Shipbuilders of Sunken Vessels:  Quick Dispatches from the Belly of the Treatment Industrial System

A confession: although I’ve been clean and sober for 11 years, I didn’t go to a 28-day treatment facility. When I reached the jumping-off point, the spot where suicide made more sense than simply wishing for death, I was lucky enough as a veteran to walk into a VA facility and say, “I’m Keith Howard and I don’t want to be alive any more.” From that short sentence, I was detoxed off alcohol—my poison of choice at that point was stolen dollar-store mouthwash—and introduced to a program of recovery that remains central to my life.  After a five-day stay, I was discharged and told to go to meetings. I did. It worked and I’m here to write about it today.

“Here” is Los Angeles and my putative purpose is the Evolution of Addiction Treatment Conference, a five-year old gathering of treatment professionals. Apparently, four or five conferences are held each year in Cape Cod, Palm Springs and other epicenters of the addiction challenge. I used the word “putative” because I’m really here for the first West Coast Faces and Voices of Recovery Mid-Year Leadership Retreat, held concurrently with the treatment conference. Like Rodgers and Hammerstein’s Rancher and Cowman, treatment and recovery folks should be friends, although that’s not often the case, with treatment folks relying on a clinical model and recovery people favoring peer-based supports. In short, and perhaps unfairly to both, treatment partisans believe letters after one’s name are important while recovery supporters see lived experience as key.

Anyway, I’ve got a free morning until an afternoon-long leadership meeting, so I’ve been chatting with a variety of treatment professionals. Despite my introversion, I can strike up conversations with most anyone. Here are some quick impressions:

–Addiction treatment is an industry, and like all industries it needs to grow to survive. I had an interesting conversation with a marketing exec for a California treatment center where they’re broadening the treatments they offer to include “addiction” to smartphones and other technologies. While I’ve broadened my view of what the solutions to addiction can look like, I’m a bit put off by the word used to include every damn behavior. During our conversation, my newfound acquaintance told me “addiction” only requires two behaviors: 1) You sometimes do more than you’d intended to, and 2) you continue despite negative consequences. Thus the following are some of my addictions:

Poker

TV news

Stephen King novels

Peanut M&M’s

Conversations with marketing execs for treatment facilities

–I’ve been invited to be part of a focus group for a treatment facility. Not because I run a recovery center. Not because I’m an active member of a recovery program. Not because I’m from New Hampshire.

I’m invited because I’ve never been to treatment and that’s apparently a black-swan event in this field.

–Interesting conversation on data with the director of an Arizona treatment program. She believes follow-up phone calls to discharged patients after 30 days, 90 days and one year are an appropriate way to determine program success. Apparently these phone calls consist of asking the former patient whether they’re using and whether their lives are better. Her concern was that it’s hard to find people after 30 days, much less a year, and that her statistics were meager because of that. When I suggested the problem might lie in asking people with substance-use disorder to be honest about their usage, she looked at me blankly. I said I spent 30 years lying to people about my drinking and drug use. She responded that if that’s true, every treatment facility faces that problem so statistics are still comparable.

People lie at the same rate no matter who the questioner, so we can trust the results of these lies? Oh.

–Treatment folks I’ve talked with seem to think the 28 days users spend in treatment is the most important part of the solution to addiction. They’re very concerned about how to structure that time and what modalities to use, with little regard for the following 20, 30 or 50 years after treatment. In fact, there’s some expectation users will go through treatment multiple times. It’s like talking with representatives from the boatbuilding industry who are focused on the mechanics of ships and their creation while ignoring all the sunken vessels clogging up the harbor’s mouth. After all, those boats can be rebuilt in 28 days and sent out to sink again.

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