For certain subsections of society, it happens so often that its occurrence becomes commonplace such as the realities for those of us who live surrounded by the effects of active addiction and alcoholism. Like a soldier who served in Iraq or Afghanistan or a teenager who grew up in the heart of West Baltimore or East St. Louis, it is all but impossible for an addict to make it more that a couple of months without a family member, friend or acquaintance dying on them. In 2011, 41,340 Americans died of drug overdoses. That’s 113 deaths a day—a mortality rate that is higher than the rates for homicides, suicides and traffic accidents and one which is 400% greater today than it was in 1990. This surge in the national overdose rate can be attributed to many factors, but there is little doubt that the sea of prescription drugs that have flooded the market over the past 20 years are at the root of the problem.
One unintended consequence in this rising tide of prescription opiates and benzodiazepines is that women have suffered increases in opioid addiction and overdose deaths at a significantly higher clip than their male counterparts. Women, who have traditionally been seen as a low-risk group for drug-related deaths, have been gaining ground in recent years, nearly cutting the ratio of male to female overdose deaths in half thanks largely to a fivefold growth in prescription painkiller deaths among women in the millennium’s inaugural decade. This trend is problematic for a number of reasons, none more so than the fact that we’re still largely in the dark in our understanding of the differences in opiate abuse based on gender and are inconsistent—if not ineffective—at screening addicts and modifying treatment plans in ways that reflect those differences. How else can we explain the fact that admissions of women to substance abuse treatment have only inched forward a few percentage points over the last decade while overdose death rates and prescription opiate overdose hospital admissions have skyrocketed to unprecedented heights?
The cruel and pernicious irony in the deaths of the young is that the old and the living are made to bear the burden of their foreshortened lives. For the deceased, all of the suffering they endured and the sadness they felt at the prospect of forfeiting the bulk of their life’s balance ends up being little more than existential window dressing. Once the weariness, fever and fret of their existence fades away, the only people effected by circumstances of their passing are those they left behind.
The earth does not give preferential treatment to post-mortem youth and beauty, just as the hereafter shows no deference to the unripened soul. Death is final for the dead. To them it is as eternal as it is immutable; a thing devoid of ticking clocks and swirling moons and rotations of a sun whose rays will never again warm their unwrinkled flesh. Death is little more than a bondsman—a thing that could care less if it found you with a needle in your arm or plaque in your lungs so long as it gets its due. No, it is we the living who are held hostage by the deaths of the fecund and the fledgling members of our little worlds.
We sit and we think of the life they might have had—the life they should have had. We ask ourselves an unrelenting stream of what if’s and how come’s, meticulously analyzing the moments before their passing with the unspoken and unacknowledged believe that if we could just tie up all of the loose ends and unanswered questions surrounding their deaths, we could somehow save them. That we could bring them back whole and as they were—as if it had never happened.
American women have seen a fivefold increase in Rx drug abuse without a corresponding rise in access to treatment (Clarence Williams/Los Angeles Times)
A few weeks ago, I found out that a young woman in recovery in my hometown of Cincinnati—we’ll call her Laura—had died of a heroin overdose. I didn’t know her personally but the recovery community in the Queen City is small enough that I knew plenty of folks that did. From what they told me, Laura’s death followed an all too familiar script of those who struggle with opiate addiction, which is as follows: First, the addict rips and runs until they hit their “bottom” or get in trouble with the law/family/significant other, at which point they head to treatment and/or transitional living to get their mind and body right so they can take another crack at sobriety.
Once the fog lifts and they have their bearings again, they get immersed in 12-step programs, make a new network of sober friends and start beginning to pick up the pieces of the life they’ve left themselves. Pretty soon, things start turning around and they start getting used to sobriety. They start thinking about the future again—about getting a better job, going to college, getting their kids back. A semblance of normalcy and calm comes over their lives for the first time in what feels like forever. Then, for reasons often not even known to them, they go back out. After such a lengthy sabbatical from using, their bodies have temporarily lost most of the tolerance they gained over the years and they overestimate how much junk their body can handle. After that the next steps are often the morgue and a burial plot.
Most of what I’ve heard concerning the immediate circumstances of Laura’s death fits with that particular substance abuse narrative and is common among both men and women who suffer from opiate addiction. Although women do generally progress through the stages of addiction more quickly than men, it would seem that the mechanics and physiology of overdose deaths in both genders mirror one another. But, that’s just the how of it all. I don’t care as much about the how as I do the why and the what comes after. Obviously, I’m not able to speak with Laura and learn more about her battles with addiction, but I was fortunate enough to sit down with a few women at a transitional living house last month who were still in the throes of early sobriety and to listen to their stories. They were not Laura’s story, but they were certainly all variations on the same theme. One woman may have struggled with eating disorders and clinical depression, while another may have come from an abusive alcoholic home and been a victim of sexual abuse as a child, but it was abundantly clear in talking to all of them that the weight of their shared experience far exceeded that of their differences.
