The American system of recovery doesn’t always work.
My journey is proof.
July 26, 2018
Part of the PublicSource series
Stories about the opioid epidemic
in the Pittsburgh region.
About this series.
Many of us are familiar with the famous experiments that offer mice the choice between food and water, or cocaine. I’d always heard that mice starve to death rather than quit the cocaine.
But of course, that’s not the complete picture.
There are other mice, and other cages. Cages with mice mazes and mice families and friends; mice Ferris wheels and slides and pillows; a constant stream of stimulus and treats. These mice Wonderlands also include cocaine. In these cages, the experiment gets notably different outcomes.
Turns out, mice don’t find cocaine that enticing when they’re living full, joyous mouse lives with their mouse peers in a safe and secure environment. There were a few who were drawn to the cocaine and inevitably became chemically dependent upon it, but they were the mouse minority.
When I heard about the mouse Wonderland, it made perfect sense to me as a former heroin addict. It made sense that the first study is what I’d always heard about, and that the second study was the lesser known. The American model of addiction and recovery is largely an all-or-nothing proposition. The second study is more complicated than we’re used to when it comes to the causes of drug use, and it asks more from us as a society regarding prevention and recovery.
I first encountered the American drug treatment system twelve years ago. By the time I got to treatment, I’d been using mind-altering substances every day for about ten years, and the last three of those I’d been a daily, intravenous heroin user. I was not a woman whose addiction began in a medicine cabinet, though that particular story of addiction has now become a familiar narrative of the opiate epidemic.
"Twelve years after seeking treatment, I've accomplished things I'm proud of."
I got lucky. The doctors I encountered were trained outside the American model; they were Scandinavian, and they used an “all-of-the-above” approach that included the following: one-on-one talk therapy; group therapy that included grief counseling, gestalt techniques, and discussions of race, gender, and class that impact individuals’ ability to live healthy, productive lives; book clubs; yoga; reiki; massage; acupuncture; meditation; medical lectures about the newest scientific research regarding addiction; workshops on nutrition and financial planning; and pharmaceutical medications like Suboxone, Subutex, and Methadone. All of this was offered in a flexible, outpatient setting in Austin, Texas. I had a full-time job the entire time I was a patient there, but still managed to engage in almost every service offered; and this wrap-around, all-inclusive, holistic treatment cost me $40/week.
Though it sounds like a rich-kid resort rehab, it was patronized by a combination of professionals, homeless people, long-term addicts, and young people in their 20s who could see the signs of something worse on the horizon. I met stockbrokers, chefs, contractors, plumbers, horse trainers, bartenders, tattoo artists, and stay-at-home moms at the clinic. I met students and anarchists and hopeful politicians and those who were homeless by both choice and circumstance. I think we all felt grateful to have landed in a place where we were given agency in our own recoveries.
One of the first things we were asked to do was to write our own goals for recovery. These goals could include things like: “I want to be opiate-free in six months, and I’d like to responsibly use marijuana and alcohol.” Or: “I want to be on long-term methadone maintenance and be alcohol and narcotic free.” Or: “I want to be free of all mind and mood-altering substances in one year, after tapering off methadone maintenance.” There was no one, right answer to our personal recovery goals, and we were encouraged to change them over time. When I began crafting my goals, they included an ability to remain free of narcotics, and to eventually be able to drink alcohol socially and responsibly. I wasn’t sure if that was possible for me, but I imagined it could be.
The second question we answered was what we wanted to add to our lives. Again, there was no right answer, but we weren’t allowed to be vague, and we weren’t allowed to be abstract. We couldn’t write “I want to be happy.” Instead, we wrote things like: “I want to earn a master’s degree in Political Science,” or “I want to learn how to speak Spanish and move to Mexico to be an ESL teacher,” or “I want to get a job with flexible hours so I can pick my kids up from school.” We wrote things like: “I deserve to be in a committed relationship with someone who treats me with dignity and respect,” and “I want to once and for all resolve all my legal issues.” In other words, we were asked to start imagining what our mouse-Wonderlands would include.
