the revolving door


Points has an interview with Bill White. He makes several points that his followers will be very familiar with, but I don’t remember him putting it together so concisely. I’ve also heard him discuss recovery capital and acute care models, but never heard him frame the acute care model as working well for low to moderate severity with high recovery capital. It puts a different frame on the the persistence of the model and cultural barriers to changing it.

. . . the cultural fate of addiction treatment may well be dictated by a more fundamental flaw in the very design of addiction treatment and the field’s capacity or incapacity to respond to that design flaw. Modern addiction treatment emerged as an acute care model of intervention focused on biopsychosocial stabilization. This model can work quite well for people with low to moderate addiction severity and substantial recovery capital, but it is horribly ill-suited for those entering treatment with high problem severity, chronicity, and complexity and low recovery capital. With the majority of people currently entering specialized addiction treatment with the latter profile, the acute care model’s weaknesses are revealed through data reporting limited treatment attraction and access, weak engagement, narrow service menus, ever-briefer service durations, weak linkages to indigenous recovery support services, the marked absence of sustained post-treatment recovery checkups, and the resulting high rates of post-treatment addiction recurrence and treatment readmission. Addiction treatment was developed in part to stop the revolving doors of hospital emergency rooms, jails and prisons. For far too many, it has become its own revolving door. Slaying the Dragon documents these weaknesses and current efforts to extend the design of addiction treatment toward models of sustained recovery management nested within larger recovery-oriented systems of care—with the “system” being the mobilization of recovery supports within the larger community.

I’m grateful to work in a program that provides long term care and support.

Leave a comment

Filed under Uncategorized

A sentence to ponder


“If they overdose and kill themselves, it just removes them from the gene pool.”

State Senator Rob Schaaf, a family physician who argues that allowing the government to keep prescription records violates personal privacy. (Source: NYT; hat tip: @DavidJuurlink)


Filed under Uncategorized

“not all marijuana users are of equal concern to us”


Keith Humphreys imagines the reactions of various stakeholders to this graph showing marijuana consumption Colorado.

  • He imagines public health workers expressing concern about the bottom two bars and trying to promote policies that will reduce the amount these heavy users consume.
  • Next, he imagines a corporate board room voicing interest in attracting users in the bottom two bars to their brand and finding ways to retain them.
  • Finally, he puts us in the legislature, which is torn between improving public health and the tax revenue these heavy users provide.

He adds that this illustrates that there is no such thing as value-free policy.




Filed under Uncategorized

1 in 8 deaths among Ontario young adults were attributable to opioids

CanadaA study of opioid-related deaths in Ontario was recently published. There were some really stunning findings.

First, over 20 years, the opioid-related death rate increased by 242%.

During the 20-year study period, we identified 5935 people whose deaths were opioid-related in Ontario. The median age at death was 42 years (interquartile range 34–50 years), 64.4% (n = 3822) of decedents were men and 90.0% (n = 5340) lived in an urban neighborhood. During the study period, rates of opioid-related death increased dramatically, rising 242% from 12.2 deaths per million in 1991 (127 deaths annually) to 41.6 deaths per million in 2010 (550 deaths annually; Figure 1).

Second, young adults have been hit especially hard. [emphasis mine]

The highest absolute increase occurred among individuals aged 25–34 years, in whom the proportion of deaths related to opioids increased from 3.3% in 1992 to 12.1% in 2010.

. . .

The finding that one in eight deaths among young adults were attributable to opioids underlines the urgent need for a change in perception regarding the safety of these medications.


When we see these kinds of statistics in the US, we’re left to wonder the role that poor treatment access played.

We conducted a serial cross-sectional study of all opioid-related deaths in Ontario, Canada between 1 January 1991 and 31 December 2010. Ontario is Canada’s largest province, with more than 13.2 million residents in 2010, all of whom have access to publicly funded health insurance for physician and hospital services.

I don’t know much about the kind of treatment that’s been available to Ontario addicts. It’d be interesting to learn more about that.



