June 16, 2017 -Bill White- RECOVERY INVISIBILITY

When one thinks of the invisibility of addiction recovery, one first thinks of the legions of people in local anonymous and alternative recovery fellowships whose stories rarely penetrate public consciousness. But there is actually a larger population of hidden people who have resolved significant AOD problems in their lives without incorporating addiction and recovery into their personal identities.
For many people, the labeled experiences of “addiction” and “recovery” exert a profound influence on personal identity. Their life narratives are clearly cleaved into the categories of before (the addiction story) and after (the recovery story). In face-to-face and online interactions, these individuals fill secular, spiritual, and religious recovery mutual aid societies supporting each other in a life-enduring recovery process. Historically, members of each of these self-contained recovery communities embraced a shared history, iconic leaders, core values and ideas, a distinct language, and distinguishing rituals of mutual identification that buttressed the recovery identity. Participation in professionally-directed addiction treatment has also been a central theme within their collective stories.
What modern epidemiologic studies of AOD problems reveal will be something of a surprise to many people: the majority of people who resolve AOD problems do so without participation in specialized addiction treatment or a recovery support group. Those who have achieved such “natural recovery” often do not self-identify with the addiction or recovery language even when they once met but no longer meet diagnostic criteria for a substance use disorder. They are the truly anonymous people in recovery who claim no named recovery club—no shared founders, literature, slogans, symbols, rituals, or regular gatherings, but who have survived addiction to compose reasonably healthy and fulfilling lives. They include people who do not want to live as a category and who do not want to be boxed in by caricatured images of addiction or well-worn pathways of addiction recovery. And they include people who shun labels that bring significant social stigma and discrimination.
Differences between assisted/affiliated and unassisted/unaffiliated patterns of recovery often reflect variations in problem severity, problem complexity, and available recovery capital. It is time we stopped talking about differences in pathways and styles of AOD problem resolution within the lenses of superiority and inferiority and instead celebrated the growing varieties of recovery experience. I have spent much of my life researching the history of recovery mutual aid societies and studying the experiences of individuals and families who embraced addiction recovery as a life-saving catalyst of transformation. It is the sheer magnitude of the varieties of recovery experience that I find most compelling. Today is a shout out to all those who have resolved AOD problems without addiction treatment or mutual aid society affiliation and often without conscious “recovery” identification.
As discussions arise across the country about how best to resolve America’s drug problems, my hope is that we will also hear your voices. As recovery stories become more public, I hope you will add your stories to this oral quilt portraying how such transformations unfold. You can become part of the larger solution without being a self-identified member of a recovery community or claiming recovery as a central theme within your personal identity. There is much America and her addiction professionals, recovery support specialists, and recovery advocates can learn from you, but first we must acknowledge that you exist.
“Recovery by any means necessary under any circumstances” must become our operational motto.

Post Date June 16, 2017 by Bill White

June 2, 2017 -Bill White- RECOVERY ADVOCACY IS NOT A RECOVERY PROGRAM

Of all the experiences I have had as a recovery advocate, none have been more heart-rending than receiving news that a person prominently involved in recovery advocacy efforts has died of a drug overdose. It reminds me once again that personal health and recovery are the foundation of all larger efforts to educate, advocate, and counsel within the alcohol and other drug problems arena.
This is not a new lesson. Consider, for example, the following stories. John Gough got sober in the Washingtonian revival of the early 1840s, but relapsed three times in the early period of his long career as America’s most charismatic temperance reformer. The lawyer Edward Uniac always stated that he was more vulnerable to the call of alcohol during extended periods of rest than when he was moving from town to town giving his temperance lectures. But Uniac suffered repeated drinking episodes and died in 1869 of an overdose of whiskey and opium while on a temperance lecture tour in Massachusetts. Luther Benson tried to use his own personal struggles with alcohol in the temperance lectures he gave across the country. His tales of continued binge drinking while on the lecture circuit were penned while he was residing in the Indiana Asylum for the Insane. His 1896 autobiography was entitled, Fifteen Years in Hell. Benson truly believed that throwing himself into temperance work could quell his own appetite for alcohol. In retrospect, he was forced to admit the following:
I learned too late that this was the very worst thing I could have done. I was all the time expending the very strength I so much needed for the restoration of my shattered system.
The stories of Gough, Uniac, and Benson are not unique. Similar tales were told by others who sought to cure themselves on the temperance lecture circuit. However, recovering people did achieve and maintain stable recovery working in the 19th century temperance movement and within treatment institutions of that era. An important lesson emerged out of the 19th century recovery movements: service activity, by itself, does not constitute a solid program for continued sobriety. This lesson was relearned throughout the 20th century, particularly within the modern rise of addiction counseling as a distinct profession.
A New Recovery Advocacy Movement is spreading across America and beyond, leaving in its wake new grassroots recovery advocacy organizations and a fresh generation of recovering people and their families seeking new ways to carry a message of hope to those still suffering. To prepare themselves, this new generation would do well to review the stories of old. The enduring message in all of these stories is clear: Working as an addictions educator, advocate, or counselor does not constitute a program of personal recovery. Those who forget that lesson court injury to themselves and to the very movements to which they claim allegiance. The key to effective recovery advocacy is first and foremost the primacy of personal recovery.

