An Addict Reaching Out For Help

Dear Colleagues:

I am copying below a correspondence I have had with an opiate addicted woman, "an addict since the age of 14", asking me for help. She asks if I can help her get into a heroin maintenance program overseas, a treatment that she sees as offering her "a small glimmer of hope" after years of failing to get free of her addiction or finding other treatments unhelpful. I offered to do an intensive, extensive evaluation and planning consultation if she is interested in that but also said I would find out what I can about these programs.

I am sending this letter to my professional community for two reasons.

Firstly I would greatly appreciate any information that may facilitate her getting in touch with one of the existing heroin maintenance programs.

Secondly, and even more importantly, I would like to use this woman's heart breaking story of chronic addiction and failed treatments to open a discussion about the need to seriously examine the negative way we tend to view addicted people and the limitations of our existing treatment system here in the United States. Unfortunately, this woman's story is more likely the norm than the exception. Untreated or poorly treated substance abuse and addiction characterizes the experience of the majority of people who struggle with substance use problems. Addiction treatment in this country is in crisis. Our evidence-based practices are not being implemented. Addiction treatment is not viewed as desirable by most addicted people or else why would the majority of patients in treatment be mandated and not voluntary patients? Most addiction treatment is conducted by poorly trained, poorly paid counselors. Our understanding of addiction as a chronic disorder, our appreciation of the motivational stages of change and the fact that most addicted people struggle with serious co-occurring psychiatric and psychosocial issues all suggest the need for non-abstinence requiring treatments to attract the entire spectrum of substance misusers and enable them to stay in treatment despite their substance use status.

Yet, our ideological, anti-scientific commitment to abstinence-only treatment is reflected in a treatment system that is irrelevant to most substance misusing people. This system, in effect, turns patients off from seeking treatment and sends the message that the patient is at fault. I still hear these practices being done at "the best" treatment programs! As a result, patients don't seek treatment because it is inadequate, substance use escalates as substance users' despair grows and overdose occurs at alarming rates. Rather than examining what we are doing wrong as a field and at the federal level to correct this tragic situation, we do business as usual and hold the drug user responsible for our failure to offer and make available appropriate treatments.

Why not support a broad continuum of care that engages substance users wherever they are ready to begin the process of positive change? Why continue to licence and fund treatment programs that don't offer state of the art treatment, don't properly train and supervise their staff, have embarrassing low rates of retention and positive outcomes and seem to thrive on the failure to help people? Why does the federal government still not actively support and promote syringe exchange? Why not lead the world in innovation in addiction treatment and explore heroin maintenance, safe injection facilities, harm reduction psychotherapy and substance use treatments that engage patients at all stages of change and around all positive change goals? If the government acknowledges that substance misuse is one of the leading public health problems in our country, why do we spend so much more on incarcerating drug users than helping them?

I would welcome dialogue on these questions. I also think it is time for us as a field to engage this crisis.

Andrew Tatarsky, PhD
Addiction Division, The New York State Psychological Association
Harm Reduction Psychotherapy and Training Associates
303 Fifth Avenue, Suite 1403
New ork, NY 10016
www.andrewtatarsky.com

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Subject: an addict reaching out for help

