Let’s Start Talking About the REAL Reasons Americans Abuse Opiates

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Although there have been many valid explanations for why we have an opiate epidemic on our Drug-Warring hands, I have not yet heard anyone mention what the primary reason actually is, so I’ll tell you what it is:

It’s Pain.

And I’m not talking just about the physical kind – I’m talking about the mental and financial and social kinds of pain which are more devastating than physical pain. The vast increase in prescribing opiates is certainly a big driver of the crisis, but many people take opiates for the duration of an illness or injury and then stop taking them. They don’t become addicts; but a lot of other people can’t get off them ever again.

I had the dubious benefit of “attending” court-ordered drug treatment (in my case it was for alcohol) in my Southern state. I took careful notice of the people I met and spoke with in both jail and treatment, and I was shocked to hear the stories they told about their lives. Absolutely every woman was a survivor of some kind of repeated sexual assault, sexual abuse (by a family member, caretaker, or significant other), violent trauma, total estrangement, or sexual exploitation. Most were mentally ill. All were very poor and underserved if not completely unserved, because of the many institutional system failures in America.

Most people got locked up on paraphernalia charges, theft under $500, probation violation, and/or insolvency.  The people in treatment with me (some of whom I also met in jail) were suffering from some of the worst life experiences and situations I’ve ever heard of. Even though some people exaggerate for sympathy, if you have to drag someone’s tale out of them after laying groundwork over weeks in stir or in group therapy, they are not making that shit up.

In jail, I slowly got to know another woman there who finally told me she was a “trick baby” and didn’t even know what ethnicity she was. (Asian? Native American?) She was also epileptic, mostly deaf, an addict, and a member of the hidden homeless. These are the “precariously housed” meaning, at least for her, that she had to submit to sex to crash on various guys’ couches. She complained in her innocent way that what she hated most was always having guys “bothering” her when she just needs a place to sleep other than her car.

Every human has a breaking point when they will seek out ANY relief from unbearable pain, and everybody has a finite amount of resources to battle it.

Speaking of the deaf and/or developmentally disabled, I met a surprising number of people with these problems, and all of them had resorted to substance abuse to numb the pain of deep isolation, the resulting poverty, and repeated victimization.  The issues of substance abuse and police brutality are very real for the disabled and largely ignored as well. Almost half of all people killed by police are disabled and usually not in an immediately  visible way.

 

 

Baby steps, I guess.

The most punishable offense to many cops is lack of a prompt response, difficulty following or understanding orders, and perceived disrespect. Lots of cops are delicate, but thuggish, flowers who require deference and unquestioning obsequiousness at all times.

But back to our national love of getting high.

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I figured out that substance abuse is directly related to the degree of isolation and trauma a person has experienced, and the more you have suffered the less able you are to summon the considerable internal and external resources that are absolutely needed to heal from the severe issues at its root. Addiction is a symptom of other serious conditions. If you put someone in rehab or jail but don’t address the financial, familial, mental, social, housing, employment, and physical problems they have, you are setting that person up for relapse or death. 

Here’s a helpful TED Talk about why people (and other animals) develop maladaptive coping mechanisms when they suffer isolation and pain which reflects current evidence-based research. Our “moral” and “disease” models of addiction have at the very least been harmfully inaccurate.

By far, the worst thing about my entire odyssey was the degree of toxic shaming we were subjected to. Initially trying a drug is your fault because you chose to “make a bad decision” and break the law. You’ve sinned. Relapse is really, really your fault because you are supposed to know how to resist temptation with the (largely useless) advice they gave you about “avoiding triggers.” The 12 Steps used in most American treatment programs is outdated, ineffective, poorly studied, and loaded with negative, shaming attitudes and more bad advice. The addict is always solely to blame rather than the life conditions and intractable illnesses they deal with.

Here’s the bottom line: 

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Source here

Fifty percent of Americans in 2017 are struggling to pay for housing and having enough to pay for food and sundries.  A health care or car emergency can utterly wipe them out. These are people who take out loans for college and well into adulthood the jobs they studied for have simply not materialized. Their debt exceeds their assets. These are also people for whom the dismantling of the mental health system by Reagan has left them without a place to get help and has simultaneously criminalized the sick, the poor, and the different.

I could go on.  Things have been getting worse for average Americans so gradually that we didn’t realize we were being cooked alive and quietly robbed of more and more of our rights and political agency. The labor unions were broken, the push for women’s rights stalled, and anyone requiring social entitlements was demonized. What we DON’T need is more tough love, shame, religious censure, and socially conservative policies.

