Archive for February, 2010

I’d Love To Change You!

Posted in Current Events with tags , , on February 23, 2010 by corecompany

I am at SECAD in Nashville. It’s being held at some creepy biosphere of a hotel, an endless labyrinth of rooms and theme restaurants, all of which suck. In any event I complain about these rehab conferences but the truth is, they can offer a good opportunity to see people, many good people trying to do the best they can in what can feel like an unwinnable war, the war on addictive disease.

A few blogs back I wrote about Brad Lamm‘s book “How to change someone you love”. Again, I have not read the book, I don’t think I could get through it without vomiting but I did see Lamm speak today at the conference. Lamm seems like a well-meaning guy, clearly cares about his clients and has a light touch when handling interventions. There was nothing wrong with how he described what he does. As I have said, and say many times, my style of intervention is not for everyone. What I think about all of this is fit is critical. Playing the odds, what is going to support the individual into a life in recovery. Sometimes it’s the carrot and sometimes it’s the rod and none of us have a crystal ball so we do the best we can, one day at a time.

The issue I have with Lamm is the title of his book. “How to change someone you love”. I was hoping to hear something profound, something revolutionary about how to change someone you love. That would seem to be a pretty big deal if he actually developed a system to change people, but nothing came. The presentation was unresearched and unsubstantiated platitudes about love, and more love, and the loved one and loving the other loved ones, there was a lot of love there. When not talking about love, the presentation was about media appearances and a portion of it was about his family, which was interesting, but it really escaped me as to how it was relevant to changing people. I kept waiting to hear how to change someone but nothing came. At one point he said, you may have to say “Sweetheart, lets stick with the change plan” which sounds a lot like a boundary to me and isn’t really changing anyone; it’s setting a limit to support change. Maybe it is loving, but is it changing them?

Working on this side of the dope fiend game we get that call all the time. “Please change ________ about _________”. Rarely do people want to look at the whole system, they want people changed.  Which is the easy solution and frankly, a fantasy at best.

The title of the book is irresponsible. It’s selling snake oil. It would be like selling a weight loss book called “How to eat ice cream daily and lose weight”. Except that when families are seeking information about interventions and treatment options they are vulnerable. We all know you can’t lose weight eating a shitty diet but few people know what to do to handle someone impaired by addictive disease. So there you are at Barnes and Noble, worrying about your husbands drinking problem and you see “How to change someone you love” and you think “yes, yes, I want to change him!”  While not as severe as Chris Prentiss, who runs an addiction “cure” center, telling people they can change someone is along those lines.  It’s a slick, well not so slick, shuck and jive.  It gives them what they want and not what they need and that never helps and individual or system out of a mess with an addiction.  At one point during the presentation when I was questioning and commenting Lamm suggested we “agree to disagree” (an alanon standby slogan by the way), fair enough. Lamm thinks he can change people and I think we can only change ourselves, unless of course, Lamm can change me.

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Alcohol vs. Drugs

Posted in Education with tags , , on February 21, 2010 by corecompany

In thinking about the drug war, I often wonder where we stand with alcohol. From my perspective, it seems to get a free pass. We hear about drugs, which we all know are terrible. Are they? Or is it that we don’t like the people who choose drugs over alcohol? Make no mistake, alcohol is a very dangerous substance and the truth is, it does more damage to society than anything else. Why is it that we treat it differently than other drugs? Marijuana is safer than alcohol and yet alcohol gets a free pass. It’s a strange aspect of the drug war and I started to wonder: what does alcohol cost society and who pays for it?

Nobody seems to know what alcohol consumption costs. Consumption of alcohol is fine but alcohol abuse is a different matter. In a sense, alcohol is just another product that people buy. Of course people are in denial and not honest about their drinking and the impact of it on themselves, their work places, or their families. I don’t think there is any real way to know what alcohol costs in dollars to the US on an annual basis. NIDA doesn’t seem to know. The Marin institute, a think tank in California estimates the cost to be 175.9 billion dollars annually. Seems like a huge number. Some of the categories they were looking into were; additional health care costs, loss of productivity, damage to property. As a side note, imagine the additional cost if we were trying to arrest people for consuming it. Forget scholarly research and stats, I argue they are never accurate with any kind of questions about chemical use because, addicts lie. In any event, let’s say alcohol cost a shitload of money every year in many ways, ways we cannot even imagine. Who pays the tab? The consumers of the product don’t pay the price, not really (when do drunks ever pay the price?). Looking into this and not very deeply, I was shocked to find how minimal the taxes are. In New York, beer is taxed .14 per gallon, wine .30 per gallon, and distilled liquor $6.44 per gallon. Cigarettes are taxed $2.75 per pack.  A gallon of beer can do a lot of damage. Is .14 adequate?