The first woman I talked to was Stephanie, a young lady from Knoxville who had come up to Cincinnati the year before in a last ditch effort to escape her addiction by changing her scenery rather than herself. Stephanie told me that she was 21, but by the looks of things, I’d wager that it had been a minute since she’d been carded at a bar. It’s not that Stephanie looked old—she really didn’t. It’s just that some mixture of drug use, trauma and genetic happenstance gave her the look of someone who was already world-weary beyond her years.
“It all started when I was 12 when I got my tonsils removed,” Stephanie told me. “I got prescribed hydrocodone—like the bigger bottles—and my mom is an addict, my dad’s an addict, my brother’s an addict, everyone in my family’s an addict. So, when I ran out of my medicine—my mom was the one drinking my medicine—I remember, she had to go out in the middle of the night and buy these pills—these little blue pills—and I didn’t know what the hell they was. They call em Percocet 30s up here. I call em Roxy 30s. Whatever, same thing, so that’s when it started for me and whenever I came off it I was withdrawing and didn’t even know I was withdrawing from pain medicine, so it never stopped from there. Started smoking weed, drinking, started doing pills every day. Started snorting pills…ended up getting suspended from school for overdosing. Took about 50 pills and uh…”
“You got suspended for overdosing?” I asked
“I was at school there and they took me off on stretcher.” Stephanie said. “Zero tolerance for drug abuse at school. I got suspended for 6 months and went to an alternative school.”
“So your school never sent you to treatment or anything like that?”
“Never suggested that I should go to treatment.” she told me. “Never any of that, so I went to alternative school and got suspended from alternative school for doing drugs there too, and while I was suspended from school I ran away. After that, I got put into foster care, about 2 hours from my hometown and it just got worse up there. My foster mom let me drive her car, we drank every day…the third day I was there all these cars just started piling up in the driveway and it was just like party, party, party every night there.”
“And this was your foster mom?” I asked.
“Yeah, and we just partied. She was like, ‘I’m the cool foster mom. You can drink so long as you drink at home.’ So I did and I found pills there so I started doing pills real bad. Got a job and spent the money on drugs—pills, pills, pills, pills, pills—and then moved back to Knoxville when I found out my mom got cancer when I was 18. She had just got out of prison and she got cancer in her back. So I took care of her and she had legal prescriptions and needles and everything, so it was like, ‘this is what’s up. I get free pills, free needles, let’s do it.’ So, I was pill sick one day and my brother was like, ‘aw, sis, mom ain’t got no more Roxies, we’re gonna have to get some of her morphine’, and I was like, ‘oh, shit, man’ and he was like, ‘you’re gonna have to shoot it up,’ and I was like, ‘okay, let’s do it.’ And that’s when the needles started for me. Morphine is, pretty much, just like heroin. I mean it really is. I was going really hard. I overdosed twice on it and when my mom died all shit went to hell. She died 3 years ago—my high school graduation—after that I just went downhill. Went to treatment once, left treatment, robbed the treatment facility for $1,000, high as shit and then went to jail for 9 months. Got outta jail, got off probation. I was getting high for another month and then I decided to go to Cincinnati—yeah, great idea. Started smoking pot up here, drinking—turned 21 up here—drink, drink, drink, drink, drink, then I found heroin and y’all know where that leads to.”
“Why Cincinnati?” I asked.
“My dad lives up here.” Stephanie said. “I called him and I was like, ‘come get me, I can’t handle this. I’m tired of doing drugs. I’m tired of sticking a needle in my arm. I’m 20 years old, I don’t want to do this—follow in the footsteps of everyone else in my family.’ So, I moved up here and thought, ‘well, I don’t know nobody.’ I only had one friend that lived up here that smoked weed and I thought, ‘yeah, I can just smoke weed because that ain’t my problem. So, I started smoking weed, drinking—going to the bar because I was legal and it was about a year ago that I started doing heroin…I started shooting heroin in May, but I was snorting it first and I was like, ‘oh, it’s okay, I’m just snorting it. I’m not putting a needle in my arm. That’s my addiction. That’s the problem. The needle’s the problem, not the drugs.’ That wasn’t it at all.”
Within a couple of months, heroin had completely taken over Stephanie’s life and it wasn’t long until she lost her manager’s job at McDonald’s, got kicked out of her apartment building and started going through the revolving doors of detox on a regular basis, spending just enough time there to get well and going back to using as soon as she left. Eventually, Stephanie ended up going to the Center for Chemical Addictions Treatment—known in Cincinnati’s recovery parlance as “The Ccat House”—for inpatient rehab and ended up in a New Foundations Transitional Living house when she was released. At the time I spoke with her, Stephanie had 36 days clean, an amount of time that was near the median for the women I talked to.
