Tribes of the recovering community – Calix Society

calixlogo

This week’s tribe is the Calix Society.

Calix is an association of Catholic alcoholics who are maintaining their sobriety through affiliation with and participation in the Fellowship of Alcoholics Anonymous. Our first concern is to interest Catholics with an alcoholic problem in the virtue of total abstinence. Our second stated purpose is to promote the spiritual development of our membership. Our gathering today is an effort in this direction. Our conversation and our association together should be a source of inspiration and encouragement to each other, geared to our growth toward spiritual maturity. Our participation in all other spiritual activities of Calix, such as the frequent celebration of the Liturgy, reception of the Sacraments, personal prayer and meditation, Holy Hours, Days of Recollection and retreats, aid us in our third objective, namely, to strive for the sanctification of the whole personality of each member. We welcome other alcoholics, not members of our faith, or any others, non-alcoholics, who are concerned with the illness of alcoholism and wish to join with us in prayer for our stated purposes.

(The “Tribes of the recovering community” series is intended to demonstrate the diversity within the recovering community.I have no first hand knowledge of most of the tribes, so inclusion in this series should not be considered an endorsement.)

NYT Reax

SecondOpinion400This blog has a point of view. We’re not fans of maintenance. (Though we still think Suboxone can be a very useful detox tool.)

If you want to read defenses of Suboxone, you can find a couple here:

The best critical response is from addictiondoctor.org, though he’s not making a recovery argument. He’s really making a harm reduction argument.

It’s key to remember that there is an epidemic of opioid overdose deaths in this country largely fueled by the unrestricted access to long active high potency full opioid agonists in “pain clinics” around the country. It’s strikingly ironic that in the midst of this, there is controversy about a long acting partial agonist that is much safer and has been used in hundreds of thousands of people to stop the compulsive use. What is even more ironic is that the use of Suboxone is limited while any physician can prescribe nearly limitless quantities of the more deadly full opioid agonists.

The NY Times published a few reactions to its Suboxone series.

There were a couple of letters from physicians writing in support of Suboxone.

There was also a letter from a recovering person.

Thank you for exposing the dark side of the recovery and pharmaceutical industries’ approach to addiction. I’m dropping my own anonymity today.

It took me 14 years of fits and starts to finally earn a decade of continuous sobriety. To stay sober I need four meetings a week.

I see buprenorphine sweeping through the recovery population. It’s obvious that newbies and kids are suffering from it the most.

And, a physician who used to be a fan, but is no longer.

As one of the earliest of the Pennsylvania physicians approved to prescribe buprenorphine, I was part of a wave of optimism. After decades of helping addiction patients struggle to save their lives, I was initially quite heartened with the results of buprenorphine. Now, the “bloom is off the rose” as I, too, see the patterns of abuse and diversion.

There were lots of reader comments that were positive and negative about Suboxone. Here’s one that captures what we hear from a lot of addicts and families seeking help getting off of Suboxone:

My son has been an opiate addict for years. Through countless detoxes and rehabilitations he found himself on suboxone. What isn’t discussed is that this is a controlled substance that is hardest of all to withdraw from. It is an opiate. My son on suboxone continued addict-type behavior. Sure, he was functioning a bit better but not good enough. He was listless, with no attention span and without any sense of urgency to taking care of himself. My wife and I realized this is a pervasive horrible substitute for sobriety and we told my son we would not support it any longer. He still struggles to find a lasting sobriety. Opiate addiction is all the evils everyone talks about and I don’t need to repeat them. But suboxone is not the answer to finding true sobriety. Doctors are too keen to provide this as a solution but it continues one’s addiction not only to the opiate but to the behaviour that si typical of addicts. We pray and continue to support ways to help my son find a true sobriety, but one opiate substitute for another is not the answer.

Here’s a comment from our facebook page:

Suboxone is perfect for keeping the addict trapped in the dark place of turmoil that so many of us are in when we are first clean. I’m not sick but I still need a steady supply of drugs just to sleep. I have no healthy ego because my life still sucks and no coping skills outside of self destructive survival behaviors that kept me alive on the street. The addict eventually has to choose between a life with little to no quality or one where they have the relief of temporary highs. You can’t get off drugs by staying on drugs. Suboxone is no different than when I got off heroin and methadone In 97 and then spent 17 yrs drinking myself to death culminating in a suicide before getting sober last year. I was off the “bad drugs”And on the one that’s acceptable.

AA is asinine?

foreignThe Boston Globe has a piece on why Russians haven’t embraced AA:

…the group-therapy dynamic collides with a skepticism about the possibility of ordinary people curing each other of anything. “The idea that another drunk can help you is asinine to most Russians,” said Alexandre Laudet, a social psychologist who has researched Russian alcoholism.

Then there’s the problem of opening up to strangers. The AA method works in part through trust in people you’ve never met before, and coming clean to them about one’s most shameful secrets.

