Abstinence Can Kill
No, not that kind of abstinence. I’m talking about quitting cold turkey from substance use.
Abstinence as opposed to medicated assisted treatment.
Before addiction barged its ugly lying-two-faced head into my family, I didn’t know the difference between methamphetamine and methadone. Sure, being a nurse, when someone was “on meth” I knew it was the former. But as methadone started popping up as an alternative to opioids, and I learned more about it, I wondered how replacing one drug for another could possibly be better.
This subject sparks as big of a debate as the ‘disease versus choice’ argument for addiction.
Luckily there’s a movement to advocate for people with substance use disorder who are unable to suddenly go cold turkey off of years of substance use.
This article from a treatment center in Tennessee called JourneyPure, explores all sides of the debate including the premise that medication-assisted treatment is just giving control of the billion-dollar opioid crisis back to pharmaceutical companies.
The ropes course at JourneyPure.Credit...Ilana Panich-Linsman for The New York Times
This was my thoughts exactly when I first started looking into treatment for my son’s substance use disorder.
Did I trust “the industry” that helped perpetuate my sons descent into this darkness? Did I want him just taking more pills? Then, what is the alternative? Going cold Turkey?
One argument in the article states:
“It’s true that if medications became the main form of addiction treatment, the pharmaceutical industry would benefit — an outrageous outcome, critics of the approach believe, given the industry’s role in creating the opioid epidemic.”
They also admitted:
There’s a small group who will probably need to be on M.A.T. for the rest of their lives, ”
Stated Mr. MacMaster, who quit drugs and alcohol 30 years ago, mostly through 12-step programs. He goes on to say:
“But everybody in this room knows drug-free recovery is really the gold standard.”
Photo by author
As a state official, he said, he had seen people enter the state’s drug court programs on medication, only to be forced by a judge to go off it and pursue abstinence-based treatment.
Faces and Voices of Recovery shows how to advocate for yourself if this happens
“These people were vulnerable, at high risk of overdosing and relapse,” he said. “We have to keep as many people alive as we can.”
There are many cases of deaths in jail cells due to withdrawal symptoms not being taken seriously.
In Kentucky, a woman Gave birth alone, because jail employees believed “she was distraught due to coming off drugs.”
So who is the judge and jury for those of our society who are struggling with an obvious brain disorder, or at the least- a hijacked brain- which affects their rational thinking? Although autonomy and self direction are paramount to a persons success in recovery; I believe they also need a thorough medical evaluation in order to place them in the best position for success.
Photo by author
“I am a clinician. The brain, sadly, knows what it wants. It too often overrides one’s capacity to set limits or to use mind over matter. Take sugar as an example. The vast majority of Americans are literally addicted to sugar. It’s the rare individual, indeed, who can be fully abstinent from sugar. Individuals with diabetes enjoy sugar free substitutes that allow them to overcome the terrible sense of sugar deprivation. If an infant were to go a lifetime WITHOUT sugar, that individual could live his or her life happily without sugar. Sadly, in the US, sugar is in almost everything we eat. Our brains learn to want, TO “NEED” sugar from an early age. Our government puts corn syrup ( very high sugar content ) in almost all processed foods. Our citizens suffer from a 70% obesity rate from sugar and many are dying because of this sugar by-product. All that being said, individuals often commence opioid use innocently either as youthful experimentation or as a physician-prescribed drug for pain. I have a few patients with opioid use disorders started because of a sports injury in high school.
Opioid use disorders are informed by the brain’s powerful, cruel, unrelenting biochemical mandate: GIVE ME OPIOIDS OR SUFFER!
The vast majority of people cannot fight back against the brain’s totalitarian control. Think of being lost in the desert without water. The brain knows what it wants!
MAT: Medication Assisted Treatment saves lives. Methadone and Suboxone gratify the bullying brain and permit the individual to focus on his or her normal life requirements, family, employment, school etc. Without MAT, the individual is locked in an unending, all-encompassing search for opioids to satisfy the brain.
Abstinence is killing our children.
AA is evolving. My son uses Suboxone and is welcome in some AA meetings.”
–Caroline Ridout Stewart, LCSW, harm reduction therapist.
As the argument goes back and forth between the risks of going cold turkey, and replacing the dangerous needle users of un-regulated street drugs with a safer option; one fact remains clear to me:
A judge, parole officer, jail warden or any other person in charge of a person with substance use disorder; should not be the one making medical decisions on someone’s long-term or even short- term recovery.
Every single person’s substance use is different as is every person’s recovery model. Most of them have used substances to self-medicate for years, so yes their opinion may be a bit skewed. That doesn’t mean they can’t have a say in what treatment plan they are most likely to follow, given their own unique circumstances.
For my struggling son, I would give anything if he was off of everything and leading as functional “normal” life as possible. But the reality is, he has been through year’s of trauma in the drug world while abusing his body with risky behaviors. He may not pick the “right” treatment path- especially if ( when) his illness is still driving his thoughts and actions. It is going to tell him to take the road that will get him back to his numbed or pleasure center driven state as quickly as possible.
However he is still human and deserves to have a choice on living a healthy life again.
Hope, is what every human relies on and should be given- freely without judgement.
