Alcoholism and Opiate Addiction

alcoholism and opiate addictionAlcoholism and opiate addiction are similar in many ways. The reason alcoholism and opiate addiction have been so difficult to treat is that both forms of addiction are what I’ll call ingrained. Some might think “ingrained” is not a useful description when addiction creates that implication, but alcohol and opiate addiction are different from, say, cocaine addiction. Cocaine and meth are bingeing drugs. The brain changes caused by cocaine make it difficult for the cocaine addict to not return to cocaine after a period of abstinence, but the human body can’t tolerate sustained, daily use of cocaine. Because cocaine and meth damage the body so quickly, cocaine/meth addicts usually reach a bottom fairly quickly.

However, with alcoholism and opiate addiction, a person can use the drugs on a regular basis for decades. The alcoholic and opiate addict usually live with the drug closely and intimately for a long time before there’s physical damage. Because alcohol or opiates gradually become normal for the addict, it’s difficult to treat. The drug becomes such an important and steady part of day-to-day living, trying to live without it is often overwhelming. The current plans to deal with the opioid crisis lack true understanding of what it will take to deal with the problem. Throwing money at the problem and locking dealers up will not solve the problem — and ignoring alcoholism while focusing totally on opioids misses the larger crisis of addiction in general.

Addiction is not about which drug is legal or socially acceptable — addiction is a medical issue that unless treated by medical professionals will continue to get worse. Yes, there’s a psychological component, and morality/spirituality is even a topic of treatment, but unless the science of addiction is understood as a medical issue there’ll be no progress finding solutions. The demand for drugs, alcohol, opiates, etc., will ensure a supply. We found out in the 20th century that prohibition efforts don’t work. Also, stating that if people never use drugs they won’t get addicted is so naïve it doesn’t deserve a response. The reality is that alcoholism and opiate addiction will grow worse unless there’s access to quality, long term treatment, along with widespread understanding of addiction among all healthcare and insurance professionals. It will also help if employers gain a good understanding of addiction, from the social/economic impact side of the issue. Our society is bleeding resources like never before mainly because addiction is misunderstood and mistreated. The worst part, though, is all the broken homes, suffering and preventable, premature deaths — we can deal with the problem, but not unless it’s understood.

Opiates and Politics

Opiates and politicsIn the last decade opiate use has risen significantly. Overdoses and deaths from opiate use are increasing at a frightening rate. Whether it’s opiates like heroin or morphine or synthetic opioids like Percocet or Oxycodone, there’s no difference when considering the consequences of addiction and misuse and possible solutions. When a person develops tolerance and addiction, the body doesn’t know the difference from heroin bought off the street or Oxycodone that comes from a pharmacy.

I’ll just use the term opiate for the sake of simplicity. Opiates like heroin and morphine are nothing new. This is from Wikipedia:

The Mediterranean region contains the earliest archeological evidence of human use; the oldest known seeds date back to more than 5000 BCE in the Neolithic age[8] with purposes such as food, anaesthetics, and ritual. Evidence from ancient Greece indicate that opium was consumed in several ways, including inhalation of vapors, suppositories, medical poultices, and as a combination with hemlock for suicide.[9] The Sumerian, Assyrian, Egyptian, Indian, Minoan, Greek, Roman, Persian and Arab Empires all made widespread use of opium, which was the most potent form of pain relief then available, allowing ancient surgeons to perform prolonged surgical procedures.[citation needed] Opium is mentioned in the most important medical texts of the ancient world, including the Ebers Papyrus and the writings of Dioscorides, Galen, and Avicenna. Widespread medical use of unprocessed opium continued through the American Civil War before giving way to morphine and its successors, which could be injected at a precisely controlled dosage.

Countries like China have had wars over opium, and the U.S. declared a War on Drugs in the 60s, when opiates were referred to mostly as narcotics. Opiate and politics are a big concern now, although the mindset of making war against opiates still prevails. All attempts to eradicate opiates have failed. Just recently government ordered a reduction in the production of synthetic opioids. Government, to its favor, has also called for treatment of opiate addiction, and government supports the use of Buprenorphine as a regulated replacement drug that allows addicts to get into treatment without overwhelming withdrawal symptoms — however, treatment resources and access to resources are sadly insufficient.

Our society seems to favor  symptomatic law and order solutions over long term, fundamental solutions like education, prevention,  treatment and ongoing support. Waging war against drugs has created drug cartels and deadly battles for domination. Addiction, drug misuse and the demand for illicit drugs are the fundamental problems. All efforts so far to change minds and hearts about drug use have come up short. As a society we’re confused about drugs. Thinking clearly and objectively about drugs would be a great first step. If we can remove the fear and stigma, maybe we’ll find fundamental solutions.

If all the resources wasted on waging war against drugs were channeled into education, prevention, treatment and ongoing support, we’d gradually experience a change. Fearing drugs and fighting drugs with weapons have not changed our relationship with drugs. I know it’s a huge problem with no easy solutions, but I have to believe that understanding the problem through real, comprehensive education and prevention efforts will lead us in the right direction.

