The Current State of Substance Use Disorder Treatment: My Interview With Joe Schrank
Totally abstinent from all intoxicating substances for nearly 20 years, Joe Schrank is a clinical social worker, journalist, public speaker, and policy advocate. As a young man at the University of Southern California, Joe medicated his depression with alcohol and avoidance. His road to stable mental health led to a social work program at Iona College, then a master’s degree program at the University of Illinois. From there, Joe worked as a residential therapist at Promises in Malibu, California.
In 2004, Joe returned to New York City where he opened the first transitional living facility. Frustrated with the lack of media coverage about addiction and mental health, he founded The Fix in 2010. Joe is also a founding member of “Sobriety, Learning and Motivation,” which established the first recovery program in a New York City public school. He has facilitated countless interventions, managed innumerable crises, and successfully navigated many court entanglements. Joe has seen many positive outcomes with his “1:1 in vivo” treatment protocol, and is a frequent contributor to Salon, the Daily Beast, the Huffington Post, and Fox News. He believes addiction is the health crisis of the modern age. Joe lives in Brooklyn with his two boys who have never seen him drink.
I spoke to Joe about the current state of substance use disorder treatment and his view that it is inherently flawed. In this interview, Joe explains how we might challenge the status quo in the recovery offering – to be more inclusive and person-cantered. These broad spectrum of recovery alternatives – such as cannabis inclusive modalities – he says, have had some great outcomes.
Liv: You say that you believe addiction treatment in its current form is inherently flawed and limited. How so?
Joe: The current state of addiction treatment is inherently flawed because it’s so ineffective and one note. All areas of health care are improving, except this one. Think of dental work even a decade ago and how it’s better and better. With addiction it’s been the same plan for decades with an abysmal rate of success. It’s different now because of the daily body count so addiction treatment simply can’t be AA indoctrination camp. The binary clean/dirty system is too limited and marginalizes far too many people.
Liv: You said that only 25% of people who enter SUD recovery find long-term abstinence. How did that figure influence decision to start High Sobriety?
Joe: I don’t think we actually know much about what happens to people who receive treatment. We know there are many converted zealots screaming from the hilltops about the virtues of AA. That’s a beautiful story but doesn’t happen for enough people. It’s unconscionable that we accept the low level of success and then go on the offensive to public ally flog people as “unwilling.”
Liv: High Sobriety supports a spectrum of recovery alternatives for those who have been unable to stop using drugs and alcohol in an abstinence-based stetting — including harm reduction, risk minimization, drug replacement therapy and cannabis-inclusive modalities. Tell me more about the cannabis-inclusive modalities: how do they work and can anyone join?
Joe: If someone has diabetes we would never say “when are you going to be off insulin?” We would never tell someone “come back when we need to amputate your foot.” We accept that it’s a varied process that is a lifestyle change. We celebrate improvement with other health issues but demand the outcome be the desires of the culture which is being drug free. We believe that medication is an important part of recovery for some people, and it shouldn’t come with shame. It’s also between an individual and their doctor. Drug-free may not be the best option for some people. In fact, I’m sure it’s not. In our context, cannabis is medicine like any other, and it’s use is up to the medical team and patient.
Liv: What have been some of the outcomes of cannabis-inclusive modalities?
Joe: We have had great outcomes. Many people have reduced or eliminated their use of opiates. We have seen many, many people move into cessation of alcohol by using medical cannabis. That’s a hustle victory. The folks who have done that have seen way better overall health. Many have lost weight, seen better blood pressure, developed healthier eating and movement practice habits. With that said, cannabis, like all medications isn’t without risk or side effect. There are those too but they aren’t the lies we have been told for decades.
Liv: Tell me more about how your residents use cannabis?
Joe: Residents use cannabis in a variety of ways for a variety of reasons. The best protocol is worked out with their doctor so it’s a very medicalized practice. What they don’t do is listen to Pink Floyd and pass around a joint, though if they did, we wouldn’t judge them, it’s just not our goal. There is inherent value for some folks with a variety of mental and physical health concerns, why not capture that value?
Liv: Tell me a little more about your mission to eliminate the risk of death from drug use?
Joe: Accepting that drug use is part of American life is a critical step to improvement. There is not now, nor has there ever been, nor will there ever be a drug free America. The idea that Americans can walk into CVS and leave with pills and alcohol that has death potential but not cannabis with no death potential is wrong. We drop 100+ bodies a day to overdose. 88k Americans a year drink themselves to death. Cannabis claims ZERO; we are chasing the wrong thing. Cannabis users can have conversations about life changes and improvements, a corpse can’t. Dead is dead. If we can get people to use cannabis as their form of intoxication we’ve managed the risk by 99.999%. From that point people can do all kinds of things including reach total abstinence from intoxication if that is their goal. Abstinence at any cost, even death is wrong.
Liv: Your website talks about your belief in the interwoven connection between mind and body. Can you tell me more about how a holistic approach to recovery benefits those who participate in High Sobriety?
Joe: I went to USC in Los Angeles and on the old gym, likely built in the 20s, it says “in concordium mantis e corpus” – in tune with mind and body. In my own mental health and drug use management protocol, body is a critical component. If I don’t vigorously workout, I think I will go crazy. I can’t quieten my mind, my self-loathing, my inherent desire to self-destruct without it. I think it all works together, and there is science and research on this about people who have a consistent movement practice doing better with their mental health challenges. I have seen that for years and believe it to be true. As a side note, I am not a cannabis consumer; I’m not on a mission to get people to smoke weed nor do I think the stuff is magic, but I do think there is potential value and the option should be explored. Dismissing the possible benefit because of a personal moral objection is wrong and unethical.
Images Courtesy of iStock, Joe Schrank