Posts Tagged 'addiction'

Addiction programs in Manitoba: support is flat in the great flatlands

As a have-less province with a significant fraction of the population that is poorly educated and un- or underemployed, Manitoba has its share of drug-related problems. Manitobans with addictions (many of whom have mental health issues) do not have ready access to treatment. Resources are inadequate and there are long waits. Take the case of methadone intervention programs.

Manitoba has only one-quarter of the methadone spaces per capita as compared to neighbouring Saskatchewan, and it is a sad fact that some programs currently operating in Winnipeg are feeling oxygen-deprived. Two Ten on Maryland, in Winnipeg’s inner city, is a non-profit post-treatment program for recovering addicts run by a former meth addict, Ian Rabb. He has been requesting more support from the provincial government for years, claiming that additional funding is required to provide round-the-clock supervision of clients and improve safety.

Manitoba spends $22 million a year on addiction services. Not surprisingly, belt-tightening is going on throughout government – the province faces a projected $592-million deficit this year – but officials claim this hasn’t prevented the funding of vital programs.

In a recent Winnipeg Free Press article [1] Rabb accuses the government of foot-dragging and insincerity when it claims that money is tight. In his view the programs offered at the facilities save the government money. Clients stay out of hospital and jail, and most of them eventually get off welfare.

By coincidence, in a letter to the editor on the same day a local representative of the Canadian Mental Health Association, Nicole Chammartin, pleads for improved harm-reduction programs for those with addictions, specifically mentioning methadone treatment. “We require a comprehensive and responsive addictions system that serves everyone,” concludes Chammartin.

Existing research provides some evidence for the value of harm-reduction programs for addicts. A Lancet study published last October found that psychosocial interventions used in England are associated with reduced use of heroin and crack cocaine [2]. Outreach programs can lead to high levels of compliance, general improvement, and treatment satisfaction [3]. Feeling that treatment is appropriate, finding staff motivating, and having enough time to sort out problems are important aspects of satisfaction with treatment among users of drug treatment services who achieved positive treatment outcomes. Services should seek to provide more individualized services based on understanding of individual client needs. This may require longer treatment periods and greater client involvement [4].

However, it is difficult to demonstrate conclusively the effectiveness of programs and successful treatment outcomes. A recent Cochrane Review went so far as to say that “there is no good available research to guide the clinician about the outcomes or cost-effectiveness of inpatient or outpatient approaches to opioid detoxification” [5].

Although Manitoba’s left-of-centre NDP government makes the appropriate clucking noises when it comes to addiction problems, its record is not looking good. The Addiction Foundation of Manitoba’s Methadone Intervention & Needle Exchange Program (m.i.n.e.) [6] has shown itself to be effective, but insufficient funds are being directed at this serious problem. People with intractable addictions are waiting for help and inner-city programs are stalled, while money earned from government-run casinos is lavished on developing yet more affluent suburbs and on purchasing law-and-order fetishes like police helicopters to make suburbanites feel safer.

References

1. Owen B. Cuts at addictions centres? Director may trim services without new provincial funding. Winnipeg Free Press. 2010 Jan 23;Sect. A:8 (col. 3).

2. Marsden J, Eastwood B, Bradbury C, Dale-Perera A, Farrell M, Hammond P, Knight J, Randhawa K, Wright C; National Drug Treatment Monitoring System Outcomes Study Group. Effectiveness of community treatments for heroin and crack cocaine addiction in England: a prospective, in-treatment cohort study. Lancet. 2009 Oct 10;374(9697):1262-70. PubMed PMID: 19800681.

3. Henskens R, Garretsen H, Bongers I, Van Dijk A, Sturmans F. Effectiveness of an outreach treatment program for inner city crack abusers: compliance, outcome, and client satisfaction. Subst Use Misuse. 2008;43(10):1464-75. PubMed PMID: 18615321.

4. Morris ZS, Gannon M. Drug misuse treatment services in Scotland: predicting outcomes. Int J Qual Health Care. 2008 Aug;20(4):271-6. PubMed PMID: 18492708.

5. Day E, Ison J, Strang J. Inpatient versus other settings for detoxification for opioid dependence. Cochrane Database Syst Rev. 2005 Apr 18;(2):CD004580. PubMed PMID: 15846721.

6. Bodnarchuk J, Patton D, Broszeit B. Evaluation of the AFM’s Methadone Intervention & Needle Exchange Program (m.i.n.e.) [Internet]. Winnipeg: Addiction Foundation of Manitoba; 2005 July [cited 24 Jan 2010]. Available from: http://www.afm.mb.ca/pdf/MINE_report_final.pdf

Photo credit: cc licensed flickr photo by wysiwtf

Addiction and poverty of the spirit

In a consumer society there are inevitably two kinds of slaves: the prisoners of addiction and the prisoners of envy. ~ Ivan Illich, Tools for Conviviality (1973)

I am addicted to the twentieth century. ~ Martin Amis, Money (1984)

Two years ago the Conservative Canadian government launched a multi-million dollar National Anti-Drug Strategy, with its predictably punitive crackdown on illicit drugs, mandatory minimum sentences, hectoring propaganda, abstinence-based “treatment,” and police-heavy approach – in short, a classic drug-prohibition stance.

