Tag Archives: United States

Addiction and quality of life

 

photo credit: davegray

photo credit: davegray

David Best recently wrote a piece on addiction and quality of life.

On the role of community in recovery:

At the heart of the recovery movement is a shift of emphasis away from “treatment” as a model reliant on professionally delivered interventions. Rather, the movement sees the recovery journey an intrinsically social process and seeks to create the conditions that allow those with addiction problems to achieve a sense of connection in their community, including with peers who are further along in the path of recovery.

On the evidence for the positive impact of social connectedness:

From the United States, we know that only around 10% of those who complete alcohol or drug treatment receive community-based ongoing help. Yet, when this is received, it improves the person’s outcomes by 30 to 40%.

Similarly, a 2009 trial of support for problem drinkers found that adding one person in recovery to the social networks of a newly detoxified drinker improved the chances of them staying sober for a year by 27%. This is a huge impact that results from changing not only social networks but the underlying values, attitudes, beliefs and expectations.

Scottish study of recovering alcoholics and heroin users in the deprived housing estates of Glasgow found that the more time people spent with other people in recovery, the greater the levels of well-being reported.

It also found that people who were active in their families and communities – by parenting, volunteering, being members of social networks, by working and training – had the best quality of life.

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Filed under Controversies, Family, Harm Reduction, Mutual Aid, Policy, Research

Tribes of the recovering community

Yoga Class at a Gym Category:Gyms_and_Health_Clubs

Yoga Class at a Gym Category:Gyms_and_Health_Clubs (Photo credit: Wikipedia)

Yoga of 12-Step Recovery (Y12SR) thinks of itself as an adjunct to 12 step recovery.

Founded in 2012, The Y12SR Foundation is a program of Off the Mat, Into the World® (OTM). Our mission is to empower the lives of individuals and families affected by substance and behavioral addictions with relapse prevention practices that enhance physical, mental and spiritual well-being.

We realize our mission through a holistic approach that addresses all aspects of the multi-dimensional self (physical, emotional, mental, behavior and heart,) promoting a greater understanding of the disease of addiction, peer generated support and leadership development.

There are some meetings in Minchigan. Looks pretty cool. Maybe I’ll check it out and report back. (That should be pretty funny. I’m pretty stiff, have lousy balance and I’ve never done yoga.)

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Filed under Mutual Aid

How full do you want your recovery to be?

Bill White on the importance of primary care:

by truthout.org

by truthout.org

The Philadelphia survey goes beyond affirming the significant prevalence of recovery in the general population to provide a detailed profile of the health of people in recovery.  The results are sobering.  People in recovery, compared to citizens not in recovery, are twice as likely to describe their health as poor and report higher rates of asthma, diabetes, high blood pressure, obesity and past-year emergency room visits. They are also more likely to report lifetime smoking (82% vs. 44%), current smoking (50% vs. 17%), exposure to smoke in their residence, no daily exercise and eating fast food three or more times per week.

At its most practical level, the survey findings suggest that every person entering recovery should have an ongoing relationship with a primary care physician who is knowledgeable about addiction recovery and who can serve as an ongoing consultant on the achievement of health and wellness.

 

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What good is religion?

AA meeting sign

AA meeting sign (Photo credit: Wikipedia)

Sigfried Gold on what religion and 12 step fellowships get right:

The work of self-transformation can be done through psychotherapy, religious practice, reading self-help books, independent resolutions and intentions, consulting coaches, gurus, psychics, body healers, mind healers and faith healers of all stripes. People come to the work of self-transformation in moments of despair, moments of hope, after long reflection, through happenstance…


Religions have certain advantages in the self-transformation arena that can’t be matched by secular forms of this work. One is the ideal–if not actual attitude–of religions towards money. Although the financial costs of religion can be quite high (giving away a tenth of one’s income is not uncommon), payment is generally voluntary; newcomers and poorer congregants can usually enjoy all the benefits of community, moral guidance and support, meaningful rituals, comfort in times of adversity, without having to pay more than they choose. Disingenuously or not, religions claim to be motivated by concerns beyond money, and obligate themselves to at least put on a show of providing services unattached to remuneration. For people outside the social welfare system, secular self-transformational help must be paid for. Much of the support in a religious community comes from other congregants rather than from paid clergy. As a special case, 12-step recovery fellowships, which include some of the largest organizations in the world, offer their members access to daily or hourly support, essentially for free, that could only be matched among secular service providers by extremely expensive in-patient treatment centers or psychiatry wards.