With 10 months and 4 days of sobriety under her belt on the day I visited, a young redhead named Amanda had gone longer between drinks or drugs than any of the other woman in her house. It was an impressive achievement to be sure, but may not serve as a good barometer of her chances for long term sobriety because 10 months and 2 days of her clean time was obtained while in prison on charges of forgery and receipt of stolen property. Now, it’s not any more or less laudable to rack up stretches of sobriety in prison or an inpatient treatment center, but it’s worth noting that it is sobriety obtained in what are little more than highly regimented simulacra of the real world. Amanda may have had more than 10 months sober in prison—where, it must be said, drugs are still in abundance—but she was only on day 2 of sobriety without borders and at a greater danger of relapse and overdose than her non-incarcerated peers. Numerous studies bear out the increased risk of overdose death in the weeks and months after a prisoner’s re-entry to the community, with one study of more than 30,000 inmates in Washington state showing that prisoners have a 12.7 times larger chance of overdose death than the general population. Add to that the fact that women have been shown to have more difficulty quitting and a higher rate of relapse than men, and the prognosis for Amanda’s sobriety doesn’t look great.
For her part, Amanda didn’t seem too terribly worried. A 20 year old with a spiked up pixie haircut, puckish smile, and a generationally appropriate amount of metal and ink all over her person, she certainly didn’t behave like someone was uneasy with her freedom after close to a year in prison.
“From a really young age I knew there was something wrong with me.” she told me. “I was adopted so I always felt like there was this void in my life. And, my adopted dad is a cop, so I always wanted to rebel against him…I played softball—select softball—and I had a bad knee so sometimes they’d prescribe me Vicodin for that. So, that started and then I had an underbite and I had to get jaw surgery and they prescribed me Percocet for that. 2 big bottles of it. And then I started selling it. And then I realized, I like to drink on it more than I like to sell it. And so, I started doing that real bad and started going through the whole Percocet-Xanax ordeal, which is when I started partying a lot. Drinking a lot…I was drinking a 30-case of Budweiser to myself a night. And then I got introduced to cocaine and…I just loved it.”
“Had you gotten in any trouble at this point?” I asked.
“Sort of…that was about the time I started hanging out with those people and, like, my dad started noticing shit going on with me. My grades dropped, I stopped playing softball and you know, I went crazy with emo kid status. Like, I started cutting myself…attempted suicide a few times. I was like, ‘I’m really fucked up.’ So, I was really, really high on cocaine one night and I was like, ‘dude, I’m seriously going to die.’ Like, ‘I’m really going to have a heart attack.’ And my best friend just so happened to have some heroin with her, and I was like, ‘man, is this going to bring me down or is this going to explode my heart?’ And she was like—I’ll never forget her saying this to me—she said, ‘Amanda, I’m going to give this to you, but I’m just gonna warn you right now that it’s going to change your life forever.’ And I was like, ‘dude, I’m a fucking grown up, I know what I’m fucking doing’ and…”
“Were you actually a grown-up at that time?”
“Almost.” Amanda said. “I was, like, 17. So she gave me a line that was this big (pinches fingers close together so they’re almost touching). I remember it was on a toilet seat at my friend’s basement party or whatever. I had already consumed shit ton of alcohol…”
“The seat?” I asked.
“Yes, the seat of the toilet.” she said.
“Not the tank in the bank?”
“No, the seat of the toilet. So, the dopeboy that me and her went to, we didn’t know he sold heroin as well, but I was running his cocaine for him. He would pay me $10 every time I left the house. So, every time I left the house to just go down the street, he would pay me $10. And after that, after I did the heroin, I was like oh—my—god. Like, speedballing was my new thing. I didn’t know it had a name yet, but I started doing that. I was snorting it—didn’t think it was that bad because I was snorting it. And, um, I was a functioning addict there for a little bit. I really don’t think there’s such a thing anymore, but at the time I thought there was. I had a job, I moved out on my own to my own apartment. I was having a lot of house parties…beating people up…getting, like, stupid drunk. And then I got into dental school, and I was going to dental school and I was top of my class, but I was still using. I remember one day driving—I was pawning a lot of stuff—one day I went home to get some more stuff to pawn, and my dad’s a cop so of course I’m stealing all this shit from him. And, like, he was in the driveway, in his cop car. And I was like, you know, ‘this happens all the time’ and I was just gonna run in—I was in my scrubs all the time because I thought I looked more professional that way and that I could get away with more shit, which was true, but my dad called me into the car and he said—oh, and by this time I had shot up 3 times—and when I got into the car he was like, ‘I know you’re using heroin,’ and I just, like, broke down because I sorta knew I had a problem.”
“You sorta knew you had a problem?”
“I would withdraw sometimes, but I didn’t know what it was.” Amanda told me.
Her dad ended up sending her to an outpatient Suboxone clinic, but she got kicked out for selling the Suboxone instead of taking it and and went back out. It wasn’t long before she was enrolled in a different Suboxone clinic and she stayed clean for 4 or 5 months until her 18th birthday when she met her birth mother for the first time.
