Recovery Today

“I never thought I’d end up here.” She said. Her clothes were torn.  Not in that fashionable way. But a sleeping outside and not having anything else to change in torn and worn way.  Her hair was matted. There was dirt on her hands and face. She was white at one time.  “I graduated college.  I had a husband and a child before social services took my baby.  I don’t know where she is now.”

She’d been sleeping in front of the bank because there was an overhang there that kept some of the rain off her sleeping bag and newspaper shelter.

“I drank first but then it got to harder stuff. I needed the drugs.  I didn’t like what I did for them.  Drug dealers are all disgusting pigs.  But I didn’t have any money. “. She was crying, shoulders shaking.  She did’t smell fresh either.

I didnt’ know if this was true or just a tale she’d picked up and used.  The stories are passed around and reworked for most impact. Especially the stories of abuse. They’re so polished that I’ve even heard the lawyers down here repeating them as their own.  Jungle tales.  But she sounded real.  What was sad is how the last thing blamed was the drugs. First the parents, then the men or women or the job or even the banks and government but finally one day if they’re lucky they look in the mirror and say, “It’s me. It’s the drugs. My drug dealer isn’t my friend.” 

AA considered calling the Big Book, the truly classic recovery read, “The Way Out”.

So many who develop drug and alcohol abuse had trauma that many think the subsequent self destructive lives are ‘identification with the aggressor’ and Stockholm Syndrome.  No one doubts that it becomes a disease.  The brain changes.  The amygdala and hypothalamus are altered. DNA and neurotransmitters are all altered.  The very thinking is high jacked like a worm in a computer. Addiction can be followed by public health like a viral epidemic.  It spreads in poverty and war from carrier to target.  There are well established vectors.  The enablers are the most interesting group.  A twisted form of narcissism.  Dr. Scott Peck described them in “People of the Lie’.  Without the enablers the natural history of the disease would be brief.

“I ran out of money and no one wanted me. That ‘s why I came in.” He said. He’d been a teacher at one time. 

I first met them in the detox ward I supervised nearly 40 years ago.  Back then the Delirium Tremens of the alcoholics challenged me. I’d be up all night trying to keep the patients alive as they crashed about screaming and hallucinating and I’d be afraid of how much medication I gave them because they’d have liver disease, heart disease and lung disease from smoking and drinking. Mostly they were older men then.

Today’s it’s children. Nobody realizes how many beautiful young women are addicts today. Female alcoholism has passed that of men.  Red Red Wine.! Poor ME. Poor Me . Poor Me Another Drink! The guys are coming in younger too.  

40 years ago it was alcohol or heroin but today it’s everything.  

“I don’t want the methadone or suboxone. I was just told I had to see you and fail your program before they’d give me the free heroin.”  He was 18 years old. He’d started using drugs when he was 6 years old. His mother was a prostitute and his father a career criminal.  “I”m pretty sure he’s my father. I visited him in jail. The guy my mother said was him. He acted okay and said we’d get to gether when he got out. He’s in for another 20 years. Manslaughter. I didn’t go back.” 

There’s lots of solutions. All the options are available here for treatment. The management of these options has been described as the worst managed in the western world.  The problem is communication and coordination.  The administration though is always playing their favourite game of divide and conquer and self aggrandizement. The emperors and empire building in beurocracy is rife.  

“I’d feel badly but when I see how incompetent the legal system is following known terrorists and dealing with criminals who use guns what is done in health care is genius by comparison.  Politics is just messy everywhere.” She said. A wise nurse teacher now working on the frontlines after leaving a cushy university position for reality.  

The housing crisis doesn’t help.  The bed bug stories and rats in 21st Century Canada frighten me.  Typhus outbreaks in Democrat California. Won’t be long before that spreads up there.  We still get syphilis cases and we’ve done everything to wipe out these diseases but as the government devolves the danger increases. We’ve got TB again but so far no Plague in Canada. The breeding grounds are growing though.  The anti vaccers don’t help either but who wouldn’t believe conspiracy theories with the lies coming out of Ottawa and Brussels about scientific ‘predictions’ that are just modern day political ‘prophecies’ .  

If the person has a job and family in tact as Dr. Ray Baker literally preaches, “We can get 80% or better outcomes at 5 year follow up with early intervention.  We do better with addiction that any of the other specialities in this regard but we are no better than they are treating end stage illness’.  Dr. Baker was the one who started the first medical school addiction education program when the authorities were in complete denial and blaming the victims like the courts and judges and too many politicians still do.  