hello,

my name is R and i am a heroin/dilaudid addict from the united states and i have been researching the herion maintence programs in canada, switzerland and the uk. i have been an addict since the age of 14 and have been to over 20 treatment programs in the states and over christmas of 2008 went to mexico to do the ibogaine program at a clinic in cancun. i have been on suboxone and have been to pain management clinics and although i have learned a great deal about addiction i have had no long term success as a result of these treatments. My family life is in a shambles and i am filled with guilt and shame that are the consequences of my addiction. i come from a good family and even managed to attend university, although i wasn't able to graduate because the drugs became to important and my life has been a neverending cycle of chaos in which heroin is the central cause, the sheer amount of time spent finding, getting and using the drug is exausting. i am 32 years old now, a have hep C, and i am desperate for change. It seems i have looked everywhere for the cure, not realising the that has to come from within myself. I have come to the conclusion that abstince, at this time, is just too big a step for me to handle, let alone all the many times i have tried this method and failed. that is why a small glimmer of hope began to burn in my heart when i read of the maintence programs that are beginning to be offered. I can imagine finally living a life of success... finishing school, a job, perhaps a mending with my family, a future to speak of that i can finally be the woman of dignity who lives on in my soul despite my addiction. I am eager for any information or availability on the maintence programs that you could offer me. I have the time and the willingness to be a model patient, i have health insurance and i know that being from the united states might be a problem but i am willing to do whatever it takes, travel as far as needed to finally have the chance to live the life of my dreams, with help, of course. thank you so much for taking the time to read this letter and any response would be so gratefully received.

Most sincerely, R

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Dear R,

I hope you are well. I would like to post the letter you sent asking for help on my website and send it out to various people to help raise some important questions that your situation highlights about the limitations of addiction treatment in this country. I would like your permission to re-print your letter as I have it below (without any identifying information) because I think your letter is very powerful and moving as you describe your personal struggle with addiction. I would absolutely respect your wishes if you are not comfortable with this or if you want to change the letter in any way....but I think your letter is really powerful as it is.

I think we need real change in the way people who struggle with substance use problems are seen and treated, or mis-treated, in this country and I think sharing your letter may support that cause.

I look forward to your response.

Best, Dr. Andrew Tatarsky

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hey doc,

you absolutley have my permission to send any and all of our correspondence to whom you wish. Any voice in the dark that may help another addict make it one more day is the voice that speaks from my heart. Any help i might inadvertently provide would thrill me, people just dont care about the plight of addicts in this country and my wish is that one day that will change. The woman i told you about. trish walsh who is involved in the trials of the HAT program in canada asked me if i would be willing to speak publicly about these issues and of course i would be willing to speak to those who would listen. what really burns me is that the problem of addiction is a fixable one and with the right kind of tx options many could be helped, but most people just want to pretend addicts don't exist or should just be locked up, much like the homeless, people just want to look the other way rather than stop to help.
just an update, i have entered the methadone program here in ft lauderdale and i'm 2 days without injecting a substance, im a little sick but i'm going to give this program a chance. the dope will always be there, heroin isnt going anywhere so why not try yet once again to get myself together. and the folks at the clinic really seem dedicated to the cause. it felt really nice to be complimented by you about the letter, ironically i have always been able to express my feelings through my writing but not so good at dealing with them in real life, hence one of the core issues surrounding my addiction. i enclose a piece of writing that best expresses my struggles with addiction, the utter helplessness i feel and deal with alot. This poem is called

Run and hide, run and hide
stay fast the demons i hold deep inside
chaotic screams cut through my mind
an eternal void sounds horrid cries
and tread carefully upon my tracks
its a maze that's confused the devils wrath
you think you're safe, but you just can't see
there are no windows here
A mothers son has undone her soul
with no repast lays to waste its toll
upon a heart, forever broken
shattered pieces all but lost
save one solitary token
its a hope that's dim, so far away
chained up, guarded well, unspoken today
yet somewhere deep, where demons reside
burns a flame unseen to mortal eye
i feel its heat but never for long
its a gunners dream, a sorrow filled song
and you think you're safe
but you'll still be blind
there are no windows here

this poem is the way i feel when the chaos of my using threatens to consume my very existence, trapped and no way out of the cycle i create when i put i needle in my arm. You feel like the biggest loser on earth but you just do it over and over and over again. That is why i am so desperate for any kind of help and so grateful that there are people out there like you that are willing to help and understand that addicts are human beings who are sick and need treatment for their illness just the same as someone who has cancer needs and deserves to be treated as well. Thankyou again doc, for you interest and ongoing support. You've no idea how much it means
most sincerely,

Alissa