Harm reduction, addiction, tough love, 12 steps, neurodiversity, and the troubled-teen industry

If addiction is like misguided love, then compassion is a far better approach than punishment.

Source: Can You Get Over an Addiction? – The New York Times

Maia Szalavitz poses addiction as a neuro-developmental learning disorder—one often developed while trying to cope with trauma, poverty, or an over reactive nervous system, particularly during adolescence.

Many neurodivergent have hyper-reactive nervous systems. Anxiety and sensory overwhelm flood the senses. A substance that eases anxiety and sensory overwhelm offers relief and escape.

I’m autistic. Much of autism is anxiety and sensory overwhelm. A widely available—and destructive—tool for coping is alcohol. Compulsive damping of my reactive neurology with alcohol compromised my health.

There are less harmful ways to medicate. Cannabis is a neuroprotectant and powerful harm reducer that is friendly to neurodivergence.

Cannabis is the least harmful way for we humans to cope with the burdens of sentience, senescence, and mortality. Cannabis is popular in STEAM cultures, at least the ones I’ve inhabited. It is part of the process of living, creating, and coping. I think the neurodivergent have long used it to regulate and cope in a world that does not accommodate. If your neurodivergence is accompanied by tics, seizures, paresthesia, fasciculations, panic, anxiety, or self-harming stimming, as but a few examples, then cannabis is a tool and ally. There are as many human operating systems as there are humans. The endocannabinoid system is a useful interface to our operating systems for which we have a natural, easy-to-grow key. All humans and their mammalian kin share this interface and this plant. We plucky prometheans figured out how to decarboxylate with fire.

Source: On cannabis and neurodiversity

The drug war’s perverse notions of addiction, addicts, and coping limit our vocabulary, stifle our empathy, and harm us all–especially those with neurodivergent operating systems and those enduring poverty and structural racism and ableism.

Through compassion, the social model, and respect for neurodiversity and structural disadvantages, we can improve our views of addiction.

Follow Maia Szalavitz on Twitter and read her book.

Addiction as a learning disorder

More people than ever before see themselves as addicted to, or recovering from, addiction, whether it be alcohol or drugs, prescription meds, sex, gambling, porn, or the internet. But despite the unprecedented attention, our understanding of addiction is trapped in unfounded 20th century ideas, addiction as a crime or as brain disease, and in equally outdated treatment.

Challenging both the idea of the addict’s “broken brain” and the notion of a simple” addictive personality,” Unbroken Brain offers a radical and groundbreaking new perspective, arguing that addictions are learning disorders and shows how seeing the condition this way can untangle our current debates over treatment, prevention and policy. Like autistic traits, addictive behaviors fall on a spectrum — and they can be a normal response to an extreme situation. By illustrating what addiction is, and is not, the book illustrates how timing, history, family, peers, culture and chemicals come together to create both illness and recovery- and why there is no “addictive personality” or single treatment that works for all.

Source: Unbroken Brain – Maia Szalavitz

Addiction is indeed a brain problem, but it’s not a degenerative pathology like Alzheimer’s disease or cancer, nor is it evidence of a criminal mind. Instead, it’s a learning disorder, a difference in the wiring of the brain that affects the way we process information about motivation, reward and punishment. And, as with many learning disorders, addictive behavior is shaped by genetic and environmental influences over the course of development.

The studies show that addiction alters the interactions between midbrain regions like the ventral tegmentum and the nucleus accumbens, which are involved with motivation and pleasure, and parts of the prefrontal cortex that mediate decisions and help set priorities. Acting in concert, these networks determine what we value in order to ensure that we attain critical biological goals: namely, survival and reproduction.

In essence, addiction occurs when these brain systems are focused on the wrong objects: a drug or self-destructive behavior like excessive gambling instead of a new sexual partner or a baby. Once that happens, it can cause serious trouble.

If, like me, you grew up with a hyper-reactive nervous system that constantly made you feel overwhelmed, alienated and unlovable, finding a substance that eases social stress becomes a blessed escape.

The learning perspective also explains why the compulsion for alcohol or drugs can be so strong and why people with addiction continue even when the damage far outweighs the pleasure they receive and why they can appear to be acting irrationally: If you believe that something is essential to your survival, your priorities won’t make sense to others.

Recognizing addiction as a learning disorder can also help end the argument over whether addiction should be treated as a progressive illness, as experts contend, or as a moral problem, a belief that is reflected in our continuing criminalization of certain drugs. You’ve just learned a maladaptive way of coping.

Moreover, if addiction resides in the parts of the brain involved in love, then recovery is more like getting over a breakup than it is like facing a lifelong illness. Healing a broken heart is difficult and often involves relapses into obsessive behavior, but it’s not brain damage.

If addiction is like misguided love, then compassion is a far better approach than punishment.

This makes sense because the circuitry that normally connects us to one another socially has been channeled instead into drug seeking. To return our brains to normal then, we need more love, not more pain.

People with addictions are already driven to push through negative experiences by their brain circuitry; more punishment won’t change this.

But it’s equally possible that I kicked then because I had become biologically capable of doing so. During adolescence, the engine that drives desire and motivation grows stronger. But unfortunately, only in the mid-to-late 20s are we able to exert more control. This is why adolescence is the highest risk period for developing addiction — and simple maturation may be what helped me get better.

