Addiction, Alcohollism and Motivation to Change

Daily Reflections Dec. 21

Listen Share and Pray

‘When working with a man and his family, you should take care not to participate in their quarrels.  You may spoil you chance of being helpful if you do. »

When trying to help a fellow alcoholic, I’ve given in to an impulse to give advice, and perhaps that’s inevitable .  But allowing others the right to be wrong reaps its own benefits.  The best I can do ….and it sounds easier that it is put into practice….is to listen, share personal experiences, and pray for others. 

I remember well meaning individuals offering kind suggestions.  The difficulty is that they didn’t realize the depth of betrayal I’d experience of myself and with others. I simply did’t trust. I trusted God but those closest to me had abused my trust.  I was at that point quite frankly paranoid.  In the sense that schizophrenics are delusional because of the depth of their anxiety and alienation so are addicts and alcoholics however they appear normal at times and can hide the insaniety brewing beneath the surface.  

Motivational therapy is the treatment of choice today for addition. It first says listen. It says identify the ‘stage of change’ the addict or alcoholic is at .  The first stage is « precontemptlation’.  In precontemplation stage the individual is in such depth of denial they reject even the suggestion of a problem and become angry with anyone or any discussion of their ‘problem’.  Their problem is ‘you’.  They don’t see any reason to change, The problem is that others need to change.  Others need to cut them some slack, get off their backs, quit bugging them.  Others are the problem, not them.

Contemplation phase is different. In this phase the person might accept there is a problem and they might even consider they may be doing something wrong. They may think they drink too much or that drugs aren’t helping.  They aren’t ready to change but they are open minded enough to consider the possibility that their best friend and solutions, drugs and alcohol and those who use them might no longer be helpful.  Before Prochaska and others studied Motivation it was found that government funding and intervention immensely wasted and counterproductive because it was aimed at those in ‘precontemplation phase’.  This only entrenched alcoholics and addicts against change.  The timing of intervention is critical in addiction and when the person shows openness to the idea of their use of alcohol and drugs being part of the problem that’s the time when it’s good to simply off solutions.  Persons’ in the ‘contemplation phase’ welcome being given ‘literature’, ‘invited to come to a meeting’, offered a phone number, advised where rehab and detox centres are.  They are like people who say they were thinking of having their house painted so don’t mind hearing what’s out there but don’t want anything onerous or involved.  Just offer them information and be prepared to follow up at some time.,

Determination is a critical time and distinguished by the person admitting they have a problem and committing to making a change This is like the smoker who says they need to quit smoking and say they’re going to fo it in the spring.  This is the time to offer time and resources to assist the person in getting to the next and most critical phase. Unfortunately many alcoholic and addicts with talk ad infinitum about needing to quit and planning to quit but the rubber never seems to touch the road.  When it does that’s the time to pull out the stops.  In the past those who cared had wasted endless energy on those in the precontemplation phase they were angry by the time the person actually was determining to make a change.  Listening carefully to the alcoholic or addict is the key to identifying the fundamental changes

The Action Phase is evidenced not by talk but by action.  The key statement that came out of the AA experience was ‘if you talk the talk, walk the walk’.  Action is evidenced by a number key actions.  The first was attending a meeting of AA. Today people can attend a meeting of SMART or any of the faith based and secular ‘group therapy’ meetings. The corner stone of therapy for addiction is the group.  Social anxiety is central to addiction along with shame and dishonesty.  When a person is actually in the action phase they will literally leave their basement, pub, crack house, drinking and drugging friends and join a group of people who have and are leaving the old world for the new.  These are the people who don’t just talk about exercise but actually go into the gym and buy a membership.  In the action they admit they have a problem and need help.  Other major actions are going to a clinician and saying they have a problem with addiction or alcoholism and asking for help.  There’s going to a Detox centre. The action is picking up the phone or going to the building and asking for help. There’s calling the rehab centre and speaking to intake and then attending. 

This is where resources need to be focussed because this is what the person is truly ready and making an effort to change.  

The success of treatment for alcoholism and addiction is truly amazing if the person had a job and family in tact.  Too commonly people have looked at addicts that are homeless and on the street and not seen the success of treatment because of these few individuals who have end stage disease.  It would be like saying cancer can’t be cured.  Every day cancers are being cured if caught early.  Countless skin cancer and cervical cancer and breast cancer and even lung cancers and brain cancers are cured routinely because they are caught early and treatment is initiated.  In the past early diagnoses and treatment wasn’t available and people avoided seeking help for a lot of medical conditions, many of the worst known, because we screen for them and treat them early.  Pilots and doctors have a 90% success rate in treatment of alcoholism and addiction because their conditions are recognised early and treatment is initiated. 

The Gold Standard Navy pilot program involved 30 day in patient treatment followed by 3 AA meetings a week and monthly meeting with a psychiatrist and counselling as needed resulting in 80 to 85% of pilots remaining sober and clean and flying 5 years later.

That’s like the success with early detection and treatment for Tuberculosis and Diabetes. These used to be lethal diseases and still have major complications at end stage but the life expectancy in the past was at 20 to 30 years but now is 60 to 70 years. Alcoholics used to die 10 to 30 years younger but now are living out their lives.  Heart disease, lung disease, liver disease, hypertension and various cancers were all often caused by addiction and alcoholism but now are recognised as treatable life style diseases.  The longevity research show now that the greatest thing individuals can do to improve the length and quality of their lives is simply to quit drinking and smoking.  

People change,  Addiction and alcoholism are diseases that are curable.  Abstinence is the treatment of choice and AA remains a cornerstone of long terms success.  Not surprisingly it was called the ‘miracle of the 20th century’ because prior to the 1930’s alcoholism and addiction were a deadly scourge akin to the various infections that were treated by the introduction of sulfa and penicillin.  

Today we also have ‘harm reduction’ therapies for those in the determination phase of change but still ambivalent about abstinence.  I liken them to those who are told that surgery is the solution to their hip disease but want to do physiotherapy and exercise first.  If that works great.  In medicine clinicians want success and realize that scientifically there are superior treatments so that we describe efficacy of therapy as ‘primary’ , ‘secondary’ and tertiary.  

Because of the insaniety associated with addiction and compulsion and obsession often an addict will think that if only they don’t use heroin in the afternoon and limit their use to the morning all will be well.  It’s important for others to listen and not argue but to explain what indeed has been proven to be effective in the same way as we’d not agree with a dying man that using a salve on his bullet would will be sufficient.  We would recommend taking the bullet out and treating the would with antibiotics instead.  Of course if he wants to try his salve and lotion first that’s okay.  Insurance companies and governments and jobs won’t usually support these subjectively appealing but objectively questionable solutions yet it never helps to ‘argue’ with insanity.  

I prefer to pray myself.  

Princeton, BC, Municipal Campgrounds, the work nightmares,

Gilbert let us sleep in till 5 am. He was coughing and his breathing was stressed.  I took him outside and  walked him. I was only wearing  a hoodie over my black underwear.  Laura has told me they look like bicycling shorts. Gilbert peed a river. The diuretics are working. He loved standing at the river edge below us drinking the mountain creek water.  He was then ready to mark his territory some more.  I was ready to go back to bed.

I let him up on the bed to join us.  Laura spoils him with tickles and massages. I fell back to sleep. 

In a bad dream, I was trying to get a judge to get funding for a guy to have an assistant and for them to set up a group for others to participate in a large community program.  The judge agreed to the money and then I turned to the counsellor and he was delighted with the high pay but hadn’t a clue what was expected now. He had no idea what oversight was   was needed. Like so many he thought it was all about him getting a job and him getting paid and anything like accountability and outcome not being important.  The fellow who I’d got the services for wasn’t even able to say thank you. I asked him in an aside, did you smoke up before this meeting, and he said,”lots and lots’.  He was totally gorked.  Such was addiction. The judge was suspicious, pausing for a moment to study me,  but finally signed the order. We had the funding. Substantial amounts. 

I had no time. The counsellor had promised they knew what to do and had complained that all they needed was money. But it was readily apparent that they didn’t know anything about what the judge expected.  I was fully booked in my own schedule for months ahead. Now I’d helped these guys and dozens more to have funding for recovery programs but  now it was apparent they just thought they were getting money and despite their education and training  hadn’t a clue what was expected. I’d attached my good name to their madness.  I had no time and yet I was going to have to make more time to babysit this program and ensure the judge had the paperwork he required.  I awoke from this nightmare.  

It really was funny when I awoke.  I smiled. It represented my constant battle of 30 years to get funding from authorities for the mentally ill and addicted and then the fight with the mentally ill addicted and their caregivers to get them to do something more with the money than buy natchos and sit around and talk.  The whole idea of accountability was a foreign idea and these people with supposed training had had so little scientific or economic training. It amused me as here on vacation I was having a nightmare of the constant insanity of  my life caught in the middle.  I really do think it’s a metaphor,

 All my work life I was challenged by ‘outcome’ measures. I knew in recovery the good standard for programs was the Navy Pilot Program.  Alcoholic pilots, flying multi million dollar planes, having cost millions to train.  One month of a recovery treatment centre, once a week drug and alcohol counselling, three meetings a week of AA and seeing an addiction psychiatrist once a month.  At 5 years 80% of pilots clean and sober flying planes.

