Running Head: ADDICTION TREATMENT PARADOX
Addiction Treatment Paradox: Combining Holistic and Biomedical Interventions in New Mexico
Danielle KabellaUniversity of New Mexico
McNair Summer 2013Final Research Paper
AbstractThis paper examines the blending of alternative treatment modalities such as energy healing, acupuncture, and curanderismo as they complement Suboxone, a pharmaceutical maintenance treatment. What is the best approach to treating opiate addiction in New Mexico? How do patients come to understand treatment options available to them while acknowledging a more holistic meaning in recovery? How might alternative medicine improve treatment? How does this reshape pharmaceutical treatments for opiate addiction? New Mexico faces many challenges in opiate addiction treatment including a high poverty rate that may lead to costs inaccessible to people without insurance, stigma and criminalization discouraging many from seeking treatment, and limited holistic treatment options available to an increasing admission rate. In addition, treatment centers are serving a diverse population where cultural and linguistic needs may not be met. Suboxone is recognized as a legal synthetic opiate for maintenance treatment of opiate dependence. Unlike methadone, it is administered in a private medical center creating a new space for recovery. This shift is part of a longer process of medicalization, beginning in the nineteenth century. Drawing on three months of participant observation and interviews with physicians, healers, and patients at a self-identified culturally sensitive medical clinic, this paper examines paradoxical blending of complimentary medicine, biomedical maintenance regimes, and ethnic empowerment to explore new approaches to opiate addiction.
Introduction
A small low cost clinic in Albuquerque, New Mexico, where multiple treatment
modalities fashion an oppositional relationship of alternative healing and biomedical
intervention, challenge the startling high opiate addiction rate faced by Albuquerque
residents. This research focus on opiate addiction in New Mexico occurs at a time when
the addiction, once defined as a moral disorder, has been reconceptualized as a
neurochemical relapsing brain disorder. As a result, the Drug Addiction Treatment Act
(DATA) of 2000, was signed into US law to waiver authority for physicians to prescribe
certain narcotic drugs for maintenance treatment. Under this law, the Food and Drug
Administration (FDA) approved buprenorphine in 2002. Buprenorphine/ naloxone (a
polydrug product under the commercial name Suboxone) is the drug prescribed at the
clinic where this research takes place. The major differences between pharmaceutical
Addiction Treatment Paradox 1
treatments for opiate addiction today and over a decade ago is the treatment setting in
both instances of where it is prescribed and where/ how it is administered. Particular to
this clinic, the pharmaceutical intervention is accompanied by alternative healing
sessions, which focus on a more holistic approach to treatment. In light of the “whole
body” (and spirit), this combination is described as restorative in both the mind with
spiritual cleansing and the brain through pharmaceutical intervention that communicates
with biological receptors in the physical anatomy. By acknowledging the two together, an
unfamiliar addiction treatment process that focuses on addiction neurology and
spirituality combine two distinct medical models. The purpose of this study is to explore
the coproduction of opiate treatment modalities in this small low cost clinic in
Albuquerque. Through participant observation and ethnographic interviews we explore
how these diverse participants in treatment together construct knowledge around opiate
addiction treatment. What is the best approach to treating opiate addiction in New
Mexico? What role should complementary and alternative treatments play in recovery?
How does it shape pharmaceuticals for addiction? How do patients understand the
treatment modalities offered to them while acknowledging a more holistic view treatment
(i.e. energy healing, pharmaceutical treatment, psychotherapy, curanderismo, and yoga)?
At this clinic, both Suboxone is prescribed along with mandatory alternative
healing sessions in order to maintain a prescription; however it is not mandatory to take
the suboxone prescription if only the alternative healing is desired. At the clinic, many
people inquiring about medical needs visit the clinic daily for treatment. The majority of
them exist in communities where Spanish is predominantly spoken, of mixed
immigration status, very low income, and who reside in the neighborhoods surrounding
Addiction Treatment Paradox 2
the clinic. The clinic, which began as a grassroots movement in a small 2-bedroom casita
in the heart of a marginalized neighborhood of Southwest Albuquerque is now a
recognized non-profit organization, the clinic serves any patients with many complex
medical needs. The opiate recovery program works to serve many individuals who are
diagnosed with opioid dependence, 304, a DSM-IV diagnosis.
