UAlbany Receives $1M for Program to Prevent HIV and Substance Abuse

The University at Albany has been awarded nearly $1 million for the creation of a five-year, comprehensive program aimed at preventing HIV infections and substance use disorders among students.

The Achieving College Completion through Engaged Support Services program (Project ACCESS) will provide timely and responsive HIV prevention services to students, particularly those from the LGBTQ+ community and racial and ethnic backgrounds that are historically at higher risk for HIV and substance use disorders associated with health disparities.

Young adults under age 24 comprise more than one-fifth of all new HIV diagnoses in the United States, according to Dolores Cimini, director of the Center for Behavioral Health Promotion and Applied Research. Compounding the issue is that young people between the ages of 16 and 25 years of age are also at risk for substance use-related negative effects, making it important for researchers and service providers to address both concerns using a comprehensive prevention approach.

As part of Project ACCESS, trained students who have experienced substance abuse disorders or HIV firsthand will assist their fellow students by linking them to specialized behavioral health services and vital medical services. In addition, Project ACCESS will hire a “prevention navigator” to support BIPOC and LGBTQ+ students in accessing these behavioral and medical services in a timely and responsive manner, thus supporting students in accessing broader higher education opportunities, completing college and continuing progress towards advanced study and entry into the workforce.

“This funding comes at a very timely juncture at UAlbany,” said Cimini, who is leading the project with associate professor Jessica L. Martin of the School of Education. “Our BIPOC and LGBTQ+ students are voicing the need for specialized services across areas that align with this grant, and it is also responsive to the current focus on health disparities by the University at Albany and New York State,” Cimini continued.

Martin, who also serves as counseling psychology division director, added, “We believe that this is the first grant under this funding mechanism that is housed within a higher education institution, uniquely positioning UAlbany to advance innovation aimed to support both health and well-being and diversity, equity, and inclusion.”

Albany Medical Center, the Alliance for Positive Health and the Damien Center will partner on the project, which began on August 31, 2021 and is expected to continue through 2026. Those interested in the learning more about Project ACCESS should contact Dolores Cimini at dcimini@albany.edu.

The new program joins the growing list of comprehensive and innovative initiatives at UAlbany. In September, the University officially became a Health Promoting University, a designation bestowed on only nine universities in the country.

The Need for Improvement in Substance Abuse Treatments

 

For decades now, America has been in the midst of a substance abuse epidemic. In fact, recent Pew research indicates nearly half of U.S. adults have a close friend or family member who has been addicted to drugs at one point in their life. The experience is so universal the dataset cuts across sex, race, age, education level, and even partisan lines. In short, it’s safe to assume addiction is as American as apple pie.

Every day, more than 115 people in the United States die after overdosing on opioids. Alcohol abuse has increased by 50% since the start of the century to the point where today, one in eight Americans abuses alcohol. According to a 2017 survey, methamphetamine has become the world’s most dangerous drug, as 4.8% of users required hospitalization in order to avoid overdose.

Though substance abuse has become a worldwide phenomenon, affecting millions of people, treatment for addiction is not nearly as universal. Public health officials have drawn attention to the problem in more recent years, yet only 10.9% of individuals who needed treatment in a specialized facility for a substance use or a dependency concern received it in the year 2013.

It’s an epidemic policymaker’s, mental health experts, law enforcement, and others are acutely aware of. But solving the problem on a wide scale has so far proven to be fruitless. Individual states have taken specific measures, like opening up safe injection sites, which allow those who struggle with addiction to use in a safe space around medical experts. It’s a solution which definitely won’t solve the addiction crisis, but it does work as a harm-prevention space. Other states have taken to suing the pharmaceutical companies themselves, using similar tactics which were used against Big Tobacco nearly 20 years ago.

While these are no doubt necessary and useful tactics which will help presently and in the future (if successful), there are other avenues that largely have yet to be explored. Perhaps the most simple form of aid is given through the Primary Care Provider (PCP).

While all doctors and patients are supposed to share a therapeutic alliance, based on mutual trust and respect, PCPs are in a unique position in the healthcare field. Often, these doctors have known their patients for a number of years, have a big picture view of their overall health over a period of several years, and are able to check in on a patient’s progress with every visit.  

Evidence compiled by a University of Michigan medical team suggests primary care physicians and their teams of nurses, medical assistants, social workers, and pharmacists can — beyond providing basic services every patient needs — also provide effective care for addiction. Including each of these moving parts not only ensures the patient is receiving quality care but also helps to ensure the patient does not fall through the cracks at any point during their recovery.

They achieve this primarily through the anti-opioid medication buprenorphine and counseling — a combination known as medication-assisted treatment (MAT). The researchers have recently published a peer-reviewed paper on the subject, where they pose this is an effective method of treatment. They do not argue, however, that it is an easy process.

“There is a major need to do this,” says Pooja Lagisetty, M.D., M.Sc., the study’s lead author and a University of Michigan primary care doctor who provides MAT to her own patients at the VA Ann Arbor Healthcare System. “It’s hard to convince primary care physicians to do this work when they’re already busy and they don’t have additional addiction-related training or experience. But if we can learn from others and find a way to offer physicians logistical support, then maybe it’s possible.”

This support must come from other parts of the medical team. As the patient goes through the process, non-physician team members aid with dosing, monitoring the patient, and check-ins by phone and in person. If done successfully, Lagisetty argues this method can achieve similar results to specialized treatment facilities, and it might reach more people.