At the time, nearly all treatment was based on 12-step groups like Alcoholics Anonymous, which help only a minority of addicted people. Even today, most treatment available in rehab facilities involves instruction in the prayer, surrender to a higher power, confession and restitution prescribed by the steps.

We treat no other medical condition with such moralizing — people with other learning disorders aren’t pushed to apologize for their past behavior, nor are those affected by schizophrenia or depression.

Once we understand that addiction is neither a sin nor a progressive disease, just different brain wiring, we can stop persisting in policies that don’t work, and start teaching recovery.

Indeed, if the compulsive drive that sustains addiction is directed into healthier channels, this type of wiring can be a benefit, not just a disability. After all, persisting despite rejection didn’t only lead to addiction for me — it has also been indispensable to my survival as a writer. The ability to persevere is an asset: People with addiction just need to learn how to redirect it.

Source: Can You Get Over an Addiction? – The New York Times

I want people to understand that addiction is a learning disorder. If you don’t learn that a drug helps you cope or make you feel good, you wouldn’t know what to crave. People fall in love with a substance or an activity, like gambling. Falling in love doesn’t harm your brain, but it does produce a unique type of learning that causes craving, alters choices and is really hard to forget.

It’s compulsive behavior that persists despite negative consequences. Once you realize that that’s the definition of addiction, you realize that what’s going on is a failure to respond to punishment. If punishment worked to stop addiction, addiction wouldn’t exist. People use despite their families getting mad at them, despite losing their jobs and being homeless. And yet we think the threat of jail is going to be different? Addiction persists despite negative consequences. That doesn’t mean that people don’t recover through coercive means, but that doesn’t mean it’s the best way to get there.

My problem with addiction memoirs has always been that this is a deeply political problem and none of them have any political consciousness. They typically tell the story of sin and redemption, an individual story that can stand in for everyone else’s story. That’s just not true.

People who become addicted are wired differently, and it affects the manner in which they learn. We see people with addiction as valueless—literally, pieces of junk. But the interesting thing with different types of brain wiring is, they don’t bring only disadvantages. They can also bring advantages. Sometimes there are blessings hidden inside of curses. The compulsive drive that set me up for addiction probably also makes me a good journalist.

Having the ability to persist despite negative consequences is a plus in many ways. You could never parent or be in a relationship without that ability. Diaper-changing is not fun. There’s a lot of stuff in life where you just have to stick it out. When those same systems that give us motivation get misdirected toward a drug, that’s problematic. It doesn’t mean you’re broken, it just means you fell in love with the wrong thing.

If addiction was genuinely a disease that got worse and worse, it should be harder to recover the older you get. But the data say differently: by their early thirties, half of people who have addiction, excepting tobacco, no longer meet diagnostic criteria. They learn to cut down on their own—and only 10 percent ever get treatment.

Language is power, and it’s important not to dehumanize people who have addiction. The term “addict” is stigmatizing and demonizing. The stereotype of the “addict” is also a stereotype we have for people of color. We have to move away from that language in order to move away from that racism.

Also, when we use the word “abuse,” it connotes really awful behavior, like domestic abuse, child abuse, sexual abuse. Nobody’s abusing a poor little drug. They might be misusing it, but they’re not abusing it.

And the very point of making something a crime is to stigmatize it. You want it to be stigmatized so people don’t do it. Yet you can’t say on one hand that you want to destigmatize addiction while you criminalize certain drugs. And the other thing that undermines the argument about addiction being a disease is that the only disease in America where 80 percent of the treatment is meeting, confession, and surrendering to a higher power.

We should decriminalize all drug possession, legalize marijuana, use the money we save to fund evidence-based treatment. We need to get rid of the cap on suboxone prescribers, (the law allows doctors to prescribe to only 100 patients) and use it as harm reduction as well as a path to recovery. We’d have fifty percent fewer deaths if we relied on medication-assisted therapy. People have to be alive to recover.

Source: Why Addiction Is a Learning Disorder – The Daily Beast

Addiction, in your view, is a neuro-developmental learning disorder. What does that mean?

It means that for one, addiction can’t occur without learning. When I say that, what I mean is literally if you don’t learn that the drug comforts you, makes you feel euphoric or allows you to cope in some way, you cannot be addicted to it—because you cannot crave it, because you don’t know what to pursue despite negative consequences. And that’s important, because people have often thought addiction is just this physiological process that hijacks your brain. That’s really not quite accurate. It involves learning, it involves interacting with the environment, interpreting the environment, and it involves making choices.

The other reason that I think it’s important to see addiction as a developmental disorder is that 90 percent of all addiction occurs between the teens and 20s. That is similar to other developmental conditions such as schizophrenia and depression, which tend to start at that age. That suggests there is a particular period of vulnerability that the brain has and also probably has to do with your life history, as well. When you hit your teens or 20s you’re learning the coping skills you need to handle the adult relationships that are necessary for survival and reproduction. If you are using drugs to escape during this time not only is your brain developmentally vulnerable to not being able to control the use of the drug, but you’re also missing out on developmental experiences that allow you to create other methods of coping.

