Towards a New Way of Doing Drug Treatment

“I may not get there with you, but I want you to know
That we as a people will get to the promised land.”
—Martin Luther King    

What’s The Big Idea?

In a nutshell, this is the big idea:

This essay is broken into two parts. Part A – Trauma and Drug Use, looks at the personal level. What is the fight or flight response? How does it operate in the brain? How is it connected to trauma? How does that connect to compulsive drug use? Part B – Connecting the Dots: Towards a New Kind of Drug Treatment, goes to the cultural level. Why does our culture stigmatize? What makes it a trauma-organized culture? How does this affect current drug treatment? What would a more humane model look like?

PART A  – Trauma and Drug Use

“I’ve been ten thousand miles in the mouth of a graveyard.”
—Bob Dylan    

Begin with the Brain

Trauma, reactions to trauma, emotional overload, it all goes on in the brain, so let’s begin there. The brain evolved to make us better survivors. Everything it does, from sending out fight/flight alarm signals to communication and social signals, is there to help us do better as a species. But it didn’t all evolve as one organized unit. It grew in response to different conditions in vastly different eras across different species, and rather like a ramshackle old house, where the old dairy is now an extra bedroom and today’s kitchen used to be a parlour, it’s made of parts built on top of each other, in a haphazard way that happens to work, though not perfectly. You can think of the brain as made of three parts, starting with the oldest:

Another important division is between left brain and right brain.

The final piece to know is about memory. Trauma memory gets stored in the area of the brain called the amygdala, which is linked to the Old Mammal Brain, and stores what is known as implicit memory. Implicit memory:

Explicit memory gets stored in the hippocampus and is linked to the New Mammal Brain, or conscious mind. Explicit memory:

Trauma work can be seen as releasing memory from implicit memory, where it is stored as a series of intrusive flashbacks, and moving it over to explicit memory, where it gets linked with left brain/New Mammal Brain systems of conscious thought and language-based understanding. This gives us the ability to be able to say, “that event was then, but this is now”.

Fight or Flight

Fight or flight is the defense system that evolved in the Old Mammal Brain and the Reptilian Brain. First we startle or freeze, and then we fight or run. When danger is gone, an animal literally shakes off the stress and goes about its business again. The response evolved over millions of generations of animals devising strategies to avoid being eaten by other animals. It is a swift, full-body survival reaction.

In the fight/flight mode:

Unfortunately for us, the Old Mammal Brain is hard-wired to go into fear states. This is because running like hell at the slightest provocation is more adaptive than sticking around to see if that rustle in the bushes really is a predator. When you think of the expressions we use to describe our fear states, they are describing that fight/flight response:

For our New Mammal Brains and selves, this system can backfire. We are social creatures, and irrational, uncontrollable fears get in the way of our normal living, especially these days when we are more likely to be exposed to chronic worries and emotional threats than occasional, sudden threats to our lives. What’s adaptive and protective for the animal part of our being becomes a liability for our social selves, and, over time, for our bodies too.

Fight/Flight on Overload

The fight/flight mechanism works extremely well for zebras being chased by lions or rabbits being chased by foxes, but three types of bad experiences can overwhelm this system, so that instead of returning to baseline, part of you stays permanently in panic mode. They are:

PTSD, Post Traumatic Stress Disorder, is the name we currently give for the reactions that come as a result of Fight/Flight overload. The “intrusive” symptoms of PTSD come when the panic mode gets stuck in the “on” position. They are:

When we try to block out the intrusive symptoms of PTSD, we create the avoidance symptoms, which are:

Dissociation is a short-term safety valve against the intense emotions of the fight/flight state. It’s like an internal cast the brain puts around “broken” emotions. Like a leg in a cast, the bound-up emotions are unavailable for normal use, which is fine if all we need to do is survive under minimal conditions. But as we evolved, our higher functions became important to social survival and quality of life. A repeatedly traumatized person may have trouble even establishing a coherent sense of self.

People cannot “get over” intrusive symptoms, because they come from beyond our conscious reach. We either suffer the emotional roller coaster of unpredictable moods, or we shut down from emotions altogether. Or, we endure an uncomfortable state where high emotionality and self-numbing follow each other in bewildering succession.