I loved morbidity and mortality stats and working for positive results

At the same time it was always like moving through molasses with so many others making more money to ensure illness and addiction. I just remembered when the Canadian liquor store staff without education, were paid more and more compared to the drug and alcohol counsellor with 3-4 years university education.  Here was the government, our employer saying one thing, doing all manner of preening and lip service but their actions spoke so much louder than their words on the inside.  I made more money doing abortion than doing obstetrics with less hassle and risk.  The same with my colleague who does Euthansia today in the MAiD program.  She makes way more money, has less expectations and is considered sexy and happy compared to me plodding away in the misery and poverty of the human quagmire actually trying to heal and rescue people. 

All the while the College, the government police agency,  was giving the pass to the people who did nothing while I was constantly attacked using a standard of ‘political correctness’ which rewarded doing nothing and punished any activity. My colleague laughed and saw the same people without any improvement in their circumstance for 40 years.  I set various standards like getting patients to get jobs, housing, reduce or stop suicide attempts, all these measures of success, achieve abstinence, live longer than their cohort. .  Meanwhile we had a variety of much higher paid Harm reduction programs that maintained the status quo.

My favourite day was when the head of the multi millionaire program in Vancouver told me “Dr. Hay I know of your great work and how successful you’ve been helping people but we’re not on the same page. You seem to want to get people better while we don’t want to “interfere with the culture of addiction” but see our job as getting them money and other resources.”  

And here I am on vacation shedding the tension of this life of doing good against the forces that ‘aren’t on the same page’.  I imagine the peace makers really piss off the arms dealers. That’s been my experience in life and dealing with the government arrogance where they see themselves as holier than thou but have made a pact with the devil to have a soft life and acquire the most resources. I took comfort at times in reading Bonhoffer’s struggles with the Christian authorities in Nazi Germany and Arendt’s study of the Nuremberg trials looking at the Nazi bureaucrats, insisting they were just doing as they were told, and not responsible.   Arendt  coined the term ‘banality of evil.’ 

Joseph Campbell described my journey of the young fool as the ‘hero’s journey’.  Now I’m at the end of that and look back and see that like any good soldier I served. I was in the wars. I fought well. I had idiots for commanders at time, other times great leaders,  and the government was corrupt mostly but other times far better than expected. In my little sphere I did my best. I served.  I frankly don’t know what I could do better.  I stopped killers. I identified pedophies. I refused hundreds of thousands in bribes. By the measures of morbidity and mortality I outdid expectations. I prevailed. I had outstanding successes. I lived through having threats and guns pointed at me and stayed true. I am sorry my dog was killed. I suspect my care of Gilbert today is somewhat influenced by the guilt I feel for taking Stuart into danger and letting him be poisoned by drug dealers. I know my marriages were hurt by my inflexibility, my refusal to go with the flow, to take it easy, to focus on the money and a good job and not ‘fight city hall’.  

My colleague laughed and said “I stopped reading medical journals 20 years ago and took up studying real estate. You keep reading science and medicine and what’s it got you. I’m a millionaire. You’re a poor clinician and you still have fools telling you what to do. It’s the system.  You can’t do any more when the government is corrupt to the very top. The Prime Minister is paid by the money they take from drugs and alcohol and gambling.  It’s just a party for him and the others. “

My teacher said ,”when you feel you’re doing more work than the patient, you’re no longer doing therapy, you’re giving them your tit.”  He was the one who taught me the fisherman story and reminded me that the best caregivers burnt out because they thought it was a race when it was really a marathon.  I had such good teachers and parents and now after 40 years of work I’m finally registering their genius.  

I’m here in a camper on the side of a stream with no threat and I’m having nightmares about work.  In the midst of the trauma there’s no time to pay attention to the wounds, we’re all just trying to survive and get through the wars , the bureaucrats and patients create. In the frontlines where I lived we were constantly in the war zone while the critics and the activists, the College, politicians and the celebrities and television preachers were always with the ultimate leadership, far from the front, living in the palaces and dachuas.  

Now that I’ve begun winding down I’m on vacation and my unconscious is churning up these dreams that truly make me laugh. Despite the best training and best intentions I got caught in the same old traps. So here I am still dealing with hubris.  Pride and self pity.  I like the idea we’re all on the journey climbing the mountain in our various ways and the idea is not to compare and not to envy or judge but just keep on trekking. I was so easily distracted. How many times did I turn aside to help a maiden in distress only to see myself conned. How many times did I leave the beaten path to help a fallen comrade only to be shot while doing the rescue.  How often were my own mistakes the cause of my own distress and yet I always looked to blame something else, or someone else.  How often I did it ‘my way’ rather than the way my elders recommended. I listened to my teachers in the workplace but not my parents in my personal life.  I am blessed to have had ministers, teachers, elders and friends who set good examples. I miss having had the ‘children police’ that truly guided and dictated most of my friends good behaviour. My dogs have exercised me and reminded me of meal time and contemplation time. I’ve learned love from and through them.  Gilbert, blind, with arthritic back, valvular heart failure and congestive heart disease is making the best of the good moments.  I’m so admiring of friends who have cared for sick relatives and parents like my Mom cared for her mother in our home till she died.  My brother cared for my father.  Dad cared for mother.  It’s in living and caring that we heal ourselves too. I weary of the shallowness of mainstream media and seek the wisdom and depth of ages. 

I’m healing here. The forest is a healing place.

I woke this morning. Another day I was ready to go bear hunting. Today is the last day of the season. Instead I slept in. The problem is that if I shoot a bear we have to pack up and take it to a butcher on the way home.  I’m liking it here. I’m enjoying the down time and even though I’ve worked quite a few hours it’s been unscheduled and responsive to immediate needs.  No strangers either. No facing the unknown insanity.  Just taking care of business and lots of reading westerns.  The great allegories.  I want to get on my motorcycle and head into the backwoods but if there’s a bear I’ll just have to shoot it so by sleeping in I’ve missed that.  In the fall I’ll shoot a deer. I love venison. I’ve never enjoyed bear meat that much and it’s all so much work since I’ve grown older. The last elk I shot almost killed me though I loved the exquisite meat I had for nearly two years.  I’ve a rabbit in the freezer from last year still.  

I’d hoped to catch some fish but I’ve been rather lackadaisical. I’ve a freezer with steaks and smokies. Last night we had barbecued smokies and I made baked potatoes after getting the gas oven working for the first time.  It’s supposed to rain. Laura is easy on the eyes and easy on the mind and soul. She’s happy. Gilbert’s happy.  I’ll probably ride into town and buy a work watch. I broke the strap on my Swatch and even that’s been a metaphor.  I need something more rugged for these excursions since I passed on my Garmin gps watch to a wilderness loving friend who had patience for setting it up each time it was needed. I’d enjoyed it the first time but didn’t use it enough to keep up with the computer updates. I love my Apple Watch but it’s not meant for the back woods.  

It’s another day in paradise and I’m really happy, feeling each day I relax a little more.

Recovery: Whose job is it?

Big Book of Alcoholics Anonymous

“You will be most successful with alcoholics if you do not exhibit any passion for crusade or reform. Never talk down to an alcoholic from any moral or spiritual hilltop, simply lay out the kit of spiritual tools for his inspection.””

Commentary

When we are teaching junior doctors and counsellors we advise them to watch themselves carefully to see if they are putting more effort than the patient into ‘rescuing or curing’ them.  Whose job is it?  I can’t make a person drink the medicine. I can give them the medicine.  Indeed it’s been said that I will hold their head under the water to make them drink but that after a while even with that approach even some would drown rather than drink.

Addiction is in part a pout.  Enablers are treating alcoholics and adults like children when they are adults.  Perhaps proto adult,  Adolescent really, but to be adult you don’t start ‘babying them’ for their own good. You offer them resources to ‘recover’, not to persist in their addiction.

I remember hearing these two addicts discussing social services, “I’ve now got a place, there’s free meals at the church, and I’ve got a bus pass, now all my disability money can go to drugs.’  

Giving money to an addict is actually giving money to his dealer.  One of the most successful ‘harm reduction’ policies which worked for years until some aetheist interfered, was a local priest who took checks from addicts on Welfare Wednesday check day, then doled their money back to them daily. I have a patient whose sister gives her brother $10 a day because when he had $20 he spent it on crack. His dealer actually approached him each day to ask if he had $20.

Adulthood is ‘accountability’.  

The brain disease of addiction is that it causes the forebrain or judgement to be impaired. A person loses the capacity for ‘delayed gratification’.

 “I want it all and I want it now.”

