What Works in Treatment?: Sapphire’s Story, Part 1

rsz_img_2357Sapphire’s Story shows the importance of person-centered treatment. Things went well when Sapphire was intimately involved in decisions about her treatment, but poorly when professionals took sole control. We’ll look at various stages of Sapphire’s treatment career.

Sapphire was being prescribed methadone for her heroin addiction, but as the dose was not high enough she was suffering withdrawal symptoms. To counter the discomfort of this withdrawal, she was purchasing methadone on the street and using benzodiazepines. Then a problem arose from her urine sample:

‘When I was 25, my urine screening revealed that I was taking benzos and the CDT sent me to a shared care GP who was to prescribe my methadone and benzos. At my first appointment, I decided to be honest and tell the GP about the methadone I was buying, and how bad my benzo use had become.

To my surprise, she said that she was a GPWSI (General Practitioner with Special Interest) in addiction. She also informed me that some people need higher doses of methadone than others, and their genuine need is not always correlated with the size of their heroin habit.

Things were starting to get a little better now I was able to see a doctor who I could be honest with, without the threat of sanctions with my medications. It felt great to freely talk about what was really going on in my life. My new GP listened to what I had to say and treated me like any other (non-addict) person. She also did not repeat ad nauseam that, ”Everything in my life would be rosy if I was abstinent”, which was the party line of the CDT.

She increased my methadone dose and I was able to function totally normally without having to buy any methadone on top, or without feeling like I wanted to use any other drugs. I felt like any other person, and it was very important to me that I didn’t have to worry about buying drugs or find the money for those drugs. I was still using benzos, but they were prescribed by my GP and I took them as I should and did not try to acquire more illicitly.

My career had gone from strength to strength since seeing this GP on a regular basis, and I was now managing a team of about 12 people. The job was quite stressful, but I loved being busy. It meant I had less time to think about drugs or to worry about anything else, such as my controlling partner.

I was still being physically and mentally abused by the man I was living with, and was a nervous wreck as a result, particularly around him, as the odd word or slightest thing out of place would set him off.’

Well, that was a good part of this Story, apart from the controlling partner. And then things went awry.

‘Everything seemed great for about three years, but then my GP suddenly died. I was sent back to the CDT for my prescriptions, where I met my old drug-using friends for the first time in ages – I had earlier cut all ties with them.

I now had a new problem with the CDT. As I was testing negative for all drugs other than those I was being prescribed –that is, I was not taking anything on top of my prescription – the CDT kept insisting they reduce my methadone dose.

They believed that I didn’t need the same dose of methadone as I wasn’t now using illicit or unprescribed drugs, ignoring the fact that it was because of this dose of methadone that I was able to abstain from other drugs and alcohol. Their logic seemed to be, “As the medicine is working, she needs less of it!” [My bold – DC]

When they reduced my methadone dose, I would start off okay, but then reached a point where the methadone wasn’t holding me physically all day. I started getting cravings and as a result I would use heroin in addition to my prescription.

The CDT would then titrate my methadone dose back up because of the positive drug screening and what I had said about the lower dose not working.

It was very frustrating to be stable and not using illicit drugs, only for the CDT to coerce me into reducing my methadone dose as soon as I gave drug-free screens again.

Due to the CDT’s coercion, I started supplementing my prescribed medication with street-bought methadone. I was sick to death of the treatment system at this point. Prescription methadone at the right dose was working well for me, but the CDT kept interfering with my treatment.

At the time, I didn’t know enough about the treatment system to know whom to approach to get the CDT to stop reducing my clinically effective dose. I also feared that if I did complain, punitive measures would be invoked.

I’m really not sure why, but I went back to a guy’s house one day after my visit to the CDT. I didn’t know that he was a crack user. I had used crack a couple of times, but then had always said no whenever anyone offered me a pipe. When he offered me a pipe that afternoon, I’m not sure why I said, “Yes.”

I think that I was under a lot of stress at work, my parents still didn’t seem happy with my career progression, and I still didn’t feel like I fitted in anywhere. I didn’t fit in with straight people as I was on a script, but I didn’t really fit in with drug users either as I wasn’t using any illicit drugs!’

And life was about to get worse, before it got better. I’ll continue with Sapphire’s journey into the treatment ‘industry’ tomorrow, although you may just want to check out her full Story, It Should All Be About the Person.

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