“I was sober when I met my birth mom.” Amanda said. “Me and my girlfriend went out to meet her one day and she was on Percocet, so, once I figured that out it wasn’t long before we started using together. Um, and this is when I got introduced to crack. And, I just…I was like, ‘this is the greatest thing in the universe’ and it took the place of the cocaine. I just loved the taste, the smell, the bell ringing in my head—it took away a lot of my issues and, I mean, I was really messed up. I ended up being homeless and me and my girlfriend were living in my car and then I, um, got in some trouble and I got a theft from Home Depot, which wasn’t that big of a deal at that point. They put me on diversion, or whatever, and then it got really, really bad because I was like, ‘I got away with it’ and I started doing a lot, a lot, a lot of drugs. So, I came up with the bright idea to steal my dad’s checks and forged a shit ton of checks. And then, this was back in October, I got arrested. The night after I had a mini stroke…”
“You had a mini stroke?” I asked.
“I had a mini stroke. They called it something else…it started with a T.”
“A Transient Ischemic Attack?”
“Something like that.” she said. “My entire right side was paralyzed. I called the ambulance on my cell and said don’t bring the cops and stuff like that. They brought the cops. But the cops just left me alone. They brought me to the hospital and let me go. Ummm, the next day they kicked down the hotel door and I was arrested for forgery and receiving stolen property.”
“Does anyone in your adopted family have problems with addiction?” I asked.
“No, no one in my adopted family is an addict.”
“So they don’t…do they have any idea what…?”
“They don’t understand anything about this lifestyle,” Amanda said. “But it was crazy, because when I met my birth family, like, everyone’s exactly like me. Like, it’s so fucking weird because…I don’t like that at all. I see so much of myself in my birth mom and it’s just disgusting to me. I mean, she tried to choke me out.”
“Your birth mother tried to choke you out?” I asked.
“Uh-huh. One night I went to my dopeboy and I guess I didn’t get enough crack for her liking so she tried to choke me out when I was driving her back home. It was so mind-blowing, I mean, I was like, I didn’t have her my whole life and now I met her and she’s treating me like this. She told me I was a piece of shit, like all of this…like, ‘this is the reason why I gave you up for adoption.’ So, I’ve just been to a lot of rehabs, a lot of psych wards, I’ve been to rehabs for eating disorders. You know, the whole nine…”
A Northern Kentucky mother grieves at the funeral of her 22-year old daughter, who died of a heroin overdose last September (The Enquirer/Carrie Cochran)
Sitting next to Amanda the entire time she was talking was Jessie, a 23-year old woman who, despite over a decade of hard drug use, looked young enough to still be in high school. Due to her youthful appearance and waifish frame, Jessie’s disposition—which could have come off as argumentative and abrasive—took on a precocious air. Whenever she talked, her arms and hands would languidly gesticulate about her body, often displaying relatively fresh bruising from her IV heroin use in the crooks of her elbows. To hear her story, it’s pretty obvious that Jessie never had much of a chance of avoiding the clutches of addiction.
“My mom’s an addict and so’s my sister,” Jessie told me, “so, I was kind of already introduced to it. I started at a really young age, like, my dad wasn’t around. Nothing like that. I lived with my mom until I was about 7 and then she overdosed at my elementary school. So, me and my sister was…”
“She overdosed at your elementary school?”
“Well, they had called her in because I had been getting in a lot of trouble at school—like, stealing shit from other kids and stuff—so, I guess someone called her in to have a parent-teacher conference or something about it and while she was there she overdosed.”
For a few seconds there was just silence. After an trying and failing to find some sort of adequate response to this information, Jessie just continued talking.
“Yeah, so then they called CPS (Child Protective Services) and then my grandma ended up calling CPS because of that and because my sister got pregnant at the age of 12.” she said. “She got pregnant at the age of 12 and had my nephew when she was 13, so my grandma already knew that shit was not right and that my mom was an addict. So, my grandma called CPS and she took me and my sister away from my mom, and then we lived with her and I would run away from there all of the time because I wanted to be with my mom, but my mom would never let me come there so I would just find myself at random places.”
“And how old were you?” I asked.
“8—I was 8 years old. After a couple of years of me running away from my grandma’s I started drinking and smoking and she just got sick of it, so when I was 14 she sent me away to my dad in Kentucky. I didn’t even know who he was and he ended up beating the shit out of me so I didn’t stay there long. Basically, they all got sick of sending me places and me running away, so they all just said that I was living with them and just let me go off and do my own thing. So, I started living on my own at 16. Like, just different places. Wherever I could.”
“Were you going to school at this point?” I asked.
“No. I did, like, the first 2 weeks of my freshman year and then I left and haven’t been back to school since.” she told me. “Okay, so…in that time, my mom met a sugar daddy. She met a sugar daddy when I was 16 and she started working for, like, his firm thing. And he was addicted to Oxys, and she was addicted to Oxys, so, it was like a perfect little thing. And, um, he had this huge house and he had, like, 5 cars and—yeah—my mom was like, ‘Yo, I got money. You don’t have to live on the streets no more. You can come live with me.’ And I was like, ‘Alright. This house is huge. This is nice.’ And he bought me all this cool stuff and, like, he didn’t know that I knew that my mom did pills and stuff…and that I knew that he did ’em…and that she was secretly giving ’em to me too. Yeah, so my mom…my mom started me on Oxys and then my sister, she got kicked out of her apartment so she was living in the house too and we were all just snorting Oxys together.”
