In Sadness, The Solution

The line between living and dying as a result of a substance use disorder is as thin as one generation in my family.

I used to wonder why my mother, who died at the young age of 32, was unable to sustain recovery from her illness while I have been able to do so and in turn have lived. I spent years going through the gauntlet of thinking maybe it’s luck, God, good fortune, motivation, her lack of motivation, her not “wanting” it bad enough, karma, me working harder, etc.

What I have learned in my journey is this:

Recovery is not about any single one of those things. Recovery is instead something that can absolutely be manufactured by making the right ingredients available for people who need them at the right time.  It is about having what it is we need, when we need it.  I was fortunate enough to have had access and continued access to what it was I needed, when I needed it.

It’s time to get rid of the myths and look at what we know.

People do not need to hit “rock bottom” in order to recover.  There isn’t just one way to recover. There isn’t one approach that should work for everybody.  People need access to treatment and support 24 hours a day, 7 days a week because substance use disorder and recovery is not a 9-to-5 operation.  Medicated assisted treatment works for many people.  Families should be included in the recovery process.  Naloxone saves lives.  We know these things.

The tricky part for me is no longer trying to figure out why some recover while others do not.  The tricky part for me lies in the ingredients and the timing – how do we begin to ensure that everybody who needs it gets their own individualized mixture of ingredients at precisely whenever the right time is for them?

For me, this is where I see hope.  Not the sort of hope we find in blind faith or in wishful thinking.  Not the sort of hope we hold onto when we don’t know where to turn.  It’s the kind of hope we have when we see a solution on the horizon.  If we know that recovery is possible, and if we know many of the ingredients that help people recover, and if we know that we need to make them readily available – well, then we know the solution.

Now all we have to do is make it happen.

I don’t know what specific ingredients my mother needed, all I know is that she didn’t have them when she needed them. Now, instead of thinking about why she died while I lived, I think about how our combined experience can be used to help make recovery available to all.

On this International Overdose Awareness Day, I think of my mother.  As we march into Recovery Month, I also think about the solutions that we have, and how the time is now to allow everybody access to them.

Medication Management Treatment and Narcotics Anonymous (NA): Time for an Open Mind

Imagine if people living with HIV had been shunned, shamed, alienated and stigmatized for utilizing Antiretroviral therapy (ART) medications.  Imagine if people living with cancer were told that using chemotherapy or radiation treatment was “taking the easy way out” and that they weren’t really in recovery, or if people using blood pressure management medications were told they should be able to lower high blood pressure all on their own. Imagine if individuals living with serious mental health challenges were told that they should be able to manage symptoms without the use of medication, or else they weren’t really healthy and well.  It all sounds so absurd, right?  Then why do many of us convey this message to people living with the deadly illness of substance use disorder?  Why is this all too often the approach to individuals considering or utilizing evidence-based medication maintenance treatments such as methadone or buprenorphine (Suboxone)?  As would be the outcome in these other cases mentioned,  in doing so we are killing individuals, shattering families, devastating communities and failing as a society wherever and whenever we allow such an absurd mindset to pervade.

I recently met with a group of individuals who are using methadone maintenance treatment as a tool in their overall toolkit for recovery from substance use disorder.  When the topic of stigma and shame came up regarding their use of this tool, many of the comments and sentiments were heartbreaking.  Here was a room full of beautiful people struggling to overcome a deadly disorder that kills more people than car accidents in our state – people who were once somebody’s cute little baby that other people cooed over, people who are an older sister or little brother, people who are somebody’s BFF or favorite cousin – and what they had to say was saddening.  For me, I was more frustrated by the discrimination and stigma they face within segments of the recovery community, in places such as Narcotics Anonymous (NA), than the discrimination and stigma they face outside of it. My experience with this goup last week served as a stark reminder of the need for change in this area.

In mutual aid societies such as NA, “truth consists of knowledge drawn from firsthand experience (inside looking out) and the transmitted wisdom of recovery elders who serve as the repository of the stories of earlier generations of NA members” (White, 2011).  Although I concede that there is great value to the oral tradition and transformative knowledge passed down within the NA fellowship, I think the time is now for all human beings – in recovery themselves or not, members of mutual aid societies or not – to become more educated about the truth of the matter when it comes to substance use disorder and the many pathways to recovery.  More than 350 people die every single day from the treatable illness of substance use disorder, and the reality is that the “truth” transmitted from one individual to another in NA and other mutual aid societies is at great odds with the scientific evidence and hard facts about effective, life-saving treatment strategies such as methadone and buprenorphine.  While the time is now for all of society to know the fact, I suppose I do expect a little more from those of us who are in recovery.

If ignorance can be seen as coming from a lack of information and knowledge, then it is fair to conclude that the ignorance found in the NA stance on medication management treatment can be reversed with education.  Language in official NA World literature that refers to people utilizing methadone or other medication management treatments as “under the influence of a drug” or “members who are not clean” (Bulletin # 29) is ignorant in nature and in turn discriminatory, stigmatizing and harmful.

Harmful, in this case, means people are shut out and dying.

While no studies exist to adequately capture the impact of restricted NA participation for an individual who discloses utilizing medication management treatment, I have personally witnessed its deadly consequences.  I have met people who were shunned by NA while using methadone as part of their recovery journey and went on to later die as a result of an overdose.  The collective restrictions placed on individuals using methadone or buprenorphine in NA are alienating and actually rob those individuals of access to some of the very ingredients that makes mutual aid societies like NA so successful.  Ingredients such as transformation through storytelling (i.e. sharing), inclusion in a “recovery-supportive social network”, participation in “rewarding, recovery-focused social activities” and the “therapeutic effects of helping” found in service and sponsorship are the four ingredients that often are withheld from members openly using methadone or buprenorphine (White, 2011).  By withholding these key ingredients and their recovery enhancing benefits from individuals using methadone or buprenorphine, people using medication management treatments are in turn not permitted to utilize some of the very things that make programs like NA work.  I think the time is now to change that.

During my time as an active member of a mutual aid society, I learned a lot about what is deemed the “spiritual principle” of open-mindedness.  I was taught what it means to be open-minded and how to practically apply this principle in my life.  I can earnestly say that learning how to go beyond my own limited lived experience, beyond my own opinions and beliefs, and beyond what appears threatening to my ego has been a gift that has served me well in my recovery journey and my travels as human being on the path to self-actualization.  It has always struck me as an unfortunate dichotomy that the very places that taught me how to be open-minded have proven to be close-minded in the area of medication management treatments.  As I stood among the group of brave, heroic individuals last week who are fighting against the deadly but treatable illness that I too am in recovery from, I couldn’t help but think about open-mindedness.  I couldn’t help but think that the time is now for mutual aid societies like NA to become open-minded to a new way of thinking about and approaching members who utilize medication management treatments.  The time is now for individuals and the fellowship as a whole to become open to learning the real truth about treatments such as methadone and buprenorphine, and in turn, become more open to offering its benefits to all those who seek recovery from substance use disorder.

If you would like to become more open-minded today, here are some great resources to start:

Narcotics Anonymous and the Pharmacotherapeutic Treatment of Opioid Addiction in the United States

William L. White

Trends in the Use of Methadone and Buprenorphine at Substance Abuse Treatment Facilities: 2003 to 2011