Category Archives: Harm Reduction

High Sobriety – a new treatment paradigm

Image courtesy of Zuzuan at FreeDigitalPhotos.net

Image courtesy of Zuzuan at FreeDigitalPhotos.net

Marijuanna has been in the news a lot lately, more and more states are legalizing the sale of it. Research is showing that medical marijuanna can have some real benefits in treating lots of conditions.
A lot of people in recovery from addiction feel a little nervous around this subject. After all, for us, drugs are the enemy. For many of us, marijuana was the entry drug. It was our first step into the dark side of illegal drug use that took us to stronger, harder more addictive substances. I had a very bad reaction to smoking pot it induced anxiety and paranoia. So I’m very clear it’s not something I can ever mess with.

So I was pretty shocked and intrigued to hear about how marijuana can as an ‘exit drug’, or to be clear, medical marijuana as a treatment for substance abuse?

Well that is just what harm minimization clinic ‘High Sobriety’ is proposing.

It’s a lot for people to get their heads around. I’ve had my struggles with the harm minimization model but I do believe it is a very necessary way we can save lives. I am skeptical when we fund things like needle exchanges (which is a good harm reduction measure, if part of wider treatment options) but we also need to fund other treatment options, so that people can move down the spectrum, to not just surviving, but thriving also.
I wanted to ask my friend and colleague Joe Schrank some questions about the new clinic. Not only does he provide some really interesting insight into medical marijuana he also raises some interesting questions about the treatment industry as a whole. Please read what he has to say and let me know your thoughts.

Joe Schrank - recovery warrior

Joe Schrank – recovery warrior


Joe, so I see you are involved in a treatment program that is based in the harm minimization model rather than the abstinence one? Can you tell me more?

At the moment my sole focus is in developing, High Sobriety, the harm reduction program. I’m not looking to disparage abstinence based programs of give the impression that harm reduction is better or the solution. The truth is, we use harm reduction all the time, motorcycle helmets, condoms, there is nothing new about it. My aim is to expand the points of entry for some people. For many, the idea of “nothing ever again” is just too daunting and while I personally am intoxication free, like Pope Francis, who am I to judge?

That sounds very interesting. I used to work in harm minimization in the UK, but I’m curious why there seems to be very little of it in the USA. Why do you think that is and how do you think this new paradigm will be received?

There are certain things Americans don’t like. Harm reduction is one of them. In spite of overwhelming evidence of the benefits of safe injection rooms, there aren’t any in America.
Our relationship with drugs has a long and torrid history and we have been stuck in the morass of criminalization. As much as we hear “addiction is a disease” Americans don’t believe that. We aren’t what we say, we are what we do and what we do is shame addiction, marginalize people inflicted with it, we set them up for failure and worst of all, we out them in cages. There will be a day when we look at our drug policy with as much shame and regret as we now view Manzanar. For Americans relationship with drugs to improve we need truth and then reconciliation.
The first truth is that criminalizing addiction makes no more sense then criminalizing diabetes. We need to understand that drug policy needs massive reform. Part of that reform would have to be the expansion of how people enter a system of improvement and how they stay engaged.
I think this will be received with a really strong reaction. People who have achieved total abstinence in a 12 step program hold that in the highest possible esteem. The premise is based on an act of providence. Harm reduction challenges that and that will always have a strong reaction. I think there are people who are very frustrated with rehab and how ineffective it is, they will be more open to the idea. For families who have lost someone to addiction, would they take them back if it meant they weren’t totally abstinent? Of course they would. There is a tremendous amount of pain and suffering out there because of the overdose catastrophe. I have lost someone very close to me to an overdose. I don’t carry guilt that we tried to force 12 step abstinence with him, but I carry regret that we didn’t give harm reduction a try.

You make some very good points and there are some hard truths in there. I definitely came from that hard-line view that abstinence is the only way, but I came to realize that I believed everyone should have the same recovery I did. I know realize that saving lives is far more important. I’m open to the idea of medical marijuana but still have some reservations. How does it work and what is the research saying?

Works like other rehab, research is solidly in favor of it as a possibility. Amanda Reiman, the Berkeley professor will address all research questions and we will post studies.

How is the abstinence based treatment community responding to High Sobriety?

