Answer Addiction

Tag: alternatives to abstinence

  • We Need Harm Reduction for All Drugs, Not Just Opioids

    We Need Harm Reduction for All Drugs, Not Just Opioids

    While we’ve made great strides with harm reduction for people who use opioids, we’re slow to provide non-abstinence-based treatment for people who use other drugs.

    A quick glance at the news reveals the catastrophic effects of opioids across the nation: around 120 people a day die from opioid-related overdoses. It’s so devastating that the nation is calling it an opioid epidemic. Yet even as we watch this tragedy unfold, we’re missing the point.

    By focusing exclusively on opioids, we’re overlooking the harm caused by other deadly drugs. How can we highlight harm reduction resources if we only focus our efforts on people who use one class of drug?

    The Problem with the Opioid “Epidemic”

    According to the Centers for Disease Control and Prevention, more than 700,000 people died from a drug overdose between 1999 and 2017. Sixty-eight percent of those deaths in 2017 involved an opioid — approximately 70,200. However, that’s not the 100 percent that the “epidemic” coverage would have us believe.

    While I’m not arguing that the opioid-related deaths shouldn’t be covered — they should! — I am saying the problem with zeroing in on the opioid epidemic is that we are focusing too narrowly on the harms caused by one drug and are blinding ourselves to the impact of other deadly drugs. We should be reporting on those, too.

    A more accurate picture of drug-related deaths in 2017, according to the CDC, looks like this:

    • Alcohol was responsible for the deaths of 88,000 people
    • Cocaine misuse killed 13,942 people
    • Benzodiazepine misuse was responsible for 11,537 deaths
    • Psychostimulant misuse, including methamphetamines, was responsible for 10,333 deaths.

    Those aren’t insignificant numbers, so why are they being overlooked? I asked recovery activist Brooke Feldman for her perspective.

    “The sensationalized and narrow focus on opioids fails to account for the fact that people who develop an opioid use disorder typically used other drugs before and alongside opioids,” Feldman said. “So, we really have a polysubstance use situation, not merely an opioid use situation.”

    She continues, “Focusing on opioids only had led to the erection of an opioid-only infrastructure that will be useless for the next great drug binge and is barely relevant to address the deadliest drug used, which is alcohol.”

    The Deadliest Drug: Alcohol

    Alcohol is responsible for more deaths than any other drug. But we overlook it for two reasons: because it’s legal, and because it’s a socially acceptable drug. Not only that, but advertising actively promotes its use — you only have to look on Instagram or Etsy to see how widely excessive use of alcohol is normalized — especially among mothers and millennials. These advertisers have been smart to market alcohol as a means of self-care — encouraging drinking to help unwind from the stresses of the week — and as a means of coping with motherhood. 

    Social media reinforces the message that alcohol is a tool to cope with stress and something that should be paired with our favorite stress-relieving activities, like yoga. Captions on Instagram read like “Vino and vinyasa,” “Mommy’s medicine,” “Mommy juice,” “It’s wine o’clock,” “Surviving motherhood one bottle at a time,” and “When being an adult starts to get you down, just remember that now you can buy wine whenever you want.”

    Perhaps what is most insidious about alcohol is that it heavily impacts marginalized and oppressed communities. For example, Black women over 45 are the fastest-growing population with alcohol use disorder. And the LGBTQ+ community is 18 percent more likely to have alcohol use disorder than the general population.

    Alcohol aside, looking at the harm done by other drugs, we can see that opioids are no longer the leading cause of drug-related death in some states. In Oregon, statistics show, deaths related to meth outnumber those that involve one of the most common opioids, heroin. In fact, there has been a threefold increase in meth-related deaths over the last ten years, despite the restriction on pseudoephedrine products, which now require a prescription. 

    Similarly, in Missouri, which was ground zero for home-based meth labs 20 years ago, the recent spotlight on opioids has overshadowed an influx of a stronger, purer kind of methamphetamine. Deaths related to the new and improved drug are on the rise.

