I was sitting, waiting in the parking lot at a methadone clinic this weekend. Watching the traffic come and go gave me hope and caused me concern, at the same time. The hope came from seeing so many people receiving care that is keeping them alive. The concern came from seeing so many people receiving care that is keeping them alive.
Most of them looked young, some with babies in tow. By some people’s demeanor, it looked like the treatment was uplifting their lives. For others, not so much. I even saw one couple I know whose family is greatly concerned about their choices with continued substance use and with parenting, even as this couple accesses methadone regularly.
The person I was waiting for came out finally. I’ve been a support for this young man for almost 12 years now — since he was, as I like to remind him, a little teenage punk-a$$ bitch. Please pardon the vulgarity, but that’s how the most hardcore of us talk to each other. I’ve also told him repeatedly that underneath all that baggage is an angel worth saving.
His mom asked me to take him to the clinic because she’s been doing it daily for almost a year now and had to be elsewhere last weekend. I waited for him to smoke a borrowed cigarette before we drove home, and he told me he’s scared. He’s scared because he doesn’t want to be on methadone for the rest of his life, but he also knows that he’s too messed up to go through life without some kind of support for his brain chemistry.
I know what he means. His childhood trauma history is so severe that the idea of living with those memories and developmental effects without drugs is terrifying. I understand because I share that sensibility and background. Fortunately I had access to treatment modalities like cognitive behavioral therapy to help me learn to manage my symptoms; and through a long and too convoluted a process to explain here, I was able to find a medical marijuana/marijuana product regimen that worked for my particular brain chemistry issues.
The right regimen also keeps me from wanting to return to my extensive problematic poly-substance abuse habits of adolescence and young adulthood.
But back to my friend’s fears. He’s also scared that he’s about to lose his MaineCare and will not be able to afford methadone treatment. While methadone has reduced his risk taking regarding opiates — which for him, is a huge deal — he doesn’t feel like he’s made much progress beyond that.
And he’s scared that if he loses MaineCare and can’t afford methadone, the resulting detoxification period may be worse than coming off heroin — or so he’s heard from other people who are on as high a dose as he is. He’s on a high dose because he’s been abusing hard drugs (prescription and otherwise) and alcohol since elementary school, which was nearly two decades ago. His mental health diagnoses include severe anxiety that has been treated in the past with a benzodiazepine, which is a drug he also has abused.
He’s scared because outpatient Suboxone treatment was an epic fail for him, but he doesn’t want to be messed up any more. His mom has been facing cancer and other health crises in the last couple years, and he wants to be there for her, for once. She’s never given up on him.
He is that extreme substance use case — someone who regularly uses a variety of substances, including opiates, on a daily basis. He’s someone all too familiar with the criminal justice system, the mental health system and the streets. Quite literally, his substance abuse life is the only one he knows — the only one that keeps his demons at bay.
And I promise you, if you met his demons, you’d want to keep them at bay, too. Like the vulgarity I used earlier may be a little harsh for some ears, the stories that turned us into such vulgar creatures aren’t appropriate for public airing. They’re the kind of stories that are traumatizing to hear as adults secondhand, let alone to experience directly as a child.
And I promise you, if you knew him the way I do as a fellow childhood trauma survivor, you’d see an angel underneath the mess, too.
When I started blogging, I was so honored to be able to write about substance use disorders and mental health issues. As someone in recovery, I consider it part of my recovery to give voice to any of the marginalized populations to which I belong.
The last year has been an exciting and fulfilling time to write about these subjects because more and more people have experience with these issues, and/or more and more people are concerned and want to be part of the solution. The One Life event that happened in Bangor at the beginning of the month is a great example of people coming together to try to effect change and save lives. The list of ideas generated is well worth perusing.
But as more and more attention has been given to the issue of substance use disorders, I started to feel like the larger conversation happening around me got hijacked and pushed in a direction that made me, as a person in recovery for over two decades now, uncomfortable. It narrowed too much for me.
The narrowing made me want to ask questions. What about when Suboxone and methadone fail or aren’t desirable to someone in need of brain chemistry support? What about when the substance use started with medications that are used for mental health and physical health treatment and more medications just feel like a continuation of a previous pattern to a given client?
Does supporting medication-assisted treatment preclude supporting other pathways to recovery and other ways of supporting long term recovery? What about the current prescribing practices for Suboxone and all the resulting diversion? What about the fact that even the Substance Abuse and Mental Health Services Administration acknowledges that recovery can happen via many pathways?
Why aren’t we having well-rounded discussions about all of them?
And, what about the most broken of us? Like me and the young man sitting next to me in the car this weekend? For some of us, recovery isn’t about getting un-broken or normal — and that shouldn’t be an expectation for countless reasons, including the fact that there is no such thing as “normal.”
For some of us, recovery is about learning to be okay with being broken and learning to find ways to make our brokenness beautiful and purposeful.
As I tried to explain to one of my clinicians once, if his goal for my treatment is to get me to be more like him, that wasn’t going to happen. No matter how stable and functional and content and happy I am — and I have achieved those benchmarks in my life — I’m never not going to be the girl who learned how to fight by trying to hurt a much larger person than myself to get him off my body because I was sick of whatever that was that he kept wanting to do to me.
And that’s okay.
I’m hoping discussions about substance use disorders, mental health and recovery start to get broader as they move forward. Too narrow a focus is a disservice to the most damaged of us and to the concept of recovery itself. The concept is almost 200 years old in terms of mental health and almost 100 years old in terms of substance use recoveries. Google it; it’s good to know.
To understand recovery is to understand that it is a person-driven process, not necessarily a clinically-driven process. Recovery was born from the idea that doctors and their treatments are not always and have never been the sole catalyst or impetus for recovery for everyone needing to recover from something. My impetus was something of a health crisis that I interpreted in a spiritual way; and I clung to that spiritual interpretation for motivation during the violent sickness in the weeks that followed. I continued to cling to it as I sought help for my underlying issues, but that was my personal pathway.
Doctors and traditional pharmacological interventions can be a very valuable tool for some and should be available in safe ways to people who want access them. However, as my friend and I know, the conversation shouldn’t stop there. The recovery story is far more complex than a one-size-fits-all solution, one kind-of-happy-ending story. If that weren’t true, the recovery movement wouldn’t exist in the first place.