Answer Addiction

Tag: Features

  • Sober Romance: Why We Act Like Teenagers When It Comes to Relationships

    Sober Romance: Why We Act Like Teenagers When It Comes to Relationships

    So many people rush into relationships in early recovery. This may be related to neurochemistry: we’re suddenly deprived of the substances that made us feel good and we need to find a substitute.

    I’ve spent the last six and a half years of recovery wondering why I have been so emotionally immature when it comes to romantic relationships. Why have I sulked over communicating my needs? Why have I formed such insecure attachments that I wonder when I’ll see the person again before they have even left? Why have I felt so crazed and simultaneously flummoxed at my behavior? Reflecting on my relationships during my recovery, I can describe them in one word: disaster. But they’ve also been a blessing.

    When I found recovery, relationships were the last thing on my mind; I could barely function. I spent most days struggling to sufficiently caffeinate myself to get out of my apartment and to a meeting. For the first few months, I lugged my 300-pound body around wondering where this elusive pink fluffy cloud was, because it certainly wasn’t on my radar.

    As time progressed, my body began to recover: my liver regenerated—which is quite remarkable considering the quantity of cocaine I snorted and the four bottles of wine I drank each day—my depression lifted enough that I was able to function, and I lost weight. I was hardly experiencing the promises, but I could see that my life had improved. The fact I no longer felt compelled to drink was a miracle in itself.

    Sufficiently recovered—or so I naively thought—I looked for romantic distraction in the rooms. A smile from someone at the break would elicit a rush of feel-good hormones. I wonder if they like me? would play through my mind (well, that’s the PG version I’m willing to share, but you get the picture). Needless to say, this didn’t end well.

    I ignored the guidance to stay single for a year after finding recovery, because in my mind I was thinking: I’m a 32-year-old woman. Why shouldn’t I date? I’m an adult! Off I went and dated, just like every other person in the room because—let’s face it—few people actually adhere to that rule!

    And so I chose some lovely chaps from that swimming pool of dysfunction, Narcotics Anonymous. Promises that they’d treat me right, and that they really liked me, were exactly that: just promises. Even though I expressed my desire for a relationship over just messing around, my experience was that once these guys got what they wanted, they were off. Wondering what was wrong with me—and playing the victim role really well—I’d move on to the next dude.

    I couldn’t see until much later in my recovery why I was so terrible at picking a suitable partner. I was blind to my part in these encounters and all of the emotional baggage I brought to them. I’d often act like a teenager: sulking, gaslighting, and holding the person emotionally hostage. I was incapable of adequately and maturely communicating my needs, or of listening and hearing theirs.

    It took several years of recovery to unpack my insecurities around attachment and the trauma I had suffered that made forming a healthy attachment nearly impossible. I can’t imagine many people would want a relationship with a needy, insecure, obsessive woman. And that wasn’t helped by my choices: people who were completely avoidant. It was never going to work.

    Keen to explore why we act this way in early recovery, I asked recovery scientist Austin Brown about it. He explained that we have to look at our inclination to use external objects, or people, to provide instant changes in mood—just like we experienced with drugs. Also, Austin says, many of the social developmental benchmarks we pass from childhood to adulthood are slowed by active use.

    “The early stages of romance offer a thrill and an escape,” he goes on. “In fact, they operate on many of the same pleasure pathways as our substances used to. One interesting phenomenon I have noted in clinical work is the almost overwhelming desire to get into a relationship that occurs when people initially get into recovery. To me, this is likely a neurochemistry issue; a starvation of the stuff that makes us feel good. So, we act on it, having neither the maturity or the self-awareness that is required for a complex adult human relationship.”

    Explaining why we act so immaturely in relationships, Austin says, “If we started using as teens, emotionally we are still there those first few months. This is a well-known facet of the disorder. But we want—and therefore think we are ready for—a relationship, often before we even get out of treatment, have a stable job, or even have a place to live. Entering into any relationship under those conditions is statistically unlikely to succeed.”

    About our inability to communicate, Austin says, “At a more scientific level we are talking about the ability to identify AND verbalize our emotional states. Often all we know are ‘want’ and ‘relief’ when we come into recovery. Those are woefully short-sighted emotional states when it comes to equitable human relationships and partnerships. It’s like bringing a juice box to a gunfight.”

    The upside is that if we work hard to grow in recovery, we can mature fairly quickly. “I usually calculate about a year to six months of growth per every month of recovery. If we started using 12 years ago, it takes us at least a year to emotionally resemble our peers. Might even take two, depending on how hard we work at it,” he says.

    Even though we think we might be ready for a relationship after we’ve achieved a few weeks of recovery, Austin says, we might want to be cautious. “Unfortunately, early recovery relationships slow our emotional maturation as well, just like substances,” he says. “If someone else can give us a sense of relief, why do all the hard work to achieve emotional growth? Early-recovery relationships prolong our process of healing and can often throw our recovery off disastrously, sometimes even to the point of a return to use and even death. So, it is quite serious business, and yet no one really talks about it in any tangible or helpful way.”

    “Personally,” he goes on to say, “I have seen relationships in early recovery ruin more lives than substances themselves. Why relational health isn’t the central focus of early recovery support is frankly beyond me.”

    View the original article at thefix.com

  • Enabling, Self-Seeking, and Recovery

    Enabling, Self-Seeking, and Recovery

    Every moment there’s the possibility of falling back into self-seeking after having recovered much of our spiritual, financial, and physical health.

    Recently, I was accused on a community website of being an enabler. The article and discussions that followed were regarding a proposed affordable housing project in our community and how some members of the local city council were concerned that if fed and housed, the persons in poverty would become dependent. After I participated in a recent homelessness count that provided the government and other organizations with information on the population of homeless people, I felt I was informed enough about the topic to comment on my recent experiences. I wondered about the label someone attached to me and how valid it was. The question I ask myself is, “how do I know if I’m an enabler?”

