Thread by @billkinkle

We often use the term "treatment" and many who use it and advocate for it have never been to an addiction tx facility as a patient. This is a long thread with some bullet points indicating what I did experience and what I did not experience over 32 treatment admissions. 1/22

Things I did in treatment:

-12 step meetings
-12 step workbooks
-12 step groups
-Big Book studies
-Groups on how to come to believe in god
-Codependency groups
-Relapse prevention groups
-Enabler groups
-Professional massages
-Equine therapy (horse petting) 2/22

-Helicopter rides
-Endless drum circles
-Music groups where 30 people in a circle with no musical talent each received an instrument to make their own music
-Ropes courses
-Rock climbing walls
-Hot tub and sauna sessions
-Pottery and other crafts
-Forced hikes 3/22

-We wrote goodbye letters to our drug of choice and ceremoniously burned them
-Required to participate in group prayer to close all groups and meetings
-Attended process groups run by other patients with no staff present to facilitate 4/22

Things I heard several times a day:

-If you’ve struggled with one drug you will struggle with every drug
-If you don’t go to meetings for the rest of your life you will die
-If you don’t find a higher power you will never recover
-You will always be an addict/alcoholic 5/22

-My character defects and self-centeredness are the root cause of my addiction
-I’m in denial
-I’m a manipulator
-I’m not being open minded, honest, or willing 6/22

Interaction with family:

-Phone calls were earned by group participation and completion of chores
-Visits were also earned and counselors had ultimate approval/veto power

-Every 3 weeks at one treatment center there was a family program in which you were required to sit 7/22

knee to knee with angry friends and family, one by one, prohibited from speaking, and were forced to listen to them unload all of their anger and belittle you. The rest of your family and peers from the treatment center were in the circle around you and offered 8/22

feedback afterwards primarily designed to break you. I still have anxiety from what I experienced over this week long session which was over 10 years ago. 9/22

Rules in treatment centers:

-No speaking to the opposite sex
-No cell phones
-No computer access
-Profanity and language policed by staff and disciplined
-Clothing was screened and restricted at staff discretion
10/22

-No hats allowed (teaching men to be socially courteous and respectful)
-Only spiritual or religious books or magazines allowed
-No music playing devices
-We could only watch wholesome movies without “debauchery”
-Bathroom use is restricted and monitored 11/22

-Staff monitor your activity at all times
-Physical labor is required, often labeled “work therapy”
-Strip searched upon demand and anytime you leave the facility and return (court, hospital etc.) 12/22

Things that didn’t happen in treatment:

-No one on one sessions with counselors.
-No trauma therapy (one facility guided patients through their first EMDR session and then told you needed to go find an EMDR certified therapist to 13/22

complete the treatment once you were discharged, usually in 2-3 weeks. No additional support was given in the post session period)
-No family counseling sessions.
-Counselors had no contact with my wife who desperately asked for updates and help. However before I was 14/22

married the treatment centers had frequent contact with my parents despite revocation of releases, citing “your parents are paying for this they have the right to know what’s going on.” I was 35 years old.
-I saw a psychiatrist on admission, no follow up during
15/22

inpatient stay.
-Counselors rarely had a masters level education or counseling training/experience, lived experience trumped clinical proficiency.
-No harm reduction interventions were ever discussed. I suggested a list of harm reduction group ideas at one facility and was 16/22

quickly met with, “you’re encouraging use and enabling” by the nursing staff.
-Medication was sometimes offered during the initial visit with the psychiatrist, however since there were no follow up visits it was never discussed again.
17/22

-Often the nurses who administered meds were in recovery themselves and typically viewed detox as something that needed to be as painful as possible. I would often hear, “well maybe you’ll remember how bad this was next time you think about picking up.”
-Nursing staff would18/22

refuse to initiate buprenorphine (detox taper) telling patients they weren’t “ready” yet.
-Withdrawal symptoms were never adequately managed, motrin and clonidine were viewed as the gold standard.
19/22

-Patients detoxifying from alcohol or benzodiazepines frequently had seizures from undermedication.
-Aftercare plans never included therapy. Aftercare was always IOP (TSF) 20/22

When I hear people say "treatment" this is what I'm basing my opinion on. Medical folks, how much of this resembles how you would treat any disease or illness?

When I say we need to define what treatment is and create some sort of standard this is what I'm talking about. 21/22

Moreover, until we stop madness like the above, I don't want to hear much about how addiction is a disease, because saying it's a disease and treating it like one are two different things. 22/22

@maiasz did I miss anything?

Some supporting documentation.

@germanrlopez @voxmedia You may be interested in this thread given your recent project regarding the addiction treatment industry.