People do substance use counseling for two reasons. They either have struggled with addiction or had a family member who struggled with it and are called to the work. Or they need a job while they are an interning counselor and stay in it only as long as they have to. Count me in the latter group, only I ended up staying for nearly three years after I completed my internship hours. By the time I finished I was burnt out, and it’s taken me seven months to get to the point where I can think about it and write about it without getting exhausted
When I started working with people with substance use issues, I had very little professional or personal experience with it. No one in my family drinks or uses drugs. And as far as the issues of legalization vs decriminalization versus continuing the drug war go, I had no opinion. It wasn’t something that affected me. The best formed opinion that I did have was that I hate inhaling other people’s cigarette smoke, so I definitely don’t want to inhale second hand marijuana, meth, or who knows what else.
After working with substance use for four years, though, well, I’ve learned a lot, and I now have some definite opinions.
One of the most shocking may be that I now support the decriminalization of all drugs. Even drugs like meth. Here’s something many people aren’t aware of, but in the US, more people die from the overdose of prescription drugs than they do all other drugs combined. These are drugs such as hydrocodone, oxycodone, benzos and other such drugs that are prescribed by a doctor that are also extremely addictive and that are easy to overdose on. In fact, pretty much every celebrity overdose in the last five years has involved prescription medicine. Prince. Philip Seymour Hoffman. Cory Monteith.
Too many people go to the doctor for chronic pain and are given a prescription for an opioid based medicine and become addicted. This is also a fast route to using heroin, also an opioid based drug, once they have a difficult time obtaining the medication they need legally. In 2011, prescription drug overdose overtook car accidents as the leading form of accidental death in the US. Further, a lot of people, even in the medical field, are not aware of the dangers of these drugs.
For instance, when I was in the hospital recuperating from having given birth to Sissy (standard vaginal delivery, so I wasn’t recovering from surgery), the Tylenol they were giving me at intervals wasn’t enough to knock out the pain and the nurse asked if I wanted an opioid based medicine. I stated I did not, that I’d seen too many people get hooked on them. She told me I didn’t need to worry about it and was completely oblivious to the dangers of prescribing the drugs. As for me, pregnancy, birth, and recovery from birth were things I expect to be not pleasant, and I decided that I’d much rather deal with a few hours of discomfort until my next dose of Tylenol than deal with a lifelong addiction to opioids and sent the nurse away. I believe the nurse was well meaning, but very ignorant about the potential for abuse of opioids.
However, the take away from this is that drugs that you get from the pharmacy are more addictive and dangerous than street drugs. Opioids and benzos are depressants, and especially when mixed with alcohol cause a decrease in respiration that can be fatal. Often people aren’t aware to not drink alcohol while taking opioids or benzos, but alcohol amplifies the effect of the medication, so instead of taking one dose of opioid, if you take it with alcohol, you’re getting three doses (this is known as the synergistic effect, and there you have your word for the day!)
Street drugs, such as meth and cocaine, are often stimulants. While it is possible to overdose on a stimulant, it’s a lot harder, and it usually happens because someone was mixing drugs (in fact, most overdoses are the result of mixing drugs). And overdosing on marijuana, a hallucinogen (really!), is not heard of.
Yet as a counselor, whether or not a drug was legal (alcohol), doctor’s prescription, or illegal had an influence on client’s perception of their drug of choice. Most people would agree that meth and cocaine were not good for you (though a few diehards denied it), but it is a lot harder to get an alcoholic to see the damage wrought by his/her alcohol use. If alcohol is so bad, then why is it legal after all?
Never mind the deaths that result from drunk driving, or that more people die from alcohol related complications than other illegal drug use, or that there’s a link between alcohol use and domestic violence. It’s legal, so in their mind, it can’t be that bad.
It is even harder to talk to someone who is addicted to prescription drugs. A lot of times they will admit that they took it so far, but they justify it with their chronic pain. And because the stigma of addiction is so great, they have a hard time seeing their problem through the lens of drug addiction. The sentiment is “I wasn’t hooking on the street corner to get some dope, I was going to the doctor’s office, I just got a bit carried away, but it wasn’t like I was addicted.”
They tend to take umbrage over their problem being lumped in the same category as street drug addiction.
People do not understand that there is nothing logical about the way the United States tackles drug and alcohol use. And yes, it is very confusing and people who suffer from substance dependence often find it’s not fair. The alcoholic or pill popper doesn’t like to be grouped in with people using street drugs. Meanwhile, people addicted to meth wonder why their drug gets such a bad rap when more people die from alcohol and pills than meth. And as a counselor, NONE of this was conducive to treatment.
As a counselor I spent a lot of time redirecting to why a client was sent to treatment, whether they had gotten fired from their job as a nurse because they were stealing pills (the prescription drug problem hits medical professionals hard), to they had lost custody of their kids because they had gotten drunk and flipped their car while their children were in the back seat, to they had been smoking a blunt and their kid got out and spent hours wandering the street with the parent unaware, to their children having toxic levels of meth in their system because their parents were smoking it in the house. And once I got the focus on there, to what needed to change in their life and onto treatment related issues.
The thing is, whether someone was going to a dealer on the street or popping pills or drinking too much, addiction is a mental health issue. It should not be a criminal justice one. Drug use alters the brain and causes severe brain damage. I once read that we should not think of drug use as a disease, but in terms of brain damage, and when I heard it put that way, it made a lot more sense. It also partly explains why quitting is often much more difficult than “just saying no.” The brain is damaged and predisposed to relapsing. By putting people with drug addiction through the criminal justice system, we are essentially punishing people for having brain damage.
(And least you say it was self inflicted, tell that to the person who started popping pills who had no idea of the risk involved when her doctor prescribed them, or the girl who was eight years old when her father started giving her meth so he could have someone to do drugs with, or the person born with Fetal Alcohol Spectrum Disorder because their mother drank while pregnant and left them predisposed from birth to having alcohol problems of their own. A lot of people did not make the choice to start using drugs. And even if they had, they shouldn’t have to pay a lifelong routine of prison sentences for a bad decision made when they were a teenager. Which do we want, to punish people, or fix the problem?)
I know when talking about decriminalization people talk about bleeding hearts. The thing is, Portugal experimented with it and decriminalized all drugs in 2001. Instead of sending people caught with drugs to jail, they got them into mental health treatment. The result? Drug use, overdoses, and addiction have all plummeted! Further, the HIV infection rate has decreased by 90%! The number of people in prison for drug related offenses has gone down, while the number of people in treatment has gone up. It has not cured the problem of addiction, but it has made impressive strides.
Granted, substance use treatment in the US is in shambles, but I will write more about that at a later time. But my conclusions from working with substance use is that to decrease the stigma of addiction, we need to decriminalize. We need to stop sending people with brain damage to prison and start getting them into quality treatment. We need to take a more compassionate view of people struggling with addiction. And we need to stop thinking in terms of punitive measures, which don’t work that well, and start thinking about what does work.