    As an addict, I am going through a set of steps with a sponsor, which is a big part of the success of the 12-step program. Currently I’m on step 6, which states: “We were entirely ready to have God remove all these defects of character.” It seemed an appropriate time to look at this behavior—and to find out if in fact it is a “defect of character.” What is an enabler?

    en·a·bler (From Wikipedia)

    noun

    1. a person or thing that makes something possible.

    “the people who run these workshops are crime enablers”

    1. a person who encourages or enables negative or self-destructive behavior in another.

    “he criticized her role as an enabler in her husband’s pathological womanizing”

    I liked “A person that makes something possible,” but then the definition erodes into some negative rhetoric. Could I be attaching my own definitions to justify my behaviors? I also wondered about alternatives to enabling.

    What is the opposite of enabler? From Word Hippo:

    Noun antonyms include: deterrent, hindrance, impediment, inhibitor, preventer, and prohibitor.

    I don’t particularly like those words either. It almost seems like a lose/lose scenario. I can attempt to clarify both sides of an argument and chose to either “make something possible” or be a “preventer” of a possible catastrophe. These implied absolutes can place people on opposite sides of the fence of their own making and create polarity and strife. 

    Before I started down the path of recovery, choices were a lot easier. I was just concerned with myself—because at its core, addiction is about being self-obsessed. If something benefited me, made me feel better or allowed me to avoid uncomfortable feelings or just looked fun, I could justify the choices and my actions.

    Today, through the recovery process, I choose a new way of living:

    I invite a higher power into my life and my decisions. It is a manner of living that involves more than my own self-seeking ways. I know some people do not agree with terms like “God” or “Higher Power” or even the concept of a spiritual existence. I struggled with the concept too when I first started in recovery. At some point, those who live a life based on the principles learned in 12-step recovery must decide what concept is working for them today. The idea is that a higher power, whether it is “God” or my support group, it is a greater power than myself. As the saying goes, “it was my best thinking that got me here.”

    I try not to complicate things too much these days, but difficult choices are inevitable. The fact that I have difficult choices to make is a choice…but that train of thought gives me a headache and might be overthinking things – another seemingly common trait among addicts. I often wonder if life would be easier if I was less concerned about those around me and more concerned about myself- as that is also a common trait among those in active addiction. After all, addicts without recovery really only think about themselves and how to satisfy their compulsion to use.

    It makes sense that the early successes of living free from active addiction re-opens the door to self-seeking behaviors. Every moment there’s the possibility of falling back into self-seeking after having recovered much of our spiritual, financial, and physical health. In fact, all those healthy options are affected by the choices we make and are part of what molds us into who we are and what the fellowship of recovering addicts around us looks like. The literature in Narcotics Anonymous even warns about the dangers of self-seeking, but some people fall back into that habit:

    “…However, many will become the role models for the newcomers. The self‐seekers soon find that they are on the outside, causing dissension and eventually disaster for themselves. Many of them change; they learn that we can only be governed by a loving God as expressed in our group conscience.” 

    In Alcoholics Anonymous, they have The Promises: “Self-seeking will slip away.” 

    If you are no longer self-seeking, then the choice of what, if anything, to seek becomes apparent. I remember very clearly in early recovery when my wife suffered a life-threatening incident. After an invasive surgery to correct a serious defect in her foot and ankle bone structures, she developed a blood clot. A piece broke off and went through her heart and damaged her left lung. She was in the hospital for quite some time as they dissolved the clot with drugs and dealt with the damage to her body.

    I tried to balance work, looking after our two small daughters, recovery meetings, and support for my wife. I thought often of praying to this new “God” I was developing a relationship with. I questioned what I should pray for. Save my wife’s life? There are many people who deserve to live but their lives end. A prayer came to mind: “Please don’t leave me a single father who is barely capable of looking after himself.” This seemed to be a desire for my own selfish needs. In the end I prayed for knowledge that I should be at the right places, doing the right things, and to find the strength for myself and others, including for my wife, regardless of what happens. Also, “Please don’t leave me alone” – and I wasn’t. Friends stepped up and many offered support. 

    In time, my wife recovered. The point to this story and how it relates to enabling is that at no time did anyone criticize the choices I made. People did what they could to support me and let me live with the consequences of my choices. 

    Mother Theresa dedicated her life to easing the suffering of the poor and destitute in India. Did she spend her entire life simply enabling people, with little or nothing to show for her work? Possibly she could have become a motivational speaker and had a far greater effect by inspiring those same people to change their lives. Not that my actions are comparable to Mother Theresa, but the choice I make today is that rather than accomplishing 100 tasks to benefit myself, I would rather accomplish 100 tasks to benefit others, even if a few lives are changed as a result. Even if only a single life is affected, or no lives at all, I would still rather spend the time for the benefit of others. In early recovery it was explained to me that I needed to separate my “needies from my greedies.” What I do after my needs are met is the basis of my recovery. Recovery from addiction and the 12 steps are based on a single premise- which is explained in the 12th step:

    “Having had a spiritual awakening as the result of these steps, we tried to carry this message to addicts, and to practice these principles in all our affairs.”

    I don’t always have answers to life’s questions. I might not be doing the right things at the right moment. I always try to be grateful for the life I lead. Gratitude isn’t a feeling, it’s a virtue. Gratitude is a manner of living that expresses our love for what we have by sharing and not hoarding. Sharing is best when it’s unconditional, as is love, and if that looks like enabling, well, I guess I’m okay with that.

    In the end what I share is freely given and my needs are met. I’m not looking for platitudes, but an appreciative “thank you” is always welcome since that can be your gratitude. What you receive and what effect that has is all on you. You choose how to apply the help someone gives you. I can be free of the burden of expectation or false hope. In the end did I enable you? That’s not for me to judge, is it?

    View the original article at thefix.com

  • Should You Breastfeed Your Baby If You're on Methadone?