“Patients might be more willing to seek help in a primary care setting because of the lack of stigma and the ability to address their other health concerns,” she said. It’s also likely to be less devastating to patients financially. All in all, this kind of treatment in Primary Care facilities makes sense.

While it’s unlikely primary care physicians pursued medicine with a desire to focus on addiction treatment, it’s a reality many are going to have to embrace and develop a protocol for as the problem persists or worsens.

There are, of course, a number of other solutions which ought to be tested as America’s substance abuse problems continue to grow. Addressing the issue at its core will require effort from governing bodies, lawmakers, public health experts, mental health experts, and of course, the healthcare system. Until this happens, a collaboration between healthcare providers might be our best bet.

ReMoved: A Poignant Short Film on Foster Care

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“It’s natural for you to think about how fostering will affect your life.  About how hard it will be or how it will impact your family. But try to imagine what it’s like for that kid in foster care. And how much harder it is for them. Because you’re an adult after all, but they’re just kids,” explained Chris Poynter, a foster parent trainer and child advocate in Southern California.

After showing a short slideshow of sentences that kids in foster care wish adults knew about what it’s like to be in care, prospective foster parents Nathanael and Christina Matanick were so inspired that they decided to make their next short film about the experience of foster care from a child’s point of view.

Their film proceeded to win at the speed film festival they created it for (the 168 Film Festival), and then went on to win numerous awards at various other film festivals worldwide (Enfoque International Film Festival, St. Tropez International Film Festival, Sikeston Film Festival). Most notably and of most affirmation for the Matanicks, the film spread virally online in March 2014 and quickly became embraced by social workers, foster parents, child welfare agencies, court appointed special advocates, and current foster youth and alum.

The film follows the emotional journey of Zoe, a 9-year-old girl who is taken from her abusive birth home and placed in the tumultuous foster care system. Separated from her brother, Zoe bounces from foster home to foster home, experiencing additional trauma within the system, and finally lands in a good foster home but experiences flashbacks and behavioral issues stemming from triggers in her environment. Through it all, she lugs her black trash bag from place to place, which contains the few items that belong to her.

The uniqueness of the 13-minute film lies in its perspective from the child’s point of view. The entire film is driven by Zoe’s voice-over, articulating the thoughts and emotions of her experience.

Says Janet Magee, founder of Blue Sunday, an initiative to raise awareness and prevent child abuse, “[ReMoved is] the most authentic video I’ve ever seen! They have it down to the trash bag she used as a suitcase – my personal pet peeve.  It’s the wake up call of the century for a nation where child abuse is epidemic.  It’s a 12 minute investment thank can change your life and hopefully a child’s.”

Child abuse is rampant in the United States—and exists everywhere worldwide as well. Current figures have the number of children in the United States foster care system as around 400,000. Rather than escaping from neglect and abuse they encountered in their birth homes, many of these children entering foster care experience additional trauma through repeated moves, unloving caregivers, separation from siblings, et cetera.

Says Nathanael Matanick, creator and director of ReMoved, “Film has a way of bypassing the intellectual arguments and getting straight to the emotion of an issue.” ReMoved does just that, usually bringing viewers to tears as they resonate and understand Zoe’s story and determine in their hearts to do what they can to make a difference for the children in their own communities.  ReMoved and its sequel, Remember My Story, can be licensed through the film’s webpage: www.removedfilm.com

Assemblymember Tony Thurmond: From Social Worker to Lawmaker

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California Assemblymember Tony Thurmond (D)

You only need to take a look at the committees California Assemblymember Tony Thurmond (D) requested to be on in order to get a sense of his top priorities.  When he took office in January, he sought to contribute on Education, Health, Human Services, and the Select Committee on Homelessness.

“That’s exactly where I would expect him to be, knowing him,” said Carroll Schroeder, executive director of the California Alliance of Child and Family Services.

After a couple of decades working with nonprofits serving children and youth, as well as stints on the West Contra Costa County school board and the Richmond City Council, Thurmond says that in his new role as Assemblymember for District 15, he is “advocating for those who have the greatest needs.”

“I’m here for the least of us,” he told an audience at a Planned Parenthood Affiliates of California meeting on a recent Wednesday in Sacramento.

In his first months in office, Thurmond has proposed legislation to establish school-based mental health services and to address chronic absenteeism of children in grades K-3.

He is a bright star for children’s advocates and the service providers he worked alongside, most recently as senior director of community and government relations at Lincoln Child Center in Oakland.

Thurmond has emerged as a leader for the youth services field in what some youth advocates in California see as an era of austerity and erosion of the social safety net under Governors Schwarzenegger and Brown.

“There’s been a disinvestment in children’s services,” says Patrick Gardner, executive director of the Young Minds Advocacy Project. “During the recession, people assumed children were doing all right and there were other areas that needed more attention, and I think the result has been that children have suffered…We need a champion for children, and I think Tony has both the background and the heart to do it.”

Thurmond, who chairs the Budget Subcommittee on Health and Human Services, said he supports the Continuum of Care Reform Plan (CCR) developed over the past three years by the California Department of Social Services, providers, and advocates.

“The result will be better outcomes for kids,” Thurmond said.

The CCR report presented by CDSS to the legislature in January outlines 19 recommendations for transforming the delivery of child welfare services, including the establishment of a Core Practice Model to create consistency throughout the state.

