The Evolution of Addiction Treatment: Desperate For a Fix
The evolution of addiction treatment began during the Vietnam War, with thousands of troops returning to the U.S. after being exposed to the abundance of cheap drugs in South East Asia. Today funding has been shaved off the treatment pillar leaving addiction treatment desperate for a fix.
My friend Leo was a raging alcoholic. A fisherman from Port Alberni, Leo loved the sea, but his family wanted him on the other side of the Island working in their gravel pit. He would put in week after week driving a grader in the hills behind Duncan, then one night he’d suddenly snap, drink a bottle of Jim Beam, get into his truck and try to make it home, like a salmon with wheels.
The last time he tried this stunt the cops found his truck in the ditch outside Butterfly World. He had a blood alcohol reading of .39. You and I would be dead. He was still trying to shift gears. The doctor told him his liver might go at any moment, but what scared him more than death was that one more drunk-driving charge would mean jail time. Yet he just couldn’t stop. So a month later, before he could repeat his offense, his family staged an intervention. They took him to Vancouver General Hospital for a check-up. Once he was inside, two orderlies grabbed him. Later he said, “It was weird. The orderlies had the faces of my brothers, and the nurse had the face of my mom, and I tried to get ’em.”
They put him in a cement cell in the psychiatric assessment unit, with a plastic ice cream pail of drinking water and another for a bedpan. He kicked the door with both feet, over and over, until repeated landings on the cement floor threatened to break his hip. “Then I got smart. I pulled the mattress over to the door so I was falling on it.” He kicked that door all night until his feet were slippery with blood. When he got home we spent countless hours at his kitchen table talking about detox and rehab. “Twelve steps really helps,” he said. “If you can just open up and talk about this shit, it really helps.” I was not convinced, because Leo was slurring his words as he spoke. In fact, every morning he rose at dawn, drank his twenty-sixer of bourbon, passed out around noon, and woke up again in time for supper and AA, whose 12-step shtick hadn’t altered his flight plan in the least. After a few months of these kitchen table chats, Leo’s liver failed and he died of a heart attack. At his funeral people said he had a death wish, but I couldn’t forget the way he kicked his cell door all night. Leo wanted to live. He just didn’t know how.
In the dozen years since Leo’s death, science has changed our understanding of addiction. B.C.’s rehab business has mushroomed into an industry, with private clinics popping up all over the province and raking in the cash. But patients still die weeks after walking out the door, because the new system is flawed in new ways. The program that failed Leo was a standard 28-day residency, which came out of the Vietnam War. Cannily intuiting that the returning troops would need some serious TLC after indulging in the cheap and plentiful drugs of Southeast Asia, hundreds of American entrepreneurs founded private rehab clinics that offered solace on a vet’s insurance budget. The 28-day period was chosen simply because it’s the length of the shortest month, the maximum stay the army was required to cover. These new facilities claimed wonderful results, which over the next few decades were slowly revealed to be completely bogus, based not upon scientific evidence but on whatever the clinic owners thought their clients wanted to hear. Before Congress cottoned to the scam, billions were squandered, and the one-month residency program had become entrenched all over North America, including B.C.
After the shakedown, the B.C. government set out to develop a new “evidence-based” policy, which is outlined in the Ministry of Health’s 2004 manifesto, Every Door is the Right Door. Appendix III of the document sums up the history of addiction treatment: the original “shame-based” model, which blamed the victim’s moral weakness, evolved by the 1960s into the “disease model” used in the original 28-day program, which treated addiction as a medical condition.
By the mid-’90s, the disease model had been retooled into “cognitive behavioural therapy”; addicts undergo behaviour therapy to help them break the connection between troublesome situations and their habitual responses to them. At the same time, cognitive therapy is provided to help them identify the thinking patterns that provoke their addictive behaviour in the first place. The government’s approach is commonly known as the four pillars: harm reduction, enforcement, treatment and education. It sounds very stable, but those pillars keep changing height. Ten years ago, little or no money was spent on such harm reduction measures as safe injection sites, needle exchanges and methadone clinics because the medical community considered these strategies ineffective.
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If it causes harm, deal with
Submitted by Anonymous on Sun, 2009-05-24 06:23.