Making Your Mental Health a Priority in 2020

As we begin a new decade, 2020 is testing the mental health of humanity. After the world mourned the loss of Kobe Bryant to start the new year,  we are now in the midst of a global corona virus pandemic with looming public health and economic consequences so severe experts are unable to quantify its impact. With social distancing, stay at home orders, and a host of economic challenges, humanity’s resolve is being stretched past our normal limits. Maybe you made a list of resolutions or life changes you wanted to make in 2020. But, one the is for sure, collectively we must be more diligent in protecting our mental health and develop coping mechanisms to help us endure these turbulent times. 

Based on surveying individuals, it was estimated that, in 2018, 19.1 percent of Americans 18 years old and up had a mental illness in the last year. Maybe you have a mental illness, maybe you don’t. Either way, your mental health is important. So what are some practical things you can work on?

Get sufficient sleep.

The Centers for Disease Control and Prevention (CDC) conveys that a person might have an elevated likelihood of poor mental health, some physical health problems, and dying prematurely if the person regularly doesn’t sleep for sufficient time. They indicate that it is advised for individuals ages 18 to 60 to sleep at least 7 hours a night.

If you’re not making enough time for sleep, now is the time to start. As hard as it may be, tell yourself you’ll finish that television show or those household chores tomorrow.

If you’re having trouble sleeping, there are things you can try. Commit yourself to a regular sleep schedule, going to bed and waking up at the same time every day (yes, even on the weekends). Don’t drink too much caffeine, especially later in the day. Stop using devices that produce blue light (like your smartphone, laptop, and television) at least an hour before bed. Practice relaxation techniques, such as deep breathing exercises.

Exercise.

One of the many reasons to exercise is that it might improve your mental health. Try to find something that you’ll enjoy, so you’ll actually stick with exercising. You might decide to start regularly playing a sport with friends, going to a fitness class, or enthusiastically dancing to some of your favorite music. 

If you have any health conditions that might be made worse by exercising, make sure to talk with your healthcare provider first. Together you can develop a plan that is right for you.

Plan ways to reduce stress.

The National Institute of Mental Health (NIMH) conveys that being stressed long-term could be detrimental: it might play a part in mental and physical illnesses, for instance anxiety, heart disease, and depression. Some things that stress us out are beyond our control. A family member might fall ill or a car might suddenly break down. However, some stressful situations can be avoided with better planning. 

If you find it stressful to do all of your household cleaning on Saturday, make time to do a little bit at a time during the week. If you are stressed as soon as you start reading those class syllabi, sit down with a planner and figure out when you will allot time to work on each thing you need to do (maybe you can start working on that final paper a little earlier so you then have time to focus on studying for exams). Yes, it takes some upfront time investment to plan, and it takes commitment to stick to the plan. However, it might help you feel less stressed (and maybe you’ll do better on those exams too!).

Another important thing to plan? Time to do things that you enjoy. Maybe its hiking or crafting or reading. Determine when you are going to do these things, whether it’s planning to do a specific activity or simply planning to do something enjoyable. Make sure it’s a plan that’s reasonable for your life, and then stick to it.

What about those things that are out of your control, or times when you’re working on what is in your control but still stressed? Relaxation techniques, such as deep breathing exercises, progressive muscle relaxation, or mindfulness, might be helpful for you. Research how to do these things, and practice them when you are not feeling stressed.

Take care of your physical health.

Mental health and physical health are connected. Physical health conditions can affect a person’s mental health. For instance, hypothyroidism might make a person feel depressed, and hyperthyroidism might make a person feel anxious. Low vitamin D levels could contribute to feeling depressed.

If it’s been a while since you’ve seen a healthcare provider for a physical, schedule one now. Even if you feel good physically and mentally, a healthcare provider might detect a health concern before it starts causing issues, and some conditions are easily treatable.

Assess your substance use.

For persons who don’t consume alcohol, beginning is not advised by the Dietary Guidelines for Americans 2015-2020. If a person is going to drink and is old enough to do so legally, for men they advise two drinks or less a day and for women they advise one drink or less a day.

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) provides limits for “low-risk” drinking. Low-risk drinking is drinking 7 or fewer drinks in a week as well as drinking 3 or fewer in a day for women. For men, it’s drinking 14 or fewer drinks in a week as well as 4 or fewer in a day. It is recommended that men older than 65 do not exceed 7 drinks a week and 3 a day. For some individuals, it is recommended to not drink at all.

If you are drinking more than these limits, it’s time to reduce how much you drink or quit drinking entirely. However, NIAAA conveys that you shouldn’t try to quit drinking on your own if you might have a dependence on alcohol, as withdrawal could be deadly. Talk with a healthcare provider if you think you might be dependent.

If you are using any illegal substances or misusing any medications, talk with a healthcare provider. It’s important to stop using/misusing these, but stopping without supervision may be dangerous, depending on the substance and other factors.

Seek help.

If you think you might have a mental illness, reach out for help. You can talk with your primary care provider or schedule an appointment with a mental healthcare provider, such as a therapist, psychologist, psychiatrist, or psychiatric nurse practitioner.

A healthcare provider can talk to you about your symptoms and work with you to develop a plan. Therapy and/or medication might be beneficial for you. 

If you are having thoughts of suicide, call 911 or the National Suicide Prevention Lifeline at 1-800-273-8255.

How To Win America’s Fight Against The Opioid Epidemic

Every day, an astonishing 115 Americans die from opioid overdoses, according to a 2017 report from the Center for Disease Control and Prevention. Approximately half of these deaths are due to the misuse or abuse of prescription opioid painkillers (such as Vicodin, Oxycontin, and morphine). Beyond that, increasingly, deaths come from overdoses of the illicit drugs heroin and fentanyl, which are often used after people become addicted to or misuse prescription opioids.

Each day, more than 1000 people are sent to the emergency room for prescription opioid misuse. In many of these cases, opioids were used along with alcohol or medications meant to treat anxiety or seizures (such as Xanax, Ativan, and Valium). When people ingest such mixtures, they face a heightened risk of injury or death as their breathing slows or stops.

Effective treatments exist. But as treatment for over-dosing is increasingly available, treatment for addiction is still not accessible to many of those who need it. Access to effective treatments for opioid addiction is the missing piece in America’s unsteady fight against the opioid epidemic.

Success in Fighting the Opioid Epidemic

Gains in the fight against the opioid epidemic have been made on several fronts. The physicians and nurse practitioners who prescribe America’s medications are being trained to be more judicious in their use of opioids to treat pain. They are also learning to consider, whenever possible, non-opioid medications and other treatments that don’t come from a pharmacy at all. National guidelines have been established for methods of relieving surgical, cancer-related, and chronic pain without opioids. Taken together, all these efforts are saving lives and reducing the volume of prescription opioids that can be diverted to illicit uses.

Similarly, emergency first responders and trained laypeople now have tools to help prevent deaths from opioid overdoses. Lives have been saved in many communities by the administration of naloxone – a medication which blocks the effects of opioids on breathing centers and reverses overdoses.

But what happens after emergencies – or to prevent them? Treatments for addiction can reduce the likelihood that people addicted to opioids will overdose and die. And such treatments are vital because, like any other chronic illness such as diabetes or heart disease, untreated addiction becomes more severe and resistant to treatment over time.