Are these the thoughts of an evangelical seeking to extend the reach of the church into more lives at their most vulnerable moments?

Nope. The writer is an atheist.

I have no nostalgia for the bad old days of clerical authorities browbeating us into morality with their hands in our pockets. But I fervently yearn for a day when people wishing to be better have easy access to free or donation-based support, offered primarily by their peers, possibly facilitated by modestly paid clergy, and offered without coercion, without insistence that one set of beliefs is right and the rest are wrong, offered because people who actively pursue their own paths towards meaning, fulfillment and some vision of the good feel a generous desire to share what they’ve learned on those paths with others. Religions may be declining in their ability to provide that kind of altruistically motivated, communally organized support, but we have few other models to work with.

This is an interesting observation in the context of the concept of a monoculture that is organized around economics. This monoculture’s emphasis on individuality helps explain our cultural aversion to a recovery solution that is free, relational and demands interdependence..

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As the ACA expands coverage for addiction, can the system deliver?

The signatures of President Barack Obama, Vice...

The signatures of President Barack Obama, Vice President Joe Biden, and Speaker of the House Nancy Pelosi on the health insurance reform bill signed in the East Room of the White House, March 23, 2010. (Photo credit: Wikipedia)

The AP recently ran an article looking at the horizon for addition treatment under the Affordable Care Act expansion in insurance coverage:

The surge in patients is expected to push a marginal part of the health care system out of church basements and into the mainstream of medical care. Already, the prospect of more paying patients has prompted private equity firms to increase their investments in addiction treatment companies, according to a market research firm. And families fighting the affliction are beginning to consider a new avenue for help.

But will those who suddenly get coverage for treatment have a place to get it?

Haymarket Center in Chicago illustrates what may await many addicts. One Friday morning, seven men slumped in chairs in a small, bare room with only an untouched rack of health brochures to break the monotony of waiting for the chance of a detox bed that night. The six-story brick building is a beehive of programs for 300-plus patients: short term detox, long-term residential treatment, recovery units where people can live sober while looking for work. Everything is overbooked. On this day, the waiting list totaled 91 people who want help.

“Last year the state cut our dollars so we had to cut back our beds,” said Dan Lustig, vice president of Haymarket, which gets most of its funding from the government. “We had clients literally pleading for services. Some were sleeping on our front steps.”

In Illinois, where 92,000 people get treatment now, nearly 235,000 addicts and alcoholics without insurance will be able to get coverage next year. Not only beds are lacking. The pool of physicians who are addiction specialists must grow by 3,000 nationwide, almost double what it is now, to handle the demand, according to health industry experts.

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Let’s sensationalize recovery

It just so happens that Dawn Farm is co-sponsoring a screening of the film next week.

One Crafty Mother has a post responding to The Anonymous People.

That last bullet point is the one I want to focus on. [There are over 23 million people in long term recovery in America alone.] Changing the public’s perception of addiction by TALKING ABOUT RECOVERY. Because, everyone, RECOVERY WORKS. There are more people in recovery from addiction than there are suffering from it.

Here’s the rub, though. People don’t recover on their own. Every single recovery program focuses on community – on finding other addicts and alcoholics who understand where you are and can help you navigate life without alcohol or drugs.

It doesn’t matter what program of recovery you follow. Recovery advocacy is for EVERYONE.

You don’t have to talk about HOW you recovery, just THAT you recover.

For those of us in programs that have anonymity as a tradition and who are confused about breaking this tradition, this point is KEY. How you stay sober isn’t relevant. You do not have to be a mouthpiece for an individual program of recovery. You can talk about recovery without ever mentioning how you do it. When someone who is suffering asks you how you stay sober (and if you talk about recovery they will ask, I guarantee it), then you are free to share – in the sacredness of a one-on-one (or group) setting – how you do it.

But until the public understands that RECOVERY HAPPENS, people are going to stay stuck in addiction. People are going to misunderstand what addiction means. People aren’t going to know it is quite literally on every street in America. Every street has someone stuck in the darkness and isolation of addiction, and every street has someone thriving in recovery. We have enough coverage of the destruction of addiction. We sensationalize the stories of celebrities crashing cars, going in and out of rehab. We condemn the havoc alcoholism and addiction bring to society.

We are sensationalizing the wrong thing. Let’s sensationalize recovery.

She’s got a great message and very gracefully addresses a couple of potential pitfalls. I like encouraging advocacy while also respecting traditions of anonymity. I also like her emphasizes that there are lots of ways to be an advocate and each recovering person can find their own advocacy approach.

