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. Now I’m going to cram more themes into this post than I should try, but here goes…
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, going as far to say that programs like Alcoholics Anonymous and Narcotics Anonymous are more like church than practical psychological rehabilitation. Fast forward not even two months and I’m in Brighton Center for Recovery- the rehab facility Eminem graduated from and shouts out in the song Underground- talking to a therapist. This delightful woman was a recovering heroin addict who specialized in music therapy and had a real flower-child vibe to her, probably my second favorite of all the therapists I’ve ever seen. I mention to her I’m not sold on 12 Step and relay the conversation I had with my aforementioned therapist 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.” And she was right, according to Americanaddictioncenters.org roughly 74% of all accredited addiction treatment centers in the United States integrate the program as a core piece of their curriculum. It’s a fact that has always seemed bizarre to me.
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 off the heels of another, less publicized, drug crisis around crack out of the 1980s. As a nation we’ve had a drug crisis in some form or another for more than 40 years now, and our best line of defense? A spiritual, not religious, program founded 84 years ago by a stockbroker and a surgeon (with no significant education in psychiatry that i can find) that’s intended to be a freaking support group. To clarify, a support group is 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.
It should be mentioned that I didn’t get sober until I said to hell with freethought and jumped into 12 Step, but nowadays there are times I retake my propensity for iconoclastic opinions. It should also be mentioned that following my near fatal overdose in 2014 I think anything would have got me off the wade array of mind altering substances I was ingesting, particularly the good ol’ pain pills. With that being said; irony in labeling Narcotics/Alcoholics Anonymous as a spiritual, not religious, program is that its 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. The problem is that we’ve created a system where it’s expected to serve a larger role than what 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 to say we might be well served to shift away from making it the focal point.
Treating addiction with psychedelics has shown promise since as early as 1964 (possibly earlier I only bothered to look as far back as 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, but 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, but rather it should treated seriously and continue to be examined.
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 just 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.
To start I’ve never used ketamine, but 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, Davis 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 just so happens to be the opioid receptors in our brain according to recent studies.
As someone well-versed in substance abuse, with a long history of “treatment-resistant” depression, who falls under the classification of a hard-to-treat patient (a list of the antidepressants I’ve been on at some point over the past 15 years include: Zoloft, Paxel, Abilify, Latuda, Lamictal, Celexa, and Lexapro) perhaps it’s that depression resistant to antidepressant can’t be cured with a pill. From my experience- I’ve been 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/being part of 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 this is a terrible, even destructive, idea. I’m looking for the words to articulate my feelings without sounding like a conspiracy theorist. Anyways, here are the facts, the most recent data shows that 12.7% of Americans age 12 or older reported taking an antidepressant within the last month. This is the latest available research from the National Center for Health Statistics, and marks the period 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 percent of adolescents in community-based substance use disorder treatment programs also meet diagnostic criteria for another mental illness.” and 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 I mentioned it’s important we keep an open mind with all forms of treatments and that we engage in an open discussion (shameless plug) on the topic of drugs and their role in society. Still the idea of an opioid used 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 and 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.