There are people who are trying to promote brain surgery for addiction using electrical
stimulation of that area and it doesn't work any better than methadone.
And that's not to say that methadone isn't the most useful drug we currently have, but
it does not involve invasive surgery!
And I should say methadone and buprenorphine, the opioid agonists, are the best treatments
that we have for opioid addiction.
And what they do is two things: the first thing is they cut the death rate by 50 percent,
which is this happens whether you continue using on top or not.
So that's like pure harm reduction and that's wonderful.
If we can keep you alive long enough that you stabilize your life, that is a lot better
than having you die.
The other thing that they do is they allow people (who are ready) to stabilize their
lives.
So you couldn't tell right now if I was on a maintenance treatment or not because basically
once you get a tolerance to these drugs you are not high or impaired, and you can drive
and you can work and you can love and you can do all of these things, but we don't understand,
we think “oh you've just substituted one addiction for another.”
No, what you've done is you've substituted compulsive behavior despite negative consequences,
and now you just have a physical dependence.
And that's not a real problem as long as you have a safe and legal supply.
Well, I think the most important place to start is that addiction is a learning disorder;
it's not a sign that you're a bad person.
And if you want to have a safe and addiction free, or at least lower level addiction workplace
or school, you want people to feel included and comfortable and safe and you don't want
this to be an adversarial thing.
The research shows that the best way to get people help is through compassion and empathy
and support, and absolutely NOT tough love.
There may be situations in which an employer has to fire somebody because their performance
has just degraded so much that there's no other option, but they shouldn't think “I’m
doing them a favor by firing them, because that will make them hit bottom and it will
help them.”
Sometimes that happens, but sometimes they just go on to a life of homelessness and then
die.
So you can't assume that creating extra-negative consequences is actually going to help a person
with addiction.
What you want to do is ally yourself with them, and presuming this is an employee that
you want to keep, help them realize that this is not a sin.
“I am not trying to control you.
What I want to do is for you to be at your best; at work, at home.
And you're not being at your best right now, so what can we do to help?”
Well, I think the important way to start that conversation is to first not assume that a
problem that you think might be drugs is drugs.
The person could be having any number of mental illnesses, the person could be having, you
know, there's a million things that could look like oh you think they have a drug problem
and there's something else going on.
So if you approach the person with respect and not assuming that you're going to find
a drug thing, obviously in some situations it's completely obvious, but in most situations
it isn't.
And so the best way I think is to say “I’ve noticed XYZ.
I'm worried about you.
I'm concerned about you.
I want to make sure that I can help you.”
So it comes from a place of not like “I caught you!” you know, because there's so
much advice that is just like “well, threaten to fire them if they don't change, and drug
test them immediately” and all of this kind of stuff, which destroys trust.
So, that's not to say that if somebody is doing something dangerous or clearly inappropriate
that that behavior doesn't need to be addressed, but it is to say that you can approach somebody
in a confrontational degrading and sort of high-powered manner or you can approach them
as an equal human being deserving of respect.
And if you do the latter you will have much better results.
And I have to say it's almost and never going to be easy because people, whether they have
addiction or mental illness or anything else going on with them, often don't want to admit
to themselves that there's a problem.
In the addiction's field there's been this whole thing we've got to break through denial
and everything like that, well people have denial for good reasons.
If we didn't have denial everybody would be sitting around obsessing about death, or at
least I would be.
It's a defense mechanism because we need defending.
So recognizing that can allow you to sort of approach somebody not from an attacking
stance, approach somebody from a befriending sort of stance.
And that is hard to do and some people are going to get very defensive no matter what
you do and it's not going to be a pleasant conversation most of the time.
But you can minimize harm.
I mean this whole thing always comes down to like reducing harm, making things less
unpleasant if you can't make them non-unpleasant (or actually pleasant).
But the main thing is like see them as a full human being.
And I think really important in getting people into any kind of treatment is that, and I
always say this to parents or anybody who has an addictive loved one, the first step
should always be a complete thorough psychiatric evaluation by somebody who is not affiliated
with any treatment organization so that you can know going in what the problems may be
and what kind of services you should be seeking.
There are some absolutely wonderful treatment providers who if somebody shows up who is
not appropriate for their services they will send them away.
There are also unfortunately many people who will just take that person to make a profit
off of them and they will not help that person and they will not inform them of that, for
example, if they stayed on maintenance they would have a 50 percent reduction in their
death risk.
They would just say “we do abstinence; that's good for you.”
Blah.
And so I think, again, this is a sort of “buyer beware” industry.
In the rest of the medicine it's pretty easy to say, “Okay, here is PubMed, this is the
treatment for this particular cancer that has the most evidence behind it, and here's
the guy who designed the best treatment.
Let's go find this person.”
In addiction it's like virtually all based on like reputation and advertising, and it
is very difficult to actually find programs that provide evidence-based care.
This is also a problem in mental health more generally.
But anyway, the point here is that in order to get care that is good for you you need
to advocate for yourself, and if you have an employer that's willing to advocate for
you that's even better.
The way I think that employers could do an enormous amount of good by demanding that
the treatment providers they work with, the treatment that they cover is evidence- based,
and is not restricted because of money but is restricted because stuff that doesn't work
shouldn't be paid for.