I love her passion and clarity. I’m going to have to watch this blog.

I’ve got one quibble with the statistic the film uses–23 million Americans in recovery. That is based on surveys asking people something to effect of, “Have you previously had a problem with drugs or alcohol and no longer have one?” That kind of question is going to get a lot of false-positives for what we think of as recovery.

The point, however, is there there are large numbers of people in long term recovery in the U.S. And, unfortunately, when people think of addiction, they don’t think of recovering people like me or friends who are doctors, nurses, lawyers, business owners, moms, dads, bothers, sisters, etc. Instead, they think of us as social parasites, or worse, scary people committing a violent or property crime.

Telling our stories is powerful. Dawn Farm often takes clients or alumni to speak to community groups like the Lions, Optimists, Rotary or school groups. The response is always the same–shock that the clients are just like their niece, nephew, neighbor, grandchild, etc.

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Filed under Dawn Farm, Mutual Aid, Policy

If it wasn’t rational, they wouldn’t be doing it

mencken-complex-problem

Ugh.

The NY Times has another column promoting a rational addiction model.

“When they were given an alternative to crack, they made rational economic decisions.”

When methamphetamine replaced crack as the great drug scourge in the United States, Dr. Hart brought meth addicts into his laboratory for similar experiments — and the results showed similarly rational decisions.

“If you’re living in a poor neighborhood deprived of options, there’s a certain rationality to keep taking a drug that will give you some temporary pleasure,”

Here we go again. Their drug use by addicts is rational. A rational choice. If you had their lives, you’d be an addict too.

I’m not even clear that there’s a causal relationship from poverty to addiction. If so, how strong is that relationship?

In an article titled, “Taking Absurd Theories Seriously“, Ole Rogeberg walks through an extensive takedown of rational addiction theories. This video is great.

Why do people insist on framing addiction as rational?

For others, it’s assimilation into the monoculture:

To begin with, in the economic story, you are an individual.

The economic story also says that as a human being, you’re rational. In economic thought, being rational doesn’t mean that you’re sensible or that you’re a clear thinker. Being rational means that when you’re faced with a decision, you move through a three-stage process to decide what to do. Assuming you know what your goals are, you first lay out all the ways you could reach each goal and identify the costs and benefits of each possibility. Next, you analyze which option is most efficient — the one that most directly lets you get the most of what you want while costing you the least of your resources. Finally, you choose that most efficient option, because in the economic story, your best choice is always the most efficient choice.

In the economic story, you’re someone who is self-interested, in the most positive sense possible.

Being cast as someone who is rational and self-interested might sound relatively harmless, but that way of thinking has implications because it’s based on the assumptions that you know what condition you’re in, you know what your options are, and you know what you want, but those assumptions don’t necessarily hold. … The story says that you act as you do because you’re trying to get what you want, and the rest of us can tell what you want by watching how you act.

For others it’s philosophical:

Although addiction may be defined and operationalized in a number of different ways, the heart and core of the concept lies in its implication of the loss of the ability to choose – that is, the loss of free will.  Hence, and logically, the concept of addiction also implies the actual existence of free will.  And there lies the rub.

The addiction concept repackages one of the Big Questions – free will and determinism – into a new and seemingly more manageable form.   But should we be entirely comfortable with the tacit implication that ordinary, non-addictive conduct is freely willed?

Of course, this assumption underlies much of our day-to-day lives.  We show up at work late and we are responsible for the choices we made that caused our lateness.  Our legal system relies on the same assumption as well.  It assumes people freely do what they do and must take responsibility for their actions.

This came up again recently when Sally Satel published a book questioning neuroscience and addiction:

“Brainwashed” is nervously libertarian; Satel is a scholar at the American Enterprise Institute, and she and Lilienfeld are worried that neuroscience will shift wrongdoing from the responsible individual to his irresponsible brain, allowing crooks to cite neuroscience in order to get away with crimes.

Once it’s defined as a choice, and the rational choice theory isn’t satisfactory, we’ve got economists coming up with their own answers to the age old question of, why do they do it? [emphasis mine]

First-hand accounts of poverty generally recognize that heavy users of drugs and alcohol pay a high material cost.  Yet they rarely reach my verdict: that other factors – like low IQ, low conscientiousness, low patience, or plain irrationality – must be driving both poverty and substance abuse.  Instead, observers usually say that the poor consume drugs and alcohol to “dull the pain.”  Some even argue that the poor are being entirely rational: If your life is a living hell, narcoticizing yourself is the simplest solution.