“Like the family that snorts together, stays together?”
“Yeah. Honestly, it brought us closer together. I mean, my mom never really loved me—at least, that just what I feel like.” She said.
“Really? So, the times that you were using with your family…”
“I felt like my mom loved me. Like, I had my family. I had my mom and my sister and we was a family when we was getting high together. I don’t know, that probably sounds crazy to you, but it makes sense in my head. Okay, so I did that. I stayed there for a while. And then my step-dad found out—he left town and somehow my mom figured out where he kept all his money in his safe and by the time he got back she had drained his safe and all 84 of the Oxy 80s he had left, you know, because she was supporting my habit and her habit and my sister’s habit and my baby’s dad’s habit, who I had picked up from Norwood somewhere in there.”
“Hold on.” I said. “When in all of this did you have a kid?”
“Oh wait, I was pregnant. I forgot about that. But, I still did pills while I was pregnant.” she said.
“Okay, and this was when you were, what, 16?”
“Yep…No, actually this was when I was 17.” Jessie told me. “So, he moved in and he’s my baby’s dad now, but he wasn’t my baby’s dad at 16. It took a year for me to get pregnant, you see what I’m saying? So, I moved him in there and my mom didn’t want to cut him in on the pills, because he was doing pills too. Okay, so he wasn’t happy with that so we had to move out…and because my mom threw him down the stairs…”
“Your mom threw your boyfriend down the stairs?”
“Yeah, well, here’s the story behind that one.” she said. “Like, she’s got this really big bedroom, right? And along with a really big bedroom comes a really big closet. Well, that’s where we would all go to…see, she had this mirror that she would scrape the pills onto and we just knew that, when we got up in the morning we’d just go in there and do our line. Well, that morning he happened to follow me in there thinking that he was going to get a line and my mom was like, ‘uh-uh…you ain’t getting nothing.’ And they started arguing and she pushed him down the stairs. And he was like, ‘oh no, we ain’t living here no more. Your mom won’t get me high. I ain’t sitting here sick watching you guys get high.’”
“What did you do after that?” I asked.
“After that we had to move out to Indiana where my baby’s dad’s mom lived. And when we first got out there we didn’t have to pay for pills anymore because his mom just got us high, but after a while she’d run out of Percs and we’d buy them. I don’t know how we were getting money…oh yeah, he was kicking in doors and shit. He kicked in the neighbor’s door because the neighbor sold weed. And he was actually his friend…and, like, stole his safebox and it had $6,500 so that kept us alright for a little bit. And then, in that time, me and him got into it and he tried to put me out on the street so I moved back to Cincinnati because I didn’t know anybody in Indiana. And, I can’t be on the streets out there, know what I’m saying? So, I caught a bus and went back to Cincinnati.”
“Where was your baby during all of this?”.
“He was with me.” Jessie said. “Oh, wait. Yeah, I got pregnant in Indiana, came back and…oh man, did I miss all of that? Woah. I got pregnant in Indiana and moved back to—that’s why I moved back to Cincinnati. I said I didn’t want to have my baby in Indiana. I was just against it. I didn’t know anybody, besides the fact that I didn’t want to be there anyway and that was my prime excuse. So, I moved him back to Ohio with me and got us an apartment in Mt. Carmel, in a place that was like dope fiend central. Everyone was on pills except for a select few and I didn’t really talk to the few that was on heroin cause I was on pills and they was like, way worse off than me, you know what I’m saying? I was still doing pills when I was pregnant, but I had stopped doing the Oxys and in my head, I’m like, ‘this is better, I’m not doing Oxys’, and I just did Percs. Well, my son came out…well, he came out with clubbed feet, but it wasn’t cause I was doing pills. My baby’s dad has that bloodline in his family, like, his cousins have it and shit—umm, that’s what my doctor told me. So, I have my apartment, and I had my baby, and we was getting high, but I was still a good mom…I think. And I still took care of my kid and all that. And then, he kicked in my front door, or something happened. My baby’s daddy kicked in my front door.”
“Are we talking about literally kicking in your front door?” I asked.
“Literally kicked in my front door…and then we fist fought upstairs for about an hour. And, when stuff like that happens—it was a Section 8 apartment—when stuff like that happens it’s like, no tolerance and you’re getting kicked out. So, I left and I brought my kid with me and moved into my sister’s in Goshen. And, when I got there, her baby’s dad had just got out of prison and their way of making money was he was selling heroin. And, I had never seen it, I had never done it, but when I got there I knew that I hadn’t had anything in 2 days and I was sick and I didn’t have a lot of money. So, my sister was like, ‘you’re sick, so I’m not going to charge you for this, but here’s this line of heroin.’ And I was like, ‘I seen what this shit does. I seen what it does and I don’t want to no part of it,’ but I did it anyways. And, uh, yeah. That was the first time my sister gave me heroin.”
“And you were how old? 20?”
