This topic arose in our podcast with Steven Slate. Let’s start off with a little bit of a history lesson, shall we? The First Amendment to the Constitution reads : “Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the Government for a redress of grievances.” This has come to be interpreted as the separation of church and state. It’s how we established a part of what has become the backbone to our nation’s democracy. As you can see, the Constitution encourages freedom of religion and forbids the federal government from obstructing the American people’s ability to practice religion as they wish.
Here’s what the amendment was intended for and what it doesn’t do. The First Amendment is meant to keep the state out of the church’s business, and the church out of the state’s. It was not to discourage religious discussion, keep religious people from civic positions, or remove religious motivations from public debate. Above all, the framers of the Constitution were a pretty smart group. Perhaps recognizing the potential for religion to be weaponized. this was an attempt to circumvent any conflict of interest that may arise.
How does this relate to addiction and substance abuse? First, allow me to explain the differences between the two. Second, we’ll examine how a similar hedge of separation might benefit addiction and substance abuse. Looking at the success rates of various treatments and other statistics.
Not every country has a separation of church and state. In fact thirty countries require that heads of state belong to a certain religion. Most of these countries are in the Middle East and require a Muslim leader. A system of government ruled in the name of God or a god is known as a theocracy. Afghanistan, Iran, Saudi Arabia, Sudan, Vatican City, and Yeman are all modern day examples of this form of government. Nazi Germany had theocratic elements. Crystal Ayres outlines these six problems with theocracies in a blog post available at connectusfund.org:
- (Theocracies) may not recognize minorities legally.
- It would allow intolerance to be common.
- It may be viewed as hypocritical.
- (They) might prefer imitation over innovation.
- It can ultimately boil down to a follow-or-die attitude.
- It sees people as fallible beings.
The problem with a theocratic government, much like the problem with treatment and recovery being viewed as the same, is that it minimizes descent (alternative forms of treatment). It’s fascinating how applicable the concerns mentioned by Ms. Ayres regarding a theocracy relate to the concerns we’re bringing up in regard to treatment and recovery. For instance, we’ve become content with the status quo offered by the traditional 12-Step approach to treatment that we refuse to entertain potential alternatives (imitation over innovation). Second, in a lot of circumstances we have also implemented a follow-or-die attitude in regard to getting treatment when it comes to recovery. Third, we see people as fallible beings under this approach.
Treatment VS Recovery
People often assume treatment and recovery are interchangeable terms. In reality, they should be viewed entirely separate. Treatment is, just that, treatment,. Typically it involves someone going to an inpatient rehabilitation facility. Oftentimes centering around helping addicts get through withdrawal and start tackling the emotional and physical issues that accompany substance abuse. It should involve a thorough mental examination. While going through treatment addicts are often under medical supervision and regularly assessed on their progress. Other aspects of treatment often include counseling, therapy, and teaching tools.
On the other hand, recovery is difficult to define, probably most accurately described as a lifestyle. It can consist of support groups or workshops and almost always consists of 12-Step (Alcoholics Anonymous AA or Narcotics Anonymous) Meetings. SAMSA (The Substance Abuse and Mental Services Administration) defines recovery as, “a dynamic change process through which individuals improve their health and wellness, live self-directed lives, and strive to reach their full potential.” The Office of Alcoholism and Substance Abuse Services also provides a good definition of recovery:
There are multiple pathways to recovery including: treatment, faith/spirituality, natural, criminal justice interventions, support from individuals, and/or family, mutual assistance groups and recovery community centers. Everyone’s journey results in their own unique experience of recovery. Therefore, recovery has many definitions and it is hard to agree on a single one. It goes beyond abstinence alone to include a full re-engagement based on hope, resilience, health and wellness, and includes family, friends and community. Recovery starts when a person begins to make better choices about his or her physical, mental and spiritual health.The Office of Alcoholism and Substance Abuse Services
Separation of Treatment & Recovery
Here’s why the separation of treatment and recovery needs to be better established, using the words of Roger Williams, the founder of Rhode Island, on church and state. According to Williams an authentic Christian church would only be possible if we had “a wall or hedge of separation” between the “wilderness of the world” and “the garden of the church.” In conclusion, he believed any government involvement in the church brings corruption. Recovery is like the church, if you recall the second inclusion mentioned by the above office was faith/spirituality after all. Furthermore, it’s become too entrenched in the “wilderness of the world” that is detox and treatment.
What we know is this: One in ten people with substance abuse disorder seek treatment. As much as 91 percent of those in recovery will experience a relapse from abusing opioids. Interestingly, the relapse rate coming off Suboxone is comparable, 8.6 percent. As is the success rate of Alcoholics Anonymous, which addiction specialists assume to be 8 to 12 percent. One in ten starts using, and one in ten stops. We also know substance abuse show’s to decrease over time:14.8 percent of the population 18 to 25 “battled” substance abuse compared to 6.4 percent of the over 26 population.
These figures have three important takeaways. First, we’re not doing a good enough job reaching those with substance abuse. Second, when using opioids, those who find treatment have a success rate of around 10 percent, regardless of the treatment used. Third, there is not a one size fits approach to treatment and use decreases over time.
Now another set of statistics, courtesy of the 2014 National Survey on Drug Use and Health, showing the most common reasons why people who knew they needed help did not seek treatment from 2011 to 2014:
- 39 percent could not afford it or did not have health insurance.
- 29 percent were not ready to stop using drugs.
- 18 percent feared a negative opinion from neighbors or the community.
- 17 percent feared it would affect work.
- 14 percent did not know where to find help.
- 8 percent did not think they needed help.
Can you spot the glaring disconnect? We know treatment, including those involving drugs (Medically Assisted Treatment), works about 10 percent of the time. Yet 29 percent of addicts who know they need help don’t seek it. Addiction is fascinating in that it’s possibly the only “illness” we self-diagnose. I’ve spoken with numerous addicts, both in recovery and actively using, over the course of this project. The majority of them, including podcast guests Justin and Anonymous, know a problem exists and want it fixed. However, people become turned off, perhaps even terrified at the idea of being force fed a spiritual program. Here’s the thing about addiction, it’s not about the drugs. Recreational use is all about the drugs, how fun they are or how much better they make you feel. However addiction is a coping mechanism, it’s about filling a need.
Like the separation of church and state works to keep politics out of religion. The separation of treatment and therapy allows us to prioritize instead of politic. Prioritizing lays out a specific set of goals- for example an in depth mental help assessment, supervision through withdrawals, unearthing the root cause, etc- and completes them in an orderly fashion. Whereas politicking makes goals/objectives contingent upon each other. For example you can’t cure from your progressive disease, only through recovery can you find a worthwhile life.
In conclusion, narratives are important, how we frame things mean everything. Practically speaking my point is this: we’re alienating too large a section, 29 percent of the population, who could benefit from treatment. Recovery is an amazing spiritual journey, but it’s not treatment. It can lead you to happiness, but it’s not treatment. It can fulfill your spirit, but you get the point. This isn’t to say don’t expose treatment patients to 12-Step, in fact we should encourage recovery discussions and debate. It’s suggesting that 74 percent of treatment centers use something scientifically based rather than 12-Steps spiritual philosophy as a staple to their curriculum.