By Kerry Porth
Earlier this year, I attended a talk on the Global Drug War. After the talk, audience members were given an opportunity to ask questions and I was struck by a comment made by a member of the Vancouver Area Network of Drug Users (VANDU). After introducing himself as a heroin user of some 35 years, he declared that “abstinence should not be viewed as a victory but rather, a defeat. It represents the complete and utter failure of self-will.” I was surprised to find myself in enthusiastic agreement with him.
For 23 years, my regular attempts to “recover” from addiction were facilitated by the 12-steps. This model posits addiction as a chronically relapsing disease. The medical detoxification facilities I attended (12 times in as many years) required daily attendance of Alcoholics Anonymous or Narcotics Anonymous meetings and group therapy sessions where we were told that the only positive outcome was complete abstinence from all drugs and alcohol. We were told that we must no longer associate with anyone who uses drugs or alcohol and that we should avoid “slippery” places such as bars or areas where we used to score drugs. We were told that we could never control our use or have just one drink. Drug addicts who had never abused alcohol were told they couldn’t drink and alcoholics were told they couldn’t smoke pot. To do so would mean an immediate relapse into hard-core addiction. We were told we couldn’t make any decisions for at least a year. We were told we couldn’t enter into a romantic relationship. Basically, we were told that we were an extreme danger to ourselves, we were sick, incurable, and would never have self control. Indeed, the first of the twelve steps is an admission of powerlessness.
Well, I call bullshit.
Without being unduly critical of 12 step programs which have, after all, supported the recovery from addiction of millions of people, I believe that there are many routes to recovery from active addiction and harm reduction is one of them. Abstinence fails to acknowledge the fact that human beings have used various substances to alter their consciousness and soothe their troubled minds since the beginning of recorded history and that we have very good reasons for doing so. Dr. Gabor Maté is a well-known and respected physician who has worked with addicts in Vancouver’s downtown east side for many years and is the author of the best-selling book In the Realm of Hungry Ghosts. Dr. Maté believes that chronic addiction is the result of childhood trauma, social and cultural dislocation, and a deep sense of emptiness and pain. For these individuals, myself included, abstinence-based programming becomes simply another source of emotional pain as we are unable to cope without self-medicating and are therefore considered to be failing.
My first great “success” at abstinence started at the age of 25 when I ceased my nightly alcohol binges that had been going on for 7 years. I knew nothing about recovering from alcoholism and I was sober for three days, going to work despite the fact that my hands wouldn’t stop shaking and the mild hallucinations I was experiencing were freaking me out, before stumbling into an AA meeting. There, I found a community who embraced me and where I could finally talk about the double life I had been living. Six months later severe symptoms of my then undiagnosed post traumatic stress disorder began to interfere with my ability to care for my infant son. A public health nurse referred me to a psychiatrist who, after a 15 minute assessment, diagnosed me with post-partum psychosis, (and just a note here that my son is adopted) informed the public health nurse that I was not to be left alone with my baby, and prescribed an anti-psychotic medication. I spent the next 5 years of “sobriety” on a bewildering variety of psychiatric medications with life-altering neurological side effects. Tardive dyskinisia, which is characterized by uncontrolled and repetitive movements, was the most severe of these effects. In my case, this meant that I acquired an uncontrollable stutter and could rarely get three words out of my mouth without grimacing, twitching, and making odd sounds. So, I stopped talking. Akathisia is an extremely unpleasant sensation of inner restlessness which makes it very difficult to sit still and stay motionless – try bottle-feeding an infant! For me, this side effect also replicated the physical sensation of revulsion I experienced during abuse as a child. Thymoanesthesia is the phenomenon of emotional blunting, of simply not caring about anything and not feeling any emotion, good or bad. I slept a lot as I was tired all the time, I put on weight, my intellectual capacity was seriously impaired and I was miserable. My psychiatrist and my family doctor assured me that what I was experiencing was all in my head and if I complained too much about how miserable I was, they simply increased the dose of whatever med I was on at the time or switched me to some other mischievous drug. But hey! I was “clean and sober” and celebrated my AA birthdays year after year with the enthusiastic support of my AA friends. And why wouldn’t they? By my completely unscientific count, well over 75% of individuals who were members of my AA group were similarly medicated. Prescription medication, no matter how mood- or consciousness-altering it is, is acceptable in AA and NA provided the medication isn’t a narcotic pain-killer. So, what is recovery? For me, it doesn’t include being in a chemical straight-jacket.
