Hypocrisy of Abstinence Only Based Therapies

[MrRoot]

Hi,

I just want to vent something as this has been bothering me a lot for few last days.

I have quitted all opiates, benzos, GABAergics and stimulants and I consider myself quite sober at the moment.

I drink 1-2 bottles of beer every week and smoke some pot once or twice a week and take MDMA once a month and psychedelics even less frequent.

I go to UA bi-weekly and I know how to space my use so it doesn't show up.

My problem is that I just simply need to lie about my use in our local healthcare clinic's drug counceling service as otherwise it would affect to my driving license as I need to give those UAs for that matter as well as for children welfare services.

I wouldn't lose my license or have any problems with children welfare services for showing pot in UA but MDMA and LSD for example would be a different matter.

It is so excruciating to go to a drug councelor to talk about issues if I simply cannot tell about my real use although it doesn't have any negative outcomes for me at the moment.

It is just stupid that they don't have any dimensions for drug use as taking MDMA once a month is considered as being same as taking +250mg oxycodone a day along with plenty of benzos, Lyrica and such.

I know how much my functioning was altered back then because of those drugs I took but as those were prescribed they didn't consider that it would have an effect for my driving skills or how I could function with my daughter but single MDMA use is considered being worse than being zombified on those other drugs.

This current atmosphere of drug counceling needs some kind of shaking so that abstinence from everything isn't the only option available.

 

[cj]

Agreed. The system fails the majority of people.

 

[Jabberwocky]

This was also my experience. I actually decided to get off methadone earlier than I'd planned because I was totally fed up with the narrow mindedness of the whole abstinence only paradigm (which the prescribing doctor definitely subscribed to).

Trying to talk to my drug counselor about how I used MDMA at a concert when I was on methadone was the worst decision ever (despite never having any issues with it, the prescribing doctor decided to punish me for being honest by taking away my take homes... the drug didn't even show up on a drug test, I just didn't want to lie to them). Lesson learned.

It's a joke, but what do you expect. Only 3% of substance use disorder treatment providers in the US give patients access to buprenorphine/methadone/naltrexone. Over 50% of them do not provide any kind of MAT for opioid use disorder.

It's a joke. But once you realize the goals of (at least in the US) drug policy isn't to support drug users heal but instead to kill them, well it isn't so mysterious why we do what we do anymore...

Help is absolutely necessary sometimes, but that doesn't mean passing isn't still a very important strategy when it comes to drug users maintaining their health and wellbeing when working with medical "professionals." Which is beyond frustrating, because one of the most important aspects of recovery is having safe spaces where one doesn't have to bullshit the people they're trying to get help from.

 

[simco]

Almost on-topic...I had an intake with a new psychiatrist yesterday (just moved to a new town). I've had a 1mg/day clonazepam script since 1998, and those clonnies are very helpful for me (I've always taken them as prescribed; never abused them). But ever since I went into treatment for heroin addiction, the majority of shrinks refuse to Rx benzos to me... it's gotten to the point where the whole matter is incredibly stressful--worried I won't be able to get a medication that is a) very helpful for me and b) that I am physically dependent on.

So, during my appointment yesterday I lied to the doctor. He asked if I use any drugs or have ever had a problem with addiction. I simply said no.

Made me feel like an asshole; I don't see a ton of point to visiting mental health providers if you don't tell them what's really going on. It's not exactly part of the abstinence-only paradigm, but pretty close--a drug addiction of any stripe seems to be enough in the US to cause doctors to make a whole swathe of assumptions about a patient.

Drives me fucking bananas.

 

[Jabberwocky]

I've definitely run into that problem before. The solution seems to be seeing a doctor who is willing to only work on the mental health stuff with me, as opposed to someone who wants to work on addiction. I've only had positive experiences working with psychiatrists post heroin use disorder who didn't focus on addiction.

Something to keep in mind is that a good doctor will understand a patient isn't always comfortable spilling their guts at the first visit. I had a doctor I saw when I was on methadone who was great. I sure as hell wasn't okay telling him about my status as a methadone patient given all the stigma surrounding it in the field of psychiatry (let alone the SUD treatment, which is a joke of course).

Eventually I did tell him about my history with addiction, opioid use disorder and status as a MMT patient. I expected him to be pissed, or at least a little judgmental. He basically responded by expressing he understood my concern about confiding this info and that it often takes time for patients to feel comfortable volunteering difficult info to healthcare providers.

He was a great doctor. I'm pretty jaded when it comes to working with doctors who specialize primarily in substance use disorder/addiction. All those I've ever tried working with (with perhaps the exception of one) were real good at being dicks and ignoring whatever I tried to tell them.

Sigh...

 

[MrRoot]

I am lucky to have my psych at different place than counceling and he said to me that although substance use and my mental illnesses may be related and possibly made worse by continuing to use drugs he still will focus on my mental health instead of abstenance of drugs as he is a specialist on that area.

I feel much more comfortable to talk about all the usage with him and he doesn't lecture me about my use but instead asks questions about my use as for example what did I experience before making a decision to use and how did I feel afterwards.

He is a nice guy and even plays Magic the Gathering and we often meet on Friday Night Magic meetings at our local hobby store.

Atleast I can be totally honest for him about my usage.