Post Date June 2, 2017 by Bill White

BLOG & NEW POSTINGS April 7, 2017 -Bill White- REDEFINING THE “RECOVERY COMMUNITY”

Over the past half-century, the meaning of “the recovery community” has undergone considerable changes. First used as an umbrella term to embrace local members of AA, the term was gradually extended to embrace members of Al-Anon and Alateen, members of other Twelve-Step fellowships, and then professional and lay allies of AA and related groups. The term was further stretched through the rise and dispersion of secular and religious alternatives to AA and the phenomenon of “dual citizenship in recovery”—individuals concurrently participating in Twelve Step and alternative recovery mutual aid groups.
Growing public and professional recognition that many people achieved recovery from substance use disorders without formal treatment or recovery mutual aid affiliation spurred some in “natural recovery” to claim membership within an expanding concept of “recovery community.” Individuals in recovery from what were christened “process addictions”—codependency, gambling, eating disorders, sexual addictions, etc. also claimed territory within the boundaries of the “recovery community.” A new addiction recovery advocacy movement spawned new recovery support institutions distinct from mutual-aid fellowships and addiction treatment organizations. Harm reduction projects advocating the legitimacy of non-abstinent pathways of addiction recovery further challenged the conceptual boundaries of recovery and recovery community.
A recently published article by Parkman and Lloyd will be of interest to observers of this recovery community building process. According to Parkman and Lloyd, the internet has extended the traditional definition of community that centered on people sharing living space within a defined geographical area. Instead, “imagined recovery communities” now exist whose members reside worlds apart and never meet face-to-face, and “portable recovery communities” afford people from disparate locations who share common experiences and identities opportunities to periodically gather and then disperse. Parkman and Lloyd further note the variability and fluidity with which people in recovery identify or do not identity with this imagined community. The authors conclude: “For those isolated in their addiction, with very little access to social support, access to an imagined recovery community that can provide support could be a valuable beginning to their recovery efforts.”
n reflecting on this evolving recovery community, four overlapping trends are of potential historical import: 1) the growth of an ecumenical “culture of recovery” that respects and blends secular, spiritual, and religious pathways of recovery and transcends geographic, political, economic, religious, racial, and generational barriers, 2) the rise of a new recovery advocacy movement proclaiming there are many pathways to recovery and ALL are cause for celebration, 3) the emergence of new recovery support structures within the arenas of business, law, communications, medicine, religion, education, housing, sports, leisure, and the arts, and 4) the increased linkage of the addiction/recovery experience to other forms of human suffering and healing. Addiction and recovery may become catalytic metaphors aiding broader patterns of personal and cultural transformation, and the broadened experience of recovery community may serve as an incubation chamber for such transformations.
As we witness the progressive splintering of the world’s social fabric into closed ideological camps, the community building rising out of the shared experience of addiction recovery is worthy of broader emulation. The wounded healers within this expanding “recovery community” have much to teach the larger cultures in which they are nested. A day may come when we all embrace our shared “woundedness,” all see ourselves and our communities in a process of recovery, and all join in transforming the world into a healing sanctuary.
Post Date April 7, 2017 by Bill White

El Rancho De La Vida- The Ranch of Life-A treatise; to address the old and outdated recovery standards and practices.

