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My PEE should not define me.

Keepin’ us honest!  That’s what I heard a doctor say not too long ago.  He was talking about the need to administer Urinalysis to his patients.  He was explaining that he could not count on his drug addicted patients to fess up to relapses ….you know, drug users are liars, so they say!!  

Many would completely agree with this statement ….if you are shaking your head in agreement, I challenge you to think about this critically.  I would argue that people that use drugs, are regularly forced into circumstances where honesty is the worst decision they could make.  The consequences of honest dialogue is usually discontinuation of services,  loss of freedoms, loss of children,  and at the very least shaming.

There are a whole host of problems with  urinalysis —starting with the the indisputable fact that they are down right humiliating! If you ask me the observed drug test has got to be one of the most humiliating drug user experiences.

For years  I have been peeing in cups with angry lookin’ women watching intently and disapprovingly as I try to pee.  It’s not as easy as one might think either, you have someone hovering over you which makes it difficult if not impossible to pee, then you try to pee as quietly and daintily as possibly without farting or doing anything disgusting. I have determined that the observed drug test has got to be at the top of my list of humiliating things that we make people who use drugs do!

A drug test can tell us one thing—maybe. A drug test can tell us if a person has done a specific drug between a certain time frame, and that is it.  The problem with this is that most people don’t understand drugs at all and because of this they don’t understand what drugs really do.  We don’t provide most Americans with any drug education that is worth a shit at all.  Fear based propaganda has corroded the understanding of many well meaning Americans about drugs and drug use.  Drugs just don’t have the power that are often ascribed to them. So my point is this, if  most people don’t understand drugs, then how can they understand or assess what it means to have a positive drug test.

A drug test might be useful if used in combination with an number of other indicators for determining whats going on with a person, but a lone drug test tells us very little. It does not give us any context, which is an absolute requirement for determining whats going on, context tells us if someone did a line of cocaine with an old buddy at a birthday party—or if a person has a life that is spinning out of control because they are stuck in a cycle of substance misuse.

The drug test result in our society is the DECIDER!  Even if the drug test is wrong the result can mean the loss of freedom, the loss of a job, the loss of a place to live….the consequences of a failed drug test are quite severe.  Severe consequences should follow evidence of severe problems not follow an arbitrary finding.  Too often we rely on drug tests to tell us everything about a person when in isolation they tell us nothing about a person.

Speaking of context….

Many years ago…..

I had relapsed after having some sober time in a 12 step program.  I started using a little and then more and more until my use was pretty much chaotic.  I was beginning to do poorly in my college classes and I did not want to fail.  My options were limited.  The people in NA and AA told me to quit school, go to detox, then rehab because my recovery had come first and that if I was not ” clean”  then nothing mattered anyway!  I could not bare to quit school.  I wanted so badly to do well and I loved my classes.  I determined that methadone was my best option.  Now, I would not have been able to make this decision if I had not done  my own personal research( the stigmatization of MAT’s is another huge problem).  Everyone I talked to was against any medically assisted treatment.  To this day I am amazed about how stigmatized MAT in the southern US is.

I went to the local clinic and was stabilized within a few days. My life had really taken a few rough turns during this relapse.  One of the reason I think this relapse was so damaging has to do with the fact that it was the first relapse from 12 step groups I had ever experienced and in 12 step recovery TIME means everything.  I believed I was doomed, and my life was doomed, and that I had lost everything, even though I had lost nothing but time.  (12 step philosophy is another huge problem).

When I started at the methadone clinic  I had quite a few problems that needed immediate attention.  My job was in jeopardy, my school situation was rocky, my boyfriend was becoming abusive and I had lost all of my friends (they were from 12 step groups and claimed they could not be around me b/c I was a danger to their recovery).  Depression had set in and I was suicidal to say the least.  I had just used after 4 years of 12 step work and I felt like an absolute failure.  Anyone who has experienced the 12 steps knows how awful relapsing in the program is, and I really took it rough.  I had drank the 12 step koolaid, hook, line and sinker.

You see when i started going to 12 step groups my life was in absolute desperation.  I was living in a completely drug centered world.  I was physically ill and emotionally unwell.  I was wanted by the police and my family had long ago cut me off.  I moved into  a halfway house in a new city.  Looking back I am a little embarrassed how much of the 12 step koolaid I drank.  I was all in….. but really, at that time in my life had  someone had come through and told me they had magic potion that would fix my life and make me happy I would have sucked it down!!

You see, when I began going to meetings my life had been totally turned upside down.   I was in an abusive situation that left me completely broken.  The abuse started with my husband at around 20, he died leaving me broken and confused at about 22.  My life spiraled out of control for years and the kinds of abuse I endured make me quiver to this day. I got off drugs and went to meetings….I though I was working through the pain of my past but i now know that I had not made a dent in the emotional work there was to be done to restore me to an emotionally well human being. But back to my original point…..

