Do you believe that if someone quits using heroin or other opioids, but still uses other substances recreationally will inevitably return to heroin use?
Is offering help to people while they are using and are not ready to stop a waste of time and resources?
Do You Believe that People who Have a Severe Opiate Use Disorder Must Remain Abstinent from All Drugs in Order to Recover?
I've attended many recovery support groups in our communities. Most of these groups require a "desire to stop" using all substances and be completely abstinent to recover.
Treatment facilities for substance abuse and community corrections (probation, parole) expect the same, complete abstinence from all substances. The generalized consensus is that if someone only quits using heroin, but continues to use other substances recreationally, it's inevitable that they will most likely return to heroin or develop an addiction to whatever substance they are using. According to eye-witnesses this appears to be the case.
Some Arguments Against:
This is the result of the phenomenon of self-fulfilling prophecy.
"A self-fulfilling prophecy is a prediction that causes itself to be true due to the behavior (including the act of predicting it) of the believer. Self-fulling, here, means “brought about as a result of being foretold or talked about,” while prophecy refers to the prediction."
If a person in recovery has a slip, this is not a relapse.
Personally, I have spoken to many recovering individuals over the years. Most, minus a handful, have a history of relapse. Many say that they relapsed on heroin because they felt that because they had a drink socially or smoked a joint after a period of abstinence they are no longer recovering. This may cause overwhelming feelings of shame and guilt. Therefore, they had stopped attending their particular recovery support group because they no longer feel like they belong. The most common statement that I've heard these individuals say is "F-it. I already relapsed, so might as well..." Then the cycle repeats itself.
Here is where the misconception of what constitutes a "relapse" occurs. If a person is diagnosed with any chronic condition, there is always a chance for relapse, hence "chronic." So if the addicted individual uses their substance of choice after a period of abstinence, they haven't relapsed. The terminology is important here. This is a "lapse." If that person continues to repeatedly lapse, this is called a "re-lapse." Meaning that the chaotic symptoms that constitute what is considered to be an addiction have returned. But that is not the case when a lapse happens.
Sporadic lapses do not cause the same damage to ones life that occurs when there is loss of control due to habitual use. The only real damage that a lapse causes, given there were no immediate consequences as a result of the lapse, is solely the loss of the accumulated time of consecutive days abstinent. Outside of high risk for overdose for people who are addicted to opiates, a person who is held to the expectation of complete abstinence where time "clean & sober" from all mood and mind altering substances is considered to be the end-all-be-all determining factor of what successful recovery is, carries with it an increased potential to give up on oneself and give in to their addiction, until it becomes debilitating, or in the worst scenario, they die.
Each drug has been converted to its own diagnosis
According to the most recent 5th edition of the DSM, the diagnostic and statistical manual written by the American Psychiatric Association (APA), that is used by medical professionals and therapist to diagnose mental health conditions, a diagnosis of "Polysubstance Abuse/Dependence" has been removed. Each substance has been changed to an independent diagnosis, with levels of severity (mild, moderate, severe), sans "abuse/dependence." This supports the fact that just because someone has a problem with one substance does not mean that this applies to every drug that a person with a severe opiate use disorder uses or has used.
Each drug influences different receptors in the brain in different ways. Thus, treating every addiction to any drug exactly the same way is a disservice. The target receptors release neurotransmitters that change a persons' mood and perception from a negative one to a more positive one at the moment. This serves a purpose to the addicted individual who is having difficulties coping with particular emotions that are activated based on past and present life circumstances. Concluding that addiction is not based specifically on the drug consumed, otherwise everyone who would try a particular drug would become addicted to it. This is not the case at all. Different drugs provide different benefits to different people. Plus, drugs are not the only form of addiction. Anything can be an addiction; gambling, sex, food, shopping, etc. creating similar destruction in the addicted person's life based on preset symptoms qualifying the diagnosis.
Do We Let People Relapse and Continue to Use Heroin or Other Opioids at Their Own Risk, Without Offering Help and Proven Safety Measures Even While They are Actively Using.
I have heard some people who attend abstinence based community support groups for the addicted say: "Some have to die so that others can live." Everyone seems to have the answer about how to recover. Most are based on personal opinion and experience. If the personal opinion and experience of a tiny percentage of people who have recovered their way would be the solution for everyone, then we would not be seeing such a catastrophe in our society. Anyone who has ever been to a drug rehab has been showed the same ways to recover from addiction. So why is there such a low success rate? Because it takes a lot of work and resources to create a treatment and recovery program uniquely for each individual. So we get angry and give up on them. Then they die.
Any addiction is a progression. It is rare that a person who develops an addiction does so after using just one time. The rate of progression is different for each person. So why is it assumed that after years of progression, one can just stop and never go back to using again as long as they shown just one way? Heroin and opiate addiction carries the highest risk of overdose fatality if one undergoes detoxification or incarceration. One lapse can end a life.
Recently, there has been a backlash of advocacy and interventions based on harm reduction to educate people on reversing an overdose and safe use of heroin. Even though these methods have saved some lives, and even one life saved is worth all the money in the world, the overall rates of overdose are still increasing.
Parts of Europe, Canada, and Australia have implemented supervised injection facilities, and this has shown the most significant results in saving lives. Most people who have addictions to heroin, really do want to stop. But it can be difficult for them to either stop or stay stopped indefinitely. The main reason why these facilities have such a high success rate for people who use them, is because the user is never alone when injecting heroin. There is always someone there to keep an eye on them, and intervene as required. These facilities are not legal in the United States, but serious efforts are being made to change that. In the meantime, people are still dying at extremely high rates.
In the U.S. the major influence to keep these facilities illegal is a political one. This stems from the war on drugs, and how the media and politicians portray people who use illegal drugs, especially heroin. You cannot wage war on a substance. So instead the war is waged on people who use the substance. They are labeled, stigmatized, and shunned by society. But I have seen the potential that people who are addicted to heroin have to be productive and successful members of society. They all have people who care about them. So just because you have not been affected by the opioid crises, does not mean that you should buy into what you have been programmed to believe by the powers that be. Because, I guarantee that if you lose someone close to an overdose, your opinion will quickly change.