“According to RBP’s 2013 annual report, Suboxone had sales of $1.2 billion. It is ranked at #39 of the top 100 drugs prescribed in the U.S., placing it above Viagra, Adderall and (generic) hydrocodone. To give this some context, Suboxone revenue is three times that of Super Bowl advertiser/provocateur Go Daddy, and dwarfs brands including Urban Outfitters and Ameritrade. In the U.S. more revenue was generated by Suboxone sales than the entire digital music download business.” –Dawn Roberts
This story of a recent University of Michigan student who died while combining Adderall and alcohol touches upon a recent theme in this blog.
Six weeks ago, her son collapsed after snorting ground-up Adderall and chasing it with enough alcohol to stop his heart.
Adderall, if you don’t know, is a prescription drug used to combat attention deficit disorder. Yet among college students, it’s prized for so much more, notably its euphoric high, speed-like jolt and, most deviously, its ability to trick the body during alcohol consumption, so that you can binge, and then binge some more.
. . .
He just wanted to drink on the weekend, ease back on the throttle a bit as he adjusted to his new work life, to adult life — he’d taken a job in sales in Chicago. The problem was the method, one he’d learned on campus, as so many thousands do.
Yes, Julie Buckner knows her son made a mistake. She also admits that she worried when her son joined a fraternity. As a college graduate, she remembers alcohol on campus — she went to U-M.
Then she attended Saturday’s U-M game against Appalachian State. What she saw scared her.
“It’s on a different level now,” she said of the drinking. “What my son did isn’t out of the norm of what’s going on in campuses. And it’s gotta stop.”
This story comes on the heels of a recent uproar about Arizona State University banning drinking games and beer bongs at tailgate parties before football games.
This ASU policy was recently discussed on sports radio with hours of ranting about other schools that have attempted to impose restrictions and that these restrictions quash the fun of tailgating and destroy tradition.
To me, these stories offer an example of cultures of addiction (and various tribes within them) being alive and well on college campuses. (One could argue whether this is really a culture of addiction, because most of the participants are not addicted. However, for the our purposes here, Bill White defined a culture of addiction as “an informal social network in which group norms promote excessive drug use.”)
In a recent discussion, I observed that some areas might be discussed as “recovery deserts” in they same way we talk about some regions as being “food deserts“. As someone who got sober on a Big 10 college campus, I can tell you that it was a recovery desert. Recovery may have existed in the campus community but, if it did, it was invisible and marginalized by the campus norms around drinking and its status as a celebrated drug on campuses.
This leads me back to the matter of recovery spaces, which leads me to the University of Michigan Collegiate Recovery Program. We’re not talking about creating a bubble for recovering students or judging everyone else on campus. In this vast university, there’s a little office that’s the place to go to learn about recovery, get some help, hang out, make sober plans with other sober people, learn to stay sober in a recovery-hostile environment and support each other.
This video says more than I can say about its importance. (And, it’s NOT phony. I know these people. They had serious problems. They are all doing REALLY well and pursuing their dreams.)
I don’t know whether Josh Levine was an alcoholic. His brother says he wasn’t and I have no reason to question that. But, if he was, and tried to quit, wouldn’t a visible recovery space like this be a very good thing?
U of M’s Collegiate Recovery Program is in its infancy. I hope it continues to grow and thrive. I wish something like it existed when I got sober. And, I wonder how many lost friends might have attempted recovery or been more successful with their recovery is something like this existed back then.
Related posts here.
The Washington Post recently ran a story about the acting drug czar, who happens to be one of us.
The nation’s acting drug czar has a substance-abuse problem.
Botticelli, 56, is an alcoholic who has been sober for a quarter-century. He quit drinking after a series of events, including waking up handcuffed to a hospital bed after a drunken-driving accident and a financial collapse that left him facing eviction.
Decades later, he is tasked with spearheading the Obama administration’s drug policy, which is largely predicated on the idea of shifting people with addiction into treatment and support programs and away from the criminal justice system.
. . .
Hours later, Botticelli stood outside the church where his recovery started and marveled at how he got from there to the White House.
“When I first came here, all I wanted to do was not drink and have my problems go away,” he said, choking up. “I’m standing here 25 years later, working at the White House. And if you had asked me 25 years ago when I came to my first meeting here if that was a possibility, I would’ve said you’re crazy. But I think it just demonstrates what the power of recovery is.”
