By Melissa Patrick
Kentucky Health News
Helping people in addiction recovery meet their basic needs should not focus on abstinence, but instead should be provided along the continuum of a person's drug use as a way to mitigate harm, with a focus on wellness and autonomy, says an expert who knows recovery from his own experience.
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| Alex Elswick |
"Harm reduction and capital building are the things that we should be doing all the time for everyone," he said. "We shouldn't be waiting until someone becomes abstinent or until they become involved in the criminal legal system or until they reach out for treatment. We can go and engage people who are suffering in our communities and we can mitigate harms. And we can build capital right now, without any barriers to access."
Elswick, who is in long-term recovery, often says that there is nothing special about his addiction to OxyContin and heroin since it followed the same path as many others have experienced. But what he says is special is his recovery, largely because of the abundance of resources that were available to support him, including things like housing, transportation, employment, access to medical and mental-health care, relationships with family and community and education.
Elswick calls those resources "recovery capital" and described them as anything that promotes recovery, anything that improves the odds that a person will be successful in their recovery.
He stressed that every person in recovery needs access to such resources, and not just after they become abstinent. And just like Maslow's Hierarchy of Needs, he said a person who has an addiction to drugs must have their basic needs met first before they can even consider seeking treatment and recovery.
But the problem is, he said, is that we often use abstinence as a precondition to providing these basic needs for people in the recovery process.
"I want to suggest that we're flipping it upside down, we're expecting people to do the incredibly, in some cases, impossible work of becoming abstinent without providing them with all the resources that they need in order to do so," he said.
A key example of this upside down thinking is housing, he said. As it stands, he said there is little to no housing available for people who use drugs or who are in the early stages of the recovery process, nor is there housing for people who are abstinent, but are on a medication for opioid use disorder, like buprenorphine or methadone.
Instead, he said, we have sober housing for people who are already abstinent -- and if a person living in one of these houses experiences a recurrence, which is common, they are kicked out.
He added that the same is true for people who use drugs and their access to social services, which often requires a drug test to gain access. In addition, he said, people are kicked out of treatment if they relapse, even though they sought treatment for exactly that problem. And, he said, families are often told to deny support of a loved one if they are using drugs, regardless of the circumstance.
In each of these circumstances, "You're going to be deprived of your recovery capital, despite the fact that research says that would improve your odds of recovery," he said. And the only way to change this, he added, is if we prioritize recovery above abstinence.
Elswick noted that the concept of recovery capital can be initially traced to a study by University of Denver Professor William Cloud, who, while studying college students with addictions, found they were recovering at a significantly higher rate, sometimes without any formal interventions, than what was being reported by the general population.
Cloud determined that the reason for these higher rates of recovery was because the college students generally come from privileged, middle to upper-middle class backgrounds and that they had access to most of the social supports that they needed to recover.
"The value of recovery capital and harm reduction is that it allows us to have a relationship with someone, as opposed to saying, 'Come to me when you're sober,'" said Elswick. "It allows us to have a relationship so that that relationship itself can be a therapeutic. That relationship itself can be a component of recovery capital."
Elswic wrapped up his address with a push to make medications for opioid use disorder more accessible and the need to battle the stigma that still exist against these drugs, even among health care providers and treatment centers. He cited studies that prove this is the gold standard of care for treating this condition, but at this time, 90% of people who need treatment don't receive it.
"My main takeaway message is I want us to shift the focus away from abstinence toward recovery capital and building recovery capital and mitigating harms," he said. "Because it's the more effective approach and I think you might find it'll lead to more abstinence than you realize."
Elswick is also the co-founder of Voices of Hope, a recovery community organization in Kentucky.
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