Three Strikes: You’re Out (of Treatment)

There are a lot of changes happening in the treatment industry these days. One of the best things that can possibly happen to this antiquated system is that is makes a sweeping change in one area that has been rock solid since the treatment industry began: “Zero Tolerance” and “Three Strike” rules when it comes to positive urine screens in treatment centers.

Whether we’re talking about complete black out zero tolerance, or a three strikes type of rule, treatment centers have long had this area of recovery so dead wrong that it’s actually laughable when you break it down. Laughable, until you consider how many addicts have probably died after being thrown out of treatment when they wern’t ready.

The average American can’t even stick to a healthy diet when they’re trying to lose weight. The average American can’t even resist a hamburger. We have companies like Jenny Craig, and Weight Watchers, that are like the treatment centers for obesity. These companies act very much like treatment centers for addiction, with one sweeping difference: They don’t throw you out on your ass when you make a bad choice and eat a cookie.

Imagine that you’re trying to lose some weight, and you go in to your weekly meeting at whatever program you’re involved in. You’re having a rough time, you’re really struggling with keeping to that diet. When it’s your turn to share, you admit that you cheated on your diet program. What happens next? You receive support from the weight loss leader. Maybe they give you the “We’ve all been there before” speech. They tell you that what’s done is done, now get back on track. The group rallies around you, maybe you get a little sticker for your honesty, and you don’t feel so bad about it by the end of the meeting. You resolve to get back on track and you’re feeling confidant, lifted up by your group, and your feelings of guilt and shame have been put to rest. The next day you get back on track.

How many of us, especially us women, have been through this before? There are no weight loss programs out there that shame us when we fall off, because if they did, no one would subscribe to that program. Because nobody wants to feel shamed. Nobody wants to pay someone to help them and then have them make you feel like garbage when you inevitably struggle with such a significant life change.

Now take that diet that you’ve struggled with over the years, and amplify it by a thousand times. Heroin addiction is much harder to kick than a hankering for chocolate, but the sensation is somewhat similar as it affects the same part of the brain. So amplify your worst food craving, your biggest diet weakness, and imagine it ruling your life. Imagine that if you didn’t eat that chocolate, that you would start to feel sick. You would start to sweat, your muscles would ache until it felt like your actual bones were cracking from your insides. Your bowels empty into the toilet like an explosion, but you also have to vomit and you can’t get off the toilet so you contort your body to try and reach the sink, or the tub, but only half of it makes it and your vomit gets all over your bathroom. All you have to do to stop it is eat the chocolate, but that would mean cheating on your diet.

Treatment centers for addiction could take a cue from weight loss programs. Instead of meeting slip ups with guilt and shame, they could try the “build you up” approach. Unfortunately, this is an industry that vilifies the shame placed on us from the outside while manufacturing shame on the inside. When someone slips up in recovery, they need to talk about it. Burying it only escalates the problem, just like with dieting. But often times, addicts keep it close to the vest because of the repercussions they’ll face in treatment and in the recovery community.

The shame from peers and professionals is bad enough, but getting thrown out of treatment is the usual consequence addicts are trying to avoid. This idea that you have to want to be in treatment, and if you wanted to be there then you wouldn’t screw up, is asanine. At our core, many of us want to be sober, but we need help. That’s why we are in treatment, because we need help.

No treatment center on this earth, no matter what their alleged success rate is or how good they think they are, is good enough to get someone sober on their first day of treatment. Or their first week of treatment. Or even their first MONTH of treatment. It takes time to relearn these habits, to relearn how to do everything from go to work to cook dinner to bathe yourself without using. Treatment centers expect you to enroll on Monday and never use again, even though you are still IN TREATMENT, it’s not like you learn everything you need to know on that Monday and you are set for life. You are learning every day, and you NEVER become an expert. There is always something new to learn in recovery.

Therefore, it stands to reason, that it might take some time in treatment before you get the hang of not using every day.

Maybe you’ve cut it down to just the weekends, and are progressing towards using less and less. Maybe you’ve been sober for the whole month, but then have a slip up. This is exactly when you SHOULD be talking about it with your counselor and your group, but we so often don’t because we’re afraid to get thrown out of treatment. Even if we don’t get thrown out, maybe that’s one of our “three strikes” and we can’t afford to waste one if we haven’t actually gotten caught with a dirty urine, so we bury it and pretend it never happened.

Any treatment center that gives an addict an incentive to lie is failing in my book.

If an addict feels the need to cheat or dodge a urine test while in treatment, that treatment center is doing something wrong. You preach honesty as a pillar of recovery but encourage clients to lie and hide their truth for fear that they aren’t getting recovery fast enough for your thirty day program.

When you think about it, it literally makes no sense. Imagine going to the doctor and you’re told you have high cholesterol. They tell you that you need to improve your diet, maybe they put you on some medication, and when you go back next they expect to see an improvement. That’s what they are looking for: AN IMPROVEMENT. Not that you’ll be cured by your next appointment!

Addiction is the only disease where we expect the patient to cure themselves BEFORE they finish treatment.

We expect addicts to become abstinent from their first day of enrollment in treatment and stay that way for the rest of their lives, before we’ve even taught them anything! It’s actually insane, when you think about it.

So what is the alternative? Obviously not a free for all, use all you want while you’re in treatment philosophy. The idea is that we should be improving, and working towards total abstinence, so that by the end of treatment we’ve gotten the hang of living life without our substance of choice. For some, that may mean giving it up on day one and never looking back. For most of us, it doesn’t work that way. We struggle, we falter, we are imperfect.

Treatment centers need to keep their doors open to clients well beyond the three dirty urines most will tolerate. If someone wants to be there, but they are struggling to get sober, who is to say they don’t deserve to keep trying? It takes many of us multiple treatments, multiple relapses, to get there. Maybe this wouldn’t be the case if we could go through this process of success and failure WHILE in treatment, rather than in between treatments.

I have NEVER gone through a treatment and stayed sober from day one. I have had many long term stretches of sobriety, but every single time I have had slip ups along the way, including this time. That’s why I don’t count sober time and sober dates. I have been living in recovery for a few years now, and if I had to “start over” every time I slipped up during the early days, I would’ve gone off and running each time to make the restart worth my while. Having a philosophy that separates “clean time” from “recovery time” makes it easier to get back on the wagon after a slip up. Just like when you’re on a diet, and you eat a cookie, you don’t start the diet all over from day one. You made a mistake, but you’re still on a diet. One cookie doesn’t negate all the kale and grilled chicken you’ve been eating for months.

As we learn more about the science of addiction, some treatment centers are becoming more progressive and embracing this crazy idea that you don’t get sober overnight. Unfortunately for these amazing facilities, they are bearing the burden and overflow from all the treatment centers who throw out clients that actually want to be there, but are still struggling to “get it”. We need to continue to advocate for more research, and more understanding, in the treatment of addiction. If we fail to do so, more and more people will be pushed out of treatment for “relapsing” before they’re even given the chance to get in recovery. I encourage those who advocate for zero tolerance and limited “chances” to think about this the next time they’re on a diet.

©Copyright 2017 In Angel’s Arms and Lauren Goodkin

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