    Oregon’s state medical examiner Karen Gunson speaks to this disparity of focusing on opioids over other deaths and the damage that those other drugs cause. “Opioids are pretty lethal and can cause death by themselves, but meth is insidious. It kills you in stages and it affects the fabric of society more than opioids. It just doesn’t kill people. It is chaos itself.”

    Abstinence Is Not Attainable for Everyone

    Our approach to recovery has been too one-dimensional, stating that complete abstinence is the goal. But this perspective is outdated. Abstinence isn’t attainable for everyone. If it were, then more people would be in recovery. However, harm reduction is attainable. It reduces deaths, treats medical conditions related to drug use, reduces the transmission of diseases, and provides options for treatment services. In fact, people who use safe injection sites are four times more likely to access treatment.

    “Whether it is with problematic use of alcohol, tobacco, cocaine, methamphetamine, etc. use, centering harm-reduction principles and practices would likely engage more people than an abysmal 1 out of 10 people who could use but do not receive SUD (Substance Use Disorder) treatment,” Feldman explains. “Requiring immediate and total abstinence rather than seeking to address overall well-being and quality of life concerns is a barrier to engagement — and sadly, it is placing the focus more on symptom reduction than it is on what is causing the symptom of chaotic drug use in the first place.”

    Harm Reduction for All Drugs Means Fewer Deaths

    Our focus on the opioid crisis has helped improve harm reduction resources — like the increased availability of naloxone to reverse overdoses, and the more accepted use of pharmacotherapy and medication-assisted treatment (which has now been endorsed as a primary treatment by the Substance Abuse and Mental Health Services Administration), and some safe injection sites — but it has also meant we aren’t concentrating as much on research, funding, and education devoted to harm reduction practices for other harmful drugs. The result is that we have fewer resources and less awareness when it comes to keeping people who use non-opioid drugs safe.

    We need to look at reducing harm across the spectrum of drug use to reduce all deaths. More safe usage sites, clean tools, safe disposal bins, medical assistance, education, referral to other support services, and access to pharmacotherapy (including drugs to treat or mitigate harms of alcohol use disorder and the development of new medications for help with other substances). Specialized treatment other than abstinence should be accessible for people who use all drugs — not just opioids. 

    View the original article at thefix.com

  • Is Recovery Possible Without Abstinence?

    Is Recovery Possible Without Abstinence?

    If I told an AA meeting I was having wine once in a while, the group would tell me that I am headed for certain demise.

    Benders, Blackouts, and Finding Recovery

    In 2013, I bottomed out in no uncertain terms. After years of heavy drinking that spawned blackouts and dangerous behavior, I had a three-day bender that left a 24-hour hole in my memory and landed me on the doorstep of a local AA meeting.

    I attended those meetings for a couple of weeks, and they saved my life. In those rooms I found people who validated what I had suspected for a long time: I was an alcoholic.

    When I stopped going to meetings, it wasn’t because I rejected the program. It was because my lifestyle had changed: shortly after I stopped drinking, I uprooted my life and began traveling. Whenever I arrived in a new city, I always looked up a meeting, just in case I needed one. But I never felt the need to go, because I was never tempted to drink. 

    I was sober for nine months when I finally settled in one spot and I felt ready to tackle the program. I returned to the rooms and found a sponsor.

    I’d had high hopes that AA was the missing piece of my sobriety. Those nine sober months had been lonely as I struggled with the unpleasant feelings that had previously been ignored with the help of wine. My friendships had become riddled with conflict as I became sensitive to even minor misunderstandings. When I was drinking, those bumps had been smoothed over with alcohol. Without it, I couldn’t move past an argument. I thought maybe it was a sober thing, and other sober people would have advice for this new territory.

    But my return to AA lacked the same connection I’d initially felt all those months earlier. My new sponsor asked me, with undisguised disbelief, “Nine months, really? All on your own?” She went on to tell me how she had once been sober for three years without AA. She eventually began drinking again because she hadn’t been accountable; she hadn’t told people in her life that she was an alcoholic. 

