October 30

The Problem with Abstinence

This post originally appeared on HealingRefuge.org

My last post considered the benefits and controversy over “harm reduction.” In short, harm reduction seeks to minimize the damage done to the addict and those around them resulting from their drug use, but doesn’t seek to actually stop drug use. This has led to criticism that harm reduction actually promotes drug use by making it easier and safer for addicts to use. In other words, opponents believe that drug addicts should be motivated by consequences to quit. But that rarely happens. Addiction has such a powerful hold on the addict that he or she will continue to use regardless of any potential consequences. So “harm reduction” simply brings a level of human decency that is already found in most affluent nations. Portugal’s approach, emphasizing public health over public order, is a great example.

But the question remains: Why isn’t abstinence the goal of our nation’s government? The answer is twofold.

First, our government doesn’t know how to foster abstinence. National policy is confused. It treats drug addiction as either a choice or a medical disease. The former approach incarcerates hundreds of thousands of nonviolent drug offenders under the theory that locking them up will cause them to give up using. (It doesn’t.) The latter is equally problematic: If drug addiction is a medical disease, then there should be a medical solution. But there isn’t. The best answer medicine has is Medication Assisted Treatment (MAT), which simply substitutes a long-lasting opiate for a short-acting one. And the replacement is even harder to get off! MAT is not so much a treatment as a substitute–another method of harm reduction.

Abstinence requires more than replacement with another drug. The needs of the addict that are met with drugs have to be met in some other way. That doesn’t sound so hard, right?

Which brings us to the second poart of the problem: The government can’t promote abstinence because it is prevented by law from supporting what works. Here’s why:

In my book The Soul of an Addict, I argue that addiction fills certain specific human needs for the addict. These include identity, life purpose, life structure, community, and moral code. And these needs are exactly what religion provides in its sociological sense. In other words, drug addicts are caught in the grip of a false and destructiuve religion. In order to changem they need to get these needs met in a healthy way– through a real religion. And our government is barred from getting involved in religion. It’s called separation of church and state.

Now religion in the sense needed for an addict to recover is very broad. The Twelve Step progams, which claim not to be religious, provide these needs. So can the various mainstream religions, from Christianity to Buddhism, although most churches, temples, and mosques don’t know how to apply their religion in a way that addicts need.

However, the ban on government supporting religion is also very broad, and includes Twelve Step programs. So the very thing that could promote abstinence from drugs cannot be included in government policy. So we cannot look to our government for help. They can’t provide it.

This leads to a strange situation, but one with which addicts are hardly unfamiliar: addiction exists outside the purview of government policy. The government will continue to lock up or medicate the addict. It has no other recourse. Or more accurately, there is another recourse but our government is prevented by law from exercising it.

Sadly, this means that the effort to help addicts find an abstinent recovery falls outside govertnment policy. It is up to nongovernmental agencies–and individuals–to promote true recovery. Those most capable of doing so are addicts who have already found recovery. Which, ironically enough, makes the recovering addict more powerful than our government in addressing the scourge of addiction sweeping our nation.

June 18

Who We Think We Are (And Why It Matters)

How we think about ourselves determines how we behave in the world. And how we think about ourselves stems from who we believe we are– our self-identity. We identify ourselves in many ways. These include where we live, our ethnic background, our hobbies, our religion, our political party, and what sports teams we root for. But most often, when you ask someone who they are, they will respond by telling you what they do. We identify ourselves most closely with our actions. “I’m an accountant.” “I’m a lawyer.” “I’m a chef.” “I’m a full-time mother (or father).” What we do with most of our time tends to be how we see ourselves.

It shouldn’t be a surprise, then, that someone who struggles with addiction identifies themselves as an addict. That’s how society identifies us. Our behavior is illegal and unacceptable, so we’re forced to hide it. This is true even for alcoholics– even though alcohol is legal, we have to hide how much and how often we drink. And when we get arrested, the judge doesn’t look at us as a parent or employee, he sees an addict or alcoholic who violated the law.

