[ibogaine] Fw: ReconsiDer Tidbit: Treatment Works... or does it?

Alison Senepart aa.senepart at xtra.co.nz
Sat Dec 28 06:09:50 EST 2002


After reading your mail and digesting it all I can't say I agree with it
all.  Are you quoting from books and literature or have you been addicted to
heroin, cocaine or any other substance.  Sounds to me as if you are quoting
from passages or literature that you have read but I could be wrong.  How
can you state that heroin leaves the body rapidly etc.  If thats the case
perhaps you could explain spending days in bed sweating, vomiting, turbulent
bowels and in general feeling like shite for days. My experience is that it
takes weeks to clean up not hours.   The reason most people resort to
Methadone is to deal with these symptoms, especially after years of using
drugs and repeatedly going cold turkey which gets worse and harder as you
get older and more tolerarant.  If you have a job and need to get up and be
there or have children to look after methadone at least lets you achieve
some sort of capability.  You said that addiction is not a sickness but a
choice as I understand your mail which is probably quite true in the
beginning when you think you can control your life and what you do but has
no bearing further down the track when you find yourself totally emmeshed in
an endless cycle that you want to get out of but don't know how or are
scared , hurting and totally screwed up.  Your mail seemed to state that all
the answers are there to be had but I'm not sure thats true for everyone.  I
thought your writing was very arrogant and self-righteous but perhaps I
picked it up incorrectly and am a bit prickly.  Would like to hear your
reply.   Allison
-----Original Message-----
From: Joshua Tinnin <krinklyfig at myrealbox.com>
To: ibogaine at lists.calyx.nl <ibogaine at lists.calyx.nl>; Ibogaine
<ibogaine at mindvox.com>
Date: Saturday, 28 December 2002 15:21
Subject: [ibogaine] Fw: ReconsiDer Tidbit: Treatment Works... or does it?


>----- Original Message -----
>From: ReconsiDer
>
>reconsiDer: TIDBIT
>
>We'd all like to believe that the "solution" to our country's drug problems
>lies in treatment rather than prison but does it? We know the problems with
>coerced treatment, but what about voluntary treatment... the "treatment on
>demand" that so many of us call for, does that work? A British doctor
>questions the whole idea of treatment in this interesting piece below.
>
>The Rehab Don't Work
>
>19 December 2002
>
>by Dr Michael Fitzpatrick
>
>'"No way could I have done this without detox and rehab" says Gale, 29.
"I'd
>probably be dead or in jail. I'd totally lost control of my life and hit
>rock bottom. I'd say I was suicidal."' (1)
>
>Mark Gale was one of the first residents of the Oxford Drugs Recovery
>Project, which provides accommodation and drug treatment for homeless drug
>addicts. He spent three months on a 'maintenance' dose of methadone, then
>underwent gradual withdrawal with reducing doses of methadone over the next
>month. During this time he attended two therapy groups a day, had
one-to-one
>counselling and took part in social activities with other residents.
>
>This was a 'stepping stone' to a six-month residential rehabilitation
>programme in London, followed by three-months aftercare to accompany his
>move into supported housing near the rehabilitation centre.
>
>The problem identified in this article is that 'Gale is one of the lucky
>ones': services for detox and rehab are available for only a small
>proportion of homeless drug abusers. The author welcomes recent government
>proposals for a dramatic increase in the provision of treatment services of
>this sort.
>
>Indeed, 'detox' and 'rehab' were the central themes of the 'Updated Drug
>Strategy' launched by home secretary David Blunkett on 30 November. Though
>the government has been widely criticised over some aspects of its drug
>policy (such as its relaxation of measures against cannabis and its
>endorsement of the prescription of heroin by doctors), even its staunchest
>critics welcome the new report's emphasis on treatment.
>
>The key shift signalled by the promotion of 'detox and rehab' is away from
a
>'law and order' approach to the drug problem towards a new therapeutic
>strategy, emphasising education, treatment and support. (It is not
>surprising that Keith Hellawell, the drug tsar, had to go: New Labour's
>crusade against drugs needs a social worker or a counsellor, not a
>policeman, as its symbolic head.) 'Detox and rehab' now go together like
>'rum and coke', but what do they mean?
>
>'Detox'
>
>The use of the term 'detoxification' in relation to the problems of drug
>addiction appears in many ways idiosyncratic. It was used in the past to
>refer to the process of removing some poisonous substance from the body.