    Without AA, You Will Fail

    I corrected her assumption that we were the same. “I tell people I’m an alcoholic, and that I am sober.” When she responded with visible relief, I realized that she’d been skeptical about my claim because she assumed I was still in denial. In that moment I felt the inflexibility of the program, and the words of speakers I’d heard echoed in my head: “Without AA, you will fail.” There was no room to do it any other way.

    After that coffee with my sponsor, the hope I’d had for AA dissolved. I realized I wasn’t looking to AA to help me stay sober, I was looking to AA to help me be happy.

    Instead of returning to AA, I found a therapist. At the end of our first session during which I had tearfully explained my sobriety and my sadness, she diagnosed me with severe depression. After hearing my history, she suggested that I had always been depressed and likely self-medicating with alcohol. 

    I asked her about AA, and if she felt it was necessary for me to continue attending.

    “Are you tempted to drink?” she asked.

    “No,” I answered truthfully. Even with the challenges of my new sober life, I’d never considered it. I wanted a solution, and I already knew drinking wasn’t it.

    “It sounds like your lack of connection to the meetings is only furthering the isolation you feel,” she told me. “If you feel like you want to drink, go. But otherwise, it sounds like you’re okay.”

    My sadness wasn’t a byproduct of new sobriety, my sadness was depression. When she told me I didn’t have to go to meetings because I wasn’t struggling not to drink, I was validated.

    Sober, but Not Abstinent

    I began having sips almost two years later. I don’t remember the first one, but I do remember having no desire to get drunk. They continue to be infrequent and small, leaving me with no desire to drink to the point of drunkenness. I have even had a sip too many on occasion: my cheeks flush and my tongue grows loose. I used to drink for that feeling. Now, it stops me in my tracks, repelling my desire for more.

    The commonly understood language of recovery does not allow for this kind of behavior. People on the outside only understand recovery in the terms presented in movies and on television: Alcoholic bottoms out. Alcoholic attends AA meeting. Alcoholic gets shitfaced after having one sip of a drink at a party and AA friends drag her out of a bar. Alcoholic is sober one year, speaks at AA meeting, and then eats cake. 

    And it isn’t just people on the outside. If I told an AA meeting I was having wine once in a while, the group would tell me that I am headed for certain demise.

    To be clear: I am not advising anyone who wants to stop drinking or who is currently sober to try sipping alcohol. Having any amount of alcohol while “in recovery” is a controversial topic and beyond the scope of this article. We all need to do what works for us to stay sober and healthy.

    But in my experience, there’s a difference between sipping and slipping. Before I received my depression diagnosis, there was one purpose to drinking: get drunk. Now that I manage my mental health properly and no longer self-medicate with alcohol by drinking to excess, I don’t have the desire to abuse it.

    Sipping vs. Slipping

    One week into my sobriety, I did come close to slipping. I’d had dinner with a friend after work and on the walk home I started to white-knuckle it. The walk was a landmine of my drinking haunts: the old man bar at the halfway point, the liquor store a couple blocks from my apartment, the fancier bar after that, and then, one building away from mine, another bar.

    Keep walking keep walking keep walking, I coached myself. You’ll go home and answer those emails and have mac and cheese for dinner. Then you’ll go to sleep and get up early tomorrow for your jog to the AA meeting.

    I made it inside my apartment with no detours. But then I checked my email and I read a piece of good news that I had been waiting months to hear. That’s when my resolve wavered. I wanted to celebrate, and my first thought was: Prosecco!

    I paused. I thought about it. What would happen if I did buy that Prosecco? I knew that I would drink it in its entirety by myself. Bottle done, I would head to the bar around the corner and have some more, and finish the night with my usual three-whiskey nightcap.

    I knew that meant I would not wake up early the next day to jog to my morning AA meeting. I knew if I didn’t go to my meeting I was probably going to take the day off being sober, and then the next one and the next.

    What stopped me from drinking that day wasn’t the thought of a horrible hangover, or even the prospect of soul-blackening shame, but the knowledge that my good news would not be any better if I drank to celebrate it. By the same token, the need to celebrate my little victory as a means to offset my usual sadness wasn’t really necessary, because I knew that sadness wasn’t going anywhere—with or without booze. If drinking wasn’t going to make things better—and I knew it wouldn’t—why bother?