The Missing Piece – Access

What most of America is sorely missing, however, is sufficient access to the addiction treatments that are the most effective – and not enough efforts are currently underway to increase such access. Currently, the best estimates suggest that only one out of every ten patients seeking drug abuse treatment can actually get into a program. To sharply reduce U.S. opioid deaths, proven forms of treatment should be readily available, on demand, to all who need them. Policymakers, civic leaders, patient advocates, and journalists, should consider the following steps:

  • Treatment and reimbursements should be evidence-based. Research shows that the most effective approach is medication-assisted therapy (MAT), where patients are given methadone, buprenorphine, or naltrexone, alongside therapy to combat addiction. Too many private payers pay for treatments based on mistaken ideas. For example, detoxification is known to be highly ineffective against opioid addiction, yet it is widely practiced and reimbursed.
  • Insurance and other reimbursement systems need to acknowledge that addiction is a chronic disease that almost never goes into remission after a one-time treatment. Treatment for addiction needs to be ongoing and long-term, just like treatments for diabetes or heart disease. But currently most health insurance companies will only cover one treatment episode or a fixed number of treatment days per year.
  • Early, intensive treatment is the most effective and less costly over time. Currently, most insurance companies will only cover outpatient treatment for opioid addiction, and will only reimburse intensive inpatient treatment if the first effort fails. Evidence shows that in many cases, the opposite approach would work better: start with intensive treatment rather than with minor steps that allow time for the disease to progress.
  • Many opioid addicts could be treated within America’s current primary care systems. Two effective medications, buprenorphine and naltrexone, can be prescribed by primary care providers. With appropriate waivers, for instance, a physician can treat up to 100 patients with buprenorphine.
  • Medications need to be supplemented with therapy. Because most primary care clinicians do not have the resources or practice partners to provide the therapies patients need in addition to medications, they often limit the number of addicts they treat or avoid treating them altogether. The answer lies in making behavioral health providers more readily available to work with primary care providers, who could then prescribe effective medications more readily.
  • Patients brought to hospitals for opioid addiction and overdose should be enrolled in therapy and other treatment on the spot. Many patients with opioid addiction end up in hospitals and emergency rooms. The current approach is to stabilize them medically and then tell them, as they are discharged, to seek further treatments. But many do not follow up or have adequate access to the help they need. A better approach would be to start treatment while addicts in crisis are at the hospital – and directly transfer them to an addiction treatment facility upon discharge.
  • Jails and prisons are other places where opioid addicts need treatment. Efforts to bring medication-assisted therapy to the incarcerated could mitigate the larger opioid crisis – and also reduce the rate at which ex-inmates commit new offenses and cycle back to prison.

The bottom line is clear: Increasing access to proven treatments for all addicts who need them would save and improve countless lives, and effectively counter America’s current opioid crisis.

Read more in Peggy Compton and Andrew B. Kanouse, “The Epidemic of Prescription Opioid Abuse, the Subsequent Rising Prevalence of Heroin Use, and the Federal Response” Journal of Pain and Palliative Care Pharmacotherapy 29, no. 2 (2015): 102-114.

7 Tips for Staying Strong During Your Recovery from Addiction

When you’re overcoming addiction, the road to recovery can be tough to walk at times. However, recovering is one of the most worthwhile things you’ll ever do, and beating addiction will make you a stronger person. Here are seven things you can do to stick to your goals and have a successful recovery.

Take care of your health.

Addiction can take a toll on your physical health, so it’s important to take especially good care of yourself now. Get some exercise every day, eat right, and get at least eight hours of sleep every night. Even small positive changes, like eating fruit instead of candy, can make you feel a lot better. When you’re healthy, you’ll have an easier time maintaining a positive mindset and saying to temptations.

Be gentle with yourself.

Don’t dwell on the time you spent addicted. It’s easy to feel bad about wasted time, money, and opportunities once you start recovery, but there’s no point in beating yourself up. The past is over, and everybody makes mistakes. The important thing is that you’re making the effort to get better right now. Shift your focus to your successes instead of your failures.

Focus on one day at a time.

It can be overwhelming to think about spending your entire future sober. Instead of worrying about how you’ll get through the next month, year, or decade, just focus on today. If thinking about the whole day is still overwhelming, focus on the next hour or even the next minute. After all, a sober future is built one minute at a time.

Reach out to your support network.

Stay in touch with your family members and friends who support your recovery. When you’re struggling, don’t be afraid to call or text someone you trust and tell them how you’re feeling. Therapists and recovery programs can also make great additions to your support network. If you’re still looking at your options for recovery programs, there are plenty of options to choose from, like Addiction Treatment Riverdale Utah or Long Island Center for Recovery. You can find the best one for you online. The important thing is to surround yourself with people who want to help you get better.

Build new habits and routines.

A daily schedule can help you stay on track and fill your time with constructive activities. In addition to scheduling your work and other daily responsibilities, set aside some time to exercise, work on your hobbies, see your friends, and pray or meditate every day. Avoid activities and people that might trigger a relapse.

Make a plan for dealing with temptation.

You’ll probably have to deal with temptation at some point. Maybe someone who doesn’t know you’re in recovery will offer you a drink, or maybe you’ll start craving a drink or a hit when you’re feeling stressed. It will be easier to get past feelings of temptation if you make a plan for how you’ll cope. Practice saying no to offers of drugs or alcohol ahead of time, and come up with some emotional coping strategies as well. For instance, if you want to relapse, you could plan to call your sponsor or go for a walk instead.

Focus on your goals.

If you’re struggling to stay strong in the moment, your long-term goals can help you stay on track. Take a deep breath and think about why you want to stay sober for the long haul. Maybe you want to spend more time with your kids, start your own business, go back to school, or just stay healthy as you get older. Learning to prioritize your long-term goals over your immediate feelings is key to staying strong during your recovery.

Wrapping Up

Recovering from addiction is an attainable goal. Millions of other people have done it, and you can do it too. Use these tips to help you stay strong and focused throughout your recovery. You’ll probably find that sobriety is more meaningful and fulfilling than you ever imagined.

Life After Addiction Treatment: How to Fill the Void During Recovery

The first year of recovery is difficult to manage. Triggers lie everywhere and applying the skills you learned in rehab is easier said than done. When a recovering addict first begins life after their addiction, they may discover a void left from their past life. Whether the void is their past experiences, low self-esteem, or avoiding bad feelings, addicts typically used drugs or alcohol to fill that void.

Now in the absence of those unhealthy “coping” mechanisms, addicts now face those voids alone. Maintaining recovery requires an addict to learn how to fill their life with positive things and not go backwards into their old ways.

The certified counselors at Cold Creek Behavioral Health have put together a list of recovery and coping skills in handling life after treatment.

Recovery Skills

Rehab isn’t the end of addiction, it’s only the beginning of recovery. Once an addict leaves treatment they soon realize that life and all the factors that brought them into their addiction are still there waiting for them.

Although you can’t change everything, you can learn how to handle things better and develop behaviors that’ll help you maintain your recovery.

Learn to Mourn

As strange as it may sound, it’s important to begin your recovery by first mourning the loss of your past addiction. Since your past addiction had been with you for a very long time, it’s important you mourn the loss of it. This can require not only giving up the addiction but saying goodbye to bad friends, places, and the unhealthy habits that led to your addiction. From where you used to hang out to who you were with regularly and on, it determined a lot of your day.

It’s important you recognize that loss but also recognize that although it was something you did—it didn’t define you. Recognize that loss and move past it. Then you can move on and maintain your recovery day to day, drug-free.

Avoid High-Risk Situations and Triggers

Some common high-risk situations are described in treatment as the acronym, HALT:

  • Hungry
  • Angry
  • Lonely
  • Tired

Recognize Your Emotions

Of course, you can’t always avoid HALT situations, but you can be more aware of them. If you take better care of yourself, you’ll be able to recognize your emotions before they send you spiraling. By develop healthy habits, use support groups, and more, many of these situations will be far and few between, rather than consistent occurrences.

Steer Clear of Boredom

For an addict, feeling a sense of boredom is dangerous. This is because it allows your mind to wander and not stay focused on maintaining your recovery. This can even go as far as triggering a relapse. For that reason, it’s important that you stay busy.

Fill your day with activities you enjoy. Find new interests. Keep busy. This will keep you busy and far from the feeling of boredom. It also helps you develop healthy habits. Remember: a routine is critical to helping you stay abstinent.

Fill Your Life with People and Love

A great way to start filling that void is to re-establish old friendships that may have been lost on your path of addiction. Surround yourself with supportive people both help you and make you feel cared for and loved.

Recovery is also a good time for an addict to mend fences with family and friends. Doing this will also help make you feel better about yourself because you’ll be righting your wrongs and maintaining your recovery.

Healthy Habits and Activities Are Crucial

There are many activities you can pick up on the road to recovery, as well. Some of these healthy activities include:

  • Making a to-do list so you can feel a sense of accomplishment as you mark things off.
  • Relaxing and trying to stay stress free
  • Playing video games to relax your mind
  • Reading
  • Doing crossword puzzles
  • Start becoming more proactive by starting a blog or doing volunteer work
  • Play sports
  • Take a class
  • Learn to coo

Other Coping Skills

Some other skills that are very helpful in maintaining your recovery include:

Stress Management

Learn how to handle your stress in healthy ways. Use tools listed above to help tackle your stress one day at a time.

Honesty

Make sure that you are completely honest with yourself and others. One of the key components of drug addiction is creating a culture of deceit—combat that with complete honesty and integrity.

Therapy

Maintaining a regular schedule of therapy sessions can really improve your chances of staying clean—especially in the first year.