Background
An introduction to the literature indicates that during the 1970’s, drug addiction
research became important to anthropology in western societies upon the increasing
amount of people reporting drug use and the application of anthropology to addressing
social problems (Singer 2012). In her ethnographic text, (Garcia 2010) looks to analyze
the way in which addiction might be caused, through land disposition and colonization in
Española, New Mexico (Gracia 2010). While focusing on these concepts, Garcia explores
the concept “chronicity”, commonly associated with heroin addiction characterized as a
neurological relapsing disorder. She argues that the chronicity model of heroin addiction
doesn’t acknowledge the material disposition and colonization many residents endured in
previous generation. Also interested in New Mexico’s landscape is (Trujillo 2009)
provides a critical perspective of Española Valley as it transitioned from a pastoral
economy to an urban economy. Poverty, drugs, and violence are attached to the negative
realities of the area, which are a consequence of Spanish colonialism. (Campbell 2013)
serves this research with similar questions in the way addiction is “framed” or
“constructed” around the model of chronic relapsing brain disease. She is also skeptical
of the concept. On this theme, Peter Conrad introduces the concept of Medicalization
where “a problem in medical terms, usually as an illness or disorder, or using a medical
Addiction Treatment Paradox 3
intervention to treat it” (2005). We see this process revealed through the discovery and
use of Suboxone. We question the influence of alternative healing in the powerful
medicalization of addiction, especially its role in pharmaceutical intervention.
Addiction research holds heavy weight in the urban setting in anthropology.
Philippe Bourgois connects poverty and marginalization in urban cities to heroin (and
crack) addiction. Using an ethnographic research method, similar to the methods being
used in this study, Bourgeois follows the lives of street-level drug dealers in East Harlem.
Looking at themes of structural violence and social inequality he analyzes drug policies,
and differences of race, gender, class, etc. With insight in everyday life experiences for
drug dealers, a connection can be made between drugs and an “underground” economy as
a result to social structures already set in place. Although my methods are only practiced
with in the clinic an ethnographic approach may reveal similar themes.
From a linguistic standpoint, language is used to narrate the treatment experience.
Using narrative speech, the addict is able to construct a reality based on sobriety (Carr
2013). She refers to this as “inner-reference”, the enforcement of a language ideology, by
speaking as a sober person would, to confront the clinical term, addiction “denial”. Using
this technique clients gain the ability to recognize self resistance experienced as he/ she
fails to view the self from the outside of denial. Similar to the to therapy/ healing sessions
practiced at the clinic, my study uses this theoretical lens to investigate therapeutic group
talks that may fall under categories of employment and personal relationships. In these
situations healers may encourage the concept of “inter- reference” and instruct how these
people show speak and act to support their sobriety in recovery.
Addiction Treatment Paradox 4
The literature reveals the way the brain plays a role in the biological context of
addiction. Nancy Campbell (2013) looks at the significance of addictions current
reconceptualization of opiate addiction being a “chronic relapsing brain disorder” as
oppose to the moral/ behavior diagnosing of it. Ann Lovell (2012), Todd Meyers (2013),
and Helena Hanson (2013) all look at the pharmaceutical interventions of addiction,
specifically buprenorphine, which adhere to this new reconceptualization of it. (Hanson
2013) compares two distinct ways of viewing opiate addiction, and exposes treatment
options as it relates to the way opiate addiction is understood. The buprenorphine
(Suboxone) require self-surveillance of personal choices by adhering to authority such as
the doctor. Similar to this, is the religious model where a “higher power” or “God” serves
as the authority over the self-selected choices made by addicts. Hansen argues that both
biomedical and spiritual interventions are individualist models while mimicking each
other in the form of personal choice overseen by authority. In another study she suggests
a contrast of treatment development from methadone maintenance of the black and
Latino poor to the emergence of buprenorphine (Suboxone) of the white middle class in
the pharmaceutical industry’s attempts to desigmatize addictions. Thus, a new
demographic of opiate addiction patients have emerged and therefore requiring treatment.