“Uhhhh…no, 19.” Jessie said. “I was 19. And, so I got a job, like, out of nowhere, 2 days after I came back to Cincinnati. I was getting fat checks and I was all getting spent on dope. Like, I was my sister’s number 1 customer. Plus, I lived in the house, you know what I’m saying? It was like, on demand. I got to ride with him when he was going to re-up and we was just snorting dope the whole time.”
“And your kid was with you, the whole time this was going on?” I asked.
“Uh-huh.” she said. “And my sister had a kid too. It was just one big crack house, heroin using family.”
“Did all of the usual, motherly duties and such happen while you were there?”
“Yeah, I told myself that was why I was doing the heroin.” said Jessie. “To keep myself energized so I can take care of my kid. Because, in my head, I’m a single mom now because I’ve left my baby’s dad, and I need this to keep me up and…I can’t be sick with my kid…you can’t do that. So, you know, I did everything I was supposed to do and my kid was well taken care of. I was a normal mom. ”
A normal mom? To us, banging heroin while living with your junky sister and her drug dealer boyfriend ain’t normal. But for Jessie—someone who had to sit and watch EMTs cart her OD’ed mother away from her school in an ambulance at the age of 7 and whose idea of taking care of her kids was making sure they had their line of Oxy ready for them when they woke up—that was normal. The only hope that Jessie, her kid and all of the women I talked to have is that they find a new normal before they start the cycle all over again
~~~~~~~ Author’s Note ~~~~~~~
<em>On the night before I was to publish this article, one of my cousins died at the hands of this insidious disease of addiction. The last time I saw her was early Thursday morning after a midnight meeting of a 12-step group in Cincinnati. She had used sometime earlier that day, but was not high so much as she was in state of blurry wellness peculiar to opiate addicts who have built up a tolerance to the drugs they use. When she shared during the meeting, she had been very emotional, talking about how it seemed like it was just so much harder for her to get clean this time and hoping that this increased degree of difficulty would help keep her sober for longer than the periods when she had been able to stop using more easily. Once the meeting was over, we talked about how she was doing and about how much we loved another one of our cousins who had died from Hepatitis C as the result of this disease, but who had more than 20 years sobriety when he passed. As we parted ways, she asked me if I could drive her to a meeting the next night and I told her I could and that she should give me a call tomorrow night, knowing that there was a more than decent chance I wouldn't hear from her. The next time I saw her face it was on a memorial on someone's Facebook wall. She was 24 years old and had a 6-year old son.</em>
<em>I simply ask you to consider donating a little money to the <a href="http://www.ccatsober.org/index.cfm?fuseaction=home.viewPage&page_ID=8CE35C4E-7E90-9BD4-C2E453F58A4F4DEE">Center for Chemical Addictions Treatment in Cincinnati</a>, which helps hundreds of addicts and alcoholics to get sober each year.</em>
When Giving Thanks, Don’t Forget Yourself
As we give thanks at the holidays, it’s easy to overlook someone important: your past self.
While it’s well documented that gratitude toward others can improve wellbeing, two University of Florida scientists find that gratitude toward your past self also has benefits.
Does thanking yourself seem a bit…selfish? The researchers, UF psychology professor Matt Baldwin, Ph.D., and undergraduate student Samantha Zaw, think not.
“Despite the fact that past gratitude is self-focused, it reminds people that they’re part of a bigger story and that they have the power to grow,” Baldwin said. “It’s possible this promotes a pay-it-forward type of mentality.”
Gratitude is what psychologists call a self-transcendent emotion, one that lifts us out of the everyday and expands our perspective, which can help us get along with each other better. In a recent experiment, Baldwin and Zaw asked participants to write brief gratitude letters. The first group thanked someone else, the second thanked themselves, while a third, the control condition, wrote about a positive experience they’d had. Zaw and Baldwin then surveyed the participants about their self-perception after writing the letter. Although the results are not yet published, early analysis shows that the exercise gave the other- and self-focused gratitude groups a sense of redemption and helped them feel they were morally good people. However, the group that wrote to themselves scored higher on both measures.
The past-self group also saw a benefit the others didn’t: an increase in the self-awareness measures of clarity, authenticity and connectedness.
“Unlike gratitude toward others, being appreciative of ourselves carries an added benefit of truly understanding who we are and feeling connected to ourselves,” said Zaw, a McNair Scholar who has been working with Baldwin since her freshman year as part of UF’s Emerging Scholars Program.
Zaw and Baldwin’s research — the first known data gathered on past-self gratitude — was inspired by a Reese’s cup. When Baldwin’s co-worker, boredom researcher Erin Westgate, returned to the office after pandemic lockdown, she was delighted to discover a peanut butter cup she had squirreled away in her desk.
“She texted me like, ‘Oh my gosh, my past self left my future self a Reese’s,’” Baldwin recalled. “I was like, ‘Wait a second. You’re expressing gratitude towards something your past self had done. We have to study this.’”
