Spending time every day working in the community with people who are living with opiate addiction, I see a lot and hear a lot.  I can’t count how many times I’ve heard everyone from probation officers to drug treatment providers to doctors refer to “typical addicts” and so-called “typical addict thinking.”

Talk like that reveals to me that the speaker has succumbed to the pervasive stereotyping and stigmatization of people with addiction in our culture.

It’s typical non-addict thinking.  And it makes me sick.

The problem is, the dominant cultural approach to interactions between addicted people and those around them is based on outdated and bogus notions about codependence, enabling, tough love and hitting rock bottom.

It’s a false and destructive paradigm that teaches that causing or permitting harm to an addicted person is a good thing.

It gives those with power over addicted people social permission to be callous and even cruel.  It makes me sick.

I see it every day.  Here are two examples from today.

Just Out of Jail And In Recovery

Young guy, recently out of jail.  Major mental illness.  Learning disabilities.  Severely abused physically, emotionally and sexually by his family.  They beat him, sexually assaulted him and to this day still tell him he’s a piece of shit.  He’s in recovery, and hasn’t used drugs since he got out of jail.  It’s not easy for him, and he is really struggling.  He lives in a sober house.  He went to two AA meetings before noon today, and plans to go to another tonight.  One day at a time.

Yesterday, his probation officer gave him a drug test.  Negative!  No praise.  He says she seemed “pissed he was negative.”

Today, she calls him in again.  She got in his face.  Pointed her finger close to his nose, and screamed at him.  Another person abusing him.  Another person telling him he is a piece of shit.

He made a mistake on some paperwork, she screams.  She held it up to his face.  He looked at the paperwork and realized she was showing him someone else’s paperwork.

Did she apologize?  No.  Instead she had him handcuffed and then took away privileges one by one.  She even told him he had to tell his ride to leave and walk home.  He says he feels she was trying to make him snap.  He kept his cool, but says he was shaking uncontrollably.  She noticed and said, “what, are you all fucked up?”

Another drug test.  Negative!

He walked the two blocks to my office and spent a few minutes telling me the story.  He was still shaking.  He left determined to hang on.  But look what he is up against.

What makes this PO feel free to act this way?  What makes her feel justified in her abuse?  She’s following a sick cultural norm!  And notice, he doesn’t even have to be using for her to feel justified in her abuse.

Young Girl Close to Death

Young girl, in the hospital.  Liver failure from drinking alcohol, and from hepatitis C contracted through injection drug use.  Major mental illness.  Homeless.

She came into the hospital a few weeks ago very thin and frail, and unable to walk.  A friend had let her sleep on the couch temporarily, but she was so weak she had to crawl to get from room to room, or be carried.

The doctor said she was close to death.  She had rallied with a blood transfusion and a few weeks rest and care, but the doctor said her condition was not likely to improve much beyond that.  They expect she has less than six months to live.  She still lays curled up in bed all day, pathetically small, and depressed.  She keeps her eyes closed when she talks to you, and when she opens her eyes, she has trouble focusing.  Her thought process is slow, and her mind is foggy.

The doctor refers to her as a “typical addict.”  Where have I heard that before?

A meeting with the hospital social worker.  They want to discharge her.  She is medically stabilized and not likely to get much better.  She still can barely walk from the bed to the bathroom.  She is still rail thin.  She can’t follow a conversation.  She has no place to go.

The social worker suggests drug rehab.  “I gave her the number to a rehab,” the social worker says.  “We’ll see what she does with it,” she adds, her tone and expression making it clear that I’m in on the joke –which is that as a typical addict, she won’t do anything with the number.  Her choice, the social worker implies, but I’m certainly not going to enable her by making the phone call for her.  She’s sure I’ll agree.  She’s sure I won’t be offended by her disrespect , or her callous disregard for the safety and dignity of a young girl who is suffering and dying.

Typical non-addict thinking, and it makes me sick.

“Medication-Assisted Treatment (MAT) Works Great For Me” proclaims a U.S. government poster educating the public about treatment for opiate dependence using medications like Suboxone, Vivitrol and methadone.

The poster is published and distributed by the Substance Abuse and Mental Health Service Administration of the U.S. government (SAMHSA).