The treatment of choice has been around since the Navy Pilot program. When AA began in 1935 there was no ‘cure’ but 50 men in Akron found that abstinence and accountability groups, 12 steps and broad based ‘spiritual’ focus rather than narrow focus resulted in 5 year cures for what was an otherwise deadly disease.  Unfortunately until people understood immunity, partial immunity and genetics of disease and disease spread little more progress was made for decades .But now, thanks to AA that millions of alcoholics were surviving and then Addicts too there were test subjects and money to continue the research that has lead to a broader based approach to the disease. The Navy Pilot program was 80% successful with early identification in the workplace, referral to a psychiatrist trained and experienced with addiction , seeing them monthly, seeing a drug and alcohol counselors weekly and attending three AA meetings a week after an initial 4 to 6 week (proverbial 28 day) inpatient treatment.  

There’s little change in that winning formula today except that there’s now ‘outpatient’ ‘DAYTOX’ and “SMART” Recovery groups alternative to the 12 step programs and a variety of faith based ‘accountability groups’ more appealing to particular religious affiliation.  Psychologists and psychiatrists have begun to treat the trauma that is usually associated with addiction at 3 to 6 months abstience.  Motivation Therapy and DBT groups are now psychological advances over the CBT developed in the 80’s .  Recovery Capital work is the foundation of modern psychosocial therapies. 

In addition a variety of drugs like Revia 50 mg a day have been developed to reduce craving and assist recovery much like the highly successful Chiantix used for quitting smoking. 

Harm reduction strategies have expanded the applicability from the original , ‘take it or leave it ‘ approach so that a number of approaches have been established to get people into the now generically termed ‘RECOVERY’ process. It’s becn said ‘you’re either on the up elevator or the down elevator.” Once it was believed that you couldn’t be ‘forced’ into recovery but functional MRI studies show that people who have been using drugs are literally ‘not in their right minds’ for at least 90 days or 3 months.  Intervention and rescue models and treatment Centers offering 3 month initial programs have followed this learning. The old ‘tough love’ AA program is still likely best practice for ‘relapse prevention’. 

 These harm reduction procedures include replacement models, like methadone, suboxone, and now morphine and injectable morphine. Internationally the highly successful injectable long acting antagonist treatments have been used though Canada and the US often because of the long delays haven’t  haven’t caught up with the Russian and Australian approaches to chronic relapsing disease. . Mostly the local  courts and beurocrats cause delays because of their lack of  scientific education in face of  crisis.  When I worked with the AIDS epidemic the courts and individual judges and beuroccrats by their delaying tactics and self aggrandizement accounted for thousands of passive aggressive deaths.  That said hundreds  of judges and thousands of beurocrats along with the front line workers turned that disease around as they are now grappling with this fentanyl epidemic.

Dr. Jordan Peterson though, always one to avoid the political correct language of deceit, confronts the problem directly but saying that today 10% of the population are ill equipped to have any work. Work and the family are the cornerstone of community and without community the gangs and drugs take over.  Work has been a key component in limiting the spread of addiction.   It literally keeps people in contact with positive associations however as Dr. Peterson points out in the past there were all kinds of work that didn’t require intellect or computer knowledge or even reading and writing. But these kinds of jobs have been mostly taken over by machines. Society must come to terms with this problem. Some countries have brought back conscription while others are moving to a similar non military but public health peace corp type approach for those young people who are not going to make it to college or trade schools.  Anything is better than leaving these marginalized people to gang predators.  Some 75% of those in jail are there for crimes to obtain drugs.  The enablers are often those with a conflict of interest in maintaining the antiquated punishment jail based legal system which has much value but not in this arena.  The drug court is just one of the very best solutions to the problem but recovery houses and work must follow.  

The good news is recovery is working. A week doesn’t go by that I don’t meet someone who says they remember me , like others,  who were along the way in their recovery journey. They stop me and say ‘thank you’ .  I don’t remember them. I’ve seen so many thousands of patients struggling and recovering from the disease.  They never look like they did when I met them in their addiction or early in recovery. 6 month, a year or 10 years later the big difference to me is the ‘eyes’.  They look alive’. “Dead eyes’ is a well known term among those who care and know.  

What’s even better is the ‘life’ the people in recovery have.  They tell me about their new jobs, their education, the trips to exotic places, their reunions with family, their church or temples.  It still remains that those who are 20 years or more recovered tend to be going to AA groups or involved in some spiritual organization.  

It’s a tough field to work in especially with the alcoholism and addiction rampant in the authorities  and the denial in high places where the desire is to expand the tax base and hope that the 90% of people who can play with fire safely are not destroyed by the 10% of people who turn out to be arsonists.  Despite that it’s still rewarding in time to see the lives gained.  Those young people who I knew who had so much potential but died premature unnecessary undignified deaths still remain with me.  But the woman who lost her children and family is now 2 years clean and sober . That’s thanks to methadone, her drug and alcohol counselors, AA,  a smart psychologist, her local church, an enlightened social worker and family who were glad to have their daughter back. She has a job working as a secretary for a housing authority, a government beurocrat going out of his way to help her get work without stigmatizing her for the other non life she’d lived before recovery. That’s the new normal story in this work.  I’m thankful to have been a part of the recovery process.

