There is a trend towards conservatism which is manifest in a whole varicty of areas. In fact, I just saw the cover story in Newsweek Magazine this week. It addresses this issue. And 1 see it very clearly affecting the drug field.
That there is decreasing sympathy for treat- ment and there is again much more of a move towards a conservative approach. If you take just the one area of marijuana decriminalization, which is in many ways an issue that seemed to be moving rather irrevocably in one direction, I think that there has been a significant stalling in the enthusiasm for decriminalization that is a direct reflection of sentiment that is spreading through the country which opposes a whole series of more progressive moves and activities.
It is what he regards as a generous alter- native to decriminalization. When I see somebody like Congressman Wolff making that kind of move, it makes me really worry what some of the other people are thinking about. And I think we also face the chronic problem of public relations and credibility of treatment programs, that we still have people attacking methadone maintenan-ce in a rather vicious way. Heroin Now, I said earlier, speaking specifically about heroin, that to some extent 1 see things have gotten better.
The real question is: is this just a treatment phenomenon or are we going to be seeing very rapidly a regression to the situation that we had before? I think we went through a period a few years ago-talking about the light at the end of the tunnel, seeing the end to the heroin problem. The Burmese for the first time have launched a major program t o interdict trafficking in their country which they had not done previously.
The Thai Government which was in existence until recently had been very, very aggressive in trying to deal with major traffickers in Thailand. I was discouraged to see in the Economist Magazine that it attributed one of the reasons for the overthrow of Prime Minister Tannin t o his vigorous effort to go after major narcotic traffickers, many of whom were very influential and powerful people in Thailand.
Barbituates 1 want to say briefly something about somc of the other areas and maybe talk about some other things that I think perhaps may be a little more positive. We have for a long time talked about the problems with prescribed drugs and particularly with the barbiturates. Next to heroin, the second largest killer of people by drugs in the country is barbiturates.
Interestingly, as you may know, this is some- thing that we focused on and had substantial publicity from in the last nine months. Beginning in March there has been a steady month by month decline in people coming to emergency rooms all over the country with problems relating to barbi- turates, which to me is a rather interesting impact from just the educational pro- cess, the publicity, the adverse attention that has been focused on the physicians overprescribing these drugs.
We are progressing with an interagency group to look at a whole series of more stringent measures that might be taken to reduce the availability of short-acting barbiturates.
One of the things that is becoming clearly a matter of considerable alarm to us i s the steady increase in the use of P C P all over the country. Its one of these things that is extraordinarily hard to evaluate at the present time in terms of the long-range implications. I think one of the things to me that is more disturbing than the admittedly rather serious problem with that drug, itself, is that it is a drug that has only a veterinary use, has no legitimate medical use, is easily made and is being manu- fact ured in very large, illicit quantities by unlicensed chemists.
One of the things particularly of concern to me is that P C P manufacture sets a precedent for a whole range of other substances that could potentially be made just as easily and that have at least as much lethal potential. I mean its reinforcing nature would seem to be rather minimal, yet its attraction to many people is substantial. And it makes me wonder, then, if there are other destructive drugs that could be made as easily and could be made as widely-available.
If so, we face a very, very serious problem. In terms of policy decision, we have moved to get acceptance of the possible medicinal-medical benefits of heroin and marijuana. Whether or not heroin has the merits that people in Britain claim for the treatment of terminal cancer or other conditions, I think that one of the things that we have been able to d o is to say that it should be judged totally on its merits like any other drug substance. And I think that both with heroin and whatever potential positive pharmacological effects marijuana might have, we have reached a position in the federal government now of having a federal policy of evaluating those drugs purely on their merits, on a scientific basis, and then letting the chips fall where they may.
Let it be that way. But if it is, and does have merit, then I think we have reached a point where it can be accepted as a legitimate drug.
One of the things I feel as we look at where drug abuse is going in the country and where I think the field should go, and something that we have slowly been trying to educate the general public on is to broaden the issue of addiction to its broadest kind of public health concern, and to move conceptually to incorporate alcohol and tobacco in a much more aggressive way. I feel that obviously the inter- relationship between all of the addictions and dependencies are so great that- particularly for people in the scientific field t o make a distinction between these drugs, again because of historical precedents, makes very little difference.
