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On the war within drug treatment

Medical and treatment providers disagree about which treatments are most effective, and people continue to face barriers getting into treatment.

Oxycodone
Fifty years ago, President Richard Nixon made it official: He declared a “war on drugs,” famously saying drug abuse was “public enemy number one.” In 1994, Nixon’s domestic policy chief, John Ehrlichman, exposed information stating the war on drugs campaign had hidden agendas. Ehrlichman explained in an interview with Harper magazine that the Nixon campaign had two enemies: “the antiwar left and black people.” The war on drugs was more about controlling non-white bodies than making a significant impact against drug use itself.

Today, in addition to the continued war on drugs as a vehicle to incarcerate non-white bodies, we have a war within drug treatment. Medical and treatment providers disagree about which treatments are most effective, and people continue to face barriers getting into treatment. The barriers include access to both residential and outpatient treatment, attitudes of law enforcement agencies to offer treatment rather than incarceration and attitudes of the medical/treatment community who may be misinformed about effective interventions for people with a substance use history.

But even for those who believe substance use treatment, versus incarceration, is the answer, there are divisions. There is a wide array of attitudes that drive the type of substance use treatment offered in our communities. Some substance use treatment mirrors incarceration in the rules they enforce, response to relapse and treatment conditions.

A new approach

Now, some are embracing a new approach to treatment – harnessing the power of harm reduction and a new view of relapse – to provide effective, responsive treatment with the goal of truly meeting the person where they are on their road to recovery.

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According to the Drug Policy Alliance, harm reduction is a “set of ideas and interventions that seek to reduce the harms associated with both drug use and ineffective, racialized drug policies.” Harm reduction removes the assumption that there is only one path to recovery – and may question whether “recovery” is the most appropriate goal. Harm reduction promotes the dignity and humanity of people who use substances and invites them into a community of care to minimize the negative responses surrounding their use and promotes health, engagement and social inclusion. The point is to not villainize people who use drugs; instead, let’s care for them and offer them choice in how (and if) they engage in treatment.

A different view of relapse

Relapse is considered a typical and expected part of recovery for any medical treatment. However, relapse in substance use treatment is misunderstood as different, more lethal and harder to treat than other medical situations. The National Institute on Drug Abuse shows a comparison of relapse percentages in four medical issues, and the stigma against substance use is compelling. People getting treatment for diabetes show a relapse rate of 30-50 percent. Substance use treatment shows a relapse rate between 40-60 percent. However, both hypertension and asthma have a relapse rate between 50-70 percent. But hypertension and asthma are not maligned like substance use, so the negative stigma is not attached to them as it is with substance use. The difference seems to be that people “have” hypertension and asthma but people “are” drug abusers.

Gary Norman
Gary Norman
Let’s keep this in perspective. In an article from 2014 from the New Zealand Drug Foundation, Maia Szalavitz, a leading neuroscience and addiction journalist, states that most people with an addiction simply “grow out of it.” According to a study of more than 42,000 Americans cited in the article, half of all people who qualified for a diagnosis of alcoholism or other drug addiction during their teens and 20s no longer met the criteria at age 35.

According to the article, the average cocaine addiction lasts four years without formal treatment. The average marijuana addiction (with significant debate about whether it is addictive at all) lasts six years without formal treatment. The average alcohol addiction is resolved within 15 years without formal treatment. These large samples showed only a quarter of people who recover from alcohol or other substance use have ever sought assistance in doing so (including 12-step programs). According to this data, we can support people through their process and they will, most likely, ride it out themselves and either reduce their usage or stop altogether – without formal treatment.

When ideology drives public policy rather than a humanistic, data-driven approach, we will continue to see the financial costs of incarceration and treatment soar through the roof, met with mediocre outcomes. We can choose to end this war on drug treatment and treat people who use substances as human first. We can choose to show compassion for them and offer them a safe, non-judgmental space for them to address their use when it becomes problematic for them. We have effective models; we just need to use them.

Gary Norman, MSW, LICSW, is the chief operating officer at Twin Cities Health Services in Minneapolis.

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