Originally appeared on Civilized.
Authored by: Calvin Hughes
Addiction treatments are too often not treatments at all—they’re punishments. Jail time, shaming and refusal of medical support are all common issues people suffering from substance abuse face. Addictions are dealt with by the criminal justice system, not the healthcare system. But addictions are first and foremost a health crisis, says Joe Schrank, and people should not be put behind bars for it.
“I don’t know why addiction is the health crisis that needs punishment,” Schrank – Founder of the alternative rehabilitation center Remedy Recover based in San Fransisco – told Civilized.
“We don’t say to people who are obese and had a heart attack, ‘Well, you did it to yourself, you should just pray.’ We help them reduce the obesity. We give them heart surgeries.”
Tell me a little bit about what are you doing as far as the drug rehab rehabilitation programs.
The opiate public health crisis in America is not like anything that’s ever been seen before, and the solution is not going to be anything that’s ever been seen before. Yelling at people and telling them to go to AA is not going to have enough of a result for it to be any meaningful or measurable change in that particular issue. At Remedy Recovery our intention is to utilize medication effectively. FDA approved medications, in the direction of a medical doctor and in collaboration with other disciplines. Cognitive therapy is important, community engagement is important.
I think one of the big differentiators is that we’re not asking people to be totally abstinent which is antithetical to what we’ve always been told—that the only solution to a drug problem is cessation of all drug use. It’s certainly not true for all people. And I think the big issue people have with us is that one of the medications we use is cannabis.
People use substances for a reason: trauma, depression, anxiety. We believe harm reduction is valid. Harm reduction was what ultimately got America on a better road with the HIV crisis. Lots of people say, ‘Oh, abstinence from sex is the solution.’ Maybe, but that’s not realistic. Abstinence from drugs is probably not realistic either. One of my things that people love is that ‘cannabis is the condom of the opiate crisis.’ If people switched from alcohol to cannabis use for recreation we’d have a lot fewer problems. We’d have less ER admissions, we’d have less violence between partners, less sexual assault.
For people who are opiate dependent there’s a bunch of different ways that cannabis can be used. One is they can circumvent opiates entirely—which is one of the things that we’re encouraging people to consider. If you’re in pain can you manage pain with cannabis? Whether it’s an edible, a vape, whatever it is—talk to your doctor. Let’s not even open the opiate can of worms. The other way is reducing the amount of the opiates that they’re taking so that they never rise to a point of being in danger of harming themselves.
And then the other way—and that’s kind of where we come in—is replacement. Let’s get rid of the opiates, let’s get rid of alcohol, let’s get rid of the benzodiazepines, Valium, the Xanax. Let’s get rid of all of those things that have a high risk of abuse and the stakes are very high when those medications are misused. The stakes for cannabis if misused are incredibly low.
How do patients feel about it when you talk to them about swapping drugs, or weaning off of their other dependencies and trading that for weed?
Most people who are dependent on something are very afraid of the detox. That’s one of the things that keep people from starting any kind of process of change. So a lot of the people that we see, a lot of people that call for inquiry are either greatly relieved for one, or they’re in disbelief.
It’s such a new idea and it’s so paradoxical to think of cannabis as an exit drug, not as a gateway drug. The challenge is for the secondary system of families, spouses, parents—‘But isn’t that going to lead them to heroin?’ Maybe, probably not. Has abstinence led them to heroin? Maybe. Maybe this sort of program of austerity has been the thing where they reach a breaking point and go back to using the thing that they were addicted to in the first place. We don’t empirically know. One of the problems we’re trying to change is marginalizing people with addictive behaviors. Not putting them in prison, stop yelling at them, fund research.
A lot of the people that we have seen have tried multiple times with the traditional 12-step indoctrination camp rehab. Where they are indoctrinated by people who are not clinicians, by people who have found success in AA. There’s a very low standard of education or licensure in most rehabs. We try to silo this in different ways so your medications are with your doctor, we will support what the doctor says with our support staff. Meaning if the doctor says they need whatever X twice a day we’re not going to say, ‘Well, then they’re not sober.’ We’re going to say, ‘Okay, thank you doctor.’ That’s why we have a nurse to dispense medication safely.
Our social workers try to work within a biopsychosocial structure—looking closely at people’s lives. If they want to return to school, if they have legal problems. Lots of people have entanglements in court at low levels. Or they want to build a life by finishing their education, returning to something. To us those are different things and they’re both a job. Managing medication is a job and managing somebody’s life and trying to engage in the therapeutic process to help them build a better life for themselves is also a job. We don’t need to co-mingle those things. We can work collaboratively but I don’t think social workers should tell doctors what medications people should be on.