They are hostile and vitriolic. Many of them who run 65k a month Malibu rehabs are lobbing “this is a money-making scheme” grenade. We are a for profit venture, like the $40 billion treatment business. We have a pro bono mission to take combat vets who want off pills and booze. I’m a socialist. If I get rich, it’ll be funding an orphanage in Kenya to bring boys to the west. I totally understand that people hold abstinence as near and dear. I have no agenda to change that. I keep saying “that’s why the TV comes with an off switch”. There is anecdotal and scholarly evidence that people can maintain cessation of lethal drugs with using cannabis as part of that effort.

The “give me abstinence or give me death” mantra is just wrong. If the current culture of abstinence that permeates so extensively is so effective, why are there so many families with a dead loved one? There are some people, mostly skilled, seasoned and trained clinicians who can say “that makes a lot of sense”. I think 12 step culture needs Vatican 2. Religions understand this. That’s why Jews have orthodox and reformed. That’s why Catholics are moving in that direction. There are certainly mass in Latin Opus Dei people and there are people in my parish that has a large gay congregation. 12 step culture has become the tea party of recovery: opposed to science, denying change, and longing for a culture that has passed. It’s very similar to people who are “opposed to gay marriage” ok, don’t marry anyone of your gender or “opposed to abortion” ok, don’t have one. The notion of imposing your way onto others doesn’t ever sit well with me. Read Langston Hughes “the more I live, the more I learn, dig and be dug in return”.

This is a really interesting conversation and really about so much more than medical marijuana, you are disrupting the market place so in many ways this is a normal reaction. You and I are both abstinent and I know 100% there is no other way for me. But I also accept that my way, is not the only way, and we are in the middle of this crisis where so many unnecessary lives are being lost.
Could you define what successful treatment looks like for your clients? And what happens when they leave?

What happens when they leave? They are beloved, they have said “you know, drugs are bad! Why didn’t I think of that?” And they become counselors. Just like on TV.
One of our goals here is to figure out what happens with solid outcome studies. My sense is Outcome studies are skewed to people doing well because people who have been to an AA indoctrination camp are afraid and ashamed to engage if they haven’t done this perfectly. My sense of what happens is life. Ebb flow, hurdles and victories, grief and loss the whole enchilada.

Please check out the High Sobriety website for more information on their research and goals.

A Look at Denmark’s Harm Reduction Measures

I’ve been thinking a lot about the drug policy now that we have a new President in the USA. Will his administration bring about a new and radical changes? Or will we continue with the pointless war on drugs and just poor more money into enforcement? Gradually things are changing in other countries, I am particularly interested in what’s happening in Portugal and Denmark.
The following is a guest post by: Alek S. Let me know what you think is the way forward?
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One of the greatest challenges that must be faced by modern society is the growth of addiction, and finding the best ways to fight it. Across the world, harmful wars on drugs have done little to stop the spread of addiction, and have only left more victims in their wake. These sorts of damaging and alienating policies are starting to vanish, thankfully, in many parts of the world. One particular country that is spearheading the paradigm shift of how we look at addiction recovery is Denmark, which has devoted itself to reforms of harm reduction, rather than rampant criminalization. Here’s how some of these measures have been working…

Usage of fix rooms

In 2012, the Danish government legalized the use of rooms for individuals to take harder drugs, such as heroin and cocaine, while under the medical supervision of a nurse. These are called fix rooms, while other countries have experimented with the use of fix rooms, such as Germany and Switzerland, none have done so to the extent the Denmark is trying to do so. The purpose of fix rooms is to bring addicts out of the fringes of society and get them in touch with medical professionals who can help them begin a path towards recovery. They also greatly reduce the number of overdoses experienced by addicts, as the environment where they are using is generally much safer than other options they had before.

Decriminalization

The key philosophy behind harm reduction is rooted in the belief that criminalization of illicit substances has proven to be futile. Although substances like heroin are still illegal, police officers have been ordered not to hassle addicts who are using fix rooms, and instead will focus their efforts towards shutting down drug distribution. Drug abuse is something that is not viewed as an issue for police officers in Denmark, and is more of a healthcare and social problem. Their focus will instead be on the actual market of drugs, itself.