As Zaw and Baldwin dug into previous studies, they found plenty on gratitude toward others and a few on self-compassion, but nothing on past-self gratitude. They designed the letter-writing experiment to test its effects, presenting their findings at the Society of Southeastern Social Psychologists in October and at the upcoming meeting of the Society for Personality and Social Psychology in February.
If you’re curious about the benefits of self-gratitude, Zaw offered a way to try the experiment at home, maybe as a new Thanksgiving tradition. Take a few minutes to write a thank you message to someone else, and another to yourself for something you did in the past. Sharing what you wrote could foster connections between loved ones, she said, but the exercise can also pay dividends if you try it on your own.
“At Thanksgiving and Christmas, we focus on other people, but self-care is really needed too, especially if we want to feel more clear about ourselves,” she said. “Maybe it can even lead to a better vision for ourselves for the next year.”
A Lifeline for Primary Care Amid a Crisis in Youth Mental Health
Most mental health care in America doesn’t happen in psychiatrists’ offices – especially when it comes to children, teens and young adults.
Instead, young people with depression, anxiety and more turn to the same people they already go to for all kinds of other health issues: their pediatricians, family doctors, school-based clinics and other primary care providers.
But where do those providers turn when they need more help in handling the mental health concerns of their patients – especially more serious issues that they’re not trained to handle?
If they’re anywhere in Michigan, they can turn to the team at MC3.
For nearly a decade, the MC3 program has helped thousands of primary care providers throughout the state care for the mental health needs of young people up to age 26. It also aids providers caring for pregnant women and new mothers of any age who have mental health needs.
More than 16,000 times since 2012, MC3’s psychiatrists and pediatric behavior specialists from the University of Michigan have connected directly with more than 1,800 primary care providers by phone, for consultations about their patients.
Together, they’ve mapped out plans for handling ADHD in young children, suicide-prevention safety planning for teens and symptoms that might signal schizophrenia in young adults.
There’s no charge to providers or their patients, thanks to the program’s funding from state and federal grants.
For providers whose patients recently had a mental health emergency or are waiting for an appointment with a child psychiatrist or a psychiatric inpatient bed, the service can literally be a lifeline: one in five of the consults involve a patient who has expressed suicidal thoughts or harmed themselves.
How it Works
MC3 also offers video-based telehealth appointments to connect patients of participating providers with psychiatrists. U-M and Michigan State University experts have also created a wide range of training options for professionals available on the MC3 website.
Though the demand has grown in recent years thanks to the pandemic, the program has room for more Michigan providers to join the network and get access to its services.
Each connection starts by contacting one of the trained professionals in MC3’s network of Behavioral Health Consultants, located throughout the state. MC3 also works closely with the state-funded Community Mental Health agencies across the state.
“Only about 3% of the children, teens, young adults and moms that our participating providers have consulted with us about are in treatment with a psychiatrist. We’re providing access to specialist-informed care to young people who wouldn’t otherwise have it,” said Sheila Marcus, M.D., who heads the pediatric component of MC3 and is a professor of psychiatry at Michigan Medicine, the University of Michigan’s academic medical center.
“The reality is that no matter where they live and no matter what their family’s income level, most of these patients would not have easy access to a specialist because of the critical shortage of such providers,” she added. “In some counties, there are no local providers trained to provide this level of care.”
Primary care providers inside and outside Michigan can also access MC3’s free online resources, even if they’re not enrolled in the program.
These include prescribing guides for mental health medications and online provider education, to equip them to provide diagnosis and care that might not have been part of their formal professional training. Much of that training offers continuing education credits that can help physicians, nurse practitioners, physician assistants and certified nurse midwives keep up their license.
“For me, MC3 has been a game changer,” said Lia Gaggino, M.D., who first interacted with the MC3 team through her pediatrics practice in Portage, Michigan and now is the team’s consulting pediatrician. “Since its inception I have used their services for children and teens who presented with very complicated mental health concerns. I wished I had had a psychiatrist to help me and then MC3 appeared and offered me a lifeline. Their services changed my prescribing practices and improved my skills and I am so grateful for their advice and support. I encourage my colleagues to sign up and call –MC3 is there to help us!”
Local Care Amid a National Emergency
As the nation grapples with a national emergency of rising mental health concerns among young people, MC3 and similar programs in other states are expanding access to critical psychiatric services at a time when demand is soaring.
The national organizations that declared that emergency in October called for more support of mental health care in primary care settings, as well as efforts to overcome the national shortage of mental health specialists for young people, especially in rural and low-income areas.
That shortage is what drove the creation of MC3 in the first place.
Michigan is third from the bottom among all states in supply of mental health professionals for young people. Only Washtenaw County, where the University of Michigan is located, meets national population-based criteria for having enough mental health providers specializing in children and teens.
The pandemic has made matters worse across Michigan and the United States. A national report from November 2020 showed that anxiety and depression in pregnant women have more than doubled, and emergency department visits for mental health concerns in children had risen by double digits since the pandemic began.
Joanna Quigley, M.D., another MC3 consulting psychiatrist from Michigan Medicine, recently presented data at a national meeting showing that 30% of MC3 consults during 2020 focused on pandemic-related concerns.
