Thursday, February 5, 2015

Harm Reducton vs. Treatment.....more thoughts

My daughter has been in traditional treatment seven times. Various forms of intensive outpatient and/or residential treatment. All have used the traditional 12 step treatment model. I happen to love the 12 steps, but like so many things that have a long history, *people* get into the mix and pollute what the initial intent was with their best ideas and agendas.

She recently placed herself into a methadone treatment program. I won't even venture to guess what the future may hold this time. For today, she is alive and working on not using. For today, that is enough for me.

Methadone treatment is considered a harm reduction approach to treating chronic addicts and relapsers. The things that I hear that transpire there makes sense to me. It feels right in my gut. Its real, authentic. Their clientele are there because they are addicts that nothing else has worked for. They have not been able to break their cycle of addiction and chronic use....*despite their very best efforts.* This is often their last chance at sobriety.

 There is no "punishment" for relapsing. They are not shamed or kicked out or questioned on how much they really want to be clean. It is *accepted* that they are stuck in some very real ways. If they could get clean any other way, they would have done it already. They walked through the door on that first day and asked for help and that was enough. There are no expectations of perfection.....just keep coming back each day. Keep making yourself available. Of course as they begin to test clean on a consistent basis, they are granted some "sober age appropriate" freedoms. A one day take home dose. A weekend take home dose. Eventually, it is possible for them to only need to check in once a month. I hear that is years down the road though.

 Traditional treatment compared to harm reduction models make me think of church. How I used to dress all of us so perfectly, hair was done, we all arrived looking so together and "Christian." We jumped through the hoops, we followed the rules, but it never seemed to be enough. What no one knew was that I yelled at everyone to get them ready, that I was so overwhelmed trying to create that illusion of perfection because it didn't feel safe to be real there. It didn't feel safe to say how hard getting 3 little kids (little one came several years later) ready for church before 9 am was. I wasn't free to be honest about who I really was....just a young mom trying to figure out the best way to raise several little kids who I would have given my life for without a thought. So I ran faster, I jumped higher, until I couldn't do it anymore.

Traditional treatment seems to foster that "Ok, you're here now. We're going to figure this out, polish you up, you're going to shape up, get up early, go to meetings, do your chores, you're going to work the steps, and at the end of 30 days you will be on your way to a life of a sobriety (or holiness...whichever shoe fits.)" For some people that works... a few, maybe. But for the vast majority of hard core addicts, its a respite for their parents. They are tucked away safe and sound and the parents can sleep at night. But none of the real issues are really acknowledged or touched there. And definitely not at any deep or substantial level. Our kids jump through the hoops and then they get to go home or to a T-house, go to some meetings, but there is nothing to sustain them for LONG TERM sobriety.


A harm reduction model that says, "You are here for a reason. You are who you are, and you are what you are...lets start right here. You are a dangerously addicted human being who can't get free on his/her own. You showed up today and you followed through on getting your dose. Tomorrow come back and you can do it again." Day by day they begin to build something starting right where that addicted person is at that moment. Its a beautiful thing and it reminds me of how God accepts us right where we are at. He doesn't expect us to clean up our mess and present ourselves as together and ready to serve Him. Not at all.....He wants us to come broken, dirty, stinky, in disrepair and He will begin to work with us right there and as we keep coming back and as we keep opening ourselves up to the process (just as these young addicts who continue to walk through those clinic doors each day) we begin to heal. We begin to change and we see that it was a gift all along. It wasn't about how well we performed or what we thought we was about how broken we had become. How desperate to do it a different way.

That changes you. Unmerited favor. Grace when you least deserve it. (For the record: grace is acceptance of what is....not necessarily condoning, but just acknowledging and accepting things as they are.) Lets be the conduit of God's grace to not only the broken among us, but to ourselves. I think we have to have experienced it before we can share it.



Courtsmom said...

What a great post and I hope you will consider sharing it on a Facebook group I recently discovered. It's called "heroin support" and I see Ron has started posting occassionally. As you mentioned there is always a heated debate on the validity of this treatment and I think your post would go a long way in helping addicts to make a decision about this life saving treatment. Hoping she finds the recovery she so desperately needs.

amy said...

Oh Annette!!!! What a terrific post. I always read your blog but I had to make sure to tell you how powerful this was. I am so awed by your ability to love and hold your girl right where she is even though it is sucky and hard. You inspire me to do the same with my family. Thank you for your honesty and for sharing. You are a piece of my strength. xxxooo

SoberMomWrites said...

Such a beautiful, beautiful post. I'm aware of the debate between these two but have never heard it described with such love and kindness.

I love your guts you know that?


Anonymous said...

A person who avoids sticking needles in her arm also avoids hepatitis,aids, and whatever illegal activities they would have done to get the heroine. It is an improvement. I have known people who led relatively normal lives while on methadone.


ditchingthedog said...

Though I am not an addict (but still sick in my own right) I needed this post. I remember getting two small children ready for church and crying on the way there and the way back. Everyone but me had it together. It reminds me again that I am broken and God just wants to spend the day with me. Right now. No change necessary.

sleepycat2014 said...

I think the "my way or the highway" approach of most conventional abstinence-based treatment does more harm than good. It's an adversarial approach suitable for prison or the military, but not for people with substance abuse.

I much prefer the idea of harm reduction because it allows the substance abuser to retain their autonomy and dignity. Rather than getting pushed away for not doing it right, they're getting welcomed where they're at and encouraged to make progress.

Dad and Mom said...


This is one of those posts that shake the world. All I ever heard was the abstinence was the only treatment and bought into it hook line and sinker while Alex was using. Think of how many good people that destroyed because their "treatment"didn't work for them.

We learn when we are open to learning.

It is the same for our addicted loved ones. We must stop shutting the door on those that need help.

Syd said...

Wonderfully expressed, Annette. Your grace comes through here in so many ways. I don't know anything about the different models of treatment but what you have written makes sense. I do know how tired and hard it is to try to be perfect and not be blemished in the eyes of others--the facade can't be kept and eventually it crumbles.

Lolly said...

Oh Amen to this whole post. What a beautiful person you are! You my dear are filled with Grace. Thank you for this post.

Anonymous said...

I am a firm believer in harm reduction. It's all about accepting people where they are and helping them on their path. There are many roads to recovery and whatever it takes to help someone along the way is keeping people safe and alive! I will never, ever recommend traditional rehab to any family that asks my opinion. I believe they were no help to my son, in fact some actually named him. I'm hoping your daughter is progressing on her path. Prayers for you and your family Annette you are a great Mom.
Lisa S.

Hattie Heaton said...

Annette, my son does not like to go to meetings. I kept worrying about it. I know that he needs to get honest before he will get better. He joined a climbing gym and he thinks that this will help him to stay sober. I worried and worried about this.

Then it occurred to me. Why do I doubt that God has this. Maybe God will touch him at that gym. Or maybe he will meet someone there that will lead him to the very thing that he needs. Maybe he needs to see that the gym, in and of itself, will not be enough. Maybe he is going to church. Or he is going to meetings and won't tell me. Who the hell knows? God does. It's not my business.

Harm reduction sounds like love to me. It's none of my business how an alcoholic or addict works to get sober and I surely don't have the insight that God does.

We just got to relax and look at this as an adventure that God has privileged us to be a part of.

She is reaching out. Don't lose sight of that. It's huge.