Unfortunately, in the addictions field, we’ve developed this idea that one size fits all, and whatever works for me is going to work for you, and we can extrapolate from my experience to be the experience of all people with addiction. That’s why I like the saying from the autism community, which is: if you met one person with autism you’ve met one person with autism. We should be saying that about addictions. I find it really annoying when people say “all addicts do X or Y.” Well, maybe you do X or Y, but don’t speak for me.

Imagine I’m trying to argue that the medical condition I have is a disease. But, everybody who has that medical condition can be locked up for having that medical condition, and, if they’re not locked up, they are sent to treatment that involves prayer and restitution.

So, am I going to believe that’s a disease? If I go to cancer treatment and I get told I’m going to be locked up if my tumor grows or I’m going to have to pray to a higher power and surrender in order to get better, I’m going to definitely think that I’m not in mainstream medicine. I’m definitely going to be thinking that this is not a medical condition, that it’s some kind of sin. The 12-step people don’t see any contradiction in saying addiction is a disease and the treatment is prayer, meeting, and confession. But, from the outside that sounds completely absurd. It does not bolster the disease argument at all.

When I talk about addiction being a learning disorder, I’m not saying that it isn’t a problem of the brain, obviously. I’m saying the kind of problem it is is more like ADHD than it is Alzheimer’s. And I think that fits the data. If addiction is actually progressive, it should be harder to recover as you get older and that is not actually true. It also gives a much more hopeful message. Because when people hear “chronic progressive brain disease” they think dementia. When they hear hijacked brain they think: oh my god, these are zombies who are dangerous and we better lock them up for the protection of the rest of us. They think of people who have no responsibility for their actions so therefore we can treat them like children.

If addiction is a learning disorder, fighting a ‘war on drugs’ is useless.

In terms of marijuana: it should be legalized. It is the least harmful, not completely unharmful, but the least harmful psychoactive substance that is regularly used. It makes absolutely no sense to give that profit to the mafia.

Where you end is a comment on neurodiversity, the idea that people with different wiring do not only have impediments, but also assets that ought to be celebrated and respected. Can you explain how this relates more to your work?

It’s quite obvious for some people on the autism spectrum that they’re quite good at things like programming but quite horrible at socializing. I think the neurodiveristy movement is really cool in valuing everybody and letting people see that what may look scary or different or totally weird on the outside may, from the inside, make total sense. It expands the world for everybody.

It’s not just that people who have disabling conditions benefit from the world being friendlier towards us, but we also benefit from being able to function and offer things that we are uniquely equipped to do. I think with addictions in particular, you can’t succeed as a writer if you can’t persist despite negative consequences.

Source: Addiction is a learning disorder: Why the war on drugs is useless, AA undermines treatment, and addiction studies can learn a lot from autism

Many of us grew up with antidrug programs like D.A.R.E. or the Nancy Reagan-inspired antidrug campaign “Just Say No.” But research shows those programs and others like them that depend on education and scare tactics were largely ineffective and did little to curb drug use by children at highest risk.

The traits that put kids at the highest risk for addiction aren’t all what you might expect. In my case, I seemed an unlikely candidate for addiction. I excelled academically, behaved well in class and participated in numerous extracurricular activities.

Inside, though, I was suffering from loneliness, anxiety and sensory overload. The same traits that made me “gifted” in academics left me clueless with people.

That’s why, when my health teacher said that peer pressure could push you to take drugs, what I heard instead was: “Drugs will make you cool.” As someone who felt like an outcast, this made psychoactive substances catnip.

They focus on four risky traits: sensation-seeking, impulsiveness, anxiety sensitivity and hopelessness.

Importantly, most at-risk kids can be spotted early. For example, in preschool I was given a diagnosis of attention deficit/hyperactivity disorder (A.D.H.D.), which increases illegal drug addiction risk by a factor of three. My difficulty regulating emotions and oversensitivity attracted bullies. Then, isolation led to despair.

A child who begins using drugs out of a sense of hopelessness — like me, for instance — has a quite different goal than one who seeks thrills.

Three of the four personality traits identified by Preventure are linked to mental health issues, a critical risk factor for addiction. Impulsiveness, for instance, is common among people with A.D.H.D., while hopelessness is often a precursor to depression. Anxiety sensitivity, which means being overly aware and frightened of physical signs of anxiety, is linked to panic disorder.

Source: The 4 Traits That Put Kids at Risk for Addiction – The New York Times

Addiction vs. Dependence, Interventions, Rehab

Much of the advice given by treatment groups and programs ignores what the data says in a similar way that anti-vaccination or climate skeptic websites ignore science. The addictions field is neither adequately regulated nor effectively overseen. There are no federal standards for counseling practices or rehab programs. In many states, becoming an addiction counselor doesn’t require a high school degree or any standardized training. “There’s nothing professional about it, and it’s not evidence-based,” said Dr. Mark Willenbring, the former director of treatment research at the National Institute on Alcohol Abuse and Alcoholism, who now runs a clinic that treats addictions.

Consequently, families are often given guidance that bears no resemblance to what the research evidence shows — and patients are commonly subjected to treatment that is known to do harm. People who are treated as experts firmly proclaim that they know what they are doing, but often turn out to base their care entirely on their own personal and clinical experience, not data.