The poster shows a diversity of smiling faces, and reads…

MAT can and does:

• Restore MY Dreams and Ability to Achieve Them
• Improve MY Health
• Increase MY Opportunities for Success
• Strengthen MY Future
• Enhance MY Relationships With Family, Friends, and Community

“MAT is effective,” the poster continues.  “Therapies including methadone and buprenorphine empower people to reclaim their lives and rejoin their families, their jobs, and their communities.”

The poster ends with the statement:

“Medication-Assisted Treatment IS Recovery.”

Medication-assisted treatment with medications like methadone, Suboxone and Vivitrol does work for many people, and it is recovery.  Get the message?

Getting out of prison is both a relief and a challenge for most people.  The adjustment isn’t always easy, especially for people who are addicted.

It’s a high-risk time for relapse and fatal drug overdose.  And a high-risk time for relapse to criminal behavior and re-incarceration.

Researchers are injecting inmates who were addicted to heroin or prescription pain killers before incarceration with the medication Vivitrol one week prior to release, and again monthly for six months.

The goal is to prevent relapse, overdose, crime and re-incarceration.

Vivitrol is an extended-release form of naltrexone, a medication used to treat addiction.

Naltrexone is not an opiate, but it has the ability to occupy opiate receptor sites in the brain.  This blocks the effects of heroin and other opiates.

Naltrexone is non-narcotic and does not result in physical dependence.

Vivitrol treatment can’t begin until patients have stopped using opiates for 7-10 days.  Detox is a painful process, and the need to detox before starting treatment with Vivitrol can be a barrier to treatment.  Treating people who are incarcerated before they are released helps overcome this barrier.

Even though most inmates have drug problems, most don’t get treatment in jail.  It makes sense to begin treatment in jail and continue the treatment after release.

Maybe we are finally getting smarter in our approach to drugs and crime.

Try This At Home!

Vivitrol was approved by the FDA for the treatment of opiate dependence in 2010 and alcohol dependence in 2006.  This means the U.S. government has already determined this treatment to be safe and effective.  And it means that your doctor can already prescribe Vivitrol to you or your loved one.

You don’t have to wait for this research to be completed to take advantage of this treatment!

Consider scheduling a doctor’s appointment to begin treatment immediately upon release.   Your doctor will help you determine if this treatment is right  for you.

Treatment with Vivitrol may help reduce the risk of:

• relapse
• fatal drug overdose
• resumption of criminal activity
• re-incarceration

Wishing you a safe recovery!

Pregnant women who are addicted to heroin or prescription pain relievers should be treated with either methadone or buprenorphine (Suboxone, Subutex).

This according to new guidelines recently published by the American Academy of Pediatrics.

I wasn’t surprised by the new guidelines, because similar recommendations have already been made by the U.S. National Institutes of Health and the World Health Organization, among others.  And it is well known that detoxification from opiates during pregnancy is associated with increased risk of fetal harm and may result in loss of the pregnancy.

Medication-assisted treatment with methadone or Suboxone is a responsible choice for pregnant women who are opiate dependent.  Women who make this choice should be praised and supported.

Instead, the opposite often happens.  And pregnant women who follow the scientific evidence and top expert medical advice often face stigma.

Part of this stigma stems from inaccurate claims that babies will be born “addicted.”  The truth is that babies born to women in treatment with methadone or Suboxone are not addicted.

Addiction refers to dysfunctional and compulsive drug use that continues in spite of negative consequences.  Clearly, a newborn baby is not capable of using compulsively, or having a dysfunctional relationship with a substance.  And we should remember that without the methadone or Suboxone, it’s quite possible that there would be no newborn at all.

Labeling an infant born to a mother in treatment with methadone or Suboxone “addicted” is not only inaccurate, it also contributes to stigma.  Such stigma can lead to punitive treatment of the mother and negative consequences for both the mother and child.

Many babies born to mothers in treatment with methadone or Suboxone will experience some symptoms of physical withdrawal after birth, but this results from physical dependence on the medication and not addiction to the medication.

Withdrawal symptoms may be uncomfortable for the baby.  But they are a side effect of a medically necessary medical treatment.  They are temporary, can be treated to limit distress to the baby, and are not known to cause any long term harm.

