Thursday, 1 May 2008

Diary: Some Clarification

DIARY: I received a comment from a cyber friend today and decided to publish this article as a few people have asked similar questions or voiced their concern about myself ‘managing’ my addiction. 

Terry, this is a general comment about your site more so than about this topic as such. Specifically about the information in your sidebar actually. Also I say this as someone who has grappled with a number of addictions so, please understand my comments are not intended to be judgemental. Mate, it seems to me, that your experience is possibly somewhat atypical, your claim (and I have no reason to believe you are being dishonest) to be living a more or less "normal" (don't like the word myself, conventional might be a better substitute)life but-for-being-a-heroin-addict seems to me to be a kind of attempt to normalise your addiction. I know I kept drinking and using drugs for many years on the illusion of managability, I believed my addiction was manageable, so I kept using. I had to -like it says in the first step- admit that i was powerless and that my life had become unmanageable. 
While you continue on with the belief that your life is manageable while you continue to use, you will relapse. Obviously this isn't something I usually discuss in a public forum so you can email me if you'd like to respond, obviously you can choose to ignore or take on board what I have to say, it's entirely up to you.
For the record I have been street drug and alcohol free for five years now and I was a daily, round-the-clock abuser of a number of substances. There was a time in my life when I couldn't even imagine going a day without some kind of mind altering chemical.

First of all, I am actually a recovering addict. I am on what’s called, substitution treatment which is the most common form of treatment for heroin addiction. Substitution treatment usually involves methadone or buprenorphine which keeps the patient “stable” by maintaining their addiction with something else apart from street heroin. These substitution drugs are just as addictive as heroin but each dose is much longer lasting and doesn’t get the patient high. The idea behind it is to give the patient time to stabilise their life without worrying about finding money or drugs everyday. Once on methadone, most patients can live a fairly normal life with work and other normal functions of life. After being stable for a period, the patient can then be weaned off methadone slowly until they are free of opiates. 

Due to a pain condition and the problems of depression and some health issues from methadone, I have been switched over to slow release oral morphine (SROM) which works on basically the same principal as methadone. Morphine is not allowed to be prescribed solely for addiction in Australia but is an option for addiction treatment in some other countries. 

Although substitution treatment can get you physically clean from heroin, often the physiological cravings can lead the patient back to heroin. To succeed with substitution treatment, counselling is recommended and it increases the chances of staying clean. Many methadone patients relapse and usually it takes a few attempts. 

A major issue is that often people start on heroin because of a personal problem, particularly deep rooted physiological trauma or mental health issues like depression. When these people get clean, their problem might still persists and the chances of relapsing are high. 

As you can see, addiction is very complex and addicts are usually misrepresented by the MSM and the ignorant as just selfish, hopeless junkies. For the majority, this isn’t true and until addiction is treated entirely as a health instead of a legal issue, the politicians and MSM will continue to use the personal health issues of addicts as publicity fodder. Some other people like myself have major problems kicking opiates and spend years or even decades on methadone. For some, life on methadone is fine and recent research is showing that it might be an appropriate strategy to keep some patients on methadone indefinitely. 

The constant push to lower your dose for the goal of becoming clean is now being questioned as appropriate for everyone. As more is being discovered, alternative treatments for long term patients are being trialled overseas like prescription heroin. 

Addiction was once treated with the drug that addicts were addicted to. Just as methadone is currently used to stabilise then reduce, heroin, cocaine and morphine were once prescribed using the same model of reducing your dose until clean.
Ironically, the real problems of heroin and cocaine started when the US declared the “War on Drugs” in 1971 and forced the UN to enforce it worldwide. The level of drug related crime and the mortality rates were only a fraction of what they are today. Prior to the push from the US/UN to enforce their “War on Drugs” policies, the US were one of only a few countries with major drug problems because they outlawed prescribing these drugs for addiction half a century before anyone else. 
As some countries are reverting back to prescribing heroin, their heroin related problems are decreasing steadily whilst drug related crime and major societal problems continue to infest countries like Australia and the US. Heroin prescription is now an option for long term addicts in Canada, England, Germany, Switzerland, The Netherlands and Spain. It has been extremely successful and many more countries are looking into it.

I used to use heroin up to 500-600 times a year or about twice a day. On methadone I got that down to zero for a while but I kept relapsing. This went on for several years until my back pain got worse, the depression became unbearable and my body was at it’s limits from the methadone. 