But
>the substances from which people now seek to be 'detoxed' - alcohol,
heroin,
>cocaine - are not poisons. Indeed they all have therapeutic uses as well as
>a range of familiar beneficial effects. It is true that they may all be
>harmful in excessive or habitual use, but that is true of most medications.
>
>Whereas the traditional process of detoxification was limited to the
removal
>of the toxic substance from the system, this is only a small part of the
>aims of the modern detox. Drugs of abuse, such as heroin and cocaine, tend
>to have a short duration of action and are cleared from the body within
>hours (the same is true of alcohol). Indeed this rapidity of effect and
>clearance is linked to their tendency to induce dependency: users seek to
>maintain or repeat the high by further ingestion. (This is also why people
>tend not to get addicted to anti-depressants, which take effect over weeks
>rather than hours.)
>
>Modern detox does nothing to accelerate the - already rapid - clearance of
>drugs from the body. The distinctive feature of contemporary detox regimes
>is that, rather than simply removing one drug, they tend to replace it with
>another. Thus alcohol is commonly replaced with a benzodiazepine (such as
>chlordiazepoxide) and methadone is substituted for heroin. The role of
these
>substituted drugs is not to remove the problem drug, but to counteract
>symptoms which may result from its withdrawal - such as fits in alcoholics
>and muscle cramps in heroin addicts.
>
>It is worth noting that both these substitute drugs are also 'toxic' in
>overdose, and both are also associated with problems of long-term
>dependence. The conviction on 17 December of Kathleen McCluskey, from
>Cambridge, for the manslaughter of two men (she was accused of killing two
>more and of attempting to do the same to a fifth) by administering
methadone
>to them confirms the lethality of this drug (2).
>
>The concept of detox is most strained when it is applied to cocaine.
Cocaine
>produces a very rapid effect (a major part of its appeal) and it is also
>rapidly cleared (requiring frequently repeated doses for those habituated
to
>its use). However, unlike heroin, it does not require increasing doses to
>produce the same effect, so it does not produce a characteristic physical
>dependency.
>
>But whereas heroin can be replaced with methadone, no drug has been found
to
>substitute for cocaine. Despite a vast amount of research, mainly in the
>USA, and experimentation with numerous drugs, including anti-depressants,
>anti-convulsants, opiate antagonists and beta-blockers, nothing seems to
>work. As one recent account by Max Daly in the UK Guardian concluded:
'there
>is currently no strong evidence to support the general use of medicines as
a
>way to ease withdrawal, reduce cocaine craving or promote abstinence.' (3).
>A survey by the Royal College of Psychiatrists came to the same conclusion
>(4).
>
>The solution recommended by Max Daly was that cocaine addicts should be
>'placed on a residential "detox" programme'. The National Treatment Agency
>(NTA) is piloting 10 such schemes in the New Year. What is the nature of
the
>detox treatment on offer? According to the NTA chief executive Paul Hayes,
>the key is 'cognitive behavioural approaches, particularly around relapse
>prevention and consolidating people's motivation'.
>
>The schemes aim to provide 'a structured series of counselling, group
>therapy and relapse prevention programmes'. Such is the fluidity of
concepts
>in this therapeutic universe that 'detox' has metamorphosed into 'rehab'.
>
>'Rehab'
>
>'The belief that one is powerless and that one's actions are somehow
>controlled by forces other than one's own choices is discouraging and
>demoralising.' (5)
>
>The concept of rehabilitation once meant restoring to their previous
>condition those whose standing in society had been impaired by injury or
>illness or some other misfortune (including their own deviant behaviour).
In
>its modern form, shortened in letters, but - as the case of Mark Gale
>indicates - not necessarily in duration, rehab does not seek to restore the
>status quo ante. It aims to effect a transition from dependence on drugs to
>dependence on some form of professional therapeutic intervention.
>
>Programmes of residential rehabilitation emerged out of the therapeutic
>community movement that flourished in the USA in the 1960s. One of the
>earliest therapeutic communities for drug addicts was Synanon, set up by
the
>charismatic Charles Dederich in California (6). Synanon pioneered a
>confrontational, hierarchical approach that assumed that drug addicts had
>intrinsic - and possibly intractable - personality defects that needed to
be
>challenged through long-term intensive therapy. Membership involved
>surrendering all personal rights and being treated as a child not allowed
to
>make personal decisions. Treatment involved forceful re-education and
>structured humiliation.