    It was years before I recognized I was chasing a feeling of false relief that would never last long enough. Abusing alcohol was, in fact, only making me more sad and depressed. Once I understood the why of my drinking, I was no longer compelled to drink to excess. I had neutered its power over me.

    Will I Be Kicked Out of the Recovery Club?

    Up until I wrote this, I was hiding my sips from all but my closest friends, because there is no vernacular in recovery to explain it. It’s simply easier to say I’m sober, and play along with others’ commonly-held picture of what recovery looks like. That’s easier than opening myself up to the judgment of those who are in recovery—and even those who are not—who will tell me I will fail, as I was told so many years ago by people who had sipped and ultimately slipped. They’d say that by doing this, I cannot consider myself sober. 

    I’d be kicked out of the club.

    As they are, though, my sips are an indulgence, equivalent to the dessert I have a forkful of but don’t need to finish, or an expensive pair of heels I’ll try on, but talk myself out of buying. The sips aren’t samples of what I miss, and they aren’t tests of will. Along with the taste of the wine itself, there are overtones of pleasure and victory and a hint of bitterness mixed in with my relationship to alcohol. The bitterness isn’t because I want more: it is the memory of that never-ending chase and where it led me. The bitterness is the reason I only want a sip—a sip I will continue to take, at my discretion, because I want to, and still remain sober.

    View the original article at thefix.com

  • Four Advocates on How Harm Reduction Can Change the Trajectory of the Opioid Crisis

    Four Advocates on How Harm Reduction Can Change the Trajectory of the Opioid Crisis

    There is overwhelming evidence that harm reduction keeps people alive and can bring them into recovery, yet it’s still met with opposition. We ask four harm reduction workers what inspires them and what we can do to help.

    Harm reduction has been a contentious topic for a while: staunch 12-step proponents who insist that abstinence is the only way to achieve recovery are met with resistance from a growing number of harm reduction activists who consider the reality of drug use more holistically while advocating for individual choice and safety. Many of us have deep-seated beliefs and strong feelings about recovery, but now more than ever we need to analyze and hopefully remove our biases, accept the overwhelming data in favor of harm reduction, and face the failed policies that have led to a national crisis. Every day 130 people die from opioid overdose in the U.S., and misuse of prescription opioids costs us an estimated 78.5 billion dollars each year.

    Abstinence alone isn’t working. If it were, we wouldn’t have an epidemic on our hands. Perhaps this realization is why we are seeing an increase in harm reduction measures—increased naloxone access, fentanyl testing strips, Good Samaritan laws, and needle exchange programs. And they work: many individuals enter recovery through various harm reduction programs. But regardless of whether people get treatment or not, harm reduction measures prevent disease and save lives.

    What Is Harm Reduction?

    Harm reduction is frequently misunderstood. Often people think it means the use of medication-assisted treatments (pharmacology), or moderating drug use instead of eliminating it entirely. But these are narrow definitions. Harm reduction is not a particular pathway of recovery; it is a means of reducing the harm associated with drug use.

    According to the Harm Reduction Coalition, “Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. Harm reduction is also a movement for social justice built on a belief in, and respect for, the rights of people who use drugs.”

    The philosophy of harm reduction accepts that drug use is complex and multifaceted, and that it involves a range of behaviors from frequent use to total abstinence. It acknowledges that some ways of using drugs are clearly safer than others. Harm reduction includes strategies such as safer use, managed use, needle exchanges, supervised injection sites, treatment instead of jail, and abstinence. It advocates for meeting the individual where they are and addressing their reasons for using and the conditions surrounding their drug use. Successful implementation of harm reduction should lead to well-being for individuals and communities, but not necessarily cessation of all drug use.

    Tracey Helton Mitchell, Devin Reaves, Brooke Feldman, and Chad Sabora advocate for the acceptance and practice of harm reduction. We asked what motivated them to pursue their activism and how we can all be more mindful of harm reduction principles.