Developmental Trauma

“I heard ten thousand whispering and nobody listening”
—Bob Dylan    

The official diagnosis of PTSD says that you need to have witnessed or been part of a life-threatening and horrifying event, and afterwards, you need to experience those intrusive or avoidance symptoms listed above. The Bible of diagnoses, the Diagnostic and Statistical Manual of Mental Health (DSM) also allows childhood sexual abuse and hearing about the death of a loved one, not just witnessing it, as causes of PTSD. Beyond that, if you feel traumatized, you’ll just have to look for a different diagnosis.

But there are many who believe that developmental trauma is just as damaging as “official” trauma. It doesn’t need to be caused by life-threatening events, and it doesn’t need to have the exact symptoms listed above. But if negative experiences happen during childhood, our take on subsequent experiences tends to settle around the meaning we have ascribed to the traumatic ones, such as, “life is dangerous,” or “I’m a piece of shit.” These kinds of negative experiences include things like:

About the attachment and bonding deficits: think of a child as a young plant in the ground. Put poison (a trauma) in the soil and the plant will start to shrivel. But what if the problem is not so much poison in the soil as a lack of nutrients? The plant will wilt just the same. For humans that lack of nutrients includes:

Just like a trauma, these experiences lead to damaging self-beliefs, such as:

The Drugs/Trauma Connection

“Take me disappearing
Through the smoke rings of my mind
Past the foggy ruins of time
Out to the windy beach
Far from the twisted reach
Of crazy sorrow”
—Bob Dylan    

Whether the trauma comes with the official definition or not, the emotional state it leaves us in – living with our panic button permanently set at “on” – is a supreme trial. No one lives long in that painful universe without doing something to calm it all down. What we do to cope may not always make rational sense, but then these internal experiences are coming out of our non-rational Old Mammal Brain. The coping mechanisms include things like:

Being mood-altering and consciousness-altering agents, drugs are a natural for this list because:

Dandelions and Orchids

“Yes, to dance beneath the diamond sky with one hand waving free”
—Bob Dylan    

Have you have ever tried to get rid of dandelions growing in a lawn? It’s a huge drag, because whatever you do, beyond poison the whole lawn, those plain yellow flowers just keep coming back. You’ll never watch a child blowing a pretty globe of dandelions seeds in the same way ever again. Orchids on the other hand, will sometimes wilt and die right in front of our noses. But the orchids make all that hothouse TLC worth it by producing startlingly beautiful and delicate flowers that we treasure.

The difference between the hardy dandelions and tender orchids has been applied as a metaphor for people with different genetic traits. Research has shown that some people are more vulnerable to trauma (more likely to have PTSD symptoms) than others, and that those same people are more likely to wind up with serious alcohol and drug problems. So the researchers concluded, not illogically, that these people carried a genetic weakness that made them vulnerable in these areas.

It turns out that the researchers were looking at only half the picture. They were so eager to find deficits that they didn’t look for any of the strengths in the people who had the so-called “bad” gene. A closer look at the data showed that:

Beyond the Dandelions of Life

“Most men lead lives of quiet desperation.”
—Thoreau    

Let’s take the ideas of developmental trauma one step further. For all people, but especially for the Orchid Children:

The limiting conditions which prevent Orchid Children from opening naturally include:

This could be called the trauma of spiritual closure and it can lead to compulsive drug use, or addiction when:

What larger vision is trauma and trauma healing nested in? How could the horrors of the world ever take place? I believe they take place after the spiritual closure has happened, that’s when we lose all perspective and do terrible things. Yes, replacing drug “treatment” with drug healing would be a wonderful thing, but it wouldn’t solve our real issue. The puzzle we have to solve is our own selves.

Healing the Trauma Fixes the Drug Problem

“I look at you all and see the love there that’s sleeping”
—George Harrison    

When we get hurt, we often medicate that hurt with some kind of compulsive activity, and the compulsion is not going to go away until the hurt part of us gets healed. Unfortunately, all creatures shy away from their wounds, and trauma memories are stored in that strangely inaccessible but strangely intrusive implicit memory. The fight or flight response, which turns us into one huge on/off switch, and which is so basic to the survival of the whole animal kingdom, backfires against traumatized humans. The only solution is to heal the pain from the original trauma.