In the past, researchers believed addiction just meant that someone needed a substance to function without suffering withdrawal. But now medical experts such as the National Institute on Drug Abuse define addiction as compulsive drug use that continues regardless of negative consequences.

That’s different from just depending on a daily dose. The latter is called physiological dependence; it affects almost anyone who takes opioids daily long term. “Physiological dependence is the normal response to regular dosages of many medications, whether opioids or others. It also happens with beta blockers for high blood pressure,” said Dr. Wilson Compton, deputy director of the National Institute on Drug Abuse. Although many chronic pain patients are physically dependent on opioids, few develop the life-threatening compulsive pattern of drug use that signifies addiction.

When opioid addiction occurs, it is rarely someone’s only mental health problem.

Addressing these underlying issues is usually essential to successful treatment – but unfortunately, many treatment programs are just not equipped to do so, despite claiming otherwise.

“Interventions are almost always destructive, and sometimes, they destroy families.”

“The pure tough love approach does not seem particularly effective and is sometimes quite cruel and potentially counterproductive,” Compton said.

Jail is not treatment. Prisons and jails tend to be neither safe nor drug-free — and interaction with the criminal system, even with drug courts, often restricts access to the best treatment while sometimes punishing relapse more severely than the original offense.

Consequently, do not try to use legal consequences as a way to help people you love, and if possible, bail them out if they get arrested for drug crimes. This doesn’t mean you shouldn’t hold them accountable, but do so in ways that are less likely to lead to lifelong problems. Meaningful employment is an important factor in recovery — and few things are more harmful to the chances of getting a good job than having a criminal record.

Because opioid addiction rarely exists by itself, experts recommend starting any search for treatment with a complete psychiatric evaluation by an independent psychiatrist who is not affiliated with a particular treatment program.

For opioid addiction itself, however, the best treatment is indefinite, possibly lifelong maintenance with either methadone or buprenorphine (Suboxone). That is the conclusion of every expert panel and systematic review that has considered the question

In the U.K., researchers looked at data from more than 150,000 people treated for opioid addiction from 2005 to 2009 and found that those on buprenorphine or methadone had half the death rate compared with those who engaged in any type of abstinence-oriented treatment.

“Rehab kills people”

Shame and punishment do not work: These tend to drive relapse, rather than recovery.

Families and loved ones can improve the odds for people with addiction by helping motivate them to get treatment; seeking evidence-based care; keeping naloxone on hand; and treating addicted people with the empathy, support and respect they’d offer if they faced any other life-threatening medical problem.

Source: What Science Says To Do If Your Loved One Has An Opioid Addiction | FiveThirtyEight

In other words, if pain medications are making your life genuinely better and improving your ability to love and work, what you are experiencing if you have withdrawal symptoms is dependence, not addiction.

“Even patients themselves confuse addiction and dependence and feel guilty about it and feel like something is wrong with them,” says Richard Saitz, professor and chair of community health sciences at Boston University. “They are often treated as if something is wrong with them, when there’s nothing wrong at all. All of that ends up leading to actions or policies or guidelines that are really misguided and address the wrong thing.”

Early definitions of addiction often did indeed see it as being identical to dependence, in part because physical withdrawal symptoms can be objectively measured and researchers were trying to minimize subjectivity.

“It is clear that any harm that might occur because of the pejorative connotation of addiction would be completely outweighed by the tremendous harm that is now being done to patients who have needed medication withheld because their doctors believe they are addicted simply because they are dependent.”

An accurate conception of addiction also has implications for the fate of children exposed to drugs in the womb. During the crack era, stigma against “addicted” babies did real harm: Teachers, parents and medical professionals viewed so-called “crack babies” as doomed to be either helpless invalids or psychotic criminals. Of course, babies can’t get addicted, since a helpless infant cannot pursue drugs despite consequences and doesn’t even know if what he craves is drugs or a diaper change. But at least one study found that the derogatory labeling produced more punitive responses from adults and lowered their expectations of the children—in itself a harmful outcome.

In fact, much of the damage initially attributed to crack exposure in babies turned out to be associated with stress and poverty—and could be ameliorated by a loving, stable home.

Addiction is not dependence, and dependence is not necessarily a problem.

Until America understands that, needless suffering will continue.

Source: You Can Rely on Drugs Without Being an Addict – VICE

12 Steps, The Troubled Teen Industry, and Tough Love

The myth is that 12-step programs and their associated treatment industry thrive simply because Americans love them. In fact, both are substantially built on and maintained by force.

Coercion into the 12 Steps comes from five main sources: criminal courts, family courts and family services, health care systems, families and employers.

So even by dated and conservative estimates, hundreds of thousands of Americans per year are forced into AA and 12-step-oriented treatment. Yet a steady stream of legal decisions confirms that such court-ordered treatment is illegal.

Every Federal Circuit Court (federal appeals court) and state supreme court that has ruled on such coercion has declared that the 12 Steps are religious in nature, and that it violates a parolee’s or probationer’s First Amendment rights for a court to require AA attendance when the 12-step philosophy violates the individual’s belief system.