There is a regression from adulthood back to adolescent learning.  In recovery we describe the person as "40 going on 15." It seems there’s an emotional delay that occurs once a person becomes addicted. Most people learn to ‘self soothe’ without drugs and alcohol. The alcoholic or addict may act juvenile but they’re always very canny.  Their capacity to think is not impaired in that sense. The fatal flaw is their inability to carry through with plans.  They have all the ideas of the ‘adolescent’ or ‘child’ but lack the capacity to complete tasks, overcome adversity, work together, delay gratification.  These are all adult skills.  Drugs disrupt learning 'adulting'.

I treat mechanical brain injury, when a person drives a motorcycle into the wall hitting their head and chemical brain injury, when a person dumps drugs and alcohol on the chemical circuit board of the brain.  The behaviour and function are very similiar though fortunately for the alcoholic and addict initially the damage is reversible if they abstain.  The recovery process are the same.

In ‘detox’ treatment, empirically it was necessary to establish a barrier if only slight to access.  Years ago when I was heading a detox we would admit a person who while drinking had remorse and wanted to ‘go on the wagon’.  As the drugs cleared their system they ‘changed their mind’ and left. Today most detox require a person to be seeking detox for 24 to 48 hours. The success is greater.  The greater the commitment the greater the success. Even with Suboxone a person must be in ‘withdrawal’ before the treatment can begin. If this medication which is a combination of opiate and antagonist was given to a person ‘high’ it would just throw them into painful withdrawal.  

The treatment of choice for addiction and alcoholism is abstinence.  Harm reduction has always been considered a valid ‘stepping stone’ or ‘entry’ point to recovery.  Recovery is the whole ‘process’.     

When you feel you’re doing more work at their recovery than they are, it’s time to back off.  Alcoholism and addiction are in part escapism. The adult with every drink becomes more childlike, seeking the tit or womb.  They become legless and incompetent.

With an injured person in the emergency we as doctors provide immediate care and take over the function for the person in the first day but even if we put them on respirators and bypass machines we are always working to get them off.

The survival post surgery is best in those who get up and walk on their own.  Why would we think differently in treating mental illnesss. The aim is to restore a person to full functioning. Yet there are enablers and those who ‘appear’ to care. but are really negative not believing in the possibility of recovery for an individual.  They are the enablers who infanticize the alcoholic or addict and provide them everything.

I wonder when I see what my mechanical brain injured patient is given versus the chemical brain injured person. When the latter is getting ‘more’ something is wrong.  The recovery from mechanical brain injury, if severe, still can occur but it’s slow. Fortunately the person isn’t continuing to hit themselves in the head with a hammer like the addict who continues to relapse.

If they  are alcoholic or addict continues to drink especially then we are the problem not them. We are enabling them to do more brain injury and more destruction.  Limit setting is adulting.

Unfortunately as children mirror adults, addicts and alcoholics mirror their caregivers.  When caregivers are unable to set limits, have rules, be themselves disciplined in their ‘giving’, then the addict or alcoholic doesn’t learn. As a life guard my first lesson was not to let the drowning person pull me down with them.

The original AA members when they went out to talk to an active alcoholic found that if they went alone they were as likely to start drinking again themselves.

We’ve seen many of the institutions established in good faith to help alcoholics and addicts take on the emotional maturity and behavioural developmental stages of the alcoholics and addicts.  The institution is pulled down by the drowning alcoholic and addict.  

There are caregivers and victims.

The joke in the church was that it should be called ‘sinners anonymous’. It was also said that we should not  ‘judge’ another because they ‘sinned’ differently.

It was found in Al Anon, the organization for friends and family of alcoholics, that ‘enabling’ and engaging in the ‘self delusions’ of alcoholics,’arguing with them’ , ‘coercing’ them etc was counter productive.  The Al Anon learned instead to ‘detach with love.’

The “holier than thou’ approach to addiction simply doesn’t work. The ‘I am the doctor, you are the patient’ doesn’t work either. What has worked quite miraculously is the approach of “I’ve had your problem" and "I’ve got a little further ahead while I’m still working on a problem.”

I asked a doctor how he had climbed Mount Everest and he told me that there was a club in Switzerland where people who had climbed Mount Everest gathered. He’d gone and learned from them.12 step programs have been similar clubs.  These are people who were spiritually bankrupt but now are rich on life. 

The job is not to ‘feed’ the alcoholic or addict for life’ but rather to ‘share the spiritual tools with those who want to learn and want recovery’.  The "Stages of Change" was developed by Prochaska to address the Motivational level of individuals who had various diseases.  As a caregiver one offers the ‘options’ and encourages ,but doesn’t do the work for the individual and doesn’t enable or ‘carry’ the person other than briefly.  

One of the problems with lack of resources in the area is that many ‘acute’ resources have been commandeered by the ‘chronic’ .  Hospital beds that are specially established as an ‘acute’ services are being used by mismanagment government for ‘chronic beds’.  Lack of chronic low cost housing results in losses of millions as the mismanaged constipated system backs up and high priced acute services are wasted on ‘chronic’ care.

Perhaps this is evidence that the ‘system’ and ‘institution’ has become more drunk or drug addicted or ‘diseased’ than those for who the service was intended.

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.

Harm Reduction Good; Harm Reduction Bad

Harm Reduction Treatment is a term which is used commonly in Addiction Medicine. It followed “abstinence based’ treatment.  In other areas of medicine the term ‘palliative care’ is an equivalent expression.

The positive aspect of “Harm Reduction’ was that it provided care specifically for those who were not ready to embrace ‘abstinence based’ treatment or for those who had failed, even repeatedly failed, conventional abstinence based therapies.  

Historically ‘abstinence based’ therapy for alcoholism was exemplified by the Gold Standard , Navy Pilot program. Navy pilots cost millions to train and flew jets worth even more millions.  When they developed addiction as they did, grounding them caused  a major loss, often involving suicide, while letting them fly, was obviously dangerous. The treatment which followed included a 30 day inpatient treatment, followed by 3 meetings a week of AA (Alcoholics Anonymous), weekly drug and alcohol counselling and monthly visits to see a psychiatrist. At 5 years 80% of pilots were abstinent and flying.  A major success.  

This treatment with some variations is the treatment principally used for judges, doctors, other professionals, union members and all those ‘contributing citizens’ who individually or by insurance can afford the ‘best’.  It is well known by the advocacy of such distinquished treatment programs as Betty Ford, Talbot, Homewood, Edgewood, Orchard etc.  Often patients begin with a period of detox and follow up today can include SMART, a cognitive behavioural group therapy.  Group therapy is the cornerstone of abstinence based therapy.  A fundamental principle of addiction treatment in this model is that substance abuse compensates for relationship deficits.  Accountability and support come through fellowship and community.  Isolation begets addiction, participation treats addiction.

By contrast Harm Reduction Treatment has tended towards maintaining the substance use with a view to control. Originally the World Health Organization validated the Harm Reduction Programs only as they ‘lead to abstinence’. Abstinence is the ‘cure’ per se for addiction.  To this end methadone, suboxone, Kadian and now Heroin are used as Opiate Replacement Therapy.  Eventually patients were weaned off opiates however where in the abstinence models this occurred in weeks, in the Harm Reduction Model this might well take years.  

Alcohol is provided in a controlled fashion on the hour for chronic alcoholics, maintaining the steady state alcohol level and avoiding withdrawal as well as the revolving door detox, hospital and jail scenarios.

There is no doubt that harm reduction is good Community Medicine. 30 years ago when I was doing a Community Medicine Residency I studied the Swiss Methadone Maintenance programs of the day, showing then as they do today, that providing methadone, reduces the spread of diseases associated with needles, like infections, most importantly hepatitis and HIV.  They also dramatically reduce the cost of revolving door hospital, detox and jail scenarios. The legal cost alone for the theft associated with heroin use is horrendous and methadone simply dramatically reduces this.  

Harm Reduction Treatment is very good for the community when it is approached responsibly and it’s fiscal benefits are understood.

 Locally the Portland Hotel Society was a scandal with all manner of corruption and devastating failure as their Harm Reduction Model became dominated by crime and a ‘better living through chemistry’ attitude which indeed promoted drug abuse as opposed to treating it. The Portland Hotel Society has since modified it’s approach. 

For individuals as opposed to the community, harm reduction can be very good.  Methadone and suboxone specifically impressively reduce the use of needles and help individuals get free from the life of servitude supporting the criminal drug dealer factions and associated crime.  Eventually patients who might otherwise have died often have the time to move on to abstinence based therapies.  When the patients come for methadone or suboxone their other physical and mental health needs can be addressed.  Otherwise they might well avoid health care.  Housing, food, health care are all available as part of the a good methadone program.  Certainly we encourage participation and provided biopsychosocial interventions to the patients on methadone. The College of Physicians and Surgeons of BC like other College programs across Canada and similarly in other civilized first world countries,  historically managed the methadone programs and encouraged they take a wholistic approach to the patient.  Opiate programs required a federal government waiver given that the laws against drugs like heroin were nation wide. Locally the addiction treatment has been transferred mostly to Province or State and University care. 