“I came this close to being in foster care,” he said, holding his finger and thumb nearly together. After his mother died when he was six, he was sent to Philadelphia to live with a cousin he’d never met. “It was kinship care but we didn’t call it that back then.”

After getting his bachelor’s degree in psychology from Temple University, Thurmond got his first job as a social worker in Philadelphia.  “All I ever wanted to do was be a helping professional.”

But that first job seemed to him like putting a “Band-aid” on bigger underlying issues facing the clients he served, such as long-term poverty, substance abuse, and lack of access to education.

“I wanted to learn how to work to change systems,” he said, so he completed dual Masters Degrees in Law and Social Policy and Social Work at Bryn Mawr College.

At a recent briefing in Sacramento held by the California Program on Access to Care (CPAC) at the UC Berkeley School of Public Health, Thurmond expressed his support for the restoration of cuts to MediCal benefits and rates. He described his proposed Assembly Bill 1025, which would establish school-based mental health programs that would largely be funded by MediCal.

AB 1025 would establish 30 pilot programs providing school-based mental health services throughout the state. The legislation calls for mental health support to be offered in schools to students who have experienced trauma or other challenges.

Naming education his highest priority, Thurmond has also proposed AB 1014, a truancy prevention bill to address chronic absenteeism for kids in grades K-3 by funding outreach workers who would do home visits and work with families to address whatever is keeping children from going to school.

“Education is my top issue,” he said. “We want to help those kids get back in school so they learn to read by third grade so they don’t drop out and enter the juvenile justice system.”

“From my perspective based on my experience at Lincoln Child Center, home visiting is one of the most effective ways to get kids back in school.”

Reductions to the state’s safety net are a continuing concern for Thurmond. In his remarks to CPAC, he noted that despite acknowledging recent improvements to the state’s fiscal situation, Governor Brown “has talked as a consistent theme about our need to prepare for the future and to save money.”

“We all know,” said Thurmond, “that we have been for the last decade dealing with the great recession and tough cuts…and tightening our belts.”

He recalled the night in 2008 when he was sworn in as a member of the school board.  Despite his “excitement to help kids,” the first decision he was called upon to make just moments after being sworn in was “a vote to close ten schools because the state budget was so bad.”

“And that has been the climate and the culture,” he added, “in every single sector including our health safety net and our social services safety net. Now is the time to make restorations.”

“Everybody’s telling us what can’t be done, and that’s been the narrative for way too long,” Thurmond said in the Planned Parenthood meeting. “What is the cost we pay if we don’t take this action?”

Noting his choice of committees, not the most sought after by new members, Thurmond said simply, “I came up here to do work.”

Why Aren’t We Talking About Sexual Assault On Campus?

By Leah Greenidge, Rosedad Francois, Valerie Jean-louis, Farah Robles

As children, we embark on various journeys in life from attending our 8th grade dance, making the cheer-leading team or making the varsity sports team in high school. Then, if fortunate enough, its surviving the hectic and often stressful 4 years of college in hopes of obtaining your degree. With this journey comes many obstacles and sadly sexual assault on campus can be one of the harsher obstacles in life someone may experience with many long-term and devastating effects.

Students found guilty of sexual assault on campuses have a high probability of receiving no consequences for their actions. It is usually the victim that has to endure the shame, feelings of embarrassment and anger which may change their outlook on life. Victims are either too scared to report or feel as if they some how caused the events to happen. Most survivors suffer high rates of Posttraumatic Stress Disorder (PTSD), depression, and co-occurring drug/alcohol abuse. Due to under-reporting, it is believed that 1 in every 5 women will be sexually assaulted while in college.

According to an article in Mother Jones,

The NIJ-funded study also examined the circumstances and risk factors surrounding sexual assault on campus, including the role of alcohol and fraternities. Nearly 60 percent of campus sexual-assault victims were under the influence of booze or drugs when they were attacked; one-fourth said their assailant was a frat member. Read Full Article

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To make our campuses safer, change needs to happen with school policies and practices to prevent these assaults from happening. Across all demographics, rapists and sex offenders are too often escape paying for their crimes and are free to assault again. Sexual assault in general is a subject that people keep on “the hush hush”, but we need to start talking about sexual assault on campus in order to create a safe environment for students to excel.

We are students passionate about empowering people, and we’ve started this campaign to give a voice to those who don’t have one #‎outofyourshadow

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Alcohol and Prescription Drug Use in Older Adulthood

Substance abuse, specifically alcohol and prescription drug use, is one of the most rapidly growing healthcare problem for older adults, 60 years of age and older in Canada and the United States. Researchers project a 3-fold increase in substance abuse in adults aged 50 and older by 2020. Consequently, an estimated 5 million older adults will require treatment for substance abuse problems in the near future. Researchers are only beginning to recognize the prevalence of substance abuse among people age 60 years of age and older as alcohol and prescription drug use in older adults was seldom discussed until recently.

Substance use and misuse place older adults at risk for a variety of possible clinical dangers, contributing to increased use of healthcare resources and a need for age-specific interventions with the increased proportion of older adults living in North American society. Presently, the misuse of prescription and over-the-counter medications is recognized as a problem.

Alcoholism-Disease-Or-Not2However, baby boomers are expected to have had more contact with illicit substances (ie. marijuana, hashish, cocaine (including crack), inhalants, hallucinogens, heroin and prescription-type drugs used non-medically) than past and present cohorts of older adults. Illicit drugs may also be increasing in a small percentage of older adults.