No matter what you do, staying busy with some type of constructive activity and surrounding yourself with healthy relationships is a key component to staying sober and not letting old triggers creep back into your life. Maintain realistic expectations and remember: getting and staying sober is a process, a marathon; it’s not a sprint.

How to Prevent an Addict from Relapsing

Preventing a relapse is typically harder than it was getting sober. The reason for this is because maintaining recovery spans a lifetime. There is always a chance that a trigger lies right around the next corner and without support in defeating that trigger, an addict can start their former patterns all over again.

Tips for Helping a Recovering Addict

Fortunately, there are a number of ways to help. For example:

Finding a support group where the addict feels comfortable, can also provide a great deal of help. Being part of a group where members have gone through the same trials and tribulations helps an addict feel less alone in his or her struggle, and more like there is somewhere he or she belongs.

Family support is also of the utmost importance. The family structure is one of the key ways recovering addicts maintain their recovery, but it can also be a trigger source for some. Making sure you’re being as supportive as possible can help them immensely.

Just being around for non-judgmental listening can help tremendously. If an addict feels they can go to you for help when they are feeling triggered will help them in more ways than one and usually helps avert any crisis.

How to Recognize and Help an Addict

It’s devastating to know a friend or a loved one suffers from an addiction. Before people get help, they often go down a long road of addiction prior to anyone, including themselves, noticing a problem. Consider the information and advice below if you know or suspect someone is an addict.

Your Gut

Addicts are excellent liars. It can seem disheartening to hear that you shouldn’t take them at face-value. However, listen to your gut. Your gut is telling you that something is wrong. Do not ignore this. They will tell you all the right things you’d like to hear. They will go into detail about where they were, why they did something and more. Everything will sound right to your mind. The very fact that you feel something isn’t right means more than likely something truly isn’t. Listen to what they say, and take notes because if they are addicts, they will slip up eventually. Don’t be the big-bad wolf that’s out to get them, but don’t be an enabler either. Enablers help them to stay stuck in their addiction by making excuses for them.

Denial

Addicts especially high-functioning addicts think that if they’re able to go to work, bring money home, do housework and other normal day-to-day life they do not have a problem with addiction. An addict is not just the junkie on the corner. Most addicts are high-functioning, which means they go under the radar for what passes as an addict to society. Because of this, and for reasons such as not wanting to face themselves, addicts will lie to themselves and the world. This is why most addicts are in denial. They might also reason that they don’t drink “enough” to be an addict. Make no mistake that alcoholism isn’t about the quantity of alcohol ingested. It’s about the mental obsession and physical craving of alcohol that makes someone an alcoholic. People who don’t drink for three of four months and suddenly “binge” can be alcoholics.

Things Don’t Add Up

It is often said that addicts lead double lives. This is true for anyone living in dysfunction. To the outside world, they have it together. Underneath that façade is a broken human being who uses alcohol, substances or anything else to get by. To make matters worse, this outward appearance can be further covered up, or justified, with a prescription medication. Abuse of a prescription medication is a serious concern. People often overdose on their pills or makeup excuses for why they need them even though they don’t have a legitimate need for them. This is why centers offer painkiller addiction treatment because it is a common phenomenon. It is also a growing phenomenon.

Real Help

To the addict, you’re “mean,” “unreasonable,” and a few choice words when you confront them. Expect this upfront. It’s not a reflection of who you are as a person despite their best attempts to assassinate your character. What they say about you has everything to do with their dysfunction. More often than not, they will choose their addiction over you. Real help and real love mean saying, “I’m going to tell you the truth,” “I need to love myself before I can love you,” or “I don’t accept your excuse. You’re responsible for your behavior, and I refuse to be a part of your life until you take responsibility for yourself.”

You can’t force someone to get help, but you can stop enabling them. Don’t make excuses for their behaviors or addiction. Addicts have to want to get help before they do. Once you know there is a problem, stand your ground. Speak truthfully to the addict. Above all, love yourself because this has been and will continue to be incredibly hard on you. Understand that they have to learn to love themselves too.

National Survey Reveals the Scope of Behavioral Health Across the Nation

The Substance Abuse and Mental Health Services Administration’s (SAMHSA) latest National Survey on Drug Use and Health (NSDUH) report provides the latest estimates on substance use and mental health in the nation, including the misuse of opioids across the nation. Opioids include heroin use and pain reliever misuse. In 2016, there were 11.8 million people aged 12 or older who misused opioids in the past year and the majority of that use is pain reliever misuse rather than heroin use—there were 11.5 million pain reliever misusers and 948,000 heroin users.

“Gathering, analyzing, and sharing data is one of the key roles the federal government can play in addressing two of the Department of Health and Human Services’ top clinical priorities: serious mental illness and the opioid crisis,” said HHS Secretary Tom Price, M.D. “This year’s survey underscores the challenges we face on both fronts and why the Trump Administration is committed to empowering those on the frontlines of the battle against substance abuse and mental illness.”

Nationally, nearly a quarter (21.1percent) of persons 12 years or older with an opioid use disorder received treatment for their illicit drug use at a specialty facility in the past year. Receipt of treatment for illicit drug use at a specialty facility was higher among people with a heroin use disorder (37.5 percent) than among those with a prescription pain reliever use disorder (17.5 percent).

The report also reveals that in 2016 while adolescents have stable levels of the initiation of marijuana, adults aged 18 to 25 have higher rates of initiation compared to 2002-2008, but the rates have been stable since 2008. In contrast, adults aged 26 and older have higher rates of marijuana initiation than prior years. In 2016, an estimated 21.0 million people aged 12 or older needed substance use treatment and of these 21.0 million people, about 2.2 million people received substance use treatment at a specialty facility in the past year.

Rates of serious mental illness among age groups 26 and older have remained constant since 2008. However, the prevalence of serious mental illness, depression and suicidal thoughts has increased among young adults over recent years. Among adults aged 18 or older who had serious mental illness (SMI) in the past year, the percentage receiving treatment for mental health services in 2016 (64.8 percent) was similar to the estimates in all previous years.

“Although progress has been made in some areas, especially among young people, there are many challenges we need to meet in addressing the behavioral health issues facing our nation,” said Dr. Elinore McCance-Katz, Assistant Secretary for Mental Health and Substance Use. “Fortunately there is effective action being taken by the Administration and U.S. Department of Health and Human Services with initiatives to reduce prescription opioid and heroin related overdose, death, and dependence as well as many evidence-based early intervention programs to increase access to treatment and recovery for people with serious mental illness. We need to do everything possible to assure that those in need of treatment and recovery services can access them and we look forward to continuing work with federal and state partners on this goal.”

“Addiction does not have to be a death sentence – recovery is possible for most people when the right services and supports in place, including treatment, housing, employment, and peer recovery support,” said Richard Baum, Acting Director Office of National Drug Control Policy. “The truth is that there’s no one path to recovery because everyone is different. And frankly, it doesn’t matter how someone gets to recovery.  It just matters that they have every tool available to them, including peer recovery support and evidence-based treatment options like medication-assisted treatment for opioid addiction.”

NSDUH is a scientific annual survey of approximately 67,500 people throughout the country, aged 12 and older.  NSDUH is a primary source of information on the scope and nature of many substance use and mental health issues affecting the nation.

SAMHSA is issuing its 2016 NSDUH report on key substance use and mental health indicators as part of the 28th annual observance of National Recovery Month which began on September 1st. Recovery Month expands public awareness that behavioral health is essential to health, prevention works, treatment for substance use and mental disorders is effective, and people can and do recover from these disorders.

5 Things To Tell Your Teenager With an Alcohol Addiction

parents-teens

The legal age for drinking alcohol is 21, but that doesn’t stop many teenagers from drinking. Although the number of reported instances of underage drinking is done, according to the Foundation for Advancing Alcohol Responsibility, there is still much to be done in the fight against underage drinking and all the problems that can result from it, such as vehicular accidents, sexual assault and death.

While most teens start drinking as a way to fit in with their friends and have fun at social gatherings, some find that the addictive powers of alcohol have made an immense impact on their impressionable minds. IF your teenager has an alcohol addiction, it can be a very difficult thing for the two of you to address. Here are five things you can tell your teenager with an alcohol addiction.

1.Their Addiction Does Not Define Them

The stigma of dealing with addiction can make many people feel like they’re a pariah in society. For a young person like a teenager, they might feel like they’ve ruined everything for themselves and the people around them. Take the time to remind your teenager of all their positive qualities and commend them for tackling their addiction. Remind them of how many people there must be who don’t have the courage to face their problems like they do.

