Coming To Terms With Harm Reduction

I’ve had an interesting relationship with harm reduction over the years. Prior to sobering up in January of 2005 I tried my luck with controlled drinking and failed miserably. At the time I didn’t know about the phenomenon of craving when it comes to alcohol. I’m one of the 10 per cent of the population who have the disease of alcoholism. A few years into recovery I also tried to cut down my smoking but failed at that as well. I’m an all or nothing kind of guy.

Early into recovery I became an addictions counsellor and my first job was with the same agency that I got sober at. It was a disease-model, abstinence-based, centre which put heavy emphasis into the 12 Steps of recovery. At that time I was steadfast in my belief that abstinence was the only way to achieve recovery, the 12 Step way at that. For my own recovery I feel that was the place I needed to be. For me, harm reduction doesn’t work and will only lead to disaster. As my career branched out to other treatment centres I began to take another look at my devotion to the idea that abstinence is the only way to go. When I speak of abstinence I’m talking about abstinence from all mind altering substances, including alcohol, marijuana and benzodiazepines, no matter what your preferred method of escape was. Oxycontin use was on the rise and more and more people were seeking treatment for addiction to it. A segment of these people became addicted to Oxy after a doctor prescribed it to them for a legitimate reason. This particular group never had an issue with alcohol or other substances. I started feel that this group of people may be able to drink alcohol or smoke marijuana safely. However, they would have to be very careful in case a problem arose.

Over the years I’ve been in recovery and addiction counselling I saw several types of harm reduction. From Methadone to Suboxone, I’m still of the belief that when it comes to opiate addiction (not in the case of the aforementioned population segment) the greatest chance for an optimal quality life is complete abstinence from alcohol and all mind altering substances. However, I’m no longer so naïve as to think that everyone can accomplish this and have realized that some individuals will be on these types of medications for years, maybe even life. However, I firmly believe that the harm reduction factor is wiped out if doctors continue to prescribe these medications knowing that the persons using them are using other substances at the same time.

Recently I changed up my career. I am no longer an addictions counsellor but am what’s called a Peer Support Worker helping marginalized segments of our population. Most notably people suffering from mental health issues, addictions and homelessness. As part of my new job I get to ride in an Outreach Van handing out food, clothes, blankets, etc. Part of the van’s function is also a needle exchange program. Not only do we hand out clean needles but arm ties, cooking kits and other types of paraphernalia needed to shoot-up substances. I know that I would not have been able to carry out this type of work early in my recovery but today it doesn’t bother me in the least. It’s not my job, professionally or personally, to tell people how they should live their lives. If they ask me for a better way then I’m available to guide them in that direction. Until then I’m just happy to be preventing the spread of disease and allowing addicts to maintain some level of dignity.

Dave the Dude

To Swear or Not to Swear

To swear or not to swear that is the question. What am I talking about? Every once in a while I get into a debate with someone on whether it’s okay to swear at the front of the rooms when sharing your experience, strength and hope. I’m of the belief that one should not swear. I was taught, by those who went before me, that when I share my story at a meeting of Alcoholics Anonymous (or any other fellowship) I am representing AA and if a newcomer sees me swearing up a storm I’m not representing the fellowship very well.

Another reason I don’t swear at the front of the room (and try not to in my day-to-day life) is that swearing is negative and anti-spiritual. I expressed this to someone recently and they launched into a giant tirade about me judging their spirituality. The person said, “Who are you to judge my spirituality?” I wasn’t judging the person. I just know, for myself, “a spiritual awakening is a personality change sufficient to bring about recovery from [addiction]” (Big Book, 1939). I acted and thought one way prior to recovery and I act and think differently now. The old me swore left, right and centre and the new me tries not to, especially when sharing my story at the front of a 12 Step meeting.

My friend was perfectly correct. It’s not up to me to tell someone not to swear when they share (except for my sponsees). However, this debate always brings back the memory of a meeting I attended at a fellowship I rarely attend any longer. I was at an open speaker meeting and the speaker was doing a great job. I thought he was great until he suddenly said, “…and then I found my fucking Higher Power”. As soon as he said that I realized that I didn’t want the kind of sobriety that guy had.

