That’s nice. Please, share with me where anyone suggested that merely more ORT alone is the solution. I certainly haven’t been. But I have been arguing it is ideally a part of the solution. Otherwise it will just be part of the problem.
On a personal note, although I take great offense at the way you characterize my own process as somehow interior to your own, you don’t see me discrediting your own recovery. Whatever works works, after all. But what is likely to work for one person compared to another is another matter. There isn’t one solution for everyone here. The end goal for everyone might be abstience from harmful substance use, but we all enter this process at whatever stage we are at as individuals developing according to unique sets of conditions and predispositions. Although I don’t want to antagonize you, I think it is telling that one of us is getting defensive about this discussion, and the other isn’t.
We give the advice we do because this isn’t an abstience only forum. The reality of the medical literature is that ORT program are simply more effective than abstience only programs. The best programs are interdisciplinary, including pharmacotherapy (which may or may not involve ORT), individual therapy (using modern modalities like motivational interviewing, CBT, trauma therapy, etc), group process/therapy, educational programs and auxiliary peer support (which may include recovery oriented groups, but is not limited to them) Most rehabs are weighted far on the site of group therapy and peer support. Why? Economics. Most treatment centers are for profit, with a programme influenced heavy on the side of maintaining profitability. This isn’t necessarily a bad thing, but there is no legitimate reason treatment should cost tens of thousands of dollars for one to two months, except for the fact that they are in an incredibly powerful position to exploit the generally uneducated fears of the public under the war on drugs when it comes to “drug abuse” and “addiction.” The most popular mentality among recovery groups and professionals alike still involved a “tough love” approach, despite the fact that there is no actual need for this past the fact it is what our society knows best. It is impossible to talk about addiction or substance use disorder treatment without divorcing them from their context, and that context is one where drug use is almost exclusively treated as a public safety and not a public health issue. Until we are able to make progress on the public health front and reframe substance use disorder away from the ideology of substance abuse and substance use as merely a matter of “hijacking” the brain, it is almost guaranteed truly effective programs of treatment will remain elusive or reserved only for those with the financial means to pay for them.
Now, in terms of this specific case, do although you say you have a lot of experience with ORT, you don’t seem to realize the difficulty involved in transitioning off a high dose of methadone. Yes it can be done in a short period of time, especially without the use of something like buprenorphine to transition them off, they will experience severe discomfort. No amount of group therapy or meetings will be able to remove this suffering alone. I’m not saying they aren’t helpful, just that they aren’t enough to avoid profound discomfort. For some people, discomfort can be a useful motivational force. However, extreme discomfort also is associated with relapse. It is release that is, if at all possible, best avoided. That isn’t to say it generally isn’t part of the process, just that if it can be avoided the recovery process is generally more manageable. .
Another reality is that, IME, someone who is unwilling to engage in a proper taper is unlikely to simply walk away from ORT. This stuff is serious medication, and nothing to be taken lightly. It can be extremely useful when used properly, but trying to kick a 70mg methadone dependency by just using a program that doesn’t take the progress that has been made in addiction science and medicine more generally, especially in terms of neuropsychopharmacotherapy and behaviorist science, is setting the client up for failure.
What we are suggesting is this I think:
- Taper down to a more reasonable dose before seeking out further treatment (actually the best option would be to seek other treatment WHILE tapering, but for a variety or reasons many treatment providers will not accept patients on ORT, especially methadone, for rather arbitrary reasons most of the time).
- Use appropriate medications to facilitate the detox and early recovery process to help prevent relapse and support the client bouncing back from a lapse instead of allowing it to devolve into a full fledged relapse. To some degree this will almost certainly mean some amount of buprenorphine.
- Utilize whatever behavioral treatment is available, such as going into an inpatient program, at the very least just for the detox, but ideally for one to three months. The program should be interdisciplinary and provide a range of modalities (at a minimum, process groups, education, peer support, CBT, motivational interviewing and trauma therapy - this is an ideal, but for the most part there are lots of programs that provide such a range of services).
- Follow inpatient therapy with outpatient therapy for a period of time to be addressed on an ongoing basis while appropriate support systems are being utilized, such as weekly (once to twice a week) individual therapy and regular meetings wth a psychiatrist and general practitioner, as well as any other specialist that is necessarily based on client need.
You notice we are NOT suggesting ORT is merely the solution. It is part of the solution in this case, if for not other reason than it has already become such as the OP is already in methadone as ORT. I have no interest in emulating your dogma. I’d rather support people figure things out on their own, what is right for them, and encourage authenticity, self determination and self actualization. Recovery is first and foremost a developmental process.
You are professionally connected to an abstience only based treatment program, if I remember correctly? That is where I seen your vested interests laying.
What I take issue with you above post is presenting ORT as an inherently inferior treatment. For some people, it isn’t the right decision for sure. But for others (many many others, far more than currently have safe access to it), ORT is essential to their process. You’re arguing that there is one approach to addiction (embodied by the abstience only ideology) that is right for everyone. I’m arguing that it is a very personal, individual process, and that different modalities will be appropriate for different people in different situations. You’re arguing from the perspective of a drugs warrior, even if you aren’t aware of it. I’m arguing from a public health perspective.
Please note, I’m not saying abstience isn’t the goal. But if the OP isn’t using a certainty drug, they are practicing abstience from that drug. I don’t care is someone is practicing total, complete and black and white abstience just as long as they are making progress moving beyond harmful behavioral patterns. All I ask is progress, not perfections. Oh, the irony!
We have more in common than you might realize jd. It is just that we different in terms of one key fundamental aspect of recovery. I see recovery from the lense of the rainbow of options available, where as you see it more narrowly through your own personal experience with it. Or that is at least how you come off in post like these. Some of your earlier posts recently have been very supportive, very even minded, very on point. But I have no time for abstience only propaganda that argues ORT (or even psychiatric medication) somehow disqualified someone from meaningful recovery or sobriety. That is simply not accurate. For some people, like I said it, it isn’t appropriate. But that isn’t an issue related to anything inherent to the pharmacotherapy. It is an issue of someone being mismatched with a treatment modality for whatever reason.
There are A LOT of options out there. Often I feel like the most challenging aspect of quality treatment is primarily a matter of triage, with an individual being mismatched with a particular treatment or getting funneled into a treatment that is narrow minded and too black and white.
If more inpatient treatment providers offered more quality support with the range of options that are available instead of what you generally see (an over emphasis on group therapy and peer support and underemphasis on other modalities), you hear me recommending it faaaaaaaar more than I currently do. But that was what I was saying earlier in this post: until we are able to treat drug use as primarily a health issue as opposed to a criminal matter, I don’t see much changing in that regard.
We love the voice for abstience in SL, and you’ve provided some great contributions along those lines. However, recovery is about more than abstience. If that were the case, people would just stop using drugs and they’d be fine. But the reality is far messier and more nuanced. The actual drug use is almost always connected with other issues. Otherwise it wouldn’t be accurately characterized as substance use disorder (which defines all this in terms of more than just whether someone is using or not).
Within the recovery industry, when it comes to abuse more harm has been done to drug users through the ideology of there being some best solution for everyone and that having options available to the patient provided in a client-centered fashion is just going to lead the client to continue fucking themselves up than any other perspective that I am aware of.
Reread cj’s last post. We strive to present the range of options available for treatment and recovery. You see it as problematic as suggesting ORT could be part of the solution, so it doesn’t surprise me that anywhere we offer it as an option for someone you take issue. It seems to be part of your worldview, and you are hardly unique in that regard. Sometimes I feel kinda like that perspective is the pimple on the ass of time when it comes to recovery support.