This demand for addiction treatment from a primarily white middle class population calls
for a “normalized” opiate addiction treatment that fits into their “normal” lifestyles in
attending to school, work, and family responsibilities. Private office base addiction
treatment not only reproduces racial socioeconomic identify, but provides a new
treatment space for “normal” patients to recover. The patients observed using the
Suboxone treatment my study may suggest a different outcome that might be worth
Addiction Treatment Paradox 5
attention. Todd Meyers (2013), conducts fieldwork by following the lives of adolescents
in drug treatment. From the clinic to outside the clinic, he considers the social and
economic conditions that allow drug dependency to continue. New pharmaceutical drug
therapies (such as Suboxone) have created new insights into opiate intervention. He
shows how the patterns if individuals in recovery are mediated by pharmaceutical
treatment in the lives of adolescents. Suboxone may offer nothing more than a medical
intervention that ignores poor social and economic conditions experiences by the clients
who are using self-payment or struggling with insurance companies who refuse to cover
the prescriptions.
Through the alternative model of addiction, a piece of literature proposes the use
of Curanderismo, a traditional Aztec healing modality, to treat patients with alcohol
problems as alternative medicine. The authors study the treatment of addiction in a
culturally sensitive setting. Curanderismo is a treatment modality under analysis used in
my research that is held equally important as the pharmaceutical intervention of
Suboxone by the medical professionals at the clinic where it is practiced. It would be
interesting to refer to this study under the process of medicalization, and recount what the
patients interest are. Where do they say a fit for the alternative healing in their recovery
process? Taken together, the literature reviews indicate a historical overview of the way
addiction is conceptualized and treated. Also, by further medicalizing addiction
especially in the concept of “chronicity” may impose the lives of people in recovery. Its
ask does holistic treatment create a different meaning for pharmaceutical intervention?
From two distinct perspectives on treatment modalities, an analysis must be made on the
combination of both. It is important to understand how the two come together and create
Addiction Treatment Paradox 6
meaning and the experiences for the people who seek use these services. Residents of
New Mexico who are struggling with the high rate of opiate addiction deserve to have
their story told as the reframing of this concept continues to form. Also, how treatment
from the combination of holistic and biomedical interventions may impact or infringe on
their lives.
The opiate addiction treatment program, as part of a family clinic, is located at a
busy intersection in South West, Albuquerque. The main street has one public bus line to
transport commuters to and from their daily tasks. The single lane two- way road is
narrow, leaving bicyclists very little room to share with private vehicles that rush through
mild to heavy traffic. An essential connection to central Albuquerque, a more urban area,
the road is the main commute for many people coming to visit the clinic. Locating myself
on the same road traveling from my residence of the downtown area, for many who come
to visit the clinic by various means of transportation, I traveled by personal vehicle to a
private family medical office. Considering the historic roots of opiate addiction
treatment, this is not a typical treatment setting for recovery. In more discrete terms,
opiate addiction recovery would take shape between walls shared with people who visit
the doctor for nothing more than a common cold, or diabetes. No indication of opiate
addiction treatment appears on the exterior of the physical building itself or the
surrounding areas.
The building itself is fairly new, considering its recent expansion. With two main
hallways of doctor offices, holistic treatments take place for opiate recovery in a large
room tucked away on a quieter end of the building. However, the paperwork of insurance
prior authorizations, blood orders, urinalyses, opioid prescriptions, patient charts, grant
Addiction Treatment Paradox 7
budgets consume the shelf space, fax machines and doctors’ boxes on a daily basis.
Always an unfinished business, work is concentrated around the recovery program. I
have the advantage of working as a volunteer with people in recovery who are addicted to
opiates at this clinic. Volunteering for interests in research is an anomaly considering
most volunteers are there with medical education interests. Prior to seeking approval for
research, the head nurse practitioner challenged my research inquiry, she asked, “are you
from here?” indicating the need to understand opiate addiction specific to New Mexico
through observable experience. I told her I was born and raised between Albuquerque and
Yrisarri (SE of the village of Tijeras). We made a common ground between the
topography of my upbringing here in New Mexico.