Methadone, technology and outcomes

Substance Matters has a post about the use of new technologies in methadone maintenance.

Patients who use a web-based intervention (TES) instead of half of their traditional counseling did better than those with traditional counseling as part of their methadone treatment.

It provokes important questions about the usefulness of new technologies and how they might be used to improve treatment outcomes.

However, what struck me was this graph:

Web based behavioral treatment for substance use disorders as a partial replacement of standard methadone maintenance treatment

This was a twelve month study. This means that subjects who got TES and did better than subjects recieving traditional methadone used opiates (other than methadone) 25 weeks of the year.

That’s a successful intervention?

 

Sentences to ponder

“I had a doctor who I greatly respect who said, ‘We thought the great problem with these drugs [opioids] is addiction. What we didn’t realize [was] that the people who take them would opt out of life.’ And you see it across the spectrum: One of the more startling things is in the area of workplace injuries; things like back strains are very common problems. But what folks have discovered is the more patients — workers — who are treated with these drugs for back strain, the longer and longer and longer they stay away from work. In fact, we’ve kind of created a legion of chronically unemployed people who are dependent on these drugs.”

Barry Meier on Fresh Air

24 month outcomes

 

surprise result road by dougtone
surprise result road by dougtone

Another study supports the effects of twelve step participation over 24 months. (I know the abstract says “self help”, but the pay-walled article makes it clear that they were looking at twelve step participation.)

Abstract

The goal was to identify factors that predicted sustained cocaine abstinence and transitions from cocaine use to abstinence over 24 months. Data from baseline assessments and multiple follow-ups were obtained from three studies of continuing care for patients in intensive outpatient programs (IOPs). In the combined sample, remaining cocaine abstinent and transitioning into abstinence at the next follow-up were predicted by older age, less education, and less cocaine and alcohol use at baseline, and by higher self-efficacy, commitment to abstinence, better social support, lower depression, and lower scores on other problem severity measures assessed during the follow-up. In addition, higher self-help participation, self-help beliefs, readiness to change, and coping assessed during the follow-up predicted transitions from cocaine use to abstinence. These results were stable over 24 months. Commitment to abstinence, self-help behaviors and beliefs, and self-efficacy contributed independently to the prediction of cocaine use transitions. Implications for treatment are discussed.

It’s worth noting that some of these factors predicting abstinence are enhanced by twelve step participation:

These models represented fairly stringent tests of the predictive power of the time varying variables, as they controlled for both baseline (i.e., early treatment) cocaine use and cocaine use status at the time the predictor variables were assessed. In analyses that included multiple time-varying predictors and baseline cocaine use, the variables that contributed independently to the prediction of transitions in cocaine use states were self-efficacy, self-help participation (for those who were currently using cocaine), commitment to abstinence, and self-help beliefs. Three of these four variables assessed self-help group related factors, which highlights the important role that self-help involvement and beliefs play in sustained recoveries in this population.

Sentences to ponder

American Society of Addiction Medicine
American Society of Addiction Medicine (Photo credit: Wikipedia)

From the ASAM blog:

…is there any evidence that the general public requires less treatment than do healthcare professionals and pilots? I would further ask, given the excellent outcomes generally obtained by PHPs and pilot recovery programs, why there have been no studies in which members of the lay public go through identical programs to determine what their long term outcome would be. Indeed, what happens when a non-healthcare professional or non-pilot goes through 90 days of rehab, and is then followed regularly by an addiction specialist physician while simultaneously attending twelve-step or similar self-help groups and being subject to random urine drug testing, all as the FAA requires of pilots requesting a special issuance medical, and as state medical boards generally require of physicians wanting to return to practice? Would they too have an 80-90% recovery rate?

[hat tip: Herb]

The ancients on will and addiction

Socrates 469 BC - 2011 AD
Socrates 469 BC – 2011 AD (Photo credit: nerosunero)

It took me a few reads, but Alan Brody suggests that addiction is a combination of impaired will and impaired evaluative faculties that lead to poor choices in how to exert our will. Then again, I’m not sure I know where he stands. He guides through some philosophical musings about addiction and will.

He presents Socrates’ view:

When faced with a choice, Socrates tells us, human nature means we want to do what we think is best. So, he argues, if we believe we know what the good (the best) thing to do is, and it is accessible to us, we will do the good. However, says Socrates, things which tempt us can have the power to alter our perception or understanding of their value, making them deceptively appear to be what is best. Consequently, we choose the temptation as the best thing to do. The experience of going along with temptation is not, Socrates argues, one in which the person protests or fights against its unreasonableness while being dragged along into gratifying it. For Socrates, ‘yielding to temptation’ is not being unwillingly overpowered, but is the experience of being a willing participant choosing what is at that moment wrongly thought to be best.