THE EPIDEMIC OF OPIOIDS IN MAINE AND BEYOND…WHAT CAN BE DONE? WHAT SHOULD WE DO, AND WHAT CAN WE DO?
This is a monograph that takes into consideration multiple attempts at battling addiction at the personal level, and recently works alongside many others in the same battle. We will be starting with the insanity of emotional precursors that exacerbate addiction. We will address the constant threat of user’s guilt, blame, self-harm, personal ambivalence, cognitive and psychiatric responses, or lack of. Then, moving up to the parties of responsibility, the corporate pirates of addiction recovery for-profit providers; the PCP for-profit level, the local for-profit government and for-profit public view, (Stigma), the state government for-profit level, and all responsible for-profit federal levels, and all scientific endeavors; as per Addiction Sciences, Addiction Medicine and Drug Addiction policy.

Never said, written or recognized is a real, understandable and implemental, Recovery Policy- like our attempts at addiction and drug polices like ‘The War on Drugs’. (names of all past and present addiction Treatment alternatives?); our Huge monolithic Government and society currently has in place. Have you ever seen an Addiction Recovery Policy?

Not until last year came The Comprehensive Addiction and Recovery Act (CARA) of 2015. The current history of addiction recovery tells us that we have failed miserably at helping our population recover properly from alcohol, drugs, sex addiction, gambling problems and every other activity that provides human beings with a false sense of power, and a true feeling of a rush, or of an intense life force, coming at us too fast, too strong, and all of us wind up, ‘battling addiction’ instead of treating both our physical selves, and the underlying emotional issues that have clearly gone awry.
This self-actualization is a way to enforce a failing system because we as Helpers like to blame. We have not taken into consideration that these people (our sons and daughters, our mothers and fathers, our wives and husbands, brothers and sisters are all quite human and quite fallible when faced with a substance or activity that challenges the very core of our humanity and living as a healthy human being. The feeling of power and confidence, when all else has not, made us feel that way, and of course, the real sense of, ‘fuck it’, when we feel that we are beaten down and abused by ourselves. That is never talked about. We want to feel good. When life gets in the way, we imbibe.
Ok, so we as helpers have failed at assuming that ‘we’ can ‘fix you’. We know or are starting to know, that only you, the human inside your addiction, is capable of ‘fixing’ a problematic behavior that was once fun and now rules our lives. We have to want to get better. This ‘faith’ in oneself is at the very essence of stopping addiction permanently. I know, as I had lost faith in myself and faith that control of usage is lost, gone and we simply fold.
Then as our addictive obsession continues “taking everything from our lives, (obsessive, compulsive behaviors that always lead to vastly uncharted negative consequences, start to pile up. Loss of self, loss of money, loss of home, loss of work, loss of pride, loss of joy, loss of comfort and of course loss of loved ones, and the love and loss of ourselves.
The Recent news on Narcan
I have recently witnessed, first hand, people lying on the side of the road, dumped off by scared friends or family in front of my current place of business, at Milestone Detox. I have been by their side as police and first responders try to resuscitate a non-alive human being. They work feverishly and patiently to assess the heartbeat or lack of, then administer Narcan by way of “The Kit”. The Narcan kit once pushed into a lifeless body miraculously brings it back to life, and most of the time, that person is really angry that they were brought back (from the dead). These addicts have had enough, and really want to die as a precursor for living in the hell that they have been living in. This is another way for providing a needed resistance to death as an alternative of the ravages of addiction.
“Dope/Alcohol” (insert addictive behavior) “has control over me and now I am fucked”. This is the top of the rabbit hole, as now, a whole new addiction industry has been built around, “We can fix it, if you can pay X amount for our modality of treatment and recovery”. Institutions and Treatment centers started to pop up everywhere (When, names, types, outcomes). There are many large and small confusing, profit oriented systems of cessation of addiction, not recovery care from addiction.
Recently I called around to Suboxone providers in the Portland area, for the purpose of finding barriers to treatment, (at the provider level). Every Suboxone provider I called told me; ‘we could fit you in, in 2 weeks’ “2 weeks, really”? “What do I do now, I am calling now”? ‘All I need is for you to bring in $350.00 cash and we can get you started on Suboxone’.
The argument being that: you were able to pay for your habit, so why can you not come up with the money that will save you? I am sorry to say that this standard of practice among providers is real and dangerously profit-oriented from the get go. Why not $100.00 or why not ask for insurance? Why don’t these providers say to the suffering person, we will take you today, and we will work out the cost when you get here and become stable?
This is when profiting from addiction starts, at the beginning of recovery with hospitalization for detoxification. When I went through detox, at a for-profit hospital and a few private for-profit detoxes, I only knew that this was the first step, (proven medically that a Human Being must detoxify the body of poisons, before any real recovery can begin). Then the levels of recovery and aftercare start with the very lucrative business of owning and operating a Sober Home. Or, there is Intensive Outpatient Centers (IOP) for- profit, and Long term Treatment for-profit and other aftercare models, such as groups and therapy, all of which need funding(for-profit), except AA/NA and all self- help groups meetings (self-funded through passing the basket).

