May 4, 2012
Recently, I traveled to Las Vegas to attend the annual, national conference on the care and treatment of opioid addiction held by AATOD (American Association of the Treatment of Opioid Dependence). It was a huge gathering of some of the most important and influential addictions professionals, counselors, medical personnel, and other entities involved in the overall treatment of this population.
HIV/AIDS was woven into many of the presentations since a person is at risk of HIV infection with the use of opioids. There is the commonly known primary risk of direct HIV exposure from sharing needles with an HIV infected individual. Several national organizations presented materials on needle exchange and the overall prevention of the spread of HIV among intravenous opioid users. There are also the less understood secondary risk factors for exposure to HIV. These include any form of opioid use, additional substance and alcohol use, mental health issues, intimate partner violence, just to name a few. AATOD hosted several workshops around Co-Occurring Disorders, which highlighted many of these challenges. Any person who uses any substances, has mental health issues, and/or is involved in a chaotic relationship is indirectly at a higher risk of exposure to HIV. Here are a few of the reasons why: such a person may be intoxicated and more likely to engage in high risk sexual behaviors; she may progress to the use of needles if she is chasing a better high; he may be experiencing a manic episode which may be fueled by higher risk sexual activities; she may not be able to negotiate condom use in her current relationship if there is a fear of abuse. In addition, those living with HIV/AIDS may be compromising the care and treatment of their disease if their opioid addiction is left untreated. All of this, and more, was discussed at this amazing and influential conference.
Okay, back to the location. Las Vegas. I know what you're thinking, "How could you travel to Vegas and not invite me?" I know, I know. Next time.
You are probably also thinking, "Addictions conference? In Las Vegas? Really?" It's okay, we got this response quite often. Even if a person wasn't comfortable enough asking the question outright, I certainly could tell it is what they were thinking. The stares and pensive looks were enough. Yes, it is ironic, no doubt. To be surrounded by excess and clear addiction in many forms (substance use, gambling, shopping) while upstairs discussing these very topics was surreal indeed.
Yet, somehow it makes sense. Vegas is a vast land of extremes. Everything is exaggerated beyond all realistic representation. Gluttony and capitalism to the tenth power. Vegas represents (with casino credit, show girls, and glitter) what most people think and feel about addiction. Anyone is allowed to have a few wild nights, along with endless alcohol, drugs and sexual exploits, so long as "what happens in Vegas, stays in Vegas." Vegas is where denial was born and now thrives. Leave your secrets in the desert. No one will know.
Our culture views addiction in this exact way. Those who have the money and ability to live it up in Vegas and then immediately return to the status quo are the only ones allowed to use drugs and alcohol. Those who can't handle the sweet seduction of all things Vegas are "bad, sick, damaged, wrong, and sinful." It is their problem and they deserve all the consequences that go along with using drugs. They certainly do not deserve any help in any way. They brought this on themselves.
Being in AATOD within the Sin City demonstrated the clear divide between drug use and drug treatment in our culture. We welcome the use of substances, so long as a person can keep it to themselves and not bother anyone (or even be the life of the party). The moment it becomes a problem and a person seeks treatment, now this same person is undeserving of our help. It is a sad reality since drug and alcohol addiction is a disease. If our society viewed it more as the true disease that it is, and embraced the true care and treatment of this disease, there would be far less negative consequences of use.
Keynote speaker William White articulated this phenomenon powerfully. He stated, "We know addiction is a chronic disease, yet we continue to treat it like a broken arm." Addiction is not about having a person stop using and be done. No, there needs to be a comprehensive approach to treatment that includes family involvement, addressing mental health issues, past history of trauma, HIV risk and treatment, intimate partner violence, housing, employment, finances, and many others. In many instances, a person may turn to drugs and alcohol as a reaction to a past (and/or current) traumatic situation. Substances can be very powerful coping mechanisms -- just ask anyone walking on the Vegas Strip after a night of partying! When a person takes steps to reduce or eliminate the use of substances, the memories of abuse may come flooding back. These nightmares and real memories can be debilitating and terrorizing. The fear of the memories could be a reason why people do not "get clean" or why they tend to relapse. In instances like this, we cannot blame the person for being "weak" or "immoral" or "criminal". This person needs further care and treatment to develop healthier coping skills to deal with the fear and pain. Yet, since our culture does not view substance use in this way, this person only gets a band-aid, not the full surgery he may need.
We have a lot of work to do. Our culture devalues those with an addiction of any sort. We frown upon anyone doing anything in excess ... even in Vegas.
Yes, there is hope. This conference exemplified the hope and inspiration we all have and all need to improve how our society treats those with addictions. More awareness is being raised about this disease, especially with more and more people coming out with their struggles. People are beginning to realize that denial is not enough. Denial is not working, even in Vegas. It's not so easy to just leave our worries on The Strip and pretend they don't exist. We all need to face this disease, show compassion to those who are living with it, and treat it comprehensively.
Next year the AATOD conference will be held in Philadelphia. Okay, it may not be the most glamorous setting, but it may just be a little more real.