The following opinions and reflections are made after about 18 months of study and volunteer work in the field of substance misuse. I hope that my views are taken with a huge grain of salt - they may change over time as I learn more and as society changes. Feel free to comment in response to this post - feel free to set me straight if there's anything here that you don't particularly agree with.
AODA vs. Substance Abuse vs. Substance Misuse
I know that the standard terminology in the U.S. is moving away from the catch-all AODA acronym toward the newer 'Substance Abuse' name. Personally, I like the name that they're using in Britain, which is 'Substance Misuse.' Why? The simple answer is that I don't like the history of the word abuse in relation to having an addiction, bad habit, or other health issue that leads to the use, misuse, or dependence on a drug (including alcohol). It conjures up the same labels of an Alcoholic, Addict, or other pejorative term that people either call themselves or others who are dealing with a problem. Many of the people I've listened to as a volunteer have repeatedly said that these labels are not as helpful as using person-centered, positive language to describe their situation. For example, instead of referring to themselves or others as an alcoholic, they choose to say, "I/he/she have/has a problem with my drinking," or, "I am a person who is struggling with an addiction." The American Psychiatric Association is due to publish an update to the DSM-IV-TR, which will rename its sections on substance abuse and dependence and rename them as 'addictions and related disorders.' This is a massive improvement and I think it will be very helpful. (Source)
Professionals vs. Peers
Professionals, i.e. those who are working or volunteering in the substance misuse field, should focus their attention on advocacy, brief interventions (motivational interviewing), assessment, referrals, and information sharing. Peers should focus on community based support (peer groups), mentoring, and advocacy (probably many other things to include here, but for now I'll keep it short. It's great when the peer is also a professional, and vice-versa, although I know that sometimes it means that the person will have a certain dogma related to their own success and possibly overlooking the myriad of ways that people 'overcome' their substance issues.
We Need to Get Real About Drug Policy and Health Insurance
Let me not belabor this point... People need health insurance for substance misuse as well as any kind of health problem. Also, we need to stop criminalizing substance misuse. It is a massive waste of time and resources. These two macro-level interventions are really critical in order to find a long term solution for all members of our society to be able to address their addictions.
Science Based vs. Anecdotal Solutions
Substance abuse interventions, strategies, and tactics are an overwhelming failure. However, hard research and evaluation is not being done on the efficacy of some of our society's most popular programs. Many interventions should be overhauled based on empirical, not anecdotal, evidence.
Secular vs. Spiritual Recovery
In addition to getting rid of poorly researched ideas about 'what works' in terms of recovery, there needs to be more effort and support available for secular based recovery programs. Programs that require a spiritual renewal dominate the entire substance abuse field and the are not meeting the health needs of a very large segment of the population. Spiritual programs are often simply psuedo-Christian alienating not only atheists and agnostics, but also people of other faiths.
Prohibition Is a Failure
I have alluded to this above, but need to say it again. Drug policy in the U.S. is a massive failure, and it is largely due to the criminalization and prohibition of drug use. If we have learned anything it is that people should not be punished for choosing to use drugs or alcohol. This is not to say that we should not keep laws on the books which discourage crimes that are committed when someone is using drugs or alcohol, but simply criminalizing usage itself has been very counterproductive.
Stigmas Must Be Discarded
The last thing I'll say on this topic for now is that people need to start talking openly about their substance misuse problems or addictions. I don't mean publicly. I mean openly. We need advocates and leaders who are willing to be honest and forthright about the issue of substance misuse. It is something that, like cancer, none of us are immune from - whether we have struggled with an addiction ourselves or we know and love someone else who has. That doesn't mean we always talk about it, or we 'out' people without their permission. But it means that there is a time and a place to share stories of success, failure, and a mixture of both, and we should all try to find good times to do that. Silence and stigmatization does not help anyone, despite what some people might think.
No comments:
Post a Comment