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.