For the past fifteen years or so, there has been a slow process of gradual acceptance of harm reduction principles in the medical community and an even slower acceptance within the addiction treatment industry. However, the Canadian Centre on Substance Abuse recognizes that there exists a dearth of “standardized, comparable data on which to base effective treatment, policy or planning decisions, especially at the national level” meaning that harm reduction principles are applied unevenly across the spectrum of addiction treatment services causing many addicts, primarily women, to simply fall through the cracks. This is a strong indication of the pervasiveness of the 12-step abstinence model as the dominant definition of recovery. Indeed, many individuals working within the field of addiction treatment are themselves recovering addicts leading to treatment models that are based on 12-step “beliefs” rather than theories based on supporting evidence. To promote this model to the exclusion of all others reduces options for addicts seeking recovery and extinguishes hope.
Concurrent with the gradual acceptance of harm reduction principles has been an increased interest in trauma as it relates to addiction leading to “trauma-informed” services. Many female addicts use substances in an effort to reduce the impact of trauma and cope with trauma-related mental illness, most notably Post Traumatic Stress Disorder. While there are many promising psychological treatments available for individuals who have PTSD related to a single traumatic event such as a serious car crash or a violent home invasion, these treatments are less successful for individuals with a history of repeated trauma. For the latter, myself included, intrusive symptoms of PTSD will continue to be an issue for therest of our lives, thus abstinence may never be an attainable goal as many of these individuals will require some sort of medication in order to function on a daily basis and achieve a better quality of life.
I firmly believe however, that this opens up the probability that female addicts may end up on prescription medications that do not support a real improvement in quality of life but are simply a substitution for the substances they were misusing. While substitution therapy is laudable for reducing the chaos in an addict’s life and eliminating their need to engage in risky practices to obtain and use illicit substances, it does not address the desire of many addicts to no longer be dependent on substances that blunt their emotions and make it very difficult through psychological therapy to address the root causes of their addiction. In other words, psychotherapy is impossible if you no longer experience emotion. Additionally, some medications may present other barriers to addicts seeking a new life.
For example, a close friend of mine who works for a non-profit that provides supportive housing for women recovering from substance abuse, has noted increasing difficulty in providing placements for women leaving medical detoxification facilities because they are leaving with prescriptions for addictive substances such as benzodiazepines or narcotic pain medication to treat PTSD. Indeed, this has become such a problem for this innovative society that they have introduced a benzodiazepine tapering program so that women using these drugs are not left homeless or underhoused. For individuals wishing to enter a treatment program after detox, these medications present an insurmountable barrier as there are no treatment centres in BC that would view these individuals as being “clean” for the requisite 30 days. A University of Toronto study completed in 2002 that looked at gender differences in detoxification noted that “Women reported a significantly different pattern of primary drug use, a younger age, a different pattern of referral sources, and higher rates of parenting status and unemployment. In addition, females were administered prescription medication and medical evaluation tests at a significantly higher rate than males.” (emphasis added) In general, women are far more likely than men to be prescribed medications such as sleeping pills, psychotropic drugs, and benzodiazepine than men are and those prescriptions are often written for non-medical reasons such as coping with trauma, grief or stress. Valium earned the moniker “Mother’s little helper” for a very good reason.
Women need to be able to make informed decisions about psychotropic and psychoactive drugs so it is imperative that doctors take the time to explain potential side effects, the risk of becoming dependent or addicted, and the difficulties many find in withdrawing from these drugs. Doctors need to understand the barriers in accessing addiction treatment that taking some of these medications present. Addiction treatment providers need to become more trauma-informed and recognize that some women in early recovery will require intensive support for a longer period of time to learn new coping skills to deal with the extraordinary impacts of trauma. Medication may be necessary, but it is critical that women are making informed decisions about their health and that pychotropic drugs are used to assist with stabilization and not as a permanent replacement for illicit substances.
I have a rich and fulfilling life now free from the chaos and desperation of active addiction. I use medical cannabis to calm anxiety, help me sleep, stimulate appetite, and assist with managing pain from rheumatoid arthritis and irritable bowel syndrome. After 30 years of chronic insomnia, I now sleep eight hours a night. Six months after starting to use cannabis, my Hepatitis C went into remission and my liver enzymes have been normal for seven years. I continue to see a therapist to improve my ability to cope with the symptoms of PTSD and yes, I even have a glass of wine from time to time. I’m not “clean and sober” according to the 12-step model but that’s okay by me because these days, I’m far from powerless over drugs and alcohol. I have been able to address the roots of my addiction thus relieving my need to self-medicate. In short, I’m recovered.