    Tracey Helton Mitchell

    Tracey Helton Mitchell came into the public eye when she was featured in HBO’s documentary Black Tar Heroin, which documented her life on the streets on San Francisco. After she found recovery, she rebuilt her life and went back to school for a bachelor’s degree in business administration and a master’s in public administration. She has dedicated her life to advocating for the individual needs of people with addiction. She documents her journey in her book The Big Fix: Hope After Heroin.

    In 2016 Tracey told NPR that “We need to have a variety of different kinds of treatment interventions that address people’s needs.” In response to the argument that harm reduction measures such as needle exchange enable drug use, she said: “We’re not encouraging people to do anything, we’re taking a look at their public health behaviors and then addressing what the particular needs are, so look at the cost of one syringe versus the cost of someone getting hepatitis C and having to take care of them for a lifetime.”

    What motivated you to work in harm reduction?

    I started in harm reduction in response to the overdose crisis that was happening in San Francisco and the Pacific Northwest in the late 90s. I knew many people who had died, including Jennifer H., a person I loved very much. 

    How can we include more of the principles of harm reduction when dealing with people in recovery, and those actively taking drugs?

    Harm reduction is seen by many in the recovery community as a crutch when it should be seen as a lifeline. Harm reduction should be included as part of a continuum of care with a wide variety of options based around what is best for the person. Too much focus has been made on “abstinence only” as the standard for recovery. We need to broaden our scope. 

    See also: Naloxone and the High Price of Doing Nothing

    Devin Reaves

    Devin Reaves, MSW, is a community organizer and grassroots advocacy leader who is in long-term recovery. He is also the co-founder and executive director of the Pennsylvania Harm Reduction Coalition (PAHRC), serves on the Camden County Addiction Awareness Task Force, and sits on the board of directors for the Association of Recovery High Schools. He has worked on the expansion of access to naloxone, the implementation of Good Samaritan policies, and the development of youth-oriented systems, and he is leading conversations to bring about public health policy changes in the area of substance use disorders.

    PAHRC’s mission is to promote the health, dignity, and human rights of individuals who use drugs and the communities affected by drug use.

    What motivated you to work in harm reduction?

    As someone in recovery who lost a lot of friends to substance use disorder, when I learned about Narcan, I wanted it to be more available because I was sick of my friends dying. Seeing that harm reduction wasn’t utilized made me want to fight to see more of it: syringe services programs or more innovative programs.

    How can we include more of the principles of harm reduction when dealing with people in recovery, and those actively taking drugs?

    We can provide Fentanyl testing strips, Narcan, and sterile needles to use. For those seeking recovery, we should also provide Narcan because they are still at risk. What people don’t know about harm reduction is that individuals in programs of harm reduction are five times more likely to enter treatment—it is a pathway of recovery. 

    Brooke Feldman

    Brooke Feldman, MSW, is a social justice activist who identifies as a member of the LGBTQ+ community and a person in long-term recovery from substance use disorder. She has spent the past decade advocating for wellness and long-term recovery being accessible to all.

    What motivated you to work in harm reduction?

    Well, I think I was pretty primed to embrace harm reduction principles over 10 years ago when I was taught what are called “recovery-oriented” care principles. Back in 2008, and only a few years into my own recovery journey, I was working for an organization called PRO-ACT at Philly’s first Recovery Community Center. We had a sign on the wall that greeted people with, “How can I help you with YOUR recovery?” and we were educated and trained in practices such as meeting people where they’re at, supporting people in working toward their own goals rather than our goals for them, recognizing that abstinence is not the goal for everybody, and embracing diversity in recovery experiences and mosaics of pathways. My experience with what we call recovery-oriented practice over the past decade set the stage for harm reduction principles and practices to fit perfectly. Unfortunately, while I have found my own professional experience, education, and training in recovery-oriented care to fit neatly with harm reduction, I still see many gaps between the harm reduction and recovery movements. A large motivator for me currently is the strong desire to bridge those gaps, to highlight shared goals and values, and to be part of unifying the two movements wherever possible. I believe people die in the cracks of the divide, and I hope to serve as part of the glue that seals the cracks.