And our lives support this self-identity. We may have a job, but the purpose of that job is to provide money to get drugs or alcohol. We wake up thinking about our drug. We plan for how we’re going to get it and when. Our biggest concern is that we might run out. Our addiction is the central feature of our lives.

Of course, we won’t admit that to anyone else. Often we won’t admit it to ourselves, either. We tell ourselves that we’re good employees, good parents, and good children. But when faced with a choice between our job or our family and our addiction, we most often choose our addiction. I recall several times when I didn’t show up for family Christmas because I was “sick.” I wasn’t sick at all– I was too loaded to drive. My wife says that she insisted she loved her son above all else, but she would often put him in the car after she’d been drinking. The truth is, our addiction came before our family.

The only people who can understand the hold addiction has over us are other addicts. This creates a social bond between those who are addicted, and separates us from those who are not. We may even believe that people who don’t use drugs are the abnormal ones, because everyone in our social circle uses like we do. (If they don’t, we don’t hang out with them, so they don’t stay in our social circle long!)

But of course we lie to our using buddies, too. We claim we don’t have any drugs even when we do, hoping that they’ll take pity on us and share what they have. We steal each other’s drugs and drink each other’s booze–and then deny we did it. We lie about where the money came from and how much dope we have. Because if we tell the truth, we risk getting taken advantage of by someone who is just as desperate as we are to feed their addiction. Despite our social circle, we usually feel pretty isolated because there aren’t many people we can trust. We certainly can’t trust those who don’t understand addiction. And we can’t trust our fellow addicts, either.

So this is most often how we see ourselves: as addicts, alone in the world, struggling to survive, and no one understands us. The world is unjust. We are outcasts, unaccepted and unwanted by society. I remember thinking not that what I did to feed my addiction was illegal, but that I was illegal, because I didn’t believe I had a choice about drinking and using. (And if they really didn’t want me to drink and drive, the city buses would run at closing time!) My identity had become entirely focused on my drug and alcohol use.

When we try to stop drinking and using, this identity needs to change. But change doesn’t come easily. In the beginning, we see ourselves as addicts trying not to use. We still identify as addicts. We’re trying not to use, but we know that the definition of an addict is someone who uses. So we don’t really believe we can stop. We tell ourselves (and anyone else who asks) that we can. But deep down, we don’t believe it because we are addicts and that’s what addicts do. It doesn’t help if we’ve been through the justice system a few times and had cops, judges, and probation officers reinforce that belief, or if our families have given up on us in frustration.

How do we change who we believe we are? It’s a paradox. We change our identity by living differently, and by associating with other people who have changed their identity. But that means we have to live differently and associate with different people, which we don’t believe we can do.

This is where the Twelve Step programs really excel. They take a two-pronged approach. In the short term, you show up at meetings and don’t drink or use no matter what. Anyone can do that for one day, right? So you do it today. And tomorrow you do it again. In the beginning, this simply takes stubbornness and the support of encouraging people.

But there’s only so long we can do this if nothing changes. Eventually, something in our lives becomes overwhelming, and we only have one tool for dealing with it. We may last a week or a year. But eventually, we go back to drinking and using because it’s the only solution we have.

So while we’re stubbornly not using today, we begin doing the program of recovery. We learn tools for dealing with conflict and uncomfortable emotions. We learn new habits like connecting with other people in recovery, talking on the phone between meetings, and taking small steps toward risking trust in them. As we do this, we discover that not using becomes easier each day. We gain more tools in our toolbox. We find other ways to cope with the challenges of life.

As we’re doing this, we also begin to realize that we’re not just addicts trying not to use today. We have become addicts in recovery. And addicts in recovery don’t use.

There are practical ways we can support this change in identity. Perhaps most importantly, we take note of our clean date (our our sobriety date), and we hang on to it. Mine is May 12, 1985. There have been several times over the years that just knowing I would have to give up that date has motivated me to ask for help when I was in danger of relapsing.