Trauma healing comes when you process the chaotic, vivid trauma memory out of implicit memory into explicit memory, where it can become a sequential narrative devoid of its toxic charge. What is that healing going to look like? In psychotherapy it will need several components:

Here are three modalities that do these things. Some other psychotherapy modalities also do this, and so do some interventions outside of psychotherapy. I’m just listing three that I know:

PART B – Connecting the Dots: Towards a New Kind of Drug Treatment

“I saw a highway of diamonds with nobody on it.”
—Bob Dylan    

In Part A, we say that the trauma model of compulsive drug use gives a coherent reason about why drug use should happen, and clear methods to fix it for good. In Part B we look more closely at the community aspect, how the larger community, or culture, can be instrumental in creating the trauma and condemning the drug user, and how a different kind of community can be part of the healing. Part B is will connect the dots that lead directly from the trauma model of compulsive drug use to new and innovative forms of drug treatment, or drug healing. There are six dots in all:

DOT ONE: Drug Treatment Doesn’t Work

The drug treatment we have in this country now doesn’t really heal people, and when it does help them, it’s more because of the respite it gives from life, or the intimate contact with one or two good providers, than it is from the treatment. That’s because:

In 1980 a study called Rat Park was published. It challenged the commonly-held disease theory of drug addiction, whose science was based largely on experiments with rats. Bruce Alexander and Simon Fraser said that these experiments were bogus, because the rats in question were held in such miserable and stressful conditions that they were bound to become drug addicts.

So Alexander and Frazer designed a Rat Heaven and a Rat Hell. Rat Heaven was made of large, airy cages with stimulating activities and plenty of opportunities to mate and raise litters. Rats who had been made to be chemically dependent were placed in there, and given a choice of bottles, one with plain water and one with laced with sugar and morphine. Said Alexander, “The rats gravitated more and more to plain water, thank you. Nothing we tried produced anything that looked like addiction in rats that were housed in a reasonably normal environment.”

However, chemically dependent rats in the crowded, bare cages of Rat Hell continued in their morphine addiction. The disease model would have predicted that any animal with a genetic predisposition would have stayed on the drug, and that circumstance would have been a minor variable. The Rat Park studies proved this wrong, and showed that the concept of “addiction” is more a cultural construct than a genetic predeterminate. The studies were replicated and published in journals, but were quietly ignored by the treatment community until the funding eventually drifted away, and Rat Heaven became a distant Shangri la for us all. (Thanks for that one, Carolina!)

DOT TWO: There’s A Reason We Do Treatment So Badly

“Tolling for the outcast, burning constantly at the stake”
—Bob Dylan    

We’re just not that stupid. We’re smart enough to split the nucleus of an atom to make electricity (or bombs), and invent arcane financial instruments that can bring the world economy to its knees. There must be a reason we are so obtuse about drug treatment.

There’s a saying, I’m not sure I agree with it entirely, that “hurt people hurt people.” What I do think is that “hurt cultures hurt people.” Because our culture has been “hurt” so often, it has become a trauma-organized society, and we have arranged ourselves around stark polarities like insider/outside and privileged/outcast. Here are some of our traumas:

Think for a minute about who gets stigmatized; it’s a familiar list:

Stigma allows us to assign all the qualities in ourselves that we don’t like (or that we fear) onto some person we perceive as flawed, or who is an outsider of some kind. We project our negative qualities onto our victim and punish him for being the way he is. If by any chance he finds a way to shrug off the assigned identity, we either work harder to put it back on him, or we just keep it moving and put it on the next scapegoat.

In a culture that started out with Puritanical settlers – intolerant, fearful, living behind compounds in a new and unknown continent – certain qualities were bound to be encouraged and others destroyed, or hidden. We are still living with their imprint to this day; just listen to the current political discourse. The qualities the Puritan fiercely abandoned were:

Don’t we all feel lazy, irresponsible, selfish, some of the time? To these impulses it’s important to say, “it ain’t me babe,” and shunt them on to someone else who looks less like us. And these days, who better to project all our feckless, lascivious, aimless, non-achieving, anti-work ethic, lazy-as-hell thoughts onto than the drunks and the junkies? They are the ultimate anti-capitalists, and they will never let us down.