Users unions

There is a tremendous amount of civil involvement in these harm reduction measures, as well. The biggest example of this is in users unions, such as the Danish Users Union, which was created with the purpose of changing how drug users are viewed in everyday society. When addicts feel they have nowhere to go, they often become alienated from the communities that can help them; frightened away by social stigmas. However, the Danish Users Union has made great progress towards showing how active users can still contribute to society, and offers a range of programs such as support groups, educational seminars, and hosts its own fix rooms.
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Challenges

These points are not to say that Denmark has become a utopia of drug policy. Plenty of research needs to be done to see how these policies will play out, and whether these measures will actually manifest into addicts achieving recovery. Many of the systems in Denmark are notedly confusing, and users have stated that they often don’t know their rights or how the fix rooms work. The system has been set up, but the kinks have not yet been ironed out.

Comparison to the United States

All of these policies stand in a very stark contrast with the United States, where criminalization, at the Federal level, is still very much the norm for dealing with drug addiction. The policies in the United States have served to dissociate addicts from the rest of society, which has created a divide that is hard to repair. Not only does this prevent people from getting help, but it has also played into the development of other crime through drug use (a phenomenon that is explored in this blog series here). The good news, however, is the trend is moving away from the failed War on Drugs, and is instead being regeared to focus on addiction recovery, and actually addressing the root of the problem.

Chasing the scream review Johann Hari – REVIEW

Chasing the scream is an insightful and thought provoking book on the origin and continuation of the drug war. This is a topic long over-due for discussion. Whilst we are pouring more and more resources into ending the ‘drug’ war’ has anyone stopped to ask if we are even winning? Is there an end in sight?

Ironically the drug war was born on the back on the failure of alcohol prohibition in the 1930’s. Once alcohol was made legal again several government departments realized they were out of business. Ignoring the entire medical and scientific establishment of the time, a small federal department was determined to outlaw all drugs in order to justify its existence. How it did this is illuminating and reveals the precarious foundations our drug war stands on. The push to make drugs, particularly marijuana, illegal occurred at the same time that the white establishment were getting nervous about the black population in the USA. ‘Chasing the scream’ makes it clear that by making marijuana illegal it would give the federal government and police a new mechanism to control and suppress the rights of it’s black citizens. This was the initial intent of outlawing marijuana.

The books real power is in exploring the effects of the drug laws on individuals. The sheer misery and pointlessness of drug prohibition is brought home through powerful interviews that Hari conducts with its victims. Particularly shocking is the system in Arizona that basically tortures and humiliates anyone found in possession of illegal drugs. Prisoners are kept in an open air ‘tent prison’ akin to a Concentration Camp. Hari looks closely at these prisoners and finds that the majority have severe and prolonged mental health problems, grew up in care homes, suffered severe abuse and trauma and used drugs as the only method available to them to numb their suffering.
How America treats it’s incarcerated citizens has never made me more grateful for the European Court of Human Rights, which at least legislates that prisoners should be treated with humanity and dignity.
But in America when you have committed a ‘crime’ all of your rights as a human being are terminated. The book details the cruelty of a broken system that abuses and tortures already broken people.
I am pro-marijuana legalization (strictly regulated) but after reading this book I am more favorable to decriminalization of all drugs. There are two sections that really convinced me of this. One where Hari examines the rise of drug cartels in Mexico and the decriminalization of drugs in Portugal.
It’s always amazing to me how American media completely ignores what is happening on its doorstep. The only solution offered to the growing and alarming rise of extreme drug-related crime in Mexico is to build a really big wall. Drug cartels rule and dominate Mexico through fear and terror. There are simply no limits to the atrocities the cartels will commit in order to protect their multi-billion dollar business. Examine the situation in Mexico and it will become clear who is winning the drug war.
Hari then examines the complete opposite in Portugal. By the 1980’s Portugal had one of the worst heroin problems in the world. The government responded according to the drug war rulebook; crimination, crackdowns and punishment. They were surprised to see the problem get worse. A task force looked at it from a different angle and saw that the majority of drug users didn’t have a problem, used for pleasure and didn’t go on to become addicts. They decided that this group needed safety advice and could be left alone. It wasn’t worth the police time to persecute them. In 2001 they then decided to treat problem drug use as a health problem rather than a criminal one. By decriminalizing drug use they put all of the resources they saved into education and treatment. What is crucial to understand about this policy is they didn’t just decriminalize all drugs and let people get on with it; they created an alternative system that focused on prevention, education and treatment. They could do this because of the resources they saved in criminalizing people. The policy goes even further, it helps addicts re-build their lives and become functioning members of society again. The government offers hefty tax breaks to anyone who employs a recovering addict for more than a year. Imagine that? In America once you have a drug conviction it’s almost impossible to get a job, a college loan, and housing. What avenues are left for an addict, but crime, under these conditions?