I understand it’s, “progress not perfection” (Big Book, 1939),  and that the odd swear word may slip out once in a while abut when it’s purposely done I have to wonder what it the point. Recovery is about change. If hold on to my old ideas that swearing is perfectly okay then I remain stagnant and do not change. As I was taught when I entered recovery if nothing changes my sobriety date will.

Dave the Dude

A Sad State of Affairs

For the second year in a row I attended Toronto’s Recovery Day event. As a person who is proud to be in recovery I think Recovery Day is a great idea. It originated in the U.S. as part of the Voices in Recovery Movement (VRM). It’s a grassroots movement with, from my understanding, a two-fold purpose. First to remove the stigma that people who suffer from the disease of addiction face. Second, to act as the vanguards of advocacy to get legislation passed to treat addiction as a disease rather than a crime.

Last year’s event in Toronto was not well attended and I blamed a broken down subway line. However, this year the subway was fine and there seemed to be even less people in attendance. I believe the reason for this is that the people in recovery, those the VRM want to help, refuse to embrace the movement. I further believe that this refusal is based on a misinterpretation of the anonymity tradition followed by 12 Step fellowships world-wide. People have this mistaken belief that if you tell someone you are a recovered alcoholic/addict or as the VRM would word it, “a person of recovery”, you are breaking anonymity. Bill Wilson, co-founder of the original 12 Step Fellowship Alcoholics Anonymous and author of the 12 Traditions, did not want people to hide the fact that they had, “recovered from a seemingly hopeless state of mind and body” from the rest of the world. Recovered people do not hide from the world they embrace it. Bill Wilson spoke before a U.S. Congressional Committee in the 1960s (after the 12 Traditions had been adopted) and both him and Dr. Bob Smith (AA’s other co-founder) appointed Marty Mann (AKA: The First Lady of AA) to be a spokesperson to the world in an effort to educate the public that addiction wasn’t a lack of morals or will-power but a medical disease. I firmly believe that both Bill and Dr. Bob would not only attend a Recovery Day in their area but announce at meetings as well.

I am a person of long-term recovery which means I haven’t seen the need to take a drink or mind-altering substance since January 7, 2005. In my recovery journey I have seen first-hand the stigma people with mental health/addiction issues face and the lack of government funded treatments for those who suffer from this illness. I have experienced the strength of various 12 Step Fellowships and the enthusiasm those involved have for recovery events. When I was six months sober I had the privilege to attend the World Conference of Alcoholics Anonymous in Toronto. Along with 50,000 other people I said the Serenity Prayer in the SkyDome. I walked the streets of Toronto proudly displaying my World Conference AA Pass for all to see. From what I observed the majority of those in attendance weren’t hiding their passes either. I regularly attend the annual Ontario Regional Conference of Alcoholics Anonymous (ORC) at the Royal York in Toronto. Although not quite 50,000 people attend there are a good 3,000. At the local AA meetings I attend the ORC and smaller events are regularly announced and received with enthusiasm by a group voracious to attend all things recovery themed. However, when I announced Recovery Day in my area I was met with hostility by some.

The founders of the 12 Step movements were for helping the still suffering person. The Basic Text of Alcoholics Anonymous states that it doesn’t know everything and promotes cooperation with those who also want to help. This cooperation was clearly not present in Toronto on the last two Recovery Days (2015 & 2016). I was glad to see a Narcotics Anonymous Booth there but aggrieved that no booth existed for either Alcoholics Anonymous or Cocaine Anonymous. I’ve seen AA booths set up in other community celebrations and/or information days but not for the one set aside especially for those it was formed to help. In fact the Toronto Intergroup is anti-Recovery Day which I can only assume is based on the aforementioned misinterpretation of anonymity tradition.

