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The State Of Substance Abuse And What It Is Doing To Our Nation

Substance Abuse | One Day at a Time

On New Years day, one of my grandchildren, in the company of a “guardian,” flew from Little Rock to Nashville and entered a treatment facility to deal with his addiction to Oxycontin and possibly alcohol. Prior to the trip, there had been a brief intervention with close family members, and then my nineteen-year-old grandson was gone.

He is one of the fortunate ones. His dad, my son, could afford to send him away to a place that can treat his drug abuse and, equally if not more important, the underlying mental health problem that was causing him to self medicate. He will stay a minimum of 60 days and more likely 90 days.

The Relationship of Mental Health Problems and Substance Abuse

Eighty percent of the nation’s substance abuse problems like alcohol, pot, and prescription drugs, for example, stem from mental health problems such as depression, anxiety, bipolar disorder, attention deficit and post-traumatic stress disorders and others.

We are beginning to develop a better understanding of this association of mental illness and self-medicating with street drugs or illegal prescription drugs. Widespread recognition of this simple truth and dealing with it, followed by taking the necessary action, would save the county billions annually and perhaps as much as a Trillion dollars (see Joseph A. Califano’s book, “High Society”).

Most hospitals and treatment facilities are now doing this as a matter of course, usually with staff psychiatrists, but not all these services are readily available to some citizens, the indigent homeless population, for example.

My Journey with Recovery

Going to free 12-Step meetings like AA, Al-Anon, and Celebrate Recovery are effective ways to deal with an addiction problem, but often medical help is also needed. It was in my case, although I didn’t realize it at first. Turns out I had a depression/anxiety problem I was attempting to treat (unsuccessfully) with alcohol and tranquilizers.

When I quit drinking in 1979, I continued to use the prescription drug Valium. I couldn’t completely let it go, and I finally admitted to myself, it was an obstacle to my recovery.

I knew I couldn’t keep doing it, but my attempts at stopping weren’t working. So I called psychiatrist Dr. Harley Harber, who is himself a recovering alcoholic and follower of the 12 Steps.

On my first visit, Harley greeted me in his office with a broad, welcoming smile and invited me to take a seat on an overstuffed sofa in front of a picture window framing the late spring morning.

I was there, I told him, because my sobriety as a recovering alcoholic was giving me little pleasure. And the reason, which I had been hiding from myself and others, I now wanted to deal with.

Yellow lined pad in hand, Harley listened, and I talked, while he jotted down a few notes. He smiled reassuringly and said not to worry. I would get off the Valium gradually over the next couple of weeks to avoid severe withdrawal symptoms. He said we’d work through it together.

We did, and it worked.

About twenty years after that first visit, I called Harley to ask if I could spend an hour or so with him in his office talking about trends in substance abuse treatment today and what role psychiatry has to play for my One Day at Time publication and web site. So we set a time, and I ended up on Harley’s couch again—this time with my own notebook in hand.

Harley, who is now retired, is well qualified. At the time he was the only physician in Arkansas to hold certification by the American Society of Addiction Medicine and board status in psychiatry and addiction psychiatry. In the mid seventies, Harley had worked on the Haight Ashbury project in San Francisco, and in later years attended Gestalt therapy training sessions both here and abroad.

Gestalt therapy is about helping people get rid of denials, facing the truth about themselves, and making healthy changes in their lives—not unlike a 12-Step program.

12 Step Programs are Predictors of Long Term Sobriety

My conversation with Harley about the state of substance abuse treatment today was far reaching. Here are six bullet points from my notes:

  • You have to get rid of the substance abuse problem before you can treat the whole person. And you do have to treat the whole person.
  • Increasing numbers of medical discoveries will help us treat the physiological aspects of addictions (brain disease itself), but they do not address our character defects and lack of spirituality. That is up to God and us.
  • A deep and wide chasm exists between what we do and what we believe. The 12 Steps and recovery bring the differences into closer alignment.
  • Impaired physicians and airline pilots have the best recovery rates of any groups—85 to 90 percent for physicians and 90 to 95 percent for pilots. That’s because there are huge financial and professional incentives (they get to keep their jobs if they recover), and they are given adequate time for long-term treatment as well as significant professional support and post-treatment monitoring.
  • Twelve-Step programs are excellent predictors of long-term sobriety. If you can stay clean and sober for a year, the chance of a “slip” drops dramatically. In the short term—less than a year—only one in ten 12-Step newcomers is there and still sober one year later.
  • Even if you go to a meeting every day, it isn’t enough in the initial stages of recovery. Remember, the founders of Alcoholics Anonymous (Bill Wilson and Dr. Bob Smith) spent a lot of time together. An hour a day is just a beginning.

I am inclined to think that a collaboration involving the private and public sectors is the way to go in addressing this trillion dollar national problem.

It will take leadership of the sort God provided during World War 11 to stunningly good effect. U.S. president Franklin D. Roosevelt and Great Britain’s Winston Churchill mobilized their citizens and armies and defeated Germany and Japan in less than five years. How long has the war on drugs been going on?

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