I'm disappointed in both the substance and emphasis of President Trump's prescription for gaining some "upper ground" in the battle against substance abuse, primarily but not exclusively opiate abuse. He seems to lack empathy and fails to realize how quickly opioid (includes opiates and opioids) dependence can spread through a community, and how urgently we need to encourage and support people who would like to find a better path. His list of priorities reads more like a buffet, palatable to most but an unpersuasive recipe for aggressive action.
He failed to clearly articulate that opioid addiction is a health crisis- both physical and mental- demanding an enormous dedication of resources. The President, and frankly the media as well, spent too much time focused on his desire to broaden the death penalty. If Trump wants to talk law and order, he could point to the growth of Drug Court programs around the country. The rate of complete success is still too low, but from my view in the program, some of the "lack of success" is due to the attitude of too many participants. New Jersey Drug Court got me into an excellent rehab, followed that with a beneficial IOP program, and made having a job essential. Graduation allowed me to have my single but very damaging and debilitating charge expunged.
Not only is he underfunding- along with Congress it should be said- this initiative but he is also reducing overall government funding to Medicaid and the large population that utilizes the addiction services they support. Budgets are a reflection of choices and priorities, and if governments cannot or will not allocate enough money, then the money and resources that are available must be used more efficiently and effectively.
Epidemiologists can pinpoint places around the country where rates of addiction are highest. These places should receive disproportionately greater resources and be used as "incubators" to develop effective recovery programs and networks. Areas like Philadelphia's Frankford neighborhood and certain communities in rural West Virginia are two that quickly come to mind.
Education programs that are heavy on preachiness, platitudes and finger wagging do not go over well with teenagers. In sobriety programs like AA an important aspect is "to identify and not to compare." When talking to teenagers, getting their actual attention is much harder than you think. It is important that, as much as possible, "in person" events with teens and parents involve people in recovery and those who are most affected by them. These presenters are the experts the kids may actually listen to.
Even though the number of rehabilitation centers has increased, a highly disproportionate number of these facilities are designed for a wealthier clientele with excellent insurance and quality resources. In the health care system, and the justice system, a recurring theme is that the poor are denied fairness. Government needs to support fairness as a vital imperative in opioid policy, especially if the private sector and NPO community-for whatever reason- come up short.
My experience, observations, and much empirical reporting leads me to believe that when it comes to opiate addiction recovery, a minimum of 30 days at a rehab facility, followed by an intensive outpatient program, a support system, access to mental health care, and a healthy lifestyle are critical to successful recovery. Probably as important, people need to embrace ideas like humility, honesty, and willingness to act if these programs are to be most effective.
One thing about programs like NA and RA is that they truly synthesize the idea of addiction or alcoholism as a disease with the idea that there is an important spiritual dimension to recovery. The disease model is evidence based and provides practical solutions, while the spiritual side reinforces ideas like choice and consequencs, encouraging members to aspire to do better and be better.
Two things that the President did address fairly well are to challenge the pharmaceutical industry to develop non-addictive alternatives to opioids, and to the insurance industry to fund pain management alternatives. Opioids like Percocet are true gateway drugs. I believe that about 80% of all heroin users got their start with prescription drugs. Companies in both these industries must be nudged to change.
Legislation and litigation might also be necessary. Whatever will work. Its gotta be all hands on deck. Addiction specifically, and mental health in general, must be treated as a health crisis. The consequences of failure corrode our civil society and ruin lives. But equally important, the nation needs to have a "conversation" about those things that make people more susceptible to legal and illegal drugs.
One of my IOP leaders really got my attention one day when he said, "drugs aren't your problem, they are the solution you have sought for problems you can't or won't take on." He's absolutely right. I also believe that America's character as a people is a problem in need of some resolution. How we as a people address this opiate crisis will say a lot about us.
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