Check-in began at 1:30pm, Monday. Each client, typically five, has to follow the
same procedure to guarantee a spot in the program. The first five who call the enrollment
line by 11am that same Monday are selected to join the healing session. The people who
are not selected are put on a waiting list for possible consideration under the circumstance
that part of the original five doesn’t show. One-by-one a payment collection or insurance
information is taken, an overview of clinic and program contract and signed
electronically agreeing to possible sharing of personal information to volunteers,
punctuality for doctor visit and healing sessions or, required attendance of each four
healing sessions to complete program and continue suboxone prescriptions, and that
prescriptions cannot sold or given away. Vitals are taken (blood pressure, pulse, and
oxygen percent) to document health status for the induction period. Consent to acudetox
procedure and completion of the Client Acudetox Record is completed with general
demographic information. An order is then sent for a Comprehensive Metabolic Panel
Addiction Treatment Paradox 8
(CMP) blood test for each individual. The blood test provides a rough check of kidney
and liver function (used to measure patients with a chronic disease). A neon green
reminder card serves as a snapshot of their contractual agreement to attend a total of four
mandatory consecutive healing seasons. In most cases it is the most important document
that serves as the responsibility to uphold the clinics expectations. The healing sessions
are mandatory and if clients miss one session they must start the process all over again.
No excuses are made for anyone. If they foresee any possible absences they are
recommended to start the cycle when their schedules are open and flexible. Being in
recovery means flexibility and the uncertainties and constant demands of court, family,
and work can impede this process. However, in the clinic’s case the hustle for illicit drugs
is equated to the hustle for recovery and these expectations are enforced heavily. So what
hustle is put into recovery? And does these translate into skills necessary for the mission?
In front of the alter, five lounge chairs are arranged in a half moon shape.
Spiritual items adorn the room with symbolic meaning all implied in the healing process.
The four elements of earth, water, wind, and fire are represented. Pieces of rocks reveal
the presents of earth. Water reveals itself in small class container filled with a flat black
stone placed at the center. The depiction of wind is narrowed down to a eagle feather
which lays flat on the alter. Fire appears only in the form of a lit candle, which is ignited
right as the sessions begin. With these elements, it is described as creating a sacred space
of healing. The aroma of lavender tincture oil adds to the alternative healing models
appeal. The biochemistry is explained as reaction to sooth the cortisol levels in the brain
that recuses fear. This same tincture is applied to the patients palms for a more
exaggerated scent delivering the brains interaction with relaxation. The clients, already
Addiction Treatment Paradox 9
checked in, are instructed to sit in one and wait comfortably for their healing sessions to
begin. They sit nervously. Some are weak and ailing possibly due to the fact that they are
recommended to present themselves in a moderate state of withdrawal in order to receive
buprenorphine, a Medication Management Treatment (MMT) used together with the
alternative healing sessions at this particular clinic.
Although the sessions are done fully clothed, I felt deprived of my security as I
was asked to store my belongings underneath my chair to receive healing treatment (for
the first time) with my eyes covered. The anticipation was high as I waited along with the
other two women for the treatment. The session began with a Narcan medication class
taught by volunteers for overdose prevention. Clients were informed about how to use the
nasal spray form of the drug. After the class they are prescribed free two doses of their
own. The Naloxone (Narcan) works by shielding unique drug receptors in the brain and
counteracts heroin and certain painkillers. Ultimately, reversing a fatal overdoes and
replaced by withdrawal symptoms ..allowing the patient to breath. Restored security?
Administered almost always by someone else… because of the unconsciousness.