The pandemic has prompted MC3’s team to plan to offer extra training to help providers identify the needs and handle the concerns of children traumatized by experiences they or their families have had during COVID-19.
Trauma-informed care is also important for children who even before the pandemic experienced very disruptive life events.
Terri Rosel, NP-C, a nurse practitioner at Cherry Health in northern Michigan, wrote to the MC3 team: “I work in a small student health center in Cedar Springs and am the sole provider in the office. Since starting this job four years ago I have had the pleasure of seeing so many students with mental health concerns. I felt ill-equipped at times to help them with my degree as a family practice nurse practitioner. I would utilize MC3 often to help with treatment plans for these wonderful kids who needed help but could not get into psychiatric services soon enough.”
As the program continues to grow, it will partner more with schools through a direct connection with the TRAILS program that offers mental health awareness and support services.
Positive Feedback from Providers
The MC3 team has surveyed participating providers and found that 99% agreed with the statement that “following phone consultation(s) I felt more confident that I could effectively treat patients’ behavioral health problems.”
The team published other findings from its survey of providers, and responded to feedback by making changes.
The quotes they received from providers are equally compelling.
“This service has been absolutely ‘practice- changing’,” said one. “As we have more and more patients with mental health issues and limited local resources- we are essentially the only option for these kids. Having MC3 support helps us make good treatment decisions and is also ‘on the job training’ which we can apply to future patients.”
In fact, MC3 data show that 25% of the interactions help the patient avoid a higher-level of care that may be difficult to access, such as a psychiatric hospital bed or emergency psychiatric visit.
One of the maternal health providers who joined MC3 recently said, “I can’t even express how this service has enhanced the care I can provide. In the past, we’d screen and diagnose and then send moms out. We’d place referrals and hope that folks could navigate the complex system. Now, with MC3, I can collaborate with psychiatry, start meds or treatment, and access community resources that I am confident they will be able to access. It’s really been invaluable.”
America Has an Anger Problem – Can Better “Mental Nutrition” Fix It?
America is a pretty angry place these days. Formerly respectful spaces like school board meetings have become bitter battlegrounds. Some people are harassing healthcare workers and threatening restaurant staff for enforcing COVID protocols. Others are openly furious with the vaccine-hesitant. Everyone, wherever they stand on the (deeply divided) political playing field, is outraged about something.
Sure, anger is part of the human condition, but have things always been this bad? Elaine Parke thinks not—and she has a plan to get America the anger management tools it needs.
“We’ve stopped listening to one another because we’ve become addicted to our own narrow and sometimes selfish points of view,” says Parke, author of “The Habits of Unity: 12 Months to a Stronger America…one citizen at a time” (Outskirts Press, 2021, ISBN: 978-1-9772-4276-1, $21.95, www.12habits4allofus.
“It’s way past time for us to take a collective deep breath and treat others with dignity, respect, and civility—and listen to them—whether we agree or not,” she adds. “It’s urgent that we make this shift now.”
Dialing down our ire is easier said than done. We are living in extraordinarily stressful times. But there’s more at play. Parke says we are shaped by the messages we consistently consume—and in today’s connected world, a lot of those messages come from our digital diet.
“Social media isn’t solely to blame for stoking our emotional flames—in fact, it was designed to be a source of information and to bring people together,” Parke clarifies. “But if your newsfeed is making you an angrier person, it’s on you to either log off for a few days or reassess the kind of content you’re engaging with. When we choose to focus on stories that are positive and nourishing, we go a long way toward resetting our emotional equilibrium.”
Parke’s “The Habits of Unity” is her attempt to help people take charge of what she calls their “Mental Nutrition.” Much in the same way that we (hopefully) approach the food we eat, we need to develop the discipline to make more nutritious mental choices every day. Her book’s 365 “one-magic-minute-a-day” motivationals make it easy to hardwire these choices into habit.
With her simple, doable framework for uplifting ourselves, boosting our mental health, and practicing unity, Parke hopes to get everyone focused on the same branded behavior each month. The idea is that the sheer force of all that concentrated positive energy sparks a unity revolution that rises from the ground up and sweeps the nation.
Yet, until that happens, we can leverage the power of “The Habits of Unity” on a personal level by forming one good habit per month:
January: Help Others
February: You Count
March: Resolve Conflicts
April: Take Care of Our Environment
May: Be Grateful
June: Reach Higher
July: Become Involved
August: Know Who You Are
September: Do Your Best
October: Be Patient and Listen
November: Show a Positive Attitude
December: Celebrate Community, Family, and Friends
Those who’ve tried it say the plan is easy to put into practice. It feels good, so you’ll want to keep doing it. And there’s a ripple effect. As you become more positive, centered, and respectful, others will be drawn to you and your relationships will improve.
“As these ripples expand, they will improve the emotional climate in our country and make it easier to seek common ground, instead of lashing out,” says Parke. “But we can’t sit around waiting for others to take action. Each American must recommit to making our country a welcoming, affirming melting pot—instead of a stewing pot.”
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