But if these people are our elected scapegoats, the “blank screens” of our projections, how deeply invested can we really be in getting them to be more like us? Isn’t it easier to jail them, tell them they are diseased, punish them by taking their kids away, put them in crack-den shelters and SROs, infantilize them with a welfare check, than it is to say, “Oh my God, you’re just like me, you just ran into some personal (or global) misfortune, you got messed up, but you could be fixed!” A benzo addict I was talking to recently said, “As a kid I was born behind the eight ball. I thought I could get away from it, but I never quite did. My big mistake was being a nice guy. They never let me get away with that.”

DOT THREE: Want Real Change? Make A New Start

“Tolling for the aching, whose wounds cannot be nursed
For the countless confused, accused, misused, strung-out ones and worse”
—Bob Dylan    

If you look at our record since we started a drug treatment industry and a drug incarceration industry you’ll see that:

Scary!

So, if we want to start drug treatment that is not quietly invested in keeping people where they are, we have to work from new principles, such as:

DOT FOUR: Far Away Places

“How many seas must a white dove sail before she sleeps in the sand?”
—Bob Dylan    

You can only heal what’s been injured. People who do drugs for fun, amusement, to fit in with the people who actually are having the fun, or because they are mildly bored, these folks do not have a drug problem and do not need drug healing. The ones who need healing usually know they do, and were hurting before the drugs ever came along. Unfortunately, that’s a lot of us.

I’ve come across three models of healing that could show the way towards a new paradigm of drug healing. There’s probably 916 more, I’m just describing what I’ve come across.

1 The Sanctuary Movement

The sanctuary model of mental health treatment was created by the Quakers in York, England, in 1796, after Hannah Mills, one of their members, was killed by the abuses of the mental health care system of the time. The sanctuary movement spread through Europe and America, and had its heyday in the early nineteenth century, until it was destroyed by overcrowding, rising costs, and an outraged medical profession. It gave rise to the word “asylum,” which originally was an untainted term, meaning a nice place to find refuge – not a Willowbrook-style horror show. It’s central features were:

The basic tenets of treatment were to:

If the majority of the mentally ill are Orchid Children, then this safe, kind, nurturing environment would have been just what they needed to recover and flourish. At its height, the movement reported between 59% and 80% success rates. “I think it is not too much to assume that insanity is more curable than any other disease of equal severity; more likely to be cured than intermittent fever, pneumonia or rheumatism.” said Samuel Woodward, Superintendant of the Worcester Asylum, 1843.

Confidence and success rates like this create lots of enemies. Those enemies, combined with the fact that the people running the sanctuaries were not medical doctors, made the death of the sanctuary movement inevitable. Swamped by patients, underfunded, and deeply criticized by the medical establishment, the asylums, or retreats, lapsed back into the medical model, to the disastrous result of anyone who wanted to get well (or be well-treated).

A new sanctuary movement, modeled on the original one, exists now, founded by Sandra Bloom. It is run by psychiatrists committed to humane treatment of patients, and struggles with funding issues, overcrowding, and health insurance issues, but continues to this day within the conventional system.

2 Shamanism

Shamanism is not a discrete belief system, but a practice spanning almost all cultures through all human time. You’d expect differences, but surprisingly, across shamanism a great deal of commonality exists. Here are some of those features:

The understanding I have of shamanic ritual is:

The Aborigine people of Australia have one of the oldest shamanic traditions on the planet, going back 40,000 years. They walked the Song Lines, lines of spiritual power which criss- cross the continent for thousands of miles. Each Song Line has its places of power and, along the way, sacred stories and songs that are associated with these landmarks. To walk a Song Line is to undergo a spiritual initiation. It’s feared that no one knows enough of the tradition to be able to walk a whole Song Line today.

So, a culture which lies somewhere below zero on the poverty scale has – had, rather – such spiritual richness that it sustained itself and flourished for an unimaginable length of time. It collapsed into drunkenness, petrol-sniffing, and despair shortly after the European invasion, and has not yet found a way to recover. The “Rat Park” of the Australian Outback was in Heaven mode for the Aborigines when they were spiritually connected, and Hell mode when traumatized and spiritually disconnected. Physically though, it was of course the exact same Australia.

