Medication and Care for the Addict
I always say this to parents, or anybody who has an addicted loved one, the first step should always be a complete thorough psychiatric evaluation by somebody who is not affiliated with any treatment organisation. So that you can know going in what the problems may be, and what kind of services you should be seeking. You know, there are some wonderful treatment providers who if somebody shows up who is not appropriate for their services, they will send them away. There are also unfortunately, many people who will just take that person to make profit off of them. And they will not help that person. And they will not inform them that, for example, if they stayed on maintenance, they would have a 50% reduction in their death risk. And it is, you know, it is very difficult to actually find programs that provide evidence-based care. This is also a problem in mental health more generally. But anyway, the point here is, is that in order to get care that is good for you.
There are people who were trying to promote brain surgery for addiction using electrical stimulation of that area. And it doesn’t work any better than methadone. And that’s not to say that methadone isn’t the most useful drug we currently have, but it does not involve invasive surgery. And I should say methadone and buprenorphine. The opioid agonists are the best treatments that we have for opioid addiction. And what they do is two things. The first thing is they cut the death rate by 50%, which this happens, whether you continue using on top or not. So that’s like sheer harm reduction. And that’s wonderful. If we can keep you alive long enough that you stabilise your life, that is a lot better than having you die.
Show Compassion to the Addict
The other thing that they do is, they allow people who are ready to stabilise their lives. So you couldn’t tell right now if I was on a maintenance treatment or not. Because basically, once you get a tolerance to these drugs, you are not high or impaired. And you can drive and you can work and you can love and you can do all of these things. What you’ve done is you’ve substituted compulsive behaviour despite negative consequences. And now you just have physical dependence. And that’s not a real problem. As long as you have a safe and legal supply, I think the most important place to start is that addiction is a learning disorder, it’s not a sign that you are a bad person. And if you want to have a safe and addiction free, or at least lower level, addiction, workplace or school, you want people to feel included and comfortable and safe. And you don’t want this to be an adversarial thing.
The research shows that the best way to get people help is through compassion and empathy and support, and absolutely not tough love. There may be situations in which an employer has to fire somebody because their performance is just degraded so much that there’s no other option. But they shouldn’t think I’m doing them a favour by firing them, because that will make them hit bottom and it will help them. Sometimes that happens. But sometimes they just go on to a life of homelessness and then die. So you can’t assume that creating extra negative consequences is actually going to help a person with addiction. What you want to do is, is align yourself with them. And presuming this as an employee that you want to keep help, you know, help them realise that this is not a sin, I am not trying to control you. What I want to do is for you to be at your best at work at home. And you’re not being at your best right now. So what can we do to help?
And so the best way, I think, is to say, I’ve noticed X, Y, Z, I’m worried about you, I’m concerned about you, I want you know, to make sure that I can help you. So if it comes from a place of not like I caught you, you know, you know, because there’s so much advice that is just like, you know, well threatened to fire them if they don’t change and drug test them immediately. And all of this kind of stuff which destroys trust. You know, so that’s not to say that if somebody is doing something dangerous, or clearly, you know, inappropriate, that that behaviour doesn’t need to be addressed. But it is to say that you can approach somebody in a confrontational, degrading and sort of high-powered manner, or you can approach them as an equal human being deserving of respect. And if you do the latter, you will have much better results.
Break Through Denial
This is a point for the addict to address. Honestly, the biggest hurdle that anybody who’s struggling with addiction has to face is “Self”. Because, you know, we subscribe to the disease concept of addiction. And it’s a disease that tells us we don’t have a problem. It’s a disease that tells us, I have this under control, I can take care of it. In the addictions field, there’s been this whole thing, we got to break through denial and everything like that, well, people have denial for good reasons, if we didn’t have denial, everybody would be sitting around obsessing about death. Or at least I would be. You know, it’s, it’s a defence mechanism because we need defending.
So recognising that can allow you to approach somebody not from an attacking stance, approach somebody from a befriending sort of stance, and that is hard to do. And some people are going to get very defensive no matter what you do. Um, and it’s not going to be a pleasant conversation most of the time, but you can make, you can minimise harm. I mean, this whole thing always comes down to like reducing harm, making things less unpleasant, if you can’t make them non unpleasant, or pleasant. You know, the, so it’s, it’s really, but the main thing is, like, see them as a full human being.
