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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


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


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.


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


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


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


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


(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


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


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


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


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


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.


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


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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