For-Profit Addiction treatment is killing us, (Put in Statistics). Why do we need to profit from the very thing that helps people get off deadly medications prescribed by physicians, or as it seems to go…we turn to street drugs because we still feel pain (The science of pain) increasing, with more Opioids increasing. Yet doctors have limits? Then they just stop prescribing opiates for pain. This is a gateway into the world of self medication.
We have gotten recovery wrong. We as caregivers can be the best and sometimes the worst caregivers, because we are not people in power(money and status), we are in recovery we have experienced loss and devastation because of addiction, We indeed may not know how or why we are to counsel or manage something that is inherently impossible to manage. Addiction is a beast from within. It implies a suffering and a state of loss, one of total confusion, and it is at the very core of being an addict. This impact is ‘not important’ in the public perception of addiction today.
We as ‘recovery helpers’ have failed miserably. We have tried everything that comes to us as a possible treatment, when we goddamn know better. The addict, the human being that is sitting in front of you is at a loss of explanation because addiction, at any level (Mild, Moderate or severe really?) is traumatic. Addiction is trauma, stemming from other ‘mental health’ issues, forming together to complete a shit storm in our brain. ‘Put down that drink or it will kill you’, sounds very attractive to a human being who is suffering a kind of madness from within. The addiction professional in recovery would know this.
I put quotes around ‘mental health diagnosis’ because initial diagnosis is not a rational way of determining a sound ‘Mental Health’ diagnosis from something we have not even begun to understand, no less, try to assess. Trauma forms different pathways in the brain to “feel better” or to feel nothing at all; because “I cannot handle any of this” I have tried and tried. (Science). Think about it, every time I have assessed a client and every case I have read about says that, we are to write down separate and distinct mental health diagnoses or the client self-reports anxiety, depression, PTSD, ADD and ADHD, all diagnosis that were assumed, while the client was most likely much younger, or not sober, nor at all rational 99% at the time of their diagnosis. (Find science).
I know. I was always high and irrationally defiant at all of my therapy appointments and psychiatric assessments, and when after checking into 10 separate detoxes over time, (all profit based), because I had to be assessed? Life seemed too unfair and my dreams and hopes were dying in front of me. That is why I used, eventually to acknowledge that it’s ok that I’m a failure, as long as I get through the day, with my medicine. The high or getting well is really described as “feeling normal, for me”. That was a big issue for me as I did not know, and no one was able to tell me, what normal for me, was when I was addicted to heroin, I rarely got ‘high”, I intended to get ‘well’. Getting high was a huge plus, if at all possible.
We also never talk or talk about what initially started our recreational use. My mind felt better, in the first place I felt warm and comfortable in my own body for the first time. A classic example is why we do not talk about how our addiction started, instead we ask, what are you taking now, how much, and how often?
At the end of my run, or at any point along my addiction, I did not ask” hey dude, what is it cut with? We do not care anymore. Addicts do not care what they put in them; we just want to feel like everything is OK. Do you believe that any of us, when we were active users, could or would put our dope in a gas spectrometer? Hell no, we are all secretly hoping this shot will make it all go away.
My point is that the whole realm of Addiction recovery has to be re-written through the eyes of people who have recovered. Only those folks know how insanely hard and uncomfortable recovery is, how it was for them, and life may be forever dull, and for sure we would have no fun ever again. Were we having fun? Was this all worth it? Skewed awful thinking yes, it is also true, yes it is. Ask any addict.
We need a new way of thinking and implementing the recovery process.
The one idea that has always been at the back of my sick mind, until I became not sick, was the idea that we as addicts need a place to call home or sense of being ‘at home’, where we as addicts, and we as helpers are on the same page, and in the same area 24-7. Where we become one with the knowledge of how, why and what does it take. And now that we have put in the grueling torment of recovery time, we need a home base for others recovering from a life changing event that is killing us one by one every day. There were 367 deaths from opiates in 2016 in Maine alone.
El Rancho De La Vida is that place. The Ranch of Life is where human beings can get back their humanity, and eventually be there for the next addict that comes into our lives. We want to care for the sick and mind-altered addicted persons because of skewed thinking, so that they can care for the next person and so on. One addict helping another, while sharing important life coping skills that each of us has acquired through sobriety. We have learned to live clean then schooling ourselves, and then working within professional ties. One person may come in with knowledge of cuisine. Why do we not celebrate that person by giving them a place to recover (to get back) one’s life, but the 2.0 version of their life.
The Ranch is the only avenue bold enough to be a real stepping stone for starting recovery and being recovered, through feeling empowered that you have now taken a choice to get well, and look forward to a life that matters. We want all of these people at The Ranch. We will not tolerate violence. That is the only line we will draw. If you have anger management problems, most likely you are not a violent person. You have become angry because inside, you know you are better that that.
El Rancho De La Vida will be a Non-Profit recovery and Life Ranch with 100+ acres of Farmland, woods, fields and a real working ranch with cattle and cowboys, Recovering cowboys living at a place that does not punish or discriminate because of your lust for passion. That is a human quality, passion that is. We need to adapt passion for inner peace through drugs, alcohol and other self empowering needs, so that we can always look forward to a rewarding feeling, when we do good works. The Ranch will be staffed by anyone in recovery who has battled with and won. We are recovering addicts who want to put other’s addictions before them. That includes Addiction Specialists like medical doctors who are in recovery and have rejoined their clinical colleagues, but feel out of place at a typical hospital or private practice.
Nurses who are in long term recovery who have a true passion for being where they do their best work, and counselors and administration staff in recovery are the front line workers at The Ranch.
Imagine for a second, one on one counseling on horseback. Or, imagine discussions while walking through fields of gold, without the constraints of modern, clinical buildings that have no personality. Imagine, Snowy afternoons on a ridge with a person beside you that is listening and compassionate, advising only if the person asks for help, or advice. We want to be there for all of us that battle with being inherently human, with its faults, and its immense pleasures.
Imagine, for example, the feeling of being in love. That is a human pleasure that most of us have turned off long ago, or forgotten about completely, on our own accord or through the devastating effects of the chemicals and lifestyles we thought would get us through.
Then a certain type of magic will occur, totally out of respect for one human, being with another human being that has run head first into a wall of shame doubt and anguish. The entire community will be built around safety, comfort, humane treatment for a disease that does not conjure the word comfort, when thinking about recovery from our previously insane life style. The Ranch is ‘the place’ I have had on my mind ever since I entered treatment for my heroin addiction.
El Rancho De La Vida will be built and hopefully staffed by the very people who can understand the insanity of active addiction. We want to help, and we will make a difference, while not profiting from the pain of another human being.

