The Current State of Substance Abuse Treatment

By Alicia Bednar

Today’s substance abuse crisis has continued to grow at an alarming rate, and the public has had no choice but to become more aware of the issue as the growing numbers of affected individuals leave less space to hide. With death tolls rising, weighing the costs and benefits of the different methods of substance abuse treatment and harm reduction has become a heated debate. Specifically, the opioid crisis has become a rampant emergency in the United States; the rise of fentanyl in addition to synthetic opioids has resulted in overdose becoming the leading cause of death for adults under 50 (Szalavitz 2019, 18). Over 28,000 people died from drugs laced with synthetics such as fentanyl in 2017, compared to about 3,000 people who died from the same cause in 2013 (Szalavitz 2019, 18). Clearly, something must be done about this epidemic rather than simply pushing these individuals outside of the boundaries of society where we don’t have to think about them. It’s important when doing so to analyze controversial methods of treatment and recognize their benefits and drawbacks. How do we decide what path to take? 

Substance Abuse Treatment and Women 

It’s useful to analyze past and current examples of substance abuse treatment methods in order to determine what would be the most effective in the United States. The WOMAN Center was a women’s treatment program in Detroit’s Cass Corridor neighborhood from 1971 to 1985 with a unique approach to address the issue, they saw drug dependence as a direct correlation to community affliction and marginalization (Travis 2017, 255). Their seemingly revolutionary gender-specific grassroots approach to substance dependence with a focus on community empowerment and deconstructing oppressive structures was a short-lived success. Their loss of their founding vision, structure, and funding ultimately resulted in their demise (Travis 2017, 276-7). Whether deemed a success or a failure, The WOMAN center provides a beneficial framework for the ways in which substance abuse treatment should be addressed which can be used as an example for future treatment centers. 

The WOMAN center used an understanding of the differences faced by men and women with addiction within their practice. They noted that women were more likely to wait longer to seek treatment, a result of less confrontation with the law and caregiving responsibilities enforced by social norms that made prioritizing their own issues difficult (Travis 2017, 271). Currently, this research is still relevant. Women with substance use disorders often have more economic difficulties than men, along with more scrutiny, stigmatization, and child care obligations (Brady, and Ashley 2005, 13). These social conditions provide reason to conclude that understanding the unique needs of women is essential when creating a gender-specific approach to substance abuse treatment. 

Kensington, PA 

 There is an estimated 75,000 residents that are addicted to heroin or other opioids in Philadelphia County in Pennsylvania, many of which regularly travel to Kensington, a Philadelphia neighborhood that is known as the “largest open-air narcotics market for heroin on the East coast” (Percy, 2018). There were 236 fatal overdoses in Kensington in 2017 (Percy, 2018). For these reasons, Kensington earned the title of the “Walmart of Heroin” by the New York Times (Percy, 2018). Kensington has faced drug-related problems for decades as a result of deindustrialization, wage stagnation, and racism (Szalavitz 2019, 16). However, the current crisis is unprecedented.  

There have been many proposals for solutions regarding the current crisis in Kensington, the most prominent being safe injection sites. The purpose of these centers is to provide addicts with a safe environment in which they can inject the drugs they use, they aim to reduce the harm involved with substance use: “ by providing sterile equipment, these facilities address the problems of infection and disease transmission that arise from reusing and sharing needles. By having trained professionals on hand, these facilities ensure that drug users who overdose will receive necessary medical attention” (Lefor 2019, 1). This form of treatment recognizes that people are going to inject substances regardless, so we might as well accept that and provide somewhere for them to do it where they can avoid and be treated for adverse health consequences. In addition, these centers also give individuals access to further forms of treatment if they desire it. 

However, would safe injection sites be effective in Kensington? Katelyn Stoler, a resident of the neighborhood who overcame years of substance dependence strongly believes that these injection sites are not the route that should be taken. She shared experiences of the dark toll that being trapped in the cycle of substance abuse in Kensington can take and elaborated on how this inevitably affects the mindset of its residents. She claimed that people there wouldn’t be interested in these sites, one of the reasons being that the proposed sites for Philadelphia are way too far from Kensington for residents to want to commute. In addition, her belief is that if these injection sites were used by residents, it would potentially be used to gain access to a small amount of synthetic substances or methadone that they can add to their daily regimen. It is important to take these real opinions from people from the community into account before we jump to conclusions about how the United States can have the same positive experience regarding safe injection sites as other countries who implement it.  

