When Self-Medication is the Only Medication You Can Find

Despite the “Drug War” myths I’d heard growing up, I wasn’t “hooked” on heroin instantly (and, in fact, most people who try drugs–even heroin–never become addicted). I did, however, notice an immediate effect on my mental condition. It was like someone twisted the top off that bottle and a decade’s worth of worries floated away. Heroin felt like medicine.

I was able to function for two years as a software engineer using heroin every day. The stereotypes you hear about drug users aren’t always true.

Heroin almost completely eliminated the stress of a 70-hour, 24/7 on-call work week. Later, when I began bartending and waiting tables, I relied on the excuse that being on drugs made me “more fun to be around” and better at my job (which was true to an extent, until my habit spun back out of control).

Eventually life caught up with me. Heroin is expensive. Even with a well-paying job, I was unable to support a daily habit and pay the rent. I found myself in a self-perpetuating cycle that only reinforced my need for more drugs.

When I started seeking treatment, the only options I could find were twelve step programs. I attended meeting after meeting, and nothing clicked. If anything, being told that I used drugs because of character defects and that I was powerless seemed counterproductive. It crystallized what I already thought about myself by that point: I was a bad person doomed to be an “addict” for life.

Through countless AA and NA meetings, several trips to inpatient and outpatient treatment, a detox facility, a dozen different courtrooms, and two years in prison (where I was offered no substance abuse treatment), at no point-of-contact with any of these institutions was I offered, or was it suggested I might benefit from, mental health treatment.

USA! USA!
It was only after I entered a methadone program and started attending SMART Recovery, a free,  evidence-based alternative to twelve step programs, that a facilitator suggested I might be self-medicating mental health issues.

The tools I learned in SMART made me feel like I could take back control of my life. Through SMART’s cognitive-behavioral therapy (CBT) and rational-emotive behavioral therapy (REBT), I learned several important skills:

  • Instead of giving in to urges or cravings to use, I could distract myself with positive activities
  • I could be on methadone or suboxone and still be in “recovery.” This was critical, because opiates did, and still do, feel like a critical part of my medical care
  • REBT taught me to dispute irrational thoughts–it wasn’t certain events that made me sad or depressed, but my thoughts about those events
  • That using once wasn’t a traumatic failure. I could slip and still keep moving forward. They differentiate between a slip, a lapse, and a relapse
  • That by changing the words I used to express thoughts about myself, my using, and my problems, I could move beyond being an “addict” to simply a person dealing with problems that I was now empowered to overcome

One of the most important things SMART taught me was unconditional self-acceptance (USA). This turned my self-esteem around and helped me survive until I was able to find effective mental health treatment. I still use these skills today, and they can be applied to more than just substance use disorders (SUD) or mental health issues.

I first noticed symptoms of mental illness in 1994. I started using heroin in 2004. It wasn’t until 2015 that I was properly diagnosed with bipolar disorder, general anxiety disorder, and post-traumatic stress disorder (PTSD).

It took me 20 years to even find my entry point to treatment for mental health issues which, had they been treated sooner, might have spared me that decade-long relationship with heroin.

The 2012 SAMHSA National Survey on Drug Use and Health indicates that 43.7 million (almost 19%) of adults live with some form of mental illness and that 20.7 million adults (almost 9%) have an SUD. About 8.4 million have both mental health disorders and SUDs. That means over 40% of Americans with SUDs also have mental health problems (and those are only the people who have been diagnosed).

According to the National Institute on Drug Abuse (NIDA), 40% of those with an SUD also have a mood disorder and about 30% have an anxiety disorder. They also estimate that genetics constitute 40-60% of a person’s risk for developing a SUD. So what about the rest?

Good News, It’s Not Your Brain — It’s Your Everything
For many years addiction was treated as a “brain disease.” This model presumed some people were “wired” to become addicted to drugs or alcohol, powerless victims with no ability to control their behavior. This was the standard belief in most of the drug and alcohol treatment community for over half a century.

But recent research (and in fact, some that dates back to the 1970s) paints a much more complicated picture. The brain does play a role in SUDs, but there’s more to a person than just their brain, and the same holds true for people who use drugs.

Data from NIDA and the CDC indicate there are a number of contributing factors to substance misuse, including emotional trauma, physical or sexual abuse, poverty, social pressure, and more. The “psychobiolsocial,” model provides a better explanation for why some people are at greater risk of developing an SUD than others.

Dr. Andrew Tatarsky, in his article “We Don’t Treat Brains, We Treat People,” describes a more comprehensive approach to managing SUDs. He writes that:

Accumulating data and clinical experience support a “psychobiosocial” model in which biology and behavior intersect with meaning and social context in complex ways that are unique to each person and give rise to the problematic and addictive behavior.”

Psychotherapy, which focuses on the patient’s mental, emotional, and physical well-being, is a critical component of treatment for people with SUDs and mental health disorders. Instead of focusing strictly on the brain, psychotherapy also addresses physical, social, and environmental causes. Tatarsky describes his approach as “a personalized treatment for substance misuse and addiction that goes beyond the one size fits all model of abstinence.

Connecting the Dots
As my experience demonstrates, finding effective treatment for mental health disorders or SUDs is not easy. While more effective treatments are becoming available, connecting patients to those treatments remains a problem.

From a policy level we must, at a minimum, provide better opportunities for mental health screening and treatment at every point of contact with the medical, drug treatment, and criminal justice systems. It shouldn’t take over 20 years for someone to find help, especially given my multiple encounters with all three.

We need funding for mental health programs and evidence-based treatment programs, but we also need an integrated approach to treatment for SUDs and mental health issues. We need more effective educational resources so that when people recognize symptoms, like those I first noticed as a teenager, they know where to turn and aren’t afraid to ask for help.

Life for those of us with co-occurring mental health issues and SUDs is especially dangerous, especially when it comes to suicide and encounters with police, not to mention overdose. There are effective treatment options out there, but without resources that make them accessible, most of us with co-occurring disorders might never find our way to a “normal” life.


More resources:

More from NAMI on Substance Use Disorders and Mental Health Conditions: http://www2.nami.org/Content/NavigationMenu/Inform_Yourself/About_Mental_Illness/By_Illness/Dual_Diagnosis_Substance_Abuse_and_Mental_Illness.htm

NAMI Dual Diagnosis Fact Sheet: http://www2.nami.org/factsheets/dualdiagnosis_factsheet.pdf

Harm Reduction Psychotherapy: A New Treatment for Drug and Alcohol Problems, by Dr. Tatarsky

Practicing Harm Reduction Psychotherapy, Second Edition: An Alternative Approach to Addictions, by Pat Denning