A personal entry from Jamie and My band; Lebish And Grinnell Music to Thank The Akademia Music Awards for winning Best Hard Rock Song

Dear Lebish And Grinnell,

We wanted to take this opportunity to formally congratulate you on winning The Akademia Music Award for Best Hard Rock Song for ‘Final Approach’ in the March 2016 Akademia Music Awards! The results are now available and public at:

http://www.theakademia.com/home1 This page includes the general announcement and some artist features.

http://www.theakademia.com/winners1 This page lists all of the March 2016 winners in your review group.

http://www.theakademia.com/march2016_bestsong_hardrock1.html This page is your permanent award certificate page.

Be sure to share your achievement with family, friends and fans. You’ve worked hard and you deserve it. Your award certificate page will remain active for years to come and may be shared easily via email, Facebook, Twitter and other sites by copying and pasting the URL page link.

Winning an Akademia Award is a rare career distinction. It also means you are now inside the gates of an organization that can significantly advance your career as an artist. We will be in touch with you shortly regarding the next campaign steps. In the meantime, please be sure to like and follow us at the following portals, as we’ll also be promoting award winners through these portals in the coming weeks.

http://www.facebook.com/TheAkademiaMusicAwards

http://www.twitter.com/AkademiaAwards

http://www.youtube.com/AkademiaAwards

Please accept our warmest congratulations from The Akademia team on your outstanding achievement in the field of music. We look forward to working closely with you to advance your music career.

