Editor’s note: This commentary is by Nina Gaby, of Brookfield, an advanced practice psychiatric nurse, a writer and a visual artist who maintains a clinical practice where she consults with Thomas Chittenden Health Center and Valley Vista. She has done workshops on addiction for the Vermont Department of Health and has taught in university programs in both Vermont and New York.
“Overdose victims almost always had some interaction with the system before they died,” the VTDigger article begins. I check with my husband, who, like myself, has been in the business of treating patients with substance abuse for decades. Had he seen this data? I summarize it for him and he asks, “So what is the point they are trying to make?” Indeed. The “system” being those of us who are clinicians, our government agencies, emergency services, law enforcement, and the Vermont Prescription Monitoring System. Is the data suggesting that we failed our patients?
I believe that many factors fail. One must understand the desperate nature of the disease of addiction. One must understand the failure of available alternatives to pain management. One must understand the degree that we do not offer adequate skill-based therapies to people, including children, who have suffered trauma. And we need to examine “harm reduction” which has insidiously begun to replace what we used to call “recovery” and the promotion of abstinence-based treatment. The double-edged sword of harm reduction makes it easier on our systems to keep people alive in the short run, perhaps, but loses track of long-term integrated principles that may help them stay alive.
We need much deeper conversation around our cavalier attitudes towards cannabis and its place in recovery.
We also need to recognize the roles of the clinicians, the EMTs, the recovery coaches, and law enforcement in this battle. This is a very hard job, often heartbreaking; please don’t insinuate that we have failed. We do the best with the resources we have. If the data from this report is to help with anything, it must serve to allocate resources to provide more training to medical personnel and give them more options for screening and treatment (emergency room, inpatient and outpatient.) We need more sober transitional housing. We need adolescent-specific treatment programs. We need psychiatric beds available for high-risk patients. We need accessible options for alternative pain management which must be covered by insurance. We need more psychiatric providers who are knowledgeable about the addictions. We need to provide more support to the teachers who are often the first to recognize the problems brewing in a family. We need to provide relief to those beleaguered family systems through therapy and education and support and options.
My husband and I examine these factors regularly as we live with the “data” on a daily basis. He is a clinical social worker and past clinical director of Valley Vista in Bradford, and I am a psychiatric nurse practitioner who has worked with the co-occurring population for 30 years. We have seen a lot of success and a lot of tragedy. These are certainly not novel ideas, all of which require far more discussion than what we have space for here, but certainly bear repeating. Let’s hope that this report helps us move forward, understanding (to quote Virginia Satir, author of the 1972 classic Peoplemakingand an early pioneer in family therapy with addicted systems): “Everyone is doing the best they can, the very best.”