2. They Are Not A Bad Person

Even if alcohol has influenced your teen to do things that they otherwise wouldn’t, you should remind them that an addiction doesn’t make them a bad person. You should tell them that their willingness to fight their addiction means they possess a strength that speaks to their character.

3. You’re Here For Them

Dealing with addiction can make people feel isolated and alone. Since it’s a largely mental battle, people recovering from substance abuse can feel as though they’re trapped in their minds with no one to turn to. Not only should you tell your teen that you are here for them, you should show it as well. Spend time with them and engage in fulfilling activities the two of you will enjoy. This will help them keep their mind off alcohol and help bring the two of you closer together. You might even look into innovative ways for your teen to help keep their mind clear. For instance, wilderness therapy is a type of behavioral therapy in which the powers of nature and outdoor exploring can help to cleanse one’s mind. These programs address matters such as substance abuse and could be the right solution for your teen on their path to recovery from alcohol addiction.

4. Addiction Can Happen to Anyone

Since your teen is young, they’re unlikely to have a sophisticated understanding of addiction and all that it entails. They might have stereotypical views of addicts and believe that they can’t be included in that group. Tell them about how substance abuse and addiction is a health matter, not a moral matter. Encourage them by telling them how addressing an addiction early on lessens its grip on them.

5. You Love Them

Addiction can put a tremendous strain on your relationship with your teen. The road to recovery can be rocky and there’s no surefire method of success. However, you’ll want your teen to know that you love and support them. You might not love or support some of the choices they’ve made, but you love them for all the joy their life has provided you. Your emotional support can make all the difference in helping them to cope with their addiction.

The Power of Uncertainty and Not Knowing

There’s a lot of talk about addiction these days: to drugs, alcohol, sex, porn, coffee, food, cigarettes. You name it, if it makes you feel good, you’re addicted.

But here’s a couple of other addictive “circumstances” we don’t talk about: certainty and knowing. If there are a couple of things we all crave for, it’s assurance and understanding.

Western culture in particular thrives on these two qualities. We get paid for having them and punished for not. Certainty and knowing are the foundations of our most valued institutions: education, medicine, law, justice, business, broadcasting, politics, marketing, science, religion…[add your favourite here].

Everyone claims to know what’s good, bad, right, wrong, best, worst, cheapest, stylish, in, out, needed, not needed, true, false, left, right, etc, etc. And everyone’s certain the sun’s going to rise, the economy’s got to grow, the day after today is tomorrow, the day before is yesterday, particular rights are sacrosanct, some will go to heaven, some to hell, there is a God or there is no such thing. Ad infinitum.

But how certain can we be about what we know and how do we know what’s certain? Natural disasters, terrorism and unforeseen crises show us we can seldom be sure of anything.

Do you think your GP knows what’s wrong with you? I never think mine does. I don’t mean that as a criticism; he’s a great doctor. But his job is not to know what’s wrong, it’s to make an educated guess. I had a sore ear last week and, when he looked in it, he didn’t say, “I know it’s allergy.” He said, “It looks like allergy. We’ll try some eardrops and come back if it hasn’t settled down in five days.”

Religious people, especially leaders, claim to know there’s a God, heaven, what’s a sin, what’s not and so on. But they don’t know. They may believe it, but belief is not knowledge, it’s “an acceptance that something exists or is true, especially one without proof.” (Apple Dictionary).

Even in some areas of science, particularly quantum physics and evolution, scientists may say they know how quantum particles behave or how the universe began, but again, they can only believe in a theory based on the perception of the human brain. How the world works can only be a mystery, because we can only subjectively experience it.

I have always said the best job in the world must be being a meteorologist — who else gets paid so much to get things wrong so often? And yet a weather forecaster rarely says, “We don’t really know what the weather’s going to be like tomorrow, but it could be sunny.” Rather they usually give the forecast like they know for sure.

With the illusion of knowing comes the perception of certainty. We live our lives assuming things will be as we predict them to be. We assume that we’ll wake up in the morning and go to work; that our kids will be straight; that the aeroplane will be on time; that the internet will work. Then, when our assumptions turn out to be wrong, we rage, blame, stress and get upset.

Admitting to not knowing or acknowledging uncertainty are uncomfortable spaces. We worry, get anxious, get scared. So we do everything in our power to know as much as we can and to avoid uncertainty by strategising, planning and scheming. Our days, our weeks, our relationships, our careers, our social policies, our lives.

Sir Ken Robinson said something interesting in an interview once. He said he’d never planned his career; he’d just chosen between different opportunities as they presented themselves and that he believed many successful people do the same. I resonated with that. I have never planned my career; in fact I seldom make plans. The only plans I really make are social and business appointments and, I confess as those who know me will attest, I can be pretty anal when those plans change, especially if suddenly or without my knowledge.

But, when I have to plan a project or a strategic process, I’m usually reluctant and cynical. My definition of a plan is something you look back on to see what you didn’t do. I stand by that definition because, of all the things I’ve been involved in planning, nothing has ever gone to plan.

You may be thinking, but if nobody planned, nothing would ever get done. I would reframe that by saying, if nobody had intentions nothing would ever get done. Intention, defined, includes planning, but interestingly, in logic, intentions are “conceptions formed by directing the mind towards an object.” The word’s origin is late Middle English, from Old French entencion, from Latin intentio(n-), meaning ‘stretching’ or ‘purpose’.

So I’ve always, or nearly always, had intentions: to be successful, happy, reasonably wealthy, generous, respectful and respected, authentic and aware. But I’ve never planned to do things to achieve them. They’ve all happened, but I haven’t known how and I was never certain I’d achieve them. There have been times when I’ve felt I’ve lost my purpose, or I’m not feeling stretched, but I’ve made some bad decisions when I’ve tried to recapture certainty. I think I’ve now learned to be still in the uncertainty of it all and wait.

There’s a therapeutic idea that confusion is a very useful state of mind, because you’re open to all opportunities, as Sir Ken spoke of. Being certain, however, can mean you miss opportunities, because you’re so focussed on one thing. That’s the power of uncertainty: it leaves you open to opportunity.

It’s interesting that certainty has two antonyms, possibility and impossibility. This suggests another power of uncertainty: being open to possibility. Uncertainty can also render impossible unwanted outcomes. If you are uncertain about failing, for example, you may just make failure impossible.

But what is the power of not knowing? For me it is the gateway to freedom. When we don’t know about things we don’t judge or make assumptions, we invite curiosity, creativity and authenticity into our world. We are free to reframe, reinvent, reimagine and re-create. When we don’t know about people, we are free to find out about ourselves, to marvel at our diversity and to build relationships built on wholeheartedness, respect and trust.

Uncertainty and not knowing are two things we are conditioned to fear and avoid. The question is though, by steering clear of them, what are we missing out on?

The Challenges of Coping with the Addiction of Someone You Love

As I have gone through the drama, tragedy, stress and shame that comes along with watching a loved one battle addiction, I have finally grown to understand that addiction is not merely a lack of willpower accompanied by a series of horrible decisions. I have had such a misunderstanding of addiction that I have needed to educate myself, if only to better understand the affliction. What I learned is that I have work to do in order to learn how to cope with her addiction.

There are many myths about drug addiction. In order to not add to the problem and to help myself make good choices, I dedicated myself to learning about the disease. I discovered that opioid addiction, which my sister suffers from, and it is considered to be one of the 5 largest public health concerns facing our nation. I learned that addiction is not just a weak-willed response to adversity, but a disease that is often developed along with mental health issues.

My learning wasn’t merely acquiring information about addiction. I was forced to confront my inability to cope with my sister’s addiction, and the challenges that it created for me. Most of what I had to understand was counter-intuitive and went against my nature. For example, I found it nearly impossible, at first, to maintain strict boundaries. I have always felt the need to provide and protect this person, and I learned that doing so wasn’t helping. This was a brutal realization. By ‘helping’ I was prolonging the necessary “bottoming out” that is ugly and brutal, but critical.

In order for an addict to truly take the steps towards recovery, they often need to feel like they have exhausted their options, otherwise, their addiction poisoned mind will continue to manipulate and bargain to maintain substance abuse. This was difficult to accept, because I love my sister and know the part of her who wasn’t manipulative or duplicitous. But that version of my sister was lost in a cocktail of drugs and alcohol that wouldn’t allow her to surface until she had no other choice. I worried that she might die, considering 78 people die every day in America from opioid addiction.

