NPR REPORT: TO TREAT SUBSTANCE USE EPIDEMICS OREGON NOW USING PUBLIC FUNDS TO HIRE NONPROFESSIONALS WITHOUT COMPETENCE

With among worst-in-nation outcomes, Oregon is funneling Measure 110 decriminalization funds for new hires in longstanding failed cronyism systems

by Clark Miller

Published May 30, 2022

In 2020, Oregon voters approved a measure to decriminalize possession of small amounts of drugs like heroin and cocaine and at the same time channel hundreds of millions of dollars from a recreational marijuana tax into helping people battle addiction. The idea is to address substance abuse through public health channels instead of the criminal justice system.

The NPR piece goes on to describe Oregon’s efforts to expand its substance use treatment workforce by paying “peer support specialists”, individuals whose competence and expertise in providing benefit to individuals at risk due to compulsive substance use is based on their own history of problem substance use, “lived experience“, rather than on training or competence in behavioral health or related field, described here, and here

Oregon has recently funded positions for dozens more of these kinds of jobs at facilities across the state, and there are many more jobs coming. It’s part of the state’s new approach to addressing substance abuse.

A peer support specialist engaged in the paid work is highlighted in the piece – 

Listening to people is a big part of her job. She remembers what it was like to feel invisible.

 

On a recent morning at Club Hope, [the] peer mentor hands a man a towel and points him to the shower. People can come here to bathe, eat or just watch Netflix and warm up. They can also access social services. The idea is that it allows people a pathway out of addiction.

But this model does not work without peer mentors . . .  who offer not only resources but also empathy.

On this morning she talks with a man who has just had a big breakthrough; he’s moving from the streets to his own apartment. He’s nervous and worried it might not work out. “You’ve gotta change your thinking,” she tells him. “Don’t even think about what happens next if this doesn’t work.”

It’s a brief exchange, but it’s these kinds of interactions that offer crucial emotional support for people in recovery. 

“it’s these kinds of interactions that offer crucial emotional support for people in recovery” 

This account serves as parody – of the doomed concept and implementation of peer support in healthcare response to epidemics of life-threatening, complex behavioral health conditions.

“You’ve gotta change your thinking,” she tells him. “Don’t even think about what happens next if this doesn’t work.”

That type of response, recognized as such by anyone in the field – by anyone with any meaningful level at all of training or competence in behavioral health or social services – was the opposite of empathy, instead predicts harm by incompetence. It might as well have been, “Oh, stop your worrying”.

Any minimally trained or competent professional would have provided active listening, with empathic response keyed to the real, deep fears of losing the opportunity to no longer be on the streets, then shifted to identification of needs and uncertainties then problem solving and generation of contingency planning for the worst case – to address real concerns and anxiety (anxiety a risk factor for return to problem substance use). 

All of that would have been provided in a client-centered interaction that validates and builds sense of self-efficacy, with concerns, ideas, and solutions elicited and drawn from the client – the opposite of what was provided: a directive to not pay attention to and express real inner experience representing needs.

 

“it’s these kinds of interactions that offer crucial emotional support for people in recovery” 

Parody. Of the failed, lethal systems generating drug epidemics in Oregon for decades, with public funding for a cronyism system controlling addiction treatment and tied to membership in a religious subculture. Self-parody of the consistently impaired celebration of failed, lethal systems perpetuating epidemics constructed and consumed as “journalism”.

Oregon is poised to dramatically expand an addiction treatment system that already consumes millions of dollars each year with no clear results.

– Rachel Alexander and Saphara Harrell, Salem Reporter

This NPR piece attempts to provide a picture of what peer support specialists do, how they interact with vulnerable Oregonians trapped in life-threatening compulsive substance use, and accidentally does provide that.  But the reporting is negligent, deceitful, and dangerous in what is left out – the actual core efforts described consistently by those peers, in media accounts, and observed by anyone with direct experience in the failed systems: the day-to-day shepherding of those vulnerable clients daily to meetings of the religious subcultures (Alcoholics Anonymous or Narcotics Anonymous) that the support specialists almost invariably are members of.

That’s the religious subculture established to have an 85 to 95 percent failure rate (return to problem substance use) for individuals exposed to its meetings and practices.

The meetings where members are socially reinforced and engage in normalized group use of arguably the most lethal and costly substance in American culture, tobacco smoked in cigarettes – the addiction that is an established gateway for return to problem alcohol and opioid use and whose yearly mortality an illness costs eclipse those of opioids, alcohol and all illicit substances combined.

cigarette butts

Meetings where the client will be expected to start work with a “sponsor” to work through the 12 Steps, including steps requiring the client to identify and dwell on his “defects of character” and all the ways he has harmed others, requiring atonement, reminders of all the emotional harm he has caused others and the associated losses and guilt. Reminders triggering the inner distress keeping him compelled to use substances. Those bizarre practices in direct opposition to research-established evidence-based approaches that focus on client strengths and that identify collaborative treatment planning driven by the client’s autonomy, competence, and interests rather than the universally applied, bizarre prescriptions of a religious subculture. With a predictable 85 to 95 percent outcome of return to problem substance use.