I decided against the advice of my sponsor and everybody else that MAT was an answer….

Now, anyone who has been put on methadone knows that the first couple of days you sleep a good bit and within about 3 or 4 days you can really get back on track.  I was busy working on putting my life back together.  I was expelled from AA and NA, they really ostracized me for my decision to go on Methadone.  I had been sponsoring, speaking, and now I could not even speak at a meeting.  I was angry to say the least.  I had dedicated all of this time and energy into the 12 steps and now they would not even have me.  My friends abandoned me quickly saying I was a danger to their recovery.  HUH?  This was not at all what I expected….but on I went.  I felt alone, the man I was seeing was emotionally and physically abusive.  This was bringing back some really difficult emotions from my past I had not dealt with.  My using was really improving. Life was becoming manageable.  I could work, go to school and deal with things.  Things were 100xxx better than they were when I had first begun my treatment.  I managed to leave this man and had moved in with my mother.  This was tremendous.  Looking back I was successfully recovering….and then boom!  The methadone clinic told me I had failed one too many urine drug screens and told me if I did not pass the next one I would be placed on an administrative detox.  So I put my mind to it and stopped….my next UA was about a week later.  I was proud of myself.  I had used nothing in about 4 1/2 days.  I thought for sure I would pass….but no.  I failed.  I was then told that they would begin a detox—and I was outta there.  I was improving I thought, I was ?  I had made so many good decisions and things were improving.  I had more control over my use than I had in years…but now, because of a failed UA,  BOOM, your  out.  I failed a drug test and the drug test was the only information they were looking at.  They did not take into consideration any of the mediating factors.  They did not look at how I had been courageous enough to leave an abusive relationship ….how i was doing well in school, how I moved in with my mother.  They just looked at the failed UA.  Luckily I found another Methadone clinic to take me in but if I had not things would have gone downhill fast.  I remember leaving the clinic that day, hopeless, with tears in my eyes. My drug test in that facility was certainly viewed without context and because of this I was harmed and my situation was made more complicated.

That is just one example of how drug tests are problematic.  Too often the drug test is the only piece of information that people look at. They do not look to see what else is going on, just one little dot on  a test decides what’s next for a person.

With addiction we expect people to go from completely sick to completely well just like that.  There is no middle ground.  You are either using or your not and that is entirely too simplistic.  We have oversimplified one of the most complex  social problems our country is dealing with.

This is a real problem!  This is often what tough love advocates base their decisions on.  They are told that if they help someone that is using, they are standing in the way of a miracle, or they are not allowing their loved one to reach a bottom.  So, they are in fact contributing to the problem.  I have thought a lot about this over the years ….tough love, detaching with love, …..refusing to help someone who is actively using, because they must feel the pain of their decisions if they are to change is absurd and can be lethal.

I just can’t get with it, probably because I know what’s on the other side of abandonment.  I know what that feels like!  Pain and abandonment have never motivated me to improve my life.  In fact, the abandonment of my family and the intense pain of dealing with life trauma without the people I love  has brought me to the brink of suicide and actually fueled the cycle of destructive substance use.

Taking care of someone who is sick is taxing.  We put our elderly in old folks homes these days as opposed to having them live with us.  Why do we do this?  Because many of us simply do not want to take care of elderly, sickly, senile adults.  The same is true for people living in chaotic use.  Many times we disagree with our husbands, wives, other family members about the best way to deal with a loved one who is out of control and then our relationships become strained. It is easy to become very angry with the person who is using. The easy answer….put them out..let them hit bottom~!  You feel guilty when you say these things  but many of you are in groups such as naranon etc. that assure you that you are doing the right thing.  You are relieved of guilt because you have a group telling you that what you are doing is right.  Believe me it’s not right it’s down right wrong, that’s why it feels so awful.

We must begin to realize there is a middle ground in substance use treatment.  You are either “clean” or “dirty” is crazy simplistic.  To say you failed your drug test…what does that actually tell a person?  Nothing really!  Now if you fail a drug test, and your behavior is erratic, you are unable to meet your obligations to your family and career, then you have some context to add to the dirty UA, but a dirty UA by itself, what do we know about the person.   We don’t know how much they used, we don’t know why, we don’ know anything except there was probably some drug use.

I don’t believe that we should not hold people accountable for their actions.  I don’t believe that drug tests are bad or wrong in all cases.  What i do believe is that too often the drug test is the only answer and that is not good enough.  We should help people that are trying to improve their lives.  My mother says :  I am not going to help you be sick, but I will help you get well.  I think this is a wonderful and compassionate way to look at things.

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