>
>Synanon became notorious when Dederich became obsessed with the notion that
>clients who left the community were betraying him. He employed a security
>force to coerce clients into staying and was ultimately convicted for
>placing a rattlesnake in the mailbox of a lawyer representing dissident
>clients (7). In his book The Meaning of Addiction, Stanton Peele notes that
>former Dederich supporters, including celebrities such as Jane Fonda,
>claimed that Dederich's actions violated the Synanon philosophy. 'In fact',
>Peele comments, 'his response was the natural consequence of the Synanon
>credo that membership in the community is a lifetime proposition' (8).
>
>A wide range of secular and religious organisations now offer residential
>rehab programmes on the therapeutic community model. Some are more
>autocratic, some more democratic; some insist on abstinence from forbidden
>substances, others take a more liberal approach. But they share a
commitment
>to communal living, group and individual therapy, and shared domestic and
>leisure activities. A survey by the Royal College of Psychiatrists in 2000
>noted that there were more than 100 centres in the UK offering residential
>rehab; the figure is now certainly higher (9).
>
>Given the popularity of the therapeutic approach pioneered by Alcoholics
>Anonymous (AA) in contemporary rehab programmes, it merits a brief
>discussion. After the end of Prohibition in the USA in the 1930s, the AA
>movement combined the evangelical fervour of the Temperance campaign with
>the modern theory that alcoholism was a disease rather than a moral
failing.
>The first two of the now-famous '12 steps' through which AA guides its
>adherents to sobriety require that they admit 'powerlessness' over alcohol
>and submit themselves to 'a Power' greater than themselves (six of the
steps
>refer to the deity).
>
>For AA, alcoholism is a life-long illness against which only total
>abstinence can prevail, in an indefinite process of recovery. As Stanton
>Peele, a veteran campaigner against the AA approach in the USA, observes,
>the style of AA groups is derived from the Protestant revival meeting,
>'where the sinner seeks salvation through personal testimony, public
>contrition, and submission to a higher power' (echoes of this style are
>apparent in the testimony of Mark Gale, quoted above) (10).
>
>Through a combination of skilful self-promotion, endorsement by the medical
>and psychiatric professions and encouragement from state authorities, AA
has
>become a major influence in the USA - and in other Western countries. Its
>approach has spread far beyond alcohol to other areas of addiction,
>including sex and gambling, and, of course, through Narcotics Anonymous
>(NA), to drugs.
>
>A patient of mine was recently admitted - at the expense of the health
>authority - to a residential rehab programme at a clinic that describes
>itself as 'one of the leading centres in Europe'. According to the clinic
>letter, she sought 'treatment for chemical dependency on cannabis, cocaine
>and ecstasy' (though, in pharmacological terms, none of these drugs induces
>chemical dependency). The centre's prospectus outlines its theory of
>addiction: 'We believe that addiction to alcohol and drugs (chemical
>dependency) is a chronic, progressive, primary and incurable disease, not a
>problem of morals or willpower. The disease, if left unchecked, will prove
>terminal.'
>
>The clinic provides five phases of treatment based on the AA model: 'the
>most important and difficult phase of the treatment is to break through the
>patient's denial.' Yet, 'once patients have accepted they have a disease
>they are able to progress through the programme to begin their recovery'.
>During treatment, my patient 'began to accept powerlessness and
>unmanageability and how this relates to the use of chemicals'. After eight
>weeks she was discharged home with recommendations that she maintain 'total
>abstinence from alcohol and all mood-altering substances', that she attend
>regular meetings of AA and NA and that she receive 'aftercare follow-up' at
>the clinic's own 'aftercare unit'. She relapsed shortly afterwards.
>
>'Treatment works'?
>
>'Many people who oppose the 'war on drugs' say that the 'solution' to the
>'problem' is 'treatment'. This is baloney. Addiction treatment is a scam.'
>(11)
>
>The phrase 'treatment works' is repeated like a mantra in the government's
>'Updated Drug Strategy'. Everybody in the world of drug policy is desperate
>to believe that it is true. Indeed it is supported by evidence from
research
>that is either carried out directly by government agencies (such as the
>National Treatment Outcomes Research Study) or commissioned by them. But
are
>such studies reliable? Here the British authorities might learn from the
>(vast) experience of the USA in this field.