Image courtesy of Victor Habbick at FreeDigitalPhotos.net

Image courtesy of Victor Habbick at FreeDigitalPhotos.net


As thought provoking, as this book is it does have some major flaws. I was pleased that Hari focuses on feelings and emotions of addicts as one of the primary motivators of addiction. Particularly a lack of belonging or connection as exemplified by Dr. Gabor Mate’s work. However he completely ignores the abundant research that also demonstrates that genetics also plays a huge part. Further exploration of addiction that as a primary, chronic and progressive mid-brain illness would have given the book more substance. Equally, there is some naivety in believing that legalizing all drugs and putting the money into prevention and treatment will solve the problem. Our global drug problem is complex. I do however support the theory that what we are currently doing is not working and I think ‘Chasing the Scream’ is a good start to an important discussion.
Throughout my career I have always been asked about what I think about drug legislation and I’ve always replied it’s not a question of if, but when. We are beginning to see that in the US, with several states now legalizing marijuana growth and use. The results of these experiments I think will spur on further legislation and decimalization of drugs. However it’s important we follow the ‘Washington’ model rather than the Colorado model of legalization. The Colorado model was based on legalizing Marijuana because it is less dangerous than alcohol. Where as in Washington state, the push to change the laws around marijuana use were driven by the recognition that the laws themselves caused more harm, and took resources away from prosecuting people who caused real harm to society. They recognized that Marijuana is not a ‘safe drug’ and shouldn’t be presented as such and it is for this very reason that is should be made legal and then be regulated. Just like Portugal the campaign focused on then re-directing the resources saved on marijuana prosecution and the tax revenue it brought in from legal sales to education, prevention and treatment. This is a pathway to marijuana legalization I can support.

I also wish Hari had explored the prescription drug epidemic in America and the role of pharmaceutical companies in creating the problem. He points out that the addiction problem caused by over prescription of opiates really starts when users legal supply is cut off and they are forced to transfer to cheaper heroin on the black market. However he doesn’t go into how pharmaceutical companies helped cause this problem in the first place.
Overall I found this a fascinating book and would recommend it to anyone who despairs of our current system that is inherently racist and targets the poor, mentally ill and damaged members of our society. What is clear is we can’t keep doing what we’ve been doing to address the epidemic of addiction in our culture.
As Hari puts it:

“Prohibition, doesn’t stop the problem, it simply piles another series of disasters onto the already-existing disaster of drug use. In this argument we are all anti-drug. The only difference is between prohibitionists who believe the tragedy of drug use can be dealt with by more jail cells in California and more military jeeps on the streets of Juarez, and the reformers who believe the tragedy of drug use can be dealt by moving those funds to educate kids and treat addicts.”

This really sums up how I feel. I am anti-drugs; I am anti anyone taking drugs. The risk of harm is too great. But I am also anti how we are addressing the problem currently. We just can’t keep criminalizing drug users when the resources could be used instead to help them instead.

September is Recovery Month!

National Recovery Month

Did you know that September is Recovery month?
This years theme is Join the Voices for Recovery: Together on Pathways to Wellness.
The purpose of Recovery Month is promote the benefits of prevention and treatment for mental health and substance use disorders.

For years addiction and mental health have been in the closet, sufferers have been too embarrassed to talk about their problems openly, for fear of being judged or labelled.
But the fact is in 2011 20.6 million people 12 or older were classified with substance abuse or dependence. What’s worse is 19.3 million of them needed treatment and didn’t get it.

I think the tide is finally turning, this problem is so prolific and effects so many people that the recovery community has decided not to stay silent anymore. More and more people are speaking out publicly about their struggles with addiction and mental health. The more this happens, the more people can see that they are not alone, more people will get help, less people will suffer.
When I launched the ‘Recovery Rocks’ interviews I though I would really struggle to get people to use their real name and a photo.
I couldn’t have been more wrong. I have met so many people who are publicly declaring they are addicts and alcoholics in recovery. It’s so inspiring.