My doctor arranged for me to see a pharmacotherapist who arranged with the health department for me to switch to SROM and anti depressants. That treated my back pain, my addiction and my depression (to an extent). I wasn’t going to get off opiates any time soon and my doctor agreed that prescription heroin was suited to my situation if available. I now use heroin 12 times a year or once a month. I don’t crave heroin like I once did but use this method as a safety measure. It’s still very easy to fall into using but once a month is enough for me. If I start to stray, I can reminded myself that my time to use is coming up. It seems to work and keep away from heroin for 344 days a year. If I was in another country, I would be on prescription heroin and the difference is it is not an option in Australia. 

For those who think I am deluding myself as all good junkies do, the use of heroin as a treatment is approved by many doctors but cannot not officially be endorsed. To summarise, my treatment plan is not focussed on being free of opiates. I would love to be clean but the current thinking is that long term addicts have different needs to most heroin addicts. I have the choice to deal with my situation with street heroin or via the medical route ... I have chosen the official medical route. My treatment is long term addiction management, not the “stabilise, then reduce” treatment like most methadone patients. I have no physical need to use heroin because of the morphine (or methadone) but I still have physiological cravings. This is treated via 12 monthly doses of heroin. BTW, my situation is fully implemented and monitored by 3 medical professionals. I should also mention that you can safely take opiates all your life. they are basically non toxic and do no harm physically. Other drugs like amphetamines are a different matter. You can never manage a life of speed or alcohol for too long because of the havoc it causes on your body and brain. 

Some Won’t (Don’t Want To) Get It. 
Tens of thousands were once treated with heroin or morphine with very little problems but that changed when the US/UN enforced their abstinence or nothing approach. Abstinence should always be the first and preferred method but if that doesn’t work, then there should be several options after that like substitution treatment. The problem is that after nearly 40 years of drug hysteria and propaganda from the MSM, politicians, moralists, conservatives and the religious right, there is massive ignorance in the public arena and total abstinence is seen as the only option. 

My whole blog is based on trying to dispel the myths and personal views that dictate how we, as a society treat the drug problem. Some will never change their minds though, choosing to ignore science and medical facts and sticking to their ignorant views. Even when presented with my blog, some choose to skip over the facts and the actual content then construe their own biased views or judgements about myself.

As an unrepentant Junkie Wright, it really is just a matter of time before he cops a shot of some bad smack or before he catches a blood borne disease and goes to the biggest trip of all. I am amazed how the likes of Everett take at face value all of Wrights protestations that he has his habit “under control”. When it is very clear that Wright is in fact a most obedient slave of the poppy and that any suggestions that this addict can control his master, like those made by Wright in his blog, actually border on the delusional as any number of former addicts will testify. In the end the only ways to stay clean are to totally abstain which Wright refuses to even consider. Indeed Wright’s ability to “cope” is predicated upon some rather fragile constructs that are only ever one or two setbacks from irrevocably collapsing in a heap Typical of the left Everett is willing to make any concession to someone who her perceives as a noble “victim” he does it in relation to our Indigenous Australians and he does it with Wright. Personally I don’t care about the fact that Wright is a Junkie it is his obnoxious and belligerent comments directed at me that I object too and I refuse to treat him with kid gloves because he loves the needle more than anything else in the world.
-Iain Hall; Moralist and conservative blogger.

The above comment was made by infamous conservative want-to-be weirdo, Iain Hall. Much of his criticisms are aimed at me personally but you get the feel of the overall ignorance that he displays. 
His views reflect the usual media driven images of desperate junkies shooting up anything and not caring about sharing needles. 

The idea that any form of treatment except the “abstinence only” method is doomed to fail is typical of conservative values and ignorance. Remember that it was the US and their conservative views that interrupted over a century of treatment with their own “War on Drugs” approach that has given us the massive drug problems we have today. 

The conviction that Hall’s conservative opinions are facts are shown with his claim, “as any number of former addicts will testify”. What former addicts? We just have to take his word for it. Although Hall should never be taken seriously, his views are reflective of those who can’t comprehend that drug addiction is complex. The black and white world of some right wing conservatives will always hinder their ability to see past drug addiction as a law and order issue. Countries that have prescription heroin or safe injecting rooms are always under threat of conservative politicians regardless of the success. There is quite a lot of research now showing the huge benefits from what would have been called radical only ten years ago. You can only ignore facts for so long and the fallacious thinking like that of Hall is luckily becoming less influential on how we approach drug addiction. 


krypto said...

what a sick little weasel that Hall twerp is huh?
I guess it goes without saying that he obviously has little worthwhile to offer humanity.