    Should You Breastfeed Your Baby If You're on Methadone?

    My daughter was born with neonatal abstinence syndrome but I was not allowed to nurse or have her in the room with me; the hospital staff said the methadone in my breast milk could be dangerous. They were wrong.

    Earlier this summer several news outlets reported on the death of an 11-week-old infant in Philadelphia by what appeared to be a drug overdose. The mother, who has been charged with criminal homicide, blamed the drug exposure on her breast milk. Although an autopsy revealed that the infant’s drug exposure also included amphetamine and methamphetamine, many news outlets chose to focus on the fact that the mother was a methadone patient. The death of an infant by drug exposure is unquestionably terrible; unfortunately, misleading articles make what is already a tragedy even worse by insinuating or directly stating that the methadone content in the breast milk was involved in the infant’s death.

    Stigma around methadone use in the United States has a long shadow. Prescribed primarily to treat opioid use disorder (but also sometimes for pain management), methadone is a long acting opioid that builds in the patient’s bloodstream to create a stable, non-euphoric equilibrium when used correctly. It is a highly effective form of both addiction treatment and harm reduction, shown to reduce overdose deaths by 50% or more. Unlike short acting opioids like heroin or morphine, methadone prevents patients from experiencing the physical chaos of sedation and withdrawal, and can help re-balance neurochemical changes that take place during active addiction. For decades, methadone has been considered the gold standard of treatment for opioid use disorder, including during and after pregnancy.

    But in spite of the demonstrated benefits of methadone and its pharmacological differences from commonly misused opioids, it has, for many years, acquired a popular status as “legal heroin.” Social media is flooded with memes mocking methadone patients or complaining that they don’t deserve “free methadone” when other drugs cost money (in fact, methadone has a price tag like any other medication). Even other people in recovery or the throes of active addiction disparage methadone, sometimes referring to it as “liquid handcuffs” because of the stringent regulations requiring daily trips to a clinic during the first several months of treatment.

    This stigma leaks into every aspect of patient care. For me, it prevented me from seeking treatment for years. I was terrified to get on methadone. Who would volunteer to be “handcuffed” by a treatment system? But when I learned I was pregnant, my doctors urged me to get on methadone. They said that attempting to withdraw from heroin would be dangerous for my developing baby, and continuing to use would be even riskier.

    I was reluctant, but I enrolled in a methadone maintenance program as my doctors advised. Because of that, I had a healthy, full-term pregnancy. But at the Florida-based hospital where my daughter was taken after a speedy, unplanned home birth, I was not allowed to breastfeed. My daughter suffered neonatal abstinence syndrome (NAS), a condition caused by opioid withdrawal that occurs in some babies whose mothers used methadone or other opioids while pregnant; she was dosed with morphine to wean her down from the methadone she received in utero, and the hospital staff told me that adding my methadone dose via breast milk could be dangerous. Because of that, my milk production dwindled, and my daughter—who stayed in the hospital over a month—never learned to properly latch. After she came home, she suffered colic, constipation, and sleep disturbances as we worked through various formulas trying to find one that was gentle on her stomach.

    But these negative ideas about methadone distribution in breast milk are flat out wrong. We know that methadone is a highly potent, long-acting opioid that is extremely dangerous if given to infants and children directly. No amount of methadone syrup should be administered to an infant or child by a parent or caregiver without physician approval. But studies have demonstrated that the amount of methadone that gets passed into breast milk is negligible, and will not harm an infant, even a newborn. A 2007 study of methadone-maintained mothers in addiction recovery found that methadone concentrations in breast milk remained minimal in the first four days postpartum, regardless of maternal dose, time of day after dosing, and type of breast milk being expressed. The daily amount of methadone ingestible by the infants did not rise above .09 mg per day. To help prevent even that slight fluctuation, John McCarthy, a practicing and teaching psychiatrist who has treated opioid-dependent pregnant and postpartum women for over 40 years, suggests splitting nursing mothers’ methadone doses in two—a measure that should have begun during pregnancy to help minimize the risk of NAS. “It’s not dangerous to nurse on a once a day dose, but it’s not the best way to give the medication. The baby should be given a smooth level of methadone.”

    Some people believe that breastfeeding an infant with NAS while on methadone will help decrease withdrawal symptoms by providing a minute amount of the same drug from which the infant is withdrawing. According to experts like Jana Burson, a doctor specializing in the treatment of opioid addiction, this belief is also false: “some mothers erroneously think their babies won’t withdraw if they breastfeed—that’s wrong. There’s not enough methadone in the breast milk to treat NAS.” Of course, breastfeeding a child who experiences NAS is beneficial, both because of the health benefits of breast milk, and because maternal contact is important for babies in distress. “Breastfeeding will help in the general sense that babies like to breastfeed and it’s calming, but not because babies are getting methadone in the breast milk.”

    Sandi C., a methadone-maintained mother based out of Massachusetts, breastfed her son for two and a half years, and plans on breastfeeding the baby she is currently expecting. Like me, Sandi was addicted to heroin when she learned she was pregnant. She began on buprenorphine, a partial-opioid agonist used similarly to methadone, and switched to methadone partway through her pregnancy. But her postnatal experience was different than mine.

    “I’m really fortunate that my area is really encouraging of breastfeeding,” says Sandi. “Actually, I wasn’t sure if I could breastfeed and [my doctor] said ‘definitely breastfeed, we encourage it.’” Like my daughter, Sandi’s son was diagnosed with NAS. But instead of being sent to the Neonatal Intensive Care Unit (NICU), her son was allowed to be in the hospital room with her, where Sandi could hold and breastfeed him as much as he needed. Her son was released after just two weeks, less than half the time my daughter spent in the NICU at our hospital in Florida. She continued to breastfeed at home until he was over two years old.

    “He never got sedated,” she recalls. “Everything was fine.”

