A Call for Help
Shortly after I left my job working in inner city poverty in Baltimore I got a call from a good friend who had been a community organizer in that program. He had become an administrator at what was referred to as a Methadone treatment program. The treatment providers were recovering addicts and social workers. They were under the supervision of psychiatrists. Those supervisory relationships were not working well. I was familiar with that problem because the administrators of the program in Baltimore had been psychiatrists and the rest of us in the treatment delivery teams had to fight them constantly so that we remained focused on the real needs of the community we were serving and how those needs were addressed. What my friend wanted was someone who could address the needs of the incoming clients to the staff in a way that meant something to them. Long term intensive psychotherapy did not. Since I had been on the street with him and other staff I could talk the language of his staff and relate to their perspective. The staff needed a down to earth approach.
A New World of Problems
So I came on board as a clinical consultant. New clients were routed to me for an evaluation. In spite of my time on the street I was surprised at who was coming for help. I had been relating more to community services and the drug world was a different place. I expected to see heroin addicts arriving to take methadone. The people who came had many different problems. Some weren’t even what I would call “physiological” addicts. One nineteen year old had been using hallucinogens for six years. He wasn’t physically addicted to anything but had missed his adolescence.
I won’t go into all the details except to say that it made me aware that drug issues rarely stop at the matter of physiology. There are developmental issues, marital issues, education issues, job issues and on and on. There was absolutely no way to address everyone in the same way. It became a matter of designing approaches and determining needed resources for a broad range of needs.
If we think anything else, we are deluding ourselves. As we begin to look at our opioid crisis there evidently are burgeoning treatment programs but some of them are shady and shabby enterprises. Just recently we learned that Google raked in over $1 billion in ad revenue related to advertising for treatment services. It seems there is insufficient regulation or attention to what needs to be provided and what is provided. We are missing the needs point. There is shouting about the addiction problem, but I’m not hearing a whole lot about a comprehensive plan or even a plan for working on having a plan.
Many Other Needs
One issue alone is illuminating. It is clear that a lot of these opioid drugs have flowed into Appalachia. This is the area where people have labored in coal mines, been injured, and suffer from chronic pain. The coal industry is clearly dying and there is little attention to what needs to be done for the economies of such areas. This alone tells us that we have a lot to study and work to be done. And much of the work needs to start today.
The Bottom Line
In some ways this blog post is nothing other than a warning. We have been diverted by political and ideological infighting. It is time to go to work in a more focused and cooperative way.
I’m going to close this post out now because this subject deserves study, certainly a book, or maybe a library of books. And we are not doing enough that is effective. We have a national scandal at many levels. We need to search and study our world.