I remember years ago concealing the truth about my past to people around me, it was just too much hard work. I thought I would be judged and that people would think I was ‘unstable.’

Alcoholism is part of who I am, in many ways it made me who I am. As awful as that struggle was, overcoming that struggle has given me what I have today and I wouldn’t change that for anything.
And besides I stopped caring what people think of me. I mean really, I don’t care what you think about my past or what I did, or that I’m completely open about being a recovered alcoholic. I don’t care if that shocks you.
I just don’t care, because what matters is what I think of myself.
And I really like myself today.

So please do what you can this month to spread the word that recovery from addiction and alcoholism is not only possible, but addicts and alcoholics can go on to have happy, successful, fulfilling lives.

Image courtesy of Naypong at FreeDigitalPhotos.net

Image courtesy of Naypong at FreeDigitalPhotos.net

Someone is suffering in despair, desperation and loneliness RIGHT NOW, and they really, really need to know they can get better.

SAMHSA National Helpline

What’s the difference between anonymity and secrecy?

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For those of you haven’t heard of David Sheff, he wrote a best selling memoir about his addicted son ‘Beautiful Boy.’
He has just written a follow-up ‘Clean: Overcoming Addiction and Ending America’s Greatest Tragedy,’ which explores the addiction treatment system and everything related to it.
One of the most interesting things he discusses is that addicts and alcoholics should come ‘out’ about their past in order to spread awareness and break down barriers. Fear and shame prevents people talking about personal experience with addiction. Families really struggle dealing with the addict in their family because they don’t want anyone to find out. Sheff is advocating that more people are public with their experience of addiction.
For the record, I totally agree with this.
I am completely open in all areas of my life that I am a recovered alcoholic. It’s just part of who I am. When you have worked as an addictions therapist it’s pretty hard to hide as the question you are most often asked is ‘how did you get into that?’
I am not ashamed or embarrassed, just very matter of fact. Because of this, I inevitably have people ask me for help or advice when they realise they have a problem or love someone who does. If I can help I do, I tell them there is hope.

My alcoholism is not a secret, it made me who I am an I am proud of what I have become.
I won’t lie, I sometimes enjoy watching people’s shocked faces when I tell them I spent most of my twenties drinking too much and snorting drugs. I can tell by their faces they don’t think I look the ‘type.’
And that’s the point.
Addicts and alcoholics can look like me, they can look like anyone. It can happen to anyone.
I used to think that alcoholics were ‘smelly old men on benches’ and because I hadn’t lost my job or got a DUI I wasn’t ‘qualified.’ I think a lot of people think like that and could get help a lot earlier if they had more information.
You can read the interview here.
What does everyone else think?

Harm reduction?

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The city of Brighton in the UK is thinking of introducing drug consumption rooms, where addicts can safely inject drugs. The goal is to reduce drug related deaths as part of their harm reduction strategy. There are already drug consumption rooms in other parts of Europe.
I honestly don’t know how I feel about this. I’ve worked in harm reduction in the UK and although I understand the reasoning behind and it seems to make sense. It also doesn’t.
It’s true some addicts and alcoholics don’t want to stop drinking or using, or they have convinced themselves there is no point to life without drugs and alcohol. But to continue using means an escalation of harm to themselves and to others.
So I guess you could argue that this is about personal choice too. If someone wants to self-destruct then they have the right to do that.
So isn’t the humane thing to do to provide them some where ‘harm-free’ to do that?
Maybe.
It just makes me feel so sad.
That, as human beings, that’s all they’re worth. A clean supervised room in which to gouge out in.
I truly believe all addicts can and want to get clean given the right opportunity. I just believe they’re really, really, really scared and the fear becomes too much for them so they use.
I get that.
I know what it’s like to be frightened beyond all comprehension with no idea how I’m going to live this life.
Numbness was always a better choice than facing my fears. Until it wasn’t and I got help.
So my fear about these consumption rooms is that the money and resources start going into them and there is nothing left for treatment. Actual treatment where people face their fears, face their past and learn the tools they need to live clean and sober. Where addicts are treated as sick human beings not lost causes.
So they can become the people they were always meant to be. Not zombies’ sitting in a room not feeling anything.