In opioid use disorder treatment, there’s been a persistent (though not always acknowledged) tension between what’s good for public health and what individuals and their families want from treatment. I’ve written about it before. For public health, there’s plenty of evidence that MAT (medication assisted treatment) reduces illicit drug use, improves health and reduces crude mortality rates.

Meeting people with opiate use disorder who were in long term abstinent recovery from illicit and prescribed drugs changed my mind about what was possible. I suppose I have met hundreds of such people over the years. That’s a game changer. I worry that some prescribers don’t spend enough time with people in recovery.

Although there are substantial benefits to MAT, there are also problems: non-engagement with those who would benefit and timely access for instance. Then there are other issues too: stigmatisation of those on methadone, poor retention in treatment and how MAT fits in with the management of problem polysubstance use, including alcohol.

So, does MAT help patients achieve their wider goals – those person-important outcomes?

We don’t really know is the short answer. A systematic review published in 2017[1], found that health related quality of life measures are rarely used as outcomes in MAT research. When looked at from a recovery perspective, we have more evidence on the negatives that go than on the positives that arrive. There are studies showing improved quality of life, but we need more on whether people reach their goals and get improvements in the things that matter to them.

A small in-depth Norwegian study[2] involving 7 women and 18 men on MAT found evidence of them being ‘stuck in limbo’ in terms of not moving on despite national guidance that the patient’s own goals ‘should be the basis of treatment’. These drug users were still engaged in illicit drug scenes. The researchers found four themes:

  1. Loss of hope
  2. Trapped in MAT
  3. Substitution treatment is not enough
  4. Stigmatisation of identity

For complete paper

This popular claim lacks evidence and leads to poor policy.

The notion that drug addiction is a brain disease has become axiomatic. Around the globe aspiring health professionals treating substance abuse are indoctrinated with this belief, especially after the idea became popular in the 1990s. Its popularity extends far beyond the hallowed halls of academia. Both the May 1997 Time and the September 2017 National Geographic magazines were dedicated to the brain science of addiction. Numerous other popular magazines have run similar cover stories over the past two decades.

But after 20 years of research, one of us (Hart) saw that paradigm yielding dismal results. Meanwhile, behavioral research on outcomes after providing both animals and humans with attractive alternatives to drugs has yielded positive results regarding effective treatments, despite the lack of mainstream attention.

Despite this seemingly solid scientific consensus, there are virtually no data in humans indicating that addiction is a disease of the brain in the way that, for instance, Huntington’s or Parkinson’s are diseases of the brain. The existing paradigm is based on intuition and political necessity, not on data and useful clinical results. Yet the diseased-brain perspective has outsized influence on research funding and direction, as well as on how drug use and addiction are viewed around the globe. This situation contributes to unrealistic, costly, and harmful drug policies: If the problem is a person’s neurobiological state after exposure to a drug, then either the drug must be eradicated from society through law enforcement or an individual’s brain must be treated. In such a myopic approach, the socioeconomic and societal factors that contribute to drug addiction are considered a footnote in research, clinical practices, and policy, despite their apparent importance. (see also DRR: Dealing With Addiction)

For complete Research Paper 

“It’s not that difficult to overcome these seemingly ghastly problems [drug addiction]… what’s hard is to decide to do it.”   Robert Downey Jnr (2004)

This is where assisted decision-making is imperative.

No matter how functional the regular drug user may appear, the drug addled brain has corrupted processes due to the presence and interference of psychotropic toxins. Whilst we may not be able to ‘arrest our way’ out of this issue, we will not be able to ‘treat our way’ out alone either. It is a more complete process, as with all behaviour change, that requires all educative and legislative measures coalescing into drug use reduction, not just attempting to reduce harms of a permitted drug use model.

This gives added weight to why a Judicial Educator is not only needed but is best placed to be engaged through problem-solving courts as a key circuit breaker needed to help facilitate drug exiting. Punitive action is not necessary, if these mechanisms are able to recalibrate the drug user into the recovery processes. But changing the status of drug use to ‘decriminalized’ is a step backwards in best-practice. It eliminates this vital, individual and community benefiting intervention and also increases drug use induced harms.

Calls for Decriminalizing Drug Use are Really Not a Care-full Agenda.   

Anti-drug laws were always meant to be a vehicle to protect community, family6 and our most important asset – our children#1 – from multiple harms caused by permission models that adults believe they have the individual right#2 to exercise around the use of addictive and destructive psychotropic toxins.

It is important to underscore that the current proactive and protective laws have not been used in any real punitive context for decades. They are part of a proactive framework – As the ‘Judicial Educator’.7

An example of drug laws used in non-punitive context includes  Problem Solving Courts,8 to facilitate not only exit from drug use but passage into productive, safe, health and community benefiting narratives.#3

The current laws do not require removal but can continue as a mechanism to facilitate rehabilitation and recovery, with great success. 9 The existing criminal codes do not need to be weakened or worse erased through legalisation or decriminalisation but used for diversion from drug use and harms.

No criminal records need be recorded if the diversion path is embraced effectively.