Previous post: How the hell did I get here?
Peter Sheath did a guest post a while back at Memoirs of an Addicted Brain that took the treatment field’s inventory:
Unfortunately many of the people working in treatment do not see any need for self-reflection and continued self-development. They have come to believe that they simply don’t have time. I’ve travelled all across the UK, delivering training, coaching and consultation, and it’s the same everywhere. Blame, intimidation, threats and arrogance become the tools of rehab, the vehicles of control. It’s just easier that way.
. . .
Unfortunately, and here’s the rub: when we have absorbed the ideology that addiction is a disease and we need to sort it out or cure it, we are unknowingly removing from the person the very thing that is going to get them well. By assuming the “expert” status we are telling people that they are sick and, as such, unable to take responsibility for their recovery. Walk into any treatment centre anywhere and suddenly you become completely incapable. You can’t even fill in a form yourself and you certainly have no capacity or competence to manage your medication. Even if you begin to take responsibility by getting honest and telling the workers you have used again, they will need to take a confirmatory drug test to prove it! “You will need to undergo an assessment, looking at everything that’s wrong with you…” Using a form filled out by a worker, because you can’t do it yourself. The process is repeated by any further “expert” you may need to see. Any initiative on your part will be viewed the same way: as an obstruction. If you don’t want a script or you want to go straight to detox, you will be met with, “you’re not ready for that yet”, or the classic, “people die doing it that way.”
His focus is on the UK, but a lot of this is true for the US as well, even if it manifests differently.
I’m grateful to work in a place that makes it our responsibility to engage clients as active participants in their own recovery by utilizing strategies like peer support, recovery planning and Personal Medicine.
Read the rest of Sheath’s post here.
PBS’s series NOW had a segment on a housing first approach with a man named Footie who is chronically homeless and an alcoholic. He’s clearly a late stage alcoholic, frequently has seizures and may have some cognitive impairment due to years of heavy drinking and seizures. (Streaming video of the entire episode is available at the link above.)
The story made a pretty compelling case for this approach with this him, arguing that it was impossible to address his higher order needs when his physiological and safety needs were not being addressed. Footie was provided an apartment with no contingencies. The approach could make a lot of sense in many cases–the question is which cases and under what conditions?
I had several reactions to the segment. First, had Footie ever been provided with comprehensive treatment of and adequate dosage, duration? Why no contingencies? Maybe his housing shouldn’t be contingent upon abstinence, but how about participation in treatment? If the fear is that this might be a set-up, how about reviewing it at monthly or quarterly intervals so that a bad week does not put him back on the street? Why not at least make it recovery-focused? If this approach is good for Footie and raises his functioning and quality of life to his potential, who’s functioning and quality of life might be reduced to something below their potential? At Dawn Farm, we see some clients who would probably benefit greatly from a recovery-focused housing program that is not contingent upon abstinence. However, how many of clients who are currently in full recovery would have settled into an apartment like Footie’s and never achieved stable recovery and a full, satisfying life? Many, I think.
UPDATE: This isn’t to say it shouldn’t be done, but rather how to go about it in a way that doesn’t lower the bar for all homeless addicts and fail to address what caused their homelessness. Maybe one way to approach it is to ask, “Absent their addiction, would this person still be likely to be homeless?” In the case of Footie, the answer is “probably so”. In the case of most of our homeless clients, the answer is “unlikely”.
Of course, another big question is how to prioritize services in the context of scarce resources.
Yesterday was International Overdose Awareness Day. Where do we stand?
- Last year, the CDC reported on a 5 fold increase in female opioid overdose deaths over a 10 year period.
- Heroin use may not be as prevelant as the media suggests, but the number of users is up by 53% over 10 years.
- Overall overdose rates are up 5 fold since 1990. (It’s even worse if we go back to the 1970s)
- Drug overdose deaths have surpassed car accidents as the leading cause of injury related deaths.
- Prescriptions for opioids have increased tenfold since 1990 and opioid addiction tripled over a 10-year period.
This crisis has brought some good policy changes. Naloxone distribution programs are spreading fast and good Samaritan laws are spreading too. These policy changes will undoubtedly save lives, and that’s important.