What we DO need is:

  • MAT (medically assisted treatment)
  • nonjudgmental, sympathetic counseling that addresses the specific reasons women and all other predominantly non-violent offenders (men, the disabled, LBGTQs, POC) end up in the system
  • comprehensive mental and physical healthcare (good luck on that one, I guess)
  • the 12 Steps replaced with a recovery philosophy that uses evidence-based methods rather than faith-based ones
  • safe rental housing we can afford
  • better jobs that pay enough to live on
  • an end to the Drug War and the decriminalization, Portugal-style, of personal substance possession and use
  • forgiveness of past non-violent drug-related offenses or at least removal from background checks so to prevent the stigma that leads to un- and under-employment (and relapse)
  • prompt, free legal help that doesn’t suck or favor domestic abusers
  • childcare and community supports
  • better treatments for chronic pain

Tall order, am I right? This is true:

Every human has a breaking point when they will seek out ANY relief from unbearable pain, and everybody has a finite amount of resources to battle it. Even the people who are “living the right way.” Thanks for being honest, Mo!

 

The vital missing parts of drug treatment

via Obama Administration Offers Desperately Needed Help For People Addicted To Opioids

When I grew up in the 80s, drugs were no less than a demon scourge come to take your soul away if you so much as got a contact high. Nancy Reagan went a long way to make a lot of people really miserable. But the guiding philosophy on drug abuse was that it’s  up to you to kick it’s ass – anything less than total sobriety is a moral failure on your part. You didn’t try hard enough. The AA Big Book famously states

“Our description of the alcoholic . . . makes clear three pertinent ideas. . . (b) That probably no human power could have relieved our alcoholism.”

-AA Big Book, pg. 60 (right after the 12 steps)

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It also has one chapter called “Women Suffer Too”

It goes on to say that the only way to recover from alcohol addiction is through a spiritual awakening. Presumably, you come to realize you are a terrible sinner and it magically cures toxic shame, trauma, and mental illness. But heroin is the end boss of addictions. It directly rewires the reward centers of the brain and can condition a sufferer’s mind to obsess over everything about the habit (including the gross parts). It turns lovely, brilliant people into cringing thieves, serial liars, and corpses. I’ve seen it first hand and I’ve had terrible run-ins with opiate addicts. Never, ever take one in out of pity if you value your valuables.

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You can buy them back cheap though.

I’ve also been to court ordered rehab myself. I was there for booze issues, and I know I didn’t envy all the women who came in addicted to needles and pills. They were quickly put on suboxone and just as quickly weaned off of it. They seemed fine, but most relapsed when returned to the compromising living situations they wanted to escape.

Obama is trying to get money to states for MAT, or medically assisted treatment, for opiate addicts. Almost all treatment facilities use faith-based methods and 12-step principles (which are also faith-based). However, there is zero evidence that these programs are any more effective than trying to quit on your own. Medication is changing the way heroin addicts are treated though. Suboxone is a maintenance opiate that prevents dope-sickness and can be controlled to wean the brain off of the changes in dopamine production that make getting clean so vexing and, frequently, otherwise impossible.

And there were a lot of sufferers, especially among the women I encountered. In fact there was a triad of opiates, alcohol, and eating disorders I kept noticing. All of us had problems with at least two. I’m sure it bears better investigation. Anyway, I’ve been sober for three years and dealing with the criminal justice system and state rehab was the hardest thing I’ve ever done. Staying sober has been a breeze, by comparison.

A female addict’s real problems are seldom addressed.

One class we had in rehab was a revelation to me. It was oddly called “gender,” just “gender” class and it means the men and the women (insultingly labeled by staff as males and females like we are on in a Mutual of Omaha special and not adult humans) were split up to discuss our unique issues. I figured out it was especially important for the ladies to go into a safe place to discuss aspects of our addictions, and what they’d done to us and made us do, that we would hardly bring up in court-ordered mixed company. Once the floodgates open in a counseling environment where problems related to relationships with men, LBTQ struggles, and our difficulties in society can be explored, it is apparent that any one of us would naturally turn to chemical solutions to deal with what we had survived. Experiences such as domestic violence, sexual abuse in childhood and adulthood, work discrimination, heart-breaking childcare challenges, the effects of rape and rape culture, neglect, financial morasses, and our submerged status start to tumble out.

By the end of the short class (which usually went on long after the men were done) I knew that more of this type of consciousness raising was absolutely a seldom-used tool for getting to the underlying trauma and powerlessness that leads women (and many men) to relapse. A female addict’s real problems are seldom addressed. 12-step programs focus overly on how relapse and the initial drug experimentation that led to addiction are our fault. It is clear that most of these women were not receiving the kind of educational awakening and support services that would profoundly improve their chances of staying clean and avoiding more contact with the criminal justice system.

The focus typical of modern treatment programs is on “triggers” and how to deal with them. But quickly one realizes in the program that life is a trigger and the majority of women there will not be able to escape the “people, places, and things” that remind them of using. What they really couldn’t escape were the life circumstances that led to addiction in the first place. They would be returning their small towns with no employment opportunities or community centers, their abusive domestic situations, their untreated (unacknowledged) traumas, their grief over the custodial loss of their children, and their very poor financial prospects.

I hope that we can come to see addiction and relapse also as failings of society. I hope we can change treatment to include medications for addiction maintenance and mental health problems. I hope we can tell women that life isn’t always hard because they are failures. It’s because life is hard for a lot of women and not enough, not nearly enough, is being done to improve their circumstances.