An Ode to Substance Use(r) Intervention Failure(s): SUIF

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Notes

1 Substance Use Disorder (SUD) is a relatively new consensus-based diagnostic judgment that is not empirically informed (American Psychiatric Association, 1994).

2 Injecting drug user.

3 Failure blindness: a common process and outcome in which people and organized systems filter out data-results and information, which challenge and/or contradict our preconceptions; our sacred cows.

4 Reefer Madness is a 1936 American propaganda film, funded by a church group, which was to be used for drug use prevention that empowers pushers as they “lure” innocent, naïve high-school students to smoke it. A hit and run accident, manslaughter, suicide, attempted rape, and descent into insanity follow.

5 Agent Orange is the code name for one of the herbicides and defoliants used by the US military as part of its herbicidal warfare program, Operation Ranch Hand, during the Vietnam War from 1961 to 1971 during which time an estimated 10% of the 450,000 American soldiers stationed in Vietnam were addicted to drugs. Detoxification from drugs, as the intervention, was implemented before soldiers were discharged and returned to mainland USA as dioxin continued to “orange” the lands of Vietnam. More than 20% of South Vietnam's forests were sprayed at least once over a nine-year period at an average concentration of 13 times the recommended USDA application rate for domestic use. The U.S. Department of Veterans Affairs has listed the following “presumptive” conditions as being associated with being exposed to the active chemical compound coded as agent orange (not a drug???): prostate cancer, respiratory cancers, multiple myeloma, type II diabetes, Hodgkin's disease, non-Hodgkin's lymphoma, soft tissue sarcoma, chloracne, porphyria cutanea tarda, peripheral neuropathy, chronic lymphocytic leukemia, B cell leukemias such as hairy cell leukemia, Parkinson's disease and ischemic heart disease, and spina bifida in children of veterans exposed to Agent Orange in order to enable veterans to be treated. http://en.wikipedia.org/wiki/Agent_Orange June 17, 2012.

6 Google the anti-depressant medication-placebo clinical trials controversy and then search for substance use(r) intervention failure.

7 Success blindness: a process and outcome in which people and organized systems, once a desired and planned goal is achieved, do not further analyze other outcomes that may represent a range of unplanned positive results.

8 truthiness: “the quality of preferring concepts or facts one wishes to be true, rather than concepts or facts known to be true.” Word of the Year in 2005, according to the American Dialect Society, and which was popularized by Stephen Colbert in the first episode of “The Colbert Report.” proofiness: “the art of using bogus mathematical arguments to prove something that you know in your heart is true –even when it's not” (Seife, 2010). Infopinion: presenting and/or mingling unreliable and misleading opinion as validated information. For example, a policymaker in a country in which methadone is illegal and thus methadone treatment is not possible, when challenged by the findings of the efficacy of more than 40 years of validated research noted: “We have our own literature.”

9 Macedonian King Alexander the Great was famed for his military conquests, as well as known for his excessive drinking, when alcohol abuse disorder was not part of the Greek lexicon (O'Brien, 1992).

10 Latkin and Friedman (2012).

11 Bachelard (1964) and Tuan (1974).

12 The cyberneticist Heinz Von Foerster posited that there are two types of questions: legitimate questions and illegitimate questions. The former are those for which the answer is not known. An illegitimate question is one for which the answer is known (Von Foerster, Mora, & Amiot, 1960). Needed breakthroughs are associated with legitimate questions. The reader is referred to Neruda (2001) for a poetic exploration of legitimate questions.

13 Rittel and Webber suggested that problems can and should be usefully categorized into two types: tame problems and wicked problems. The former are solved in a traditional known and tried “water fall paradigm:” gather data, analyze data, formulate solution, and implement solution. The latter “wicked problems” can only be responded to individually, each time anew, with no ultimate, repeatable solution. Substance use is a wicked problem (Rittel & Webber, 1973).

14 The reader is referred to: Petroski (1992, 2006).

15 Chein, Gerard, Lee, and Rosenfeld (1964). This classic book, based on data collected in New York City 50 years ago from a small sample of “junkies,” exemplified that all addicts suffer from deep-rooted, major personality disorders.