Kind regards,

The Akademia

CAUTION;SMOKING MAY LEAD TO BANK ROBBERY: The True Trials and Tribulations of a Jewish Bankrobber


My Book has been published in MedCrave
I am beside myself as this was a Final 4th step attempt for my (A/A-N/A) Step Work….It became a manuscript, to a full paper and Book available on Amazon EBooks.
http://www.amazon.com/dp/B014DTUE0O/ref=cm_sw_r_fa_dp_xP7ewb0SP84CV

Please pay attention to this If you or anyone you know is suffering from Alcohol or Drug abuse. A first person narrator of a True Story of a Man going through a Journey of self discovery.
Thank you for letting a voice stand out of the shadows. Recovery is Real.
Jamie

BLOG & NEW POSTINGS October 30, 2015 – Bill White- DR. VINCENT DOLE (1913-2006) ON METHADONE MAINTENANCE TREATMENT

Dr. Dole always regarded methadone as a legitimate medication to normalize aberrant metabolism and thus behavior in the chronic disease of opioid addiction…Dr. Dole was always at the service of patients and advocacy groups to help resolve issues of stigma and misdirected policies…–Herman Joseph and Joycelyn Sue Woods, 2006
In 1964, Dr. Vincent Dole and two colleagues, Dr. Marie Nyswander and Dr. Mary Jeanne Kreek, pioneered methadone maintenance in the treatment of heroin addiction. A half century later, their work stands as a pivotal milestone in the history of addiction treatment. Few subjects within the history of addiction treatment have elicited greater heat and less light than the rhetorical debates that long raged and continue today on methadone maintenance treatment (MMT). I have detailed earlier (see here) my transformation from a rabid critic of MMT (a role I acquired by osmosis during my early years in the field) to a supporter of MMT and other forms of medication-assisted treatment (MAT), even as I sought to elevate the quality of such treatments. The papers and speeches I made on MMT/MAT (see here, here, and here as examples) generated some of the harshest criticisms of my professional career.
As MMT passes the half century mark, I thought it appropriate to revisit some of the original MMT papers authored by Dr. Dole and co-authors. In rereading these early papers and Dr. Dole’s later reflections on the evolution of MMT, I was struck anew by his passionate appeals for science-grounded addiction treatment and by his fierce loyalty to the needs of patients. I recalled that same passion when I interviewed him as part of my research for Slaying the Dragon.
All addiction professionals and recovery support specialists should be knowledgeable of the science and history of MMT. I have highlighted below some excerpts from the papers of Dr. Dole to provide some historical perspective on the evolution of methadone maintenance as practiced in the United States—in Dr. Dole’s own words. I hope to return later to highlight the thought and work of his collaborators, Dr. Nyswander and Dr. Kreek.
On His Initial Introduction to the Addictions Field
“I said what a shame it was that there was none of the scientific thought in the field of addiction that I had encountered in my other researches. It didn’t have recognition as a scientific problem.” (1989)
On Perception of Persons Addicted to Opiates
“. . . the traditional image of the narcotics addict (weak character, hedonistic, unreliable, depraved, dangerous) is totally false. . . .I had an exceptionally gifted teacher, Marie Nyswander, who taught me how to listen to patients rather than rush into their problems with pre-formed judgements. . . .the typical heroin addict is a gentle person, trapped in chemical slavery, pathetically grateful for understanding and effective treatment. In short, a sick person needing treatment.” (1994a)
“. . . it must not be too quickly assumed that these are weak individuals who would fail in society if relieved of the compulsion to obtain drugs. The potential strengths of addicts, like their faults, cannot be judged while the addicts are trapped in the orbit of drug abuse.” (Dole & Nyswander, 1967)
Nature of Opioid Addiction / Rationale for MMT
“It is postulated that the high rate of relapse of addicts after detoxification from heroin is due to persistent derangement of the endogenous ligand-narcotic receptor system and that methadone in adequate daily dose compensates for this defect…methadone maintenance provides a safe and effective way to normalize the function of otherwise intractable narcotics addicts.” (1988)
“The most important principle to recognize is that addiction is a medical disease. And, as a medical disease, it’s the responsibility of the medical profession. . .” (1996)
“It is important to distinguish the causes from the consequences of addiction . . . The rapid disappearance of theft and antisocial behavior in patients on the methadone maintenance program strongly supports the hypothesis that the crimes that they have previously committed as addicts were a consequence of drug hunger, not the expression of some more basic psychopathology.” (Dole & Nyswander, 1967)
On Complexity of Opioid Addiction and MMT