The National Survey on Drug Use and Health reported that illicit drug use by adults 55 to 59 has increased from 1.9% in 2002 to 5.0% in 2008, which depicts the potential for growth in illicit drug use in the baby boomer cohort. However, illicit drug use in older adults is typically linked to individuals who are lifelong drug users.

In addition, approximately 15% of individuals 65 years of age and older living in the community are at risk for alcohol abuse or dependence and 50% of individuals living in personal care homes drink moderately or are dependent on alcohol. However, only 90% of individuals who are at risk for alcohol abuse or dependence do not receive alcohol treatment services.

Therefore substance abuse services in the future will need to anticipate and acknowledge problems with the use and misuse of both licit and illicit substances in older adulthood. However, due to insufficient knowledge, limited research data, and limited and rushed healthcare visits and appointments, healthcare providers often overlook substance abuse and misuse among older adults. Therefore, despite the number of older adults experiencing problems related to substance use, the situation remains underestimated, underidentified, underdiagnosed and undertreated.

The reasons for the inability to acknowledge substance use problems in older adults are due to many factors. First, healthcare providers often overlook substance abuse and misuse among older individuals, as their symptoms are often mistaken for depression, dementia and health problems common to old age such as falling, infections or digestive difficulties. Second, older adults may also hide their substance use and are less likely to seek help for their problems with substance use. Third, many family members of older adults with substance use, particularly adult children, are often embarrassed of their family members’ problems which often results in their inability to seek treatment.

As a result, thousands of older adults who need treatment never go, and the number of substance abusers among older adults continue to rise. Healthcare professionals must acknowledge that older adults’ struggles with substance abuse are becoming a prevalent issue and the stigma associated with these issues must be addressed as well.

Healthcare professionals must acknowledge that older adults’ struggles with substance abuse are becoming a prevalent issue and the stigma associated with these issues must be addressed as well. Mental health practitioners should also receive specific training and education to develop sensitivity towards these issues.

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

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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

40-years-of-the-war-on-drugs_51fe10028e876_w1500

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.

New Tennessee Law Will Criminalize Pregnant Women

by Katherine Bisanz and Maggie Rosenblum
of Social Workers for Reproductive Justice

As we speak, the law in Tennessee is turning against women and families. The General Assembly has approved SB 1391, a bill that would turn pregnant women and new mothers into criminals.

SB 1391 takes a law that was intended to protect pregnant women from violence and instead turns them into assailants. The law would permit prosecutors to charge women with assault for losing pregnancies, or giving birth to babies with health problems at birth. The targets of the law are women who are in the most need of support: largely women who struggle with narcotic addiction during pregnancy.

Pregnant_woman2This is all happening under the guise of “finding a solution” for neonatal abstinence syndrome according to the State of Tennessee. They claim that the law is a way to use misdemeanor charges to get women into treatment. Anyone aware of the criminal justice system in our country knows that assault charges can heavily impact the course of a person’s life.

A prison or jail sentence could mean that women will be unable to be present to care for the families they already have or sustain the employment necessary to support a family and get through a treatment program. In a nutshell, Tennessee lawmakers seem to believe that they can “keep babies healthy” by punishing their mothers and don’t seem to grasp how terribly backwards and simply unrealistic this idea is.

It’s clear that no evidence-based information is backing this law being that research around the issue of child health have shown that babies are healthiest when pregnant women are treated with care, and when babies are kept close to their mothers after birth. Even women who struggle with addiction love their babies, and can have healthy pregnancies if they can form supportive relationships with their maternity care providers say Connecticut Affiliate of the American College of Nurse-Midwives.

Groups like National Advocates for Pregnant Women (NAPW) have made clear in past cases that punitive measures are the wrong approach in dealing with the “decades-old” question of how to handle pregnant women who take drugs. As opposed to taking a punitive approach that scares women away from seeking help, the state should treat pregnant drug abusers as addicts with medical problems, NAPW states.

Given their role as gatekeepers and mandated reporters, this law could have serious implications for the roles of social workers in the lives of their substance abusing clients in Tennessee.  Social Workers we are trusted to protect clients self-determination and strive to work with clients to empower and better their lives and this bill could compromise our ability to fulfill this imperative and not to mention obligatory aspect of our work.  Despite Rep. Weaver’s (R-TN) comments to the contrary, it’s hard to believe that child abuse allegations akin to those that have popped up in years past won’t arise in some form and in turn question social workers role as mandatory reporters.

This law will also erode choice as it relates to pregnancy. This law may be used by those who wish to prevent a woman from having an abortion who can now just report their concerns that a pregnant woman is using illegal narcotics in order to have her arrested so she will not be able to access abortion care.

Furthermore, this law may pressure some women into having an abortion they do not want in order to avoid prosecution under SB 1391. One study reported that “two-thirds of the women [surveyed] who reported using Cocaine during their pregnancies … considered having an abortion… (Jeanne Flavin, Our Bodies, And Our Crimes: The Policing of Women’s Reproduction in America 112 NYU Press 2009.)

Additionally, while the bill appears race-neutral at first glance, prosecutors and judges will wield the law against Black women more so than white women, based on a long tradition and culture of deeply embedded racial stereotypes about Black motherhood and drug use. The law would likely lead to Black women being thrown in jail for up to 15 years for aggravated assault should they choose to carry a pregnancy to term while struggling with an addiction to illegal narcotics. Should social workers be mandated to take part in this, they would directly be violating the discrimination clause of the NASW code of ethics, which includes the responsibility to racial justice and gender justice.

