Like the bail bonds industry, the DEA & so many other entities profiting off the drug war, the drug-treatment industry in America is another booming racket profiting from the ruined lives of addicts while failing them in every way. The success rate of 12-step programs, which make up the overwhelming majority of treatment centers in the U.S, is between 5 and 10%. Left untreated, addiction is a fatal disease. Imagine being diagnosed with cancer and told the treatment you were to receive had a success rate of 5-10%. Not very promising, eh?
Harm Reduction. What's That?
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| Harm reduction = common sense safety measures |
When dealing with "the problem of addiction," a society must focus on the entire issue, from first-time use to full-blown addicts looking to enter treatment & get clean. This is a much bigger problem than just the end-stage addicts dragging themselves into addiction clinics (or being forced in by court-ordered programs). The current treatment model completely neglects an entire population: those who are still in active addiction & not ready--or able--to quit yet. While total sobriety may be the ultimate goal, not everyone will arrive at that revelation at the same time. Some never will. And that's okay.
People in active addiction deserve a safe supply of drugs, paraphernalia & information not only for their own well-being but to protect the public health. Diseases like HIV, Hepatitis B & C are especially rampant among IV drug users and those who live on the street or in other unsanitary conditions. But they're not confined to those populations. They spread readily to anyone who has sex with, shares drug paraphernalia with or has other intimate contact with someone who does those things... or a 3rd party who has done those things with a drug user carrying those diseases. That's where harm reduction comes in, and it's vital at every level of society, from the street-level drug addict to drug treatment centers to drug education programs in our public schools. But it's being neglected altogether at the moment by our federal agencies. Any harm reduction that does exist is left to private organizations that operate at the edge of legality in some states where things like needle exchange & fentanyl test strips are illegal.
The bottom line is that harm reduction programs help everyone. For instance, safe injection sites give addicts a place to get high out of view of the public while also providing access to fentanyl test strips, clean needles & educational materials, reducing the burden of communicable diseases like Hepatitis C & HIV. The other alternative is for them to shoot up in the street or public bathrooms where children and others may be present. When harm reduction is in place, literally everyone wins. For those who complain about drug addicts getting free naloxone & the like: Harm reduction is just one part of an overall universal healthcare program, not something that takes away from patients who need affordable insulin, chemotherapy or other vital treatments. That's not how any of this works. Functioning democracies & actual first-world nations don't have to choose which of their citizens live and die.
The Dearth of Evidence-Based Treatment
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| Real photo from a drug treatment center. Because beaches = sobriety apparently. |
For those who ARE ready to enter treatment, there are many other options than the 12-step model offered in so many clinics. One of the main issues with this treatment modality (aside from its high failure rate) is its faith-based 'higher power' rhetoric which is offensive to atheists, nihilists and those who just flat out don't subscribe to the belief that something outside themselves is responsible for their behavior & fate. This takes both power and responsibility away from the individual, which can be dangerous. But so does the "powerless against my addiction" and "once an addict, always an addict" mindset that's drilled into the heads of 12-steppers.
That's not to say this method doesn't work for some people. Clearly it does, and that's great. But for the majority of people who try to stay sober this way and fail repeatedly, other options must be readily available. Whether it's opioid substitution therapy (Suboxone or methadone), antagonist drugs like Vivitrol (naltrexone) and Antabuse that block the pleasure centers or induce illness when the drug of choice is ingested or non-traditional treatments like ibogaine therapy, the data is clear: no single treatment works for all addicts. Imagine offering only one antidepressant medication to every patient with depression and then blaming them when it fails to help. Maybe it helps some people, which is great. But the vast majority are left feeling the same or worse than before. That's what we're doing to drug addicts right now and it needs to stop. Which brings up the next controversial point:
100% sobriety for the duration of one's life is not and should not always be the goal of drug treatment.
Read that again. The primary goal of drug treatment should be preserving the patient's life. Once they're safe from all imminent threats to their life (overdose, the secondary harms of addiction like living on the street or injecting drugs), the next goal is returning them to a life of purpose, contentment & productivity. For some addicts, that can best be done with a substance-free life. For others who have been using hard drugs like opioids for decades that have changed the structure & function of their brains, or those with severe ADHD who require stimulant medications, "drug-free" may not be the best option. In that case the goal should be to determine what substance, dose & dosing schedule works best for the patient to control their symptoms while allowing them to live a happy & productive life.