“I urged that physicians should see that the problem was one of rehabilitating people with a very complicated mixture of social problems on top of a specific medical problem. . . The strength of the early [MMT] programs as designed by Marie Nyswander was in their sensitivity to human problems. The stupidity of thinking that just giving methadone will solve a complicated social problem seems to me beyond comprehension. . .” (1989)
On Perception of MMT as “Drug Substitution”
“This medication [methadone] given in fixed dose to tolerant subjects, does not make patients “high” or cause any other narcotic effects. On the contrary it eliminates the abnormal euphoric responses of addicts to narcotic drugs.” (Dole, Nyswander, & Kreek, 1966)
“What was not anticipated at the onset was the nearly universal reaction against substituting one drug for another, even when the second drug enabled the addict to function normally. . . . The analogous long term use of other medications such as insulin and digitalis in medical practice has not been considered relevant.” (Dole & Nyswander, 1976)
On Functioning of MMT Patients
“[MMT] patients are normally alert and functional; they live active lives, hold responsible jobs, succeed in school, care for families, have normal sexual activity and normal children, and have no greater incidence of psychopathology or general medical problems than their drug-free peers.” (1988)
On Importance of Service Relationships within MMT
“Like teachers in a one-room school, we knew each patient personally. The ones in trouble were seen more often, the successful ones, less often; all were followed closely enough for us to know what they were doing.” (1971)
“I made a practice of spending two or three hours almost every day just sitting and talking with the addicts in a somewhat aimless way. I was just trying to get a sense of their way of thinking, their values, their experiences. They educated me about a world that was out of my reach, one that I had never been in and would never enter.” (1989)
“The most that any chemical agent can do for an addict is to relieve his compulsive drive for illicit narcotic. To give him hope and self-respect requires human warmth; to become a productive citizen he needs the effective support of persons who can help him find a job and protect him from discrimination. It is these human qualities that the treatment programs of the past five years have failed.” (Dole & Nyswander, 1976)
“. . . with addiction we’re dealing with a disease in which human relationships are integral to rehabilitation. (1989)
On Early Fears about the Future of MMT
“The success of this treatment in rehabilitation of addicts will decline significantly if methadone programs cease to be medical institutions, and instead become instruments of another bureaucracy.” (1971)
On Early MMT Expansion
“The difficulty was not that methadone expanded, or that it did so rapidly, but that it expanded faster than medical competence developed. . . . across the country people who had very little understanding of the pharmacology of methadone, and no comprehension of the wider array of medical and social problems presented by addicts, jumped into the field, feeling that all they had to do was hand out the drug.” (1989)
“. . . abstinence rather than rehabilitation was restored as the goal of treatment; doses were lowered to levels that were frequently inadequate; administrators became punitive and often contemptuous of the patients’ (now called “clients”) termination of maintenance was encouraged despite an 80% relapse rate…Underfunded, crowded, operating in poor quarters, harassed by teams of inspectors who criticized their deficiencies without providing money or political support for improvement, with a negative image fueled by disinformation in the media, the methadone clinics nevertheless survived, thanks to the dedication of their overworked staffs.” (1999)
On Coerced Involvement in MMT
“Is it proper for a judge to force treatment on an addict by sentencing him to a maintenance program? Is it advisable for a physician to accept patients on these terms? I would say definitely no to both of these questions. . . . I would object to the imposition of methadone maintenance treatment just as strongly as I have objected in the past to its unavailability . . .” (1971)
On Withholding or Reducing Methadone Dose for Rule Violations
“The results are generally poor, as might be expected from the fact that limiting or withholding medication that reduces drug hunger increases the need for illicit narcotics.” (1988)
On Regulation of MMT
“Bureaucratic control of methadone programs has given us “slots,” a rule book, and an army of inspectors, but relatively little rehabilitation.” (Dole & Nyswander, 1976)
“True patient-oriented [MMT] treatment guidelines will emerge when the medical profession insists on applying the same standards of chemotherapy in addictions as it applies to chemotherapy in infectious disease, cancer, schizophrenia, depression, and endocrine disorders.” (1992)