Harm Reduction Therapy could well be seen as bad if all the doctor was doing was being a ‘drug pusher for the multinationals’ rather than using motivation therapy,   12 step facilitation therapy and cognitive behaviour therapy to move patients along the spectrum of motivation to change as laid out by Prochaska.  The preventative medicine aim was through relationship therapy with the physician , psychiatrist, pharmacist and overall treatment team aiming to ensure the patient’s self esteem and health indices  improved.  These indeed do and for many individuals the methadone and suboxone treatment have been life saving.  Heroin and other ‘needle maintenance programs’ are early ‘add ons’ whose value is not nearly as evident given that the key feature of methadone was that it moved patients off needles with the community risk inherent to methadone or suboxone, oral medications.

The alcohol therapy has been an end stage treatment model for chronic alcoholics who have failed all other programs and whose lives are more manageable without the drunk then withdrawal roller coaster broken by relationship with health care and managed hourly alcohol intake.

Champix  and bupropion, nicotine replacement gums and patches, and vapes are all Harm Reduction Therapies which have had proven success in helping people become abstinent for nicotine and smoking.

Revia (naltrexone) is a medication which reduces craving for alcohol and empirically reduces alcohol intake in those who abuse.  Acamprosate is another such medication. 

Narcan kits which reverse overdose are definitely a harm reduction strategy especially when put into the hands of first responders.  They are a simple preventative medicine strategy for those of my patients who I encourage to have on hand when they are using with family or friends trained to know how to use them. 

The safe injection site is obviously another  harm reduction strategy.

Needle Exchange programs are proven harm reduction therapy where the patient exchanges a dirty needle for a clean needle. Unfortunately locally the needle exchange program devolved into a ‘free needle’ program with needles being tossed out of a basket in the local park. 

A variety of medications have been used along with diets to treat obesity and overeating, sometimes call food addiction. At the extreme, when behavioural change fails, surgical interventions such as stomach stapling have been long acknowledged as life saving.

So why is Harm Reduction Bad?  Obviously it isn’t of itself.  Reducing harm is good and the use of this marketing term is very seductive indeed. Unfortunately it can be ‘enabling’ and can cause the disease to persist given the huge element of denial involved in addiction.  Further the Harm Reduction Therapies tend to be pharmaceutical or medicalized  and costly compared to the low cost equivalence of the more labour intensive approaches of treatment centres and frankly almost cost free community support programs.  Often all the high cost and front end approaches are used and use up the patients resources while in the end the recommendation is to continue in AA/NA or SMART as this is a chronic disease process and unfortunately the real issue is prevention of relapse.

When patients have work and family and community relationships still in tact they are most likely to benefit and succeed with the conventional abstinence based programs, detox, treatment centre, and group therapy. In traditional medicine this is considered the ‘primary’ care model and harm reduction therapy is considered ‘secondary’ or ‘tertiary care’.

Harm Reduction becomes ‘bad’ when judges and doctors and the wealthy are given the abstinence based approach while the poor are ‘maintained’ on their drugs without giving them the opportunity of ‘cure’ which comes with abstinence based models.

Further, the harm reduction models can contain an inherent negation of the patient’s capacity to change.  Seminal studies have shown that a patients capacity to change and get well depends strongly on the therapists belief in their capacity to do so.   If the therapist doesn’t believe the patient can overcome their addiction to heroin the therapist will indeed prove to be the rate limiting step. The success of AA and NA is that the rooms are simply full of individuals who have indeed climbed the Mount Everest of Recovery and encourage others to believe they too can succeed.  

Both models have their naysayers and both models have their glorious success stories. The social justice warriors often argue that the addict and alcoholic should have ‘free’ stuff , in this case ‘free drugs’.  Unfortunately the disease of addiction is one of ‘more’ and there simply isn’t enough of whatever to suit the active alcoholic or addict who will die or commit crimes to persist in his or her narcissistic hedonistic pursuits.  

Should society pay to increase the risk to itself.  Part of the difficulty today is that there are increasing numbers of those who feel society should allow them to ‘spread their disease’ , a group of HIV positive individuals having parties with ‘non infected’ but those seeking “solidarity”.  

In the best of possible worlds when physicians, psychiatrists and other care givers are seeking what is best for the patients ,understanding the severity of the disease, the limits of resources and looking at each case individually there is rarely any conflict between the models .as in the individual’s life and care both models are at different times and sometimes together  being used.  

Politically, Harm Reduction Therapy has, I believe, a great deal more potential for harm than traditional abstinence based therapies.  Naturally there is a concern that the rise in addiction and death has been parallel to the increase in Harm Reduction Programs. Is this an association or is some of this cause and effect.  Changing the ‘drug dealer’ from the street criminal to the State has sent a different message. Legitimizing drug and alcohol abuse can be problematic.  Promoting marijuana use for profit just like promoting alcohol for profit may cost individuals and communities while a few profit.  

What is best for the individual, what is best for the community and what is best for the State and treating services are great when they all work together. Historically, the individual has been lost in the demands of community and State and those that ‘profit’ from individuals with disabilities such as addiction.  

We have always done ‘Harm Reduction’ as doctors. My concern has principally been individuals get the best care. The group “Like Minded Doctors” developed in part to discuss these concerns. 