The Voices in Recovery Movement seeks to show politicians that those in Recovery do vote and can have significant sway in elections. It’s based on the movement by the gay community formed in the 1980s when it was faced with the AIDS epidemic. Sad to say, at least in Toronto, this advocacy movement is not as successful as the one it tries to emulate. In fact, based on the numbers of people in attendance I cannot see our current government or any future one making any changes to the health care system that would help the still suffering alcoholic/addict. A sad state of affairs - indeed.

Dave the Dude

My AA Nightmare

As I sat in the meeting last night I observed that the gentleman next to me had a bad cold. As the meeting went on I noticed that he was blowing his nose and using tissue after tissue. It appeared to be quite the mucus mess. I had a hard time remaining in the now as all I could think of was having to hold his hand during the closing prayer thus risking picking up whatever virus was wreaking havoc on his body. 

At the conclusion of the meeting I was relieved to see the gentleman had gone to the bathroom and not yet returned. I finished the meeting grateful I did not have to take ahold of the infected hand. 

Later that night as I awoke with the beginnings of a sore throat it dawned on me I had shaken the aforementioned gentleman's hand when I introduced myself prior to the start of the meeting. Ahhhhhhhh!!!! 😱

Dave the Dude

Objectionable Treatment Practices

There is a plethora of addiction/mental health treatment centres across Canada, many of them private. In Ontario anyone with a load of money and/or a desire to make more can open one as there is no regulations whatsoever and no plans in the near future to bring in any. This opens the playing field to a host of ne-er-do-wells who take advantage of the lack of regulation, preying on the misery and desperation of families suffering from the disease of addiction and/or mental health. Not only do these people prey on those needing help they also prey on those wanting to help the sick individuals.

Many of the people who open a treatment centre get it into because they have found recovery themselves. Unfortunately, as we say in Alcoholics Anonymous, if you sober up a horse thief you still have a horse thief. Or in this case if you sober up a scum-bag you still have a scum-bag. I’ve been in the field of addictions for over a decade now and have run into my fair share of unscrupulous people. Without naming names (as I’ve had to sign confidentiality agreements) let me share with you a few of my experiences.

There was one centre I had the displeasure to work for that seemed okay at the beginning. The front-line staff was great and even some of the on-site management. I began to see the perniciousness of the centre when I met the main owner. He made his money (prior to getting into the treatment business) by targeting the very people he now wanted to help with a string of payday loan outlets. Actually I wouldn’t say he wanted to help the ones who patronized those establishments as they wouldn’t be able to afford the addiction centre he had opened. This guy went after the whales of addiction – people who still had money or whose families did. I knew something was off with the guy when I first met him. He came to the centre in his high-priced car accompanies by his newly purchased pure-bred puppy. The puppy’s ears were a bleeding mess as the owner had just had them clipped. He mentioned that he had to return the puppy as it was sick. When I asked what would happen to the dog he shrugged it off giving a clear impression that he didn’t give a shit. As time went on myself and other staff realized that this guy didn’t not only didn’t give a shit about canines but didn’t care much for employees or those they were trying to help either. Problems soon arose with bounced bay cheques or none at all. At first staff was patient but when there was not even a sorry from this multi-mansion living owner we began to despair.

The centre owned by this Machiavellian of money-making didn’t have intake counsellors but sales people (a commonality of private centre in the province and across the nation). These sales people, posing as addiction experts, would say anything to get a client signed up for the $20,000 per/month treatment program. One of these hucksters was able to convince a disabled guy in a wheelchair to sign up for treatment, despite the fact that the facility was not accessible to someone in his condition. The guy was able to stick it out for three days before he came to his senses but that was all that was needed because after three days in the facility there was a no-money back clause in the treatment contract. I wish I could say this type of thing was isolated to this one centre but it is becoming a wide-spread epidemic amongst centres in Ontario and across Canada for that matter. Owners/CFOs/CEOs will often tell counsellors to try to makes sure a client stays in treatment at least to the no-money back clause kicks in.

