Defying Convention

“You just overdosed; you need to go back to treatment,” my mother said firmly. I fiddled with a paperclip to divert my attention from what my mother was saying. I had foolishly hoped that by ignoring her last remark, she would leave or change the topic. In a hopeful manner, she asked, “I had a conversation with your prior treatment counselor, the one you were so fond of, and he agreed that you should return to treatment. Would you be willing to go back?”

I pondered her question, considering the advantages and disadvantages of returning to treatment. I may have been quiet for a bit too long, but I wanted to ensure that my decision was carefully considered. Although I felt fortunate to have such a supportive and caring mother, as well as the opportunity to receive continued treatment, I questioned whether treatment was the best choice for me. After contemplating the question, I finally replied, “Mommy, I’ve been to treatment numerous times. Each time I return, I feel depressed and dejected and end up relapsing within the week. You know I do well when I am in school. Can’t I just return to my classes?”

I anticipated that my mother would frown on this suggestion. Given the circumstances, why would she agree with me? Enrollment in higher education has never served as a treatment modality for opioid use disorder, and in the previous week, my shirt had been ripped open in a nearby emergency room (ER) to resuscitate me. As I further reflected on my proposal, it dawned on me how ludicrous it must have sounded to my mother. How could someone who had just overdosed be fit to participate adequately in class?

If I wasn’t ready to return to class, should I return to treatment instead? Most of the treatment centers I had attended adhered to the 12-step program, a common treatment framework rooted in Christian principles. In this program, I was frequently advised to “Work your steps. The program works if you work it.” However, that method proved ineffective each time I completed my 12 steps. Being an atheist, I didn’t subscribe to the concept of a higher power. Was I supposed to undergo treatment until I believed in such a power?

I also thought about engaging in pharmacological treatment, an evidence-based approach for mitigating overdose risk. However, when I contemplated this option, I was reminded of a previous attempt with an opioid antagonist that had resulted in minimal alleviation of my cravings and an increase in overdose risk due to my sporadic, concurrent use of illicit substances, a risk that neither I nor my mother wanted to take. Given the setback with these medications, along with challenges accessing them and the societal stigma associated with these medications, I paused before considering other medication options. Instead, I redirected my focus toward school. This route just seemed more promising given that it filled my time and fostered more self-satisfaction as I worked toward academic achievement. For me, it was simpler to concentrate on a goal that would indirectly decrease my substance use, rather than aiming for abstinence itself.

As I pondered the potential impact that returning to school could have on my substance use, I had a flashback to the last time I overdosed. My usual dealer had been arrested, compelling me to cop from an unfamiliar source. The substance appeared remarkably potent, evident even from its appearance in the bag. Shortly after, I regained consciousness in the ER. It’s strange how the mind dwells on specific details from traumatic encounters, such as the fact that my favorite shirt—a blue V-necked shirt that had always provided me with a sense of comfort—was ripped in the ER, which really bothered me, despite the turmoil of the situation.

“Liba, are you even paying attention?” my mother inquired, her frustration evident.

After regaining my attention, she attempted to further persuade me, saying, “I think school is a great idea, Leebee. Why don’t you consider going back to treatment, and we can revisit the idea of your return to university after the next semester?” My mother calls me “Leebee” as a term of endearment, using it to express her love, or when she senses I could use some additional affection. This time, her calling me Leebee served as a reminder that her intentions were rooted in love, making me feel treasured rather than exasperated by her suggestion to return to treatment.

After a flood of thoughts, I replied, “I know treatment has always been a place where you knew I was safe, and I know you're probably tired of taking care of me. But can I have some time to think it over?”

I understood her perspective, but inexplicably, I strongly disagreed with her. As mentioned above, I had participated in various treatment programs in the past, each yielding unique lessons beneficial to my recovery. Whether it involved acquiring healthier coping mechanisms, practicing mindfulness, confronting triggers, or boosting self-confidence, every experience enriched my understanding of recovery from substance use. I pondered, however, whether after multiple treatments there was still unexplored potential for further rehabilitation. Would treatment centers be the only path to attain recovery?

My mother hesitantly agreed to allow me more time to consider other options. I think she wanted to ensure that my decision to undergo treatment again was entirely voluntary because she understood the importance of my entering treatment willingly.

A few weeks later, I resumed my undergraduate studies, a decision that likely did not come as a shock to my mother. However, what surprised many people in my life, including her, was the minimal, almost nonexistent, extent of substance use during my university studies. After finishing all my school tasks, I would often stay on campus, lingering in the library until I needed sleep, determined not to leave and risk relapsing. Moreover, I found a sense of belonging and purpose while immersed in my studies and joined a new social circle, which mostly comprised individuals who did not struggle with substance use—a deliberate choice on my part. I felt comforted by an understanding that if I remained on campus, my safety was ensured, and even more so, that I would encounter fewer triggers by staying within the academic environment among my newfound friends.

Although I mostly refrained from using substances throughout my studies, I still grappled with additional mental health challenges that I aimed to address, some of which were among the root causes of my substance use. I also feared being in my hometown devoid of any distractions, dreading that staying there might tempt me to return to my old harmful habits. So, a few months after graduation, I embarked on a 12-month volunteer expedition to East Africa. My goals were twofold: first, to contribute positively to others, likely influenced by my persistent feeling of being a burden during times of illness, and second, to detach from the demands of American society and embrace a simpler lifestyle.

During my time in Africa, I experienced a profound sense of satisfaction, potentially akin to what others might feel upon completing a 12-step program or the fulfillment I felt upon graduating from university. I also found fulfillment in helping others, cherished the slower pace of life, and experienced the most grounded state I’ve ever known as I slept, cooked, and ate outdoors with ample time spent with animals—a therapeutic remedy I’ve found beneficial in the past. I facilitated the installation of a gravity-flow water system in a Maasai village to enhance access to clean water and adopted two street animals that later followed me back to the United States.

In my story, further education, travel, and volunteerism served as supplemental therapies and aided my previous rehabilitation from an opioid use disorder. The convergence of these experiences took me away from environments where I used substances, disconnected me from social circles centered on drugs, offered a supportive environment with fewer triggers, ignited a sense of passion and purpose, and provided a space for introspection and self-acceptance through meditation. Most remarkably, the supplemental therapies that I considered most beneficial for sustaining recovery were diverging from conventional options for individuals with substance use disorders.

I remain uncertain whether my journey would have unfolded similarly had I chosen to again undergo treatment. Notably, my narrative is not intended to undermine the effectiveness of standard treatments for substance use disorders. In fact, my experience might attest to the effectiveness of such treatments. The treatment I received had provided me with vital skills, and the later phase of my recovery entailed employing them in everyday situations and making use of the abundant resources at my disposal.

I hope that my story serves as a compelling example for recovery, highlighting the importance of exploring nontraditional approaches and potentially departing from conventional wisdom when tackling opioid use disorder. I further hope that my account encourages others to share their journeys to help foster deeper discussions about effective approaches for sustained recovery from mental health challenges.

I am also optimistic that the unique aspects of my experiences will raise important questions, such as, Does treatment saturation exist, particularly for individuals with higher socioeconomic status? Are atheists encountering extra challenges with 12-step treatments? Are treatment plans adequately tailored, and is there an adequate array of treatment choices for addressing opioid use from a long-term perspective, beyond medication-based approaches? Delving into these questions, among others, may offer valuable insights and raise additional challenging and potentially uncomfortable questions such as, Do current mental health approaches to manage opioid use disorder truly help most individuals in their recovery efforts?