Recovery Day

When I attended my first Recovery Day celebration in downtown Vancouver I was impressed with the slogan, « I’m in recovery and I vote ».

The history of abuse of the mentally ill but specifically those with addiction and alcoholism has been longstanding.  Being a doctor who works with the mentally ill population and especially with those with addiction I’ve had to literally take all the same abuse that my patients suffer routinely. Being in recovery myself for decades I know intimately the demeaning humiliating behaviours directed to those who have one addiction by those who have another. Closet alcoholics were the worst for the ‘holier than thou’ approaches to the addicts.  Tobacco smokers condemned pot smokers.   

All the while neuroscientific research exposed the  disease of the reward pathways of the brain lambic system with studies showing this not only in man but also in monkeys and rats. 

 No longer do we encounter the offensive name calling and dismissive arrogance that so dominated the social Darwinism of the eighties and beyond but still the neglect is palpable in this field.  Blaming and shaming are the principle approaches to those who suffer from addiction.  It’s no more a moral issue than the colour of one’s hair is a moral issue. It’s a brain disease which develops with exposure no different than the radium sickness that plagued the women who painted the numbers on watch’s with uranium paint so they glowed back in the day when radioactivity was just being understood.. 

A little of something may even be good but a lot is bad for you.  A brief exposure is tolerable but prolonged exposure is deadly.

Each person has a genetically defined level of tolerance for alcohol, for instance.  In genetic studies, 50% of identical twins who develop alcoholism will see their twin develop alcoholism even when raised in a different home. That’s powerful evidence of the disease basis of addiction.  

It’s not just illegal drugs or activities but increasingly with chronic illness people become ‘dependent’ physiologically on the substance that at first saved them. Medications like morphine and clonazepam which can result in dependence can lead to addiction just as food which can save a person can kill them in obesity with diabetes, arthritis, and heart disease. .

Addiction itself is not just the ‘drug’ but rather a characteristic set of behaviours and changes that occur once individuals pass the proverbial cucumber to pickle line of dependence. These changes included spending an inordinate amount of time involved in the seeking and use of the agent, moral and ethical changes associated with obtaining the agent, psychological changes, mood sswings, character lapses, work behaviour change,  relationship changes, all well documented and gloriously evident to observers all the while the actual sufferer is wholly incapable of seeing or doing anything about this, commonly themselves in denial. Most commonly they even react to any external approaches to place  restriction on their aberrant behaviour with mild to severe and outright paranoia.  These behaviours of extreme mental illness are uncharacteristic of the individual and yet those with the chronic disease will despite origins in society and estate end up in jails, institutions or death due directly because of the disease of addiction.  Skid row is well known to politicians, lawyers, professionals and the once very wealthy. It is no surprise that Alcoholics Anonymous was begun by a surgeon, stock broker and lawyer. Yet the average member of society would not likely associate the drunk or addict as one of their own.  

The greatest threat to the addicts and alcoholics are those who capitalize on their disease, the enablers and the outright psychopaths and sociopaths.  In Canada 10 % of the population consume 80% of the alcohol and this figure is the same for each of the most recognized major addictions whether they are mood altering drugs or so called process addiction like gambling and sex.  

A world reknowned addiction researcher declared at an international conference that his research is not funded in the millions to stop addictive behaviours but to identify those who are at risk for persisting in these behaviours which profit others past the point when they no longer have money to pursue their addictions and continue to embarrass the industry that some would say stole their livelihood.  

Today the principle culprit is the government ‘pushers’ who lie outrightly with forked tongue, claiming to want to help addicts while at the same time their salaries are paid for by the avails of this addictive process. So to this day the government approach is lukewarm at best to the purveyors of death, those disgusting members of tobacco boards and their recent cohorts the pushers of marijuana.  It’s all about money and you can’t make a killing of a profitable omelette if you can’t break a few eggs.

A tshirt of the Recovery Movement  is « ‘I’m evidence’.  For so long the lie that addiction was not curable prevailed yet as painful and difficult as it was millions have thrown off their chaîns.  The ‘butt out’ anti smoking movement under taken individually and at a public health level has been so successful that the very air we breathe in the work places and restaurants of advanced countries is no longer second hand smoke.  The evidence is even more powerful in the changes in life expectancy and the survival in lung and heart diseases.  Exercise programs are altering the food addiction obesity that had always plagued the richest of society whether in India, Africa or America. ‘Super size it’ is being challenged by information and exercise.  Just knowing the source of the disease in the compulsive behaviours protects individuals from the fad diets and countless other ineffectual approaches to addiction, a mental and physical illness.