We connect with people who are also in recovery, and we build relationships with them. We get to know them, and we let them get to know us. They will see our attitude changing for the worse before we do, and they can warn us that we’re not doing the things we should in order to stay in recovery.

And we become members of a group of recovering people. This is important. When we feel connected to a group, that group membership influences who we think we are, just as belonging to a political party or a church do for “normal” people.

And we begin to share our experience with others. This reminds us of where we come from and how we’re different today. My first sponsor told me that if I have 30 days clean, I have something to share with the person who only has one day clean. (It’s so easy to forget that when I had one day clean, 30 days seemed impossible!)

These are the basics of living a life free of active addiction. There are more tools, and we gain more experience, but these basics will take us well into recovery. And as we do, we probably won’t even notice that our self-identity is changing. But it is. We are ceasing to be addicts trying not to use, and becoming addicts in recovery. We are giving up a hopeless state of mind and beginning to live in hope.

But we don’t just live in hope, we become symbols of hope for those who still struggle. When we realize that, our new identity has fully taken hold.

March 10

Broken Minds in a Broken System

Cory grew up in a violent home. He turned to alcohol at an early age. He also suffers from schizophrenia. When he drinks, he sees the world as a threat and responds in kind. He was released from prison a few months ago after a decade for making a threat he did not have the ability to carry out.

Cory needs psychiatric help. He’s been on a waiting list for months. Now he’s back in jail, awaiting trial for getting drunk and making a threat he had neither the means nor the knowledge to act on.

Jack, too, grew up in a violent household. He turned to drugs at age 12 and lived on the streets for a time. He recently graduated from a recovery house and is trying to live clean and sober. But Jack suffers from bipolar disorder. When he gets manic, which is about every other week, he gets paranoid and believes the world is out to get him. The only way he knows how to manage this is through self-medication. Needless to say, he hasn’t stayed clean for more than a few days at a time.

Jack, too, has been on the waiting list to see a psychiatrist. In his desire for help, he went to the emergency room and was hospitalized, but the medications they put him on didn’t help. He wound up back there again last week, in a suicidal depression after a week of manic behavior and drug use. The doctors changed his medications and sent him home.

These two men, both of whom want to change their lives, may be just statistics for most people, sad stories that we want to believe are the exception rather than the rule.

I don’t have that luxury. Like them, I have struggled with addiction. Like them, I suffer from mental illness– in my case, PTSD (Post-Traumatic Stress Disorder). And like them, I struggle to get help in a broken mental health system.

When Trauma Comes Home

My recent troubles began, like so many things, with Covid. The isolation caused by the pandemic not only led to depression, but eliminated a lot of my regular coping mechanisms. Visiting friends and working at the library became impractical if not not impossible. My world shrank to our home, and my family became my social circle. Between Covid and the weather, my 6-year-old, special-needs son has only been to school about one day a week this year, causing his problem behaviors to multiply and adding to my emotional challenges.

Meanwhile, our political situation deteriorated, frighteningly resembling a traumatic situation I experienced almost 30 years ago. I’ve done a lot of work on my trauma over the past two decades, but now the nightmares returned. So did the irritability, depression, and sensitivity– all classic symptoms of PTSD.

I’d been seeking help. It took over two years to find a practitioner who dealt with trauma (and accepted my insurance), and I’ve only been working with her for a couple of months.

About two weeks ago, unbeknownst to me, my 16-year-old intentionally startled my wife. She let out a blood-curdling scream. And something inside me snapped. I left the house and drove around for two hours, unable to deal with my feelings and the world around me. I scratched myself because the pain felt good.

After much internal consideration of less desirable alternatives, I went to the hospital. They shipped me to a facility two hours away, where I received medication and watched TV for a week. (I hate TV, so this was not a relaxing vacation.) Then they released me, advising that it would take weeks to know if the  medication was really helping. The side effects are arguably worse than the PTSD symptoms they are intended to treat, and the psychiatrist I saw after leaving the hospital immediately discontinued the medication.

