I was seeing a therapist before my first tour of rehab, probably the second best of all the ones 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. 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 two months and I’m in Brighton Center for Recovery talking to a therapist.
This delightful woman was a recovering heroin addict who specialized in music therapy. I mentioned not sold on 12 Step, referencing the conversation I had with my aforementioned therapist. “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 this objectively a minute. We’re in the midst of an opioid crisis. The President went as far as to declare it a public health emergency. 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 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 that 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 as the premier staple curriculum in substance rehabilitation.
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. It is a problem with the system we created in expecting a support group 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). In recent years researchers see promise in ibogaine, a well-known hallucinogen, and related compounds. Personal experience has showed me there might be something to this. We should view it as a serious alternative and continue to examining it as an option.
Ketamine for Depression
One might speculate that 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.
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.
Most recent data shows 12.7% of Americans 12 or older used antidepressants within the last month. 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.