There’s also no doubt that there are a lot of deaths that these programs won’t prevent. Consider the death of Phillip Seymour Hoffman. As is common, he appears to have died while using along, which casts doubt on any suggestions that naloxone and good Samaritan laws would have saved him. Even for those they save, they don’t offer a way out of their suffering and a lives that they hate.
How are we doing in terms of access to treatment of adequate intensity and duration? We don’t have much in the way of statistics for that, but it’s save to say that we’re not doing so well. We’ve got models that work really well, but we only use them with health professionals, lawyers and pilots.
Too often, we’ve had one faction calling for more treatment and another calling for harm reduction.
Naloxone is not enough. And, even access to quality treatment of adequate duration and intensity were improved, we couldn’t engage and successfully treat everyone.
We need a both/and approach rather than an either/or approach. Let’s increase access to naloxone and make sure that every rescue is followed by the kind of care an addicted health professional would get.
Cassie Rodenberg’s blog has had a couple of heartbreaking posts recently. They look at the lives of women in the culture of addiction–prostitution, pimp boyfriend, sexual assault, having to provide sex for a place to stay, etc.
It brought back Bill White’s book, Pathways and his discussion of sex within the culture of addiction. Not only does the use of sex as a vehicle to maintain access to drugs or other needs within the context of addiction detach sex from pleasure, intimacy and love, it also is a consequence and contributor to the objectification of others–people become objects to be used or avoided.
All of this got me thinking more about a post a while back where I discussed a post from Bill White on the need for “recovery spaces” and how the concept was getting some push back. DJ Mac (who is supportive of the concept of recovery spaces) titled his post, Does recovery space equal recovery ghetto? Much of the discussion seemed to be between people who are culturally empowered, mobile, do not live in a ghetto and have never been trapped in a ghetto.
Cassie’s posts reminded me that, for some, ghetto isn’t just a metaphor–it’s their world.
These people need more than harm reduction.
They need more than MI, CBT or 12 step facilitation.
They need Recovery Management.
Bill White calls on us to raise our expectations of ourselves and the system while focusing on recovery and the community as the locus of healing. [emphasis mine]
Addiction treatment must always adapt to the evolving context in which it finds itself. Such redefinition may push treatment toward the experience of retreat and sanctuary in one period and toward the experience of deep involvement in the community in another. I would suggest that the focus of addiction counseling today should not be on addiction recovery-that process occurs for most people through maturation, an accumulation of consequences, developmental windows of opportunity for transformative or evolutionary change, and through involvement with other recovering people within the larger community. The focus of addiction counseling today should instead be on eliminating the barriers that keep people from being able to utilize these natural experiences and resources. Our interventions need to shift from an almost exclusive focus on intervening in the addict’s cells, thoughts and feelings to surrounding and involving the addict in a recovering community.
Over the years Bill shifted his language to emphasize “community renewal”:
A major focus of RM (Recovery Management) is to create the physical, psychological, and social space within local communities in which recovery can ﬂourish. The ultimate goal is not to create larger treatment organizations, but to expand each community’s natural recovery support resources. The RM focus on the community and the relationship between the individual and the community are illustrated by such activities as:
- initiating or expanding local community recovery resources, e.g., working with A.A./N.A. Intergroup and service structures (Hospital and Institution Committees) to expand meetings and other service activities; African American churches “adopting” recovering inmates returning from prison and creating community outreach teams; educating contemporary recovery support communities about the history of such structures within their own cultures, e.g., Native American recovery “Circles,” the Danshukai in Japan;
- introducing individuals and families to local communities of recovery;
- resolving environmental obstacles to recovery;
- conducting recovery-focused family and community education;
- advocating pro-recovery social policies at local, state, and national levels;
- seeding local communities with visible recovery role models;
- recognizing and utilizing cultural frameworks of recovery, e.g., the Southeast Asian community in Chicago training and utilizing monks to provide post-treatment recovery support services; and
- advocating for recovery community representation within AOD-related policy and planning venues.
It’s worth noting that, over the years, Bill has written about recovery employment, housing, education, etc,
It can be overwhelming. But, the alternative is despair.
UPDATE: This post was re-titled based on reader feedback.