Pubdate: Sat, 24 Jan 2015
Source: Montreal Gazette (CN QU)
Copyright: 2015 Postmedia Network Inc.
Contact:  http://www.montrealgazette.com/
Details: http://www.mapinc.org/media/274
Author: Laura Beeston
Page: B3

KICKING THE HABIT

Opinions Differ on Which Treatment Approach Is Most Effective for Cocaine Users

In Montreal, it's relatively easy to find cocaine and get high.

Even though the next day comes with a requisite crash of the 
neurochemical dopamine, one partygoer might sleep it off and continue 
to use casually, or not at all. Another might keep using, attempting 
to regulate short-term feelings and find that euphoria, eventually 
becoming addicted.

As pervasive as the use of this drug may be, Sante Montreal says it 
has no specific information how many cocaine addicts there are in 
this city. Health Canada statistics from 2011 indicate that 9.4 per 
cent of Canadians had used illicit drugs over the last year, with 0.9 
per cent using cocaine or crack.

For those who do become addicted, the picture can be bleak. A recent 
Universite de Montreal study found that cocaine users are twice as 
likely to attempt suicide as those abusing other drugs.

Lilian Vargas, human resource agent at the Addictions Centre of 
Laval, says it's not likely the rate of cocaine addiction in Montreal 
will decrease in the short term.

"Society puts a lot of pressure on people to be effective, to 
perform, to do well," she says. "There is less emphasis on community 
.. so there is certainly an increase in clients who say they feel 
lonely. There are a lot of lonely people in Montreal, struggling with 
feelings of isolation. How they deal with that is by drinking or 
using drugs. That's increasing more, for sure."

And since every addict is different, expert opinions also vary on 
which approach to treatment is the most effective.

Robert, a Montrealer in his late 50s, has been sober for 31 years. 
(He agreed to speak to the Montreal Gazette on condition that only 
his first name be used.)

By the time he was 28, he says, "I was at my bottom. ... Then I was 
given another opportunity to get treatment in Alcoholics Anonymous.

"I went away and worked the steps, which is what we take with us when 
we live our life outside. When you leave that room, you have to 
function and make decisions all day long. I use these steps to help 
maintain a good life."

Founded in 1935, AA and its 12-step approach has branched off into 
groups supporting a wide range of compulsive addictions, including 
drug use. Cocaine Anonymous (CA) was first established in the United 
States in 1982, and was started in Montreal in 1986. Robert was a 
founding member of the local CA branch, the first of its kind in 
Canada, and today is its public information chairman.

While CA chapters in Quebec keep no official data on its membership 
numbers, Robert estimates between 3,000 and 4,000 CA members used 
French and English services across the province in 2014.

Cocaine Anonymous held a bilingual convention in Montreal this month, 
from Jan. 16 to 18. The event welcomed hundreds of CA members from 
Quebec, Ontario and the United States, Robert says.

"The point of all of this is to let addicts know that there is a 
place for them," he says. "There is a room for addicts every night 
with chairs that should be filled to the rafters, but they're not."

Anonymity is a central tenet of the 12-step programs, as is complete 
abstinence. Group therapy is led by the addicts themselves. Members 
who relapse are welcome back "with open arms," Robert says, although 
their sobriety count returns to zero.

The 12-step program offers a sense of community, the feeling of not 
having to go it alone, and having the personal support of a sponsor.

Both AA and CA still follow the "Big Book" of steps - 12 rules 
derived from the original founders of AA in 1939 - including belief 
in a higher power, turning oneself over to God "as one understands 
Him," taking a moral inventory, and the promise to carry the message 
forward. It is one of the best-selling books of all time.

Robert cannot comment on the success or relapse rates of CA but says 
that attending a meeting every day for the past three decades is what 
has worked for him. "It's just one addict helping another."

Twelve-step abstinence programs are often the first things people 
associate with treating drug dependencies, but there are other 
approaches addicts can take when seeking out help.

Vargas says one problem is that people simply don't know what kind of 
help is available.

The provincially funded clinic is part of the Association des centres 
de readaptation en dependance du Quebec. One of 16 centres, the 
organization sees 57,000 cases annually and estimates 30 per cent of 
clients are youth under 25 years old.

Vargas says she wishes more users were able to talk about their 
problems with a doctor, counsellor or psychologist, but understands 
"that first step is very hard."

What many people also don't realize, she adds, is that a clinical 
assessment is free in Quebec. Every addict who walks in the door is 
seen for a clinical evaluation to identify specific dependencies and 
its impact on their quality of life, as well as given care by a nurse 
and psychologist. Recommendations for treatment, then, depend on 
their individual situation.

Vargas has been working in the addictions counselling field for three 
years, and sees a diverse caseload of up to 50 or 60 clients 
individually and in groups. For external, outpatient programs, the 
centre often advocates group therapy, Vargas says, and she has seen 
it "have a positive impact because people don't feel so alone."

Unlike AA, group therapy at the Laval centre is led by a certified 
psychologist or therapist, who will set up addicts with 12-step 
groups for medium-to long-term programs for extra support.

"We see lots of people who don't have faith so don't see (12-step 
programs) as a place to get help," she says. "(But we tell addicts) 
if they don't have religious beliefs, they can turn it into something 
else that's spiritual. ... We recommend to people to go there for 
support, take what they rely on, and don't take the stuff they don'."