Perhaps you didn’t believe that in a major American city in 2016, a court—nay, a drug court—could force people into AA against their belief system, with no sense that this was illegal, inappropriate, or ignorant of other options?

In fact, it remains standard practice.

We must realize that the American 12-step-treatment monolith, thought to be so facilitative and appealing to millions of people—and I have often lamented its cultural dominance—couldn’t operate to anything like its current extent without constant threats of denial or withdrawal of legal freedom, of custody of children, of licensure or employment, of medical care, of family support.

In the meantime, drinking problems, drug addiction and drug deaths in America continue to grow unabated, with our only response being more of the same.

Source: American Gulag: The Five Ways Hundreds of Thousands of People Are Coerced Into Rehab and AA | TheInfluence

Island View — which housed more than 100 children at a time, aged 13-17, and charged parents at least $10,000 a month — caused lasting damage to its students, a dozen of them told HuffPost. Former residents said the staff tormented and abused them — pitting teens against each other, physically restraining them, secluding them, medicating them with high doses of powerful antipsychotics and forcing them to sit without speaking for hours or days at a time.

But there’s little evidence that “tough love” techniques such as isolation and humiliation actually work. And the basic setup of residential treatment facilities lends itself to abuse, critics of the industry argue.

“If you have an institution where you have vulnerable people, abuses of power will almost always occur unless you have really strong safeguards against them —especially if you have vulnerable people who can’t contact the outside world,” said Maia Szalavitz, a journalist who wrote a book, Help at Any Cost, about the troubled-teen industry. “That in itself is a recipe for abuse.”

Despite this record of abuse — which journalists have been writing about for decades — parents upset by their children’s treatment at facilities like Island View often have just one option: lawsuits. “It’s one of the most horrendous things,” said Thomas Burton, a Utah attorney who has helped parents sue the centers. “The state isn’t going to prosecute these RTCs, and local law enforcement agencies aren’t going to impair the enormous amounts of money being brought into local communities. I mean enormous amounts of money — they’re cash cows. So where else can [parents] turn?”

Even solitary confinement — which President Barack Obama has banned for juveniles in federal prison — is permitted at many private treatment centers.

Island View and similar facilities demand one thing from students: absolute compliance.

Compliant children were rewarded with special privileges, like trips outside the facility. Noncompliant children were punished with physical restraint and isolation. They were all expected to participate in group “therapy” sessions that required them to complain about and attack each other. Many of them were medicated with high-dose antipsychotics.

Demands for compliance began the moment students arrived at Island View. Staff strip-searched new students.

“Long-term treatment facilities are like … a jail without having done anything illegal,” said 25-year-old Michelle Lemcke, who attended Island View in 2006.

Pysically restraining students and pitting them against each other weren’t the only ways Island View staff had to enforce compliance.

Island View’s resident handbook forbids “any form of sexual acting out … including note writing.” So when Graeber passed a note to a boy in her class one day — and locked eyes with him — she was immediately sent to the Yellow Zone.

Students in the Yellow Zone had to sit silently in a white plastic lawn chair at a desk in a hallway for hours — or days.

Graeber and others said they were often given the maximum sentence: 72 hours of isolation and silence.

“These kids were being used as damn lab rats,” he said. “Poor kids are falling asleep in class, getting in trouble, and they’re always so thirsty — mouths super dry. … All they did was pass pills. But if a kid was sick or throwing up from the medication, they wouldn’t do much else but give you a Sprite and watch you.”

Then she was placed in a Yellow Zone variation called “Individual Focus” — which included sleeping in a brightly lit hallway — for more than two weeks. As an additional punishment, Graeber said she was not allowed to speak for 58 days.

Parents sometimes forget that “troubled teen is not a diagnosis,” said Szalavitz, the journalist who wrote the book on the industry. “If your kid has behavior issues, generally the first thing to do is get a psychiatric evaluation — somebody who is independent, not an educational consultant, no affiliation with any industry — and figure out what the heck is going on.”

Moreover, the rote compliance these places demand is not a useful coping strategy for life outside an institution, Burnim said. “You can teach them to be compliant in an institution because they get the reward of … getting out,” he explained, “but once they get out, it’s the same old problem, and they haven’t learned how to better manage their condition.”

But the gold standard for treating most disturbed children is giving parents the support and services they need to keep their kids with them. There is a “virtual national consensus among people in the mental health field that children with mental health difficulties and behavioral problems should be treated at home,” Burnim said.

Source: The Troubled-Teen Industry Has Been A Disaster For Decades. And It’s Still Not Fixed

However, I’ll also deeply regret that people in the program persuaded me to give “tough love” a try.

The tougher I became, the worse Wyatt and I fought and more sneaky he became. He lied, stole, bullied and badgered me. And I was consistently guided to hold my boundaries, to kick him out of my home before I let him call the shots.

There’s a reward/shame element to the 12­-step philosophy. You get a chip when you do well. You start from square one when you “relapse.” After his anti­-extended care outburst, Wyatt was promptly bumped down a level and his phone privileges were taken away. In retrospect, this seems like nothing but pure punishment.

I have two very close friends whose sons died of heroin overdoses. When we talk, it’s often about our pain and anger over the rehab racket. And it was one of them who first told me about a different type of approach, known as “harm reduction,” that opened a bright new door for Wyatt and me.