>
>Research on the efficacy of treatment programmes for problems of addiction
>in the USA follows a now-familiar pattern. This begins when promoters of a
>new scheme or programme claim dramatic successes (often accompanied by
media
>and celebrity endorsements). Early studies, often influenced by the
>enthusiasm of the promoters and the zeal of those they have cured, tend to
>confirm impressive results. Later, when the publicity had died down and
>independent researchers take a more dispassionate view of the outcomes of
>treatment over a longer period, the extravagant claims cannot be sustained.
>
>Writing 25 years ago, Griffith Edwards, one of the leading British
>authorities on alcoholism, summed up the problem: 'It is not only that the
>research literature is poor in reports which suggest that any particular
>treatment is advantageous; on the contrary, it is rich in reports which
>demonstrate that a given treatment is no better than another.' (12) This
>does not mean that nobody benefits from treatment. It is simply that they
do
>not seem to do so at any higher rate than without treatment. As Jeffrey
>Schaler, a trenchant critic of these methods, puts it: 'One treatment tends
>to be just about as effective as any other treatment, which is just about
as
>effective as no treatment at all.' (13) Both Schaler and Peele provide
>examples that substantiate these conclusions.
>
>In his book The Therapeutic State, another American critic, James Nolan,
>presents a detailed account of the drug courts in Dade County, Florida
(13).
>These courts pioneered the diversion of drug abusers from the criminal
>justice system into treatment programmes, developing a model that has been
>taken up widely in the USA - and now features prominently in British drug
>policy. Nolan shows that the claims for the success of these programmes
have
>not been borne out by independent scrutiny. He reveals how the redefinition
>of goals and a number of statistical scams have contributed to the
>impression that 'treatment works'.
>
>A recent British account draws together the results of a number of studies
>of long-term patterns of heroin use (14). These reveal that many users
>spontaneously give up the drug of their own accord, without benefit of
>detox, rehab or any other professional intervention. The authors reckon
that
>'at least five to 10 percent manage this every year' and estimate that the
>average length of a 'serious heroin-using career is about 15 to 20 years'.
>
>They emphasise that 'this figure is independent of treatment': 'There is no
>evidence to date that any form of treatment makes any difference to length
>of heroin use.' They conclude that 'people give up when they are ready to
do
>so. Events in their lives are much more important in making this decision
>than anything that occurs in the clinic'.
>
>The dangers of detox/rehab
>
>'Rehabilitation is shite; sometimes ah think ah'd rather be banged up.
>Rehabilitation means the surrender ay the self', wrote Irvine Welsh in
>Trainspotting (15)
>
>If the best that can be said of the detox/rehab approach is that it is
>ineffective, the more serious charge against it is that it reinforces a
>concept of addiction that is degrading to people with drug problems and
>results in the further diminution of their autonomy.
>
>Behind the manifold absurdities of 'detox' lies a conception of drugs as an
>autonomous malign power over individuals and society. This tendency to make
>drugs a fetish pervades the government's 'Updated Drug Strategy', which
>refers to the 'damage caused by drugs' to communities and to the need to
>'protect young people from drugs'.
>
>But drugs are inanimate material; they have no will or power of their own.
>As Schaler observes, 'drugs don't cause addiction': people choose to use
>them for a variety of reasons, often to help them cope with problems of
>living (even though the costs may appear to exceed the benefits). Stanton
>Peele and Archie Brodsky insist that 'it is important to place addictive
>habits in their proper context, as part of people's lives, their
>personalities, their relationships, their environments, their perspectives'
>(16).
>
>The preoccupation with the supposedly objective 'toxic' character of drugs,
>and the notion of addiction as a disease, leave the subjectivity of the
drug
>user out of the picture. Yet as Peele and Brodsky emphasise, any attempt to
>influence addictive behaviour must take into account the wider realities of
>the life of the individual in society. It is only as targets of the 'war on
>drugs' that drug users come into focus: it is of course impossible to wage
>war against pharmaceuticals, only against those who use them.
>
>Though the AA's 12-step approach has crossed the Atlantic, it is
regrettable
>that its critics are not yet widely known in Britain: as a result, rehab
>clinics using these techniques have become widely established with
virtually
>no public controversy.