After several stints in rehab centers and the hospital, she is doing much better. She is clean and appears to be committed to her sobriety. But life has a funny way of testing one’s resolve. She just had an MRI and discovered that she has a torn ACL. She will have surgery and the tear, although complete, is repairable. The problem is that it is a significant surgery, which will require pain killers after the surgery is done. This will require her case worker and all of us who care about her to become familiar with the signs and dangers of her using opioids to deal with the pain. There is an array of complex treatments for pain, but the addiction must be constantly and vigilantly monitored, otherwise we risk sending her back into a severe usage spiral.

This is similar to what happened with people like former San Diego Chargers’ quarterback Ryan Leaf, who is now in prison for stealing painkillers because he became addicted due to the violent repercussions of playing football. Then he seemed to have his addiction under control, but needed surgery to remove a tumor. He vowed to have the operation without anesthesia due to his addiction, but now he is doing a seven year sentence as a result of his crimes.

Now my research has pivoted to the topic of helping my sister stay sober, without enabling her and allowing her to have a necessary operation to fix her knee. What the knee surgery seems to do is pile on to the complex and confusing circumstances that accompany addiction. I feel like this is new territory, and I have no experience to draw from.

But, I have learned that I need to keep growing. I now go to Alanon meetings and continue to ask questions because my first instinct is to help which may be the wrong response. There probably are no perfect responses in this complex process, but working to be more effective with the steps I take is critical. Otherwise, I am part of the problem and not the solution.

Into the Woods: On the Path to Recovery

Addiction is devastating at any age, but for parents with a teenager substance abusers, it can all but tear the family apart. Adolescence is a period prone to experimentation, but unfortunately, the desire to try new things can lead teens down a dark path that stops being fun and becomes life-threatening.

Studies demonstrate that many teenagers hold a blase attitude regarding drug use; dosomething.org — a global youth outreach program — reports that 50 percent of American high schoolers in 2013 did not find it harmful to try crack/cocaine once or twice; 40 percent reported that they believe trying heroin is not a bad or dangerous thing. In the same study, it was found that a total of 6.5 percent of American high schoolers smoke pot daily and that 54 percent of them do not see a problem with regular steroid use.

Signs and Symptoms of Teenage Drug Abuse

Teenagers who are using drugs actively usually exhibit telltale symptoms. Some of the most common include a change in friends, a careless attitude toward work and school, lower grades, changed eating and sleeping habits and strained relationships with people they were once close to.

Teenagers who struggle with drug addiction may be scared to admit their problem due to the consequences they’ll receive from their parents, but getting help as soon as possible is critical. Teens who do not seek help with their drug addiction during adolescence face psychological and developmental damage that will only hinder them the older they become. They are also more likely to engage in criminal activity that could further disrupt their life and tarnish their future; a 2012 TEDS report by the Center for Behavioral Health Statistics and Quality revealed that the primary reason for drug treatment referral was the criminal justice system; 51.2 percent of older adolescent (15–17 years old) rehab patients were admitted under court orders.

An Alternative to Rehab

While a teen substance abuser can seek help from a psychologist or traditional drug rehab, there are other options that have proven themselves to be incredibly effective in more ways than one. Wilderness therapy for drug addiction is one such option.

Wilderness rehab presents addicted teens with a new, challenging environment over a 6 to 9-week recovery program. There are many advantages to teen wilderness drug therapy that can elicit profound and life-changing results.

Control & Self-Discipline

Although the wilderness rehab programs for drug-addicted teens are incredibly regimented, the fact teenagers take such an active role in their treatment and survival outdoors leaves them with a sense of control and empowerment.

For teenagers who have problems with authority and struggle to thrive in a structured environment, wilderness camps are difficult. However, the structure that is provided throughout the duration of the course demonstrates to teens that they are capable of succeeding under a set of rules and that they don’t need drugs to tame their insecurities or fears.

Useful Life Skills

There are a lot of skills that a teenager picks up in wilderness rehab that they will continue to employ throughout their recovery and well into adulthood. Anger management, healthy emotional coping mechanisms, goal-setting, perseverance, conflict resolution, and enhanced communication skills are just several of the aspects teens explore and develop during treatment.

Don’t Wait for a Sign

If you suspect your teenager is addicted to drugs or you are a teen struggling with drug abuse, don’t avoid seeking outside help. Because of all the doubt and fear involved in sending a teen off to rehab, it’s not uncommon for people to try and figure things out at home instead of seeking professional treatment.

Consider wilderness rehab programs and other types of drug therapy now. Doing so in the midst of addiction can help stop it from spiraling even further out of control and put teens back on the path toward a productive, healthy life.

The Presidential Policy Series: Combatting Drug Abuse

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The Presidential Policy Series has been exploring where the Democratic and Republican nominees, Hillary Clinton and Donald Trump stand on a variety of healthcare policy issues. We examine how already the presidential nominees plan to address our country’s largest healthcare epidemic—addiction.

Across the country from small, rural towns to large cities, drug abuse has been on the rise. The most recent National Survey on Drug Use and Health in 2013 estimated that approximately 22.7 million Americans needed treatment for a drug or alcohol problem, yet only 11% of these people were able to actually receive treatment. Nearly eight out of nine people who are struggling with addiction fail to gain access to the care they need. It’s a frightening statistic, especially as 7,800 individuals above the age of 12 try a new drug every single day.

While drug use has long been an issue, it has gotten worse in recent years. More people died from drug overdoses in 2014 than in any other year on record. The majority of those drug overdoses were the result of opioids, prescription painkillers, or heroin.

What policy proposals have the two candidates announced to address America’s drug epidemic?

A ‘Bold Plan’ to Tackle Drugs

Hillary Clinton is proposing a “bold plan” to prevent, treat, and support recovery from drug abuse. As part of her plan, Secretary Clinton vows to launch a $10 billion initiative that will work with state and local governments to focus on prevention and educate communities on how to intervene early to prevent addiction. She has also announced new initiatives to work with providers to aid prevention and ensure that opioid painkillers are being administered more appropriately by requiring new training and monitoring programs.

For those suffering from addiction, Clinton wants to expand inpatient and outpatient services, increase the number of specialty-trained providers, and ensure insurance is not a barrier to receiving treatment. She also plans to make naloxone, the rescue drug for opioid overdose, accessible to every first responder. Finally, she plans to increase investment in programs that divert people to rehabilitation instead of prison for low-level and non-violent drug offenses.

Stronger Borders to Decrease Drug Availability

To date, Donald Trump has expressed no discernable, coherent policy around resolving the drug crisis. He has mostly focused his attention on calls for tighter border security; one of the side effects, ostensibly, being a reduction in the availability of drugs that are being illegally smuggled into the country. To our knowledge, his only stated position on prescription drug reform has been a liberalization of pharmaceutical overseas imports, which we will cover in the next article in the series.

Traditionally, the GOP has supported stricter drug legislation with many legislators at the national level opposing the legalization of marijuana and speaking out against the improper prescription of painkillers, which often leads to the opioid abuse. Many Republicans support in-school education programs targeted at preventing and delaying substance abuse among children and adolescents. Unlike Democrats, who have come out strongly against the War on Drugs, the GOP continues to support harsher penalties, such as jail time and mandatory minimums, to deter drug use.

The growing drug epidemic across the United States is a serious domestic issue that the next President will have to address. In our opinion, opioid and prescription drug abuse is one of the most troubling drug crises our nation has ever faced and poses a more insidious threat than drugs illegally smuggled across our borders. Healthify encourages continued, bi-partisan efforts to educate, prevent, and delay drug consumption among children and seek to promote greater access to rehabilitation and treatment for substance abusers.

The Rising Danger of Fentanyl Abuse

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In recent years, the United States and Canada has seen an increase in fentanyl related overdoses. Fentanyl is a pharmaceutical drug classified as an opiate. It is a whitish powder that can be found in the form of tablets, in capsules, and cut with other drugs. The drug’s infamous potency and accessibility has attracted many buyers and sellers.

Fentanyl was first used as an anesthetic during operating procedures.  It is currently being used to treat pain symptoms from a variety of medical conditions. Fentanyl produces a feeling euphoria and a sense of well-being, the effects can last up to 6 hours. A primary cause of addiction is the high tolerance after the first use. This leads to higher doses constantly needed to reproduce the initial high. The discomfort from ‘coming down’ is another leading factor in addiction, users will avoid withdrawal symptoms by simply dosing again. Other side effects include weight loss, hallucinations, shaking and sweating.

