Continued from above post:

What I personally agree with is that people need to try being clean, if they feel it's their place. What I don't agree with with is that they should try it right off the bat.

Have you ever seen the look in a junkie's eyes, one who has tried to be clean over and over again and just keeps failing? I have seen it many times, and it's one of the most horrible things you can see. To have these people keep trying to get clean in futile attempts is nothing short of inhumane.

I did take pot-shots at NA/AA, and I do NOT subscribe to their "faith-based" approach. I think it's a solution, but I think that accepting god as a solution to a problem is nothing short of a "cheap way out" as I believe you put it. That doesn't mean that I don't believe in any type of counselling period. I don't believe in group therapy with other junkies - it's a ridiculous idea. If it worked for you, great, but I think overall it is so ineffective and it puts people in a position they shouldn't be in that I wouldn't recommend it for ANYONE...

I am getting ahead of myself. Let me try and address them as you say them.

So, while I can't say it without it coming off as a personal attack (as it's a personal topic for the both of us), I mean it generally. Again, I don't know you.

What I do know something about is addiction, and addicts of all stripes. Background on me, some of it anyway, I'm a recovering addict myself. It's pretty much ruled my life from adolescence on (I'm in my late 20s now, so say 15+ years). I've been in numerous inpatients, outpatients, detox wards, mental hospitals, jails, etc over the years. Believe me when I say I understand the issues involved intimately.

I see that your history is littered with the most horrible of places. What is so great about buprenorphine is it lets you go to your doctor, take home a script, and return to a normal life. Then, and only then, when you are completely into a normal life and a normal mindset removed from drugs does anyone really have a chance at success with abstinence that I feel they should try. I think the chances of abstinence right off the bat are so low, and the chances of severe harm with relapse - guilt, further self-doubt, even death from overdose which happens most often with the relapsing junkie, that it simply doesn't even warrant trying at that point - unless there is simply no other option. But that is my opinion, and everyone is different, and there are always unique situations.

I also know, for me, what works and what doesn't.

I also want to make it clear what works for you doesn't necessarily work for other and vice versa. I think I already made this clear. In this world, everyone is very unique, and there is no one solution for everyone. Your story is but one anecdote. I know several thousand. I am sure you know plenty as well.

Indeed, in the recent history of addiction treatment (last 100 years or so), psychiatry, psychology, criminal justice, certainly pharmacology, have all failed in providing effective and holistic treatment for the addict.

Agreed.

AA and NA have been, consistently and unequivocally, the constant form of treatment that has proven most effective for long-term sobriety. What's more, any psychiatrist, psychologist, parole officer, or even pharmacist who knows anything about this and isn't trying to sell you something, will absolutely tell you the same thing.

Sorry, I disagree. My first doctor, a doctor from overseas in France who was personally responsible to a large degree for helping Paris get off heroin (at that time) and bringing buprenorphine here, understood many of the things I said, and I was so lucky to have had him. He thought leaving yourself on your own was the worst thing you could do - but surrounding yourself with other junkies was the second worst.

I DO agree that AA/NA is the most effective group therapy available - period, and that's an important thing to say. It is a well-designed program that works well for alot of people - especially alcoholics where in their case alcohol isn't illegal and the situation is very different from a junkie. But as I said a while back, a large hunk of their success is due to people giving themselves to god, and doing so for convenience. I am an atheist, and I find it disgusting, for personal reasons. People need to learn that they have the power over themselves, not some invisible force has the power over them.

I don't want to turn this into a discussion on god. I will address the issues of group therapy (alone) vs. medical treatment with therapy (of any kind.)

In your diary, you stated simply that long-term abstinence isn't for you because...the odds aren't good.

I should have made it clear that I meant that it isn't for me right off the bat. It isn't for just about anyone right off the bat, unless they are extremely special. The potential benefits don't outweigh the risks, and their chances of success are the lowest of all. Your mind is simply too fucked up to just go cold turkey and be clean - it just doesn't work in 99% of people.

I will likely have a go at abstinence sometime this year. I am afraid, but I am ready. It took me longer than most wait, but I didn't want an exercize in futility, it simply wasn't worth it. Methadone has many hardcore downsides (including the most severe withdrawals imaginable), buprenorphine has virtually none, and I am going to make this clear in the diary.

