Seems like lots of patients in my practice are getting cataract surgery this year.  I enjoy the pre-op visits with these folks because cataract removal is typically a very low-risk procedure, and when people have it done they will say “Wow! I can see so much better now!”  In a very positive way, working to develop a harm reduction program here at the health department has truly opened my eyes, too.

For years I only thought of recovery from addiction in dualistic terms:  “clean or not,” “sober or not,” “using or not.”  On a regular basis I work with people who use drugs, and up until recently I framed my approach to their health care in those vastly oversimplified terms…if you were abstinent, you were “healthy,” but if you were still using an illicit substance, there was no point in working with you until you “recovered.”

You want to talk about denial, well that “clean or dirty” approach was a prime example of what writer Ken Wilber calls “performative contradiction.” I was working as a healing professional, ostensibly to heal the sick, but my actual performance of the role ignored some very basic realities about addiction.  Namely, that abstinence-only approaches for opioid addiction, like “medical detox,” increase the risk of overdose death after discharge.  Without comprehensive follow-up, including medically-assisted treatment when appropriate, abstinence-based programs fail more often than they succeed in creating long-term recovery.  Probably the most eye-popping statistic I have encountered in reading about addictions is this: the majority of people who use illicit drugs stop using without any specific treatment whatsoever!

According to Dr. Carl Hart, neuroscientist at Columbia University, roughly 10% of people who try drugs become addicted…and among this 10% are high rates of trauma, depression, and poverty.  So rather than spend our time focusing on the chemical signature of the substances a person injects, ingests, or inhales, we need to start focusing “upstream” on the social determinants of health driving the addictive behavior.  Without meeting the basic human needs we all have for healthy relationship, most people participating in an abstinence only program are bound to relapse.  With each tumultuous turn on the roller coaster ride between sobriety and getting high, the patient spirals closer to death.  Hepatitis, overdose, abscesses, despair.  So what do we do?

I decided to ask the experts.  As part of a series of community discussion meetings around the county, I encountered a cohort of very dedicated and caring neighbors who volunteered their time to help.  This group has formally become The Exchange Union, a volunteer organization of people with direct experience of chaotic drug use, particularly opioids.  Their mission is to

  • Promote improvement in the lives of people who use drugs,
  • Facilitate positive change along the spectrum of recovery,
  • Co create healing in individuals, families, and the community, and
  • Reduce stigma thru accompaniment, advocacy, service, and education.

In straightforward terms, this is a group of people whose lives were out of control because they lived for getting high, but now want to help others move in the direction of “any positive change.”  That’s how union members describe “Recovery”…”Any Positive Change.”  The union is a refreshing collection of people who have literally been through hell, and are willing to stick around to help others still struggling with the painful circumstances that keep them in chaos.

No matter what baggage you bring to a union meeting, you’ll be met by folks who aren’t going to judge you or deem you unworthy.  They’ll listen, but not try to fix you.  They’ll let you know you are worth knowing, and help you be your healthiest self.  You are a success for showing up.  If you are interested in learning more about The Exchange Union, feel free to join us Thursdays at 6:30 PM.  We meet at Jefferson County Community Ministries, 238 West Washington Street, Charles Town.  You can also touch base by email: and eventually online at

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