A New Mission
How successful do you think the response to opiate addiction will be?
Congress has gotten religion in the form of dealing with the national opiate addiction problem. I listen to their concerns and it is touching. Reality will be far different and we will see how far the compassionate concerns go.
Heroin addiction was an issue when I went to work in the inner city of Baltimore. But it was not our job to deal with it because we were doing community mental health. Drug programs were starting and we could see that the problem ran deep. But I did not delve into it until I left the program.
Not So Simple
Not being impressed with the state or national leadership when it came to mental health, after I left the program, I chose not to seek employment with either the state or the federal government. I found various consulting activities. One day I got a call from the man who had been our lead community organizer. He had also left the program and had taken a job as the administrator of a drug program. His line staff was mostly recovering addicts who served as counselors and social workers. The program was administered by psychiatrists and they were oriented to psychotherapy. It was not a good match with the line staff.
Finding a Way Back
I agreed to being a clinical consultant since I was closer to the line staff after my work in Baltimore. I did not find what I expected. I thought the main emphasis was on methadone dispensing to hard core heroin addicts. Yes, they were there but drug programs attract much greater diversity. I interviewed one young man who had been taking hallucinogens from age 13 to his present age of 19. He had missed his adolescence and needed to be raised through an adolescence he had never had. Intensive psychotherapy the psychiatrists loved was not at issue. One hard core junkie told me that he knew if he wasn’t clean by age 35 he would be dead. There were people of all ages who abused a bewildering array of drugs for an equally bewildering array of reasons. What they all had in common was that they had lost their way and it was the job of the clinical staff to help them find a way for their life.
The long and short of this story is that Congress simplistically thinks they will authorize funds to combat an opiate addiction epidemic. Of course a lot of their dedication is nothing other than political fodder. The way they put it sounds easy enough and is supposed to indicate their dedication. Not so fast. People have to be given resources, education, hope, training, purpose and on and on. Each person is different. They can’t be fed a given drug to manage their addiction and plunked in a group discussion. Even if there was a way to focus purely on opiate addiction, the needs and stories will be highly diverse.
Reality at the Door
We have to change the medical climate where opiates have been too readily dispensed. We need to educate the public about the alternatives available to deal with pain and change their expectations. Part of the process is educational of diverse kinds at all levels, meaning professionals and the public at large. In Appalachia, for example, opiate addiction is a major problem. People have been injured in the mines and suffer form chronic pain. But they also do not have suitable job possibilities. Dealing with addiction means many things including providing educational and job opportunities along with training.
The statements of concern and compassion are touching. Reality is waiting just outside the door and it requires flexibility, assessment and addressing a bewildering reality. Shoveling money at the problem is not going to manage the epidemic.
What have you seen?
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