Those of you who know me know it's no secret that I'm in a methadone maintenance program.
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| Currently at a 30mg daily dose |
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I started "Medication-Assisted Treatment" (MAT) for substance use conditions" in 2000 and have been a fierce advocate for the use of
MAT for those of us who suffer from opiate addiction ever since.
In talks and presentations around the country, I have been sharing the fact that Methadone maintenance not only saved my life, it allowed me to take my recovery to a point that I could establish stability and predictability in my life. The associated counseling and clinic "case management" services, helped me as well, and I learned about the nature of addiction in general, along with healthy ways of managing the issues life brings you on a daily, sometimes hourly basis. I cannot tell you how important this has all been for me, and I think if you simply compare where I was at in my life when I first entered treatment to where I am at today, some 12 years later, you would agree that the benefits of the program were not lost on me.
When I first came into the program, I won't candy-coat it, I was skeptical of the potential for recovery through the use of another drug, especially one that was so closely related to the heroin I'd been using on the streets for decades. I'd been
12-stepping it via court order, and while there is research that points to the fact that
coerced treatment is as effective as voluntary treatment, I didn't find the NA program either effective or palatable. This was primarily because I'd been forced into the program in a small California town and just about everyone in those meetings were lying about their length of sobriety. I knew that because I was out partying with them when we weren't sitting in the meeting rooms. It took me a while to "work my own program" instead of worrying about others, but those initial experiences soured me for a long time on the whole 12-step scene.
I also couldn't get into the "higher power" thing, what with my utter hatred and loathing of authority back then, not to mention the feelings of spiritual abandonment. It wasn't easy to "give up control" to anyone, let alone something I felt had let me down over the course of most of my life. Perhaps the biggest thing I took away from that program was that the only way to achieve "sobriety" was to abstain from all drugs.
This approach is all well and good for those who could
choose to do so. But true addiction is a
disease, not a choice, so while I could appreciate the 12 steps, I did not and was not able to maintain sobriety through "fellowship" and/or "working the program" with other 12-steppers.
Something I think is important to note here before I go further is that as I began to progress through MAT and into recovery as I
understand and believe it to be, many of the steps themselves I ended up working over the last 12 years as a part of the recovery process in general. I didn't realize this until recently when, in researching something around the 12-step program, I re-read them and was struck by how many of the steps I'd actually worked since entering MAT.
But back at the beginning of the journey into sobriety, I could recognize that I was having a helluva time trying to navigate the world while strung out on heroin and having that nasty little monkey on my back pull my strings like a damned puppet master. I'd used street methadone during the course of my "runs" out on the street, and liked very much its ability to keep me "well" for an extended period ("well" here refers to the absence of withdrawal symptoms. It does NOT reference a "high," which in my circles, was known as being "gowed." This is a critical distinction because once we realized we were physically addicted to the crap, we realized that getting a buzz off the dope was really a luxury, since most Junkies, self included, often will "chip" at their dope, trying to stretch out the stash for as long as possible, unless of course, one has endless piles of money. Since the people I ran with were definitely not rock stars, movie stars or spoiled rotten rich children, chipping quickly became the norm and actually getting high off the drug occurred only when we were lucky enough to afford a bigger dose. Dealing and stealing provided that for most of the junkies I knew. In my own case, I traded cannabis I'd grown for the dope).
At the end of the day, that's what the heroin lifestyle is all about, once the thrill of coming face to face with the "Dragon" and stepping over the edge and into the saddle of the "baddest" drug on the planet. Like most practicing addicts who don't realize they're addicts yet, my desire to do the "best" the world's pharmacy had to offer led me straight into the clutches of the worst the world's pharmacy had to offer as well.
And anyone who has used drugs beyond cannabis for recreation can tell you that when the "partyers" were hanging out and the subject of heroin came up, there was a tacit understanding that "there wasn't anything stronger, scarier, badder" and more symbolic of the "hard drug" world than to be a user of heroin.
I have to say too - and my fellow policy makers take note, here - those early days of my experimentation with more powerful drugs arose
directly as a result of the scare tactics and misinformation I'd been fed by TV and the propaganda campaigns.
I clearly remember some of the more atrocious ones in the late 60s and early 70s that tried to paint drugs as more dangerous than they actually were (in retrospect, I can say today that those commercials didn't come close to describing the misery of a long-term addiction, but they also were moronic in the sense that they attacked the drug itself, rather than the long-term impact, which I think would have been far more productive in the long run). Once I realized "they" had lied to me about the evil weed, I lost my inhibition.