Maybe one of the ways that we can finance treatment and continuing care options is by taxing alcohol in a real way. How about a .25 per drink tax in NYC bars? Who would this hurt? Bar owners? Not a chance. Who supports the low taxes on alcohol? Must be the alcohol lobby. In spite of our enmeshed relationship with alcohol, it is not a ‘needed” product. It’s not bread, milk, heating oil or gas. Have we become so fucked up by this substance that we just accept the damage it does to us? If cigarettes are taxed at 2.75 per pack, so should a bottle of wine, a 6 pack of beer or a bottle of liquor. Nobody likes taxes so I will take the heat: it can be called the “Schrank damage control/treatment option tax” and if you don’t like the tax, don’t buy the product. Take the money you will be saving and throw it into the hat at an AA meeting and shut the fuck up, you’ll thank me later.

Is Dr. Conrad Murray The Only Killer in Michael Jackson’s Death?

Posted in Current Events with tags , , , , on February 10, 2010 by corecompany

What’s wrong with convicting Dr. Conrad Murray of manslaughter in the Michael Jackson case? Nothing, clearly he was not practicing ethical medicine and his patient died. The drugs that were administered to Michael Jackson ultimately killed him but in a larger sense, did Dr. Murray kill him? Is he the only party culpable in Michael Jackson’s death? While Dr. Murray may have been the straw to break the camels back it brings up an interesting question when an addict overdoses. Where do we assign blame?

To read the comments of the Jackson family in the press, they seem to want to blame Dr. Murray. What culpability do they share? Are they to blame? After all they watched for years as son Michael slid further into addiction, mental illness and obscurity. Surely this must have been a problem long before Michael had hired Dr. Murray to be his personal physician. What other doctors wrote prescriptions to Michael Jackson? Did the family attempt to intervene? Maybe they did, we just don’t know. How about the sycophantic insulation of people collecting paychecks from Jackson (family seems to be included in this arena) are they listed as murderers? How about his adoring public and the people who watched him disintegrate before their very eyes?

Like so many others before him, Michael Jackson died of addictive disease. Denial will fuel the disease as will shame, secrecy, and not holding people accountable – but do we blame the drug dealer? In this case the dealer is a physician, often that is the case.  What about Michael Jackson himself? Did Dr. Murray hold a gun to his head, making him ingest drugs?

All kinds of things contribute to the death of an addict and it all funnels into the disease of addiction. Family dynamics, unethical doctors, denial, shame, all symptoms of a deadly disease.

I think Dr. Murray should be held accountable for his treatment of Michael Jackson and I think he should face the full extent of the law but I don’t think he killed him. Maybe blaming Dr. Murray is part of the diseased family system and cultural belief; we even want a quick fix to understand an overdose. Are we an addicted culture?

Penn. State – #1 Party School in the Nation!

Posted in Education with tags , , , , on February 8, 2010 by corecompany

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On Tuesday afternoons at the center for counseling services on the campus of Penn. State, there is a substance abuse group. There are other groups offered at the center as well. Groups for: undergrads, women, depression management, mindfulness (what?), stress management and yes, a substance abuse group on Tuesday afternoons. Just how out of control is undergraduate drinking on American campuses and just what are we doing about it?

According to the Princeton review, Penn. State is the #1 party school in the nation based on their criteria and responses from an online survey.  Graham Spainer, president of the university says he doesn’t mind being known as a party school but wishes they weren’t number 1.  This is odd considering Penn State routinely lists alcohol as one of the biggest problems they have in Happy Valley.

