I had written on Facebook about praying on Monday this past week about the two women at Titus 2 and reminding God that he had promised to bring women to us for help.
Truth be told, as I prayed about the 2 women at Titus I wondered at the decreased number of applications that have come to us in the last few months. I asked God if he was reducing the number as a prelude to bringing Titus 2’s ministry to a close altogether. A flurry of applications a while back all came from a single source and confirmed what I had heard elsewhere…. that there is a coordinated effort (with government funding) at work by certain agencies to shift toward Medication Assisted Treatment – with substitutes for the drugs of abuse by putting people on vivitrol, just as has been being done with methadone or suboxone for nearly 10 years. One for-profit treatment and counseling agency that oversees vivitrol treatment contacted me to “educate me” on the benefits of vivitrol and ask me to allow women on vivitrol to come to Titus 2.
Vivitrol is a once a month medication that reduces craving by blocking the pathways in the brain where cravings arise in those who have been using addictive drugs. Vivitrol itself is not “addictive”, it doesn’t induce a “high”. It simply blocks the nerve receptors so that they cannot be excited by opioids or alcohol. And if one with an addiction cannot achieve a “high” using alcohol or drugs, what’s the point? Right? It is supposed to be used in conjunction with counseling and must be re-administered monthly. Physically preventing the craving while counseling toward a more stable, work-ordered lifestyle appears to be the up and coming solution to a community drug abuse problem. So much so that it is being promoted within the substance abuse education program at the local jail and treatment is being initiated before people are released. And, on the surface, I agree that MAT is probably the only means of managing the addictive behavior of some people. Law enforcement agencies appear to be embracing Medication Assisted Treatment in an effort to reduce repeat arrests of drug abusers. It is being managed as a medical issue, not a criminal issue. It is viewed as a compassionate and, theoretically, a less costly alternative to incarceration.
I am philosophically opposed to this new MAT modality for treating addiction. I am open to psychiatric medications used for mental health diagnoses like depression, anxiety, PTSD, etc. and Titus 2’s guidelines allow many of those psychiatric drugs, as long as they do not have potential for addiction themselves. We are as concerned with one’s attitude toward her medications as we are with the medications themselves. Does the individual believe that it is primarily the medication that will give her freedom from the emotional/psychological dysfunctions she has experienced in her life in addiction? Or is she willing to explore the underlying causes that led to substance abuse, engage in psycho-education and life skills training, be transformed by the Word of God and relationship with Christ and in faith community, and trust that God can help re-orient her life toward new conditions of life…….setting aside the “people, places, and things” of the past and building a new foundation altogether?
Titus 2’s approach is intensive and long term. Not everyone will take the time and have the patience and commitment for this approach. There aren’t enough beds at Titus 2 or anywhere else for all the people in need of help and many of them wouldn’t submit to the long term transformational process anyway. So, Medication Assisted Treatment (or as I think about- it Drug-for-Drug Substitution Treatment) is a reasonable alternative to long-term intensive transformational treatment for many addicts.
I raised this issue while I was still at Bethel Village and PCRM. Each program has to evaluate how Medication Assisted Treatment with vivitrol (or methadone and suboxone) fits with its philosophy and goals. Even Celebrate Recovery and other support programs for addictive behaviors have to decide how they will view MAT. If someone is sober only through the use of a substitute drug, is he really “sober”? It is medically managed addiction, not victory over addiction.
I have given quite a bit of thought to this issue since it became clear a few months ago that MAT is a government-promoted solution to our country’s addiction problem. The philosophy under which Titus 2 was formed and our commitment to life transformation through discipleship and mentoring will continue. I expect that in another 12 months or so we will begin to see applications from individuals who have failed on MAT due to not keeping their appointments for monthly administration of medications or their weekly counseling.
There are programs to help people manage addiction and there are programs that seek to help people be free of substances (and behaviors) of abuse. We will continue as we have in the past as long as God brings women to us. Titus 2 is not in business to provide a service for fee, to secure government funded grants, to employ people, or to make money for stockholders or business owners. We are in ministry to serve God and the people God brings to us. Each applicant will be considered on the basis of her personal goals in recovery and whether they are compatible with what we view as God’s call for us in ministry to women in crisis.
3-24-19 Post-It Note:
As we have worked through the community’s growing commitment to Medication Assisted Treatment regimens, Titus 2 has found one application where the use of Vivitrol appears to be working. Among older (40-something) females with recurring relapses on alcohol for whom alcohol is the only problem, Vivitrol administration and the accompanying intensive counseling, individual and group, is proving to be helpful. Titus 2 has referred a third client to local mental health providers for Vivitrol treatment. After 4-6 months in the program, we are seeing hopeful results – new insights and increased confidence that one can have freedom from craving. Even so, it is still clear that the greater advantage is in the counseling that is changing the clients’ minds about how they think. They are realizing that the root of the pain that sends them seeking escape through alcohol lies in their sense of isolation, depression, lack of vision for their future, boredom, anxiety, unresolved emotional issues, etc. Is there a time at which there will be sufficient healing to allow them to get off of the monthly Vivitrol injections? Is that part of the plan? It remains to be seen.
1/11/2018
I have come to accept and even appreciate the current initiative to reduce alcohol and opioid abuse with Vivitrol. We are actively enrolling certain clients in the available programs….specifically those non-polysubstance abusers with alcohol addiction who truly want to be free of their cravings and the dysfunction of their alcohol-abusing past. Already it is becoming obvious that some people who are treated for opioid addiction will simply continue on the Vivitrol medication, but will resort to alternative substances to continue getting high….like meth….for which Vivitrol offers no benefit. The counseling component of the Vivitrol program is vital to its success. ..and then really only for those who are truly ready to change.. Those with a history of polysubstance abuse who are forceably required to participate and who are quite happy with whatever substance they can get to continue their romance with the “high” will be no better off with Vivitrol than with incarceration…..and may be in even greater danger from lethal street mixes of potent illegal drugs when the Vivitrol prevents them from getting the “high” from alcohol or opioids.