    Just because methadone is safe for breastfeeding moms doesn’t mean the same is true for other drugs. If the Philadelphia baby’s death was in fact caused by what many outlets have called “drug-laced breast milk,” it would have been due to the amphetamines, not the methadone. Methamphetamine breast milk exposure has not been studied as extensively as methadone, but current recommendations are that lactating women should wait 48 hours after their last use of methamphetamine before resuming breastfeeding. Experts like Burson and McCarthy agree that mothers on methadone maintenance who are not using other substances can safely breastfeed. “All of the major medical groups recommend it,” Burson said, adding, “even on higher doses they all recommend that mothers on methadone breastfeed.”

    View the original article at thefix.com

  • Let’s Get Real: How To Handle the Tough Stuff in Recovery Without Using

    Let’s Get Real: How To Handle the Tough Stuff in Recovery Without Using

    Of course, people had good reason to think that I couldn’t handle upsetting news. Every time a hardship, breakup, or something unsettling happened, I wound up in the psych ward, detox, ER, or a bloody, tear-filled mess.

    When I was drinking, I was the girl who took pulls of rail vodka right from the bottle. I took it straight, no chaser. Others looked at me with a mixture of surprise and disgust. Girls were supposed to mix their vodka with fruit juice or soda. Girls weren’t supposed to out-drink the men or keep straight razors in their wallet for chopping up fat lines. Fellow drunks patted me on the back. I was one of them. I embraced my heavy drinking as a point of pride, wore it like a badge of honor.

    But the point of this isn’t to share my war stories or act like I was the most bad ass alcoholic or junkie to ever haunt the planet. Rather, I want to share how I still prefer to apply the “straight, no chaser” motto to other areas of my life. I prefer when loved ones are straightforward, blunt, and honest with me about tough stuff and hardship rather than trying to gloss over the truth or protect me from pain. Even though I have been in recovery for years, some of my loved ones have continued to worry that I will relapse upon hearing bad or heartbreaking news, as though I was some sort of wounded dove with the word “fragile” stamped on my forehead.

    Of course, they had good reason to think that I couldn’t handle upsetting news. Every time a hardship, breakup, or something unsettling in my life happened, I wound up in the psych ward, detox, ER, or a bloody, tear-filled mess. I categorized people as either “normies” or “addicts and crazies” because it was easier than embracing the messy complexity of human beings. In my mind I was broken. Normal people went to the gym, spa, or the mall when they were troubled. But those options didn’t work quickly enough to soothe my mercurial temperament and smooth my edges. I labeled myself as a crazy addict, so I went straight to the liquor store or to the organic grocery store (ironically this was where my dealers were, standing outside with signs reading: “needs money, anything helps”).

    If you’re someone who struggles with addiction, you understand this self-destructive pattern. It’s hard to deal with “life on life’s terms,” as they say in the program. When stressful life events happen, we often turn to our familiar coping mechanisms. In fact, the National Institute of Drug Abuse found that up to 60 percent of people relapse within their first year of recovery. 

    There is a constellation of reasons that people relapse. Studies have found that being exposed to stresses that originally caused someone to excessively drink or use drugs is a major trigger for relapse. Another study found that patients with alcohol and opioid dependence were most likely to relapse when they had a family history of substance use and high number of relapses, used maladaptive coping strategies, and also had “undesirable life events.”

    I can relate as I had my share of undesirable life events this past year. Even though I’ve been clean for a few years, I still felt a massive urge to use after hearing about the death of my god-daughter and, on a less serious note, a heartbreaking romantic let-down.

    These events were handled very differently. The morning after my god-daughter died, my mom called and told me the tragic news. She wanted to make sure I heard it from her directly rather than passively finding out about the death on social media. Although this was devastating news, I appreciated that she was direct and real with me.

    What really triggered my cravings was ambiguity and a romantic disappointment. Although we broke up a few years ago after I relapsed, I still consider my ex one of my best friends. We text every single day and I even stayed with him for five days when I was visiting Portland in December. He let me sleep in his bed while he slept on the couch. Wrapping myself in his blankets, I was comforted by his familiar smell of Camel cigarettes and Old Spice. Although the visit was platonic, there were moments when I felt a possible rekindling of our romantic relationship.

    He paid for all my meals, opened doors to restaurants, and even took me to the Oregon Museum of Mental Health in Salem where I researched an essay. Okay, maybe going to a museum of mental health isn’t exactly a hot date, but the fact that he was willing to take me felt positive. He also talked about taking a road trip together in his new BMW coupe, laughing at how when we had been together he drove a Buick and we barely made ends meet. I reminded myself that my intention for this visit was to make amends in person for spinning him in my addictive chaotic orbit and leaving him in the wreckage of our relationship. Yet I still got my hopes up that we would get back together and I wrote him a long letter proclaiming my feelings for him.

    He never responded. He faded away from me, and his texts became infrequent and vague. He said that he was busy and stressed with work. Finally, he admitted to our mutual friend that he had a girlfriend but was afraid to tell me because I was “constantly on the verge of suicide” and he was worried about relapse.

    I was crushed, but at the same time I sort of understood his perspective. He knew the story of my old self. I had shown him in the past that I couldn’t handle such rejection or disappointment.

    So how do we deal with the tough stuff in recovery? Amanda Decker, a Licensed Addiction Counselor (LAC) and Licensed Professional Counselor (LPC) in Fargo, North Dakota, explained: “There will be growing pains throughout the ebb and flow of recovery. It’s hard knowing how to deal with life without drugs or alcohol but it’s helpful to remember that perspective shifts over time. It also helps to develop hobbies and interests. When people in recovery can embrace these things, drugs and alcohol become white noise in the background.”

