Where Are We Going?

I’m a recovered drug addict, addiction clinician, therapist, recovery coach and healthcare executive. After 20 years of self-medicating the impacts of trauma, I got help, went back to school and have since spent the last 15+yrs integrating throughout the addiction treatment ecosystem.?

I’m writing this because every day something comes across my waves about the addiction treatment system being broken. Running off the rails. People are dying at alarming rates with overdoses killing more young adults than auto accidents and guns combined . We were the blind led by the blind, the tail that wagged the dog.

The beautiful but antiquated 12 step model, while helpful to many, is too all-in-one and obsolete when used as framework for healthcare. The Steps will always hold critical space and utility, but they can no longer remain the cornerstone of addiction treatment. The Ten Commandments set a nice foundation, but we stopped burning witches at the stake for a reason. As in other areas of healthcare, there have been amazing innovations and breakthroughs in addiction medicine, yet most treatment centers and recovery communities shun these life-savers like anti-vaxers ignore science. Anything that goes against the Big Book is fundamentally a no-go. The prevailing ethos is if it worked for me, it will work for you so let’s keep doing it the same old way. Any change or deviation is a direct threat. Keep on keepin’ on. We’ve spent decades investing in more tow trucks rather than overhauling the broken roads that are causing the accidents.

Meta analysis of rigorously reviewed and published research in medical and scientific journals provide compelling evidence of breakdown. On the flip side, no other area healthcare has such a void of actual outcome data. According to the National Institute on Drug Abuse, 85% of people will relapse within the first year of treatment. A 15% success rate is not very encouraging. Science must override ideology in clinical care in order to progress.

We need to meet people in the time and place in which we are. Evolve our messaging. Become more sophisticated, inclusive and accessible. We don't have to be so binary, pass fail.

This is the thinking and methodology that I subscribe to: You may not have to remain abstinent like you’re entering a purity contest, just abstain from what is problematic. Your best thinking may indeed be part of the solution- it is up to you to define a successful outcome. You don't have to identify yourself by your disorder- own your own story. You do not have to work the steps or go to meetings, but you may have to explore the why’s beneath your what’s. Set intentions, have a structure of support and clear channels to the help you need. Have purpose and meaning. Have stoke, stay curious.

We need to acknowledge the individuals for whom the system fails and labels unmotivated. Concentric systems like criminal justice and health insurance only reinforce this. I have had countless conversations with drug courts, probation/parole officers, protective social services and insurance reps advocating for patients who are clearly making measurable progress, achieving desired outcomes, yet not meeting outdated criteria, being shot down. Many are dead whom I wonder would be alive if given a better chance.

To effectively respond to the overdose epidemic, the leading cause of accidental death of young adults in the US, (and even contributed to the first decline in life expectancy in modern times) we need to overhaul the system, As a clinician working on the front lines, I cannot express the frustration when reporters such as Maia Szalavitz so accurately cover this topic to absolutely no movement of the needle on the inside. Heroes and pioneers like Deborah C. Mash , Tom Horvath and Andrew Tatarsky have spent decades blazing trails but the needle remains stuck. We need to do better. We need to demand more. More outcome data, more research, more accountability of allocated funds.?

The solution lies in culture. Culture eats strategy for breakfast as the quote goes. From recovery culture to cultural movements, we need continued progress. Science, medicine and healing are not spaces for conservation or regression, yet that is the direction that addiction healthcare is going in. There is too much polarization where there does not have to be. Diverging views and philosophies can coexist and even collaborate. I ask those in the addiction treatment and recovery communities, are you willing to open your minds to trying something new if it will save lives? If so, let’s all work together. One definition of insanity is doing the same thing over and over expecting the same results, high time to disrupt this trend.