Rethinking Substance Disorders

There Might Be Better Ways

Today's Learning Moment  01-05-23 – Rethinking Substance Disorders

Written by and for people with Lived Experience - Port Alberni Community Action Team - Families Helping Families

We use to think the world was flat. We use to think the sun revolved around the earth. We even use to think that the heart was the centre of thought, emotion, and spirit – not the brain.

Funny how we humans shun change. Frankly, most of us suck at accepting new ideas. Sometimes decades or even centuries go by before proven ideas become recognised as truths. Often, the people proposing new ideas use to be thrown into prison or even executed for daring to make us think. Now we just ignore them – even when they are backed up with evidence-based science.

From my experience as someone who has struggled with substances, and as a clinician for most of my life, I know that the science and tools to address the complex layers of "addiction" (substance disorders) are evolving. What I knew forty years ago is only a small portion of what I know now, what others are learning and what our communal knowledge of substance disorders will know in the future.

It is not the tools or the developing knowledge that is flawed, it is our collective resistance to change. It is the insistence that there is only this way or that way. It is our system founded on policies created decades ago, in the last century. Ideas based on moral and pious religious judgment. Ideas that were based on economic factors rather than humane factors. These old concepts stand in the way of flexible and human-centred attitudes and policies that would best address substance disorders. We desperately need flexible responsive and accessible  (treatment) options. We desperately need to expand and own our definitions of what treatment is now. Each of us needs to catch up to the current theories and models and be open to expanding on and introducing new evidence-based proven methods.

Today there is a vast amount of information out there that readily shows how complex "addiction" to substances is. We all need to accept that and start moving towards these new concepts. Trauma, displacement, personal and social disconnection, mental illness, economic status, hell our whole culture is the perfect storm for "addiction" or what we should be calling substance disorders. However, most of us are still trying desperately to avoid that elephant in the room.

So if treatment alone worked, then people would not die when they relapsed. We know that well over half of people relapse while in the recovery process. People would not die in treatment or recovery homes. People would not die when they were just experimenting at a party, rave or concert, or after work with "the boys" or in a million other situations, we put ourselves in.

So, "addiction" is not the main reason people are dying!

People are dying because of an increasingly poisoned toxic supply of substances. What do you think people are using when a relapse happens? When they are experimenting? When they are addicted? A safe, untainted product? Well of course not – we don’t have a safe supply!

The "Iron Law of Prohibition”. This law frames it this way; - the tighter the criminalization of a substance, the more toxic the substance becomes, the more use increases, the more crime increases, and more deaths from toxicity occur. This happened during the prohibition of alcohol. 

All anyone has to do is look around and ask the question; Is drug use down? Are there fewer drugs on the streets? Has criminalization made anything better? Are deaths from the poisoned drug supply decreasing? The answer is so obviously no! Frankly, the “Iron Law of Prohibition” has caused the opposite of what it was intended to do. Nobody has to be a rocket scientist to understand this. However, what we have to be is open to letting our old beliefs of prohibition and criminalization go. It’s the only way we’ll move on to accept the new ideas of substance disorder.

There is a valid argument that the Iron Law has caused our current crisis with fentanyl and other equivalents and substances being mixed in with false products as a means to bolster black market profit and get around law enforcement. This is the exact replica of what occurred with alcohol in the early part of the 20^th century.

Criminalization causes more harm than the drug in almost all cases. Just go to a courtroom and watch someone going through the pain of opiate withdrawal while getting lectured on how evil they are for doing drugs. Watch them getting sentenced for something that should be a health and social issue rather than a crime. Talk about torture!

Individually we need to critically rethink our beliefs and values. I can tell you, from the hundreds of thousands of stories I have heard, and the systems I have had to work and struggle in, that we all play a role in this. I have had a role to play in the mistakes I made as a counsellor to the mistakes I made as a parent and as a person struggling with "addiction". So it is up to me and YOU to keep learning, have an open mind, open heart, and a willingness to explore the uncomfortable unknown; to hear what we might not want to hear.

We will continue to stay right where we are if we do not take a step forward; if we continue to pound our heads against the same wall. We need to stop cracking our heads and we need to tear down the wall. Keep questioning, keep learning, keep exploring, and keep challenging! It is the only door out of this mess we now call substance disorders.

Let's make this new year a year of growth and change and save some lives!

NOTE: For clarity and understanding with a wider audience, some older terms have been used in this article. Example "addiction" We acknowledge that language is crucial in combating stigma. Terms like (a person with substance disorder) are by far better in moving to a more humanistic view of concurrent disorders.

Author: Ben Goerner – Ben is a retired counsellor, with-lived experience. He advocates for people with substance or mental illness.
Families Helping Families is an initiative of the Port Alberni Community Action Team. We regularly send out "Learning Moment" articles to help folks understand substance illness. Knowledge is vital in understanding the disorder of our family members. You may copy, distribute or share our articles as long as you retain the attribution. Add yourself to our distribution list by dropping us a note at - albernihelp@gmail.com

Here are some of the awesome resources that Ben used in writing this article.

https://www.cato.org/blog/prohibition-theater-iron-law-prohibition-unpublished-letter-editor-wall-street-journal

Lewis Marc Dr, (2015) The Biology of Desire, Public Affairs Perseus Books New York

Boyd Susan et al (2016) More Harm Than Good: Drug Policy in Canada, Fernwood Publishing Nova Scotia.

Mate Gabor M.D., (2008) In the Realm of Hungry Ghosts, Vintage Canada Toronto.

Alexander Bruce Dr, (2008) The Globalization of Addiction, Oxford University Press