Must We Treat Drug Addictions with More Drugs?
Considering a community approach that leads users to sustained recovery
When someone breaks a leg, we don’t respond with “just suck it up and get over it.” We help. How? We give pain medication to relieve the discomfort and then address the source of the pain, offer surgery and fix the broken leg. Then we care for them until they can walk again. No shame; no guilt. Just care.
Now what comes to mind when you think of someone who is strung out on drugs? Or heavily intoxicated due to a drinking problem? Do you think: lazy, lack of control, pathetic? That they chose this life? Do we consider their personal story? Of what might have brought them to this point? Do we think they’re even worth helping?
Add to that the fact that “more than 50 percent of those seeking help for an addiction also have a mental illness, and 15 to 20 percent of those seeking help from mental health services are also living with an addiction,” according to the Canadian Centre on Substance Abuse, and things get complicated.
Welcome to the stigma of addiction.
A large number of addicts are what we term “self-medicated.” I have heard repeatedly from addiction medical specialists and counsellors about the large number of people struggling with addictions who have experienced horrific abuse or trauma, and turn to prescription or street drugs to numb the pain of their mental anguish. When you consider that 62 percent of victims of sex offences were under 18 years of age, and of these, 30 percent were children under 12, according to police data in a report by Ontario’s Attorney General, it’s easy to see that a large population of adults are dealing with traumatic memories. How many of them will turn to drugs to ease their pain?
My experience with mental health began early in my career, as a nurse giving methadone on the acute wards of St. Paul’s hospital in Vancouver throughout the 1990s; then as a senior project manager with physicians and other clinicians in downtown Vancouver; and, most recently, as the Executive Director at L.I.F.E. (Living In Freedom Everyday) Recovery Association, a supportive recovery care continuum of services for women striving to overcome addictions. Yet, in all of that, I’m no expert in either mental health or addictions. What I can share with you are reflections and insights from my life’s journey, which includes listening to many who work closely in the addictions and mental health fields, and with whom I have been blessed to learn from.
A Christian Response
The Church is not immune to these struggles. Available stats pertain to pornography addictions rather than drugs and alcohol, but things like childhood trauma, or tragic life events do not discriminate. (Nor do mental health challenges.) I recently heard from an educated, affluent woman who was brought up in a loving, caring Christian home. She began her addiction experience in her late 20s as a response to a horrible, dysfunctional marriage and not being able to deal with the shame involved.
The need for all church leaders to be aware of the depth and degree of addictions and mental health struggles is critical, as the lead pastor is often only aware of a small percentage of these situations. Be proactive! Make resources available in your church; talk about it from the pulpit and in small groups, educate your church leadership team, and enact safe church policies for interacting with children and vulnerable people to help break cycles of abuse.
We can take our cue from Alcoholics Anonymous. Christian alcoholics started the 12-step program. Run by volunteers for over 80 years now, the good news of AA (and Narcotics Anonymous) is this: it is about relying on God, as well as building a community of care. Our hope comes from knowing how our great God can work through many people to provide solutions that our healthcare system cannot.
A Disconnected System
In my view, the problem with addiction and mental health services are the many gaps in care as well as the stigma and stereotypes that accompany both illnesses. I’ve heard of people who have checked themselves into the mental health ward at a hospital, only to be essentially “locked away,” and then medicated to control symptoms. Further compounding the problem is often a concurrent diagnosis of a mental health issue, such as depression, schizophrenia or an eating disorder in addition to their addiction challenges. Too often, the problem is treated with more drugs, while the root cause is ignored.
Back in my nursing days at St. Paul’s in the 1990s, methadone was used to help addicts for the short term. (It first gained prominence as a treatment for heroin addiction.) It was a temporary band-aid on a wound that runs deep. Thirty years later, methadone is being prescribed to addicts like insulin to a diabetic, that is, as a permanent treatment regime.