Opioids are the leading category in overdoses and fentanyl is steadily rising with people looking for drugs that are more accessible and more potent. Fentanyl has the same high inducing effects as morphine, only stronger. “Fentanyl is a powerful synthetic opioid analgesic that is similar to morphine but is 50 to 100 times more potent” according to the National Institute on Drug Abuse. Like any synthetic drug the potency is only an estimate but could easily be more as a result the likelihood of death is also higher. In Sacramento county 53 fentanyl related overdoses resulted in 12 deaths. Fentanyl, along with other prescriptions, can cause noticeable impairment that puts others at risk, particularly while driving. Drug dealers aren’t sure of the potency and users have no way to tell what they are consuming. Most fentanyl seized has been illicitly created.

For producers, fentanyl is relatively inexpensive to make. A kilo of fentanyl can be made for cheaper than it takes to produce a kilo of heroin. Fentanyl from China and Mexico has been found in the United States, with similar cases in Canada, both pharmaceutical grade and illicit. Fentanyl’s strength allows for the sale of smaller quantities to more people since the drug is highly addictive it results in a consistent demand. It can also be bought and sold over the internet on black market websites, it is a lucrative business for drug dealers.

Non-illicitly created fentanyl is sold from people with prescriptions or by those with access to the drug. According to Drug Abuse, “Because Fentanyl is frequently administered in a hospital setting, people with easier access to the drug (those working in or around a healthcare setting) may fall prey to fentanyl addiction.” Since it is accessible and prescribed to patients, law enforcement have found it difficult to prevent abuse.

Most labs and law enforcement are not equipped to detect fentanyl since its use is still gaining momentum. During 2013-2014, the CDC found there were over 400 percent more cases of fentanyl use than the previous year. With a high estimate for unreported cases, its various forms and mixture with other drugs make it difficult to be detected. It has been found mixed with heroin, OxyContin, and cocaine.

Withdrawal from fentanyl is non-lethal but it has similar painful withdrawal symptoms as other drugs in its category. Its potency make users particularly vulnerable to relapse. Support groups, clinics, and medication is available for fentanyl users to overcome addiction. Unfortunately, fentanyl related incidents are expected to increase in the next few years.

Why Is Drunk Driving So Prevalent?

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The first step to correcting a problem is admitting that you have a problem. That’s where a debate of drunk driving falters. It’s difficult to pinpoint where the problem starts or how it ends. There are numerous solutions, but neither drinkers, drivers, nor authorities seem to care much about stopping drunk driving.

Alcohol Is More Available Than Ever
Admitting a problem starts with a moral investigation and moral questions have no consistent answers. They differ from person to person, culture to culture. With over 50% of Americans drinking somewhat regularly, alcohol, like tobacco, will continue to be prevalent. In fact, alcohol merely stepped up after the demonization of tobacco. Most people don’t believe, or don’t care, that alcohol is a big problem.

In the 21st century, the popularity of alcohol mostly has to do with organizations like the WTO promoting sales worldwide, making booze the new tobacco in terms of marketing and social acceptance. When alcohol can be purchased anywhere that sells anything, including the nearest coffee shop and the most noted sports star of the era drops references to drinking during victory speeches, the number of people drinking dramatically increases.

So much alcohol advertising completely negates any sober movements. Particularly in times of economic despondency, drug and alcohol use will be inevitable. Drug dealers and liquor stores sell the most in economically depressed areas because of so many desperate people. Drinking is so natural, it doesn’t need the advertising. Maybe the real moral issue should be whether businesses should target vulnerable populations.

American Car Culture
In the U.S. more than most countries, it has long been a social disease to ride the bus. It’s a status symbol for Americans to drive (and to drive a Mercedes if possible). The idea of driving for transportation is so entrenched that there is almost no infrastructure beyond cars. Uber has helped put a band-aid on a gaping wound in the past year or two, but unless you live in a progressive metro area there aren’t many options for getting home from the bar.

When the most common method of transportation is to drive a car, and the most common pastime in society is to drink booze, then it becomes almost hypocritical for a governing body to suggest people don’t drink and drive and especially to penalize people so harshly for it.

Options
It is apparent that taking away cars or booze is not a realistic solution. Nonetheless, society doesn’t go to enough measures to stop drunk driving. Basic steps that have never worked are guilt trips and fines. Appealing to people’s sensitivities, such as MADD or SADD, only affects sensitive people. Certainly, more laws and stiffer penalties haven’t curbed the problem in the least. The bigger the stakes, the more of a game it seems to be. Moreover, the unrealistic part to such ends is that legal, ethical or emotional decisions are nearly impossible to consider when drunk.

What society needs is a global solution. The most realistic option is to have cars manufactured with devices to not operate if the driver is drunk. If Google can program cars to drive by themselves, a car can be programmed to not drive. In fact, diversion programs often require interlocking devices on the ignition for just that reason. In India, there is now a breathalyzer helmet that uses bluetooth signal to motorcycle ignitions when the rider is unsafe. A similar device could easily be installed on every car as commonly as a seat belt or a radio.

A simple and practical solution to drunk driving could have been implemented decades ago, but didn’t because…money.

Revenue Generator
The question is, are there a greater percentage of drunk drivers on the road now than decades ago, or are there just more people getting charged with drunk driving? Thirty-five years ago, a person needed to be blacked-out before they would be thrown into the drunk tank until morning. Now, one drink could end up costing a couple thousand dollars.

In general, more people are being charged with more crimes and they come with a fairly arbitrary method of determining who should be ticketed or arrested. The constitutionality of DUI checkpoints gets called into question. And further, police officers themselves continually have problems, such as a 28-year New Jersey State Police veteran ramming a woman’s car while drunk on duty or cops working half-drunk.

It’s not just driving drunk that can lead to problems. Drunk walking is said to be more dangerous than drunk driving and drunk biking can also result in fines or arrests in some states. On the other side, one person was apparently charged with a DUI for sleeping in their car. When trying to be responsible comes with a penalty, then there is no incentive to be responsible. This is another example of targeting vulnerable populations.

These examples show that it’s basically drinking that is against the law. We can’t make it illegal to drink, but apparently it can be illegal to do any activity while drunk. That’s not to suggest any of this activity is a good thing, but when society continually endorses drinking and then doesn’t provide any support in the aftermath then there is a contradiction and the law is irresponsible. With a de facto taxation collecting thousands of dollars routinely from half the population base, this is instilling the rationale that one may as well drive drunk because the legal system is going to fine them anyway.

Now, who is going to be the one to admit that they have a problem, the drunks, the drivers, or the authorities trying to fund their own endeavors through unnecessary extortion of citizens? Everyone has a problem in this scenario, but the authorities are basically blaming a problem on someone else. Instead of actively trying to make society safer, the present solutions to drunk driving only serve to conflate problems.

When Fathers Are Not Engaged We Miss the Bigger Picture in Child Protection

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Today, it is common to hear about the rise of domestic violence and children living in poverty who are raised with single mothers because the father is not around. Nearly every issue has another side to it that is often ignored. For example, responsible fathers who have been separated from their kids, are at higher risk of suicide and emotional hardship. Children growing up without their fathers in these communities have a higher dropout rate and are more likely to either become incarcerated or become young parents too early.

Even though, the federal government has recognized the importance to support responsible fathers and their active involvement in their children’s life, today’s common practice in the family courts and social services demonstrate minimal proof that they are “on-board” with the idea. Fathers often experience negative biases and inequitable treatment. They are neglected of the rights to their children, therefore, the children are neglected of the rights to their fathers.

Over my three years as a volunteer intern for Paternal Opportunities Programs and Services (POPS) in San Diego, I saw the other side of this story. I had the “eye opening” experience of meeting the fathers of these children every Wednesday. We were a very diverse talk group, no one was the same, and everyone’s situation was different. Even though we were all different, we all connected in several ways. The reason is, all these fathers shared something in common, they loved their children and wanted to be in their life.

Unfortunately, most shared the stress and agonizing suspense of not seeing their children for months and trying to resolve the conflicts with either the other parent, social services, or family courts. However, it was common for a father to be battling all of these stressors at the same time just to stay involved with their children.  After my three years of hearing the same issues, it is clear that common practices of our family court system and social services need to be monitored, revised and updated. Our children are paying the price for it.

We rarely end up living the life that we have always expected to be in. Think of the homeless man you see sleeping on the park bench, the drug addict getting picked up on the streets from the police, or the individual walking down the street carrying a child’s backpack and pushing a baby stroller with no child in it. These behaviors may seem odd to us, but these individuals have another side we do not see. There is almost always an unknown story which explains how they got there. It is a story they never expected, nor wanted and a reality they had to face.