Fentanyl Epidemic

“I’m a doctor just like you,” he said.  I knew him in passing.  A good fellow.  Well intentioned. Most of his life a drug addict.  Now he and a friend like two teen agers going fishing patrolled the Downtown Eastside with Narcan kits they got free from the pharmacy.  Instead of trout he caught life slipping away in the gutters. Occasionally, he brought it back with drama and flourish.
“I’ve saved a dozen lives,” he said.
It was good entertainment. He used himself. The suboxone helped him and only a few times a week did he ‘party’.
 “We like the fentanyl because it’s strong enough we can push through the suboxone.” he said.  The patients liked the oral methadone and suboxone because it stopped the withdrawal sickness.  They could have a life separate from the daily grind of finding the money and getting high.
Their faces linger in my memory.  Only weeks ago I saw them.  A couple of young Caucasian women, in their 20’s with boyfriends.  They came as couples to get their opiate replacement medication.
I talk up a storm about AA/NA/SMART, the non pharmacological treatment groups, Detox and Treatment Centres and Recovery Homes..  We really only get paid for the prescriptions. The doctors break into two groups. The rich ones who write a lot of prescriptions and the poorer ones like me who do counselling and try each time to push the patients closer to recovery.
Recovery isn’t Harm Reduction.  Recovery is a proactive program of wellness leading to abstinence from mood altering substances.  Harm reduction is supposed to be a step on the way. But now our Prime Minister is so vocal about smoking pot and all the tobacco company wealth is back in the business of smoke everyone in the DTES is either smoking marijuana or cigarettes or both.  The trouble with drug addiction is that it really dulls the senses and their addiction to smoke is seen as nothing compared to the heroin and crystal meth and crack cocaine.  Then there’s the sex addiction, gambling and pornography and crime.  It’s a smorgasbord of free choice in the DTES.
But mostly they tell me they don’t want God or any of that spiritual or religious stuff.  They want drugs.  Addicts are materialist hedonists.  They are sometimes even like the monkeys we studied back in school with the electrodes in their amygdala pleasure centre who would live to pull the lever of pleasure.
More and more they tell me they don't want any of the recovery options. "I just want that free heroin. Can you direct me to where I can get my injections for free.  I don't want to stop using. I just want to get the stuff free."
Each of the women was demure with whimsical smiles and street smart eyes. College drop out. They’d been into opiates only for a year or two at most. They’d started with pills they got at parties and then became hooked. With their boyfriends they now needed fentanyl pills every day, at least one or two, sometimes more. They ground up the pills and snorted them.  They smoked marijuana too.  A lot of the marijuana had been sprinkled with fentanyl so the herb was hurting folk bad.  Even the organic shops marijuana had been tested and come back positive for fentanyl. I imagined with the fentanyl so cheap dealers were going about sprinkling powder here and there to increase their clientele.
Drug dealers are lizards who want to be your friend.
The Fentanyl was coming from China.  It was sold on line and brought in over the border en mass.  My hypochondriac patients complain that it and crystal meth are in the air in the DTES.  The paranoids are afraid of the food outside in the markets. They’re crazy but no more so than the neighbourhood.
It’s just that their faces linger. The two women from last month. I've mostly forgotten the patients that died before them.
Sometimes I remember Gordon Lightfoots song, “Only a go go girl in love with someone who doesn’t care.”  I think of their mothers.
They’re dead now.
Their boyfriends each on different weeks came in and told me the same story.
“We got high together and overdosed.  I woke up but she didn’t”.
They were sad but it hadn’t changed their own drug habit.  If anything they did more.  Running from the demons. Burying the pain.
“Sometimes you see the shadows out of the corner of your eye,’ the older guys tell me.
I talk about higher power and participation.  I repeat till the cows come home that it’s a disease of relationship and that they have to find a way to associate with people that don’t use.  I hand out pamphlets and point them to all the different groups and services that we have.  The government pays for drug and alcohol counsellors but it’s like getting adolescent boys out of gangs, one on one care doesn’t work. They need a new group, a new club, a new association.  Their religion is addiction. They see their drug as god and their dealer as their priest.  It’s high ritual.  The language doesn't tell you that but it's there as bold as the body bags.
I ask him if he’s stopped using.
“Not yet. “ he says telling me about the great feeling saving a life gives him with his free narcan kits.  I think of it as band aids.  It’s like a lone medic in Afghanistan. Every life counts.  Don Quixote charges another wind mill.  There has to be a Dulcinea.
I expect the feminists would call me chauvinist because I remember those two women more than the half dozen more young men I’ve known who are just as dead in these last few months.  It’s wrong to even speak of gender. Freedom of speech is dying as quickly as youth.  It's only okay to speak of what we're told to speak.  Designated truth or fake news.  More illusion of choice. There are so many divisions today.  I worry I’ll offend someone even by asking them to live. The Prime Minister is proud of his new physician assisted suicide programs.  They’re opening more and more needle injection sites with dilaudid and some are even giving free heroin.
They once assisted the Tong, Euro Gangs and Hell’s Angels who brought in the Heroin profiting by the government taking care of providing drug clubs, keeping their business alive with safe injection sites  and carrying all the costs of bad drugs.  Now they’re actually going toe to toe with pharmaceutical grade product versus the ‘shit they call down’, the gangs provide.
“It’s not heroin anymore.  It’s not been for a long time. Synthetic shit. That’s why the fentanyl is attractive. Cheaper and it does the trick better.” he said.
The uppers go with the downers.  Jib, or crystal meth is everywhere as well. Not as much crack smoking as doing jib these days.  There’s a lot of doing jib then heroin to get to sleep and then getting onto straight heroin and maybe cigarettes or pot. After the drugs get happening big time the alcohol which may or may not have been there in the beginning becomes less important.  Some say drugs account for 80 or 90% of the material theft.  The insurance companies are not suffering.
Legalization which is what our Prime Minister was pushing means that a drug could be sold in a school candy machine. If it’s legal, it’s legal. Like mother’s milk.
Decriminalization is accepting the disease model and treating the whole matter not as a moral issue but rather as an epidemic.  Harm Reduction, really palliative care, a term with a marketing twist came out of the cancer treatment and then the Aids Epidemic.
Harm reduction may not be that good for the individual. Individuals do best if they get into AA or NA , treatment, recovery houses or join a church.  When they look at people 20 years abstinent individually they mostly work,  belong to spiritual organizations and have replaced their previous habit with community participation and love.  Love of God, love of family, love of fellow man and woman.  Drug addiction is at best mental masturbation.
The Harm Reduction is good public health and ultimately may be preventative as the profit in drug sales moves into the public purse. It’s hard to say if there’s any less gambling today but the government gets the money rather than the Mafia.  Now one then wonders what’s the difference between public sector crime and private sector crime.
But I’m a medic in D Day and the enemy in this case, the drug dealers, they don’t provide medics for their ‘side’.  I still think I'm on the good side. I just don't know some days if I'm doing righteous work or enabling.  There’s a whole lot of other types of medicine I could do.  But I’m down here in the DTES with more and more young people. When I began in the 80's working in a detox the clientele was mostly in their 50's.  Not a lot of really old people in this work.  Living past 60 not so common here as in the suburbs.
My patient is going off with his buddy to look for more bodies in back alleys in hope he can revive them.
I’m just doing what doctors do, pushing life, where the profit always seems to be more in pushing death.

Addiction Dialogues, Hillcrest Community Centre

The Hillcrest Community Centre host for the evening was very helpful and organized.  We had a large room upstairs  away from the busy but healthy pool and gym activities below.  We began as people were still coming in till it was finally a full house.
David Berner, radio host, actor, founder of X-Kalay Foundation for addiction, author of the recent book, All the Way home and group therapist at Orchard Treatment Centre on Bowen Island, was the moderator extraordinaire for the event.
Opening the panel was Counsellor Candace Plattor, author of Loving an Addict, Loving Yourself.  She spoke mostly to the effect of addiction on family and community. She described solutions for treatment incorporating choice and choices individual and family needed to make to avoid enabling.
Brenda Plante, Executive Director of Turning Point Recovery Society , spoke to the incredible success of their recovery home programs over that last 30 years. Brenda Plante is a household name in the recovery community of Vancouver for her big hearted, thoughtful but well managed programs. She has support from communities, neighbours, clients, governments, RCMP and all the doctors and counsellors working in addiction.   Already with houses in Richmond she's  just opened their newest house for women in North Vancouver.  She spoke of the program and the need for addicts to be reintegrated into life. Addiction is so isolating. It takes everything away. She encourages  people to become involved in groups,  clubs and various activities as part of their process of abstinence and recovery.
(I already have half a table of  tickets to the Turning Point's annual Gala. This year  Mathew Perry of the show "Friends"  is the keynote speaker.)
I, a physician, psychiatrist and addiction medicine specialist,  sat next to Brenda,  proud to be among such greats of the recovery community. I spoke mostly to the medical and psychiatric aspects of addiction, talking about genetics, liver, damage, lung damage, cancers caused, HIV and Hep C spread,  neurochemistry, harm reduction and medications, only being valid as they lead to abstinence and recovery. The 'cure' for addiction is abstinence.  (I did express my concern that there is a ‘customer’ model developing in the ‘harm reduction’ arena, with  conflict of interest, lack of faith and cynicism with increasingly two tiers of treatment, abstinence for the rich and educated and  harm reduction for the poor and less informed.  I spoke to the tremendous success of smoking cessation and how only 20 years ago this room might well have been filled with smokers and their accompanying clouds.  No better example could attest to the success of recovery. What is possible for cigarettes is equally possible for other drug addiction and alcoholism.  I mentioned Sabet's definitive book, Reefer Saniety, on the myths associated with marijuana.
AnnMarie McCullough began the first Recovery Day in Vancouver Canada. Now it’s spread throughout the provinces  so that it’s likely to be a national day perhaps as soon as  this year or next.  She also began Faces and Voices of Recovery while working at Orchard Treatment Centre. She spoke to the millions who are in recovery and the significance of their vote and political power. She was glad that the Health Minister, Terry Lake, provincially and Health Minister, Tony Clement, federally were so supportive of recovery. She encouraged everyone to speak to MP's and MLA’s and get involved like they were this evening, increasing  community awareness of the disease and need for treatment.  She spoke to the success of 12 step programs, other group therapies, treatment centres and recovery houses.
David shared a letter he’d received recently from a man, 35 years, clean and sober from drugs and alcohol, thanking him for believing in him in the days of  X-Kalay.
The audience participation began their with questions and answers.  Members from the Portland Society used this time to speak of  their controversial  provision of  alcohol for alcoholic and crack pipes for crack addicts. This lead to some interesting discussion.
A school teacher expressed his concern for the need for adolescent services.  Brenda Plante and Ann Marie spoke of the acute shortage of beds and other resources for adolescents.   Last Door Treatment Centre had however just opened some more  The need for adolescent services was a major concern to the audience.  I shared how Dr. Shimi Kang, an adolescent addiction psychiatrist was doing truly amazing work in the field.  (Our host  later told me he knew her and her husband personally and what a wonderful caring people they were.)
A tall man shared sadly how many friends of his had been killed by addiction. He spoke of Canadian solders who’d survived tours in Afghanistan only to come home to die in the clutches of drug addiction. He was very angry with  criminals invading every aspect of Canadian society with their "drug terrorism".
I couldn’t help remember  Sturges North motorcycle rally hearing  the great Canadian rock and roll band, Steppenwolf, singing their classic song, Goddam the Pusherman! I say, Goddam the Pusherman!
David thanked everyone for coming then individually we answered questions  speaking with people who told such tragic  stories of family members and friends  devastated by the disease of addiction.  A lovely woman was caring for the small children of her brother and wanted to know how to speak to the absences of addicted parents.
We were thanked all round.  Further Addiction Dialogues are planned.