    How can we include more of the principles of harm reduction when dealing with people in recovery, and those actively taking drugs?

    I think that if we center the human rights of choice, self-determination and autonomy when it comes to directing the course of one’s own life, we become more inclusive of harm reduction principles across the board. One concrete area for centering these principles is that of the use—or declined use—of medications to treat opioid use disorders. People have a right to utilize evidence-based medications to aid in their recovery, and people also have a right to decline the use of medication as part of their recovery. Nobody should face discrimination or refusal of resources, supports, and services based on this choice of what to put in their bodies. Also, one of the things I love about the harm reduction movement is the social justice focus. In my experience, the harm reduction movement centers the roles that oppression and marginalization play when it comes to how our systems, and society at large, respond differently to drug use depending on the skin color or socioeconomic status of the drug user. I think that centering social justice would put us all in the right position when it comes to both people currently using drugs and people in recovery, however that recovery is self-defined.

    Chad Sabora

    Chad Sabora is the co-founder and executive director of the Missouri Network for Opiate Reform and Recovery (Mo Network), an organization that offers services to those struggling with substance use disorder and their loved ones. He has been the focus of several episodes of the show Drug Wars on Fusion and was part of an Emmy award-winning episode of NBC News with Brian Williams. Sabora has been an expert correspondent on CNN and MSNBC. He is also president and co-founder of the nonprofit Rebel Recovery Florida, and he is on the board of directors of the Discovery Institute for Addictive Disorders in Marlboro, New Jersey. Sabora is also known for filming himself while touching fentanyl, thus debunking the myth that you can overdose through skin contact with the illicit substance.

    Uniquely experienced as a former prosecutor and a person in long-term recovery, Sabora left legal practice in favor of pursuing drug policy reform and advocacy. He founded Mo Network in 2013, where he heads their work on legislative policy reform. Sabora and Mo Network focus on expanding services based on evidence-based solutions, and they lobby for more effective drug policy locally in Missouri and also at the federal level.

    He has helped write, advocate for, and pass several pieces of legislation in Missouri, namely first responder access to Narcan, third-party and over-the-counter access to Narcan, 911 Good Samaritan immunity, and access to medication-assisted treatment in various environments such as addiction treatment, mental health facilities, family court, and for certain frequently-overlooked populations such as veterans.

    What motivated you to work in harm reduction?

    The overwhelming data, basic common sense, failed policies of the past, and unconditional love was the motivation.

    How can we include more of the principles of harm reduction when dealing with people in recovery, and those actively taking drugs?

    Inclusion will come in time, as long as we stay vigilant. Changing moral compasses and inherent biases could take a generation before we see the full impact.

    Read Chad’s rules for staying alive while using drugs (including how to use naloxone to reverse an opioid overdose)

     

    A Call to Action: We Need Harm Reduction Now

    The evidence is clear: If we provide the education and resources for people to use drugs safely, we reduce disease and save lives. Frequently we open the door to recovery. Isn’t it time for us all to start advocating for (or at least accepting) harm reduction wherever and whenever we can?

    View the original article at thefix.com

  • Anatomy of a Relapse

    Anatomy of a Relapse

    When my father died, I hadn’t been to a meeting in over a year. I had no active knowledge of how to apply healthy coping mechanisms to a devastating situation so I just went back to what I knew: opioids and numbness.

    Two years ago I wrote a controversial feature for The Fix, “I Take Psychedelic Drugs and I’m in Recovery.” It was controversial in the sense that the response from the publication’s readers — many of whom have an obviously vested interest in topics related to addiction recovery — ranged from sarcastic, hyperbolic criticism to open-minded consideration, with some even condoning the perspective I was sharing.

    The reason I chose to write this honest, albeit uncomfortable “Part 2” of sorts, is to do what folks in certain recovery circles do best (when at their best): share experience, strength, and hope, so that whoever may be listening, reading, or watching may, at the very least, relate and ideally, be helped by it.

