As a licensed alcohol and drug counselor Boston Medical Center’s Project ASSERT, part of the Grayken Center for Addiction, I treat patients at all stages of recovery. From the bedside of a patient who has just experienced an overdose, to the person who was in remission for two months before another relapse, to the person ready to start medication for addiction treatment — I see it all. My own personal experiences with addiction recovery have allowed me to be a powerful advocate for my patients.
For nearly 20 years, I was living in the throes of an opioid addiction on the streets of New York City. Somewhere along the line, someone saw in me what I couldn’t. When I finally went into long-term treatment at Project Return in the Bronx — unfortunately no longer in operation — my counselor, a woman named Alvera, told me, “You are a human being who is loved, and until you learn to love yourself , I will love you.” She and many others built me up to a place where I felt confident enough to go on and maintain my sobriety at whatever length I had to.
I’ve never forgotten her, and I try to be an Alvera to the people who come to see me.
I’ve been through many phases of recovery but have been in sustained remission for 23 years — 19 of which I’ve been working in this field helping others. Those personal experiences allow me to know intimately the behavioral aspects present in addiction and fully recognize that the person in front of me is a human being deserving of care. I can empathize and provide knowledge from this unique perspective and can identify with the most stigmatizing parts of addiction and recovery, including relapse.
Understanding how trauma develops with addiction
We know that the data shows how the COVID-19 pandemic has worsened the opioid crisis. Personally, anecdotally, I have heard scary stories about people who have had long-term, 20-year-long recovery who have slipped during the pandemic. I do hear about a lot of people going to treatment and staying sober, too — I must emphasize that — so in my experience, the news isn’t all grim. But what it shows me is that we collectively are not doing a good enough job addressing the unbroken cycles of trauma that lead to addiction.
The population I work with here at BMC is composed mostly of housing insecure or unhoused people caught in the grip of addiction. I see a lot of people with generational addiction; the babies of people I treated 20 years ago are now becoming adults and they’re struggling with the same problems their parents were.
“We collectively are not doing a good enough job addressing the unbroken cycles of trauma that lead to addiction.”Click To Tweet
Trauma is, I can say confidently, at the root of addiction for about the vast majority of the people I meet and is rarely treated appropriately. It’s very difficult when trauma is very acute — it’s hard to address because for so long we’ve treated mental and behavioral health as something entirely separate from physical health, when the two things are so undeniably intertwined.
On the one hand, I understand the struggle within the medical community. It’s hard to have a struggling patient stay in one physical place long enough for us to truly help them work through trauma, and, in my experience, many people who are struggling with trauma and addiction have difficulty staying focused long enough to address it. In my case, it took me 20 years to feel good with myself and recognize the trauma that I’ve been through in my life, so I can imagine what my patients are going through.
Unfortunately, large portions of the medical community don’t understand this.
Still, today, some practitioners still use words like “alcoholic” or drug-seeker,” as opposed to “person struggling with alcohol dependence.” I’ve even heard people referring to patients with SUD as “junkies.” To be clear: These labels further stigmatize and ostracize people with substance use disorders, which can — and does — lead to patients forgoing their care for their SUD and other health needs.
My own experience with the system has allowed me to adopt a person-first, harm-reduction model of care where I treat the person like a human being with compassion and care, period. That’s the solution.
What harm reduction looks like in the addiction field
For the first seven years of my being a provider, the addiction field was focused on the abstinence model — commonly, the 12-step model. The abstinence model is not realistic for every person and every circumstance. People are not often ready for total abstinence. Harm reduction, which is where the field is focused now, prioritizes survival and centers the person suffering, which is critical.
That’s how I work with my people. What it looks like in practice is that, if we are going to do this counseling work together and they’re going to continue using for the time being, I ask them to let me help them connect with a needle exchange program like AHOPE. I’ll also provide education around safer injection or put them in touch with a recovery coach for someone to guide them through the process of recovery when they’re ready.
“Harm reduction…prioritizes survival and centers the person suffering, which is critical.”
Another resource we have at BMC now is referring patients to the Roundhouse hotel, which I do frequently. What’s significant and very, very important about having the Roundhouse is we see a lot of people here who need immediate, acute care. For example, I had a gentleman that came in recently who needed withdrawal management. We couldn’t get him placed anywhere because of the shortage of beds in Boston. So, I sent him to the Roundhouse for the evening. He had some withdrawal symptoms during the evening, but he was able to come right back in the next morning, and we placed him in longer-term treatment. It’s critical having the Roundhouse; having it as a resource allows patients and providers some peace. Even if people are only there for a 24- or 48-hour period; it’s a safe place where people are monitored and cared for.
Another harm reduction approach is connecting patients with providers to speak about medication for addiction treatment (MAT). There’s a very wrong-headed perception that MAT is not “true” remission. This is categorically, unequivocally false. MAT, in combination with behavioral therapy and counseling, is clinically effective at preventing death and the need for detox. MAT may not be the right path for everyone, but it is a proven treatment that helps many people get on track to a better, more fulfilling life. In my opinion, the next step is creating residential centers that are focused on medication for addiction treatment. There can no longer be a stigma to MAT — it saves lives.
“That’s a huge part of what I do in my work: move forward with people, no matter where they are.”
My personal experience in recovery helps me remember that treatment is not one-size-fits-all, and I must use a different approach depending on where each individual is coming from. I often say to people in my care, “To stay in recovery, you have to be comfortable with being uncomfortable.” I sit with them in the discomfort to let them know they’re not alone. It’s part of it. They must feel that discomfort before we together can move forward.
That’s a huge part of what I do in my work: move forward with people, no matter where they are. The longer I work in this space, the more I see how invaluable my lived experience is in treating patients with SUDs. Not only can we provide a unique lens for our patients, but we can assist in building recovery models that actually work and educate our peers who don’t have that same lived experience. My being in recovery doesn’t define me as a human being. However, it does play a big role in what I do. For me, working in recovery, it’s a life mission.