Chronic Relapsers Misinformation

These are some rough estimates and truisms.. 10 % of people will have problems with an illicit substance. A proportion of those who avoid problems ‘spontaneously’ quit.  The earlier one quits substance abuse, the greater the success rate. Drugs and alcohol and other addictions are ‘fun’, ‘fun and trouble’ and finally just plain “trouble’.
Abstinence is the most successful ‘treatment’ for addiction. The WHO advocates that all harm reduction approaches should only serve as stepping stones to abstinence. There have been countless horror stories associated with ‘controlled drinking’ and clearly to date there are no good stories of ‘controlled crack’ use. The whole ‘control’ movement is as historic as ‘just say no’.
In studies of those who do ‘abstinence based’ therapies up to 80% achieve 5 year or more recovery. Dr. Marc Gallanter’s Harvard studies of doctors in recovery in AA shows 80% recovery up to 50 years after the last drink, decades of abstinence.  I personally know hundreds of people who once had severe addictions that cost them health, jobs and relationships but today are decades drug or alcohol free with successful careers and relationships.  Most of them are members of 12 step programs or churches.  Indeed addiction is described as a ‘spiritual disease’ by some and ‘cancer of the brain' by others.
The first ‘remission’ marker is one year.  The DSMV considers a person in full remission with a year of abstinence.  Most others including Dr. Vaillant of Harvard saw that the disease effects were significantly present for 5 years of abstinence when finally  a person potential for relapse was no greater than an as yet unidentified person’s risk of developing addiction.
In a famous Montreal study, 50% of those who returned to drinking, were able to avoid returning to their previous level of drinking, somehow maintaining ‘harm reduction’ without descending into their former abyss.  Interestingly a Holland study showed that people abstinent for 15 years who returned to drinking, 70% were able to maintain ‘harm reduction’.  While one in two odds of redeveloping a life threatening illness aren’t actually encouraging, and even a 30% chance of devolution at 15 years doesn’t look bright, this does suggest that the original disease appears to ‘burn out’ with abstinence over years.  The modern research on neuroplasticity and adaptation certainly takes into consideration the increasing information of the effects of ‘intoxication’ on the brain.  All research to date shows that those who achieve abstinence have the best life course, physical and mental health.
Note the word ‘toxic’ in intoxication. Addiction is associated with altered consciousness, dissociation and impaired mental capacity, the effects of which can last hours or days or , with marijuana for instance, weeks after the chemical brain trauma.  By contrast with alcohol, where there is social drinking where a person does not drink to toxicity (1-2 drinks)  with drug addiction, all drugs are used for the ‘effect’ :’chemical drunkeness”, “getting high”, ‘being stoned’.  People drank as a beverage whereas drug abuse is done to achieve 'toxicity'. Drug abuse alters consciousness. It impairs brain functioning. Enhancement of one function is countered by loss of other capacities as with drunkeness.
Addiction is like slavery.  A person is freed by abstinence but with relapse return to their slavery with the attendant lack of hope, lack of faith in their ability to get free, increased cynicism about their potential but more significantly increased negativity about ‘freedom’ itself despite the high success of those around them.  Their relapse and the associated depression that is usually concomitant in time is associated with severe 'cognitive distortions'.
Fruitflies were the great genetic tool of genetic research since they shared 70% of human DNA and had short life expectancy. Thanks to the overwhelming success and the extraordinary numbers involved in the recovery from cigarettes, Cigarette addiction and recovery have taught us as much about ‘addiction recovery’ in general as fruit flies taught us about human genome.
When people relapse they have already progressed through the Motivational stages of Prochaska from Precontemplation, Contemplation, Determination and into Action.  Unfortunately ‘relapse’ commonly throws a person back from the Action phase to the pre contemplation phase for a period of time.
In this phase they tend to be extremely negative and blame the treatment failure on a variety of usually inconsequential or irrelevant factors.  Rarely will they early acknowledge that they were no longer following a program.  Relapse is the outward manifestation of the 'thinking disease'  which is the precursor to actual substance abuse.  Mostly people begin by minimalizing their own previous difficulties with alcohol or drugs, begin to grandiosely believe that things will be 'different' this time round and delude themselves into believing that they can 'control' their drinking or drug use despite no personal evidence of their being able to maintain this in the past.
One of the prime criticisms of Alcoholics Anonymous was ironically the ‘god’ issue.  Addicts worship their alcohol and substance, living a ritualistic religion surrounding their death bound existence.  However in research with obese people, 12 step programs weren’t initially recommended but rather it was suggested that the grossly obese go to the gym. In contrast to alcoholics and addicts who are highly adept at ‘excuse making’ (the disease of alcoholism being personified as ‘cunning, baffling and powerful) the food addict, those grossly abese, simply said, “I don’t want to go to the gym’.  When advised to go to Overeaters Anonynous, they never mentioned the 'god problem's but  simply said “I don’t want to go out”.  It's refreshing to work with obese people in that they don't tend to waste their 'energy'  on 'excuses' despite their equivalent difficulties with stopping their compulsive food use.  At best they'll tell you they have a 'metabolic' problem.
It has long been known that alcoholics and addicts will go anywhere for a drink or drug and never complained about crosses in the room or pictures of the queen or president as long as their drug of choice was available there.  In the ‘contemplation’ phase of motivation they would complain about the colour of the paint if it convinced people they personally were the exception to the rule that recovery is good. The fact is, a person who has relapsed, has lost hope in themselves.
Psychiatrists long ago knew that with those who were ‘suicidal’ and had similarly lost hope in life, especially the chronically suicidal, needed the psychiatrist to ‘lend them their ego’.  We make decisions that suicide is not good for a person.  Similiarly those working in recovery who are successful maintain the idea that recovery is good for a person, much like thinking oxygen is.  Those who don’t, have been found to be associated with a very poor outcome measures as we saw with those who had a poor view of the suicidal. Outwardly the caregiver could go through the motions but at the covert and passive aggression level they were and are best recognized by their high death rates.
Much of the push for ‘harm reduction’ has been associated with a similar phenomena. The caregivers and those who promote harm reduction most are often ‘burnt out’ or always had a very negative view about the addicts and alcoholics.  One psychologist described this as 'caregivers and victims'.
It's even worse when those promoting harm reduction have an obvious 'conflict of interest'.
A recent Welsh study showed that Harm Reduction proponent counsellors  gave the success rate for recovery of their charges at less than 20% , but when these same people were in ‘abstinence’ based programs they achieved greater than 60% success.
This separation between those caregivers with hope and those without was also shown in cancer treatment.
Palliative Care is a program developed first for cancer therapy where the person’s disease was so severe and all alternatives for cure were tried without success and no successful treatment was known for the type of cancer the person had.  Palliative care is compassionate but it would not be if it was offered as a first choice or 'alternative therapy'.
Lack of success is not the case in addiction therapy.  Alcoholics anonymous has an 80% success rate 5 year and decades beyond but the ‘program’ is like the ‘birth control pill’.  If one takes the birth control pill once it is highly likely to fail.  This is the reason research did not identify the factors of high success in AA. Researchers simply asked people if they’d been to AA or NA. It’s common for people to go and not return, like those who asked if they used the condom for birth control might say they had but leave out that they’d only used it once in their life, and not the year they got pregnant.  The Navy Pilot program showed that 5 year 80% success with AA required a minimum of 3 meetings a week. The recent Scottish study which confirmed the 80% success rate included ‘home group’ and 3 meet ings and having a sponsor for instance to indicate ‘actual involvement’. As one person commented, a lot of people attend basketball games but you're more likely to find out how basketball is actually played and become good at the game yourself if you join the folk down on the court with the ball, rather than talking with drunk in the bleachers.
Relapse was associated with:
1) stopping or  reducing frequency of meetings. I often think this isn't different from any form of education since I meet people who despite having gone to university haven't read a book since and seem a hell of a lot stupider than people without a university degree continued studies.  With HIV treatment we need people to continue to take medication or they will die. We don't question the validity of the life saving 'medications' because people are 'noncompliant'.  We work on improving follow up and compliance but we are most impressed with our 'success' in developing treatments for HIV and Aids when at first there were no treatments. Since the 1930's we've made major strides in developing successful treatments for addiction and recovery.  Commonly people's lives are enriched in recovery and complacency returns.  Then stress occurs.  That's when all the 'tools of recovery' are thrown out.  I personally love the Dr. Martin Luther King quotation. "it's going to be a tough day so I have to spend more time on my knees".  When people have more stress, activity, change or success in their lives they usually need more 'recovery' activities, not less.
 2) Returning to previous association with drug abusers.  Recovery has been shown to be as “contagious’ as addiction. Having one abstinent friend in ones friendship circle reduces the chance of relapse by 25%.  People who relapse commonly begin to associate again with 'slippery people, places or things'.  Dr. Bob and Bill Wilson recognized that alcohol was ubiquitous in their society so said that recovery had to occur in the community. However it was also true they didn't recommend people avoid people in recovery and spend their nights in 'speakeasies'. In treatment today people are advised to avoid crack houses, dealers, and especially paraphernalia, as we know that 'jonesing' something not seen so much with alcoholism, but common in cocaine addiction does occur for up to a year after abstinence.  This phenomena is like we see with PTSD and the 'trauma' of addiction and the associated lifestyle. People with addiction today are often starting their addictive lifestyles earlier and have a world of hurt by the time they get into recovery with much less life experience, education or positive communities to fall back on.  
3) Commonly people recover from addiction but then have ‘expectations’ which are highly unrealistic.  Expectations have been called ‘preformed resentments’ and while AA and NA and other recovery programs treat the disease of addiction they specifically describe the need for members to get outside help with other issues.  These issues commonly include financial management advise, job advise and job training,  relationship counselling, pastoral care, anger management and a wide range of ‘maturity’ issues which are not achieved by addicts whose addiction stunts emotional, intellectual and social growth.  A person who has been hanging out with ‘potheads’ may stop their addiction but it takes time to develop a strong and positive friendship network , the kind that gives meritorious advice that makes life in general more successful and rich.  Increasingly the isolation of addiction is associated with the isolation of the internet following the positive experience of recovery in treatment.  Internet addiction then leads back to chemical addiction.
4) Attending a treatment centre may help establish abstinence and break the slavery to addiction but commonly just as with education there is a need for more advanced treatment education. Some treatment facilities like Betty Ford have programs for continuing education and also are set up for return of ‘sober’ or ‘abstinent’ members to work on more advanced issues like ‘emotional sobriety’.
5) Commonly ‘cross addiction’ leads to relapse. This is especially true with sex and gambling addictions which then lead to a return to chemical addictions.