“Harm Reduction means taking control—of your use of drugs or alcohol, of the damage that use does to you, of the harm your use causes others, and how you live your life,” write Patt Denning, Jeannie Little and Adina Glickman in Over the Influence.

According to this philosophy, abstinence is not required to be the goal—moderation, a reduction, or simply safer use are also seen as valuable positive outcomes. Importantly, individuals are encouraged to set their own goals, rather than having them imposed by others.

Substance use disorders don’t have to be viewed as lifelong diseases. And within this framework, many therapies, such as Cognitive Behavior Therapy (CBT) or Dialectical Behavior Therapy, process groups and individual counseling can be utilized. It does not hold that someone experiencing drug-­related problems must hit “rock bottom”—quite the contrary.

After a couple of sessions with a harm reduction counselor, Wyatt agreed to go to a SMART Recovery rehab in California. SMART Recovery support groups are abstinence-­based, but they recognize that not everyone walks in the door with an abstinence goal, and everyone is welcome. They don’t require the use of terms such as “addict” or “alcoholic”—in fact, these are discouraged. The overarching philosophy is one of empowerment and the use of scientifically proven tools.

When Wyatt returned home he continued to see his therapist. One day he described his cravings to me, and how marijuana helped them. I was still in abstinence­-only mode, but then a light switched on: If he found that using cannabis could help his PTSD and keep him off other, potentially much more harmful stuff, so be it.

I was very reluctant at first. But I considered a dear friend of mine who has acute lymphoid leukemia, and who treats her pain and nausea with cannabis. I decided I had nothing to lose.

It works. For Wyatt, it alleviates the anxiety and panic he experiences and assuages most (if not all) of his cravings for dex.

Last week, Wyatt commented that it had been a full year that he had not been in a hospital, in jail, on probation or in a rehab—the first full year since 2009.

I am certain that had I continued on the “tough love” path, he’d be dead or in jail. I am also certain that in addition to the trauma of my parents’ deaths, there was considerable additional trauma as a result of the application of certain Al-Anon principles.

I no longer attend Al-Anon. I wish I could comfortably and honestly share in meetings about the benefits of marijuana, but I can’t. My friend whose son died has told me she’d have been more than willing to let her son smoke some marijuana to keep him alive. She feels she has learned too late about harm reduction.

I can no longer tolerate the sobs of a parent who has tossed their child on the street in the name of “tough love” and “hitting rock bottom.”

I now know that there’s a better way.

Source: How I Learned That “Tough Love” Was Failing My Son—And Found Something So Much Better | TheInfluence

Fully buying into the program requires desperation, in other words, and to “help” addicts get to that desperate point is to help them recover: “From this perspective,” writes Szalavitz, “the more punitively addicts are treated, the more likely they will be to recover; the lower they are made to fall, the more likely they will be to wake up and quit.”

Szalavitz explains that this is a totally pseudoscientific concept — the founders of A.A. embraced it as dogma but were not in a position to test it scientifically. And even they realized, on some level, that “hitting bottom” was it was a bunk idea, simply because some A.A. members would recover before thoroughly screwing up their lives. A.A. had to introduce the conceptual trick of “high bottoms” — some people hit “bottom” at a relatively high point, in other words — to account for this.

“Misinterpreted ideas taken from 12-step-based rehabs are integrated with the criminal justice system and are part of the belief system that quietly upholds current policies. They are deeply embedded … in nearly every public and private system that addresses addiction.” Specifically, 12-step programs “are now a required curriculum in at least 80% of American addiction treatment programs.” And since many people get referred to these addiction programs via court orders, countless vulnerable people are shuttled into programs that embrace a totally false, harmful view of what addiction is. In many cases, drug-court advocates argue against treatment and in favor of harsh punishment, simply because it fits into the 12-step, “bottoming out” framework — a bare prison cell certainly feels more like “hitting bottom” than a treatment program.

Forcing patients to hit bottom had results that were, in retrospect, predictable: It gave rise to “attack therapy” in programs like Synanon, launched in 1958, where “the idea was to demolish the ego, using intimate secrets people revealed to find their weak spots and try to obliterate the ‘character defects’ believed to be found in all people with addiction.”

But what is clear is that these ideas all fly in the face of what the literature shouts at us about treating addiction: that it’s best done by providing addicts with empathy, support, and healthy social networks — not by snatching these vital lifelines from them.

But throughout her book, Szalavitz argues, and argues compellingly, that when it comes to “hitting bottom” and so many of the other pseudoscientific approaches to fighting addiction, the actual goal — or part of it, at least — has always been to marginalize the addict, to set them apart and humiliate them. There’s a deep impulse to draw a clear, bold line between us, the healthy people, and them, the addicts. What clearer way to emphasize that divide than to cast them down into a rock-bottom pit, away from the rest ofus?

Source: The Tragic Myth of Addicts ‘Hitting Rock Bottom’ — Science of Us

I think that 12-step programs are fabulous self help. I think they can be absolutely wonderful as support groups. My issue with 12-step programs is that 80 percent of addiction treatment in this country consists primarily of indoctrinating people into 12-step programs, and no other medical care in the United States is like that. The data shows that cognitive behavioral therapy and motivational enhancement therapy are equally effective, and they have none of the issues around surrendering to a higher power, or prayer or confession.