The NASW Code of Ethics states that, “Social Workers should act to expand choice and opportunity for all people… (NASW 2008).” If SB 1391 is signed into law it will limit choice and opportunities for all Tennessee families. We strongly urge the National Association of Social Workers and its Tennessee chapter as well as individuals who identify as social workers across the nation to speak out against TN SB 1391.

The Language of Effective Social Work

I find it fascinating that we, as social workers, proclaim we want to help people make better choices and choose healthier behaviors on their own, but then we speak to them as though they don’t have any power. In the past, I have noticed some of my colleagues experience trouble connecting with those we serve due to their language. The language portrayed two completely false ideas as if it was the honest truth such as our clients had no options/say-so in their own lives or we are psychic and know exactly what was going to happen to them at any given moment in the future.

We tell them that they have to do something or need to be somewhere. As Morgan Freeman/Joe Clark proclaimed in the movie Lean on Me, “I don’t have to do nothin’ but stay [insert your race here] and die!” Some of us may still talk to our clients in the exact same way. Whatever we choose to call this pattern of speech  ‘aggressive’, ‘controlling’, even ‘male’, I’ve found that I am much more successful and a more effective practitioner (and a healthier wife, sibling, child, friend, and co-worker) when I lean towards making a few simple changes in the way I talk to others.

Try to Avoid Telling People What They Can and Can’t Do

notlisteningDoes anyone have to go to treatment? No.  Do people need counseling? Not at all.

However, these things could be very helpful, may have some benefit, and could help people achieve their goals in life.Can you see the difference between “You have to go to treatment or you’ll never get better” and “You might want to consider entering treatment. I’ve seen it help a lot of people get their lives back on track.”?Let’s listen to ourselves, our clients, and our peers for the following phrases in bold, and see if we can start using (and encouraging others to use) the words and phrases in italics:

You have to   –   You might like to…, You might want to consider…

She should   –   It might have been more helpful to…, Maybe a better choice would have been…

You can’t   –   You might run into some problems if you…, I haven’t seen people be very successful when they…

I know   –   I get the impression that…, It seems as though…, I can understand if…

He always   –   I often see him…, I’ve noticed that he usually…, I can’t remember a time when he didn’t…

Addicts never   –   People suffering from an addiction often don’t…, Alcoholics generally don’t…

I’ve especially noticed a resistance to more aggressive language from people who have issues with authority figures, due to their past experiences with them. However, when we interact with them with an attitude that expresses the fact that they have all the power, and every right, in the world to get up and walk out our door, they seem to feel less of an urge to actually do that. They don’t have an overly controlling figure to “rebel” against. Think about how it takes two to tango, just like it takes two to argue. Let’s try to steer clear of being that opposing force that they use to push themselves away from us and, in many cases, a healthier lifestyle.

Being someone that is there to help, versus someone who is there to control someone else’s life, can be really helpful in building stronger, more effective helping relationships with the people we assist. As a bonus, speaking in a less controlling manner to our spouses, family members, and co-workers can often have a similar effect. The relationship becomes more open, more relaxed, and people feel more comfortable sharing their problems (and successes) with us.

Steer Clear of the Habit of Prophesizing

I’ve found it helpful to avoid telling people what is going to happen to them. Sharing what I have seen or experienced in the past, or even giving them and idea of my fears for them should they make a certain choice is one thing. However, I’ve seen many a practitioner guarantee (they sometimes even literally use that word) that something catastrophic or fantastic is going to happen to someone if they make a certain choice.

“If you don’t go to treatment, you’ll die.”

“If you try to live independently, you’ll fail. Schizophrenics need assisted living–it’s a fact!”

“If you stay in treatment for 30 days, you’ll live a happy, healthy rest of your life.”

“If you don’t go to the therapy group for help, your wife’s gonna leave you–plain and simple.”

“If you quit using heroin, you’re going to have so much more money!”

“You don’t stand a chance without Narcotics Anonymous.”

“If you start a business, you’ll just shoot all the profits up your arm.”

While I understand that most of us have been in the field long enough to have seen multiple examples of people struggling with addiction after leaving treatment or having a hard time living independently with a mental illness, there are (many) exceptions to those situations. So, if we decide to essentially promise someone that something will happen, when we really have no way of knowing, the second that terrible thing doesn’t happen to them, or it doesn’t happen to someone who our client knows, we become somebody who has no credibility. It’s hard to trust somebody without credibility, so we have just severely injured our relationship with that person. Try using phrases like “I’ve never seen,” “It’s not impossible, however,” and “Feel free to try, but I’ve never heard of” in order to express humility. We can still give the person the caring warning and advice that we want to offer without delivering it like Ms. Cleo.

Here are some tweaks to the above example sentences to make them more realistic:

“I’ve seen lots of people avoid going to treatment and it often leads to them living a really hard, chaotic life, or even dying. I’d hate to see that happen to you.”

“Trying to live independently can be hard for people who don’t have any mental health concerns. I’m worried about you wanting to live on your own, but let’s look at some ways we might be able to make that more feasible, such as hiring an aide to check in on you or getting you on some medications.”

“Though there are no guarantees, I’ve seen people do a lot better in their recovery when they have some form of formal treatment.”

“I know your wife threatened to leave if you didn’t get help, and I can’t predict what she’s going to do, but her and I both are encouraging you to attend a bipolar support group. Is not going really worth the possibility that she might actually divorce you?”