No one questions that drug addiction is a problem, but the Harper government’s dogmatic handling of this complex issue betrays its inability to get at the true roots of substance use and abuse. The resurgent puritanism in Ottawa angers Bruce Alexander, who has recently published a new book, The Globalisation of Addiction: A Study in Poverty of the Spirit (Oxford University Press).

Alexander, a psychologist and Professor Emeritus at Simon Fraser University, believes that addiction is not about sinners in need of salvation, but about the society they live in. “The conventional wisdom depicts addiction most fundamentally as an individual problem,” he writes. “Some individuals become addicted and others do not. An individual who becomes addicted must somehow be restored to normalcy.”

The government’s dogmatic thinking fails to recognize that a problem as terrifying as addiction has its roots in the kind of fragmentation that is inevitably produced by free-market economics. The solemn press conferences and media images of frowning officials in dark suits or uniforms simply repackage and reinforce the old idea that the reason we have people who aren’t behaving properly is drugs – that drugs have a magical quality of taking over human beings who would otherwise be normal smiling happy people shopping at Wal-Mart.

The Globalisation of Addiction presents a radical reappraisal of the nature of addiction, which science and sermons have failed to manage. There are no reliable methods to cure it, prevent it, or take the pain out of it. There is no durable consensus on what addiction is, what causes it, or what should be done about it. Meanwhile, it continues to increase around the world.

Addicts are people struggling to adapt to and deal with difficult psychological and social circumstances. Viewing addictions of all kinds as adaptive responses to dislocation seems odd at first, for we have been taught to view addiction superstitiously as some kind of malevolent entity taking over the soul. But understanding addiction not as “possession” but as an adaptation makes the phenomenon both more comprehensible and more familiar, and is ultimately a deeply sympathetic and humane perspective. It is also a hopeful one, offering a variety of options that can help addicted individuals find social integration and therefore happier lives.

Alexander argues that the failure to control addiction can be traced back to the conventional wisdom of the 19th and 20th centuries which focused too single-mindedly on the afflicted addict. Although addiction obviously manifests itself in individual cases, its prevalence differs dramatically among societies. For example, it can be quite rare in a society for centuries, and then become common when a traditional culture is destroyed or a highly developed civilization collapses. When addiction becomes commonplace in a society, people become enslaved not only to alcohol and drugs, but to a thousand other destructive pursuits: money, power, dysfunctional relationships, gambling, or computer games.

A social perspective on addiction does not deny individual differences in vulnerability to addiction, but it removes them from the foreground of attention, because social determinants are the more influential factor. This book shows that the social circumstances that spread addiction in a conquered people or a declining civilization are also built into today’s globalizing free-market society. Capitalism is magnificently productive, but it subjects people to irresistible pressures towards individualism and competition, tearing rich and poor alike from the close social and spiritual ties that normally constitute human life. Alexander calls this a “worldwide rendering of the social fabric.” People adapt to their alienation or dislocation by finding the best substitutes for a sustaining social and spiritual life that they can, and addiction serves this function all too well.

The most effective response to a growing addiction problem is a social and political one, rather than an individual one. Because addiction is an individual and social response to “dislocation” – especially severe social, economic, and cultural dislocation – the solution is “psychosocial integration.”

“People can endure dislocation for a time. However, severe, prolonged dislocation eventually leads to unbearable despair, shame, emotional anguish, boredom and bewilderment. It regularly precipitates suicide and less direct forms of self-destruction. This is why forced dislocation, in the form of ostracism, excommunication, exile, and solitary confinement, has been a dreaded punishment from ancient times until the present.”
“Material poverty frequently accompanies dislocation, but they are definitely not the same thing. Although material poverty can crush the spirit of isolated individuals and families, it can be borne with dignity by people who face it together as an integrated society. On the other hand, people who have lost their psychosocial integration are demoralized and degraded even if they are not materially poor. Neither food, nor shelter, nor the attainment of wealth can restore them to well-being. Only psychosocial integration itself can do that. In contrast to material poverty, dislocation could be called ‘poverty of the spirit’.”

Overcoming poverty of the spirit through such integration would not put physicians, psychologists, social workers, policemen, and priests out of work, but it would incorporate their practices in a larger social project to reshape society with enough force and imagination to enable people to find social connectedness and meaning in everyday life. Then great numbers of them would not need to fill their inner void with addictions.

So far, governments have chosen to ignore Alexander’s analysis, which was first introduced in his much-read 2001 paper The roots of addiction in free market society. Not surprising in a nation that is rapidly moving to the right and busy squandering its treasury on unwise stimulus spending and war-making.

References

Alexander BK. The globalisation of addiction: a study in poverty of the spirit. Oxford University Press; 2008. ISBN 978-0-19-923012-9.

Alexander BK. The roots of addiction in free market society. Ottawa: Canadian Centre for Policy Alternatives; 2001. Available from: http://www.cfdp.ca/roots.pdf

Levine HG. Review of “The globalisation of addiction: a study in the poverty of the spirit” by Bruce K. Alexander. Harm Reduct J. 2009; 6: 12. Published online 2009 June 23. doi: 10.1186/1477-7517-6-12. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2717062/



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