16 The reader is referred to Tilly (2008) for a stimulating analysis of the processes of blaming and giving credit in Western culture.

17 Consider the Zen teaching tool that asks one to list the non-flower parts of a flower without which there can be no flower. The sun, light, a temperature that fosters growth, sufficient water, and good soil are immediate responses. In addition, a supportive environment in which people do no pick the flower, interfering with its growth, as well as other creature that can trod upon it. You the reader may have additional contributions to make. One can explore the non-intervention parameters in a similar way, which, unfortunately, is not often an integral part of effective intervention planning.

18 The reader is referred to Fletcher (2001) for a stimulating visual experience.

19 Petroski (1992, 2006).

20 Gladwell (2001) describes the processes, individuals, and conditions that are necessary for an idea, trend, or social behavior to cross a threshold.

21 This relatively new term, introduced into the intervention literature, refers to major events such as mega-disasters, natural as well as man-made famine, conflict, genocide, disparities in health, epidemics, mass migrations, economic recessions, etc. that effect adaptation, functioning, and quality of life of individuals as well as systems. Existential threat, instability, and chaos are major dimensions, and loss of control over one's life is experienced.

22 Curto (2004) presents an in-depth analysis of the use of alcoholic beverages as a tool of colonization. van Onselen (1976) analyzes the role of alcohol in the development of European imperialism and Southern African capitalism, with special reference to black mineworkers in the Transvaal Republic; Jankowiak and Bradburd (2003) examine the important roles a range of drugs played in European economic growth and global colonialism in aboriginal Australia, Papau New Guinea, West Africa, colonial New France, English America, Trinidad, Namibia, Botswana, and the Andes, both introducing new drugs to replace indigenous ones, whose use was connected to the labor process, and creating and reinforcing relations of dependency upon European trading partners.

23 The reader who is interested in exploring the dimensions of answers to why, and their implications, are referred to Tilly (2006).

24 Hill and Cheadle (1996).

25 Treatment can be usefully defined as a planned or unplanned, goal directed, temporally structured change process, of necessary quality, appropriateness, and conditions (endogenous and exogenous), which is implemented under conditions of uncertainty and is bounded (culture, place, time, etc.), which can be (un)successful (partially, and/or totally) as well as, at times, being associated with iatrogenic harms, and can be categorized into professional-based, tradition-based, mutual-help based (AA, NA, etc.), and self-help (“natural recovery”) models. There are no unique models or techniques used with substance users –of whatever types and heterogeneities –that are not also used with non-substance users. Whether or not a treatment technique is indicated or contra-indicated, and its selection underpinnings are considered (theory-based, empirically based, principle of faith-based, tradition-based, etc.), continues to be a generic and key treatment issue. In the West, with the relatively new ideology of “harm reduction” and the even newer quality of life (QOL) and conflict resolution treatment-driven models, there are now new sets of goals in addition to those derived from/associated with the older tradition of abstinence-driven models. Treatment is implemented in a range of environments: ambulatory as well as within institutions that can include controlled environments. Treatment includes a spectrum of clinician–caregiver–patient relationships representing various forms of decision-making traditions/models: (1) the hierarchical model in which the clinician–treatment agent makes the decision(s) and the recipient is compliant and relatively passive; (2) shared decision-making that facilitates the collaboration between clinician and patient(s) in which both are active; and (3) the “informed model” in which the patient makes the decision(s).

26 The following words, ascribed to an important Rabbinic source, the Kotzker Rebbe, are an important caveat in this ode's trek: If I am I because I am I, and you are you, because you are you, then I am I and you are you. However, if I am I because you are you, and you are you because I am I, then I am not I, and you are not you (Heschel, 1973, p. 144).

27 The reader is referred to Sandage (2005) for an in-depth historical analysis of “failure” and the creation of “losers” in a country and culture driven to win and to succeed from the time of the colonies until recent times.

28 A process in which there is a superficial understanding of how complex systems work while feeling that we do understand until we are asked to explain how it works…confronting us with how little we actually know. (Keil, 2006).