It is important to remember that both parents love their children and are equally important in a child’s life. Lets take some extra time to get understand the bigger picture. When we open our eyes to the other side of the story, it may save a child from ending up having a life they never wanted and do not deserve.

Understanding Substance Abuse, Addiction and Treatment

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Substance abuse can include alcohol, tobacco, marijuana, and other drugs, and is prevalent in all ages. For adolescents, the top three most abused substances are alcohol, marijuana, and tobacco in that order. At the end of 2014, it was found that around 2.8 million older adults in the US abused alcohol and there was a 3.3 percent increase in illicit drug use among older adults between 2002 and 2013.

Now clearly, drug or alcohol use is different than abuse or addiction. Typically substance abuse has three criteria: tolerance, withdrawal, and continued use even when there is negative consequences. The withdrawal seems to be a key factor in that many people build up a tolerance and continue drinking even after having had negative effects, but not everyone has withdrawals, which is the separation between use and abuse. Another difference is that those abusing substances or with addictions often need treatment to overcome their excessive use and dependency.

There are countless substances out there but the big ones are alcohol, tobacco, illicit drugs, and other drugs such as caffeine and misused prescription drugs.

Alcohol

Excessive alcohol consumption is a leading cause of death, killing more than three million people each year worldwide. Still, excessive use is not the same as alcohol abuse or addiction. According to the Center for Disease Control and Prevention (CDC) defines ‘alcohol abuse’ as “a pattern of drinking that results in harm to one’s health, interpersonal relationships, or ability to work,” which is different than alcoholism–defined as a chronic disease. About 17.6 million Americans either abuse alcohol or are dependent on alcohol. Although this number seems small relative to the US population, it is actually close to 1 in 12 adults in the US. But keep in mind that it isn’t just adults using alcohol, many underage persons are as well.

Many states are considering changes to their alcohol sales laws; hopefully these changes will lessen the amount of alcohol accessible to underage persons. It will also limit the amount of alcohol-related crimes. However, some of the law changes being proposed seem to be more relaxed about alcohol sales instead such as not asking for ID for people who look older than 40 and allowing sales on Sunday–many states currently have laws prohibiting alcohol sales on Sunday.

Tobacco

Tobacco is another highly addictive drug. Action on Smoking & Health (ash.org) has a very extensive list of tobacco statistics for the US and world. Some of the more glaring statistics are that over twenty percent of deaths in the United States are from tobacco, there are currently 1.1 billion tobacco users worldwide–which is terrifying because tobacco kills up to fifty percent of its users, and that there are over 4000 chemicals in tobacco, 250 of which are known to be harmful to humans.

Although cigarette smoking has declined in adolescents recently, it is still around. Many start trying tobacco at a young age, which is a factor on becoming a regular smoker later in life, especially if their parents or peers smoke as well.

Illicit Drugs and Other Drugs

Other drugs that lead to addiction and abuse are not often thought of as “doing drugs” or even drugs in general. Prescription drug abuse is the next most abused substance by American teenagers other than marijuana and alcohol. These drugs are often obtained from taking a relative’s prescribed drugs without them knowing. Along with prescription drugs, many teens are also using cough syrups as means to get high.

The most popular drug–even though most don’t realize it is a drug–is caffeine.Dr. Harold Urschel, author of Healing the Addicted Brain, said:

“Caffeine is quite addictive in the sense that it is a psychoactive substance. It stimulates certain chemical systems in the brain and this keeps you awake. If you use it on a daily basis, you develop a tolerance, just as you would to pain pills or other drugs. After a while, you need more and more to produce the same effects. Unfortunately, along with waking you up, caffeine also makes you agitated, irritated, and anxious – and those effects increase along with your daily dosage of caffeine. You get acclimated to caffeine’s wake-up aspect, but never to its agitation, irritation, and anxiety aspects.”

Not many people consider or think of caffeine as a drug when in fact it holds the properties of drugs and can become addicting in the sense that some people “can’t function without coffee” or other forms of caffeine.

Treating Addiction

Other than the obvious health issues that come along with substance abuse, there are other problems caused by drug use including overcrowded prisons. Because of the excessive amounts of people either committing crimes as a result of drug use or crimes related to the possession or use of drugs, one suggestion to stop overcrowded prisons is re-evaluating prison sentences for drug-related offenses. But instead of putting a band-aid on the issue, what if there were more efforts into treating these offenders before they get to the point of incarceration?

“Ours is an honorable profession. We serve people who have incredible resilience and drive.” –Jim LaPierre (substance abuse counselor)

The type of treatment used for substance abuse or addiction with the most success varies with each individual. Not only does any given treatment not work the same for any two clients, but each client has a different background and chemical makeup. Kathleen Farkas of the Case Western Reserve University Mandel School of Applied Social Sciences said that “those who have problems with alcohol and other drugs, the age of onset of the problem is important for diagnosis as well as for treatment planning,” saying that some have been dependent on the substance for most of their lives while others began late in life.

 

The Persistent Stigma of Substance Use Disorders

“Stigma is a five dollar word for a two dollar concept. It’s prejudice.”

Stigma, a set of negative stereotypes tied to behavioral health conditions, is not a new problem. Results of a recent survey suggest that views may be changing when it comes to mental illness. Advocacy efforts are getting results, and the public is beginning to recognize that mental illness is, in fact, a health condition.

We need a similar evolution to start when it comes to substance use disorders. Public perception of what it means to be addicted hasn’t shifted significantly. This is a problem.

In a study of Americans conducted by Johns Hopkins University, only 22% of people surveyed were willing to work closely with someone suffering from drug addiction, yet 62% were willing to work closely with someone suffering from mental illness.

Every person struggling to manage a substance use disorder, and every family stigmatized while supporting a loved one, are part of this broader landscape. Our current culture of stigma creates resistance to funding prevention and treatment. Belief that persons with substance use disorders are immoral, not ill, reduces support for behavioral health-centered policy.

Funding for treatment of substance use disorders isn’t commensurate with the scope of the problem. If substance use were recognized by the public as a health issue, it’s likely that prevention would be a higher priority.

We must help each other, and our communities, reshape the distorted image of substance use disorder as criminal and deviant. A person with a substance use disorder remains a person first. Examples of person-first language for substance use are included in this chart shared by Michael Botticelli, Director of Office of National Drug Control Policy. Note: Mr. Botticelli is himself a person in long-term recovery.

Language for addiction

Of course, stigma-free language is only one step and changing a stereotype takes time. We should see this as part of the process of removing structural roadblocks to health. As we break the persistent stigma that clings to substance use disorders, we’ll turn the focus instead to very real opportunities that exist for health and recovery.

Dealing With Addiction During the Holidays

The holidays are meant to be a time of reflection and relaxation as people celebrate with their family and friends. Many choose to spend time with their loved ones enjoying the chance to spend quality time. However, the holidays may also bring with it stress and additional pressures especially for those who struggle with addiction.

For those battling addictions during the holidays, this stress may be magnified. The temptation may be to fall back on old habits such as drugs and alcohol to cope with such stress, or perhaps the jovial atmosphere of a holiday party may tempt an addict to use as well. Whatever the case may be, those facing substance abuse battles will want to have reliable plans in place so that they do not make a decision they will later regret as a result.

Steps to take to prevent relapse during the holidays

HE_holiday-drinking_s4x3_leadFirst, take special note of what tends to cause you stress during the holidays. Perhaps you lost a loved one at this time of the year and this still brings you sadness. As a result, you will want to avoid situations and events that remind you of this person. Focusing on what causes you stress may be difficult at first. However, remember that you are doing so to prevent further complications later on.

Be sure to simplify your holiday plans so that you are not taking on too much or setting yourself up for failure. If there will be a party with alcohol present, then you should logically avoid such gatherings as an alcoholic. Also, avoid any parties where drugs will be present so as to not set off any addictive tendencies. Be aware that as an extra incentive, the police will be anticipating such behavior for the holidays. You will be avoiding any legal consequences that arise as a result in the process as well.

If you do end up attending a party where alcohol is present, politely decline an offer for a drink. You are not further obligated to explain why to anybody. A true friend will not question you further or pressure you about it. However, remember in turn that you can’t necessarily tell others whether they can have a drink or not. This only applies if you are hosting your own party, where you have specifically stated that you do not want any alcohol or drugs present.