Aristotle offers another take:

Aristotle thought that by asserting that when we gratify our desires for what tempts we are still doing what we think best, Socrates was denying the existence of akrasia – ‘weakness of will’, or a failure of self-restraint. The denial of both compulsivity and of weakness of will in explaining addiction has resulted in a willingness model commonly referred to as the moral model of addiction. On this view, what the addict does can be explained in terms of Socrates’ willingness model and an addict’s immoral character: ie, they want to do it, and care more about satisfying their addiction than the consequences of doing so. The addict’s moral deficits reside in their motivations, as illustrated in the accusation: “If you cared more about peoples’ safety than drinking, you wouldn’t drink and drive.” Here, the individual is judged to be morally deficient for not prioritizing peoples’ safety over their own desire to drink.

He rebuts the willingness model with this story:

One day in Hell the Devil approached a man who loved the drinking parties there. The Devil told the man that as long as he was willing to quit drinking he could immediately go to Heaven, where he would forever have a better time. The man replied that although Hell wasn’t so bad, and the parties were great, he preferred Heaven, and was willing to go there right now. The Devil told him that if he wanted he could have a great send-off party now, and go to Heaven tomorrow. The man thought it seemed a good idea to have the best of both worlds, so he accepted the deal. The next day the man was reminiscing about how great the send-off party was when the Devil approached him and said he could have another terrific party right then, and go to Heaven the next day. Of course the man accepted. Each day the Devil made the same offer, and each day the man accepted the party, replying, “I’ll quit drinking tomorrow.” Well, the Devil knew that the man didn’t have what it takes to ever refuse a great party.

In order for our well-being not to be undermined, we need to be able to be motivated by certain preferences. The protagonist of our story would prefer to get out of Hell, but he also needs the ability to be motivated by that preference – and he doesn’t have what it takes to do that. His desire to drink trumps his preference to do what he would prefer to be able to do, thereby undermining the kind of self-regulation he would prefer to have. The willingness model fails to capture the presence, nature, and significance of these kinds of self-regulatory failures, but this kind of dynamic is what addiction is built upon. … This is called ‘clear-eyed akrasia (failure of self-restraint).

He also meanders back to Socrates teachings on “self-mastery”, which is rooted in self-knowledge and offers these thoughts:

Addiction is not just a condition made up of a bunch of weak-willed acts. Addiction undermines the person’s self-regulation, true. But it also undermines their ability to accurately assess their problem’s seriousness as it repetitively generates a willingness or motivation for acting in violation of their most important preferences, even knowingly. Moreover, those who follow addiction’s callings do not simply act from their own sanctioned desires; they have become the enchanted followers of yearnings arising from a metastasized love. The ability to recover often has to develop as a result of experiencing addiction’s deep hardships. Addicts often talk about how it took a lot of destructiveness, danger and ‘craziness’ before they could realize how ‘insane’ they had become.

When thinking how misfortune has deprived someone of what is needed for doing better, we sometimes respond compassionately by communicating that the person would have done better at controlling their over-eating/smoking/alcoholism/other temptations if they could have. When we realize that luck is required to put into place what was needed in order to have what would have enabled us to have done better, more compassion might arise towards ourselves and others, as we see how the trouble we bring about is also what fortune sets up for us.

My problem is that, while rebutting these moral models, it feels like he never strays very far from talking about a flaw in character. This is why, to me, the hijacked brain metaphor is so helpful.

Human rights and coerced treatment

 

Superior Court Judge Jason Deal, right, congratulates one of three graduates, who successfully completed Dawson County’s Drug Court.

A recent article looks at the ethics and effectiveness of coerced treatment:

It has been argued that quasi-compulsory treatment (QCT) may be considered ethical (under some specific conditions) for drug dependent offenders who have committed criminal offences for whom the usual penal sanction would be more restrictive of liberty than the forms of treatment that they are offered as a constrained, quasi-compulsory choice. It has briefly reviewed research that suggests that QCT may be as effective as treatment that is entered into voluntarily. This may help individuals to reduce their drug use and offending and to improve their health, but it is unlikely to have large effects on population levels of drug use and crime.

Memory ‘trick’ relieves drug cravings

We’ve previously posted about the use of medications like propranolol to interfere with memory reconsolidation and reduce the power of addicts’ neurological triggers to get high.

Chinese researchers are experimenting with non-pharmaceutical approaches to using memory reconsolidation to reduce craving:

Addicts tend to associate a drug’s effects with drug-taking equipment and a certain environment, which can make them vulnerable to relapse if they encounter those conditions. The technique, studied by Lin Lu of the National Institute of Drug Dependence at Peking University in Beijing and his colleagues, aims to break that link by briefly reactivating the memory of drug taking and following it with an ‘extinction session’ of repeated exposure to the same memory cues.

The short reminder of drug-taking seems to take the memory out of storage and make it easier to overwrite.

 Read the rest here.