>
>Peele and Brodksy summarise the flaws of the AA model as follows: 'it is
>'religious and dogmatic', demanding strict adherence to the group policy
and
>not allowing personal choices or individual variations; it 'undermines
>individual confidence' by insisting on members' weaknesses and predicting
>the worst outcomes for those who violate group policies; it reinforces the
>'addict identity' and discourages people from emerging out of it; it
focuses
>on the addiction and the group itself, ignoring the quality of members'
>lives outside the group. (17)
>
>The authors do not deny that AA groups have proven effective for some
>people. But the basic premise of AA - that the individual is powerless and
>should seek to replace the control of one external force (drugs) with
>another (God, or, in the interim, the group) - can only intensify the loss
>of autonomy that leads to drug abuse in the first place.
>
>No doubt some rehab programmes reject the AA model. But by their very
>nature, residential schemes isolate the drug user from the context in which
>the problem has arisen. The intensity and intimacy of relations established
>among members of the therapeutic group - and between clients and
therapists,
>is likely to reinforce the client's isolation from society. It is not
>surprising that residents quickly become drug-free in their communal home -
>or that they quickly relapse on leaving it. Though this is clearly why
there
>is such an emphasis on 'aftercare' and 'follow-up', it also indicates the
>client's continuing dependency on the therapeutic relationship forged in
>rehab.
>
>The trend for drug users to be mandated to attend detox/rehab programmes,
by
>the police, the courts, occupational health services, reflects the
>authoritarian dynamic behind the therapeutic face of official drug policy.
>The therapeutic approach is not an alternative to the criminal justice
>approach to drug abuse, but proceeds in tandem with it. And, whereas a
>prison sentence comes to an end, therapy goes on for ever.
>
>But surely it is better to be dependent on therapy than to be hooked on
>heroin? Perhaps, but better still to live an independent life, free of both
>drugs and therapists.
>
>Dr Michael Fitzpatrick is the author of The Tyranny of Health: Doctors and
>the Regulation of Lifestyle, Routledge, 2000 (buy this book from Amazon
(UK)
>or Amazon (USA)), and a contributor to Alternative Medicine: Should We
>Swallow It? Hodder & Stoughton, 2002 (buy this book from Amazon (UK).
>
>Read on:
>
>spiked-issue: Drink and drugs
>
>(1) Guardian, 11 December
>
>(2) 'Black Widow' killed two with methadone, Guardian, 18 December 2002
>
>(3) Rocky road, Guardian, 23 October 2002
>
>(4) Royal College of Psychiatrists, Drugs: Dilemmas and Choices, Gaskell,
>2000, p176
>
>(5) Jeffrey A Schaler, Addiction is a Choice, Open Court, 2000, p40
>
>(6) Tom Carnath and Ian Smith, Heroin Century, Routledge, 2002, p 159
>
>(7) Stanton Peele, The Meaning of Addiction: an unconventional view, Jossey
>Bass, 1985, p144
>
>(8) Stanton Peele, The Meaning of Addiction: an unconventional view, Jossey
>Bass, 1985
>
>(9) Royal College of Psychiatrists, Drugs: Dilemmas and Choices, Gaskell,
>2000, p162
>
>(10) Stanton Peele, The Meaning of Addiction: an unconventional view,
Jossey
>Bass, 1985, p31
>
>(11) Jeffrey A Schaler, Addiction is a Choice, Open Court, 2000, p 141
>
>(12) Quoted by Jeffrey A Schaler, Addiction is a Choice, Open Court, 2000,
>p44
>
>(13) James Nolan, The Therapeutic State: justifying government at century's
>end, New York University Press, 1998
>
>(14) Tom Carnath and Ian Smith, Heroin Century, Routledge, 2002, p171
>
>(15) Irvine Welsh, Trainspotting, Minerva 1993 , 1993, p181
>
>(16) T Stanton Peele and Archie Brodsky, The Truth About Addiction and
>Recovery, Fireside, 1992; p42
>
>(17) Stanton Peele and Archie Brodsky, The Truth About Addiction and
>Recovery, Fireside, 1992, p 314
>
>
>Associated links:
>
>Reprinted from : http://www.spiked-online.com/Articles/00000006DB92.htm
>
>Hope you are enjoying your Tidbits. If you're not a member of ReconsiDer
and
>would like to join, please fill out our membership form.  And be sure to
>visit our website.
>
>
>




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