Our commitment as physicians t o the field of abuse has to d o with the damage that these substances d o to people and our attempt to understand the process and the problems that these cause people and to alleviate the suffering that results.
Therefore, we should not restrict ourselves only to the segment of those drugs that cause the least problems, as we traditionally have done. So I hope that we will have a broadening of the field, to consider tobacco and alcohol, too. And I know there is a great deal of talent in the drug field that could be applied with great benefit t o alcoholism and to tobacco abuse.
And I hope the increases will be a fairly substantial increase. In addition, we asked Secretary Califano HEW t o look at the possibility of incorporating the intramural research programs of NIAAA and NIDA into a single research institute-that is: the program at Lexington and the NIAAA intramural program-and to consider establishing an institute for research, whether it be an alcohol and drug research institute or a substance abuse research institute, probably on the NIH campus.
In other words, abstinence is the direction toward which the Escalator guides people but abstinence is not an automatic requirement to work within the Escalator, especially early in the process.
Nevertheless, the Escalator is also not a method that promises help with or promotes controlled use, because as stated earlier, many people will find out that in their case, controlled use may just not be an option for them. Therefore if the only thing that someone is willing to do is reduce their use for now, then it is better to sta rt from there than do nothing at all.
For some people, attempting controlled use is a life and death issue. For example, it would not be advisable for someone who has a history of serious suicide attempts when they are drunk to attempt controlled drinking. Nor would it be advisable for a www. Risk of harm must always be factored into this equation.
In summary, abstinence should always be considered for its simplicity and basic effectiveness. However, a commitment to abstinence is not a requirement for all to engage in the upward change process.
Abstinence is often the ultimate goal, however people, often guided by their level of motivation and insight, often take many different paths toward that goal. Sometimes it is important to remember that the journey is often not as important as the destination. Therefore, it is important not to exclude or discourage abstinence as a part of the goal because for many individuals abstinence is the only viable outcome for them.
However, for the purpose of including the many more people who are involved with overcoming substance use issues who are not yet ready to accept abstinence as their goal then the goal of this process needs to be of a broader scope. In fact, individuals who attempt this process of trying to deal with substance use issues effectively can still make progress regardless of the eventual outcome.
In other words, even if someone never stops using substances abstinence there still can be a measurable level of progress. Consider an example — The Builder- Suppose someone needs to build a house but lacks the skills to do so. In this example, the person spends weeks working on the house and it is a great struggle. The person does the best that they can to buy the tools to build the house and then try to use these tools for the actual construction of the house.
Now suppose, in this example, that after a few weeks the house is built so clumsily that it does not pass inspection and cannot be lived in. The person who tried to build the house then gives up. Was this situation a total failure? Consider the fact that the person who worked on the house now still has some of the tools that they bought. This person also got to practice some of the skills involved in construction as well as learning to use the tools.
The next time this person gets motivated to build a house again do you think that they are in better shape for the next attempt? Of course, this person is better prepared as they can learn from past mistakes and use experience from the first attempt for the future.
This example has a direct parallel when it comes to substance use issues. Therefore even when someone does not achieve the ideal outcome sobriety any attempt at upward change is still valuable and often brings with it a degree of progress. There is something to be gained each time anyone attempts the process of upward change.
There can be success without sobriety if we look beyond perfection as the way we measure success. Even when some of the most resistant, hard-headed, and argumentative individuals end up getting help for substance use issues, which is usually against th eir will which makes matters even more challenging , the goal of those trying to help these individuals is to somehow instill even a small www.
The hope is that there can be a little inspiration to look at things differently increasing insight and also some inspiration to consider changing and working on these issues motivation. Even if inspiration is short lived, those inspired moments we might have can bring us closer toward self-improvement.
Even small, intermittent bursts of inspiration can have a cumulative effect and can even strengthen over time.