“Stopping your heroin use can really increase the amount of money you have left to save or spend as you please.”

“I’ve seen kicking a habit be a real struggle for some people, but they often seem to do a lot better when they have the support of the people at Narcotics Anonymous.”

“It’s not impossible, however, I have witnessed several incidences in which people suffering from addiction who do actually gain a profit from running a business slip back into using because they have large sums of money that they’re handling on a daily basis.”

Parenting Troubled Teens: Indications of their Cry for Help

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It can sometimes be difficult for parents to determine the difference between normal teenage mood swings and having a troubled teen. Therefore, it is imperative to learn which signs to look for to help you figure out if your teenager needs you to intervene or simply give them some space. Fortunately, most troubled teens will give several indicators if they need help due to emotional or even legal difficulties.

1. Emotional Issues

Every teenager will battle with the occasional emotional instability that accompanies hormonal changes and dealing with peer pressure. However, it is estimated that at least 4,600 teenagers commit suicide in the U.S. on an annual basis, and every parent needs to be aware that issues such as sleeping all of the time and changing hygiene habits can be indicators that something is seriously wrong.

Sadly, you cannot rely on your teen to openly discuss this problem with you, so you need to carefully monitor their behavior so that you can take steps to assist them if necessary. Keep in mind that they might be resistant to the idea of discussing their problems, but getting them to open up to someone they trust or a trained counselor can help improve their outlook on life.

2. Legal Issues 

There are several different things that can cause a teenager to get into legal trouble, including drug usage, shoplifting and drinking and driving. Therefore, you need to be involved enough to recognize the symptoms of all of these risky behaviors. For example, someone who has been abusing drugs or alcohol is likely to exhibit mood changes, dropping grades and a tendency to be more secretive than usual. Additionally, if your teen starts wearing clothing that you have never seen before, this could mean that they have started shoplifting.

Unfortunately, any illegal activity could easily cause your teenager to get into legal trouble. If this happens, you need to provide them with emotional and legal support, and it is critical to hire an experienced lawyer. As stated by Kevin W DeVore, a Minnesota criminal defense attorney experienced in juvenile law, “Achieving a favorable outcome and minimizing or avoiding consequences after you’ve been accused of a crime is possible, but you should have a knowledgeable and caring advocate protecting your rights and fighting for you.” Your attorney should have a firm understanding of how to represent your teen’s case so they will have a much better chance of getting an acquittal or the minimum possible penalties.

3. Health Issues 

Some troubled teens are simply struggling with an undiagnosed health issue that is impacting their ability to live a normal life. ADHD is a common problem that can prevent sufferers from properly focusing on their schoolwork, and it could also cause them to lash out in frustration. Due to this, if your teenager seems to be having a difficult time staying focused and completing tasks, you should definitely consider taking them to a doctor for a checkup.

As you can see, there are many issues that can impact your teen, and it is highly likely that they will try to hide these problems from you. Fortunately, you can still take action to help them as long as you pay close attention to all of the potential indicators of an issue such as declining grades, hygiene issues and secretive behavior. 

Dangers Of Alcohol Use In College

Many young people in college give themselves to partying and drinking alcohol, and it is very common for most college students to drink heavily on weekends. It has become part of the college culture, but what are the dangers of partying this way? What if you are one who has decided that you want to stay away from alcohol altogether? How do you do it?

The Dangers

shotsSome of the dangers of drinking heavily and partying while in college is the potential for your grades to slump. If you are focusing all your energy on partying and drinking on the weekends then are you spending adequate time studying and doing homework? Also, many students party on Sunday nights despite the fact that they have to be at school on Monday. Showing up to class with a hangover is not fun nor is it helpful.

Since there is so much drinking going on in colleges, due to new found freedom and the ample resource, there is also a lot of pregnancies that happen as well as the transmission of STD’s. When you are under the influence of alcohol your inhibitions are lowered and you do things that you wouldn’t normally do. Many college students practice unsafe sex simply because they are under the influence of alcohol and they don’t think straight enough to use protection or not have sex altogether. Students and people in general become careless when intoxication happens.

Learn more stats about college drinking here at www.niaaa.nih.gov

How to Stay Away

If you are one of the rare ones who would like to stay away from alcohol altogether while at college, then you will have a battle ahead of you to fight. Though it is not the easiest to stay away from alcohol while in college, it is possible.

First, you should let your friends know where you stand. A true friend won’t try and tempt you into doing something you don’t want to do. Instead of going to bars or parties where you know there will be drinking, go to coffee shops or places where there is “dry” entertainment. Check out theatre productions, museums, or movies. Get creative. There are a ton of other options

Find people who share the same desire as you do to stay sober and away from alcohol. Together you can have parties and things together while still staying in your right mind. You can have fun apart from using a substance.

There is no doubt that alcohol can be used safely and responsibly, but it is also true that a lot of alcohol abuse happens on college campuses. There are a lot of dangers that come with binge drinking in college so be smart and drink responsibly if you decide that you do want to drink. If you are not interested in drinking then you have to be proactive in finding friends who share the same desire and you have to figure out what hobbies you will take part in. Just because you don’t drink alcohol in college doesn’t mean that your social life has to be over. It is what you make of it.

Growing Careers in Social Work

Social work is a field offering a diverse array of challenges and exciting opportunities to improve the lives of individuals in all sectors of society. The jobs in social work and the human services field are considered to be some of the fastest growing career opportunities, with the Bureau of Labor Statistics predicting growth rates exceeding 23 percent in many areas. Some of the fastest growing sectors of the human services field are discussed below.