A recent broadcast of “This American Life” from the Penn State Campus observed all kinds of drunken mayhem right outside the door of one of the producers of the show. In the span of 30 minutes the show producer witnessed drunken students stealing a stop sign as well as three girls who hike up their skirts and pee in her yard. We have always expected boys to pee in the yard but it’s good to know that this practice has now crossed gender lines. Later the show interviewed a girl celebrating her 21st birthday at a football tailgate party. Stating her goal was to get drunk. The celebrants included her parents and women from a neighboring tailgate who came over to watch this young girl get drunk and deliver her some kind of lemonade and vodka concoction.

According to student surveys, 75% of the Penn State undergrad population (more than 30,000 young men and women) drinks an average of 4.5 drinks on both Friday and Saturday nights more than enough for what the Harvard School of Public Health calls “binge drinking”. This does not include what they are doing on other nights. What is the problem with this? Is this wholesome behavior?  A rite of passage? Is it the entitlement of a generation raised on being told they were all “geniuses” and protected from human experience for fear they would have ‘low self esteem”?  I don’t think that is it because back in my day, we behaved in largely the same way. Inconsiderate, entitled to drink, party and do as we pleased because we were ‘in college”. Is this behavior so enmeshed into the American experience that we just accept it? Does it need to be “corrected”?

Strangely, for a guy whose life is so steeped in living free of intoxicants, I kind of think much of what goes on is late adolescent hijinks, that when sequestered to certain areas is harmless fun. Incidentally it seems that one of the biggest issues at Penn. State is the conflict that the undergrad revelry creates for the families that live on or near fraternity row. Umm, how about move dip shit? Maybe it is kids just being kids. I can’t imagine having 40,000 young people living in close proximity of each other without many things going on. In one sense, Penn State seems pretty honest about it. They don’t seem to be telling the kids not to drink in a hypocritical scolding. Many of the young people who live this way will be OK. It is true that kids will be kids and for most, they will age out of this kind of lifestyle.

What is disheartening about the substance abuse climate at Penn State, and college life in general, is the flagrant disregard for the recovery life and culture.  Considering the overwhelming amount of drinking on the campus, how would a kid in recovery make it? The simple answer is, they wouldn’t. How would a kid questioning what impact partying is having on their life flush that out at Penn State? I guess they could attend the group on Tuesdays but is that really adequate? The short answer is No, it is not in any way enough to support a young person who is having issues with alcohol. My issue is not that Penn State has a culture of drinking but that they don’t have a culture of recovery and marginalizes youth who want to live a recovery lifestyle. Nobody can foster a recovery lifestyle alone. We all need peer support, community, a sense of belonging, and a blend of community based and professional helping to sustain recovery. So I guess, kids who want this are not eligible to attend Penn State? That seems wrong, is it different from excluding a kid in a wheel chair? How about a kid with diabetes? What if they were raised in Pennsylvania, grew up watching Nittany Lion football, idolizing Joe Paterno is it fair to deliver the message that a huge land grant university can’t accommodate you? Fair or not, that is the message. On the off-chance that someone undergoing treatment at Hazelden youth and family or at Caron’s young adult program is reading this and thinking about how to integrate into an undergraduate life, scratch Penn. State off the list.

Recovery is never served by an evangelical membership drive. It makes no sense to try to police an entire culture on undergraduate campuses. Not to mention that I don’t think everyone who drinks has a problem. I loved every beer I drank out of a red cup and oh how I wish I still could but I don’t think everyone else should be sober, it’s really not my business. What does make sense is to start to think of recovery as something for young people and to make strides toward treating it as the acute illness that it is. What’s the worst thing that could happen? Kids might stay sober?

D.A.R.E. Fails!

Posted in Drug Reform with tags , , on February 3, 2010 by corecompany

Who would dare to complain about D.A.R.E.? It’s an organization whose sole mission is to keep kids off drugs, what could be wrong with that? Absolutely nothing, except that they leave a few things out, minimize the problem, exclude people already impaired, shame children of alcoholics and perhaps worst of all, eclipse and consume potential because after all, we must be addressing the drug issue in schools, we have D.A.R.E.