For example, when considering going on a diet, think about how many times a person may experience little bursts of inspiration until finally one day they stick with the diet and actually start losing weight. In fact, going forward in the Escalator, inspiration will be linked with readiness to take action. If inspiration is the fuel that moves us forward, then progress is the mileage we accumulate along the road we travel on.
The farther down the road we go, the closer we get to our destination and goal. Even if we go backward after a period of progress, the next time we travel that road moving forward we know the way a little better. Every time we try to move forward we gain some experience and therefore make progress regardless of whether or not we reach our destination.
All movements made in a positive direction are critical aspects of the upward change process. Inspired Progress by definition consists of the two factors we just discussed: inspiration and progress. Any attempt that someone makes toward getting better from a substance use issue in which there is a degree of inspiration and at least some change in a positive direction can be considered as a positive and valuable experience.
Obviously, the greater the degree that an individual is able to sustain inspiration and demonstrate actual progress and upward change then the more successful the experience has become. Nevertheless, regardless of how an attempt in the upward change process ends, if there were periods where both inspiration and progress were present there was a degree of success that is useful and valuable. The best case scenario when it comes to achieving the goal of the Escalator is a degree of sustained inspired progress.
When someone ends up staying inspired long enough to maintain the changes, improvement and progress that they made in the upward change process that is the most desirable outcome. In many cases, that outcome may involve sobriety which is a wonderful thing. However, often there are setbacks on the road toward inspired progress where someone may actually takes steps backward or lose progress or lose motivation and insight and thereby temporarily lose their inspiration.
The Escalator, takes this into account and is therefore designed for repeated use for as many times as needed until our goals are achieved. The Escalator itself is designed so that eve n when activities or stages are repeated there is always something new to learn about ourselves and there are always different ways we can learn to develop and sustain motivation and improved coping abilities.
Redefining the Method www. It would be difficult for anyone to dispute the extensive history of the 12 Steps as effective path to self-improvement and self-help. As explained earlier, the Escalator is an alternative to the 12 Steps and for some the Escalator can even be a supplement to the 12 Steps. This book is not designed to put down or disparage any 12 Step programs like Alcoholics Anonymous or Narcotics Anonymous or anything at all involved with those programs or concepts.
When looking at both research as well as the millions of personal testimonials from people all over the world, 12 Step programs have been a lifeline for countless people struggling with substance use and addiction for decades.
Many people will continue to benefit from the wisdom of the 12 Steps and the 12 Step philosophy. People who are currently benefitting from 12 Step programs and 12 Step philosophy may not need this book unless they are looking for something additional to supplement their recovery.
From early on in my career, I found myself having a soft spot and curiosity toward those troubled individuals who just did not benefit from the 12 Steps no matter hard they may have tried. When I started in this field most substance use programs were still 12 Step based.
I found myself growing in my concern for those individuals who disagreed with or had difficulty grasping the 12 Steps and other similar or related concepts. In actuality, recovery is a lot easier for those who can accept that they are powerless over their addiction Step 1 then believe in and turn over their will to a Higher Power Steps 2 and 3.
The 12 Steps have been a successful great formula for those people who are able to buy into the process. If followed wholeheartedly, success in recovery is not far off. That is a question that tickled my mind like a pebble in my shoe. Should those people who cannot get past step one be doomed to failure? As my career and education in the field of substance use progressed I noticed another trend that increasingly caught my attention.
Not only was I developing an increased empathy for those who were not getting the full benefit of the 12 Steps but I was also noticing an increase in the number of young people entering programs who had difficulty with 12 Step recovery.
It was really eye opening for me when I expanded my work with adolescents and young people. Over the years I saw that this younger group had progressively become more and more resistant to 12 Step groups and philosophy. The 12 Steps and 12 Step based programs continued to have good outcomes, however those who refused to embrace the 12 Steps in treatment were often left on the outside looking in.
Often there was a choice to be made for those who did not fit in to 12 Step recovery. In many areas the legal system got wind of the success that 12 Step programs were having and therefore many judges, probation officers, parole officers, etc.
