It has been many years since I have addressed a subject that, in my opinion, has been a source of embarrassment to our industry as Addiction Professionals.
I had an inspiring career for over forty years as a professional in the alcohol and other drugs profession. The journey all began in 1974 as a 24-year-old out of control under the influence of many addictive substances, eventually finding myself in a hospital in Minneapolis, Minnesota, for treatment of chemical dependency.
We all know the story. I got the help I needed and then dedicated my life to helping others achieve the same. Over my career, I worked my way up the ladder and found my niche in program development and marketing. My greatest achievement to date was co-authoring the design and implementation of the Professional Recovery Program at the Betty Ford Center.
What a satisfying time it was being able to work with the former First Lady and her staff.
In doing so, I also had the satisfaction to align with Professional Monitoring Groups and Professional Assistance Programs from around the country. Those groups were responsible for the well-being of attorneys, physicians, nurses, athletes, licensed health care professionals, and an array of other professionals that fit and met the criteria for the level of care to enter our program.
Ironically after the program was opened and operating successfully, I was in New York City marketing the newly established program, and I experienced a horrific fall, which led to spinal fusion surgery. It also led to the need for opiate pain medication to treat the horrible pain I was suffering from. This then led to unleashing the monster within.
We have heard the story, yet the difference here is my experience was not from my making but from an iatrogenic disorder, that being physician-caused. I did not see it coming.
This all occurred prior to the knowledge we have today about the severity of opiate pain medication. I was not out looking for drugs. It came to me. Looking back, yes, there were things I should have done going into surgery, yet I really didn’t think it would be any big deal - denial, as we define it.
Prior to the surgery, I was being treated for chronic pain with opiates to get through the day. If you have ever been a chronic pain patient, pain knows no boundaries. It is the first thing on your mind when you wake and the last thing on your mind when you go to sleep, if you’re lucky enough to sleep. The medicine eventually became more of a problem than the physical pain. The illness of being dependent on medication now became my primary problem and a new source of pain, that being the pain of addiction.
I found myself locked into a lonely corner. Where did I turn, being an addiction professional in recovery and now being addicted to pain medication? I wanted to stop but couldn’t, and I was way too frightened to ask for help, for I knew what the consequences would be. Here I was working with professional groups all over the country that advocate for their clients in getting help. These licensed professionals, in particular, knew that help was available to them, and all they had to do was ask and it would be given. They could call their State’s Confidential Hotline, and they would be given assistance to stay clean and sober, return to their jobs with professional monitoring, and be subject to years of advocating and monitoring. But I had nowhere to turn because these programs for the Recovering Addiction Professional (RAP) were not available to me.
It is a sad statement that there is no such advocacy for the RAPs. You are just met with loss of job and reputation, judgement and shame. With my entire career in substance abuse treatment and four children at home to provide for, what was I to do? The answer was to stay quiet and live a life of a lie to survive. It was a perfect storm.
So, this all brings me to the point. What can be done to support the RAP? The truth is we simply don’t know what to do. There are very few state assistance programs available to RAPs. I am not aware of any national advocacy groups, yet many treatment centers have advocacy statements for the disease. I am afraid it all stems from stigma, denial, and shame.
What we have experienced in our profession is silence. Isn’t silence what we find in the addicted family? Can this also be true for an organizational dynamic where we will find denial, enabling, and secrets? I recall what my old friend and colleague Claudia Black used to say: “Don’t talk, don’t tell, don’t trust, don’t feel.” We are silent over shame and the implications of this issue.
We’re only as sick as our secrets. This is what we tell our patients. Our industry secret is what happens when one of us relapses? Despite the high relapse rate among addiction professionals over the course of their careers, there have been few studies specific to relapse among RAP’s. This can be misleading as we speak of relapse for RAPs but not of other behavioral concerns. How do we deal with personality disorders, anger, eating disorders, tobacco use, sexual addiction, and gambling? Are these issues inconsistent with our attitudes? Does this reflect a deeper-rooted stigma about substance abuse? Do we hold RAP’s to a higher standard than other healthcare professionals?
The profession of addiction has struggled to be recognized as a legitimate profession, in part due to the population we serve and the tradition of utilizing the lay counselor as a therapist. This of course is changing as more states now require a credential or license for Addiction Counselors/Therapists. We experience the same institutional denial as other health care professions. Simply, “We don’t have a problem.” The silence in the field protects the secret. If we admit that a large number of our RAP’s relapse over the course of their careers, does this exposure prove the treatment process is ineffective? If an RAP cannot stay clean and sober, how do we expect those we work with to remain sober? It challenges our professional competence if we cannot keep our own workforce sober. Then what do we have to offer?
When we terminate an RAP over a relapse, I would ask you to consider if our subsequent policies are legal or if they are discriminatory. I would say we do not “walk the talk” when we consider addiction a disease of relapse. We must implement alternatives to termination being the only recourse and handle these issues on a case-by-case basis.
If we are treating a disease without a known cure, what hope do we offer the RAP? Don’t we owe our clients and patients an obligation for hope? We have to demonstrate we are there for them.
So, what needs to be done? I would suggest that credentialing boards set up national standards for RAPs. States need to set up confidential advocacy programs with private, 24-hour hotlines similar to what is already in place for licensed health care and legal professionals. What would that look like? Initially, for substance abuse disorders and comorbid disorders, intensive high-quality treatment, mostly residential, and lasting for one to three months. This would then be followed by implementation of five plus years of random testing for alcohol and other drugs, with zero tolerance for any use. The consequences of leaving the monitoring programs or relapse to substance abuse include risk of losing your license or credential. And, to go without saying, immersion in recovery fellowship of Alcoholics Anonymous or Narcotics Anonymous is essential. Monitoring is rare, yet we have to be held accountable.
Policies and criteria have to be established and different standards individualized. Relapse is not the same as impairment. All relapses are not the same. Policies currently in place for length of sobriety discriminate against those with the disease of addiction.
We owe it to our profession to save the lives of not only the clientele we work with but also those of our colleagues. I would highly recommend that when a recovering addiction professional suffers a relapse, the agency they work for considers a few factors to benefit the RAP to return to work. That criteria would look like the following:
- A successful treatment stay.
- Accepting and understanding the disease of addiction.
- Bonding with AA/NA with active participation and sponsorship.
- Good relapse prevention skills.
- Other psychiatric disorders in remission.
- Healthy family relationships.
- Good living environment.
- Balanced lifestyle.
- Supportive work.
- A commitment to monitoring and a recovery contract.
All of the above would and ought to be required for immediate return to working in the treatment field.
In closing, I would like to quote the late David Powell, Ph.D., when he said:
“I am not into outing people, though the hypocrisy that exists and the people who get harmed and reputations destroyed because of the gossip is so against the ethics we stand for and the work that we do, helping others without judgment and continuing to get the word out there that this is a disease, not a decision to hurt others and destroy one’s life. All this does is set us as a field backwards and cause those that might need help to be too afraid to speak up because of how they have seen others treated.”
Thank you to the following for all the years of support and information I have received:
- Michael Wilkerson, MD
- Gregg Skipper, MD
- Robert DuPont, MD
- James Tracy, DDS
- David Powell, PhD
- Dottie Greene, MSW, LCSW, LCAS, CCS
- Mel Pohl , MD