How does ASAT support recovery?
People get to a point where they think, okay so I stopped the coping behavior, now what? If just stopping substance use or stopping something that was causing negative effects in my life was adequate, I wouldn’t be thinking about what my New Year’s resolutions were going to be this year. So once you’ve gone through withdrawal management, you’re stabilized, you’re no longer using a substance in a negative way, what does your recovery look like? And that’s where abstinence supported environments come in. You have this period of life where you can practice recovery-based skills and competencies and get the basic life skills of growing up.
Self-Medicating - Simon Pegg’s experience with self-medication is likely familiar to many other recovering addicts. It absolutely reflects my own life story. Like Pegg, I was diagnosed with depression as a teenager, and started “treating” it with alcohol from an early age. Alcohol made me feel better in the moment, while doing nothing whatsoever to address the underlying issue. In fact, by the time I eventually got sober at age 29, my depression had grown worse than ever before. This falls exactly in line with a warning from the CDC that excessive alcohol use may increase anxiety, depression, and other mental health issues.
Simon Pegg drew on his experiences with addiction when co-writing The World’s End with Edgar Wright. The movie is a science-fiction comedy about a group of friends trying to complete a pub crawl which ends at a bar called “The World’s End.”Fittingly, as they progress through the bars, aliens invade, putting the characters in the wake of a potential literal “world’s end.” It’s a funny movie, but it’s also a parable about alcoholism. As everything goes to hell around them, Pegg’s character remains obsessed with finishing the pub crawl.
Pegg told Jonze “that’s what addiction is like. It’s like you have grown a second head and all it wants to do is destroy itself, and it puts that ahead of everything else — your marriage, children, your job.”
In opioid use disorder treatment, there’s been a persistent (though not always acknowledged) tension between what’s good for public health and what individuals and their families want from treatment. I’ve written about it before. For public health, there’s plenty of evidence that MAT (medication assisted treatment) reduces illicit drug use, improves health and reduces crude mortality rates.
Meeting people with opiate use disorder who were in long term abstinent recovery from illicit and prescribed drugs changed my mind about what was possible. I suppose I have met hundreds of such people over the years. That’s a game changer. I worry that some prescribers don’t spend enough time with people in recovery.
Although there are substantial benefits to MAT, there are also problems: non-engagement with those who would benefit and timely access for instance. Then there are other issues too: stigmatisation of those on methadone, poor retention in treatment and how MAT fits in with the management of problem polysubstance use, including alcohol.
So, does MAT help patients achieve their wider goals – those person-important outcomes?
We don’t really know is the short answer. A systematic review published in 2017, found that health related quality of life measures are rarely used as outcomes in MAT research. When looked at from a recovery perspective, we have more evidence on the negatives that go than on the positives that arrive. There are studies showing improved quality of life, but we need more on whether people reach their goals and get improvements in the things that matter to them.
A small in-depth Norwegian study involving 7 women and 18 men on MAT found evidence of them being ‘stuck in limbo’ in terms of not moving on despite national guidance that the patient’s own goals ‘should be the basis of treatment’. These drug users were still engaged in illicit drug scenes. The researchers found four themes:
“It’s not that difficult to overcome these seemingly ghastly problems [drug addiction]… what’s hard is to decide to do it.”
This is where assisted decision-making is imperative. The drug addled brain has corrupted processes due to the presence and interference of psychotropic toxins. The Judicial Educator effectively used, is best placed to be actively engaged through problem-solving courts as a key circuit breaker needed to help facilitate the exit from this capacity and agency diminishing haze. Punitive action is not necessary, if coercive mechanisms are able to recalibrate the dysfunction posture, through drug use exiting recovery processes. This is just one reason why 'legalizing' drugs is a very bad idea, as it eliminates this vital, individual and community benefiting intervention and it is also a care-less action for a society with increasing drug use induced harms.
Why Calls for Decriminalizing Drug Use, is Really Not a Care-full Agenda! Anti-drug laws were always meant to be a vehicle to protect Community, family and our most important asset – our children – from the harms caused by permission models that ‘grown ups’ believe they have the right to exercise around the use of psychotropic toxins.
These proactive and protective laws have not been used in any real punitive context for decades now and our families and communities are paying the price for this so called ‘progressive’ agenda.
It’s time we tasked these protective laws again in their most proactive framework – As the ‘Judicial Educator’.
The law used (not in a punitive context) but as with Problem Solving Courts, to facilitate not only exit from drug use, but entrance into productive, safe, health and community benefiting narratives, that are drug free.
You don’t have to change or remove laws, but you can task that legislation to facilitate rehabilitation and recovery, as is being done more and more to great success.
The existing criminal codes don’t need to be weakened, or worse erased, through legalization or even depenalization. They can be used, as mentioned for diversion, but still have the coercive potential of criminal sanctions if the drug user choices to carelessly re-offend, often with harms to those around them.
No criminal records need to be recorded if the diversion path is embarrassed to its effective end.
The pro-drug lobbies completely fallacious meme of ‘war on drugs has failed’ only has traction for the uniformed. There has been no ‘war on drugs’ in this nation since 1985. However, the ever growing ‘war FOR drugs’ continues to look to remove genuine tools that can bring best-practice drug use exiting outcomes, by mislabelling and propagandizing.
The Judicial educator is the perfect bookend for the other bookend of health and education. Together these will see, not further ‘permission’ for drug use and the ensuing uptake that always precipitates, but rather, as with Tobacco, a community with One Voice, Once Message and One Focus – the cessation of humanity, dignity, agency and family devastating drug use. That should be the agenda of all drug use reduction vehicles.
The excising of any vehicle that can assist with that proactive and productive end, is not only non-sense, but also only adds to the harms that drug use does to our communities and their families.
Once psychotropic toxins are an intrenched part of the behavioural mechanisms of an individual, whether it be short-term intoxication, or long-term dependency, the risk to health, safety and well-being of that individual and more concerningly, those around them requires more than a ‘doctor’ for change. Secure welfare engaged for rehabilitation continues to prove the safest and healthiest vehicle to assist that change.
We seem to care more for Tobacco users, than illicit drug users – Don’t the latter deserve the same passionate enabling to exit drug use, with no voice of permission or approval in the marketplace?
There must be a thorough enabling, equipping and empowering of drug users to exit drug use, even more importantly before the inevitable dependency takes hold.
Any permission model – decriminalisation, legalisation or depenalization – does not add to that capacity of drug users to move out of drug use. However, it has and will continue to do so, if the only proactively coercive vehicle – The Law – is removed, further normalizing drug use and the inevitable entrenched harms this will bring.
The Judicial Educator At Its Best – Law for Recovery + Drug Courts + Secure Welfare = Rehabilitation!