Drug addiction researchers seem to agree that while ongoing support 
will help addicts improve their chances for long-term recovery, the 
spectrum of available treatment options ought to be better understood.

One of these researchers is Dr. Lance Dodes, who has been working 
with addicts since the 1970s, becoming an outspoken critic of the 
12-step method after studying its success rates.

An assistant clinical professor of psychology at Harvard Medical 
School and an analyst emeritus at the Boston Psychoanalytic Society 
and Institute, Dodes is the author of several books, including The 
Sober Truth: Debunking the Bad Science behind 12-Step Programs and 
the Rehab Industry.

Using 50 American AA case studies, Dodes argues in his book the 
success rate of 12-step programs is between five and 10 percent. 
Rather than a predisposition or moral failing, he says, "addiction is 
a psychological symptom; a mechanism that is a subset of 
psychological compulsions" and that many factors can contribute to 
addictive behaviour. Over the course of his career, Dodes has found 
that addictive acts serve as a way to restore a sense of power when a 
person feels helpless.

"People switch addictions all the time, so that suggests there is 
something the same about them, that they serve the same purpose," 
Dodes said in an interview from Los Angeles, suggesting therapy, 
secular sobriety programs and harm-reduction methods to those who 
can't work 12-step programs.

"No one talks about the fact that it's actually harmful for (addicts) 
to go to treatment that will not help them," Dodes says. "For most 
people, it's useful to understand how their mind works ... so they 
can anticipate and understand the next time they feel an addictive urge."

At the Addictions Centre in Laval, Vargas agrees that finding 
treatment that suits the addict's needs and personality is one of the 
biggest challenges of the work, as is seeing clients through relapse 
- - something that is often part of the healing process.

"We place success on a spectrum," Vargas explains. "The addicts are 
the ones who decide to reduce or maintain abstinence (since) they are 
the ones who are making the effort to change. It has to come through them."

Roxane Beauchemin, the director of clinical services with CACTUS 
Montreal, has worked primarily with injecting drug users over the 
last 17 years and adheres to a similar individualized, harmreduction approach.

"In our work, we strive to educate people about best practices, 
inform them of treatment options and give them the materials they 
need to reduce their risk," Beauchemin says. "The intervention 
depends on the capacity of the person who wants help. ... We do not 
operate as though they are powerless; we give them the 
decision-making power. ... We ask them, 'What do you need right now? 
What do you want to do?'"

Whatever the approach, healthcare workers and addicts can agree that 
non-judgmental support is an essential part of the formula.

[sidebar]

Various ways to treat drug dependency

ADDICTION TREATMENT APPEARS IN MANY FORMS, INCLUDING:

12-step programs: A set of guiding principles outlining a course of 
action for recovery from alcoholism, drug addiction, compulsion or 
other behavioural problems. Originally proposed by Alcoholics 
Anonymous (AA) as a method of recovery from alcoholism. 
Detoxification (detox): In a case of physical dependence to a drug, 
the process by which the body adjusts to being without the drug, and 
experiences withdrawal syndromes; includes various treatments for 
acute drug overdose. Drug rehabilitation (rehab): The processes of 
medical or psychotherapeutic treatment for dependency on psychoactive 
substances. The rehab industry is a multibillion-dollar operation 
featuring different types of therapies and centres. Psychotherapy: 
The treatment of an addict's underlying mental health problems by 
talking with a psychiatrist, psychologist, licensed clinical social 
worker or other mental health provider. Counselling: Advice or 
guidance, especially as solicited from a knowledgeable person. Sec! 
ular sobriety programs: Nonreligious recovery network that offers 
cognitive, behavioural and educational strategies to people who want 
to abstain from addictive behaviour. Harm-reduction methods: 
Policies, programs and practices that aim to reduce the harms 
associated with the use of psychoactive drugs, rather than focusing 
on the prevention of drug use itself. Abstinence: Refraining from 
compulsive behaviours, or the discontinuation of a substance completely.

THE 12 STEPS AS LISTED ON WWW.CA.ORG:

1. We admitted we were powerless over cocaine and all other 
mindaltering substances - that our lives had become unmanageable.

2. Came to believe that a Power greater than ourselves could restore 
us to sanity.

3. Made a decision to turn our will and our lives over to the care of 
God as we understood Him.

4. Made a searching and fearless moral inventory of ourselves.

5. Admitted to God, to ourselves, and to another human being the 
exact nature of our wrongs.

6. Were entirely ready to have God remove all these defects of character.

7. Humbly asked Him to remove our shortcomings.

8. Made a list of all persons we had harmed, and became willing to 
make amends to them all.

9. Made direct amends to such people whenever possible, except when 
to do so would injure them or others.

10. Continued to take personal inventory and when we were wrong, 
promptly admitted it.

11. Sought through prayer and meditation to improve our conscious 
contact with God as we understood Him, praying only for knowledge of 
His will for us and the power to carry that out.

12. Having a spiritual awakening as the result of these steps, we 
tried to carry this message to addicts, and to practise these 
principles in all our affairs.

- - Compiled by Laura Beeston
- ---
MAP posted-by: Jay Bergstrom