It was sacrilege, utter heresy. In the Inquisition I’d have started the fire and felt justified tossing him into it. We all knew what worked and what didn’t, yet here he was espousing another way, as if truth was negotiable.
I’d known Chris for years. He was a solid citizen, well respected in his profession, the kind of guy you could really count on. But he had obviously gone over to the dark side. Even more stunning, he was at my workplace to talk about it. Did the man have no shame?
His presentation was optional. I could have gone about my day without sullying my reputation by association, yet I was morbidly intrigued to discover what could have possibly caused the downfall of such a reasonable person. Heck, his name was on the bottom of the certificate hanging on my office wall, attesting to his professional expertise and experience. So I changed my schedule and went to hear him speak. I’d left the matches at home, but I was sure there was going to be fire.
And there was. It was scorching, relentlessly consuming, burning away my resistance one assumption at a time. An uneasy awareness began to settle in. Memories of all the people to whom I could have offered another way flooded my mind. It had been convenient, smug almost, to view treatment failures as evidence of being unready for recovery, that one had not “hit bottom” yet. Recovery groups had worked for me, for friends and numerous clients, but admittedly they had not worked for everyone. Here was Chris offering another option, and for the first time in my life I listened without bias to a harm-reduction approach to sobriety.
Over the following months and years I became more interested in Medication Assisted Treatment (MAT). It paralleled my growing understanding of addiction as a chronic disease. Some people can manage symptoms through lifestyle changes alone, while others need medications to achieve the same goal. It was not my place to insist that someone get sober the same way that I did, or to view them as still active addicts if they elected to use medication. To be of service to others, I had to recognize that there are many paths to recovery, not just one.
Some of the medications used to treat addiction create physical dependence, which seemed absurd when I first discovered this. Why just switch one drug for another? It was like changing deck chairs on the Titanic. If the medication was suddenly stopped, a patient would go into withdrawal just like it was heroin. That’s the downside of such medications, and I’ve never tried to sugarcoat it. People who elect MAT typically don’t choose it as their first option. They’ve typically tried total abstinence repeatedly, have gone through multiple treatment programs, and yet keep losing more and more. By the time they’re ready to consider MAT, the choice isn’t between total abstinence or medication; it’s between medication or death. To insist that someone be able to achieve recovery without medication or die trying is perhaps one of the cruelest travesties we inflict in the name of caring for someone.
I eventually became director of two MAT programs in the Midwest, seeing first-hand the successes afforded by that modality. Done correctly, it was a lifesaver. When prescribed by a knowledgeable physician, titrated to a therapeutic dose (enough to avoid withdrawal symptoms but not enough to get high), monitored by random drug screens and call-backs for medication counts, and accompanied by counseling to develop healthy coping skills, the benefits can be fast and remarkable. With brain chemistry stabilized by medication, a person can actually engage in the hard work of recovery.
I’ve undergone a paradigm shift. For many years I was critical of those who didn’t embrace my understanding of addiction and recovery. Now I see multiple paths where I had seen but one before.
Chris didn’t go to the dark side. He illuminated it.
• Michael Craig Smith has worked in the behavioral health field for 33 years. He currently works at JAMHI, where he anticipates they will be using Medication Assisted Treatment in more depth and frequency. Smith is not representative of JAMHI, and the views expressed here are his own.