If you look at the shelters, SROs, and ghettos of our culture, you’ll find the people who live there are immeasurably wealthier than the pre-conquest Aborigines could ever have imagined. But the place most of our poor folk live in is an unspeakable Rat Hell of violence and degradation. A lot of rich people also live in their own Rat Hells, because Rat Hell for humans is not just a place of physical discomfort, it’s one where connection with community and connection to spirit have been shattered.

The shamanic way says that we are not on this planet to reach a higher standard of living. We are here to live to a higher standard. We are all here to learn, and we can all learn from each other.

3 Reconnecting with the Ancients: Asclepius

Asclepius was the son of Coronis, a mortal woman, and Apollo. Being one of the guy gods, Apollo killed Coronis in a fit of jealous sexual rage, and then immediately regretted what he had done. He plucked the infant from Coronis’ womb just as she was being consigned to the funeral pyre, and named him Aslepius, which means “to cut open.” Apollo had him raised by the centaur, Chiron, from whom Asclepius learned the healing arts so well that he eventually graduated to god of healing.

The temples, or Asclepieia, flourished from about 300 B.C. well into the Christian period. Their main features were:

DOT FIVE: Not Drug Treatment, But Drug Healing

One way to begin devising a new form of working with drug users on a communal scale is to take elements from the sanctuary movement, shamanism, and the Asclepieia, and see if a coherent pattern can be created from them. But what do we call the work that will be done? I don’t like to call it drug treatment because in drug treatment:

Drug healing happens where we recognize that:

To do this healing we – ideally – need:

A Final Thought

In ancient cultural time, in 1626, the Lenape Indians were foolish enough to sell the island of Manhattan for $24 worth of beads, buttons and a few other trinkets. But they were people who thought you could no more sell the land you live on than you could rent out the wind that blows over it. Though they paid dearly, what they kept was their own selves. We, on the other hand, have sold our soul’s heritage for an ongoing stream of baubles and trinkets, and contrive to feel enormously pleased with the quality of the electronic knick-knacks and glossy toys we have secured. Our culture is disconnected from Earth. As individuals, we have disconnected from our moment-to-moment joy in experience of self. We don’t quite know how to completely be here.

As I walk down the streets on the island that was bought and sold, I see how we carry the weight of all the harm that’s been done. The bad end of our cultural bargain is written all over us, in the expressions of weary boredom and guarded grief that we have held for so long they have sunk into us and become our own shape. We try to cover it with a sharp look or a sharp outfit, but the burden of the past clings to us heavily. We have not made peace with it, and it is slowly squeezing the life from us.

In this “lost world” that turns out to be our own world, no wonder many of us steal the illegal cookies of heroin, cocaine, speed, marijuana and so on. Drug treatment that is just about drugs keeps us in place; it supports the illusion that “consensus reality” is real, when it isn’t. Shamanism is about soul-retrieval; but today, in our times, it is we who must retrieve our own souls, and we need our shamans back, to help us do that. Most of all, we need to wander the lost and dusty passageways of our hearts to find the lonely, exiled parts of ourselves, sleeping somewhere on a bed of straw, ignored and forgotten.

Many of us have been through terrible traumas, sometimes in prisons or in torture camps, but our quiet rowhouses and sedate suburbs also hold their own dramas of soul-closure and unwatched despair. Years of inauthentic and stultified communication, a dreary life lived entirely in square boxes, being surrounded by people who don’t sing together – these will bring you to loss of soul just as certainly as abuse and trauma. A people that doesn’t have the heart yet to sing the kind songs of humanity or to hum among the spirits will not protect its vulnerable ones from shame and stigma, or find the road to its own truth.

Everybody needs to help everybody. We just need to accept ourselves, trust ourselves, and then the terrible things we have done to each other over and over again may be finally be put to rest, and the ghosts of our own action may be lifted from our shoulders. The healing can always begin.

Wherever the spirits are, we thank them for bringing us together and making us dance. We thank our problems for making manifest what might otherwise have passed as normal life. That state, the one called “normal” is what we need “recovery” from. Our hearts know better than us where we should be going. This is my prayer: that we begin our journey.

“We are going, Heaven knows where we are going,
We know within.
We will get there, Heaven knows how we will get there,
We know we will.
It will be hard I know
And the road will be muddy and rough
But we’ll get there, Heaven knows how we will get there
We know we will.”
—Osibisa