Mothers who are in treatment with methadone or Suboxone are encouraged to breast feed their babies (unless otherwise contraindicated).  Small amounts of methadone or Suboxone that may be passed to the baby with the breast milk can help reduce any symptoms of withdrawal.

Research shows that women who are pregnant and addicted to opiates have the best outcomes for themselves and their child when they:

• Participate in treatment with methadone or Suboxone while they are pregnant

• Breastfeed their baby

• Continue methadone or Suboxone treatment as needed to successfully initiate and maintain long term recovery

Medication-assisted treatment is responsible for the safe delivery of many healthy babies to mothers who would otherwise still be using, and therefore less able to parent successfully.

Perhaps the Academy of Pediatrics should recommend medication-assisted recovery for expecting fathers who are addicted too.  I know I do.

Essay contest winners described their addiction recovery in their own words, and explained how medications like  methadone, buprenorphine (Suboxone and Probuphine) and naltrexone (Vivitrol) helped them get sober.

Over 125 people from the US and the UK entered the essay contest.

The winners are:

First Prize:  Darlene DeMore of (Pennsylvania, USA)

Darlene wrote about her methadone treatment and 14 years of recovery.

When I became pregnant, I was terrified that I would not be able to take care of my child.  MAT allowed me to become well, function normally and raise a beautiful daughter.

Second Prize:  Louis Buchhold (California, USA)

Louis wrote about his naltrexone treatment and 11 years of recovery.

In 8 long years I had never been able to get longer than 30 days sober, being in/out of AA, therapy and having tried to kill myself…If it wasn’t for MAT I would not be here to tell my story.

Third Prize:  Ian Christenson (Minnesota, USA)

Ian wrote about his Suboxone treatment and 5 years of recovery.

“Suboxone saved my life…I had been attending 12 step groups but after years of heroin and pill addiction, numerous drug treatments, and chronically relapsing I had to do something different…I feared the judgments of others in recovery…MAT is the best decision I made in a long time…Suboxone has stopped my cravings and preoccupation with getting high…I’m 100% committed to my recovery…I now have a good job, a house, and a family…I now have something I never thought I could, sobriety and true happiness.

Congratulations to the winners on both their wonderful essays and their recovery success.

The contest was sponsored by the Addiction Technology Transfer Center (funded by the US government), Faces & Voices of Recovery, and the National Alliance for Medication-Assisted Recovery.

Read the full Recovery Essays.

Drug users who are infected with HIV are 74 percent more likely to experience drug overdose, a recent study suggests.

Researcher Traci Green, Ph.D. says factors contributing to the increased risk may include poorer physical health, poverty and poor access to medication-assisted therapy to treat opioid dependence.

Green points out that drug treatment with methadone or buprenorphine (Suboxone) has been shown to protect against fatal drug overdose, and she suggests that improved access to these therapies would be one important way to reduce high overdose risk in this population.

The study was conducted by Rhode Island Hospital and the Lifespan/Tufts/Brown Center for AIDS Research.

New research suggests that Vivitrol is an effective long-term treatment for addiction to heroin or prescription pain killers.

Half of all Vivitrol patients in a recent drug treatment study remained opiate-free for the entire one-year study.

Vivitrol is a medication used to treat addiction to heroin and prescription pain killers.  The non-narcotic medication blocks the effects of heroin or other opiates.

Vivitrol is an injectable, extended-release form of the medication naltrexone.  Patients visit their medical provider once per month to receive a shot.

Study participants were taking part in a one-year extension of an earlier 6-month study.  Treatment included psychosocial support.

Methadone moderates emotional responses including elation and depression says a new study reported in the science journal Addiction.

“Easy Does It” is a common recovery mantra.  Emotional stability is especially important for people in early recovery.  Both emotional highs and lows can contribute to relapse.

For people who are addicted to heroin or other opiates, methadone treatment may support recovery by taking the edge off of mood shifts.

Of course, methadone also supports recovery by limiting cravings, preventing withdrawal symptoms and blocking the effects of other opiates.

You may have heard about the benefits of committing random acts of kindness.  The benefits are very real and very concrete.

This works for people who are currently using, people who are in early recovery, people who are in long term recovery, and family members.  So try it yourself and suggest it to those who are close to you.