So, um, obviously I'm a subscriber to the view of addiction as illness theory.
The notion of trying to treat addiction as wayward or errant behaviour which can be "corrected" with discipline or whatever is misguided at best, morally culpable at worst.

But here's the problem Terry, for the most part, medicine and psychiatry don't recognise addiction as an illness. There is no DSM diagnosis for addictive behaviours for instance.
The old buisiness adage "if you can't measure it, you can't manage it" applies here I think.
The medical view of addiction is as a symptom I think, as you pointed out, that isn't necissarily so.

My belief is that addiction is indeed a disease and has physical, mental and spiritual manifestations.

Physical manifestations of addiction are things like delerium tremens in alcoholics, tremors, sweating, cramps, diarhoea and so on. Of the three, the physical manifestations of the disease are the easiest to manage. They last a couple of days to a couple of weeks and can be remedied with over the counter medicines.

The mental component comes in the way of an obsession, an obsession with the substance, fantasies, cravings and repeated invasive thoughts about the substance are all part of this.
This obsession can pervade other aspects of the person's existance, the person's very identity can become intertwined with the addiction. An alcoholic collecting wines, accumulation of drug paraphenalia etc. are all part of this. Obviously for the person to recover, those need to be separated. A painful but necissary process.

The spiritual component is the most vital of the three, it's what prevents recurring relapse.
I think of it like this, nature hates a vacuum so if you take something away you have to replace it with something else.
If you remove substance abuse, it becomes necissary to "plug the hole" with something else.
People can turn to gambling, unhealthy sex, stealing, temper tantrums, all kinds of things to remove them from the state of mind they USED to escape with drugs or alcohol.
All those things can cause problems of their own obviously so a benign substitute is needed.
Spirituality in this sense doesn't mean going to church or anything silly like that, it is about turning one's consciousness to a state where it is acceptable to just BE.
Contented inertia if you like.
I used to often feel like I needed to be somewhere, anywhere OTHER than where I was. That is a manifestation of discontentment within one's own skin. Another way of escaping an unacceptable state of consciousness if you like.
Attending to one's spiritual development is a positive way to alter consciousness in a way that is beneficial rather than harmful. There are a number of ways to do this, I started the journey at AA (NA works equally well) and have continued the process in a number of other ways.
No group or organisation has a monopoly on spiritual development but any addict who neglects their spiritual development is in constant danger of relapse I can assure you of that.
Good luck with it, as I'm sure you're already aware people die of the disease of addiction with some regularity many more suffer and it's not just about lives lost, it's about misery inflicted so it is worth treating.
You obviously have some things in your life worth living for and your untimely death would cause a good deal of suffering, so it's worth getting a handle on it.
Incidentally, a common trait distinguishing addicts from non-addicts is the ability to slow down or stop using to avoid negative consequences.
A true addict will destroy everything they have in life before they can see the consequences of their own actions. The common term for it is "rock bottom" and it's an essential part of recovery.

Anonymous said...

I don't agree that addiction is a "spiritual" disease, any more than any other medical ailment. Many people benefit from their spiritual beliefs and practices, and the calming of the spirit can allay fears and assist in healing--but that's about it as far as I am concerned. Opiate addiction has, for far too long, been held hostage to the monopoly of the 12 step ideals and program and the belief that there is no other way to recover, or that no other type of treatment constitutes "true" recovery--a "higher power" must be present in order for a person to recover being the ultimate idea here. However, countless people recover from all manner of illnesses both physical and mental without such aid, including the addicted--despite the fact that it has pervaded every corner and niche of the recovery world.

Also, I would like to comment on the statement that methadone is "as addictive as heroin". Addictiveness is defined by the propensity of the drug to establish in the mind of the user a strong, immediate desire to do more. Short acting opiates like heroin cross the blood-brain barrier immediately, causing a brief but very potent "rush" and an intense, longer lasting euphoria or "high" that strongly reinforces repeating the behavior. Methadone, on the other hand, is very slow acting and takes hours to cross the barrier, and provides no "rush" and minimal euphoria in most people. That is why, when people taper off methadone and relapse, they relapse on HEROIN or another short acting opiate, NOT on methadone. Methadone stabilizes the brain chemistry of opioid users who have done long term, perhaps permanent damage to their natural endorphin systems by persistently shutting down production of endogenous opioids to the point where the brain simply no longer will produce them, no matter the amount of abstinent time they have achieved.