Our Broken System

Our mental health system is broken. It doesn’t do prevention or healing, it manages crises. Getting an appointment if you’re not in crisis can be difficult or impossible, even with health insurance. Waiting lists are long for those who are not bad enough to be hospitalized.

For those requiring hospitalization, our system uses a “catch and release” approach, diagnosing and medicating patients, then sending them home before the effects of the medication on that specific person become evident. How often have we heard a psychiatrist, following up on a hospital visit, say, “I don’t know why they selected that medication!” When side effects crop up, refer to the previous paragraph. Your options are to suffer, or go back into crisis management. Six years ago, I was hospitalized three times– once for the condition, and twice to deal with the life-threatening side effects of the supposed treatment of the condition.

And our system doesn’t do healing. Instead, it manages crises of symptoms with medication. It works for some, but many do not find relief. This approach pays little attention to addressing the underlying condition– much like using pain pills without treating the broken bone.

There are exceptions. Dialectical Behavioral Therapy, for example, has been shown to reduce both the frequency of crises and, for some conditions, the need for medication. Eye Movement Desensitization and Reprocessing (EMDR) is incredibly effective in treating trauma. Long term inpatient substance abuse treatment, when paired with mental health care for underlying conditions, can be very effective not only in treating addiction, but in preventing future mental health crises. But there isn’t enough of it. In fact, in many communities, there isn’t enough mental health care available, period.

A system is defined as “a set of things working together as parts of a mechanism or an interconnecting network.” By that standard, our mental health “system” isn’t a system at all. The parts don’t work together. Some parts are missing.

Does ignoring our mental health make the problem go away? Hardly.

An estimated 56 percent of state prisoners, 45 percent of federal prisoners, and 64 percent of jail inmates have a mental health problem. –“The Processing and Treatment of Mentally Ill Persons in the Criminal Justice System
Few of these prisoners get treatment. Most will return to incarceration after being released.

Counting the Cost

We pay for our nation’s mental health problems, whether or not the treatment is effective. But instead of recognizing the problem, we ignore it or criminalize it. By official estimate, we pay $80 billion per year to incarcerate 2.3 million people, But that doesn’t include the out-of-pocket costs to the families of the incarcerated. One wonders, what kind of a nation would rather pay for jails and prisons than treatment facilities for its sick citizens?
Suicide is the 10th leading cause of death in the nation, and the 2nd leading cause (behind accidents) for Americans aged 10-34. Yes, you read that right: Suicide is the 2nd leading cause of death for children 10-14 years old, and continuing well into their 30s. Yet we’d rather argue about gun control than address the cause, which is mental illness.
With nearly 1 in 5 Americans living with a mental illness, you’d think we’d pay more attention to it. That’s almost one person in every American family. But we seem to be too ashamed of mental illness to admit this medical affliction– as if having diabetes, for example, was a moral failing.
Mental illness is NOT a moral failing. And that’s why I post about it. Go a few rounds with our mental health care “system,” and you may begin to see our national denial the way I do: Mental illness is not a crime, but ignoring it is.
September 26

Why We’re Losing the War on Drugs

Singapore’s arrival card. The big red letters leave no doubt as to their policy.

In the past 40 years, we’ve spent trillions of dollars on the War on Drugs in an effort to eliminate supply. Yet drug overdoses are up over 1,200%. We’re losing the war. And not for lack of trying.

We’re losing the war because the very premise of it is flawed.

Trying to solve the drug problem by eliminating the supply presumes, as many conservatives believe, that drug addiction is a choice. Eliminate the supply and people will make better choices.

It’s like those candy displays at the cash register of your local store: you want it because it’s there. It’s tempting. That’s called an impulse buy. And if it didn’t work, they wouldn’t keep doing it.

But drugs are not an impulse buy. Yes, the first time a person uses is clearly a choice, unless it’s given by a medical professional. And that does happen.

But once a person becomes addicted, the drug fills a need that nothing else does. It’s no longer an impulse buy. It’s a requirement.