It is critical to recognize that the ‘excuses’ that addicts and alcoholics give for relapse are usually time and ‘disease’ specific.  I’ve asked people who achieved abstinence after several initial failures what was the key. Almost invariably  I have heard that they really didn’t want to stop their addiction but had only planned to stop for a while to get somebody off their back. It's hard to accept having a lifelong disorder. I see the same difficulties with diabetics. No one questions the benefit of 'insulin' but all those who treat adolescent diabetics have seen the same problems we see addicts have coming to terms with the limitations of disease and the need to learn new methods of self care.
Often people in recovery get success but then the ‘boredom’ of everyday living lacks the ‘drama’ of the previous chaotic lifestyle and they solve the ‘little problem’ by creating a ‘big’ problem. Anyone who has 'worked on long term relationships' knows how the 'little things' if not addressed can grow into bigger things.  So often over time the 'little resentments' and 'lack of honesty' and 'living a lie' grow to a point where they taint the good life and recovery and relapse follows.  Recovery isn't a white knuckle affair but a lifestyle which is 'happy, joyous and free' because life is to be 'lived' not merely endured. This has been called 'emotional sobriety' and 'spiritual awakening'. It was always recognized that people who drank or did drugs has an 'underlying' predisposition or greater level of anxiety or sensitivity and had to learn new coping mechanisms for fulfillment.  When a person becomes an addict it is 'normal' for them to drink, drug or abuse. It is not 'normal' to be abstinent for an addict or alcoholic. To be abstinent requires them to daily live a life which promotes well being beyond that available by their previous lifestyle which 'lead' to addiction.

The ‘treatments for addiction’ are to date superior than most of the treatments for physical illness when they are applied and managed as recommended.  The problem which occurs with addiction is the same as doctors are finding with all the chronic diseases or diseases of lifestyle.  Indeed the treatment of chronic disease is increasingly learning from the successes first seen in addiction. The advances brought forward by 12 step programs are actually being translated to ‘accountability’ groups and used in the "normal' work place.
AA and NA introduced the concept of ‘anonymity’ as a ‘spiritual foundation’. They didn’t want people to speak of their personal success at a time when people’s relapse caused people to question the success of prevention and abstinence treatments.  Today there is overwhelming evidence of success of prevention and addiction treatment but increasingly vocal chronic relapser misinformation.
We used to hear “I stopped smoking but I didn’t feel any better’ in the first weeks of people quitting smoking.  They then used this ‘excuse’ to continue smoking.  However, now, with millions having lasted that first year of recovery we hear endless numbers of former smokers saying what a relief it is to them to be no longer be a slave to cigarettes. This is true of 80% of those who maintain abstinence from substances for five years.  Then those who relapse stand a very good chance of achieving long lasting recovery with appropriate treatment and relapse prevention programs developed for the individual relapser.

I liken this in my work to people with bladder infections. The vast majority get better with one antibiotic. A number relapse and the the antibiotic works again but there are those who need a different antibiotic and even those who we simply find it best to keep on antibiotics indefinitely.
The one week detox program has now had the 28 day program and there are recovery treatment programs which last 2 years. This was the same with mental illness where patients with similar psychosis were unsafe for themselves or others even with 1 week, one month or 3 months programs and they benefitted for a year long recovery in asylums.
All of these approaches standard in the scientific medical treatments are the same as we use with great success in the treatment of addictions.
Part of the success in treatment of mental illness was the recognition that substance abuse, like marijuana, alcoholism or harder drugs were all interfering with the learning and recovery process from mental illness. When I reviewed the suicide completion statistics in one program I found that though there were many who were at one time suicidal it was almost only those who had addictions
that completed suicide.

I’m commonly asked to see people suffering from depression or anxiety and almost all the time the family physician and especially the parents,( especially the mothers) , rarely know how severe the patients addiction to alcohol or marijuania, crack, methamphteamine or heroin is.  The patients tell me because I ask very directly and am highly trained in recognizing the signs of dissimulation that the alcoholic or addicts uses to ‘guard’ their ‘secret’.  
Relapse is treatable but the best solutions to treating relapse are to be found from those who once were ‘chronic relapsers’ and succeeded. I liken this obvious reality to our collective human experience with climbing Mount Everest. For centuries people ‘failed’ and we learned ‘how to fail’ from the ‘failures’ and eventually when people climbed ‘Mount Everest’ we learned how ‘best to climb Mount Everest from those who "succeeded."

Today the ‘harm reduction’ groups are arguing not only that Mount Everest can’t be climbed but that we should listen to people who either have never seen a mountain or may never have got to a base camp.