Case Management

Growing Careers ImageHuman services case management opportunities continue to top the list of growing fields in the social work arena. Professionals taking on these tasks assess individuals to determine their needs and make recommendations of community resources that benefit them. These professionals maintain a relationship with their clients for as long as services are needed, and they constantly reassess to ensure resources remain appropriate and necessary. Case managers work in long term care facilities, with geriatric clients in their homes, assisting children and families in the court system, in hospital settings and with clients in community corrections. The Bureau of Labor Statistics anticipates a 27 percent growth rate in this field between 2010 and 2020, making it one of the fastest growing professions in the United States.

Substance Abuse Counselor

Another growing sector of the human services field is substance abuse and behavioral health. Counselors working in this capacity advise people who are facing addictions. They might work in a hospital setting, outpatient care facility, within the prison system or in private practice. Substance abuse counselors can expect to see a 27 percent growth rate in their careers between 2010 and 2020 according to the Bureau of Labor Statistics. Continued growth in the field of substance abuse and behavioral health counselors is largely due to the transition that managed care insurance companies are making, moving clients away from seeing more expensive psychiatrists and psychologists and toward sessions with less expensive counselors. In addition, as jails seek solutions to overpopulation problems, the criminal justice system continues to sentence drug offenders to counseling rather than jail time.

Health Education

Health education is a third field of human services that is experiencing tremendous growth. The demand for healthy living information continues to escalate, and this is leading to an increased need for professional health educators. These individuals often work in private practice or hospital settings, and they teach individuals about behaviors that promote physical and mental wellness. Corporations are also employing firms that offer wellness services in an effort to reduce employee illnesses and cut down on increasing healthcare costs. According to the Bureau of Labor Statistics, a 37 percent growth rate is expected in this field between 2010 and 2020.

Social Services Assistant

Individuals seeking a more entry level human services occupation might be interested in a social services assistant position. Professionals working in this capacity provide support to social workers and their clients. They assist in locating resources, transporting clients, completing social work documentation and generally providing support to the organization in which they serve. Social service assistants work in a variety of settings, including hospitals, government agencies, nursing homes and non-profit agencies. This is an excellent position for the new graduate, as it provides exposure to the field of social work and additional on the job education. The Bureau of Labor Statistics predicts a 28 percent growth rate in this profession between 2010 and 2020, a higher than average rate when all occupations are considered.

Marriage & Family Therapist

Finally, individuals with higher degrees can consider a career as a marriage and family therapist. This profession requires at least a Master’s Degree, and licensing is required in all fifty states. Therapists assist individuals, couples and families during times of crises, and they empower their clients by recognizing strengths and teaching coping techniques. Many therapists are employed in private practice, but mental health facilities and hospitals also offer positions for these professionals. The growth rate for this field is anticipated to be 37 percent between 2010 and 2020, with continued increases expected as managed care programs show a preference for paying reimbursement to therapists versus more expensive psychologists or psychiatrists.

The opportunities a social work degree presents will continue to see extensive growth well into the 21st century. Graduates should consider the challenges that each area of social work presents, and apply their talents in the area that best represents their individual strengths. In addition, considering positions such as the ones described above helps ensure continued upward career mobility and job security for many years to come.

Deciding Whether or Not To Take Medication for Mental illness

To Use Medication or NotDeciding whether or not to take medication for our mental illness has got to be the most difficult decision one has to make. Personally, I decided not to take medication for my anxiety. Instead I wanted to take the natural route by exercising, eating healthy, taking vitamins, and therapy. Whether you decide to take the medication route or the natural route having good insight and weighing your options can be really benefit you in your decision-making.

Medication is the primary treatment for many mental illnesses. Despite the negative portrayals given by the media, there can be many benefits to medicating your mental illness. Medication can really help people function in their day-to-day lives by reducing some of the paralyzing symptoms of mental illness. It is important to note that the reduction of symptoms does not indicate a cure. Many have really positive results from taking medications when taken the right way.

On the other hand, taking the medication route can also have its downsides. One of the main turnoffs to taking medication for me was the fear of certain side effects. Some common side effects for anxiety meds include drowsiness, dizziness, blurred vision, heart racing, rashes and more. They can also eliminate one symptom but with these side effects other symptoms may persist. Another thing to consider when deciding on medication is that it will involve a tough trial and error process. This process can include going through several different meds until you find the right combination with the right dosage. The most serious consequence that taking meds can come with is the risk of addiction.

All in all, by recognizing your mental illness, weighing your treatment options, and talking to your doctor, you are bound to find the path that is right for you. Many people, who go into treatments blindly, do not end up finding the right solution. As long as you do your research and go into the situation with an open mind, your mental health will thank you.

Listen to Episode 3 of my podcast Anxious Ramblings:

This episode will begin with some updates from my personal life. I will discuss my thoughts on medication as a treatment for anxiety. Anxious Ramblings will conclude with me reading some responses to the question: What role does the medication play in your mental health? Is it more beneficial or detrimental?

Listen to Episode 4 of Anxious Ramblings

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Is Compulsive Behavior the Same as Addiction?

There are tons of compulsive behaviors that people now refer to has addictions such as sex, gambling, shopping, internet, video games, eating, TV, cell-phones, pornography to name a few.  However, calling these behaviors addictions is a relatively new phenomenon.  Someone referring to themselves as a “sex addict” was virtually unheard of before the 1970’s.