    Decker suggested developing a “pre-emptive” relapse prevention plan by thinking about how to handle life stressors without alcohol or drugs. If we are in the position of telling difficult or uncomfortable news to a family member or friend who is in recovery, Decker advises: “As an addiction counselor, I’ve had to tell my group about a fellow group member who has overdosed. The first thing I did was to be direct and be present with my group members who were struggling in that moment. There will be a lot of grief and sadness that we have to learn to cope with.”

    The truth is that hardship, tragedy, and disappointment are parts of life that we have to learn how to come to terms with in recovery. We have to start embracing and seeing the shades of wellness and addiction rather than labeling things “normal” or “crazy.” It’s hard to tell a different story about ourselves, it’s even harder to break the story that others have about us. But I have faith in myself and I have faith in you, my fellow humans in recovery. For we are resilient, brave survivors, not fragile wounded doves.

    View the original article at thefix.com

  • My Journey from AA to NA, with Stops Along the Way

    My Journey from AA to NA, with Stops Along the Way

    While making my own transition from one fellowship to another, I interviewed people with experience in both AA and NA to find out what’s working for them, and what’s not.

    For a long time, I considered myself an alcoholic with drug addict tendencies. This is why, for the most part, I was a member of AA exclusively for the first six years of my sobriety. Besides, where I lived in Connecticut at the time, Narcotics Anonymous meetings were too far and few in between – as is often the case in more rural areas of the country.

    Also, while in AA I’d heard things about that other fellowship.

    Yes, I was fine right where I was, thank you very much. Like my mother and my uncles and my grandfather before me, AA would remain my easier, softer way til death do us part.

    And then I relapsed: a year and a half bender in which my disease had progressed to include cocaine and prescription pills and after which I was detoxing from alcohol and benzos.

    That’s when the rooms of recovery turned strangely uncomfortable.

    I can’t say it was because I was no longer welcome. No, my mutual friends of Bill were there with open arms when I came back from the relapse… As long as I didn’t share openly about the drug problem.

    “I came to an Alcoholics Anonymous meeting,” an old-timer quickly informed me, “because this is where I come to hear about alcohol – not pills!”

    This got me to thinking. (Not about the chapter in AA’s Big Book entitled Acceptance Was the Answer in which an alcoholic physician describes in painstaking detail his struggles with prescription pills. No, why would I think of that? The old-timer certainly wasn’t.) 

    No, I was thinking I ought to give Narcotics Anonymous a try for a while. Not only would I be able to share more candidly about my relapse but I’d have some time to work through the little resentment I’d suddenly copped against AA and its old timers.

    So, I began asking around. I knew the best way to transition between fellowships was to look to the rooms themselves for advice and guidance. I found four people in recovery, each of them knowledgeable about both AA and NA, who were willing to share their experience not only with me – but with you as well.

    About the Personalities:

    “I had been in AA for 11 years and just kept relapsing,” recalled Christy, 45, from the San Francisco Bay Area. Hers was a vicious cycle of diet pills and wine, always using one to offset the other. “I was sure that people were sick of hearing me talk about how I just couldn’t get it. Well I was sick of talking about it, anyway, at least to the same people again and again. It was embarrassing.”

     Taking the advice of her husband – a former amphetamine addict of 15 years – Christy decided to give NA a try.

    The kinship she felt was immediate, not only because she felt able to share more freely in a room full of new faces, but also because “NA’s a little bit ‘roughie-toughie’ and I liked that. NA had more people with missing teeth,” she joked. “There were so many people just totally out of their minds – exactly like me – and everyone seemed ok with it.”

    Three years later, Christy’s bond with NA is stronger than ever.

    “I find myself spiritually connected to that craziness,” she said. “There’s stories of abuse, there’s sharing about the prison time. It helps keep my recovery feel fresh. NA reminds me of how bad it can get out there.”

    For Johnny L., 39, from New England, the NA group in his area had a more adverse effect.

    “Well there I was, a newly clean and sober gay white man in a heavily black, heterosexual, inner city NA meeting,” he laughed. “I really gave it a shot, too, but after about three or four meetings I still wasn’t relating at all.”

    Thankfully Johnny found himself having to move for work to a more rural area within that first year of recovery and along with the change of geography came a new atmosphere within his meetings. Though he considered himself dually addicted (meth and drinking), Johnny ultimately settled into the rooms of AA, finding the comfort of a home group he’s still part of to this day.

    Back in California, Trey S., a 22-year-old addict, compared the members of fellowships like this: “NA is definitely more of a mixed crowd. There’s a lot of diversity, incorporating more experiences with much heavier drugs, and I think there could be stronger personalities in the rooms because of that. This means a lot more opportunities for conflict.”

    As is so often the case with young people with substance use disorders, Trey was introduced to Alcoholics Anonymous through a rehabilitation center at the age of 16. He eventually gravitated towards NA, identifying more strongly with those rooms, particularly young people’s meetings.

    “At the time AA felt more rigorous and less free-flowing. And I think in general NA attracts a younger recovery crowd, which makes sense because of the pill problem these days. I mean, I was on Adderall at 5 years old and I think that’s fairly common for my generation.”

    As for the old-timers, like Red from the West Coast who has been a member of AA for over three decades, it’s often their job to remind us of that tried-and-true adage, principles before personalities, regardless of the fellowship.

    “Whether it’s AA or NA, as long as you’re living your life according to a program of spiritual principles you’ll do okay,” he told me. “It doesn’t matter what gets you into the rooms, but what you do with yourself once you get here.”

    About the Literature

    Of course, changing recovery programs also means a change in the accompanying literature. After six years of study groups, sponsor assignments, and constant references to the Big Book, I had developed a deep appreciation for AA’s “bible” and was hesitant about NA’s basic text as well as the rest of the program’s literary canon. 

    “So many people claim that all the answers are in the Big Book,” said Christy. “But Living Clean – it seems like every time I pick it up, whatever I read feels like it was written just for me.”