Filed under Uncategorized

Radical Recovery

This week’s Throwback Sunday is Bill White’s description of radical recovery.


Be-The-Change-e1348837935700For MLK day, here’s an article by Bill White on “radical recovery.” He describes a convergence of social activism and addiction recovery.

The article offers a model that goes well beyond the the interests of recovering people themselves and encourages advocacy in larger community contexts:

A radical recovery movement is now rising in America. That movement is flowing from the realization that addiction and its progeny of problems are visible everywhere, while recovery from addiction lies hidden. It is rising in the recognition that the stigma attached to AOD problems has increased in recent decades and has fueled the demedicalization and recriminalization of these problems. What started out as “zero tolerance” for drugs rapidly evolved into zero tolerance for people with AOD problems. It is in this regressive climate that a style of recovery is emerging that is radical in its scope (focus on environmental as well as personal transformation), radical in its inclusiveness (celebration of multiple pathways and styles of recovery), and radical in its synthesis of social responsibility and personal accountability. People in recovery are looking beyond their own addiction and recovery experiences to the broader social conditions within which AOD problems arise and are sustained. A radicalized vanguard of people in recovery is using personal transformation as a fulcrum for social change. They are living Gandhi’s challenge to become the change they wish to see in the world. Those who were once part of the problem are becoming part of the solution.

1 Comment

Filed under TBS

I don’t get it

scott_pilgrim__noclue_getsit_by_nippey-d31sjjcYesterday, I read this, “we still don’t get addiction” article and was a little bemused.

The article presents an argument that addiction is a learning disorder and presents this as a controversial theory.

It’s not.

She also presents it as a theory that undercuts the ideas that addiction is a brain disease and that it’s a chronic disease.

It doesn’t.

Addiction is a disorder of learning. It’s also a disorder of motivation, a disorder of pleasure, a disorder of  memory, a disorder of stress responses and a disorder of choice. Environmental and social factors influence the development, course, severity and response to treatment. None of this is considered controversial.

Without much controversy, ASAM recently defined addiction as, “a primary, chronic disease of brain reward, motivation, memory and related circuitry.”

For years, I’ve advanced the idea that there are multiple mechanisms involved in addiction and that some addicts may have all of them, while people with  less severe substance use problems might have one or two. I’d also assume that we do not know of all the mechanisms.

Somehow, “we” still don’t get it.

The post is clearly meant to discredit most of the information we know and hear about addiction. Why? Especially on the basis of an idea that’s so widely accepted? I don’t get it.

I wasn’t the only person who noticed. DrugMonkey took exception with a post titled “Insinuations, misdirections, straw arguments and obsfucation in drug abuse journalism“.


Filed under Uncategorized

Moderation’s hard work for an alcoholic!

44685143AfterPartyChat has a really interesting first person piece from an alcoholic who tried Moderation Management.

Every now and then my addiction tries to convince me that I never truly hit bottom with alcohol and could probably drink moderately again one day. When that happens, I remind my disease that I’ve tried that, thanks. Before surrendering to 12-step recovery, I tried Moderation Management, a secular support group for “non-dependent problem drinkers.”

. . .

. . . would choose a certain number of drinks as their daily maximum. Ideally, we’d scale back our max each month until it stayed firmly in the green zone: four drinks for men, three for women. I could never manage a limit below five. The most annoying part of this wasn’t counting the physical drinks, it was figuring out how many drinks my drinks counted as. Some cocktails, and even some beers, contained enough alcohol for two or even three standard drinks. All in all, it was a lot more math than I’d bargained for.

. . . you couldn’t drink more than two days in a row. So if you wanted to party (moderately) on Friday and Saturday, both Thursday and Sunday were off limits. I struggled with the two-day rule even more than with the daily max. It completely changed my conception of what a weekend was.

Very interesting, and not written with an axe to grind. Read the whole thing here.

Leave a comment

Filed under Uncategorized