Who lives in a park? Who lives in a cage?

Thanks to blogs of David and others from Wired In, I am slowly getting familiar with the current situation in drug policy and services in UK and I read the debates around its expected transformation with a lot of concern. As I understand it (and correct me if I am wrong…), the situation has reached the point when methadone treatment is applied as a number 1 choice for heroin users who may then stay on the substitution for a long time without any (or only small) additional support.

In Czech Republic, we experience a different situation, partly because of the fact that heroin is not as popular here as in UK and partly because of the fact that not many practitioners or psychiatrists are actually willing to prescribe any kind of substitute drug. But it seems that the general direction goes towards more methadone and Subuxone prescriptions. I do not think it is bad but it needs to be followed by efficient and improving ways of recovery. Apparently, the problem starts when these approaches are seen as binary opositions. Then, this „treatment“ x „recovery“ controversy would remind me of similiar contradiction between a cage and a park.

The famous experiments with rats in a cage with access to unlimited source of heroin or cocaine are well known. A surgically implanted catheter was hooked up to a drug supply that the animal self-administered by pressing a lever. Their increasing consumption of the drug was used as an explanation for the assumption that the drug is causing the addiction which is progressive and leads to death.

Professor Bruce Alexander, a Canadian psychologist from Simon Fraser University, tried similiar experiment, but with an alteration. He did not place the rats into a cage, but into an „Eden“ for rats: it was a place 200 times larger than the cage, there were cedar shavings, boxes, tin cans for hiding and nesting, poles for climbing, and plenty of food. Also, because rats live in colonies, the „Rat Park“ housed sixteen to twenty animals of both sexes. Bruce Alexander put there two bottles: in the first one, there was plain water, in the second one, there was a morphine-laced water.

The results were very clear: unlike rats in cage, the rats in park preferred the plain water to the morphine. The modification of this experiment was that the rats had access only to the morphine water for some time.After several months, a bottle with plain water was added and the rats in the park were more likely to switch to the water! „Addiction“ did not seem progressive, chronical and untreatable any more. More importantly, it seemed that it is not the drug that induces the addiction.

People do not live in cages. But we do not even live in parks. However, in some conditions, life can look like a cage, the same as life can look like a park. Since drugs, as heroin or cocaine, may be the only possibility how to cope with life in a cage, in a park, it is one of the many options. And what needs to be said: people are not at the same distance between cage and park. But even if some are caught in a cage, many of them find their way to the park.

Obviously, we want to help people who are in a cage. As I see it, methadone makes the life in cage less stressful. Recovery is a way from the cage.

Should they "know"?

Today, I have a reflection not from my research but from the Houston Galveston Institute where I study and work on my dissertation these days.

HGI is a non-profit ogranization that offers psychotherapy and training in psychotherapy, as well as it develops effective practices in mental health field through research and theory building. Even if the house in which HGI is placed, is quite small, the impact of the innovative ideas is huge and recognized all over the world. Influenced by postmodern theory and theory of social constructionism, the team of scholars, clinicians, students and clients create a unique learning community with a lot of enthusiasm.

There are many sources of inspiration for me and even if HGI is not primarily concerned with the drug issues, two days ago, I heard quite an interesting story and interesting discussion about that afterwards:

At the staff meeting, a therapist was describing her therapeutic contact with a young lady who had stopped using cocaine several weeks ago. She did not evaluated the contact as really good, since the client was quiet, sad and depressed at the sessions. The therapist was mentioning that the psychiatric explanation could be that this is the common situation in the first stages of recovery.

The question that I have been asking there for some time was: Should the young lady know about these biological consequences of drug use? Would it help her?

A lot of practitioners say YES. For example, A. Gray from Rugby House in UK suggests that these information are essential and necessary for people in recovery. In Czech treatment centers, the important part of the therapeutic program is self education. Clients get books about drugs and addiction (often more than 20 years old) and then they must write a report from selected chapters. For a long time, there was no doubt that people must be informed about their "illness". But I am asking once again: Are these information helping someone?

I am not sure about this. Consider following citation from excellent Paul Watzlawick´s book "Change: Principles of Problem Formation and Problem Resolution" which he wrote together with J. Weakland and R. Fisch in 1974.

"Everyday, not just clinical, experience shows not only that there can be change without insight, but that very few behavioral or social changes are accompanied, let alone preceded, by insight into the vicissitudes of their genesis. It may, for instance, be that insomniac´s difficulty has its roots in the past: his tired, nervous mother may habitually have yelled at him to sleep and to stop bothering her. But while this kind of discovery may provide a plausible and at times even very sophisticated explanation of a problem, it usually contributes nothing towards its solution." (p. 86)

So, what gives us the feeling that we MUST provide the drug user or former drug user with an explanation of the biological and chemical processes that are going on in his brain?

Let me raise one, maybe a little provocative, hypothesis: We, people working in the drug field, perceive ourselves as having a special kind of expertise. We call ourselves "drug counselors", "drug service providers", in Czech Republic we even have the name "adiktolog". There are sole study programs on "drugs" and "addictions". But, what is our expertize? That we know something about drugs? In fact, when dealing with a person who wants to change his or her lifestyle, needs to find the sense of life and improve the relationship with the significant others, we do not need this kind of expertise. Which leaves us at the same position as the other therapists in the mental helath field. But we want to be special! And so, we use our expertise, even it does not have any effect.

Well, this might be the explanation. But, of course, it contributes nothing toward the solution...