How the U.S. is Failing People With Substance Use Disorders (and Failing Miserably)
(Originally Published by Matt Finch, Addiction Coach, at opiateaddictionsupport.com)
I know the title of this piece is pretty intense. To some, it may even appear like ‘click-bait’, but for those of you that actually read it through, you’ll see that it’s anything but.
For other readers, they might feel attacked by the content of this essay.
But I assure you that my intentions are purely to shine a brighter light on the issues we are facing today — in the hope that my message reaches the right people.
You know, the folks that can actually do something about illicit drug use policies and addiction treatment policies in the US.
Table of Contents
Why Are Rates of Addiction Going Up Instead of Down?
For those of us that were around and remember the 1990s, the 2020s seem like a dystopian nightmare.
Rates of substance use disorders (SUDs), mental health disorders, and suicidal ideation have risen at alarming rates during the pandemic.
However, it was really bad even before we were forced to stay home and lockdown for what was supposed to be a couple of weeks to a month.
But this article is not about COVID (at least most of it isn’t).
It is about the atrocious job our government has done in regard to illicit drug use.
It is about the biggest, longest, and most expensive and damaging failure of our government, the War on Drugs.
It is about the traditional treatment centers that make up a $50 billion industry which most researchers believe have a 90-95% failure rate.
It is about the widespread ignorance of addiction and what actually causes it, how the brain changes (neuroplasticity, neurotransmitter deficiencies, midbrain hijacking, prefrontal cortex disabling, and more), and why people with substance use disorders are often looked at and talked about with contempt, disgust, or other negative feelings.
It is about the widespread prevalence of physicians that do a poor job treating addiction.
It is about the widespread prevalence of chemical dependency counselors that aren’t very qualified, not compensated well, and have caseloads that are way too high, causing them to burnout and oftentimes quit or relapse or both.
It is about the FDA and Big Pharma and the many cases where corruption has been proven and cases where it’s unproven but highly evident… at the expense of the health of our country’s citizens.
And finally, it is about those of us who are sick and tired of this all continuing on and on with seemingly no end in sight.
Make no mistake…
We’re still in the “Dark Ages of Addiction Treatment”, despite rapid advancements in neuroscience, psychology, health, nutrition, biohacking, medicinal therapy, and other integrative modalities.
Why are we still in these dark ages?
Allow me to point my high-beam flashlight on the following contributors…
Mainstream Rehab & AA
The vast majority of mainstream treatment centers subscribe to the ideology of Alcoholics Anonymous (AA) and the dogmatic teachings of The Big Book—written in the 1930s by two drunks that found God and religion as their path to sobriety.
For decades or longer perhaps AA was the best bet for most individuals.
Nowadays, if you actually look at the research you’ll find that most researchers have found AA to have between a 3-10% success rate.
During the pandemic (at least in my state, California) AA meetings were forced to go online and have largely remained that way even to this day.
For the folks dependent on in-person meetings to stay sober, the pandemic/lockdown caused many to lose their foundation and recovery routine. As a result, many have relapsed back into active addiction. Some have overdosed and even died.
At this point, I believe it’s important for you to know that I think AA is a wonderful resource for the individuals that resonate with it. The program helped me at various times in my addiction and I’ve witnessed the positive changes many have had as members.
It’s also important for people to know that AA and complete abstinence from all mind-altering drugs is the prescription given to all that attend mainstream rehabs.
They literally prescribe a one-size-fits-all approach no matter the person’s unique situation and psychographics (their values, interests, beliefs, way they view the world, and more).
Here’s a statement that could lead ‘Big Book Thumpers’ to become emotionally-charged, combative, and defensive… maybe even righteous.
“There are many paths to recovery… not just AA.”
I’ve been verbally attacked and even persecuted many times for making the statement above.
You’d think members of a program that wholeheartedly promotes ‘open-mindedness’, ‘love’, and ‘tolerance’ into the very fabric that makes up the ideology would not make such attacks.
However, if you thought that before then now you know the opposite is often true. They are only human, after all.
Again, this is not to dis AA; it’s merely to showcase why so many of us are turned off or even repelled by the program.
It’s the dogma that scares most away.
But for the people that feel it’s a great fit, it’s saving lives all over the world and that is nothing short of a miracle.
The War on Drugs
The term ‘War on Drugs’ was popularized by the media in 1971 following a press conference held by President Richard Nixon. During his speech, President Nixon declared drug abuse “public enemy number one."