There’s just one problem with this explanation: By almost all accounts, substance abuse eventually makes your life worse.  The long-term addict’s life is utterly wretched – even if you average in his periodic drug-induced euphorias.  Someone who has yet to start using drugs and alcohol doesn’t face a choice between “full pain” and “dulled pain.”  Instead, he chooses between two paths of pain:

Path #1: Full pain in the short-run, followed by gradual life progress.

Path #2: Dulled pain in the short-run, followed by a gradual downward spiral into abject misery.

Suppose you’re poor.  Your life is unusually painful, so the immediate effect of drugs and alcohol is especially attractive.  The long-run prognosis for a poor substance abuser, however, is especially repellent.  You hit “rock bottom” sooner because you don’t have far to fall.  And your version of “rock bottom” is extra bleak because you lack the financial resources and social connections to cushion the blow and get back on your feet.

The lesson: On net, poverty isn’t a believable root cause of substance abuse, because being poor doesn’t make substance abuse a better overall deal.  Why then would poor people be more inclined to narcoticize themselves?  Once again, we should look for root causes of poverty and pathology.  Low patience is the most obvious suspect.  If you loathe to defer gratification, you’ll tend to have low income, and eagerly use drugs and alcohol today despite their awful cost down the line.

While I detest the blogger’s character-based explanation. He closes with a very salient question and observation:

Closing questions: If you were poor, would you turn to drugs and alcohol?  If you were a social worker, would you advise the poor to turn to drugs and alcohol?  I doubt it.  The reason, of course, is that on some level you already know what I’m telling you: Poverty is no excuse for substance abuse because substance abuse is an absurd response to poverty.

UPDATE: I’ve had several posts over the years about free will and addiction. One important thing to keep in mind is that when we say it’s a brain disease, it doesn’t mean the person always has zero control over their behavior.

Here are some excerpts that offer different ways to think about it.

On co-existing deterministic factors and free will:

A helpful metaphor is offered: If a machine has two controllers (one controller representing deterministic factors and the other representing free will), does that mean that only one controller works? Or, is it possible that they both are capable of controlling the machine?

On deterministic factors as a continuum:

There is certainly room to incorporate biological and genetic vulnerabilities in such a model. People may vary as to the reward power of drugs and alcohol: Some people get more pleasure than others from them. Social factors and personal experiences may also contribute to individual differences in such propensities. Thus, some people end up with stronger cravings than others.

Still, some freedom remains. The wine does not pour itself into a glass and thence down the alcoholic’s throat. The person thus makes a choice between competing impulses: indulging pleasure now versus abstaining for the sake of nonspecific but substantial delayed gains. Choosing the path of virtuous abstention depends on willpower, however. When willpower has been depleted (such as by other acts of self-control, or even by decision making in any context; see Vohs et al. 2008), their likelihood of choosing the immediate pleasure increases.

If a disease model for addiction is to be retained, we suggest abandoning the virus or germ models in favor of something more like Type II diabetes. One does not become infected with diabetes. Rather, a natural bodily vulnerability becomes exacerbated by experiences, many of which are based on personal choices. Many people will not become diabetics regardless of what they eat, but others will suffer diabetes to varying degrees as a function of diet and exercise. Moreover (and again unlike a virus), there is no definite boundary that separates the sick from the healthy. Diabetes, and by analogy addiction, is a continuum. Those who are constitutionally vulnerable move themselves along this continuum by virtue of the choices they make.

On will power as psychological energy:

…within the context of their metaphor of psychological energy, there might be times when a person has none and times when a person has no internal or external resources to replenish this energy.

…Acknowledging these considerations does disavow the role of choice. Even on the end of the continuum where a person’s biology and environment doom them to developing addiction, choices could influence the onset, course and severity. And, within the psychological energy metaphor, during periods of replenished energy a person may have the power to make choices that will protect or expend this energy in ways that preserve it (and initiate/maintain recovery) or diminish it (and lead to relapse).

On ditching the all or nothing mentality:

One way to partially reconcile the dilemma between the traditional and emerging views of choice is to first acknowledge that free will in addiction and recovery is not an all or none phenomena. The capacity for volitional control over AOD use and related decisions is variable across individuals (as a function of the interaction between problem severity/complexity and recovery capital) and is dynamic (shifts incrementally on a continual basis within the same individual through both addiction and recovery processes).

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