Those meetings, that peer support specialists – paid with public healthcare funds – ensure their vulnerable clients get to daily, often as a condition of continued services, or on threat of eviction back onto the streets from their emergency housing.

That peer support’s admonition to a vulnerable client to stop their thinking and stop worrying about their problems might make sense at those religious subculture meetings, where the client will be admonished – between cigarette breaks – to stop relying on his own “stinking thinking” to address problems and instead “give it over” to a “higher power” to take control of his life. That is, to forfeit and rob the client of the key factor established by research as critical to success in overcoming problem substance use – self-efficacy – and instead defer to and depend on the groupthink prescriptions of a religious subculture and a magical Higher Power. Those meetings.  

From an earlier post – 

Self-efficacy: The Opposite of Helplessness and Powerlessness

Another, complimentary factor strongly supported by extensive research as protective against relapse and required generally for change is self-efficacy, or sense of confidence in one’s own choices, abilities, and effectiveness to make the changes needed to resolve a problem or regain health and safety.

Self-efficacy is developed, reinforced, experienced and strengthened in a process of interaction with skilled therapists over which experiences that include active changes (not passive changes like taking a pill) are experienced as effecting positive changes in the patient’s life and resolution of problems. 

Self-efficacy – blocked, subverted, robbed from vulnerable individuals inculcated with the psychologically assaultive prescriptions in the religious subculture meetings to not trust in your own thinking, instead depend on groupthink and the magical guidance of a Higher Power, to dwell on your defects of character, to view yourself as powerless. 

Self-efficacy, a key factor established by research as required to stop and protect against return to problem substance use requires work in therapy over time in order for patients to internalize, own, and self-affirm personal agency and effectiveness, control, in behavioral and other changes that protect against problem substance use. Subverted and undermined by promotion in the religious subculture meetings of the long-invalidated “disease of addiction“.

Medical visits and the sham “treatments” are a barrier to self-efficacy, that is a barrier to healing and wellness. That process is subverted when vulnerable patients are reinforced, by medical visits for a non-medical problem – in the false belief of a passive fix for substance use, a pill.

The trained belief in a non-existent condition “addiction” as a medical condition with medical treatments was predicted, all along, to generate illness, “treatment” failures, ultimately lethal epidemics.

That’s the true face of the unqualified workforce populating Oregon’s failed treatment systems and of the movement to recruit peer support specialists, untrained, lacking basic competence, to address increasingly lethal substance use epidemics generated over decades of public funding for the same systems. You don’t have to pay them much, and they’re vulnerable – not likely to jeopardize a cronyism, state-funded employment position by exposing the harm done in the systems so generous to them, the harm-perpetuating mutualism described here, and here, here, here, and here

They are hard to keep employed, as described here in a recent post –                                                                                                

The recovery community individuals and organizations are highly competent at something else: protecting, including in closed-door meetings with Oregon legislators, access of members of their organization to cronyism employment in Oregon’s sham addiction treatment industries.

Some of those employed, with public funds, are “peer support specialists”, their paid employment predicting perpetuation of worsening substance use epidemics, as explained here, and here.

How’s that’s going these days, the work of paid peers promoted as effective and important by “recovery leaders” (former drug users who have worked to ensure Measure 110 funds continue to fund failed systems that provide cronyism employment to other members of their “recovery community”) ? Not so well, as reported by NPR. So many of these addiction treatment professionals are returning to problem drug use themselves, that their positions are unfilled. Who could have predicted that?

Several organizations contacted by NPR said the number of people relapsing, anecdotally anyway, has skyrocketed.

In fact, some groups say they’re having trouble finding enough peer counselors because so many are back using.

“The relapse numbers have gone up so much,” says Elly Staas with the 4th Dimension Recovery Center in Portland.

“because so many are back using.”

Who could have predicted that?

Why A Critical Discourse?

Because an uncontrolled epidemic of desperate and deadly use of pain-numbing opioid drugs is just the most visible of America’s lethal crises of drug misuse, suicide, depression, of obesity and sickness, of social illness. Because the matrix of health experts and institutions constructed and identified by mass media as trusted authorities – publicly funded and entrusted to protect public health – instead collude to fabricate false assurances like those that created an opioid crisis, while promising medical cures that never come and can never come, while epidemics worsen. Because the “journalists” responsible for protecting public well-being have failed to fight for truth, traded that duty away for their careers, their abdication and cowardice rewarded daily in corporate news offices, attempts to expose that failure and their fabrications punished.

Open, critical examination, exposure, and deconstruction of their lethal matrix of fabrications is a matter of survival, is cure for mass illness and crisis, demands of us a critical discourse.

Crisis is a necessary condition for a questioning of doxa, but is not in itself a sufficient condition for the production of a critical discourse.

Pierre Bourdieu - Outline of a Theory of Practice 1972

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