I am tired...but I will keep fighting for change

I am tired really.  A friends post this morning about overdose deaths immediately brought it to the surface for me. It's always right there, just beneath the surface, my feelings and frustrations with how our society has, and continues to, treat people with substance use disorders.  

I am tired of how our government, who have engrained in the average citizens mind through the nearly 100 year Drug War, that people with substance use disorders are part of the problem and they, the government, have the solution. This has been a joke since the very beginning. The idea that we can just incarcerate our way out of drug problems in America is comical. Don't believe me, look up the data. Actually, screw the data.....talk to any law enforcement officer who has any amount of experience and they will tell you; we will not incarcerate our way out of this. It's a revolving door for to many people who have a substance use disorder.  The door just keeps swinging with people in and out of jails and prisons, returning to use, returning to criminal behavior, returning to jail. People complain about wasted tax dollars.....here you go......well over a trillion dollars spent, and the amount of drugs and associated problems has increased since the beginning.  The long ago call by Nixon saying "Enemy number one is Drugs" has fallen on deaf ears on this point, and, countless lost lives.

I am tired of a broken treatment system that has also engrained in the average citizens mind that their model of treating people is the answer and those that don't adhere to it are the problem.  The vast majority of treatment centers in our society are running on an antiquated model of treatment based out of the 50's. Yes, you heard that right, based out of the 1950's. That model, The Minnesota Model of Treatment has seen little change since its inception. This model teaches people about the twelve step model of recovery based on the Program of Alcoholic's Anonymous. There is some psycho-therapy and skills learned, but, at the core of the entire model is the twelve steps.  Go to most any treatment center group room and you will see iterations of the twelve steps and twelve traditions, quotes and sayings based out the book of Alcoholic's Anonymous or Narcotics Anonymous, and nearly all of the treatment lectures and discussion surround the all to familiar, go to meetings, get a sponsor, work the steps.  Now, that might work for some, but it for sure doesn't work for all. This might seem like a no-brainer right?  Why would anyone think that teaching one specific way to maintain your recovery would be the way to go when treating people with substance use disorders? Aren't there other ways?  There are other ways and other models, but, they are far and few in between the Minnesota Model being given as THE primary method in the vast majority of treatment centers across our nation. 

Imagine going to your doctor when you have a medical condition and your doctor lays out a treatment plan to treat that condition. You try that treatment plan, and, it doesn't work. What would you do? Would you go back to your doctor and say give me more of that same treatment? Likely not. At minimum you would have a discussion with your doctor about different treatment options. Your doctor, if they are doing their job effectively, would find other treatment methods to try. You would even go and get a second opinion if your doctor wasn't giving you other options right? Guess what happens with treatment for substance use disorders when the Minnesota Model of Treatment Model doesn't work?

In most cases, they end up back in the same method of treatment (Minnesota Model) they were given the first time. This time they are told maybe they will listen this time.  And, to give some credit here, that might be the case. Maybe someone didn't listen the first time. Maybe they weren't ready to hear the information. Now, what about those who DID listen? What about those who WERE ready? What if they simply don't believe in that method?  Shouldn't they be given other options?  Shouldn't they, at minimum, be shown the myriad of other paths one can take to learn about and maintain a life in recovery (SMART Recovery. Secular Recovery, Life Ring, Moderation Management, etc., etc.)?  There are all to many working in the field who balk at this idea. The idea that treatment providers should ACTUALLY do what they say there are doing when they use the tagline "individualized recovery" in their advertising, grant applications, and other materials is something I believe we should be holding them accountable to if they say there are doing it. Many treatment centers are so engrained in the Minnesota Model that they can not think outside of it. I have said what I believe to be true.  Our treatment system needs to be imploded and rebuilt from the ground up with entirely new ways of thinking. Lives are depending on this to happen.

Recovery supports after treatment, well, here's another area that failing people every day. People who do navigate the chaotic and bureaucratic path to get to treatment and at least get something, all to often, return home to a mountain of barriers that prevents them from sustaining their new found life in recovery. What are the barriers?  For one, ongoing professional help for what 80% and higher need help with after inpatient treatment; mental health disorders.  The fucking research is so crystal clear on this, yet, we keep the barriers as high as possible so those who need help in this area have to fight to get even a small amount of care.  Depression, anxiety, PTSD, childhood trauma, the list goes on and on.....we KNOW that the vast majority of those who have a substance use disorder also have mental health disorders.  And to be real honest I am not sure which system is more fraught with issues....substance use or mental health disorder treatment systems. Just getting in to get an appointment is problematic at best.  Those who do work in the system are overworked and underpaid and the turnover is high. Paying for this care is outrageous and many simply have to decide whether to pay rent or get counseling.  

I won't even go into the competitive nature that has now pitted mental health providers against substance use disorder providers that only ends up hurting the people who need help in both areas. It used to be that substance use disorder providers only provided that service and mental health disorder providers only provide that service.  Now, both do both and they are competing with other for local, state and federal dollars. This wasn't supposed to happen because they SHOULD be working together in both of these areas, but, the unintended effect is competition.  The two entities have never really played well together and now it isn't better, it's worse. 

There are other critical areas that someone needs help with when they return form inpatient treatment centers that create real issues for people.  Housing, employment, familial issues, criminal justice system issues, etc, etc.  This is another area, ongoing recovery support, that is fraught with problems.  Funding for ongoing recovery supports is just now starting to trickle in for those who provide these types of services. 

We, as a society, will continue to see the death toll rise. We, as a society, will continue to see crime rise due to ongoing substance use disorders. We, as a society will continue to see fatherless homes.  We, as a society will continue to see motherless homes.  We, as a society will continue to see grandparents raise grandchildren.  We, as a society, will continue to see our tax dollars wasted on ineffective systems of care. We, as a society, will continue to shake our heads and say the same things over and over again until. 

We, as a society, demand change.  I am tired really, but, I will keep fighting for change.