Helping others releases endorphins into the brain (a natural good feeling) and reduces stress.  Benefits include improvements in physical health and mental health.  And the benefits have been documented by scientific research.

But did you know that for best results you should commit these acts of kindness on a schedule?

You can get good results by commiting about 5 acts of kindness all during the same day about one day per week.

Acts of kindess can be just about any nice thing you can think of to do for another person.  The idea is to go beyond what is expected and reach out to another person in a way that demonstrates empathy for them by an actual act.  It’s not just about feeling empathy for another person, but going beyond feeling and actually acting on empathy so your empahty is made concrete and visible between you and the other person.

Watching for opportunities to be kind in and of itself can make a powerful change in the way we feel and look at the world.  Actually acting in kind ways has even greater power to change our emotional state and create conditions of happiness.

It’s ok to plan your act of kindness in advance (the idea of random acts of kindess was in response to the often heard phrase “random acts of violence”).

Acting out of the goodness within us benefits us and creates a ripple effect well beyond the person we reach out to with kindness.

I’m going to do 5 random acts of kindness on Mondays.  Pick a Random Act of Kindess Day for yourself and leave a comment on your experience.

Will your son’s arrest ultimately turn out to be a good thing?  Not likely.

I certainly understand how a mother could feel a sense of relief when her son is arrested.  Even her son may feel a certain sense of relief.

Finally something might actually derail the runaway train.  But what about the train wreck that follows?

For the last 10 years, I’ve run an incarceration-prevention program for people living with opiate dependence.  Our goal is to help people find a path to recovery that does not pass through the jailhouse door.

Not only is it possible to find a path to recovery that does not pass through the jailhouse door, but passing through the jailhouse door reduces your chances of long term recovery success.

Sure, arrest and the threat of incarceration can result in a new focus on the need for change, and provide motivation for change.  But this particular path to focus and motivation risks some devastating side effects.

There are other ways to elicit focus on the need for change and build motivation for change.  Ways that are more effective over the long term and less harmful.

I fear that as a society we are too ready to use the cudgel of coerced treatment.  We’ve talked ourselves into believing that incarceration is a therapeutic response to addiction.  But the many-forked path through the criminal justice system often leads every which way but stable, long-term recovery.

I think we would be smart to be wary of a system of coerced treatment for addiction through the threat of incarceration –just as we would be wary of a system of coerced treatment for any other health issue with a behavioral component such as obesity, smoking, diabetes or heart disease.

I think we should recognize and be wary of the “enablers” of this system:

1.  Desperate parents, families and communities;

2.  Lazy and unskilled treatment providers who bottom feed on coerced treatment;

3.  Politicians who get more political mileage out of putting money into the criminal justice system instead of the drug treatment system; and

4.  Unjustified stigma against drug users that grants social permission to incarcerate rather than provide effective treatment.

I feel no sense of relief when a client is arrested.  I recognize that the job of helping that person build a safe and sustainable recovery just got a lot harder.

“I’m never coming back here again.”

“I’m never going to use again.”

“Getting arrested saved my life, if I wasn’t here I’d be dead by now.”

I hear these statements often from clients I visit in jail.  I recognize the sincerity behind the statements.  After many years of experience, I also recognize that these kinds of sincere statements are often not only not actually accurate, but almost the opposite of the reality of the situation.

Once in jail, more likely to be back in jail again.

Once in jail, less likely to be able to achieve the conditions of stability necessary to achieve long term recovery.

Incarceration is more likely to put a life at risk.  Getting effective treatment would have been more likely to save a life.

Getting sucked into the criminal justice system most often delays recovery, complicates recovery and destabilizes recovery.  Most people don’t get treatment in jail, and don’t get linked to treatment after release from jail.  Instead, statistics show that a large percentage of fatal overdoses happen right after release from incarceration.

There is a basic human impulse to try to make sense of bad experiences by finding the good that might give the experience a positive meaning.  We do this with war, serious illness, and even the tragic death of a loved one.  It’s a healthy coping mechanism.

It’s healthy to focus on the good.  It’s healthy to take the bad things that happen to us and weave them into our personal narratives in way that gives them positive and hopeful meaning.  But as a society, it’s more healthy to recognize that bad things are bad.

Incarceration as a solution to addiction is BAD.