    Full disclosure: My name is not James Renato. It’s a pseudonym, adopted out of respect for the principle of anonymity in a 12-step offshoot group I am a member of. It’s also, of course, meant to protect myself from facing unnecessary personal backlash merely for engaging in public discourse.

    Now that I’ve successfully buried the lede, in the spirit of qualifying in the style of an Alcoholics Anonymous meeting: “here’s what it was like, what happened, and what it’s like now.”

    Last April, I ended a full-blown relapse of what previously was an opioid use disorder in remission. In other words, I’d started injecting heroin again eight months earlier, for the first time in over six years.

    It was the culmination of a tripartite experiment involving: firstly, a noble attempt to actively practice a program I helped form (namely, Psychedelics in Recovery [PIR]). Secondly, a misguided lack of acknowledgement that I was inviting a serious risk to my life by no longer practicing abstinence (not just from psychedelics). And lastly, a gradual ceasing of the daily commitment to personal growth in the form of meeting attendance, regular contact with a sponsor, associating with peers in recovery, and just continuing to work on improving the overall quality of my life and relationships with others.

    People in recovery continue to regularly engage in their program of choice because life is unpredictable, and the myriad tools we learn are not always the same ones we rely on for every situation. One day a simple phone call can be all that’s necessary to get ourselves out of “a funk.” Another day it’s hitting four meetings, extensively praying and meditating, and taking a newcomer out for coffee because we were just laid off from a full-time job and needed to avoid the danger that can come from “feeding the poor me’s.”

    In my case, when I stopped participating in my ongoing recovery process, I made an inexplicably impulsive decision to reintroduce opioids to my system. When the DEA announced that they were planning to classify kratom as Schedule 1, I purchased a kilogram from an online vendor for literally no good reason. Several weeks after I received the package of high potency kratom leaf powder (of the “super green vein” variety), I conducted a dose-response self-experiment. I have a history of progressing down the road of “continued use [of opioids] despite negative consequences” (the current best definition of addiction), and within a few months I developed a dependency and went through the entire kilo, despite attempts to reassure my partner that the amount I purchased was intended to last for years, and would only be used when absolutely necessary.

    Right around the time my supply ran out, a friend who had no idea of the habitual relationship I had with kratom use told me about another mild opioid sold on the supplement market called tianeptine sulfate. Tianeptine had undergone clinical trials as an opioid-based antidepressant in the 1990s but did not progress past the second of three phases required by the Food and Drug Administration (for unknown reasons). With the drug’s unscheduled status, enterprising entrepreneurs in the unregulated supplement industry capitalized on tianeptine’s acute, short-acting antidepressive effects at low doses, but savvy opioid connoisseurs discovered the euphoric high it brought on (also short-acting) at much larger doses.

    My kratom habit switched to tianeptine, in large part because of how disgusting I found the taste of the tea I made from brewing the leaf powder, and the hassle of masking the taste by encapsulating the amount I needed to take to reach the effects I preferred. In addition to the perfect storm of things perpetuating my now very active addiction, I’d even stopped attending PIR meetings, was becoming increasingly disillusioned with my graduate studies, and was now too ashamed to admit to anyone that I was seriously struggling.

    Then, tragedy struck. My father, a seemingly healthy 64-year-old on the verge of retirement, suffered a sudden, fatal heart attack on a scuba diving trip in the Caribbean. I was already treading on thin ice, and this kind of event is something I’d long heard people in 12-step meetings share reservations over in their commitment to recovery. But I hadn’t been to a meeting in over a year at this point, so I had no active knowledge of how to apply healthy coping mechanisms to a devastating situation. It was a situation that countless people have gone through, relying on their recovery program to help them navigate as safely as possible, but I’d learned from the opioids I’d been relying on that if I could just figure out how to stay numb 24/7, that’s all I needed to do.

    After the standard bereavement rituals of a wake, funeral, and burial at the family cemetery plot, which was actually a very supportive and comforting assemblage of close friends, loved ones, and long-lost acquaintances paying their respects, I ended up alone in a dangerous situation. I called my old dealer, whose number I still had memorized after over six years of no contact, and one night drove out to meet him just like old times. No need to bother snorting or smoking whatever powder he claimed to be heroin; I had already been well reacquainted with the too-mild results of those routes of administration, so I went right back to the needle.