An additional controversial method of addressing the problem is Medication Assisted Treatment (MAT) which is regarded by federal policy to be the most effective form of treatment for all people suffering from Opioid Use Disorder (OUD) (Drabiak 2019, 1). One form of MAT is the commonly used methadone; however, these methods do not address the root of individual’s drug problems nor does it address the marginalization within communities that creates the framework for drug abuse. The previously mentioned WOMAN center of Detroit initially took a stance against methadone treatment, stating: “We see narcotic abuse (including methadone) as a huge profit-making business based on the destruction of people’s lives… Therefore, WOMAN asserts the commonality of all forms of substance abuse and does not make false distinctions” (Travis 2017, 275). Although they did not agree with the use of methadone, the WOMAN center eventually had to compromise by using it in moderation to comply with federal policy in order to maintain funding, and this was one of the reasons they did not see long term success. Many people against the use of methadone and other forms of Medication Assisted Treatment are against the idea that a person is treating one form of dependence with another. Katelyn Stoler from Kensington agrees with this sentiment; she feels that when people are given methadone, they are following a continuous cycle of substance dependence that will never end. She further claims that people who are in Medication Assisted Treatment will go to these treatment centers to receive their dose of methadone just to add it on top of other drugs without the intention of getting better. Stoler’s valuable experience within this community leads her to the belief that the best way to address an individual’s substance abuse is to remove the presence of drugs all together and treat the underlying causes with group support and improvement of their environment. 

After analyzing some of the most well renowned forms of substance abuse treatment and harm reduction, it seems as though no form of aid is without controversy. However, the effectiveness of these methods will vary based on differing communities and social circumstances, but the most important thing to keep in mind when assessing if a method is the right fit is the needs and opinions of individuals. Cases from the past and the present are particularly useful in determining course of action; we can learn from the WOMAN center’s focus on community empowerment and gender-specific approach. Although harm reduction practices may not seem as fast and easy of a fix as different forms of treatment, they are irrefutably beneficial in practice as they give individuals access to safer methods of consumption when that consumption is inevitable. Additionally, advocacy projects like The New Recovery Advocacy Movement (NRAM) by William White offer hope for the future of substance abuse treatment by altering public and professional attitudes toward recovery and supporting efforts to break inter-generational cycles of addiction and related problems. It is clear that the foundation of substance abuse treatment is changing, but there is still a long way to go.  

References 

Brady, T. M., & Ashley, O. S., eds. 2005. Women in substance abuse treatment: Results from the Alcohol and Drug Services Study (ADSS)Rockville, MD: Substance Abuse and Mental Health Services Administration, Office of Applied Studies. 

Drabiak, Katherine1. 2019. Expanding Medication Assisted Treatment Is Not the Answer: Flaws in the Substance Abuse Treatment Paradigm. DePaul Journal of Health Care Law 21 (1): 1–67. http://search.ebscohost.com.ezproxy.lib.usf.edu/login.aspx?direct=true&db=ofm&AN=137635936&site=eds-live. 

Lefor, Scott R. 2019. Safe Injection Sites and the Ethics of Harm Reduction. Ethics and Medics 44 (5): 1–4. http://search.ebscohost.com.ezproxy.lib.usf.edu/login.aspx?direct=true&db=rfh&AN=ATLAn4488971&site=eds-live

Percy, Jennifer. 2018. Trapped by the ‘Walmart of Heroin’. New York Times, October 10, 2018. 
https://www.nytimes.com/2018/10/10/magazine/kensington-heroin-opioid-philadelphia.html 

Szalavitz, Maia. 2019. HOW TO SURVIVE A DEATH CRISIS. Nation, March 11, 2019. 

Travis, Trysh. 2017. The Intersectional Origins of Women’s “Substance Abuse” Treatment: Learning From Detroit’s WOMAN Center, 1970–1985. Contemporary Drug Problems. https://doi.org/10.1177/0091450917738074 

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