The program itself is standard “Just say No!” fare. It does little to educate about the complexities of the problem, nor does it present it as a health issue. It presents it as a “choice”, don’t make the wrong choice and do drugs, play sports, dance, support your school!! All great ideas but really are we going to combat a complicated biological disease with dance? C’mon kids, dance those blues away! Dance that depression away! Dance your abusive parents away! Dance! Dance! Dance!! I am too old to be a graduate of the D.A.R.E. program but if it had been around when I was in school, I wonder what it would have done. There were individuals and systems letting me know that drinking was bad but it wasn’t doing anything for my internal world, my isolation and feelings of being disenfranchised but that keg party was working a fucking miracle.

The D.A.R.E. message is clear. Drugs are bad. Dumb people do drugs; lazy people do them as well. In other words “bad” folks get themselves involved with drugs. I am not sure what blameless holy virtuous people do, I assume they dance because the DARE website really promotes dance. Does the DARE program have happy feet? Why all the dancing? The message is shaming and shame never helps with drug issues. Additionally there is no mention made of disease, the AMA, treatment or recovery. Nowhere is the message: “not their fault but their responsibility’ delivered. Just don’t be bad, dance!

The advisory boards with the DARE program include: education (makes sense), Law enforcement (Oh, Jesus, not this again) and scientific. There seems to be something missing here. How about a doctor, people in recovery, social workers, family therapists, the kind of people who are on the front line of the drug culture in America. Shall we hear from them? It makes no sense to me – the greatest success of living drug free has been people in recovery. For some it’s 12 step participation, others find their own road. Somehow I would think that government agencies would want to hear from people who live drug free. Never do I see ‘recovery advisory board” in any of this and DARE is no exception.

The cost of the program is unclear. DARE itself estimates anywhere from 438 million to 604 million. I guess that is the cost of running the program, paying for the officers who facilitate it etc. Also I think they have a dog mascot, maybe it’s a lion, one of those creepy American kabuki things. I’m sure those things don’t come cheap. What is the net result of DARE? I don’t know. I don’t know if it keeps anyone off drugs or not. What I think is it is a gross oversimplification of the problem, and the added value is not much. Additionally, I can’t imagine being a school aged child listening to how bad and dumb alcoholics are when they are holding a family secret. That must be torture. Unless of course they are deeply engaged in expressive dance.  Thank God DARE isn’t into hiking. I can’t tell you how many conferences I go to where people try to treat mental illness with hiking. Frankly, I hate hiking; I’m not crazy about bugs or dirt. I do however like the comfort of knowing I can order Chinese food at any moment which is why I live in New York but OK if DARE knows something I don’t, let them hike, dance, whatever it takes.  In any event, is this the best allocation of funds? Maybe, but it seems lopsided to me. The other thing I wonder about is the kids there will most likely agree with the basic concepts of the program but what about the tortured iconoclasts? Do they agree? Do they challenge the ideas? I don’t think we know because I think those kids are out smoking weed, missing the dance-a-thon.

My biggest issue with DARE is that it has become some kind of sacred cow in American culture. You see their t-shirts, their corporate partnerships, we all know their logo and their bumper sticker, often next to those obnoxious “my kid is a (whatever)’ sticker. DARE has become a fairly powerful lobby, rejecting any idea other than “just say no”, they are the Christian right of all those interested in drug policy. They oppose reform, damn to hell the idea of tax and regulate and shun discourse about the drug issue in America. I was not surprised that all regional directors are white and male with the exception of an Asian female. Lets see some black people on these boards, children who have grown up fatherless as a result of the drug war, overworked grandmas left to care for children of drug war casualties. Where is their voice?  As a side note, DARE was listed by the US surgeon generals office in the category of ‘ineffective programs” furthermore the government accountability office reported in 2003 that there are ‘no significant differences in illicit drug use  (this would exclude alcohol) between students who received DARE and students who did not.

While well meaning, DARE misses the mark, stifles progress, shames us children of alcoholics and the government calls it “ineffective”. Maybe it’s just incomplete. Maybe education needs to expand to families and schools about how to handle a substance misuse issue. Of course we would have to be honest and assume that all schools and communities have some range of substance misuse. I will chair the committee to design the curriculum, make the board of many people from many disciplines. My fee will be HUGE but no matter, we will partner with Perdu Pharma (makers of Oxycontin), I am sure they won’t mind my fee and giving me the keys to the jet, me and my board will be busy and we will need to travel. DARE? You have got to be fucking kidding.