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Health/drug-linked patterns of addiction: SAMSHA Online Stakeholder Forum on Principles of Recovery censors sexual health

August 31, 2011
by Douglas Braun-Harvey
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The U.S. Substance Abuse and Mental Health Administration (SAMSHA) is piloting a new online feedback forum as part of its continuing efforts to increase opportunities for public engagement, collaboration and participation. The SAMSHA discussion forum web page is organized around a large search box for finding existing topic entries. The site also gives users up to 10 votes for endorsing existing entries. The online vote rates entries as top ideas and hot ideas.

I applaud SAMSHA for piloting online feedback forums, specifically their recent Internet discussion concerning the 2005 Working Definition of Recovery and 12 Guiding Principles. This August over 350 people contributed their ideas and comments on the definition of recovery. (Complete listing of the 363 responses is online: http://feedback.samhsa.gov/forums/129063-closed-definition-of-recovery)

As a sexual health author, trainer and psychotherapist I am interested in the integration of sexuality within many areas of mental health. In my 2009 book Sexual Health in Drug and Alcohol Treatment: Group Facilitator's Manual I commented on the significance of SAMHSA's 12 guiding principles of recovery omitting any reference to human sexuality, sexual health or sexual behavior. I believed then, as I do now, that the absence of sexual health in the Working Definition of Recovery and 12 Guiding Principles of Recovery reflects a broader lack of acknowledging or discussing sexuality, sexual health and sex/drug-linked relapse prevention within current treatment and recovery.

So it was pretty typical for me to enter the term "sexual health" in the Give us your feedback search box. I was curious if other contributors noticed the unfortunate omission of sex/drug-linked patterns of addiction in the Definition of Recovery.

Much like the SAMHSA document, my search found no postings addressing sex, sexuality or sexual health in the then over 300 entries. I again studied the 12 Guiding Principles looking for a good home for two words: "sexual health." The fourth principle, Recovery is holistic, looked like a good recommendation. I typed my feedback with enthusiasm and pressed send. I was happy to be having a sexual health conversation not only with SAMSHA but also with the hundreds of site participants and readers. As a sexual health advocate, I felt grateful and inspired.

Seconds later I saw this headline at the top of the Definition of Recovery Forum.

****** health: ***/drug-linked patterns of addiction remain invisible in the 10 principles

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Doug:

I read your post. At first, I was incredulous when I visited the SAMHSA Definition of Recovery Forum site and saw your comment. If your comments weren't a serious issue, what happened to them would seem like the punchline of a joke. No references to sex allowed in a medical/treatment discussion? This would mean trouble for any discussion of HIV/AIDS among drug users, for example.

Then, I tried to think it through:

1) I called a media contact at SAMHSA and raised the questionas you did. He took the question very seriously and I trust that he'll replyI'll post the response.

2) I searched the terms "sexual" and "sexual health" on the SAMHSA site and found a large number of documents (mostly "finished" .pdfs) that used these terms in a normal fashion.

3) I know that SAMHSA and HHS have been alert to the social pain suffered by LGBT individuals, especially young people and that Kathleen Sibelius has addressed this topic publicly. So, the reflex response of thinking that some ultra-religious person is censoring sex from the site seems farfetched.

4) My theory (arrived at only after considerable thoughtit was hardly apparent at first) is this: SAMHSA's not reluctant to use these terms when it's in controlsuch as in a finished report or document.

But, on websites or blogs that are entirely open to any comment from anyone, I bet that there's an automated filter in the "User Voice" software/blog service that can be programmed and used to flag and filter out spam or inappropriate comments . (Of course, someone at SAMHSA would still have to OK the use of it.)

I would think, though, that instead of editing a submitted public comment like yours, it would have been flagged the comment and put it into a moderator's queue, assuming a moderator was available. Of course, then you'd have wondered why your post didn't appear right away like everyone else'sanother censorship concern.

In the context of the web as a whole, the words "sex" and "sexual" are big attention gettersthings that might be loaded into an inappropriate message to gather attention. But in the context of this medically-oriented blog, it seems like someone should have known that wouldn't work.

It's got to be a tough balancing act on SAMHSA's endespecially for the attorneysHow do you have a tough, emotional and live blog discussion about social issues that stays open (and vulnerable) to all, even to those who might manipulate free speech to cause embarassment to and/or sabotage the discussion?

I'll let readers know what I hear from SAMHSA. I'd be willing to bet there will be a logical explanation.

And, let's not lose the initial point you madethe comment blot is a great comment/feedback toolit shows that SAMHSA is using a "big tent" approach to buiding policy that's inclusive of all.





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Douglas Braun-Harvey

Sexual health author, trainer and psychotherapist

Douglas Braun-Harvey

www.dbhnow.com

Douglas Braun-Harvey, MFT, CGP, is a psychotherapist and certified sex therapist based on San...