In fact. ,ethadone was NEVER intended as a short term aid to detox. The founders of MMT, Dr Dole and Nyswander, did not intend it as a short term medication--they stated clearly that they felt it was unimportant how long a patient took methadone--what mattered was returning them to society as a functioning, happy, useful person. That goal has been obscured in recent years by a fervor among many clinic operators to prove that they are "successfully" curing this incurable disorder by getting patients off methadone asap, despite the 90% relapse rate of those who leave treatment. That is a tragedy.

In closing, addiction and dependence are two different things medically speaking. Addiction involves not just physical dependence on the drug but a set of behaviors that must also be present for diagnosis--behaviors that are not generally present in compliant MMT patients.

I do believe that it IS possible to live a fairly "normal" existence on heroin--the bulk of the bad behaviors seen with this stem from the illegality of the drug, not the drug itself. My husband, who has been drug free for many years, took heroin daily for 26 years without getting arrested, losing a job, etc and worked the whole time, supporting a family (this was before we met). Not all addicted persons are robbers, rapists, thugs, street people, etc.

Terry Wright said...

Thanks for your comments.

Krypto, I have to agree with anom here. The "spiritual" side is one of the major problems with trying to treat drug addiction with science. I'm not knocking it in that it does help many people but to me, it is the least important part. Governments, especially the previous government, the religious right, moralists and ultra conservatives push the "spiritual" aspect mixed in with moral based treatment as the primary key to solve every addiction. Anything beyond that, especially medical solutions are poo pooed as evil. The "spiritual" and "moral" aspect is strictly non scientific/medical and should be used for those who want it and not the basis for treatment. I'm glad it helped you and as I said, it does help many so I agree that it should be another tool to treat drug addiction. Addiction is very much a medical issue and is recognised as one. The problem as I have pointed out is that for drug addiction, it has been hijacked by moralists who push their personal agenda on the drug addicts with "spiritual" and/or moral cures. It might work well for non drug related addictions like gambling etc. but not for drug addiction/dependancy.

I get the feeling you really mean the physiological (mental) treatment for drug addiction. This deals with the personal issues you have mentioned and proper counselling would include all these factors. I'm probably lumping too much together here but I get that the "spiritual" side doesn't include discipline as treatment or alike but more of a personal awareness. It's just that programs like NA can be very much against substitution treatment and some people miss out on medically proven treatment . Everyone is different though. Counselling did nothing for me at all and my only wish was to be physically clean. I knew I could handle the rest. I am very strong personally and that's what makes my addiction unbearable. I had always dabbled in drugs, especially lots of alcohol and had a fantastic life. I could always feel when I was getting too far into it and would act accordingly. I had a new house in the inner city, a new car, an incredible wife, a successful business with a few employees and was going places. I had lots of confidence and the best set of friends possible. So when I lost it all, I should have given up but I never have. I just learnt to adapt and thinking when I do get clean, I will back up very quickly. The mental side was hardly a worry for me and counselling meant nothing. 11 years on and now I'm probably committed to a life on opiates and counselling still means nothing to me. But that is just me.

Anom, good point about methadone. My doctor use to always tell me this and complain about the cowboy doctors pushing rapid withdrawal and short term methadone. Buprenorphine was supposed to be ideal for those with smaller addictions and shorter withdrawal time. I wonder how that's working out.

I understand what you mean about the short concentrated bursts that heroin give you compared to the long lasting methadone but I feel there's 2 sides to this. If your main problem is the physical side, then no, methadone has a tendency to saturate your body and organs and become incredible hard to kick. But if your main problem is the physiological dependancy, then yes, you're right. People do crave the "rush" of injecting heroin.

Thanks again for both your comments.

bron said...

OT but something to maybe write about?

On Topic: Am finding these discussions very interesting. Keep up the good work!

albi said...

Whoever this 'hall' fellow is, he's pretty succinctly encapsulated the ignorance that surrounds much of the talk around drugs and addictions. Unfortunately, his lack of knowledge and obscene prejudice will see to it that he'll remain enslaved to his own foolish attitudes.

Wonderful post by the way. Addiction is a medical issue, and those claiming otherwise are either stupid or don't have the facts.


Terry Wright said...

Interesting story Bron.
I think some of your comment was cut off.