What you don't mention are the odds of people getting "better" by any measure on maintenance drugs. If you look at methadone, the "success" rate is astronomically small. The success rate with buprenorphine is simply non-existent, as we have no measure of its long-term effects.< You're betting the farm on 0% or 5% (buprenorphine and methadone respectively) against 5-15% (the % you put to abstinence, which I promise is A. wrong and B. doesn't tell the whole story).

What in gods name are you talking about (no offense)? Your numbers are just plain wrong. The numbers are upwards of 50%, IIRC, in keeping people off of heroin and keeping people safe from AIDS and other related problems. I will find the studies to prove it to you. The fact that you would quote such totally bogus numbers makes me question the the objectivity of your information.

Even based on your logic, you're playing the wrong numbers. But the other question you have to ask yourself is: how do you define success? If "success" on buprenorphine's terms means taking a narcotic daily for the rest of your life because you can't live without it, versus the "success" of say a 12 step program--which is abstinence and living a better life--well, I'd say the pot of gold at the end of the rainbow for abstinence is a heckuva lot richer than with maintenance pharms.

Hell no. While I feel that lifelong maintenance IS a valid option, and one that works for many people - I have seen them - they are professionals in many cases. My trip to the upscale methadone clinic absolutely boggled my mind.

But as I said, hell no. The goal of buprenorphine is NOT lifelong maintenance, even though *I* feel that's a valid option. The goal is treatment through medication until you are ready to become clean. And with buprenorphine, getting clean is a heck of a lot easier than with heroin or methadone. It's about being able to get your life in order. You are incorrect, whoever has told you this information does not know their facts. Any clinical trial of methadone or buprenorphine has the people go clean at the end, and that is the stated goal.

The bottom line though, and why BOTH maintenance pharms and long-term abstinence have low success rates, is because it's hard. Simply put. If it was easy to get off drugs, everybody who had a problem would do it. It isn't, it's going to be tough no matter how you try to do it, and most people won't make it (remember, this goes for maintenance pharms also).

Absolutely! But being on a maintenance med is no comparison to abstinence, and if you think it is, no offense, you are simply misguided. Either way it is hard, and no matter what abstinence is going to be super hard. But it is my strong opinion that abstinence after maintenance is a far better shot, and really the only one worth taking in almost any case, than abstinence cold turkey from heroin.

The thing is, you can't decide what you're going to do based on what seems easiest, which is essentially what you're doing. You need to decide based on asking yourself the question "What do I need to do to be the person I want to be?" I tell you what, dieting and exercise regularly for life is pretty tough too, but if you have a weight problem and want to change, that's the best way to go, versus putting your faith in every new miracle pill that comes on the market promising to make you thinner. It was easy(er) for me to quit shooting dope if I just drank a case of beer and smoked a few joints every night, but guess what, that was pretty shitty too. The thing is, I might have even been able to live like that, long-term, and I could tell myself I was living a reasonable life (getting to work on time, maintaining a relationship, not getting arrested, etc). But I'd ultimately be lying to myself. I know, I've tried it. If that's what some people choose to do, hey more power to them, but I have a hard time believing that they're much self-actualized that way, just based on my own personal experiences and the personal experiences of pretty much every single person I've ever met that's tried to stop using drugs by substituting with other drugs.

I am sorry, but I have to strongly disagree with you here, and I have already outlined my case. Your analogy is very flawed.

That's the general stuff. Specifically on this post, you say that it's not an ideal situation for a person trying to get clean to surround themselves with other addicts or alcoholics. And yet, it's consistently the most tired and true method we know over the last 70+ years.

Not so. That would likely be methadone. It's been used since the early 60s with great success.

Look at every person in that room that's more sober than you; that's exactly what worked for them when nothing else did it. You're acting like it's a drug party you're walking into: what it is is group therapy and a fellowship of people who have struggled with the exact same problems you're struggling with and have come out the other side. Your psychiatrist who is prescribing you drugs has no idea what you're going through or even what works for the problem. He hasn't faced the same demons you've faced and prevailed. The guys in the rooms of NA have.