    I’ll spare you all the details of the familiar downward spiral and just hit on the highlights: I depleted all of my savings, misappropriated funds from an award I’d received, stole thousands of dollars from my father’s still active bank account, then my mother’s shared account, totaled my partner’s car from multiple accidents, couldn’t maintain my job, took a leave of absence from school, and wreaked a devastating emotional toll by shattering the trust of my friends and family.

    Miraculously, I was not arrested, did not overdose (though I came close), and was not robbed (although certainly ripped off repeatedly). About six weeks before I was confronted about the missing money, I obtained a 15-day supply of Suboxone from a chemical dependency clinic, but I shelved it, having no intention of taking it. Towards the end of the first week of April, my partner was preparing to go out of town for the weekend, and I had just been asked by my mom if I knew anything about the empty bank accounts.

    I woke up alone on April 5th, a Thursday, and began my morning ritual of taking stock of the heroin I had left, trying to negotiate with myself on how to titrate the remaining amount throughout the day. I always lost these negotiations and usually just did all of it, or the rest soon thereafter. But after I injected the last of it, I didn’t feel the slightest bit high. Instead, I wept. With only the company of my two cats (who avoided me as much as possible), I realized that I could no longer hide. I faced a crossroads: I could escalate my lies and attempt to find another hustle — knowing full well how inept I am when it comes to actual criminal behavior — or, surrender.

    I remembered the Suboxone sublingual film, and without really taking any time to talk myself out of it, I tore open the package and put the film under my tongue — realizing that if I kept it in long enough to absorb the full dose, I’d be inducing opioid withdrawal. I felt incredibly lonely and remorseful, so I begged my partner to come home from work, admitting to her what she had long known but felt powerless to help me with. Then I texted my mom, hinting to her that I was in a desperate state, and needed to spend the weekend at her home or I wouldn’t be able to “see things through.”

    Tears were pouring down my face in these moments, and I was wailing — one of the deepest emotional pits of despair I’ve ever found myself in. I’ve never found the concept of rock bottom useful. Instead of labeling that moment or attempting to explain it, I attribute my actions to grace.

    A New Perspective on an Old Idea

    I’m a wholehearted believer in the potential of psychedelics or plant medicines in recovery. I have heard first-hand tremendously powerful stories from people who have overcome their reluctance and the doubt instilled upon them by their peers, and are actively integrating the spiritual insights from their psychedelic journeys into their lives. PIR continues to meet regularly via an online meeting, twice a month, and our members gather from across whatever time zones they’re in to come together and share experience, strength, and hope with each other. We’ve formulated a list of guiding principles, meant to clarify the scope of our suggested program. I had strayed from those principles and met the predictable outcome we’re hoping to help others avoid.

    There are ongoing FDA-approved clinical trials for the use of psilocybin (the active pro-drug of psilocin, a psychedelic found in several species of mushrooms) for nicotine, cocaine, and alcohol use disorder, as well as a recently approved study in Europe looking at MDMA-assisted psychotherapy for treatment of alcohol use disorder. While these trials are aimed at treatment of an acutely manifesting substance use disorder, one of the primary guidelines for PIR is that our members should have a firmly established foundation of recovery in a primary qualifying recovery fellowship, and are actively working that program as it’s suggested.

    Recently, now just five months out from ending my relapse, I considered having a ceremony with iboga (the alkaloid-containing root bark of a shrub indigenous to western equatorial Africa), as I wanted to commemorate the one-year anniversary of my father’s death. After soliciting the feedback of my support network, none of whom gave me any advice, but instead offered honest and open perspective to help guide me in making a decision, I decided against it. Ultimately, the decision to commemorate the anniversary unaided came during several of my morning sitting meditations, a practice that has become vital to my ongoing recovery.

    Instead, friends, family, and loved ones gathered at our house on the anniversary day, and shared memories, pictures, and videos of my father.

    View the original article at thefix.com