    Living Clean is NA’s version of AA’s book, Living Sober, and both address the nitty gritty of living in recovery. Like instruction manuals for the soul and mind of an addict, both publications offer insights on topics such as relationships, aging, failure, and isolation.

    I quickly learned that my AA books had NA counterparts that were just as valuable and respected. 

    According to Trey, “Even though AA’s literature has more program history, it has more character. It actually feels more playful to me – while NA’s stuff strikes me as much more serious.”

    But when Trey does his step work, he combines the books of both fellowships, studying all the information each program has to offer. “They each bring their own material to the table and all of it is important.”

    “But the NA basic text is so much more international,” Johnny told me. “It feels all-inclusive. Through it I get an idea of what it’s like to be an addict in Iran, in Africa, all around the world. It makes the Big Book feel very old. Like an older language.”

    When it comes to step work, Johnny also works with the writings of both fellowships, first reading what the Big Book and Twelve and Twelve lay out and then hitting the NA’s Step Working Guide afterwards.

    This workbook is the most significant difference in program offerings.

    “That thing makes you feel like you’re in a Master Class for sobriety,” Johnny claimed. “It challenges you to think things through more deeply.”

    Finding that the Guide has become such a big part of his recovery, Johnny has begun searching for a new AA sponsor who would be willing to integrate the book and its myriad of intensely provoking questions into his program; a sort of AA/NA fusion.

    Christy felt just as strongly about the Step Working Guide:

    “Going through it reminds me of the kind of effort I put into my recovery at the very beginning,” she said. “My self-awareness is much higher because of it. And I’m sure my recovery is evolving more strongly as well.”

    Like Johnny, Christy found that mixing and matching materials gave her a more balanced and satisfying program. In fact, while Christy’s primary fellowship was NA, she continued to go to one weekly AA meeting.

    As for Johnny, his six meetings a week were equally split between AA and NA (Crystal Meth Anonymous, more specifically).

    Trey was the purist of those I’d talked to, attending only NA meetings.

    At this point in the conversations, I felt ready to start altering my own meeting schedule. Thoroughly advised on what to expect, I was excited to head over to NA and start sharing from the heart again.

    But first I would have to learn how to talk.

    About the Language

    “We are presented with a dilemma; when NA members identify themselves as addicts and alcoholics or talk about living clean and sober, the clarity of the NA message is blurred.”

    From NA’s Clarity Statement, read out loud at a meeting’s start. The gist of the announcement, from what I could gather, was that I was to no longer call myself an alcoholic because: “Our identification as addicts is all-inclusive.”  

    And all I could think was, Here I go again.

    “I was stopped mid-sentence at an NA meeting when I tried talking about the Promises,” said Johnny, referring to AA’s 9th step list of spiritual and material rewards. “I was disappointed in that. It was embarrassing and awkward. I wound up never going back to that particular meeting.”

    Of course, censorship within the rooms goes both ways:

    “I once saw someone completely shut down in AA when he mentioned his struggle with crystal meth,” Trey told me. “The chairperson interrupted him, saying, ‘Sorry, we don’t talk about that here.’”

    That chairperson had been acting in accordance with the Singleness of Purpose, AA’s version of the Clarity Statement: “We ask that when discussing our problems, we confine ourselves to those problems as they relate to alcohol and alcoholism.” Remember the scolding I’d received from the old-timer when talking about the pills?

    “In my first year of sobriety I was going to all the A’s – AA, NA, CA (Cocaine Anonymous),” joked old-timer Red. “I found out real quick that I couldn’t say this or I couldn’t say that, depending on where I went. In NA I couldn’t claim I was an alcoholic, and vice versa in AA and on and on and on. I don’t know about you but in the beginning I just wanted to say what I needed to say in order to get better!”

    Trey agreed. “Sometimes you can feel negativity in the air when the Clarity Statement is read. I worry it stops people from speaking from the heart. I mean, as long as they’re sharing about appropriate behaviors and it’s coming from a loving and caring place, that’s great.”

    About Recovery

    As I compiled all my notes, the quotes and information, I was relieved to find an absence of what I’d feared most. Nowhere in my talks with these four fellow people in recovery did I find any negativity or slander from one fellowship against the other.

    “I’ve always been aware of the contention between AA and NA,” Johnny had told me, “but I’ve been lucky to stay out of it. The groups I go to are small and intimate and I don’t have to hide whatever I may be struggling with, alcohol or drugs. They’re very supportive regardless.”

    Christy agrees: “I can say that both AA and NA are responsible for saving my life and I gladly still participate in both.”

    With Trey, one of the things he’d always admired most about NA is how the program openly acknowledged its roots. “Right on the first page of the introduction of the basic text, Narcotics Anonymous expresses gratitude towards AA for‘showing us the way to a new life.’”

    Yes, by the end of my inquiries it was clear that the fellowships of AA and NA can work together well, with a combined effort and goal of unity, service, and recovery.

    View the original article at thefix.com

  • Dopesick: An Interview with Beth Macy

    Dopesick: An Interview with Beth Macy

    It takes the average user eight years and five to six treatment attempts just to achieve one year of sobriety. And in an era of fentanyl and other even stronger synthetic opioids, many users don’t have eight years.

    As recently as a few years ago, the opioid crisis could be referred to as a “silent epidemic,” perhaps in part due to its degrading nature. Opioid addiction is frequently described using metaphors of slavery, or enslavement, and those within its clutches are liable to feel acutely ashamed. No longer, however, is it possible to argue that the scourge of opioid addiction is being overlooked.

    No doubt that is partly due to the growing enormity of the problem. For each of the past several years, more people have died from drug overdoses than American service members were killed during the entire Vietnam War.

    Meanwhile, energetic and compassionate journalists have been doing outstanding work, covering the crisis from various vantages. Chief among them is Beth Macy, a New York Times-bestselling author, who first began noticing the effects of opioid addiction as a reporter for the Roanoke Times, where she worked for 25 years until 2014. Now she is out with Dopesick: Dealers, Doctors, and the Drug Company That Addicted America. Gracefully written and deeply reported, Dopesick should act as a vade mecum — a handbook, a guide, an essential introduction — for anyone who may be seeking insight into the deadliest and most vexing drug epidemic in American history. 