I worked at this one place where families sent loved ones with extreme addiction/mental health issues to get help. Unfortunately for these people they weren’t properly assessed prior to coming to the centre and as a result staff was not properly informed of the issues the person was facing putting both them and clients’ safety in jeopardy. Again it seems the aura of green overshadowed the need to help. There were also very blurry lines between some clinical staff and clients. There was one counsellor who would take two individuals out for day passes when he was off-duty. There seemed to be no line between counsellor and client. There also appeared to be sets of rules that were enforced on regular clients but not on individuals who head clinical staff had a soft spot for. Treatment centres need to be client-centred but they also need to have a set of guidelines that must be adhered to or chaos ensues and no one is helped. For some reason I’ve seen these guidelines thrown by the wayside causing great havoc masked with veil of a therapeutic intervention.

At one centre clients facing therapeutic consequences for negative behaviours were able to plead to the owner to overrule clinical staff. The owner would do so, despite having no clinical training himself, thus throwing a whole stink on the therapeutic dynamic in the centre and undermining the authority of all. In my experience therapists often undermine the authority of addiction counsellors in much the same way but an owner doing this is, my in opinion, is much worse.

What can be done about this? The government must bring in regulation. A few organizations have been formed to try to bring a degree of professionalism but none are recognized by the province or the feds. When and if the government brings in regulations it needs to do so with input from experts in the field hailing from the many successful interventions, including 12 Step which government officials tend to be wary of – most likely because it has to do with a Higher Power which is not quantifiable.

Every so often I have friends and family asking for advice on places to send loved ones for addiction/mental health help. I have come to the conclusion that people should only be sent to institutions that have been around longer than 15 years. This isn’t the only criteria I tell them to look at but it is an important one

Dave the Dude

The 12 Step Effect on Addictions Counselling

I’ve been in the addictions field for around a decade. My inspiration in joining the addictions counselling ranks came from my own personal journey in recovery. After battling addiction for several years I finally became sober by joining a 12 Step fellowship and working the 12 Steps as laid out in the Basic Text of Alcoholics Anonymous. In all the various treatment centres I have worked at there have been fellow employees who also found recovery through a 12 Step program. I have found that counsellors who sobered up with AA or CA or NA, etc. can be divided up into several categories. Here are the three I see most often.

The first type is the hard-core, only 12 Steps will work, counsellor. This is the type of guy (or gal) who upon meeting a new employee says something silly like, “are you one of us?” These types of counsellors are close-minded to other approaches to recovery just as they may have been close-minded to something like Alcoholics Anonymous prior to becoming sober. They openly mock those employees without 12 Step recovery. When I first began working in the addictions field I would have fallen, for the most part, into this category. Luckily I was exposed to the right kind of people and philosophies and have since broadened my perspective.

The second type of counsellor who found recovery in a 12 Step fellowship is the 12 Step Apologist. This type of counselor tries to distance himself from AA, CA, NA, etc. as much as possible going so far as expressing embarrassment towards their exposure to the program. They openly mock 12 Step suggestions, change the wording of the Steps and make fun of those counsellors who try to share their experience with the program. These guys have gone over to what I call the dark side of addictions philosophy using only “science-based” interventions to help people. This counsellor disregards their own spiritual awakening thinking that it doesn’t belong in the so-called professional setting of addictions counselling.

The third type of counsellor is the one who is comfortable with his own 12 Step journey and is not afraid to share it with clients. He is not embarrassed by it and tires to impart that power a 12 Step approach can have on someone seeking recovery. At the same time this person is open to new ideas that may be beneficial to recovery even if he doesn’t use them himself. I like to think I am in this category. I realize that things not written in the Big Book of AA can be beneficial to recovery. I have not tried yoga but have seen its benefits. Saying this I recently came under fire at a former job when I suggested reducing mandatory yoga from four times a week to three times a week in order to include an extra 12 Step meeting, inferring that it may be more beneficial to a newcomer’s recovery. Other interventions I have not tried but seen help people with addictions have been acupuncture, hypnosis therapy and mindfulness. I still believe that a 12 Step Program is essential for success in recovery but realize that the interventions I have mentioned, and that I have not, are also a big part in helping a person find stable sobriety.