For the legal system www. Still, the same issue comes up for those who fail to adopt the 12 Step methodology. Along the same lines of reasoning as the legal system, many insurance companies and other funding sources that pay for substance use treatment began viewing 12 Step programs as a mandatory part of the recovery process.
Once again, the reason is that 12 Step involvement improves outcomes is because those who become engaged in 12 Step groups like Alcoholics Anonymous or N arcotics Anonymous have a statistically better chance of staying sober. Better outcomes means having to pay out less for treatment and 12 Step meetings are free.
On the surface it makes fiscal sense for those who fund treatment such as insurance companies and government grant agencies to require 12 Step involvement as a way to cut costs and improve outcomes. Still, once again, what about those individuals who do not experience a benefit from 12 Step meetings?
Is it fair to cut off payment for treatment just because someone does not respond to the most highly recommended and accepted form of treatment? Consider another example: If there was a fatal disease that had an available course of treatment that could cure two thirds of those inflicted with the disease, would it be fair to cast off the other third who did not respond to the accepted treatment as hopeless?
In reality, if that were the case, someone else would be hard at work looking for another course of treatment for the one third of people who do not respond to the most widely accepted method. What if the number of people who failed to respond to the accepted treatment was growing? That would be even more reason for someone to develop alternative treatments for the disease.
For all of the success that the 12 Steps have had there are still a huge number of individuals who have not responded. Other methods are very much needed for this population. Since then, other non Step methods and techniques have been in use by treatment providers. Some of these methods have been effective, while some others have never really caught on.
I have been trained in a variety of techniques that over the years and I found myself, like most counselors, breaking down and combining in order to utilize an array of the best principles, skills, techniques and ideas from various methods for the variety of situations and problems faced by people I was trying to help. Nevertheless, I and many of the colleagues I have worked closely with have seen a need for an inclusive, comprehensive design specifically created for the changing needs of problem substance users in the modern world.
The Escalator therefore was born from a desire to provide an alternative but reasonable, sensible, yet comprehensive and effective option for those with substance use issues who fall into one or more of the following categories. The Escalator promotes abstinence as the ideal way to stay out of trouble and then make progress and positive change but at the same time this method acknowledges that people have different paths toward their goals that are not all abstinence based.
The same holds true for those with legitimate pain management issues who may be on medication considered questionable by others in recovery. Keep in mind; this is not meant to say anything against group therapy. Nor are we saying that the Escalator should not be used in groups. To the contrary, groups when functioning like they are supposed to, are the most effective modality for substance use treatment for the vast majority of people — However, those individuals who do not feel comfortable with groups should not be left out by a method that caters only to groups.
The Escalator is designed to be interchangeable and adaptable for both groups and for those who are more comfortable staying out of groups by working individually. There still are ways to pro-actively address these issues www. Rather than letting the steps www. The Escalator consists of the following areas of focus: 1. The Escalator allows each individual to determine their own starting point based on the unique circumstances that brought about a need for change.
Once an accurate starting point us determined, each individual can choose to move to different areas within the matrix as needed based on their individualized needs with ongoing consideration to variable motivation and insight levels which can change with time and circumstances.
The Escalator is designed to help people to look within themselves for inspiration, hope and change while using others for guidance and support. The Escalator emphasizes quality over quantity when it comes to levels of inspired progress. Although, experience is commendable and highly useful, someone does not automatically merit more consideration as being an expert based only on clean time. As touched upon earlier, the Escalator focuses more on the real than the ideal.
This system is open to honestly accepting things as they are without pigeonholing people to strive toward ideals that they are not yet ready to believe in. The Escalator is a highly effective alternative for the growing number of people out there who are using or abusing substances and who are in a position where they need to or must get help, whether that help is wanted or not.
The Escalator is for the more modern substance user who tends to have more complex issues, and different viewpoints and attitudes than in years past.
The Escalator is person-centered as it starts and ends with each person as a unique entity with a particular set of beliefs, attitudes, values, desires, circumstances, goals and experiences. The Escalator takes into account changes in technology and developmen ts with regard to how we communicate and obtain information.
If you are having trouble with the steps, try taking the escalator www. Addiction Recovery By Yasmin Meneses.
0コメント