Do you have any concerns around cannabis dependency or potential health risks associated with cannabis consumption?
I don’t find cannabis to be a miracle potion the way a lot of people in California seem to. Nothing is without risk—Tylenol kills 500 people a year. There’s always risk with ingestion of anything. We don’t want to present it as, ‘oh my god, we figured out this magical solution.’ We also don’t want to lie to people about it, we want to give them factual information about their risk. Humans can develop a dependency on anything: video games, doughnuts, sex, shopping.
One of the things I tell people all the time is, ‘Nobody finds any kind of recovery if they’re dead,’ so if they’re going to, they have a proclivity to be dependent on something, so let’s give them the safest form of that and then address that issue as it arises.
This happens all the time, a young guy tells me he went back to school, he’s taking in class, he has a part-time job. But he tells me, ‘Oh, well, my girlfriend doesn’t like the weed.’ ‘Do you like the girlfriend, or the like weed? What do you want me to do?’ But this is a kid who had infected injection sites and was teetering on death. And because we paced this rather than screamed at him, he’s making the decision: ‘Is this going to be effective for my life or the life that I want now?’ This kid was not rational enough before to think, ‘Well, what does she want, can I compromise?’
Making decisions like that are not something that heroin addict do. It is something that people who use cannabis can do.
How do you reach the patients’s wider social circles or families to battle the stigmas associated with addiction?
First and foremost we need to communicate and educate families and people around them that there is a behavioral element of addiction. People who have addictions behave very poorly and people are angry with them – and rightfully so – but that’s not the whole story. There is a genetic component or biochemical components, there are emotional histories, we don’t know until we start digging through their story. We need to put as much of that aside as we can without placating. They’re still responsible for their behavior and they’re still responsible for managing their problem.
Some people have parents who are like, ‘I’m not hearing any of this, this is wacky.’ That’s fine, we’re not on a sales pitch. We can tell you about cannabis if you’re interested or listening. A lot of people who do listen say, ‘That actually make sense.’ There are people who will not even talk to us. Their kid wants to come here and they think the idea is, ‘Well, they want to sit around and smoke weed all day….’
That may be what they want to do, that’s not what they’re going to do. Cannabis here is a medication like any other medication. If they choose to use it recreationally down the road, we may not like that decision. And we may even say to them, ‘This is not a great decision,’ but it is their decision. People need to understand that Americans are not giving up intoxication any more than they’re giving up guns or Cheetos. It’s here, get with it. This is where we are, how are we going to improve this situation? Pleasing the people around the the person of concern is not a treatment plan. That’s what a lot of these rehabs are doing. ‘How do we keep these parents happy to keep the money flowing?’ Rehab is a thirty-five billion dollar a year industry with very little incentive to change.
Can you tell me about your therapy dogs program, how that’s working out?
We have a fully trained narcotic detection dog, Cassie, who we rescued. She’s the runt of the litter and no police department or customs wanted her. For our purposes it’s great because medication-assisted recovery it’s only as good as the compliance with the plan. We can’t have people bringing drugs in here. We can’t have people hoarding their medications. Cassie helps us avoid those situations. When people come in with bags she can go through the bag, she can go through the facility. I think it’s a proactive approach, I think lots of people think, ‘Well, the dog will find this, I’m not even gonna try.’
Just as an energy dogs are good for people. Your dog is always happy to see you. There’s no judgment, there’s no shame, there’s no discrimination. They don’t care if you’re gay, black, transgendered, or a white kid in the suburbs. All she cares is, ‘do you have my tennis ball and will you pat me?’ That’s it, that’s their only agenda in life.
Have you found that people you’ve had through your program react to Cassie positively?
Absolutely. There are people who are so shut down, who have been injecting drugs in a dark room for long periods of time. It is a process to be able to talk to them sometimes. Let’s start with petting the dog. I don’t think it’s magic and I don’t think it’s science. But I think it’s absolutely beneficial. People on exit surveys say, ‘The dog is so cute, she’s so nice. She was so well behaved, the dog helped me. I loved when she would nudge me to pet her more.’
If you have a dog you have to go out, you have to walk the dog. If you live in a city—we’re right in in the heart of San Francisco—you’re going to see neighbors, going to talk to people. I always tell the young guys who say they can’t party so they’ll never meet a girl again, ‘Really? Walk the dog, you’ll meet a girl. Some girl will come up and wanna pet the dog.’
A dog is a portal into better health. We all have a need to care for something and we all have a need to interact. That’s one of the things that plagues people with addictive behaviors—isolation.