Replacing one addiction for another can be helpful to some, it is argued, providing effective and relatively easy treatment to people struggling with opioid addiction. But it fails to explain what I am hearing from many L.I.F.E. clients in my current line of work. Repeatedly, they tell me that physicians are so convinced that abstinence does not work that they are increasing the methadone dosages rather than helping to taper the client off, even when requested by the patient. (Some people are on methadone their whole lives.) I will never forget the words of one father I knew personally, who angrily stated in his agony and grief, that he and his wife were told their 30-year-old son was put on suboxone (another opioid) because he “could not overdose” on it. He told me this at his son’s funeral.
Is it compassion fatigue? Is the increase in prescription methadone a result of the challenges of treating people with concurrent disorders? Limited options? Are mental health and the addiction disciplinary teams working together or are there still too many silos? What about the controversy surrounding profits from prescribing methadone, as well as accusations that physicians offer such prescriptions too readily? (Though many physicians believe strongly in the treatment and are calling for increased supply and better funding.)
The latest version of drug treatment is the “safe supply program,” where free, clean, prescription opioids are dispensed in a controlled, safe manner. Sanctioned by Health Canada, Jan. 8 marked the kick-off of free “dillies” (five Dilaudid pills – another opioid), to a select 50 hard-core users in the downtown east side of Vancouver. There’s a similar clinic in East Vancouver called Cross Town, which gives free heroin in a controlled manner. The rationale: meeting addicts where they are at; giving them what they need and helping them stay crime-free, alive and safe in the hope they decide to seek help.
The thinking behind these programs is to address the source of the whole mess (currently dubbed “the opioid crisis”) since “bad” drugs (drugs laced with Fentanyl) are reported in 80 percent of overdoses in B.C. (and 72 percent across Canada). Rather than the outdated “war on drugs” model, current ideas seek to fight illicit drug suppliers with a clean supply, and do away with prohibition, instead offering clean narcotics to addicts in an attempt to help in other ways. Numbers from the Public Health Agency of Canada report that 9,000 Canadians have died from drug overdoses between January 2016 and June 2018 alone, with one-third of those in B.C.
A recent publication by the B.C. Centre on Substance Use entitled, “Strategies to Strengthen Recovery in B.C.: The Path Forward” reflects on the main barriers to treatment and recovery: Individuals not believing they have a problem, dealing with the stigma and misconceptions about addiction and recovery, accessing services, cost, and lack of female- and age-specific services are all listed as problems that need to be addressed. Because of the wide range of issues involved (and there are many more), the report is a call to work together. Health professionals are simply the first step of a community-based effort that should focus on and bolster people’s strengths and resiliencies through a network of people committed to being supportive for the long term.
A Good News Story
Building on this idea of community support is L.I.F.E. Recovery. Twenty years ago, a small group of congregants from a few churches in the Abbotsford area helped some loved ones “detox.” They volunteered for eight-hour shifts, 24/7, to see one man, then one woman overcome their initial stages of recovery. The group quickly learned that there were fewer resources for women than for men. On Feb. 22, 1999, L.I.F.E. Recovery Association became an official society. Today, we have four women-only homes with 33 beds, delivering a continuum of first, second and third stages of recovery. This would not be possible without the support of a “mother church” (Trinity CRC) and the partnerships of people from different churches uniting to finance our first home. We would not be here today if it were not for their continued support.
The board has learned, through trial and error, that focusing on long-term recovery and client-focused care, not deadline-driven programs, facilitates higher success rates. Without stringent admission criteria, L.I.F.E. staff have the flexibility of responding to specific needs, such as helping pregnant women obtain proper prenatal care and go on to give birth to drug-free babies. We are blessed to be what is needed most: communities caring for addicts for the long haul.
Sometimes you get a glimpse of both sides of a situation. I’ve experienced the heart of hopelessness by witnessing the ever-revolving door of overdoses and crisis cases at St. Paul’s hospital; now, I hear story after story of love, care and hope through L.I.F.E. Recovery.