Albi, it's refreshing to hear from a professional.
Hall is the very type of self important and ignorant attitude that I oppose so much. Not because he dislikes me personally but the whole abstinence only mentality. These are usually the most vocal types and of course, with no evidence what so ever. If you ever read his blog, you'll see why he is considered irrelevant by every person who has ever read his dribble.
It's funny isn't it how "conservatives" want to turn the clock back 30 years especially with D&A treatment. If they went back 40 years, they would realise that addiction was treated with heroin, morphine and cocaine. Most of their push for abstinence based treatments come from a religious influence that true RW proponents were so against. It's only over the last 20-30 years that a new hybrid of conservative views and evangelist zealots has created the new right. Hall is an atheist so his mixed up politics leaves him exposed for everyone to see his ignorance and bigotry. Pretty sad.

krypto said...

Terry and Anonymous (the irony is not lost), I doubt you'd find anywhere in any conference approved 12 step literature any claims to have a "monopoly" on the healing process or on recovery as a whole.
Quite the opposite in fact, I can think of several passages that RECOMMEND people seek additional treatment where warranted.
Sure, go to enough individual meetings and you're bound to come across some kook or other who claims this or that is the "only way" to recovery, I find it's important to bear two things in mind.

1. that they are speaking as an unwell person AND
2. that they are expressing THEIR opinion, it has no bearing on anything or anyone beyond that.

I don't think for one instant I gave the impression that 12 step recovery is the "only" way to abstinence and sobriety, what I do know is that it worked for me when a number of other approaches did not.
There are plenty of atheists in 12 step recovery, the concept of a higher power is optional and strictly personal.
I knew one guy who had a rock as his "higher power".
Literally a lump of granite.
20 years he was sober then.

I'd say over-all your comments would tend to indicate a bit of a misunderstanding of what the 12 steps are all about, I'm certainly not going to try to "sell" it to you, but if you are genuinely interested in redressing your mis-information on the subject I'll try to help as best I can.

david l. said...

My name is David and I am an opiate addict on MMT living in the USA. Almost everyone I know, who is on methadone, runs into the same attitudes: non-addicts see you as a junkie scumbag and recovering addicts, who abstain completely, see you as still active in your addiction.
I have been an active addict my whole life. By that, I mean that even as early as I can remember I have been looking for something to make me feel alive. Nicotine, alcohol, drugs, and just about any illegal activity that would get me humming like an exposed electrical wire. And to me that is the problem. Addiction for me is the behavior. Everything I used was just the catalyst.Now Ive said all that to say this: I no longer care what anyone thinks and I don't argue about it. For me it is just not a philosophical issue. It is spiritual.
This is what I KNOW. I have had times in my life when I was completely abstinate and my life was still out of control. I eventually went back to using. My longest clean (abstinate) time was 6 months. Well, 22 months ago my life was at it's end. I was completely nonfunctional. I rarely left my home but to cop more drugs.
So I started calling around looking for help. Of any kind. In-patient, out patient, whatever. I recieved the same treatment from everyone; no insurance or 10 to 20 thousand upfront, we wish you well but can't help you. Eventually someone put me on hold, and when next someone answered it was a methadone clinic. I had no idea there was even one in my area and no clue how they worked. The lady on the phone was very nice and explained everything about how they worked. I decided to try it as I had no other choice oter than try to go clod turkey and I knew I would never make it through without procurring to stop the pain.
The clinic was 45 miles from my house. I am 42 years old and thank God every day for my mother. She loaned me the money and the use of her car every day so I could try this. I went on Friday, January 12th 2007. Through the first 3 days I used other things besides my prescribed dose of methadone. I decided there and then that I was going to make this work. I stopped my dose at 70ml. I have not touched any other drug or alcohol since Jan. 15th 2007. Only 4 times have I taken more than my prescribed dosage. I have not missed a dose by doubling up on my take homes. The clinic I go to has some pretty strict regulations because they are state spnsored through medicaid. I have attended every group there I possibly could. I do not miss counselor meetings. I now go only twice a week and am down to 60 mg a day. I became heavily involved in NA and even attend some AA meetings.In other words, I work a full recovery program. I work, have acquired a vehicle, and enjoy life with a very positive attitude. God is with me, I have learned just what it means to live, and am constantly striving for spiritual meaning and calmness. I love to hear of people, like yourself, who are doing better in their lives. It fills me with hope for all addicts. No one who has not known my past would ever consider me a scumbag (if they just knew, huh?)
All my abstinent friends and fellow 12 steppers can say what they want to. They can point to nothing (other than my admission to taking methadone) that can prove that I am still an active addict. My behavior and way of life tell a different story. I still crave occasionally and have seemingly overwhelming problems, but I work at living a clean rewarding life. I just do it with the help of methadone. Thank you for listening and love and prayers for your continued life improvements. David L.