That's just the thing. In most cases they haven't. They are trying to prevail against the demons, but in most cases they haven't. If there was group therapy where everyone was verifiably clean, that would be another story.

But this is what gets me most:

What if I believe in empowerment instead of helplessness? Teaching helplessness as a drug treatment strategy is poor to say the least, IMHO.

You believe in empowerment and not helplessness, by deciding that you are absolutely incapable of abstinence and the only way you can live a productive life is by ingesting a narcotic daily? How is that empowering? You've already decided you're helpless, it seems to me.

I have already addressed this for the most part. I am, for the most part, helpless. But for me to change that, empowerment is the only option. I am not going to give myself up to a higher power - and that simply won't work for me - period. As I said, everyone is unique in this case.

But, you share that with the folks in NA and AA. You said it yourself, you already know that trying to "will" or "empower" yourself clean doesn't cut it; the folks in AA and NA know it too. So instead of giving into that and saying "So fuck it, I'm helpless so I'll just keep taking drugs the rest of my life", the folks in those programs say "I'm helpless, I can't do it alone, but I know people who can help me and as long as I admit that I'm incapable of getting high anymore, I can figure out a way of life where getting high is no longer required."

I find it hard to believe you have ever been in NA, no offense, I am not questioning your truthfulness merely suggesting that your case is not like most. I have been to several NA meetings, though never have attended fully. I have scored heroin at NA meetings. Does that sound like it's going to work for anyone struggling to deal with their demons, as you put it?

I am not going to respond to the rest of your post. It is your personal experience, and your defense of NA, and I am not going to question it. In fact, I am going to put this entire post into the diary, to give people a full look at the options available - and hopefully find the studies to back up my claims of methadone and buprenorphine's success.

It was nice speaking to you, and even though we disagree - pretty strongly at that - I am glad we can keep it civilized.

Best of luck to you, and I am sure I will hear from you again soon.

The folks in AA and NA admit that they're powerless over drugs and alcohol so they're done trying to get on top of it. You admit you're powerless, but you`re embracing that helplessness and sitting in it. When you say the folks in NA and AA are trying to force a higher power on you, what they're essentially saying is "You are not God. You cannot control everything. Realize that and learn how to build a life around that very plain and self-evident truth."

And you're right, if you're just a statistic, you probably won't make it no matter WHAT you try. But I just can't imagine trying to live my life like that anymore, constantly trying to right myself with chemicals. If that's success, I want no part of it. I'd rather admit defeat and instead focus on being the person I truly want to be than wallow in my helplessness for the rest of my life. What's the longest you've been abstinent since you've been addicted? If you've just gone from one drug for another, are you sure you're giving it a fair shake? Shouldn't you try it first before passing judgement?

Finally, everybody has AA and NA horror stories. When you go in there looking for things to object to, more than likely you'll find them (guess what, that goes for anything else in life also). There are also more people for whom AA and NA has saved their lives than you'll ever find in line at the pharmacy or clinic. I know, on this site, Maryscott O'Connor is pretty open about her own experiences there, and I`ve heard a few others as well.

Finally, I hate how this post sounds. I hate coming off high and mighty and judgmental. So, my apologies, this is off the cuff and dreadfully early in the AM. But I just read a lot of posts about people who have family members struggling with addiction, and I can tell you based on what I know now that if my son or daughter is ever struggling with the problems I have, I will surely not recommend that they find a "better" narcotic to become addicted to. I've known people that have tried it both ways. I've never met somebody who long term has found a successful life by substituting one drug for another; I`d reckon that you haven`t either. Maybe it's possible, I don't know, but I've never seen a success story myself, and I've been around literally thousands of addicts. On the other hand, in my experiences in AA and NA, I've found some of the best, most self-actualized, and empowered people I've ever run across, anywhere, period, and nearly every person I've ever run into who has tried, HONESTLY tried, with willingness and an open mind, to work the NA or AA program, I've seen succeed, time and time again. REAL success.

Anyway, sorry for the rant. Like I said, it's a personal subject.

