The importance of purpose

Recovery from addiction cannot start without it

The process of becoming a drug addict and the path to recovery from it are both highly individual experiences. However, distilling it down, there are two common elements for all:

• The presence or absence of a sense of purpose.

• The masking effects of the drug chosen by the addict.

Sure, many sorts of trauma figure into addiction, as do personal battles with gender or sexual orientation or sexual abuse. Genetics too, must play a role, along with happenstance. Bad luck. Chronic pain from an injury that takes away your ability to make a living and care for family may lead to drug use. Crappy parents. Born addicted.

Not everyone without purpose become addicts. But once addicted, all active addicts are without useful purpose in their lives, and they won’t fully recover until they stop the drug they are using so they are able to look for that purpose.

While addicted to our drug of choice, addicts mimic purpose. The drug’s effects provide escape, but addiction also provides an overwhelming focus to procure the next investment in that drug and join a community of addicts to which you belong, where you have the agency that comes of shared experience and the diminished self-respect resulting from dependency.

Imagine a day in the life of a fentanyl addict living on the street. You will no longer need to ask, “Why don’t they just seek help?”

Fentanyl provides an intense and overwhelming euphoria lasting several hours in which you can barely stand, if at all, and can bend into positions you could never achieve without the drug. Call it the “nod.” The nod does not last more than a few hours, and you start feeling “unwell” as soon as it’s gone. Time for another nod. In the meantime, fentanyl gives you cravings for sweets and salty foods. Notice the wrappers left behind. Fentanyl makes you constipated. Your health declines and your teeth rot. Digging through dog poop bags for returnable cans in trash cans doesn’t help, and neither does occasionally eating the food off the top left behind for others or scrounging for cigarette butts with a little tobacco remaining.

Smoking is a nice fit with fentanyl. The drugs, and what they are mixed with, are not meant for your body, and you develop sores and abscesses. Your clothes are filthy, access to restrooms restricted so you use any convenient alcove, corner or bush to relieve yourself, sans toilet paper. Just imagine. You need medical care for your wounds, and a trip to the Oasis (the new day shelter in Old Town currently serving all of Portland) to do laundry and secure fresh clothes. But that is a low priority. You may need a new bus pass or other document. You need to charge your phone so you know where your dealer will be next or you can contact relatives. You need to go to the library so you can access the Internet.

But, through all of this, you need the nod, which increasingly means you need to just “feel well.” You need enough cans to procure your next nod, and you need your network to find the dealer. And you are starting to feel more unwell. It has been four hours since you last smoked or fixed fentanyl. Time for action. Time for purpose.

Not much time for reflection. Once you are in your nod, you are oblivious to all your problems. An outreach worker may come by and ask if you are ready for treatment. They can get you on a waiting list or maybe there is an open bed available the next morning. “Just meet me here or wait for my call. Sit still, I’ll try to get you an emergency bed in a shelter until then.”

There are a few who say yes but often leave when the withdrawals get worse. A few make it into the limited number of detox beds voluntarily. A few of those complete that detox, without leaving, if they get methadone or Suboxone, themselves addictive, to diminish withdrawal pain. A few of those gain access to sober housing and the services they need afterward to continue their recovery and find their purpose.

Finding purpose starts with detox from the drug of choice, followed by an individual recovery plan. Both require a lot of outside help as well as new focus from the addict. Physical and psychological detox, which takes about 30 days depending on the addict, is the hardest part. There are not enough detox beds for the population of addicts in Multnomah County, and they are scattered among different providers with different sources of funding and criteria for entry and methods. All of this is voluntary and subject to ability to pay or verification of source of payment. The exception is hospital emergency rooms treating overdose crises, a path that helps bankrupt our health care system.

The focus for Multnomah County is on the individual identity of the addict and developing trust through outreach by identity peers and in keeping addicts as safe and comfortable as possible in their misery while we wait for them to wake up and ask for detox and start recovery. It’s a noble idea. It provides employment for those themselves in recovery. And it may work for some who had an inkling of purpose before their addiction and who also have the family, educational and financial resources to pursue that purpose. A criminal past may further foreclose options.

Most of those addicts we see on our streets will not “wake up and see the light” from their drug-focused life and miraculously find full social agency. It will be a long and individual process, and they need help moving toward a better future. Tents, pipes, needles, Narcan, tarps and tents and even shelters will not start their path to a full recovery, but detox will. They amount to compassionate neglect; well-intentioned but misguided and not designed to give purpose.

What is purpose? What is recovery? A topic for a separate column, because both, like addiction, depend upon the individual. But it starts with detox.

As readers are aware, I have been an advocate of a maximum 30-day detox via civil commitment to address the need to start getting addicts off the street and into a place where they can begin the healing process. This time would be used for a clinical assessment, medical care, peer support and development of the addict’s individual recovery plan. I have advocated use of 250 beds in five separate dorms located in the Inverness Jail. This gives addicts a shot at recovery without saddling them with the additional burden of a criminal record, which only makes permanent housing harder.

We do not need to make this so hard. We need to stop practicing compassionate neglect and start addressing the problem of people with behavioral health illnesses living untreated on the streets of Portland. That would give the county “useful purpose.”

Dick Perkins confounds many who would put him on the spectrum of local attitudes on social issues. A former heroin addict and homeless person who later had a successful career in banking, he balances the needs of people suffering on the street with the interests of the wider community. He advises the Behavioral Health Resource Center and public officials on related issues. Read his recent opinion piece in the NW Examiner, Free will, ‘housing first’ strategies not working