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...

Professional ex-s´

Thanks to the actual free trial of Sage on-line publications (http://online.sagepub.com - only until the end of May so hurry up!!!!) , I have found really interesting article in Journal of Contemporary Ethnography from 1991. The author, J. David Brown, is Assistant professor of sociology at Northern Illinois University who had struggled for 13 years with substance abuse problems, then he went to rehab and after then, he started to be a counselor himself. He uses the introspective methods and the qualitative interviews to describe the identity transformation of drug users into professionals - drug counselors. According to him, the identity of "professional ex" is formed even before the professional trainings - he calls this process "preprofessional socialization". As he points out: "One of the most pervasive characteristics of preprofessional socialization is its ability to transform the stigmatized identities of substance abusers into identities that have adopted a calling to a profesional counseling career" (p. 159).

He cites really amazing statistics in his article:

- 72% of the people working in more than 10.000 treatment centers in U.S. has experienced substance abuse problems (according a research of Sobell and Sobell, 1988)

- there was only 13% recidivism rate within ex-prisoner who were hired to work as a prison-counselors

Also, he notes that all the ex-users he was interviewing were working in treatment programs that were based on 12-step approach and most of them evaluated the knowledge of disease concept of addiction as significant for being effective substance abuse counselor.

From my point of view, Brown describes quite special group of people who had transformed their "fixed" identity of drug addict (ill) into another "fixed" identity of drug counselor (professional ex). People who I was doing interviews with, have not created so "fixed" identities. Their identities seem to be more flexible, more fluent. But even within them there were two people who started to work as professionals after they stopped using drugs.

One of them, Milos, was a methamphetamine dealer and consumer for three years. Then, one day, he went with his friend to the "meth cook" place and he met his sister in law. She said: "why don´t you come to see your daughter?"
"Where is she?" he replied.
"In our place... Her mother left her here and went to Germany with her new friend."
It was the turning point for him. He went to his sister in law place and when he met his daughter, she gave him a big hug starting to shoout: "Daddy, daddy!" He started to cry. He deleted all the friends´ phone numbers immediately and was for few weeks only with his daughter. Then, for two years, he worked in different positions doing mainly in constructions field but he all the time he was attracted by the drug issues somehow. So he applied for a job as an outreach worker in drop-in center. He was hired and after several weeks the number of clients increased from 30 to 120.

"...the people started to perceive me as one of them, I did not use any professional language, I used slang words, and they accepted me and started to bring their friends too. The worst feelings were when the people whom I used to hang around with and whom I used to sell drugs appeared there. But at the end, it helped. Like me, they also did not want to talk about the past, however, they were bringing other people bacause they knew me."

"...so they can see on their own eyes that it is possible to stop. Also, we get lots of help from people who stopped using and they visit us from time to time. The others, who are still using, can see that they have good clothes, they are smoking good cigarettes, telling the stories as they were skiing in the mountains at the weekends and they are just impressed... they say... that guy was totally down and look, where he is now..."

Milos has not been using for seven years. Even if her daughter is in care of her mother again, they are connected all the time.

The most difficult thing

The interviews with former methamphetamine users I was conducted were narrative; which implies that I had no questions prepared in advance. Nevertheless, there was one question I was often asking: What was the most difficult thing for you when you were quitting the meth use? Interestingly enough, the answers had not much to do with drugs. The severe compliactions were caused by relationships, daily routine, hobbies, life-styl in general... let´s look at those few citations:

"I: What was the most difficult thing after you decided to stop?
L: To handle the time somehow. To adopt myself to the fact that the day has 24 hours, that one should sleep for some time, one should be up for some time... and somehow... what to do with myself, right? How to fill up the time."
(Lenka, 28 y.o., female)

"The first couple of months was terrible, I did not talk to anybody, I started to walk out almost with the first guy I have met. He was an awfull asshole. But I didn´t mind. I just didn´t mind about anything."
(Magda, 23 y.o., female)

"...the most difficult was to convince everyone that I mean it. It was the most difficult. I was convinced, but the others... some of them just did not trust me.... someone from my family was pushing my father not to leave me at home: you will be surprised when you come at home and there is nothing... but this has pushed me forward, I wanted to prove them that it´s not like that..."
(Milos, 33 y.o., male)

"The most difficult thing was not to meet those people. And it was the basic thing. They have tried, one dealer was sending people to my place: whether I want something. But then I was able to say radically No! leave ma alone, I am not interested in these things at all. Try it again and you will fall out badly."
(Libor, 25 y.o., male)


From my point of view, quitting long term drug use is equal to radical change in one´s identity. Not because the chemical structure of the drug is so devastating. But rather because of the specific life-style which is connected with using that drug and which is detemined by its legal status, cultural assumptions about the drug and the whole mythical narrative around that. The growing into the culture of drug use was interestingly described by H. Becker in his Outsiders (1966) and later by T.L. Anderson, for example in the article Drug Related Identity Change which she published with J. Mott (1998). The identity change that takes place after one´s termination of drug use was precisely captured by McIntosh and McKeganey in their recent book Beating the Dragon (2002). One of the few books that travelled with me form Czech Republic to U.S.

By the way, today it is the 10th day I do not smoke. And the most difficult thing...
perhaps waiting for the bus... Especially when it is broken...

Short introduction

The question I am repeatedly asking for couple of years sounds like this: What happens with the identity of someone who has stopped using illicit drugs? This is also my central research question for a dissertation project within my Ph.D. study in social psychology at Masaryk university, Brno, Czech Republic. As a Fulbright research scholar in Houston Galvestone Institute, USA, I am currently trying to find some answers based on interviews with former methamphetamine users who recovered without formal treatment. Finally, I want to use these answers to improve the drug services of NGO Podane ruce in Brno, Czech Republic where I have worked for five years. I´ve heard lots of interesting stories about recovery and self-change in my work,
during my research and also reading the blogs and the website of Wired In. Let´s talk about it...

P.S. Just before my departure to USA, I have stopped smoking. I wonder what will happen with my identity... For sure, I will replace the picture in my profile if I will not smoke after I come back to Brno...