If you will be attending such an event where alcohol is served, you may choose to attend with another person who is in recovery. This may help you feel less alone and more confident in your decision not to drink. By relieving such anxiety, you will be less tempted to indulge. Call a mentor or sponsor before attending if you are able to as well. They will be able to give advice and ideally, they will be available if you need to call during the festivities. If you are able to get through a single event without drinking, then the next event will only be easier. You may also choose to carry a picture of a loved one to remind you of the importance of your sobriety to those in your life.

If wine is present at an event, another option is to choose cranberry juice. This will prevent others from questioning you about your beverage. This also works if you choose a beverage such as ginger ale instead of champagne. You may also choose to arrive at such an event later on than others and leave earlier than others. The point is you still have appeared polite by accepting an invitation and showing up. There is no need to be present for the end of a party when alcohol consumption has become more excessive and others may be more likely to be pushy about your sobriety.

Don’t make the mistake of thinking that you can handle troubles related to addiction all by yourself. If you need to confide in someone close to you so that you can help get something off your chest, then you should. Be sure the person you choose is someone you know will listen and not be judgmental. You may choose to speak with a professional counselor, especially if you are not sure you have someone close to you that you can confide in.

Continuing care support groups are always available for additional help if needed as well, such as Alcoholics Anonymous and Narcotics Anonymous. It’s important to remember that you are not alone and that there are plenty of others out there who will be struggling to maintain sobriety this holiday season as well.

 

Prescription Drugs: Overdoses Still on the Rise

transparency drug stuff

A number of alarming statistics have shown that prescription drug abuse is one of the most prevalent epidemics in the United States. For instance, in 2010, prescription drug overdoses were shown to be one of the nationwide leading causes of death.In the past year, more than one quarter of people who began abusing drugs did so with prescription drugs. Additionally, more than one million hospital visits in 2011 were due to recreational prescription drug abuse. Also in 2012, nearly 500,000 people aged 12 or older abused prescription drugs for the first time within the past year.

There is a common misconception that prescription drugs are safer and less addictive than street drugs, when that is not necessarily true. Fatal prescription drug overdoses, especially those resulting from prescription painkillers, have been on the rise in the past decade. These painkillers include medications such as fentanyl, hydrocodone, hydromorphone and oxycodone. A wide range of prescriptions such as sleep medications, benzodiazepines and barbiturates have also been abused.

To help minimize such tragic occurrences in the future, it is necessary to be educated about these controlled substances. Hopefully, being able to spot the warning signs in an individual and helping to reduce the stigma of seeking treatment for addiction may help save lives and reduce prescription drug abuse.

Statistics

Generally speaking, men statistically abuse prescription drugs more than women do. However, there is an exception to this regarding the age group of 12 to 17. Females in this age group abuse prescription drugs more so than males.

In terms of age groups in a broader sense, young adults aged 18 to 25 are the most likely to abuse prescription drugs. Naturally, older adults are often prescribed drugs because of the higher incidence of illness. However, prescription drug abuse at this age becomes even more risky as drugs are metabolized differently due to age. Also, if the older adult is taking supplements or medications, these further increases the risks presented to health.

Effects of use and signs of an overdose

Prescription drugs often have an intoxicating effect when they are abused in excessive amounts. The user may experience symptoms such as lowered anxiety, lessened inhibitions, drowsiness, lack of concentration, diminished coordination, memory loss, slurred speech and more. In addition, using such drugs recreationally may also lead to long term health problems. These may include slower breathing, respiratory distress, symptoms of withdrawal, symptoms of tolerance, decreased blood pressure and more. In addition, barbiturates may bring about irritability, fever and fatal withdrawal.

In a prescription drug overdose, the sufferer may experience a coma, which may eventually lead to death. Brain damage may result, as well as serious nausea and pain. Permanent physical damage may occur as well. Other effects may occur, depending on which prescription drug has been taken and what kind of amount. If you believe you are in the presence of someone who may be overdosing, it is critical that you call Poison Control immediately.

Means of prevention and helping the addicted

Of course, there are always methods of prevention for those wishing to avoid addiction, perhaps because they are an addict recovering from past abuse. In this case, you will want to ask your doctor specific questions about your medication, so that you are better educated about how it works. Also be sure that your doctor is aware of any other medications that you are taking concurrently, so that he or she may be sure that they will not conflict in any way. Only take your medications as directed and be sure to keep them secured in a safe place. Also, be sure to correctly dispose of any unused medications as well.

Many doctors will often prescribe non-habit forming medications in response to patients who have developed dependence. Oftentimes, this may be combined with cognitive behavioral therapy for maximum effectiveness in recovery. A detox process that is derived of natural vitamins and supplements is also another option to help rid the body of prescription drugs and restore mental clarity.

If you know someone who is battling a prescription drug addiction, there are a number of ways to assist in getting them help. You will want to speak with a medical professional, such as a doctor, nurse or school counselor. If the person is going through withdrawal, you must be sure that they receive medical attention. Withdrawing from such drugs without being monitored may also lead to a fatal overdose. Prevention methods for relapse are also discussed, as well as how to best recover if a relapse does indeed occur.

Treatment and removing stigma

One problem associated with substance abuse is that of the stigma that society places upon those facing such difficulties. For instance, an offer of employment may often be withdrawn if the employer realizes that the potential employee has had a previous history of prescription drug abuse, even if they are now clean. This is also often the case for offers of housing for those in recovery. However, the problem is having stable living conditions and work opportunities are two important aspects that help such people continue to move forward, as well as maintain sobriety.

The recovering prescription substance abuser may also fear entering a pharmacy to pick up medications to assist their recovery. This is because they believe they will be stigmatized as merely picking up more medications that they will be using recreationally as before. This stigma also extends to medical professionals, who may be resistant to prescribe medication to such individuals when they are in actual need of them, because of past problems they have had with prescription abuse.

The most powerful and obvious way to reduce the social stigma attached to substance abuse is for those who need help to get it, therefore showing others recovery is possible. Treatment providers can aid in prescription drug abuse, offering detox, therapy sessions, cognitive retraining and continuing care such as transportation to Narcotics Anonymous.

Those who have battled prescription drug abuse should be able to share their stories and how they overcame their addiction. This will in turn encourage others to step forward and do the same, helping to remove the stigma, prevent future drug abuse and hopefully prevent fatal prescription drug overdoses. Former prescription drug abusers and those who support them may also choose to turn to policymakers and advocacy groups to help them get the word out and do away with the myths of this epidemic.

Dope Sick With Mouths To Feed: The Struggles of American Women in Active Addiction

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.

A quick overview of the rise in drug overdoses in the state of Ohio

————-

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…”

herointreatment08

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>

<em>Thank you,
Drew Gibson</em>

~~~~~~~~~~~

Addiction: Treat the Parent – Treat the Child

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This past week has seen a report from the London School of Economics that has looked at the impact of the war on drugs. What they found is that it has been a miserable failure around the world. From an economic perspective, the war has cost billions but the supply of drugs is cheaper and better quality while rates of usage has not been impacted. The time for a conversation about drugs as a health problem seems to be at hand.

Addiction is one of the most common problems for families that come to the attention of child protection. The Substance Abuse and Mental Health Service Administration in the United States estimates that about one out of every ten children live with a parent who has a substance abuse or substance dependence problem. Michelle Kelley and her colleagues at Old Dominion University point out that fact in some new research.

We also know that children exposed to greater amounts of chronic substance abuse tend to have more emotional, behavioral, social, academic problems than their non-exposed peers. They also have a 2-4 times greater risk of developing their own substance abuse problems.

This is a major health concern. Yet, it is often not treated as such. The National Academies have just released a report that shows that the United States incarcerates more people for drug offences than any other country in the world. In general, from the 1920’s to the early 1970’s saw stable rates of incarceration. But as the war on drugs began, the rates quadrupled. Drugs became a criminal as opposed to a health issue.

Sadly, many drug users resort to fairly low levels of crime in order to sustain the drug habit. But, they also get caught and end up jailed. Too many of those people are parents. Yes, it is true that drug use exposure for children is negative but so too is the loss of a parent to the prison system.

Knowing the negative impacts on children, when we are able to focus on rehabilitation services for the parents, we can too often ignore the needs of the children. They too need therapy. The research by Kelly and colleagues identified that most parents will consent to their children also getting treatment.

There is a lot of good research that shows addiction is really a family disease. Thus, we should treat the family. A parent entering rehabilitation seems like the perfect opportunity for us to pay attention to the needs of the other family members, including the children.

It might also be remembered that, if the parent is sent to jail, there may be less focus on the health issues, particularly for the children. The research published this last week should allow us to think again. It should also cause child protection to ensure that case planning with these families should have specific treatment objectives for the children.

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