My mouse-Wonderland included a romantic partnership of kindness and respect; going back to school and publishing my first book; being able to engage with the news and politics in a way that kept me informed but did not overwhelm me or send me into chaotic spirals of depression; maintaining relationships with friends and family that had appropriate boundaries; most of all, I was interested in defining for myself a code of ethics that I could live by, no matter what mistakes I might make in the future. One of the activities my therapist and I worked on most fervently was writing that code of ethics, which turned into a personal Bill of Rights, which I still consult when I have questions about a relationship or big decision.
Though this may not seem radical to those unfamiliar with the American approach to drug treatment, it is. The dominant model of American treatment is abstinence. Our model is dominated by a reliance on 12-step programs whose philosophy includes a complete subtraction of chemical substances in all forms of drugs and alcohol. It is extraordinarily helpful for some people whose lives have become unmanageable because of drugs and alcohol; for others, it is an all-or-nothing approach that ends up perpetuating cycles of relapse, shame, penance, and redemption.
I have attended many of 12-step meetings, which I have found profoundly useful in my recovery. Two distinctive characteristics that can’t be stressed enough: it is free, and it is self-sustaining, led by those whose personal experiences informs their outreach. There is an inherent hopefulness in learning the stories of those who have experienced addiction and come out on the other side. I am grateful that 12-step programs exist in such abundance in America. I also know my recovery would have been much different if 12-steps were the only strategy I had. For too many people, it is the only option on offer.
"I think we all felt grateful to have landed in a place where we were given agency in our own recoveries."
Now is the time we must confront our approach to treatment and recovery. I hope we learn from the rest of the world that an all-or-nothing approach inevitably excludes the wide swath of middle-ground where most people hope to one day live moderately and responsibly. Most people do not imagine their ideal life to include casual heroin use; but most do imagine it including the indulgence of a New Year’s Eve toast or the fun of cold beer at summertime barbeques. That is possible, and there are many, including me, who are proof of it. But our stories are more difficult to tell, because they are more complicated and more specific. There is no meeting place for us to come together and say, “Here we gather to confirm we all do it a little differently.” And so the story of recovery is left to those who work within a template.
Twelve years after seeking treatment, I've accomplished things I'm proud of. I have a career as a writer and educator, and I contribute to my community through volunteer outreach. I have mostly great relationships with my family, friends, co-workers, students, and partner. I experience a full-range of good and bad days; heartbreaks, disappointments, joy, and frustration. I don’t use narcotics; I occasionally drink alcohol; and I recently gave up cigarettes after 20+ years. I was far more concerned about the cigarettes than the occasional fancy cocktail.
This life corresponds to the life I was imagining in those first months of treatment. In those first few months, I was not making inventories of all the things I’d done to hurt others, as I would have been in 12-step recovery; I wasn’t trying to conceive of a higher power or admitting my failures, as 12-step participants do. I was using my imagination to redefine my life. I was given free-reign to identify and define my own ambitions and then I worked with a team to find practical ways of achieving them. I say this not to disparage 12-step programs, but to add my experience to the range of experiences that might lead to successful recovery. As we encounter more people seeking treatment, I hope we’ll imagine more ways of shaping that treatment. I hope we’ll find solutions that marry the best from science, medicine, psychology, social work, the creative arts, philosophy, spirituality, and community-based fellowships like 12-step programs. I hope we’ll leave every option on the table, and remember to focus less on the cocaine drip, and more on the context of the cage. I hope we arrive at a place where we understand that recovery is additive rather than subtractive; that it is far more powerful to focus on the things we want our world to be full of, rather than the substances we wish to subtract from it.
I hope we give ourselves the collective benefit of hearing lots of success stories, and that we allow those stories to be as specific as the people who tell them; that we move away from the binary notion of clean vs. using or drunk vs. sober, and more toward a spectrum of recovery that includes a full range of diverse voices.
The Pittsburgh-area author is a writer and educator. She chose to remain anonymous.
Edited by Halle Stockton and Mila Sanina.
Web design and development by Natasha Khan.
This project has been made possible with the generous support of the Staunton Farm Foundation.
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