Let's Talk About Recovery...

Before getting started here, I'd like to state a little disclaimer of sorts. 12 Step programs work for a lot of people. This is in no way intended to bash 12 Step Programs. They have existed for decades for a reason, and I expect them to last for decades more. They're good programs and many people find new lives there in recovery. They just aren't the answer for everyone. 

     The substance use disorder treatment world has a problem (well, many), especially in rural areas like mine. It tends to be a one-size-fits-all kind of program, in an increasingly diverse and changing population. Not that long ago, just a few decades, rural Midwest states were dealing mostly with White clients struggling largely with alcohol, marijuana, or methamphetamine related substance problems. In fact, treatment centers and counselors were so used to dealing with alcohol and marijuana, that meth became a huge deal (rightly so!), an epidemic in White rural culture. Truly, it was and remains a huge problem impacting so many lives across the country, and especially in the rural areas where it is easier for small-time "cooks" to manufacture undetected. 
     However, in the last couple decades the population of rural Midwest areas like rural Iowa have changed dramatically. Largely this is due to the influx of immigrants recruited to better paying jobs at the meat processing plants across the Midwest. Companies recruit from all over the world, help with transport and often with paperwork, and promise them high pay and a low cost of living to change their lives. What they don't do is offer them much support once they get here. 
     So small towns like mine in rural northwest Iowa go from predominantly White, farming areas to becoming a true melting pot in less than a generation. Folks from El Salvador, Guatemala, Sudan, Micronesia, and Southeast Asia are suddenly living and working in a place so very different from what they knew. Often, they don't speak English yet, and they struggle to get by. There are many stressors. Substances such as alcohol are readily available here, in fact alcohol is treated as a celebrated past time. It's a piece of every fabric of life here in America and in other cultures as well. It's part of our sports culture, weddings, divorces, and celebrations. Marijuana is quickly becoming a legal substance, state by state. Meth, though still quite illegal, is also quite available. In fact, many of the people I've worked with in recovery from meth encountered it by chance. They were exhausted, trying to keep up with their work hours, feeling pressure to meet demands all around, and someone made an offer. Or, heard about it at a party and eventually curiosity or desperation got the best of them, and they tried it. 
     No one sets out to suffer from this disease of addiction. (We now refer to addiction as a substance use disorder, it has less stigma and helps people understand it's a disease rather than a choice) No one thinks it will happen to them. Most people understand it's a risk, but I can guarantee you from my own experience that in that moment, you aren't thinking about the risk. You are thinking about making something that feels far worse go away if you're bothering to think at all. Trust me, logic really isn't hanging out with you right then. 
     When it comes to treatment, outpatient or inpatient, there aren't many options out here. This town has two main choices for community mental health care and substance outpatient counseling. To receive inpatient care, you must go a minimum of over an hour away, usually more than two. If you don't have any insurance, you're almost always out of luck entirely because there are very few places that receive enough state funding to comp you. Insured care will net you 28 days of inpatient treatment after an average wait of 2-4 weeks (when it's not terribly busy). If you are an undocumented person, or someone who doesn't speak English very well, or someone with a very different cultural view, or LGBTQ+, I promise you that you really won't feel welcome in the regional rehabs. Not because they don't want you, but because they simply aren't built to accommodate you. 
     In addition to the struggles of accessing inpatient care, there is also the matter of what comes after that. Largely, people are sent right back home to the same situations they came from. Many go back to the same jobs, families, and towns. They are told to go to support meetings such as NA or AA, and to continue outpatient treatment as recommended. What they aren't told is that there is no transportation to the meetings, and there is only one a week in this town. Maybe two. If you want to continue the intensive support you just had 24 hours ago, you'll need to travel a minimum of 20-30 minutes to surrounding towns on various nights of the week to get to their meetings - assuming you still have your license and access to a vehicle.  You'll probably wait a couple weeks before you get back in to see your counselor for outpatient work, and then you'll continue with them once per week. In the meantime, you'll go back to work, back to your friends and family (many of whom were problematic to begin with), and you are expected to STAY CLEAN. Don't go to the bars, don't go to parties, don't make bad choices, make sure you don't isolate, don't hang out with those old friends, do this, don't do that, etc. Yet, there are no sober hangouts, it's difficult to access meetings, rural areas don't always have reliable internet for virtual meetings, almost every community activity revolves around alcohol or an establishment that serves alcohol, and your only peer support meetings are AA and NA or sometimes the more Christian-based versions of those. None of this even addresses differences in culture, gender, or sexuality. 
     When people (almost inevitably) stumble and fall in their recovery journey out here, we take away their chips and sober days they somehow carved out despite those obstacles and make them start over. We steep them in shame for their failure and bad choices. They must not have called out for support. they must not have leaned on their network. They must not have been to enough meetings. They must have chosen to hang out with the wrong people or in the wrong place, putting their sobriety in jeopardy. 
     We spend a lot of time as a treatment and recovery industry preaching about stigma and hope, but we are also continuing the very culture of shame we denounce. How can we expect anyone to manage these obstacles while navigating their recovery? Now just imagine how much harder these must be for folks who are also experiencing additional stigma and difficulties related to their disability status, language abilities, or cultural, racial, gender, or sexual identities? 

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