Drug-free recovery as fantasy?

There is MUCH less tension these days between harm reduction (HR) advocates and treatment providers.

HR advocates confronted treatment providers with legitimate questions about their thresholds for accessing and staying in care. More recently, the opioid overdose crisis pretty dramatically changed the calculus. As a result, most treatment providers are using harm reduction approaches and have lowered thresholds to accessing and remaining in care.

However, if you want a good example of why some tension remains, check out this article entitled, “Vivitrol offers the fantasy of being drug-free. But that’s not the most important thing in tackling addiction“.

Whatever the sins of Alkermes and the flaws of some drug courts, the author’s repeated reference to abstinence as “fantasy” reveals a lot about his own bias. (At first, I assumed that an editor came up with a provocative, click-baity headline. However, the author used the word 3 more times in his piece.”)

Low expectations

Bill White wrote about Recovery and Harm Reduction in Philadelphia. Here’s a quote he offered in a blog post introducing the paper:

Traditional harm reduction programs have pioneered low threshold services, but they have often also been characterized by low expectations.  Our vision is to expand low threshold services that at the same time elevate peoples’ sense of what is possible for them.  We do this by exposing them to living proof that recovery is possible even under the most difficult of circumstances, confirming that there are people who will walk this path with them, and offering stage-appropriate services to support people in their journeys from addiction to recovery.  –Arthur C. Evans, Jr., PhD, Commissioner, Philadelphia Department of Behavioral Health and Intellectual disAbility Services, 2013

Recovery-oriented Harm Reduction

This reminds me of posts I’ve written about “recovery-oriented harm reduction” over the years.

From one of those posts:

Recovery is all about freedom. The freedom to live one’s life in the way one chooses without being a slave to addiction or being controlled by treatment or criminal justice systems.

…

This is the key. We’ve struggled mightily with maintaining a professional culture that is focused on recovery. It often conflicts with human nature and the instincts of professional helpers, so we have to accept that it will be a constant struggle. On the subject, we contributed to this paper.

I’ve been thinking about a model of recovery-oriented harm reduction that would address the historic failings of abstinence-oriented and harm reduction services. The idea is that it would provide recovery (for addicts only) as an organizing and unifying construct for treatment and harm reduction services. Admittedly, these judgments of the historic failings are my own and represent the perspective of a Midwestern U.S. recovery-oriented provider:

• an emphasis on client choice–no coercion
• all drug use is not addiction
• addiction is an illness characterized by loss of control
• for those with addiction, full recovery is the ideal outcome
• the concept of recovery is inclusive — can include partial, serial, etc.
• recovery is possible for any addict<
• all services should communicate hope for recovery–recognizing that hope-based interventions are essential for enhancing motivation to recover
• incremental and radical change should be supported and affirmed
• while incremental changes are validated and supported, they are not to be treated as an end-point
• such a system would aggressively deal with countertransference–some people may impose their own recovery path on clients, others might enjoy vicarious nonconformity through clients

I’ve also admired Scott Kellogg’s writing on gradualism. Here’s a quote from a story about him a few years back:

A Gestalt-trained therapist, Kellogg holds some views that seem to place him closer to the harm reductionist’s way of looking at substance use and recovery. He questions treatment center practices that appear to profess abstinence at the risk of losing many clients before they can start making progress. He states his belief that “there’s a crisis in our treatment world because many people don’t like treatment.”

Yet he also says his perspective goes against the tenets held by many harm reductionists. He is most impatient with the attitude in some needle exchange programs and similar initiatives that “we would never tell people what to do.” Offering a shower, a sandwich and a clean needle and then repeating the process time and again are fine in the short term, but at some point you need to help build a life after you’ve saved one, he suggests.

Unicorns?

Some local people in recovery from opioid addiction were growing frustrated with media representations of opioid addiction that suggest full abstinence-based recovery is not a realistic goal.

They decided to start The Unicorn Project and  I’ve helped them with a website.

Media reports and comments from “experts” give the impression that opioid addiction (heroin, vicodin, etc.) is a near hopeless condition and that the only hope is maintenance on other opioids (buprenorphine and methadone).

Some of these reports acknowledge that there are people who achieve drug-free recovery, but imply that they are extremely rare. It almost sounds like everyone’s heard of them, but no one’s seen one—like unicorns.

We know this isn’t true.

. . .

We want people to know that opioid addicts can achieve full recovery without opioid maintenance drugs. And, it’s not rare or unusual when people get the right kind of help.

We’re not here to argue that medications like buprenorphine and methadone are bad, or that our path to recovery or one form of treatment is better than another.

We just want people to know that drug-free recovery is a legitimate path to recovery, that many people already succeed with this path, and that more people could also succeed on this path—if they are offered the right kind of help.