Drug Rehabilitation or Revolving Door?

[groovedaddy]

ROSEBURG, Ore. — Their first love might be the rum or vodka or gin and juice that is going around the bonfire. Or maybe the smoke, the potent marijuana that grows in the misted hills here like moss on a wet stone.

But it hardly matters. Here as elsewhere in the country, some users start early, fall fast and in their reckless prime can swallow, snort, inject or smoke anything available, from crystal meth to prescription pills to heroin and ecstasy. And treatment, if they get it at all, can seem like a joke.

“After the first couple of times I went through, they basically told me that there was nothing they could do,” said Angella, a 17-year-old from the central Oregon city of Bend, who by freshman year in high school was drinking hard liquor every day, smoking pot and sampling a variety of harder drugs. “They were like, ‘Uh, I don’t think so.’ ”

She tried residential programs twice, living away from home for three months each time. In those, she learned how dangerous her habit was, how much pain it was causing others in her life. She worked on strengthening her relationship with her grandparents, with whom she lived. For two months or so afterward she stayed clean.

http://www.nytimes.com/2008/12/23/health/23reha.html?th&emc=th

[Warpy]

1. "Should" and "ought" never got anybody clean

The only thing that ever worked was "I've had it!" combined with social support.

Educating people about their addictions is important. It gives them extra tools when they've finally had enough and it's time to get off the merry go round of living their lives around the next high.

Just don't expect it to work until an addict is damned good and ready.

The only inpatient treatment with a great success record is prison. There are quite a few people sitting in AA and NA meetings who say they'd never have managed to stay clean without five years of meetings in the pen. I don't think locking people up for 5 years or so as a matter of course for simple addiction is the answer, though.

The treatment program with the greatest success rate ever recorded was a pilot program in the UK where addicts registered and were able to obtain a steady supply of their drug of choice at any drug store. When the program ended 10 years later, half the addicts were clean. Street crime had dropped 80% in the areas where the program was in force and nearly all had gotten jobs.

The program was not renewed due to pressure from moralists and probably the US.

[groovedaddy]

2. I didn't know the study in the UK you mentioned had been done but have felt

something like it should be tried. I think it would make a huge difference along a number of lines, not the least of which is the reduction in street crime. Busting up families is another huge societal drain.

[Warpy]

3. Living with an addict of any description is pure hell

Been there, done that. Families of addicts will always suffer and many of them will dissolve, abandoning the addict to his habit.

However, what we're doing now isn't working. We need to try something else.

Humane treatment of people with the type of brain chemistry that predisposes them to addiction (current research) should be the first step.

[Asgaya Dihi]

5. It's been more than tried

I've mentioned this here before but nobody asked for details so I didn't bother to share them. The Swiss have had a heroin program for quite a while now and it's been successful enough to have been first expanded by popular vote then more recently accepted as a permanent program, again by popular vote. Germany has run a trial of the sort as well with good results and as Warpy mentioned so have the Brits. That one was was going great until profiled on 60 minutes as a success story. DEA didn't like that a bit so pressured them to shut it down.

When we take the hysterical "someone got high" reaction out of it the programs are outstanding in terms of results. Successful enough that as I mentioned above the Swiss made the program permanent, even as their anti drug use attitudes lead them to keep pot illegal. The heroin maintenance programs are about anything BUT someone getting high or allowing it, what they actually accomplish is in the short term greatly reduce the damage of drug use and over the long term to reduce the use itself. The hysterical "we can't support use" accusations of opponents tend to ignore what the results of the program actually are.

Here's a link to a short article from when it was recently made permanent, if anyone is curious there was a Lancet Medical Journal article on it some time back as well as some other info on the type of program I could point out for you. http://stopthedrugwar.org/chronicle/563/switzerland_heroin_prescription_marijuana_vote

[groovedaddy]

6. Thanks for the info. n.t

[stillcool]

4. I know many people..

who have been to jail numerous times, and still can't stay clean. In my fathers case, I think it was either the slow death of alcoholism or the fast death of suicide. I don't know which is preferable. I also had a friend that had an 'issue' of dealing with the experience of getting raped by her father for a number of years. She ran away from home and spent a number of years on the street. I think that might have something to do with the reason why jail didn't straighten her up. I've spent plenty of years in the rooms of AA and NA, and I know of no woman who has not abused. Of course, that might be just birds of a feather flocking together, but getting sober for many is the beginning of their problems, not the end.

[ellisonz]

7. “Honestly, you just don’t care how or why something works for you...Just that it does.”

One of the earliest and most prominent critics of faith-based treatment: http://peele.net/

Pioneer in harm reduction and cognitive behavioral therapy.

[duhneece]

8. See the HBO "Addiction"

Features the National Institute on Drug Abuse head, Nora Volkow and many others. It's the most complete look at addiction I've seen. A must-see for anyone dealing with addiction, but watch the full interviews as well as the 'feature.'

Addiction is defined as a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful (I would add: despite CATASTROPHIC consequences) consequences. It is considered a brain disease because drugs change the brain - they change its structure and how it works. These brain changes can be long lasting, and can lead to the harmful behaviors seen in people who abuse drugs.

Relapse is part of the disease cycle, not a moral lack on the part of the addict. It means the addict has to ask, what did I learn, what do I need to do differently?
Diabetes has higher rates of relapse (from appropriate lifestyle choices) than addiction.