Angela Garcia- Overdose (suicide)
The patients are next instructed to take a restroom and cigarette break to alleviate
any business as the body is to be detoxified. As they return to we return to our seats, the
healers/ practitioners have started setting up their healing supplies. On one table a healer
(reike and certified acupuncturist) is seen laying out single packages of tiny disposable
acupuncture needles, alcohol swabs, and a medical sharps container to safely dispose of
used needles after session. The acupuncturist breaks open one of the swaps and begins
Addiction Treatment Paradox 10
cleaning both outer ears and punctures each client one by one in five distinct spots in the
ear.
Auricular Ear Acupuncture
Acudetox, a form of auricular acupuncture to treat substance abuse, relapse
prevention and harm reduction. It consists of placing five small, sterilized, disposable
needles in specific sites on the ears. The first point is the sympathetic points, which
relaxes the muscles and calms the nervous system. The second point, shenmen point, or
the heart, reduces cravings, anxiety and insomnia. The third point, kidneys, clears blood,
reduces fear, provides access to emotional reserves. The fourth point, the liver, helps
detoxify and reduce anger and depression. The fifth point, the lungs, help detoxify and
restores a joy for life. In order for it to word successfully, clients are to have the needles
in for at least 45 minuets of relaxation. Ear seed in between sessions- when cravings (or
intrusive thoughts) occur, you press on the seed to stimulate ear reflexes.
Reiki
Reiki, a Japanese healing system, use healing energy transferred through the
hands of the practitioner to promote healing, balance, and well being for the receiver. The
energy is derived from the unseen “Universal Life Force Energy”- ** high and low** the
English translation of Reiki which permeates and sustains all forms of life. The Reiki
treatment is given lying down, fully clothed. The Reiki practitioners will place her hands
on different areas of the body. These areas coincide with the main body organs (heart,
liver, lungs, kidneys, stomach, etc.) and the glands (pancreas, adrenals, thyroid, etc.) The
practitioner moves their hands to these areas and keeps them still as needed for several
minuets so that each patient receiving the treatment draw the amount of energy that meets
Addiction Treatment Paradox 11
his/ her individual needs. As the acudetox treatment creates a warm tingling, electrical
movement, heaviness and sleepiness, Reike relaxes the body, calms the mind, and
refreshes spirit. Reiki restores good health to the body and also helps to release emotions
and feelings trapped in your subcounscious- helping to face and transform them creating
a balance in both body and mind. Reiki= a spiritual massage, sunlight is important
Curanderismo
Platicas/ limpias (heart to heart talk)- helps practitioner and patient determine
appropriate steps in addressing the patients needs. Limpias- spiritual cleansing- working
with energy, meditation, imagery (remember when you were a child), prayer, the
elements of water, fire, earth, wind and the use of herbs and incense.
Buprenorphine
Along side the holistic side of treatment, the drug, buprenorphine/ naloxone, is
prescribed to the clients, under the commercial name suboxone. In a setting of a private
medical office under strict regulations, Suboxone is prescribed to opiate addiction
treatment patients. Ultimately making the maintenance therapy safer from overdose and
eliminating pleasurable euphoria affects, naloxone was added to the molecule structure.
With the additive drug, naloxone, Suboxone® was designed to manages the risk of drug
abuse and diversion. Naloxone, makes suboxone safe enough for private consumption
because it ceiling effect for euphoria creates less of a chance for drug abuse.
**Moral authority over addiction- This reminds me of the pharmaceutical intervention
and how the authority given to the patients through the common tern “honesty” relates to
an authoritative relationship to spiritual authority where God is in supervision of you, and
Addiction Treatment Paradox 12
you must adhere to his power and authority of you have “lost control” or connection with
god. And all boundaries plunder, and one loses privileges to treatment.
At this particular clinic, the pharmaceutical intervention cannot work without its
partnership with the alternative healing, the reiki, acudetox, and meditation exercises add
to the compelling effects of habitual physical and emotional healing that help clients to
embody their recovery. At the healing sessions, alternative healing is the main focus.