Counsellors with a personal 12 Step background can be a very powerful tool in the fight against addiction as long as they realize, as the Big Book also states, that their experience is not the be all and end all of addiction interventions.

Dave the Dude

The Great Treatment Fallacy

Any good treatment centre will tell you that treatment is just a beginning it’s not a cure. Treatment is a safe place for an addict to remain sober and learn the tools he will need to continue a sober life once he returns to the outside world. Unfortunately, there is a fallacy that addicts and their family members have fallen prey to and that’s that therapy is needed right away. This couldn’t be further from the truth and often causes further suffering for the addict and her family. Ontario, Canada (most likely the whole country) has a terrible mental health system and not enough, publicly funded, treatment beds which has resulted in a plethora of private addiction treatment centres popping up and competing for those who can afford it. Due to the fact that addicts and their families are not properly educated about how treatment should work these private facilities boast one-on-one therapy sessions for clients in order to attract new customers and the customers buy into it.

Constant drug and alcohol abuse not only affects the body but it also affects the mind. The brain begins to get re-wired and the addict acts out in odd ways. I remember becoming very paranoid when using stimulants and depressed and anxious when I wasn’t using. Near the end of my drug and alcohol use I’d break down in tears on my way to work for no discernable reason. Many people looking at this behaviour would classify me as mentally ill but a good diagnosis could not be made until I had some stability in my sobriety.

People self-medicate in order not to feel pain.  When I say the word pain most people jump to the conclusion that I’m talking about physical pain but we all suffer emotional pain in our daily lives. The addict cannot handle this pain and turns to the most successful tool in getting rid of that pain- self-medication. Regrettably, the tool works so well at first the addict doesn’t pick up any other methods to deal with pain relying solely on drugs and alcohol which inevitably turn again him. This is the reason that therapy at the beginning of recovery causes more problems than good and the addict will most likely relapse.

A therapist deals with trauma, PTSD, body-image issues, etc. All of these things bring up strong and painful emotions. Therapy-based treatment centres try to deal with these strong emotions immediately without allowing an addict to practice using tools, other than self-medication, to deal with pain.

A therapist will see a client swearing and disrespecting both staff and other clients and ask the question, “What’s behind this behaviour?” A good counsellor will acknowledge that there may be some underlying issue but will put a stop to the anti-social behaviour first. When I first entered recovery I was full of distorted thinking which resulted in negative behaviours. Due to the re-wiring of my brain (that came as a result of my alcohol/drug use) my thinking would be distorted for months to come. At the behest of good counsellors and 12-Step sponsorship I began to change my behaviours first and as my brain returned to homeostasis my thinking followed. Not until an addict’s behaviours and thinking line up can therapy become effective. Many addicts have suffered physical, mental and sexual abuse. Many have seen things they can’t deal with on their own. It’s vital that this type of trauma be dealt with but trying to dig into right away in the first days, weeks even months of sobriety is fool-hardy. Stability in recovery comes from routine and cognitive-behavioural changes (and yes 12 Steps are CBT with a spiritual approach). With the tools used to maintain this stability the addict can safely deal with traumatic issues that will bring pain. Nature proves this to us. Denial is a natural part of addiction. The brain goes into denial mode as part of the flight/fight approach so as to not cause us pain. By learning from our own bodies (kind of sounds like mindfulness to me – and therapists LOVE that stuff) we learn not to bring up painful emotions during the most vulnerable time of recovery – at minimum the first nine months.

Until the public is better educated as to how addiction works and is treated they will continue to shell out thousands of dollars to therapy-based treatment centres and the relapse rates will continue to rise. Until governments realize that it’s cheaper to treat the disease than to jail the sufferers this won’t happen. It’s ironic that if an addict calls a publicly funded treatment centre she will not receive help for weeks or months to come but if the same addict robs someone, while she is waiting for her treatment appointment, she gets thousands of dollars’ worth of service immediately. One of the only countries that seem to have figured this out is Portugal where drugs are decriminalized and addiction treatment is readily available.

Dave the Dude