Addiction Dialogues, West Vancouver

I was honored to be asked by David Berner to be apart of Addiction Dialogues.   A panel discussion would allow the community to discuss and answer the concerns of homeowners, citizens, parents, employers and others interested in what addiction is and what can be done about it at an individual, family, work and community level.
David Berner, Executive Director of the Drug Prevention Network of Canada, had founded the first residential treatment centre which began in Vancouver British Columbia as the X -Kalay foundation and continued in Manitoba with Jean Doucha and the Behavioural Health Foundation.   His recently published book, All the Way Home, tells of those early years. Today as well as being an endless crusader for truth and proponent of living life to its fullest, as a weekly talk show host  and addiction counsellor, he helped co found the first Recovery Day in Vancouver.
AnnMarie McCullough started the Faces and Voices of Recovery and began the first Recovery Day in Vancouver which now occurs nationwide.  She also leads work at Orchard Treatment Center.  She was radiant sitting beside me, her inherent beauty even more so, since her recent engagement announcement.
Lorinda Strang, Executive Director the the Orchard Treatment Centre sat next to me. Her experience and work in the field is especially well known to the community of West Vancouver where she raised her family.  Wealthy communities such as West Vancouver are preyed on by drug dealers, their children at greatest risk.  
Candace Plattor, Registered Clinical Counsellor, and author of Loving an Addict, Loving Yourself, completed our panel.
As moderator, David Berner opened by asking us all what we thought addiction was.
Candace spoke mostly to it’s impact on family and relationships as well as stealing the life from the individual.  In her work she as often cares for family members who find themselves pulled into the desperate chaos of those addicted to a variety of chemicals as well as the process addictions, like sex, internet, eating disorders, gambling.
Lorinda Strang spoke to the total destruction of the person’s life purpose and the loss of all their interests and relationships and their failures in their relationships and the workplace.  She described how positive it was that businesses and families were recognizing addiction earlier and getting these members to treatment centres such as Orchard earlier when successes were most assured. She described the denial process and the abhorrent thinking, the rationalizations that ‘explained away’ all manner of loss and failure but never addressed the addiction itself. She talked of the wasted lives she saw daily in their work, people arriving like zombies and becoming human again in their relationships with other, lives restored with hope and joy and purpose.  She spoke of detox as only a first phase but the next months made easier in a treatment centre but then the life long need for awareness. The disease of addiction is a waxing and waning  condition from which one may recover, as evidenced by the millions that have,  but still they carry the risk for relapse.
I spoke to the neurochemical evidence of disease, the  genetic evidence, the twin studies, fMRI data, the hijacked dissociative thinking likened to a computer virus or cancer so that a person begins to ‘worship’ and ‘serve ultimately as a slave’ their God of addiction despite ‘negative consequences’ such as health problems,  failure in school, athletics, loss of important relationships and inability to maintain or manage work at previous level.  Whereas I tended to quote studies and research and stats, boringly, impressed myself by the science, the others tended more to tell personal stories, speak of clients, their families, friends and lovers and the communities they knew.
AnnaMarie McCullough spoke to the negative effects on the individual and the community. She spoke to the stigma associated with the disease and the isolation the individual experiences and the road back to community which comes in the recovery.  She expressed concern about the ‘enabling’ individual and community services which were in as much denial as the individual with the disease of addiction. She spoke of Recovery Day’s function in increasing awareness and helping individuals and their communities see just how successful recovery is and how beneficial it was for the community.  She especially emphasized the joy that recovery restored and the love that people felt after often years of being desperately hiding and lying about their disease.
David Berner spoke to the grief and tragedy of the individuals who turned to addictions as their only solace and how this immediate relief then turned around and hurt them more and more as time went on.  He spoke to these individuals not wanting to be addicts, their mothers and fathers and brothers and sisters. He spoke to their being sick and the horrible lives they so often endured before  they became addicts. He spoke to the child who was physically and sexually abused and developed an addiction as a teen. More and more he said his concern was for the children who were turning to addictions and becoming horribly addicted because of the high risk teen agers have for addiction to marijuana, alcohol, cocaine, and all the process addiction. He said more and more the people he was seeing had not known any normal life having so often left homes and schools to follow their addictions.  He spoke eloquently for the tragedy of the addicted, their families, the loss to individuals and families. There is so much grief, he said.  He was sad that so many young addicts had lost the capacity to work and how much work had meant in his life, how addiction took away purpose from individuals he saw and yet how much joy he'd had himself having purpose in life and working to complete what he set out to do.
When the subject turned to treatment each individual spoke to the hope and the scientifically proven successes of a variety of treatments, the high success of 12 step programs and abstinence, the benefits of treatment centres and recovery houses, the amazing successes of the drug courts, the usefulness of urine testing and variety of medications and services that were of proven benefit.
Candace spoke of the benefits of the therapy to family members and how even when an addict didn’t respond family could learned to protect themselves from the consequences of the addictions and be prepared to help when they could.  She described her work of recovery with loved ones and how as they learned to take care of themselves the addicted one often came round.
Lorinda Strang talked  of the countless successes that she had seen in her 20 plus years working in Addictions and the work of the Orchard Treatment Center on Bowen Island. She described her anxieties raising her children in West Vancouver, the difficulties that wealthy communities faced when it came to addiction and what could be done for the community and the children.  Living in this community she had seen the success of recovery and still continued in contact with people who once were thought to be untreatable but had recovered and gone on to be shakers and makers of society.
I spoke of the need to treat addiction and mental illness, as a dual diagnosis.  Yes it was common for those who abused alcohol to be anxious and depressed (alcohol is a depressant - 2 drinks on occasion, beneficial, 3 or more drinks toxic)  No treatment of only the anxiety and depression was  going to improve the addiction. Freud said addicts and alcoholics were untreatable and Dr. Carl Jung said only a miracle would work.  Because addiction is a brain disease the thinking of the addict is diseased so one had to treat the addiction first then it was possible to address whatever mental illness was underlying. All the attempts at treating the ‘underlying’ conditions first were proven repeatedly to lead to failure in the majority of people, but especially children and teen agers.  It was like trying to stop the bleeding being made by slashing without taking the knife out of the persons hand.  Hence the dual diagnosis and concurrent treatment programs that focussed first on the addiction then as safety and stabilization was achieved more and more secondary treatment of the mental illness was incorporated into the overall treatment plan.
I said that the success of all addiction treatment was evident in the amazing society success of the anti smoking campaigns.  Being of an age when all such community meetings were in a 'cloud of tobacco' smoke one didn't even have to think of the actual incredible reduction in cigarette smoking in society.  The loss of adult sales had caused the evil tobacco empire to directly target children in their marketing campagns so to my mind, we'd stopped short not arresting the CEO”s of Tobacco Companies.
These were the people who were now looking to make even more money selling misery to the young  by offering their ‘marijuana smoke’ or maybe even a ‘lighter cigarette, one half tobacco and half marijuana’ . As Amsterdam and Holland have moved their BC Bud products into the most restricted drug category, the same as Heroin and Cocaine, these big business forces were pushing for legalization of marijuana so they could get greater access to the teen and children ‘customers’ .  All the abuse of drugs including heroin and cocaine, except marijuana, had been falling as a result of education and recovery but now big business was targeting the young with marijuana.
No smoke is ‘safe’ and all evidence points to the the extensive health costs of all smoke (tobacco, marijuana, cocaine) yet these same corporate individuals who profited from tobacco smoke are now funding the marketing behind the ‘legalization’ of another ‘smoke’.
(I think I got a little upset at this point and told of the three young men I’d seen last year who’d developed schizophrenia after smoking BC Bud, and spoke of my scotty dog being murdered by the drug dealers who objected to my refusal to lie about their positive urine tests when they wanted to get “safety sensitive’ jobs where the other workers there didn’t want cheech and chong ‘pot smokers’ in their midst because they caused so many workplace deaths and accidents’)
David Berner kept the topic on track and opened the floor to comments from the audience. One amazing young man spoke eloquently of his experience with addiction and recovery and seeing so many of his friend damaged by drugs and then those like himself who got clean and sober getting back to school like he did, getting work and having great lives compared to their previous lives.
The audience asked great questions.  Someone talked of Gabor Mate’s book, Hungry Ghosts and how it helped them understand the trauma of addiction. Asked about the use of hallucinogens to treat addiction, I pointed to the possibility of a ‘sexy’ treatment helping one individual in a thousand but that we’d seen such ‘sexy’ cancer cures come out of Mexico with false promise only to have people spend their life savings on these 1 in 1000 remedies and then die when they could have taken a safe and proven treatment.  
I commented on the local work and research of Dr. Ray Baker, who started the first Canadian addiction education program for medical students . Working in Occupational Medicine he speaks to the high success of addiction treatments, in the 80% range, when the disease is caught early enough that the person still has a job or is  in school and has supportive family.   Dr. Baker still shows that in those who are at the end stages of the disease, physical illness, unable to work, isolated, that the success that present day addiction treatments with modern approaches, 12 step programs, treatment centres and recovery centres is still greater than the rest of our medical colleagues treating end stage diseases like tuberculosis or diabetes.
There were excellent questions about the lack of government funding, specifically for adolesenct treatment facilities.  AnnMarie McCullough and Lorinda Strang spoke of the poor histories of past governments in their waking up to the epidemic of addiction but that increasingly the government has been on board with helping but still had to come to a better understanding. David Berner spoke of his meeting this week with the British Columbia Minister of Health, Terry Lake.  “Terry Lake was very concerned about addiction in the community, especially it’s affect on adolescents”.  The BC Liberals were invested in addressing the need for increased treatment.  An example was the support the new Turning Point Recovery House in West Vancouver had received from local and provincial government.
I answered the questions about changes in methadone ‘delivery’ policies stating that the primary concern of the College of Physicians and Surgeons of British Columbia was the safety of the citizens of BC.  The greatest concern of the College of Physician and Surgeons is the ‘diversion’ of methadone and the risk diverted methadone would pose for an adolescent or child.  The concern for that ‘risk’ was the basis of the review of the present day ‘delivery’ policies because some pharmacists had not been able to ensure the level of safety that the College of Physicians and Surgeons and their sister organization the College of Pharmacists require for the Methadone Program to run.
Regarding the question of Harm Reduction versus Abstinence I pointed out that the World Health Organization position was that all harm reduction program were only valid so far as they worked towards abstinence.  Controlled drinking had been a failure and as David Berner pointed out Mothers Against Drunk Drivers had done amazing work to ensure that judges, especially  remembered the danger that addicted persons posed to the community and didn’t just listen to the major alcohol  producer and sales lobby.
There was question too about some of the  more controversial local Harm Reduction programs. I quoted the Welsh study that showed that the lack of faith and hope of some counsellors for the recovery of their members was often far far less that the scientific evidence of success of the individuals themselves. In the Welsh study the ‘harm reduction’ counsellors had commonly given their ‘clients’ an under 10% or  30% likelihood of success when the follow up studies showed that 60% of these individuals a gained and maintained abstinence.  Dr. Marc Gallanter of Harvard showed that 80% of doctors maintained long term recovery in Alcolics Anonymous and Narcotics Anonymous many being 30, 40 and 50 years abstinent in his research.  I expressed the concern locally that no judge or doctor with addiction would be advised to accept a “harm reduction’ program whereas often that’s all my poor patients were being advised to take.  This white collar and blue collar approach to treatment was simply wrong.  Further when I talked to some of the harm reduction proponents they were really saying there was no 'hope' for their 'customers' and that they should be just given 'palliative care' (i.e. comfort, since no cure was available).  I found myself thinking of some of the people I'd met who had promoted 'euthanasia' for all mentally ill patients. I was so thankful that the Welsh study showed how wrong these individuals usually were.
Everyone loved Candace' concern for family and friends of addicts;  Lorinda’s experience and expertise helping individuals and family, the world renowned fine work of the Orchard Treatment Centre, AnnMarie McCullough’s passion for community and recovery and David Berners great sense of humour and skill as a public speaker and moderator.
I was just thankful to be apart of something very good  and be there for those special moments when David, AnnMarie, Lorinda and Candace’s words touched my very soul. The people who were present wanted the very best for their community as their presence, attention and questions showed.  I really admired them most