In fact, when I heard of a new danger about a drug, I immediately
sought it out because I figured if they were telling me how bad it was, it had to be very very good, indeed. Of course, after almost 40 years of heavy abuse and the trail of destruction left in its wake, I know differently, but the dangers of the use weren't realistically portrayed and until they are, there will be many more exactly like me who will throw away large portions of their lives figuring it out.
I make my living by raising awareness around this very issue, so in a bizarre twist of fate, the misery and agony of drug abuse paid off for me. Lest anyone at all think this is the way to "success" let me be crystal clear here, I'd rather be run over by a dump truck, twice, than to have to go through even half of that experience again, so don't fool yourself.
What often get's lost in the whole discussion around the issue of drug use is that people didn't start using with some expectation of collapsing into addiction and horror. They began using for a number of reasons, but the primary one is that "partying" is/was fun. Getting "high" was exciting, and for many of us it was also sometimes mind expanding, enjoyable, empowering to those who were shy, nervous, and/or ordinarily quiet types, and countless other reasons as well.
We use at the beginning to alter ourselves, escape boredom, get some kicks, have some fun, experiment with our consciousness. And we are definitely not alone in this endeavor. Drug use has been around for centuries, folks. It's not a new phenomenon.
With all that said, today I think the majority of folks, at least here in the US, are using drugs to cope as well as to entertain. It's a vicious circle, as well as a "chicken or the egg" argument to be sure, but regardless, once one has moved from the on-ramp and into the carpool lanes of drug use, the exits seem to be few and far between.
Not sure that the typical methadone clinic even realizes this about their users, since most clinics, like just about every other agency in behavioral health, is understaffed, with ridiculous patient/counselor caseloads.
And speaking of the clinic itself, let me connect this rambling post to the central point I wanted to make about reminding myself of my consumer status; it is when I must go to the clinic and deal with the stigma, the hidden skepticism when explaining why I miss diversion control because I've been traveling for work (diversion control is for those of us who have take home medication. Twice a week, the patient must contact the clinic at a special phone number. If the patient number is listed in a recording, that patient must bring in "all full and empty bottles. They must drink that morning's dose in front of the nurse." It's a way that clinics work to combat the diverting of the drug to others, whether it's friends, family or selling it to others), the standing in the dosing line, pissing in a cup for drug testing, etc. etc. etc., that I remember oh so clearly the treatment many of us receive at the hands of the behavioral health "professionals."
Enduring this experience regularly is humbling, enlightening, and motivating, let me tell you.
It reminds me continually of where I came from, how we're treated as we enter recovery, and how we're viewed, even after sometimes decades in piss-test verified sobriety. Perceptions die hard, and many in behavioral health continue to stigmatize those suffering from the disease of addiction, regardless of the length of sobriety and/or success in their lives that they have achieved.
Until those perceptions are reconfigured, I will remain motivated to change the paradigm around Medication Assisted Therapy because I know what MAT did for me, and I know I can't be the only one who's benefited in such significant ways from access to methadone and the counseling, groups and information about addiction and recovery available at the clinic.
But here's the deal with all of that; ya gotta be ready and willing to change your life in order to take advantage of the expertise and the tools available to you at these clinics, and for that matter, in any drug treatment environment, whether it's an in-patient facility or a 12-step program.
Unfortunately, folks use methadone clinics for a whole host of reasons, actual recovery being only one of them. How then to determine who should be eligible for the treatment protocol? I suppose if I knew that, my colleagues at
SAMHSA would hire me to make it so.
But what I
do know is that a medication assisted therapy program works for those who want it to, just like any 12-step, outpatient and/or inpatient rehab, faith-based recovery programs, and a host of other things developed to help a user stop using. Keep in mind here that this is a 'recovery tool" -
one tool in a "recovery support" toolkit - and it should not be construed as
the mechanism for recovery. While this seems axiomatic, it is often lost on everyone, including the person in recovery.
What I mean by this is that recovery is - and really
must be - considered
and achieved in a holistic sense, by understanding and adhering to the "
Guiding Principles" of recovery. Most of us did not travel into addiction as the goal of our substance use. We ended up there as a
result of the substance use.
This is another important distinction here, and it can be more clearly understood simply by asking the question "why is it that two different people can experiment with an addictive drug and one can wind up an addict, while the other gets the message and hangs up the phone, never to call again?"
Every time I enter the clinic to receive my methadone, I am confronted with my addiction, with the conditions of treatment, with the multiple personalities that arrive looking for help, and with the magnitude of the problem of addiction in America.
It keeps me grounded in the work I do, close to my roots, and true to my calling.
I am a person in
recovery, as well as a consumer of services. Those services were fundamental in my recovery journey and every time I visit the clinic, I remember.