Are these behavioral issues really addictions?

Is Compulsive Behavior the Same as Addiction The answer depends on how one defines an addiction. When speaking of addiction, substance abuse and dependence usually come to mind first. Determining if someone has a substance abuse problem typically depends on the presence of 3 criteria which consist of tolerance,withdrawal and continued use despite negative consequences.

Brain imaging studies have found that substance abusers respond differently to drug-related stimuli when compared to those without substance abuse issues. These studies have shown that addiction to drugs and alcohol is rooted in permanent changes to the brain.

However, when it comes to compulsive behaviors the answer is not so clear cut. Recently, a brain study of so-called “sex addicts” failed to show similar findings to those seen in substance abuse studies.  This calls into question whether compulsive behaviors related to sex, shopping, and gambling should be labeled as addictions. Articles have already piggy-backed off the study and poked fun at the idea that Tiger Woods and similar celebrities don’t have a “real excuse” for their identifying as sex-addicts any more.

We currently know that compulsive behaviors probably don’t develop in the brain the same way as drug addiction. However, we must exercise caution. Despite, this particular study showing no neurological link, we should not exclude the possibility that an undiscovered connection. It also doesn’t mean we should undermine the experiences of people dealing with these behavioral issues. There is no doubt that people with behavioral compulsions can suffer from extreme loss of functioning.

To assert the individuals have full control over their behavior because there is no discovered neurological link may be detrimental in accessing treatment. When a gambler spends more and more money (tolerance), has anxiety build up when not gambling (withdrawal) and loses their home (negative consequence), there is a clear lack of control and compromised choosing of behavior.  When looking at tolerance, withdrawal and negative consequences, these behavioral compulsions fit the definition of an addiction.

If people with compulsions for sex, shopping or gambling have similar loss of functioning to drug addicts, then why do we need to put them in a different category? Since it is unclear if these behaviors have the same biological basis as drug addiction, we don’t know that substance abuse interventions would be the best treatment for these problems.

If we assume that substance abuse and compulsive behaviors are the same, we risk missing biological components that may be specific to each disorder. As long as research continues in this area, a pathway for compulsive behavior problems could be discovered and provide direction about medications, therapy and specific brain regions involved.

6 Risk Factors for Suicide

Recently, three people have died by suicide in downtown Greensboro, North Carolina in less than a year by jumping off the top of a parking garage.  If three people have died just in one small area within Greensboro, how many die annually in North Carolina? The answer is a figure that is historically higher than the rest of the nation which averages of over a thousand suicides per year.

suicide-preventionNews-Record.com reported on the latest suicide committed by a 35 year old local woman on June 18, 2013:

This is the third suicide from an eight-story parking garage in downtown in less than a year. On Aug. 4 one man jumped from the Bellemeade Street parking deck. A second man jumped from the same parking deck on Sept. 1. That parking deck is about a block away from the Marriott parking deck. Read More

When faced with suicides that make the local news or impact a loved one, we often ask ourselves how this could have been prevented.

Here are six factors that can help identify who is at risk for suicide.

1. A previous attempt:  It is estimated that for every completed suicide, there are anywhere from 11 to 25 attempts.  Hospitals see at least eight times more patients for self-inflicted injuries than the average number of suicides per year.  In the case of suicide, past behavior can be a predictor for future behavior.

2. Family:  Those with a family history of suicide are at higher risk.  Not only are genetic factors inherited from family, but maladaptive patterns of coping can be learned.  Some people may feel they are destined for suicide if those in generations past died from suicide.  Those who have experienced physical, sexual or emotional abuse in their families are also at risk.

3. Depression: Not all people who die by suicide are experiencing acute mental illness.  However, having a history of depression or other mental illness can make coping with everyday life difficult and is a risk factor.  Some studies cite that up to 90 percent of those who commit suicide have been diagnosed with depression or bipolar disorder.

  1. Substance Abuse: A 2009 study showed that 25 to 40 percent of suicide victims had alcohol in their bodies at the time of death. About 69 percent of suicide deaths occur by prescription drug overdose. The use of drugs and alcohol can cloud judgment, enhance impulsivity and
  2. Sexuality and gender issues: Individuals who are lesbian, gay, bisexual, or transgender can be outcasts in society and face stigma and discrimination on a daily basis.  This, along with negative family reactions, conflict with spirituality/religious affiliation, higher rates of violence and substance abuse make this population vulnerable. Suicide among LGBT youth is particularly high, with up to 30-40 percent attempting suicide.

6. Access to means: An immediate risk factor for suicide is one’s access to the means used to commit suicide.  Are there guns and knives in the home? Is medication being stockpiled? How likely is it that someone could access these things?

These are just a few risk factors.  Others include being bullied, PTSD/Military involvement, being male, incarceration, living in a rural community, physical illness, lack of treatment, hopelessness, and grief or loss.  As a graduate school professor once told me, “Suicide happens when the world throws a situation at you that you don’t have the resources to cope with besides death.” Any stressful situation may lead to someone considering suicide.

How to help:

Be a good listener. Be non-judgmental. Offer hope that things can get better with help. Pay attention to mood and the risk factors listed above.

Don’t be afraid to ask “Are you thinking about suicide?” This shows you are not afraid of the situation and clears up any gray areas.

Offer to find local resources and help. Find a licensed mental health professional who can help.

Call 911 if situation is imminently life-threatening.

More about how to help a suicidal person here:

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