The message to Congress included statements about devoting more federal resources to the “prevention of new addicts” and the “rehabilitation of those who are addicted.” Regardless of these statements, the media chose to focus on the statement “War on Drugs.”
Obviously, that term would get more people to watch/read the news.
I wish I could say that mainstream media in 2020 is any better. In reality, I think most people would agree that real unbiased journalism and reporting in mainstream media nowadays is biased at best and propaganda at worst.
Two years prior to the press conference mentioned above, President Nixon had declared a War on Drugs, which was and still is a global campaign by the U.S. federal government.
This campaign involves drug prohibition, military aid, military intervention, and incarceration for drug dealers as well as for people that don’t sell illicit drugs but take them for personal use only.
The main goals of this War on Drugs are to discourage the production, distribution, and usage of illegal drugs.
Currently, the Drug Policy Alliance (DPA), an opponent to the War on Drugs, estimates that these policies cost the U.S. around $51 billion annually.
Nearly a decade ago, the Global Commission on Drug Policy published a document stating “The global war on drugs has failed, with devastating consequences for individuals and societies around the world.
In his best-selling book, In the Realm of Hungry Ghosts: Close Encounters with Addiction, Canadian addiction expert Gabor Maté, M.D., calls for the end of the war on drugs and discusses well-researched alternatives that other countries have had success with.
Family Practice Physicians
While I do admit there are some extraordinary doctors in the U.S., the majority of them who deal with substance use disorders simply don’t know what they’re doing.
According to med school students I’ve met, they are only required to do around 4 hours of training on addiction, and around the same amount of time for nutrition.
Getting prescribed medicines for drug or alcohol detox from a family practice physician or psychiatrist is often hard for people with substance use disorders.
They are often viewed as not having the ability to take any potentially addictive substances after they have been addicted to one substance—even though there is no solid evidence to support this belief.
Buprenorphine Prescribing Physicians
When it comes to buprenorphine (an opioid used to treat opioid use disorder) prescribers, often you’ll hear them state “buprenorphine for opioid addicts is just like using insulin for patients with diabetes.”
They often recommend lifelong or at minimum long-term maintenance treatment as the best option for a person with opioid dependence.
When you think about it, this makes perfect sense (at least from a business vantage point).
There are only three ways to grow a business:
Increase the number of customers/clients
Increase the number of times customers/clients make purchases
Increase the average amount of sale per customer/client
For buprenorphine prescribers it would be:
Increase the number of patients on buprenorphine formulations
Increase the length of time patients remain on buprenorphine therapy (patient retention)
Instead of allowing patients that have been clean from illicit drugs to reduce office visit frequency, many buprenorphine prescribers will continue to make them come at least 1-2x a month even though the patient at a certain point should not have to visit more than 1x every 2-3 months (but these doctors make more money with more office visits)
Buprenorphine prescribers want to stay in business and the best way to stay in business is to have plenty of patients that stay on buprenorphine for years and years… and years (easy money).
They actually lose money if they help a patient detox from buprenorphine successfully. And many don’t believe people with opioid use disorder have the ability to quit all opioids and return to a state of mental and physical health and well-being, so they think buprenorphine is the best approach for every patient, which is in their personal financial interest as well. Pretty convenient if you ask me, and dare I say a little too convenient?
Chemical Dependency Counselors
With chemical dependency counselors who are also doing triage on the front lines of the addiction epidemic, there are many issues as well.
The vast majority of counselors working at rehabs are in recovery from addiction themselves and often got clean from AA or Narcotics Anonymous (NA).
This invariably leads to the widespread promotion of the one-size-fits-all recovery myth to people that need customized treatment based on what resonates with them, not treatment based on what their counselor thinks is best for them.
I was a certified chemical dependency counselor in mainstream treatment. Every single counselor I worked with promoted 12-step as the only way to live life without addiction.
It’s no wonder that I was the most popular counselor at all times. I was literally the only counselor that didn’t try to shove AA down every person’s throat.
Additionally, most rehab counselors are under-qualified, under-compensated for the stressful work, and overworked with big caseloads and never-ending paperwork.
Substance abuse counselors have the fastest burnout rate of any profession. The average length is only two years, which is funny to me because that’s exactly how long I lasted before I couldn’t take one more day of it and gave my two weeks’ notice.
I would no longer work 40 hours a week with a caseload of 100 patients and the majority with co-occurring disorders for a mere $15/hour before taxes and health insurance.