I think that one of the problems with the primary 12-step approach that we’ve seen in addiction treatment is that because the 12 steps involve moral issues, it makes people think that addiction is a sin and not a disease. The only treatment in medicine that involves prayer, restitution and confession is for addiction. That fact makes people think that addiction is a sin, rather than a medical problem. I think that if we want to destigmatize addiction, we need to get the 12 steps out of professional treatment and put them where they belong — as self-help.

Source: ‘Unbroken Brain’ Explains Why ‘Tough’ Treatment Doesn’t Help Drug Addicts

Cannabis and Harm Reduction

Using data on all prescriptions filled by Medicare Part D enrollees from 2010 to 2013, we found that the use of prescription drugs for which marijuana could serve as a clinical alternative fell significantly, once a medical marijuana law was implemented. National overall reductions in Medicare program and enrollee spending when states implemented medical marijuana laws were estimated to be $165.2 million per year in 2013. The availability of medical marijuana has a significant effect on prescribing patterns and spending in Medicare Part D.

Source: Medical Marijuana Laws Reduce Prescription Medication Use In Medicare Part D

The researchers found that in states with medical marijuana laws on the books, the number of prescriptions dropped for drugs to treat anxiety, depression, nausea, pain, psychosis, seizures, sleep disorders and spasticity. Those are all conditions for which marijuana is sometimes recommended.

If the trend bears out, it could have other public health ramifications. In states that legalized medical uses of marijuana, painkiller prescriptions dropped — on average, the study found, by about 1,800 daily doses filled each year per doctor. That tracks with other research on the subject.

Marijuana is unlike other drugs, such as opioids, overdoses of which can be fatal, said Deepak D’Souza, a professor of psychiatry at Yale School of Medicine, who has researched marijuana. “That doesn’t happen with marijuana,” he added.

Source: After Medical Marijuana Legalized, Medicare Prescriptions Drop For Many Drugs : Shots – Health News : NPR

A 2002 review of seven separate studies involving 7,934 drivers reported, “Crash culpability studies have failed to demonstrate that drivers with cannabinoids in the blood are significantly more likely than drug-free drivers to be culpable in road crashes.” This result is likely because subject under the influence of marijuana are aware of their impairment and compensate for it accordingly, such as by slowing down and by focusing their attention when they know a response will be required. This reaction is just the opposite of that exhibited by drivers under the influence of alcohol, who tend to drive in a more risky manner proportional to their intoxication.

Today, a large body of research exists exploring the impact of marijuana on psychomotor skills and actual driving performance. This research consists of driving simulator studies, on-road performance studies, crash culpability studies, and summary reviews of the existing evidence. To date, the result of this research is fairly consistent: Marijuana has a measurable yet relatively mild effect on psychomotor skills, yet it does not appear to play a significant role in vehicle crashes, particularly when compared to alcohol. Below is a summary of some of the existing data.

The results to date of crash culpability studies have failed to demonstrate that drivers with cannabinoids in the blood are significantly more likely than drug-free drivers to be culpable in road crashes.

“Cannabis leads to a more cautious style of driving, but it has a negative impact on decision time and trajectory. However, this in itself does not mean that drivers under the influence of cannabis represent a traffic safety risk. … Cannabis alone, particularly in low doses, has little effect on the skills involved in automobile driving.”

1. There is no evidence that consumption of cannabis alone increases the risk of culpability for traffic crash fatalities or injuries for which hospitalization occurs, and may reduce those risks.

In contrast to the compensatory behavior exhibited by subjects under marijuana treatment, subjects who have received alcohol tend to drive in a more risky manner. Both substances impair performance; however, the more cautious behavior of subjects who have received marijuana decreases the impact of the drug on performance, whereas the opposite holds true for alcohol.”

Evidence from the present and previous studies strongly suggests that alcohol encourages risky driving whereas THC encourages greater caution, at least in experiments. Another way THC seems to differ qualitatively from many other drugs is that the formers users seem better able to compensate for its adverse effects while driving under the influence.”

Source: Marijuana and Driving: A Review of the Scientific Evidence – NORML.org – Working to Reform Marijuana Laws

The reduced rate of opioid-related fatalities translated into about 1,700 fewer deaths in 2010 alone. The researchers suggest several possible explanations for this effect. “Patients with chronic noncancer pain who would have otherwise initiated opioid analgesics may choose medical cannabis instead,” Bachhuber et al. write. “In addition, patients already receiving opioid analgesics who start medical cannabis treatment may experience improved analgesia and decrease their opioid dose, thus potentially decreasing their dose-dependent risk of overdose. Finally, if medical cannabis laws lead to decreases in polypharmacy—particularly with benzodiazepines—in people taking opioid analgesics, overdose risk would be decreased.”

That last possibility could be more significant than you might think, since opioid-related deaths typically involve mixtures with other drugs, with benzodiazepines playing a substantial and increasing role. Bradford and Bradford found that medical marijuana laws were associated with decreases in prescriptions for drugs used to treat anxiety and sleep disorders. Benzodiazepines are commonly used for both purposes.