As I argue in my book, The Soul of an Addict, for an addict the drug provides more than just relief from withdrawals and from past traumas and pains. It provides certain basic human needs which the user has not found anywhere else. These include identity, purpose, meaning for life, structure, and a moral code consistent with these.

Without the drug, in the absence of a suitable alternative, the person is miserable. They’re not waiting for an impulse buy. They are actively looking for relief, and they will do anything and pay anything to get it.

This is a ready-made market, a demand for the substance. And, as anyone who has taken an economics class knows, where there is a demand there will be a supply. Scarcity and risk cause the price to go up. But the person who needs drugs will find a way to pay that price, because they quite literally believe they can’t live without the drug. And that means the methods they use to obtain money may cross the line of legality, from theft to prostitution– and worse.

Is it even possible to stamp out the availability of drugs?

I say no, and here’s why.

Singapore is a small, island nation off the southern tip of Malaysia. It is ideally suited to control what crosses its borders because there are very few ways in or out. And Singapore has one of the toughest drug smuggling laws ion the world. Their arrival card makes it clear: the penalty for smuggling drugs is death. And they’re not kidding: smugglers are executed.

If anyone could eliminate the supply if drugs, it would be Singapore. Yet they had 14 drug overdoses in 2017. Their rate of overdose has more than doubled over the past 30 years. Yes, that’s far better than the U.S. rate of overdoses. Singapore’s is 0.25 per 100,000 people; ours is 18.75. They also have better health care and social services and less wealth inequality than we do, which would tend to drive down the rate of drug abuse and overdose.

But, even with supposedly absolute control and strict penalties, drugs are still available in Singapore. And if they can’t stamp them out with limited access points and draconian penalties, how do we expect to?

The War on Drugs is doomed to fail because it’s impossible to address the problem on the supply side. So long as there is a demand, someone will take the risk to make money by providing a supply. (Singapore’s penalty is death, yet people still risk it!)

And we can’t address it by locking up those who use drugs. We’ve spent trillions of dollars trying. Our prisons are full. Yet the problem keeps getting worse.

There’s got to be a better way.

And there is, but we’re not going to like it.

We’re not going to like it because it calls into question our post-modern ethos of consumerism, the whole premise that life can be fulfilling because of what we buy. That ethos is false, yet that’s what it takes to keep our economy afloat. People have to keep buying. When people start saving money instead, the Federal Reserve gets nervous. They need us to be happy consumers, floating in a sea of debt buying stuff we don’t need (but think we do).

Some of us may be satisfied with this purpose for life some of the time. But the fallacy is revealed in the rise of drug overdoses, alcohol deaths, and suicides. Consumerism doesn’t answer the big questions in life. Like, “What is it all for?”

That’s the realm of religion, not social policy. And religion is something society doesn’t prescribe for us. In fact, it has increasingly fallen out of favor. Over the past 40 years, the number of Americans who identify their religious affiliation as “None” has risen from 7% to 21%.

But even that number may be optimistic. I’ve been to many churches where the point of going to church is to go to church. It’s what we do. Yes, there’s a vague message that we should live good lives, but no specific guidance for doing so.

I’ve been to other churches which focus on what happens after we die. For someone like me, a recovering addict, this fails to answer the burning question of my life: how do I live now? (And if the afterlife is so much better, isn’t that an argument for a sooner death?)

Sociologist Emile Durkheim suggests that a religion provides identity, meaning, structure for life, and a moral code. If that is so, then much of what we experience in church fails to meet the requirements of a religion. It doesn’t provide these basic human needs. No wonder the fastest growing religion in America is “None”! And no wonder deaths of despair are rising.

Doing Something Different

There is an answer to the drug problem. The Twelve Step programs recognize it. Every aspect of those programs is designed to give people identity, purpose, structure, and a sense of belonging. Although most of these programs aren’t religious, they do a better job of practicing a religion, in the sociological sense, than some churches.