    Beth spoke to The Fix over email:

    The Fix: The first chapters of your book, on the origins of the opioid crisis, cover some material that others have explored (most notably Barry Meier, in Pain Killer: An Empire of Deceit and the Origin of America’s Opioid Epidemic). Still, I don’t have the sense that many people are aware of the role that Purdue Pharma played in setting off current epidemic. Briefly, what is their culpability? And why do think their crimes aren’t crimes better known? 

    Beth Macy: I think Meier’s book, Pain Killer, was too early, initially published in 2003, and it was largely set in central Appalachia — a politically unimportant place. Also, let’s not overlook the role that Purdue took in stifling Meier. As I write in the book, company officials had him removed from the beat after his book came out, arguing that he now had a financial stake in making Purdue look bad.

    After the 2007 plea agreement, in which the company’s holding company, Purdue Frederick, pled guilty to criminal misbranding charges and its top three executives to misdemeanor versions of that crime, Purdue and other opioid makers and distributors spent 900 million dollars on political lobbying and campaigns. Purdue continued selling the original OxyContin formula until it was reformulated to be abuse-resistant in 2010, continued for years after that pushing the motion that untreated pain was really the epidemic that Americans should be concerned about. Their culpability in seeding this epidemic is huge.

    You weren’t able to talk directly with any of the Purdue executives who made fortunes from OxyContin, and who criminally misled the public about its addictive potential. But you spent an afternoon interviewing Ronnie Jones, who is currently serving a lengthy prison sentence for running a major heroin distribution operation in West Virginia. How were Jones’s crimes (and his rationalizations for his behavior) different from those of the Purdue executives you wrote about?

    Great question. Jones refused to see that he brought bulk heroin to a rural community in ways that overwhelmed families and first responders in the region with heroin addiction; he told me he believed he was providing a service — his heroin did not have fentanyl in it, he argued, and it was cheaper than when people ran up the heroin highway to get it in Baltimore (and safer because they could stay out of high-crime places).

    At the 2007 sentencing hearing, Purdue executives and their lawyers repeatedly claimed they had no knowledge of crimes that were happening several rungs down the ladder from them; that the government had not proved their culpability in the specific crimes. According to new Justice Department documents unearthed and recently published by The New York Times , that was simply not true. For two decades, Purdue leaders blamed the users for misusing their drug; they refused to accept responsibility for criminal misbranding that resulted in widespread addiction and waves of drug-fueled crime that will be felt in communities and families for generations to come.

    You quote a health care professional who said that previous drug epidemics began waning after enough people finally got the message: “Don’t mess with this shit, not even a little bit.” That provoked a thought: Shouldn’t we be long past this point with opioids? On the one hand, I’m enormously sympathetic to anyone who is struggling with addiction. But it’s frustrating to realize that the opioid crisis is still building. Why aren’t more people as risk-averse about heroin as they obviously should be?

    The crisis is still building because the government’s response to it has largely been impotent. And it’s been festering for two decades. Opioid addiction doesn’t just go away. It takes the average user eight years and five to six treatment attempts just to achieve one year of sobriety. And in an era of fentanyl and other even stronger synthetic opioids, many users don’t have eight years. I hope we will soon get to the point of public education where no young person “messes with this shit, not even once,” but right now we still have 2.6 million people with opioid use disorder. Even though physicians have begun prescribing less, we still have all these addicted people who should be seen as patients worthy of medical care, not simply criminals. Too often that doesn’t happen until we’re sitting in their funeral pews.

    One of the women you write about, Tess Henry, slid down a long road. You got to know her and her family quite well, over a number of years. And some of the other stories in this book are just as heartbreaking.

    It was a lot of pain to absorb and process, yes. And yet my heartache was nothing at all compared to what these families are going through.

    In a couple instances, Tess reached out to you directly, asking you for help. How did you calculate how to respond?

    I took it case by case; I just went with my gut, and I got input from my husband and trusted friends along the way. I decided it was okay to drive Tess around to [Narcotics Anonymous] meetings, recording our interviews as I drove, with her permission. But it wasn’t okay when she texted me late one night to come get her from a drug house. (I referred her plea to her mother and recovery coach instead.)

    I occasionally gave her mother unsolicited advice because I cared about her and I cared about Tess, and I felt I had access to objective information about medication-assisted treatment that Patricia didn’t have. When Tess was murdered on Christmas Eve, I put my notes away and for several days just focused on being a friend to her mom. But I did accompany the family to the funeral home when they made arrangements (taking occasional notes), and I was there in the room of the funeral parlor with her mom and her grandfather when they said goodbye to her. It took funeral technicians two days to prepare her body for that. It was the most heartbreaking scene I’ve ever witnessed. There was no need to take notes in that moment. I will never forget it as long as I live. I said a tearful goodbye to our poet, too.

    Was there ever a risk, over the course of your reporting, of becoming too involved in the lives and predicaments of the people you were writing about? 

    Always there’s a risk, but I’ve been doing this for more than 30 years now, and I know that my greatest skill — which is that I get close to people — can also be my Achilles. When I trust my gut and try to do the right thing — always also getting advice from editor and reporter friends along the way, including my husband, who is just so smart and so spot-on always — it usually works out.

    I’m grateful to have read Dopesick. But at various times it left me infuriated, appalled, and depressed. Can you leave us with anything to be hopeful about? 