“We find fairly strong evidence…that states providing legal access to marijuana through dispensaries experience lower treatment admissions for addiction to pain medications,” Powell et al. write. “We provide complementary evidence that dispensary provisions also reduced deaths due to opioid overdoses….Our findings suggest that providing broader access to medical marijuana may have the potential benefit of reducing abuse of highly addictive painkillers.” Like Bachhuber et al., they found that the longer medical marijuana was legally available, the bigger the apparent benefit.

Source: Medical Marijuana Replaces More Dangerous Drugs – Reason.com

Cannabis is the least harmful way for we humans to cope with the burdens of sentience, senescence, and mortality. Cannabis is popular in STEAM cultures, at least the ones I’ve inhabited. It is part of the process of living, creating, and coping. I think the neurodivergent have long used it to regulate and cope in a world that does not accommodate. If your neurodivergence is accompanied by tics, seizures, paresthesia, fasciculations, panic, anxiety, or self-harming stimming, as but a few examples, then cannabis is a tool and ally. There are as many human operating systems as there are humans. The endocannabinoid system is a useful interface to our operating systems for which we have a natural, easy-to-grow key. All humans and their mammalian kin share this interface and this plant. We plucky prometheans figured out how to decarboxylate with fire.

Because, the drug war. The drug war preys on and abuses the different and the powerless. It puts neurodivergent kids in pipelines to prisons and foster systems where the incentives are to drug minds into compliance so that bodies can be more conveniently warehoused and souls more conveniently iced. The great many of us using cannabis to medicate and regulate are under constant threat of violence, humiliation, and confinement  in inhumane jails and prisons. The drug war’s perverse notions of addiction, addicts, and coping limit our vocabulary, stifle our empathy, and harm us all. The drug war, zero tolerance, and compliance culture are enemies of neurodiversity. Cannabis is a friend and a lever for change.

Source: On cannabis and neurodiversity

“The Silk Road website was in many respects the most responsible such marketplace in history, and consciously and deliberately included recognized harm reduction measures, including access to physician counseling,” he wrote. “Transactions on the Silk Road website were significantly safer than traditional illegal drug purchases and included quality control and accountability features” that kept purchasers “substantially safer” than regular drug purchases.

Many reformers, myself included, have long been highlighting the forward-thinking benefits of Silk Road and the ways it began to slowly revolutionize drug sales around the world. For instance, it provided a platform that could allow indigenous growers and cultivators around the world to sell directly to the consumer, potentially reducing cartel participation and violence… None of the transactions on Silk Road, for instance, resulted in women drug buyers being sexually assaulted or forced to trade sex for drugs, as is common in street-level drug transactions. Nor did any Silk Road transactions result in anyone having a gun pulled on them at the moment of purchase.

In his declaration, Caudevilla testifies that the site “espoused a harm reduction ethos which was reflected in the individual buyer-seller transactions on the site and in the community created on the site’s forums.” That community “enabled some site participants to reduce, if not entirely eliminate, their drug use.”

Caudevilla participated on the Silk Road forums for seven months and states that he “never came across even a single report of a Silk Road-related drug overdose.” Ulbricht’s lawyers point to the lack of such a “report” as a telling fact, although one wonders which section a user who had overdosed was expected to post in.

Source: Ulbricht’s lawyer: Silk Road was “the most responsible” drug market in history | Ars Technica

Supervised Injection

The more we degrade and ostracize people who inject drugs, the harder it is for them either to quit using their painkiller or to use it in a less risky way. When marginalized drug users walk through the doors of a supervised injection facility, the medical staff often become the only people in their lives who believe in them.

SIF staff may administer naloxone to stop clients from dying, but it is the human connections they forge that may give their clients the will to live.

Source: Supervised Injection Facilities Save Money and Lives: My Research Shows They’d Work for San Francisco | TheInfluence

 

The problems presented by injection drug use are legion, but creative solutions exist. One is the provision of safe drug-use rooms. Cities as far-flung as Vancouver, British Columbia, and Paris and Berlin have opened safe, well-lit rooms where addicts can get clean needles and other equipment without fear of incarceration. In New York State, Ithaca and Manhattan are considering similar initiatives. Such facilities can also connect addicts to needed services like preventive testing, acute care and treatment for addiction.

Safe drug-use rooms are typically designed to help keep addicts out of the hospital, but they could work for addicts within hospitals. A safe place to inject for addicted patients in the hospital could reduce conflict with staff, protect patients and providers from dirty needles and other drug hazards, and enable patients to receive respectful, high-quality care when back in their hospital beds. Safe drug-use rooms could also offer treatment for addiction, a step often neglected in hospitals.

The creation of these rooms for hospitalized addicts won’t be easy. There will be legal liability concerns, and hospitals must safeguard against the risk of overdose or unseemly behavior. It will be worthwhile to tackle these issues if it enables the provision of compassionate care for at-risk patients whose treatment would otherwise be endangered by conflict with providers.

Source: Let Opioid Users Inject in Hospitals – The New York Times

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3 thoughts on “Harm reduction, addiction, tough love, 12 steps, neurodiversity, and the troubled-teen industry

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