Too many treatment centers have a purity mindset when it comes to addiction. Addicts who relapse are kicked out onto the street for the very disease they're supposed to be treating. Or they're forced to withdraw cold turkey with no tapering medications & find it too difficult, so they leave on their own to find relief. I don't know about you, but that doesn't even meet the first criterion of "preserving the addict's life". All you've done is lower their drug tolerance so that they're more likely to OD once they go back to using. This is why abstinence-only methods are so dangerous. Instead of saving lives & helping addicts, these treatment centers moralize drug use, making it a black-and-white, all or nothing endeavor for their "disciples" to either pass or fail. No grey area. But life is full of grey areas, and so is addiction.
Unregulated, Unproven Therapies
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| Addiction care is dangerously unregulated in the U.S. |
Addiction treatment in the U.S. is largely unregulated by any federal agency & outsourced to private companies, which means they get to choose what methods they use. The result is a wildly varying hodgepodge of programs including faith-based groups like Scientology's Narconon & Alcoholic's Anonymous which subscribes to a "higher power"; wilderness & equine therapy often targeted at drug addicted youths (which are notorious for their bootcamp-style slave labor & sexual abuse allegations) & potentially worthless, dangerous alternative medicines like NAD therapy that's not approved by the FDA.
Increasingly, treatment centers employ the dual diagnosis method where mental illness & trauma are addressed in addition to the addiction. This is a much more comprehensive & effective approach than the 12-step method, but it can still be risky if the addict is forced to quit cold turkey or go from high doses of drugs to total abstinence. While it's vital to treat the underlying problems that lead to substance abuse in the first place, it's much easier doing that while the addict's withdrawals & cravings are under control. These clinics often schedule every moment of their patients' day, leaving no time for spontaneous rest and reflection. Putting addicts to work & giving them meaningless chores to keep them busy while in treatment is not sustainable either--real life doesn't work like that. It's full of downtime, quiet moments, boredom, loneliness & temptation.
This type of busywork treatment is reminiscent of that show The Biggest Loser that forces its contestants to lose massive amounts of weight through brutal and unrealistic amounts of exercise. They almost always gain it all back and then some upon returning home because nobody can maintain that bootcamp lifestyle in their daily life. That's what happens with many work-focused rehabs (that's to say nothing of the ethics of putting addicts to work for private corporations). The addict fails upon returning home because they can't keep up the frantic pace of constant busywork they were expected to engage in at the clinic, nor is their everyday life equipped with a live-in therapist, addiction specialist & other professionals to guide them.
And then you have the opposite end of the spectrum: the super expensive elite rehabs with gourmet chefs, heated pools, massage, acupuncture, breathtaking views & attractions like miniature golf and bowling. But these are no better than the poor-man's rehabs in terms of employing woo and unproven treatment methods. In some ways they're worse. Take Paracelsus in Switzerland, the world's most expensive rehab center. They offer bioresonance imaging on intake to "diagnose" what's wrong with their patients, from food intolerances to full-blown food allergies. Allegedly. Quackwatch.org has labeled bioresonance imaging as bullshit, which means Paracelsus's other device--the Metatron--which does similar "diagnosing" is also worthless woo. In a clip from Vice we see these devices used on a patient who is then prescribed gold as a sticker to wear on the back of her neck to "help with the allergies" diagnosed with these bunk machines. Yes, elemental gold.
A 5-week stay at Paracelsus costs $370,000. Well, yeah. They're strapping solid gold to their patients' necks.
This might be funny if not for the fact that we're talking about the most unfunny thing ever. In 2021 alone, drug overdose deaths in the U.S. surpassed 100,000 for the first time in history. That's just the deaths from overdose, not counting all the lives ruined by addiction & its other secondary consequences. It's not much better in Canada where fentanyl is just as ubiquitous. If we don't get serious about science-based addiction treatment & harm reduction, we're on track to keep losing hundreds of thousands of Americans needlessly in the prime of their lives. Before our leaders worry about the "low birthrate," maybe they should concern themselves with the people already living--and dying--in droves from these deaths of despair.
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