We are concerned about the dangers of addiction as never before. For good reason–the opioid epidemic has become an overdose epidemic.
One undercurrent in the coverage of the issue is the implication that abstinence-based treatment contributes to overdose deaths. (There’s no question maintenance drugs reduce overdose risk and short term abstinence-based treatment of opioid addiction is irresponsible. However, there’s a lot more to the story. I’ve addressed this in several previous posts.)
A recent Addiction Professional article includes a sidebar entitled, “Dangers of drug-free treatment“.
Then, right on time, comes Kevin McCauley with his new video, Memo to Self: Protecting Sobriety with the Science of Safety.
McCauley introduces us to the Swiss Cheese Model of safety that he borrows from his background in aviation.
He uses this safety framework to propose a plan for protecting recovery. He proposes 10 protective layers. (Or, if you prefer, layers of cheese.)
His 10 layers are as follows:
- Treatment (residential or inpatient)
- A therapist, coach, and/or advocate (for regular recovery maintenance check-ups)
- Recovery residences
- Mutual support groups
- A relapse plan
- Drug testing (frequent and prolonged)
- Job or school (for meaning and purpose)
- An addiction medicine specialist
- Hedonic rehabilitation (learning to have fun in recovery)
Within this frame each layer provides a layer of protection and choosing to remove a layer increases the risk of relapse. This safety frame provides a way to make these risk increasing decisions more concrete and less emotionally charged. If there’s good reason to remove a particular layer, it also sets up exploration of what might be done to add another layer to replace it.
Unlike most educational videos, it’s not boring, preachy and tedious. McCauley gets us to laugh at his story and, in doing so, gets us to reflect on our own experiences with the distorted thinking of early recovery and see the importance of building protective layers to get the very precarious early months of recovery.
Further, one of the limitations of all lifestyle medicine approaches has been the dearth of knowledge about maintaining change over years and decades. This safety model provides a way of thinking through what layers are needed, not just to achieve stable recovery, but also to maintain stable recovery over years and decades.
The too-frequently and simplistically proposed solution (prescription?) for the overdose epidemic is opioid replacement medication, like buprenorphine or methadone. This model makes plain that, at best, these medications (or others, like vivitrol) compose only one layer of a safety plan. Of course, going to inpatient treatment is also only one layer.
Unfortunately, the treatment system does not deliver anything resembling this model for anyone other than doctors, pilots and possibly lawyers. This makes the video and model especially important for programs that want to improve their services as well as families and addicts that want to piece together these layers of protection on their own.
This video is a real service to treatment providers, advocates, families and addicts. It is highly recommended.