Increasingly the anger so common with interruption of the source of abuse is being identified and the unconscious lies that go with the often psychotic rage that invariably attempts to form allies, and seek rescuers and ‘demand’ changes to ‘achieve’ what is some often simply  ‘ more’ of whatever.  These individuals  enlist those financially and politically themselves addicted or likely to profit from the addiction.  Addicted women are especially so seductive in enlisting men to help them persist in their addictions. 

 Dr. Paul O. , a great leader of the Recovery Movement, himself a recovered addict , paraphrased, said “I could find a problem with a blank wall and if you didn’t see the problem, then it was even a greater problems.”

So historically the pressure of the addicts with collusion has seen a variety of addiction issues phrased as civil rights concerns, bars being allowed to be open around the clock, legalization of drugs, man boy love decriminalization for the ‘8 is too late’ crowd, the right to candy bars, one armed bandits , the crack of gambling, showing up everywhere.  

The doctors who work with addicts, like the leper doctors before them are not only shunned but are covertly attacked by legal systems which discourage health care workers in this field and enable the disease while appearing as a rescuer of those who have descended to psychosis and will use any means to kill the messenger who ‘confronts their addiction’ or stands in the way of their disease.

Meanwhile  the overt and covert aggression, the shaming and blaming in the ranks of those who themselves are apart of the drug pushing profiteers continues. 

Originally the Washingtonian spiritual movement and other evangelical movements were the only effective forces against addiction.  Dr. Freud considered addiction worse than schizophrenia and Dr. Carl Jung said that he knew of no cure for addiction but had seen some who had a miraculous recovery. The original 12 step peer support movement was the first reproducible cure with 50 men maintaining  abstinence from alcohol for five years and more. This epidemic of historical proportion saw this ‘cure’ , a true miracle of the 20th century, even as billions moved forward financially and in terms of leisure time to having the means to develop and maintain addictions which in the past were commonly only stopped  by poverty,  disease, or death. Spirituality though not necessarily any religion per se remains a special part of the recovery process.  

Anonymity helped the early movements because of the stigma associated with this ‘behaviour’ labeled a moral failing much like ‘bed wetting’ was until it was found to represent a delayed bladder development.  Even homosexuality, a naturally occurring behaviour throughout the animal kingdom, was considered degeneracy but worst of all were  the alcoholic and addict. The joke might well be that a person could say, “I may be a bed wetting homosexual but at least I’m not an addict.” 

Thanks to the incredible success of the 12 step programs millions of alcoholics and addicts not only recovered but went on to be rich and powerful and influential. The consequence was that all manner of parasitic ‘fad’ approaches latched  onto  the body of recovery. Every charlatan ,now that addicts and alcoholics were no longer impoverished, wanted to get their new earned money for whatever positive or nefarious scheme.  Even the medical community got on board and with the help of governments all claiming the best intentions began to prey on those in recovery . A famous psychologist summed it up by saying that America had become a nation of ‘caregivers and victims’.  It was all about money. 

Now the Recovery Movement began with those who like the ‘friends of schizophrenics’ and the various ‘cancer societies’ was developed by those themselves who had  recovered from addiction or had family and friends who had recovered from addiction.  It takes an addict to know an addict was a saying that helped raise the awareness of many.  This grass roots movment which served not only to raise awareness and get private and government funding to the people and places of greatest need also served to protect fellow sufferers from the often ‘subtle’ abuse of the enablers and profiteers, private and public.   Some of the ‘do gooders’ were addicted to the deceit of political correctness and two faced  countered the real efforts to address addiction with smiling falsehoods and feigned half truths.   The power of the tobacco companies was never appreciated until those in the streets realized how much money influenced the government politicians and government regulation bodies.  The very men and women paid exorbitantly in government regulatory bodies  to protect citizens were themselves profiting by protecting the ‘pushermen’ of various ‘ilks’.  Thankfully those in recovery in their personal journeys had learned to recognize the hidden addicts and those profiteers who claimed to be helping.

The community of recovery was vast and coined  the phrase  “there is shame in addiction but there is dignity in recovery’. Carry the message.

 Recovery Day is an international celebration and coming together of all those who individually and together are working to address the disease of addiction and support those ‘cures’ and those ‘processes’ which truly work.  It’s a wonderful event.  It’s a fabulous day. It’s hope and inspiration in face of a centuries old epidemic.