The pro-drug lobby’s completely fallacious meme of ‘war on drugs has failed’ reverses the real causes and effects of drug harms and violence. There has been no ‘war on drugs’ in this nation since 1985.  Instead there is an ever growing ‘war FOR drugs’10  as it continues to look to remove genuine tools that can bring best-practice drug use exiting outcomes and instead  mislabels and propagandises these genuine efforts as ‘wars’ against drug users.

The Judicial educator is the one bookend to the corresponding health and education. Together these ensure a cohesive and compassionate message as experienced for decades with combating tobacco addiction and its attending harms, a community with One Voice, Once Message and One Focus. This should be the agenda of all drug use reduction vehicles.11

The removal of the protective legal vehicle that would otherwise compel people into treatment, will instead only assist in adding to, not only individual drug harms, but harms to our more vulnerable communities and their families – and particularly to our children.

Once psychotropic toxins are an entrenched part of the behavioural mechanisms of an individual, whether it be short-term intoxication, or long-term dependency, the risk to health, safety and well-being of that individual and more concerningly, those around them requires more than a ‘doctor’ for change. 12 Secure welfare engaged for rehabilitation continues to prove the safest and healthiest vehicle to assist that change.13

Do these changes indicate that as a society there is more concern for tobacco users than illicit drug users? The latter deserve the same passionate assistance to exit drug use rather than any further enhancement or endorsement.

Any permission model – decriminalisation, legalisation or depenalization – that does not add to that capacity of drug users to move out of drug use is a counterproductive measure.14 Consequently, the drug using individual will more readily continue use if the only proactively coercive vehicle – the law – is removed, further normalizing drug use and the inevitable harms that follow.

alternativesFor the safety and future of not only the current drug user, but the protection of families and the most vulnerable in our community – our children – the legal status must remain unchanged. Yet re-tasked for better outcomes. The Dalgarno Institute is available to dialogue and assist in formulating this re-tasking.

It is important to glean all the evidence-based facts about models prior to profiling them as options, particularly models that have either failed or are being reviewed due to poor outcomes and/or just plain limited, inaccurate or misrepresentative data.

For a thorough and clinical review of the Portugal Drug Policy Framework go to Portugal Drug Policy – A Review of the Evidence 15

The Judicial Educator: Law for Recovery + Drug Courts + Secure Welfare = Rehabilitation!16

 

 

 

 

This is where assisted decision-making is imperative. The drug addled brain has corrupted processes due to the presence and interference of psychotropic toxins. The Judicial Educator actively engaged through problem-solving courts is the key circuit breaker needed to help facilitate the exit from this will diminishing haze. Punitive action is not necessary, if coercive mechanisms are able to recalibrate the dysfunction processes, through drug free recovery processes. This is why 'legalizing' drugs eliminates this vital, individual and community benefiting intervention and a care-less action for a society with increasing drug use induced harms.

https://clearskyibogaine.com/robert-downey-jr-and-drug-addiction/  

Helping an Alcoholic Loved One

Need Counselling

Do you, or someone you know have already taken up drugs and alcohol and you’re concerned?

The following agencies/groups can be a real help.

Teen Challenge

Phone: (03) 5852 3777

Fresh Start

Recovery Programme
Helping Families With Addiction

Therapeutic Communities

for AOD dependencies

Therapeutic Community

Addiction, there is a way out!

NSW Therapeutic Community

Rescue – Restore – Rebuild

Alcoholics Anonymous

SHARC-Oxford Houses

Sherwood Cliffs Rehab

Phone (02) 6649 2139

Remar Rehabilitation

Phone: (03) 5659-6307
Mobile: 0419 436 687

Transformations

Phone: (07) 55 923 677

Seahaven Private – Rehabilitation

Phone: (03) 8738 4252 

Life International Counselling and Coaching

email: info @ lifeinternational.com.au

Womens Domestic Violence Crisis Centre

Phone: 24 Hours - 1800 015 188

Positive Lifestyle Counselling Services Dandenong

The Cyrene Centre

Suite 5, 49-54 Douglas Street, Noble Park 3174
Phone: (03) 9574 6355

Centacare

7 Brunswick Street, Fitzroy 3065
Phone: (03)94956144

Living Springs Counselling Centre

Berwick Church of Christ

446 Centre Road, Berwick, Victoria, 3806
Phone: (03) 9702 1011

Pastor Larry Edwards Counselling

Dandenong Church of Christ

139 David Street, Dandenong, Victoria, 3175
Mobile: 0410 613 056

Total Wellbeing Centre

Suite 1 / 857 Doncaster Rd,
Doncaster East, Victoria, 3109
Phone: (03) 9855 9555

Woman's Domestic Violence Crisis

Phone:1800 015 188

Eagles Wings Rehabilitation Centre

Phone: (03) 5726 5060

DasWest Drug & Alcohol Services

Details Pending

Odyssey House Victoria

Addiction Center

Alcohol Rehab

- Treating Alcoholism -

Narcotics Anonymous Australia

Addiction Resources for North America