Addiction treatment or jail?

reducing recidivism

Jails are filled with addicts in need of treatment

Addiction treatment or jail? This is a question that hasn’t been answered. It’s a well known fact that alcohol and other drugs play a significant role in crime and incarceration. Selling drugs is not the only connection. Many people with no criminal background do something very stupid under the influence of drugs and wind up in prison. It’s true that many crimes are committed by hardened criminals who drink for the courage to carry out the crimes, but who knows what effects long term drinking and drug use has on judgment — does drug addiction drive a significant portion of these people to crime, and is addiction treatment a better solution than jail?

When I bring up the topic of addiction treatment as a substitute for incarceration in prison, if the crime and circumstances warrant treatment, I get push back from those who say that courts have tried this and treatment doesn’t work. Most people in prison who receive “treatment” receive peer assisted addiction treatment, and I’ve witnessed these peer treatment efforts. Peer assisted treatment in prison is not really treatment, although it’s better than nothing. Only around 15% of prisoners receive professional treatment, and I have to question the quality of the treatment. Is the treatment a half-hearted effort to fulfill some request from superiors to try a new approach? Is the treatment offered by prison employees who have little training and hardly any follow-up, on-going support from superiors? I think so.

A problem this size requires a quality, effective addiction treatment approach that’s backed by a determination to achieve goals and outcomes. I venture to guess that at least 40% of prisoners with alcohol and other drug problems would respond positively to treatment and that recidivism would fall precipitously. It should be tried. As we’ve seen with what was revealed with the recent New York prison escape, the present system is only ensuring recidivism.

Sufficient leverage is critical to ensure treatment compliance, and many would require half-way house type settings, but an effective treatment that builds on what drug courts and DUI courts have already accomplished is possible.

Below is a list of treatment principles that if applied would work:

Treatment Principles: An Overview

Principles for Drug Abuse Treatment for Criminal Justice Populations: A Research-Based Guide provides research-based principles of addiction treatment. The 13 principles are:

  1. Drug addiction is a brain disease that affects behavior. It affects people both physically and mentally. It can alter the brain and body chemistry for months or even years after a person stops using, so relapse is often part of the recovery process. It should be treated like any other disease.

  2. Recovery from drug addiction requires effective treatment, followed by management of the problem over time. Drug users cannot alter their behavior without taking care of their addiction. Treatment that starts in prison or jail must continue after release. Treatment and recovery is hard work that must continue throughout a user’s life.

  3. Treatment must last long enough to produce stable behavioral change. Without the right treatment, most drug users will use again once they return to their neighborhoods, even though drugs might put them right back in prison. Treatment should last long enough (90 days or more) to help drug users learn to manage their own drug problems.

  4. Assessment is the first step in treatment. Drug users need to be examined by a doctor. The doctor might prescribe medicine, and will look for other possible problems, such as depression and anxiety, or medical conditions such as hepatitis, tuberculosis, or HIV/AIDS.

  5. Tailoring services to fit the needs of the individual is an important part of effective drug use treatment for criminal justice populations. Each drug user has different needs regarding addiction counseling and treatment. The best approaches take each person’s age, gender, ethnicity, culture, and needs into account.

  6. Drug use during treatment should be carefully monitored. Individuals recovering from drug addiction sometimes return to drug use, called relapse. Testing for continued drug use is an important part of treatment.

  7. Treatment should target factors that are associated with criminal behavior. Offenders often have patterns of behavior, attitudes, and beliefs that support a “criminal” lifestyle. Treatment that helps offenders avoid negative thinking patterns can be effective.

  8. Criminal justice supervision should incorporate treatment planning for drug using offenders, and treatment providers should be aware of correctional supervision requirements. It is important that corrections personnel work with treatment providers to make sure the individual treatment plan meets the needs of both the offender and the institution.

  9. Continuity of care is essential for drug users re-entering the community. People who start receiving treatment while incarcerated need to continue treatment after release.

  10. A balance of rewards and sanctions encourages pro-social behavior and treatment participation. During treatment, it is important that both positive and negative behaviors are recognized.

  11. Offenders with co-occurring drug use and mental health problems often require an integrated treatment management approach. Drug treatment can sometimes help people who have depression or other mental health problems. It is important that these issues are addressed in treatment programs.

  12. Medications are an important part of treatment for many drug using offenders. Medicines like methadone have been shown to help reduce heroin use. Medicines for mental health issues can also be used as part of treatment.

  13. Treatment planning for drug using offenders who are living in or re-entering the community should include strategies to prevent and treat serious, chronic medical conditions, such as HIV/AIDS, hepatitis B and C, and tuberculosis. Drug users and offenders are more likely to have infectious diseases like HIV/AIDS, hepatitis, and tuberculosis. People seeking treatment should be tested for these diseases and receive counseling on risky behaviors and seeking medical advice.