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Thank you, glibfidget, even if I disagree with you. I sincerely apologize for not making it clear that not everyone believes the same as I do, although with all honesty most people in the heroin recovery community (who are addicts themselves) feel pretty strongly about maintenance. I can provide references to, for instance, the Advocates of Recovery through Medicine, who's hard work has been invaluable to people like me.

Update (day 2/part 2): I just realized this is a little unfair, my rebuttal without him being able to respond to my comments. If you want to see his response, as I am sure he will respond, as well as a post from someone who agrees with him, here is a link to his original comment:

glibfidget's post

Update (day 2): I promised to include other treatment options (besides maintenance and abstinence) and certain "harm reduction" policies (the current strategy today), and I am going to deliver.

Besides abstinence and maintenance, there are essentially two other treatment options. One is called "Rapid Detox." It is nothing new, and I have never heard a positive word about this method except from those trying to sell it to you. This is what I had to say about Rapid Detox, as well as a mention about the other new potential option, ibogaine:

"It's absolute quackery"

It's for people looking for miracle cures - and it just plain doesn't work. It's been around for quite some time now, it's no "breaking" treatment. It also costs ridiculous amounts of money. [Thousands of dollars]

Someone coming out of rapid detox has the lowest chance of success at abstinence of all - 5% at best. You just can't close your eyes and wake up cured. It DOES work in that you don't experience withdrawals - but if you ever see one of these things, up close or filmed, you wouldn't even consider it. It's downright horrible. They put you to sleep and force your body to go through what it needs to to be clean compressed into a 6 hour period. There have been deaths, and I wouldn't be surprized if it's shut down eventually. On top of that, you have protracted withdrawal symptoms, more minor nagging symptoms that continue longer than they should.

I have yet to meet anyone in the "loop" that had anything positive to say about rapid detox.

The only other treatment they have is this stuff called ibogaine. Well, that's not exactly true - they have plain symptomatic treatment for withdrawals, but NOTHING works to cure heroin withdrawals. Nothing - save one exception. There is a blood pressure med called Clonidine that depresses one area of the brain that heroin does - but far from all. So it does help - in some people - but others report no help or worsening of symptoms.

Back to ibogaine...it's this stuff that makes you have something resembling an unpleasant acid trip. Apparently some people think that when you take it, it does something to you that makes you look at your life and no longer want drugs. It has had mixed reviews, but there are some reports of success in clinical studies, which I need to catch up on.

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I will look for some further info on Ibogaine, including a link to a site possibly with info about it, and hopefully provide that. My opinion on it is it might be worth a try, but it's no miracle cure. I think we are mostly seeing the power of placebo here. But I will investigate further, it's overdue on my part.

Harm Reduction

The current stragegy of the government, after much lobbying, is called "harm reduction." This means that while we still send people to jail, while they are using we will do what we need to reduce harm (to everyone involved.) This mostly includes:

#1 - Education and Addict Outreach

#2 - Needle Exchanges

Needle Exchanges have done extroadinarily well, at least here in New York (I am positive there are places that need to catch up on this.) They essentially allow addicts to trade used needles for old ones. The goal is preventing the spread of HIV - and there is plenty of evidence of it's effectiveness in this regard. Guiliani opposed the first needle exchange tooth and nail, but eventually relented. The other important thing needle exchanges do is take used needles - thus preventing, to a certain extent, spent needles in places they shouldn't be.

Many states, including now New York, have also taken the step of making needles over-the-counter, meaning you can just buy them without a prescription. They are fairly cheap, and this is an important step for the type of junkie who would rather not go to a needle exchange - or where there are none available (or available at the time the junkie needs the needle.) I hope the other states that haven't implemented this follow the lead.

As for addict outreach, it's not nearly what it should be. Street addicts, most homeless and have HIV, need to be hit on the head with a stick to really get through to them, and many are very fearful of going to jail. I hope to see improvement here in the coming years.

Well, that's it for now. Hope I have given you what you have wanted.

UPDATE: future additions to my series on the drug war

Drug Prohibition: a Primer on Drugs from my vantage point - This is an opinion piece about drugs, and an overall introduction and background information for the future.

Next to come: Drug Prohibition: Where we Stand [tentative]

Source:

http://www.dailykos.com/story/2005/1/8/17424/52761