Why can’t churches do what the Twelve Step programs do? They could. So could non-religious groups. But that would mean bucking the national religion of consumerism– and potentially being branded un-American, or worse. It would mean pushing back against the long-embraced idea that religion belongs in the private sphere. If your purpose and structure for life comes from your religion, it’s going to show.

Do we really believe that it’s better to spend trillions of dollars on trying to stamp out supply and incarcerate users, no matter the price tag? Is that a necessary “overhead expense” to maintain our consumer economy? Or is that just what we’ve always done?

In either case, it isn’t working. The problem is getting worse.

It’s time to do something  different.

September 9

Praise for Soul of an Addict

“The book elucidates the agony of addiction in a fresh, new way. It emphasizes the role of trauma in setting the stage for debilitating behaviors, and explains the importance of community support in the healing process. With anecdotes of many people who grapple with addiction and have survived, as well as sad stories of addicts who died, this book provides healthy doses of grit and inspiration.” –Christopher Key Chapple, Loyola Marymount University

September 3

Getting Out

Whether it’s jail or rehab, how does an addict stay clean when they get out?

I met William in his last week at a program that helped former inmates deal with addiction and prepare for the real world. We talked for almost an hour. I told him my history, and about how I stayed clean. He seemed excited to know someone in recovery. He took my number, and promised to call as soon as he got settled in his new apartment.

I never heard from him.

The are literally hundreds of thousands of men and women incarcerated for drug related offenses, many of them nonviolent. What happens when they get released? Some of these go to halfway houses or rehabilitation programs. Do these improve their chances? Thousands are voluntarily in rehabs. Are their chances any better?

There’s one aspect of addiction that few programs, and few theories of addiction, take into account: Addiction is a way of life. It defines what we do with our time. Conversely, it tells us what to do when we don’t know what to do.

This means the first day or two after getting out, whether from incarceration or from a program, are critical. Structure has been removed. Even if there’s a job to go to, which there often isn’t at that stage, there are still 16 hours in the day to navigate. In an unfamiliar world. With complete freedom of choice. After months or years of complete structure, the person is suddenly expected to know what to do with their time.

That’s not a reasonable expectation. Anyone who has become unemployed, or who has faced a quarantine that disrupts their normal routine (and that’s most of us now), knows that it isn’t easy to find a new routine. And we generally start with what we know, whether that’s exercise or prayer.

What an addict knows is not exercise or prayer. I say this as one who struggled with addiction for many years. The drug becomes the center of our lives, defining our identity and our purpose. And it tells us what to do with our time.

How long will a person wait for something new to happen before returning to their old ways? My experience indicates that it may be as little as 24 hours, and certainly not more than a few weeks.

This is the window of opportunity for the person to develop not only a new routine, but a new circle of friends and support. In the absence of those, he or she is alone and without tools for navigating their new reality.

If you think about how long it takes to find and adopt a new routine, find support, and make friends, this is a nearly impossible task.

So what is the answer?

Those who have relationships with supporters and friends before their release are more likely to succeed. They already have some of the most important pieces in place. If we want to support addicts in staying clean, this should begin while they’re still inside, whether it’s a rehab or a jail.

But secondly, when they get out we shouldn’t expect them to reach out to us. They have been conditioned not to trust, and to believe that those who need help are weak. It takes time for those beliefs to change– time they may not have. There’s also the shame factor. They may be ashamed of their social status, and of their need for help. They also may be afraid of rejection, betrayal, or abandonment– all common occurrences in the world of addiction.

We need to reach out to them! And we need to do so with persistence, but not harassment. They may or may not respond. They may or may not stay clean. Working with addicts always risks heartbreak, including the ultimate heartbreak of funerals. But we do it because there would otherwise be even more funerals.

William, my new friend who disappeared, taught me one thing: not to just give out my number, but to take his. I didn’t do that for him, and he is likely back in the trap of old behaviors. But I have done it for others since then.

For more on addiction, read The Soul of an Addict: Unlocking the Complex Nature of Addiction.