FDA & Big Pharma
The FDA has become somewhat of a joke these days. When the Drug Enforcement Agency (DEA) failed at making Kratom (a controversial plant with psychoactive effects) illegal, soon after the commissioner of the FDA at the time, Scott Gottlieb, started a War on Kratom.
While it’s true that Kratom addiction is real and is a problem, the smartest plant chemists and botanists in the world have proven with science that Kratom is much safer than pharmaceutical opioids, heroin, and fentanyl, which is the main population that uses Kratom (people quitting more dangerous opioids by using much safer and weaker plant opioids).
In fact, the FDA claims that Kratom is deadly and the massive war they launched on Kratom based on lies that were debunked by real scientists have made them lose all credibility with many citizens of the U.S, myself included.
Scott Gottlieb launched this War on Kratom pretty much right after becoming commissioner. It’s important to note that prior to securing this position, he was a consultant for Big Pharma and had earned hundreds of thousands of dollars in compensation from them.
He immediately went after Kratom and opioid withdrawal supplements, which you might find interesting to know were seriously taking away from Big Pharma sales of Suboxone, Subutex, and many other medicines at the time (and still are today), as Kratom has been anecdotally reported to be used by several millions of people in the U.S. as a natural alternative to pharmaceutical drugs.
And the growing popularity of using supplements for addiction recovery has to really piss off the FDA and Big Pharma, who want people with addiction to use FDA-approved drugs (which kill hundreds of thousands of people yearly) and not supplements (which typically don’t kill a person!).
Kratom is still legal to use federally, however, many states banned it while Scott Gottlieb was still commissioner and contacting judges state-by-state to make Kratom illegal the slower way.
This is all easily proven and quite simple to find online. However, the only thing you won’t find is proof that the FDA commissioner was in fact paid by Big Pharma to get rid of supplements for withdrawal and Kratom. You be the judge. It all seems just a little too coincidental to me.
Important Caution: Kratom can be highly addictive and with daily use can cause dependence and even a withdrawal syndrome when quitting it cold-turkey after prolonged daily use (especially with high dosages).
Other plant medicines can provide benefits for recovery without having to go down the Kratom road, and many are using these safely with no negative consequences.
There is Hope
Despite the challenges mentioned in this piece (as well as the ones that weren’t mentioned), change is in fact happening.
The Alliance for Addiction Solutions (AAS), pioneers in Neuro-Nutrient Therapy for addiction such as Julia Ross and Christina Veselak, fringe recovery coaches Chris Scott and yours truly, companies like Mindmed with 18-MC (a manmade ibogaine derivative), recovery advocates and activists, politicians, non-profit organizations, and many more have been directly involved in progressing the field of addiction treatment and/or policy reform in this area.
The public is waking up and demanding holistic treatment approaches that treat addiction as a bio/psycho/social/spiritual disorder.
The biochemical component to addiction should be the foundation of all treatment and of course, this is the main reason mainstream treatment is falling so behind… they leave this component out (I learned this paradigm-shifting concept from revolutionary texts authored by Julia Ross (The Mood Cure) and Dr. Charles Gant (End Your Addiction Now).
Here are some alternative modalities that can help mainstream treatment get with the program:
Nutrition for addiction recovery (especially the type of nutrition taught by the Academy for Addiction and Mental Health Nutrition
Supplementation (including amino acid therapy, herbs, adaptogens, vitamins, minerals, omega-3’s, and many others)
Deep tissue massage
Chinese tonic herbalism
Binaural beats (brainwave entrainment)
And many more!
In the past few months alone, I’ve read news articles discussing therapies available now or in the near future that all sound promising (eg contingency management, virtual reality, deep brain stimulators, and many others).
So why then, you may ask, did I write this article if things appear to be going in the right direction?
Well… they may be going in the right direction but the pace of change is too slow to make much of a difference on the national level, and I’m sick of reading about so many people suffering and dying needlessly.
I believe we can do much better, especially since certain other countries (like Portugal) have already had documented success with their decriminalization and free treatment approach, which in my personal opinion should be discussed and looked into for our nation.
People with substance use disorders are not bad people. They are simply individuals with a health issue. Anyone that has studied the changes addiction has on the brain can easily understand this. Unfortunately, those of us that truly understand are far outnumbered by the ones that still believe addiction is a moral failing.
My goodness, I can hardly believe it’s almost 2021 and I’m having to write this. My great hope is that 5-10 years from now I won’t need to discuss these topics anymore. Until then, the work must continue. I’m doing my part in this mess, and others are doing their parts. With diligence and consistency, I do believe the future will be a much better time for addiction treatment in the U.S.