Although we are in the age of the Millennium generation and treatment has involved from its birth to its present state, we remain behind times. The evolution of addiction has grown Beyond what we in the profession ever could imagine. The opiate crisis that we face in this country has baffle the minds of scientists therapist researches and everyone in between.
Let us take a look at the treatment industry back 30 years and compare it to the present models and modalities utilized across the u.s. today.
The year was 1998, the location Western Massachusetts. The facility, a highly structured Therapeutic Community. For those that maybe too young to have experienced that error of treatment I will explain.
The concept of a Therapeutic Community offten known by the acronym TC was based somewhat on what one could experience in the military back in the 1950s. The belief was if the treatment facility could break the moral character the individual and their belief system as well as their Behavior therapist could begin to formulate a new way of thinking acting and believing with the primary focus of loving yourself and life without drugs or alcohol.
The message were often very cruel with signs being hung on the client when your client broke a rule. It was common for a sign with a picture of a cigarette to be found hung over the neck of a client who smoked without permission or smokes more than one cigarette without approval. Other tactics were to have a funeral where the individual would dig a small hole and bury a cigarette holding a mass and then burying it. The belief was that it was you the client being buried. Let me clarify, the correlation of the cigarette and the funeral was to make you understand that you smoked the cigarette without permission just because you wanted to, that was the same behavior you utilized in your community with your drug addiction. You did what you wanted when you wanted with no regard for anyone else and as you result ultimately addiction would change your life. The cigarette represents that life and the end of it. It was a very difficult concept to understand because it was used in most everything you did. But for the 1960s and 70s heroin addict that was primarily in their thirties and very hard core this was an ideal treatment. It has since stopped and there are a couple of programs that utilize the fairies but not the harsh actions.
If you come up to the current generation and system being used today you will find a complete opposite. Today that use motivational therapy and reality therapy along with dozens of other models. They are all sent it on the theory that you give support and guidance as opposed to consequences. The generation now are 17 year old kids and they would not be able to tolerate the psychological pressure of a TC. Here is the problem with the past and present.
Many in the field and The Advocates that work in the communities believe that treatment has been changed so drastically that it is not effective. In the 80s you could be in a detoxification unit for two weeks upward to 30 days. A residential treatment program was primarily 90 days as a relapse model with a six-month minimum as a traditional treatment model. Most went from six months to one year and then a graduate program allow you to work and stay in the safe environment for another year. What we are receiving today for our clients is a three to five day detox. Clients are leaving treatment in withdrawal. There is no transitional Treatment available and they have added so many different levels of treatment. It has actually in my opinion taking away options rather than adding them. We have too many levels of care and no beds to fill them. Clients are leaving a detox only to go right back to the drug of choice only and mostly because of the withdrawals.
We have been asking the government to increase detoxification stay time back to a minimum of 14 days but we prefer 30 days. Even with that amount of detoxification a number of clients will still be in minimum withdrawal. When you add the backlog due to meds not being available and the onset of the new synthetic drug movement such as Fentanyl and many others we have a situation where individuals are leaving Detox After 3 days and over dosing and dying because of the Fentanyl mixed in with the heroin. We have basically sending people out of a detox right to their death.
And the government’s quest to make his fancy model of treatment and all these other disciplines they have simply destroyed the structure that once showed results. We need to change the way we are working with these clients. The models they are providing for these clients are simply outdated or in many cases in effective because they do not challenge the client to be the best they can. They are more concerned with ofenden a client with structure and confrontation than they are about how many people are dying.
We need to take some of the past treatment models and incorporate them with the current models to start with. We need to increase the detoxification as well as the residential and Transitional Care models having everything increase will give us a better chance to have a good outcome. Everyone is asking for more detox beds. If we continue to put people in detox for only 3 days you could have 1000 beds in every city and not see any results. Sending someone back to the community sick from withdrawal is in automatic sentence. If we can get them stabilize with minimal withdrawals and to them into a transition or Step Up program then into a residential program for six months the outcomes will change dramatically. All the professionals that worked in the industry back in the seventies all agree with this Theory. Better treatment and longer treatment time will give us the best chance we have at saving lives changing behaviors and hopefully turning attics into responsible community citizens.