Editor’s note: This is not meant to be a criticism of Narcotics Anonymous, Alcoholics Anonymous, or 12 Step Programs. I love the program, rather it is meant to spark the discussion on addiction to change the dialogue and to reassess the problem of drugs in society. We also touch on Ketamine for depression and hallucinogens in addiction treatment. Now I’m going to cram more themes into this post than I should try, but here goes…
Setting the Stage
I was seeing a therapist before my first tour of rehab, probably the second best of all the therapists I’ve ever seen. A cool, relatable dude with a full sleeve, he always seemed present when I talked with him. At some point during one of our weekly discussions I shared that I had some reservations about jumping on the 12 Step bandwagon (a bandwagon I’ve been on for some time now, but that’s not the point of this post). To my surprise he agreed with my concerns. He went as far as to say that programs like AA and NA are more like church than psychological rehabilitation. Fast forward not even two months and I’m in Brighton Center for Recovery talking to a therapist. The rehab facility Eminem graduated from and shouts out in the song Underground.
This delightful woman was a recovering heroin addict who specialized in music therapy. She had a real flower-child vibe to her, and was my second favorite of all the therapists I’ve ever seen. I mentioned not sold on 12 Step, referencing the conversation I had with my aforementioned therapist. Done as evidence to discredit the notion that Narcotics Anonymous is a prerequisite to sobriety. “I don’t know why he’d say that,” she relied, her tone noticeably irritated. “There’s a reason any drug in-patient program worth a damn, with any credibility at all uses 12 Step”. She was right. According to Americanaddictioncenters.org roughly 74% of accredited addiction treatment in the United States integrate step-work as core curriculum. It’s a fact that has always seemed bizarre to me.
The Role of 12 Step
Think about it objectively for a minute. We’re in the midst of an opioid crisis. President Trump went as far as to declare it a bloody public health emergency in 2017. The opioid crisis started in the 1990s right on the heels of another, less publicized, drug crisis around crack in the 1980s. As a nation we’ve had a drug crisis in some form or another for more than 40 years. What’s our best line of defense? A spiritual, not religious, program founded 84 years ago by a stockbroker and a surgeon. One intended to be a freaking support group.
To clarify, a support group can be defined as a group of people with common experiences or concerns who provide each other with encouragement, comfort, and advice. That’s exactly what Bill W. and Dr. Bob, the founders of AA, intended for Alcoholics Anonymous to be. A support group of addicts to help addicts. It was never intended to be the stable curriculum for more than 70% of our nation’s drug rehabilitation facilities. This is the problem I have with 12 Step Programs. It’s really not a complaint against 12 Step so much as it’s a complaint against our approach to addiction treatment. A complaint against the institutionalization of 12 Step- a support group- as the premier staple curriculum in substance rehabilitation.
I should mention that I didn’t get sober until I said to hell with freethought and jumped into 12 Step. Nonetheless there are times I retake my propensity for iconoclastic opinions nowadays. Following my near fatal overdose I think anything would have got me off the wide array of mind altering substances I was ingesting, particularly the good ol’ pain pills. Here’s the irony in labeling Narcotics/Alcoholics Anonymous as a spiritual, not religious, program. It’s become “weaponization” to suit a societal agenda in an astonishingly similar way to what we’ve seen with organized religion time and time again.
The problem with 12 Step isn’t a problem with 12 Step. We’ve created a system where the program’s expected to serve a larger role than it was ever intended for. It’s a phenomenal program- one that aided in my return me to sanity- but it’s handicapping to treat it as the end all, be all for chemical dependency rehabilitation treatment. This isn’t to say that we should remove Alcoholics Anonymous entirely from treatment programs, we shouldn’t, but rather we might be well served to shift away from making it the focal point.
Hallucinogens for Addiction
Treating addiction with psychedelics has shown promise since as early as 1964 (possibly longer I only looked back to 1960). In recent years researchers see promise in ibogaine, a well-known hallucinogen, and related compounds. I was two years into my habitual drug use and on my way to chemical dependency the first time I took a hallucinogen, mushrooms, my junior year of high school and I remember clearly my urge to consume fistfuls of Vicodin faded ever so slightly following the experience.
Of course it returned full force after another ten years of repetitive use. Nonetheless, personal experience has showed me there might be something to this. To be clear taking hallucinogens sounds positively terrible to me today, in fact I found the experience terrifying. Of course this isn’t to say I encourage anyone struggling with substance abuse to eat a bunch of mushroom caps. However, we should view it as a serious option and continue to examining.
Ketamine for Depression
Now the section of the article where I sound part hypocrite, part prophet. America’s next drug epidemic will be around the use of ketamine and it was born last week when the FDA approved a ketamine-like medication for patients with “hard-to-treat” depression.
The Food and Drug Administration approved Spravato as a fast-acting treatment for patients who have failed to find relief with at least two antidepressants. Up to 7.4 million American adults suffer from so-called treatment-resistant depression, which heightens the risk of suicide, hospitalization and other serious harm, according to the FDA.
I’ve never used ketamine. However, after doing research and having heard second hand experiences I’ve got a decent idea how it works. In this Live Science article David Olson; an assistant professor of chemistry, biochemistry, and molecular medicine at the University of California described ketamine-like substances as dirty. “Meaning they likely hit a variety of targets in the brain,” Olson told Live Science. What I didn’t know was that one of those targets ketamine hits happens to be the opioid receptors according to recent studies.
As someone well-versed in substance abuse, with a long history of “treatment-resistant” depression, I fall into the classification of a hard-to-treat patient. A list of the antidepressants I’ve been on over the past 15 years: Zoloft, Paxel, Abilify, Latuda, Lamictal, Celexa, and Lexapro. Perhaps depression resistant to antidepressant can’t be cured with a pill. From my experience- clinically depressed for fifteen years and clinically bipolar for seven- the most successful treatment for clinical depression have been physical activity, talking with a good therapist, contributing to something bigger than yourself, and developing hobbies and skill sets. Antidepressants help with depression, treatment-resistant depression require more than a pill. Yet, the FDA just gave the green light to pharmaceutical companies to prescribe an opioid for severe depression.
I think Ketamine for depression is a terrible, even destructive, idea. I’m looking for the words to articulate my feelings without sounding like a conspiracy theorist. Here’s the facts. The most recent data shows that 12.7% of Americans 12 or older reported antidepressant use within the last month. This is the latest available research from the National Center for Health Statistics from 2011 to 2014. That’s a 64% percent jump from 1999 to 2002, when 7.7% of respondents reported antidepressant use.
“Overall one in five, 16.7 percent, of 242 million U.S. adults reported filling one or more prescriptions for psychiatric drugs in 2013”. Wrote the Journal of the American Medical Association’s JAMA Internal Medicine. According to Drugabuse.gov, “over 60% of adolescents in community-based substance use disorder treatment programs also meet diagnostic criteria for another mental illness”. The FDA just signed off to treat up to 7.4 million Americans with mental illness, one of the highest correlations for addiction, with an opioid…
Perhaps I’m wrong. As mentioned it’s important we keep an open mind on all forms of treatments. Likewise, it’s important we engage in an open discussion on the topic of drugs and their role in society. Still the idea of using Ketamine, an opioid, to treat depression terrifies me. Specifically in regard to drug rehabilitation programs it’s imperative we adopt a more all encompassing approach to treatment options. Centering on 12 Step has hindered this. To be clear, this is not a shortcoming of the program. It’s society overextending what the program was ever intended for in the first place.