“. . . the contempt with which many regulators and program administrators have treated their [MMT] patients seems to be scandalous.” (1996)
On Termination of MMT
“. . . methadone patients are not necessarily committed to a lifelong dependence on the medication. A significant fraction of the abstinent ex-addicts in New York today has previously been stabilized and socially rehabilitated in methadone programs. The key to this result is the realization that the most important objective in treatment of an addict is support of good health and normal function. This may or may not require continuation of maintenance.” (1994)
“The question of whether and when to discontinue methadone therapy can be answered in medical terms if the treatment is judged by the same standards as apply to other chronic diseases.” (1973)
“. . . the possibility of detoxification should be evaluated on an individual basis, taking into account the patient’s own desires in the matter, his progress in rehabilitation, and the potential hazards of relapse.” (Cushman & Dole, 1973)
On Predicting Positive Outcomes Following Termination of MMT
“Available data suggest that the longer a patient continues in a maintenance program that provides adequate doses (e.g., five years or more), the greater his or her probability of permanent abstinence after termination of [MMT] treatment. Apparently, the neurochemical adaptations produced by thousands of heroin injections (with sudden impact on the nervous system and rapid elimination) are capable of gradual repair in some cases under the steady conditions of methadone maintenance.” (1994)
On the Need for Post-MMT Recovery Checkups
“A good physician, experienced in treatment of chronic disease, will weigh these factors before attempting detoxification and will follow his patient for several years afterward, keeping the door open for return to maintenance if indicated.” (1973)
On Patient Advocacy
“. . . I think methadone patient advocacy groups are going to grow in proportion to the numbers of people or programs who abuse their powers over methadone patients.” (1996)
Future View of MMT
“I would say 30 years from now that current attitudes regarding methadone as substituting one drug for another and other negative outlooks on drug addicts in general will seem pretty archaic. What’s happening today seems more like a carryover of medieval attitudes that affected much of the thinking toward mental illness in the last century.” (1996)
“Methadone is very valuable in controlling a specific kind of addiction, namely opioid addiction . . . But the emphasis should be on the fact that you’re controlling the disease; you’re not curing the disease. In time, and with full knowledge of all disturbances to in the neurohormonal systems in the brain, we may find ways to remedy and cure or restore a person to “normal”.” (1996)
On His Involvement with Alcoholics Anonymous
“. . . before accepting the position [non-alcoholic trustee of the Board of A.A], I discussed my research with Executives of the fellowship and raised the question as to whether this appointment might involve a conflict of interest. . . . The insisted that they saw no problem. . . They were right. There never has been a problem in my association with AA, and my admiration for Bill Wilson and the dedicated AA members that I came to know increased over the years.” (1991)
“At the last trustee meeting that we both attended, he [Bill Wilson] spoke to me of his deep concern for the alcoholics who are not reached by AA, and for those who enter and drop out and never return. . . . He suggested that in my future research I should look for an analogue of methadone, a medicine that would relieve the alcoholic’s sometimes irresistible craving and enable him to continue his progress in AA toward social and emotional recovery, following the Twelve Steps.” (1991)
References
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Dole, V.P., Nyswander, M.E., & Kreek, M.J. (1966). Narcotic blockade. Archives of Internal Medicine, 118, 304-309.
Dole, V.P., & Nyswander, M.E. (1967). Heroin addiction—a metabolic disease. Archives of Internal Medicine, 120, 19-24.
Dole, V. P. (1971). Methadone maintenance treatment for 25,000 addicts. Journal of the American Medical Association, 215, 1131-1134.
Dole, V.P. (1973). Detoxification of methadone patients and public policy. Journal of the American Medical Association, 226, 780-781.
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Dole, V.P. (1989). Interview. In D. Courtwright and J. H. Des Jarlais, Addicts who survived (pp. 331-343). Knoxville, TN: The University of Tennessee Press.
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Dole, V.P. (2002). Conversation with Vincent Dole. In G. Edwards (Ed.), Addiction: Evolution of a specialist field (pp. 3-10). Oxford: Blackwell Science Ltd. (Reprinted from Conversation with Vincent Dole, by Dole, V.P., 1994, Addiction, 89, 23-29).
Joseph, H., & Woods, J. S. (2006). In the service of patients: The legacy of Dr. Dole. Heroin Addiction and Related Clinical Problems, 8(4), 9-28.