However, at the end of the second session, a small Suboxone educational class is given to
the clients at the end of their treatments were finished. I have observed one of these
classes after my experience with the treatment. After the treatment was over, a
practitioner uncovered my face and lifted me to a sitting position and gave me an herbal
mint tea. One of the physicians came in to explain the way Suboxone works and firm
expectations while on the drug. The Suboxone was explained as a “shield” to block
synthetic opiates from communicating with receptors in the brain. A meaning to the
alternative healing was given to express the “emotions” and physical feeling experienced
with the treatments to share a role in the recovery as a whole. The pill itself works to
transform the brain as the alternative healing works to body and mind. Is there a
connection?
Methodology
This research uses an ethnographic design to take in information about the
detailed inter-workings of the clinic and how the people involved subsist through an
opiate addiction recovery process. Drawing on three months of participant observation
and interviews with physicians, healers, and patients this research examines paradoxical
blending of complimentary medicine, biomedical maintenance regimes, and ethnic
Addiction Treatment Paradox 13
empowerment to explore the impacts of new approaches to opiate addiction. Stage 1 will
conduct participant observation focusing on healing practices and therapeutic approaches
of the healers and doctors only. This stage will span over three hours per week for a total
of three months. Stage 2 will conduct audio-recorded semistructured interviews with
medical professionals where discussion will revolve around expert opinions of suboxone
treatment and the relationship with other treatment modalities. This will include the two
physicians who prescribe the suboxone treatment and five healing practitioners including
a Reiki master, acupuncture specialist, Curandera, and an herbalist. Stage 3 will conduct
audio-recorded semistructured interviews with the clients eliciting information about
their experience, knowledge, and conceptualization of treatment. The clients are a diverse
many, thus a great analysis should formulate upon this. Stage 4 will organize the data into
a excel spreadsheet to connect common themes expressed by both client and medical
professionals. Using my hypotheses as a guide, I will analyze themes around
medicalization of the biomedical technology, Suboxone (Conrad), inner-reference and
linguistic authority (Carr) and the use of complementary and alternative medicine in
opiate recovery. Together these themes with an ethnographic description of the clinic will
make up the contents of this study. Where this clinic provides a variety of opiate
treatment modalities there are many jobs and complicated responsibilities at multiple
levels of group interaction that will benefit an analysis under participant observation used
within this study. This study only analyzes the clinic itself and the day-to-day processes
with the people involved. There are limitations of observational everyday life outside the
clinic’s walls within the scope of this study. Access to observation outside the clinic is
limited and may withhold some essential information worth looking at in a further study.
Addiction Treatment Paradox 14
Expected Results & Conclusions
I expect in my results to find three conclusions. First, clients will become active
players in their recovery process, provided that instructive principles encouraging their
sobriety are suggested. From a linguistic standpoint, language is used to narrate the
treatment experience. Using narrative speech, the addict is able to construct a reality
based on sobriety. In other words, the addicts are instructed to act and speak in a manner
as if they are already sober. Carr refers to this as “inner reference”. Thus, with instructive
material for daily “attitude performance” (including 5 Reiki principles), the clients may
respond with this “inner reference” also (Carr 2013).
Second, clients who attend healing circles beyond the requirement and treated
with complementary and alternative medicine will report a more positive experience. A
study on curanderismo and alcohol treatment indicates better outcomes for recovery. A
focus group methodology captured the experiences of the curanderos who used
alternative treatment modalities such as herbal tea preparation for withdrawal, message,
and ceremonial cleansings. Measuring by both high and low referenced treatment
modalities, the curanderos reported that the clients preferred a more traditional approach
to treatment. I suggest this may be possible in this study as well.
Second, clients will prefer biomedical intervention to alternative healing and will
only attend the mandatory healing circles in order to receive their suboxone prescriptions.
Medicalization, a term defined by Peter Conrad as “a problem in medical terms usually as
an illness or disorder or using medical intervention to treat it”. For example, addiction
was once understood as a moral/ behavioral disorder, but now is redefined as a
neurological relapsing brain disease requiring medical intervention such as the Suboxone
Addiction Treatment Paradox 15
to treat it. This, I suggest that the clients will attach greater value to the suboxone
prescriptions over the alternative healing under this process of medicalization.
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