    There are some pretty heartening grassroots efforts that I spotlight at the book’s end, mostly involving providing access to treatment and harm-reduction services. And Virginia just became the 33rd state to approve Medicaid under the Affordable Care Act, which will help 300,000 to 400,000 people in the commonwealth have access to substance use disorder services. Seventeen more states to go! There is so much more work to be done, especially in Appalachia, where overdose deaths are highest and resistance to harm reduction programs (easy-access MAT and syringe exchange and recovery) can be severe. My goal is that Dopesick not only educates people but also mobilizes them to care and create what Tess Henry called “urgent care for the addicted” services in their own hometowns.

    View the original article at thefix.com

  • Real Housewives of Recovery: Reality TV and Addiction

    Real Housewives of Recovery: Reality TV and Addiction

    It is no secret that alcohol is readily available on set while filming these shows to grease the wheels of conflict, and not everyone who drinks alcohol misuses it.

    When I got sober, I started watching reality television like it was my job. The mindless escapism helped me fill the stretch of evening hours that I would have otherwise spent at a bar or at home with bottles of wine. I had my go-tos: Real Housewives, Southern Charm, Teen Mom. I was content to enjoy the alcohol-fueled drama, the table-flipping, and the manufactured cat fights from the sober safety of my couch.

    But as drunken fights frequently become the central conflict between cast members—like the cake throwing incident on last season’s Real Housewives of New Jersey—I noticed a new storyline making its way into the shows: recovery. And lately, I’ve been able to find the whole life cycle of addiction and recovery on reality TV.

    But are these accurate and helpful portrayals of addiction and recovery?

    Dorinda Medley from Real Housewives of New York City slurs her way through dinners and ends the night in ashamed and guilty tears. Luann de Lesseps returned to the show this season fresh from rehab after a drunken arrest, but still keeps wine in her fridge. Kathryn Dennis of Southern Charm is most evolved: back from rehab, she lovingly mothers her young children, keeps her cool when faced with typical reality show-style attacks, and, most inspiringly, speaks honestly about her struggles with anxiety and depression.

    The appearance of these storylines in this kind of reality show is a new phenomenon. When Sonja Morgan of the Real Housewives of New York City quietly cut back on drinking, she casually mentioned that she was “trying something new,” in a blink-and-you-missed-it moment during a confessional. The drama factor in her storyline went down to nothing. She was calm, reasonable, collected; it all went mostly uncommented on by her castmates. As a recovering alcoholic, I was disappointed this wasn’t a point of discussion on the show, especially because taking a step back from alcohol was having such a positive effect on Morgan. Here was an opportunity to talk about the very real and negative effects of alcohol use disorder and emphasize the positives Morgan was experiencing as a result of abstaining, even if not entirely. 

    Jenelle Evans’ drug use in Teen Mom 2 was impossible to ignore because it was documented on camera for the show in 2013. But any recovery or treatment Evans may have had never made its way to the small screen. In recent seasons, her past drug use is never even acknowledged. Susanna, who asked that we only use her first name, is a 32-year-old public health and substance abuse professional in Denver, Colorado. Based on her knowledge of people in recovery from opioid addiction, she thinks it is “highly unlikely” Evans’ use disorder could go untreated. By not acknowledging her possible treatment, MTV paints an unrealistic picture of addiction and recovery. Susanna says that “as the viewer, we have no insight into [whether or not Evans is in recovery] since it is excluded from the story line. We therefore assume she is not addressing her substance use disorder.”

    Susanna also finds fault with how the ancillary characters dealing with addiction are represented on the franchise. Adam Lind, the father to former teen mom Chelsea DeBoer’s daughter Aubree, is never filmed. But the negative talk from on-air cast members surrounding his drug disorder, Susanna says, “only further stigmatizes addiction…and does little to raise awareness about substance use disorders.”

    Are shows like Celebrity Rehab and Intervention, where addiction and recovery is the focus, doing any better? Not according to Molly Smith, 24, in long-term recovery for alcohol use disorder. Smith used to watch the show Intervention but says that it had little impact on her getting help because she feels it presented a “narrow view of what addiction looks like.” It was so narrow, she said, that “Years later, when I began struggling with substance use, I had a hard time recognizing that I had a problem because I didn’t fit the narrative I witnessed on that show.”

    The homogeneous representation of addiction Smith saw is likely due to the selection process of shows like Intervention. People familiar with the casting (who have asked to remain anonymous) speak of a thorough vetting process to ensure that the treatment the show is offering is the right fit for the individual, and that being filmed (and other show-related variables) won’t interfere with their ability to successfully participate in that treatment. The storylines appear to have a lot in common because the people involved all meet the same specific criteria. Other viewers have reported seeking help after recognizing themselves in the people featured in these shows. And, unlike a lot of other reality television vehicles, the behind-the-scenes goal of these shows is successful treatment, not drunk drama. 

    When Kathryn Dennis of Southern Charm met the much older Thomas Ravenel, there was plenty of drunken drama between the two of them as well as between Dennis and her other castmates. She is now the mother of two and has completed multiple stints in rehab. In the recently-completed fifth season of the show, Dennis is sober and drama-free. In fact, Dennis was doing so well that she felt like she didn’t need her depression-treating medication anymore. But when she stopped taking her meds for a week, she ended up missing in action, to her castmates’ great concern. After resurfacing, she opened up to them about her struggles with depression. 

    Dianna Jaynes, a licensed marriage and family therapist in Eagle Rock, California, whose patients include people in recovery from drug and alcohol use disorder says that there is “evidence of [Dennis’s] recovery through her behavior.” This is unlike Luann de Lesseps, where real recovery “is not being portrayed at all.” 

    The arrest and widely-viewed police video last year of a combative and intoxicated de Lesseps forced the conversation about sobriety into her storyline as she returned to the show from rehab. As she told People magazine last month: “This was a warning….I’m grateful to the universe for making me change my life.”

    But her recent return to rehab suggests that Jaynes may have been right: perhaps de Lesseps wasn’t fully committed to recovery. Unlike with Kathryn Dennis, “we haven’t had the gift of time with Luann.”

    This season of Real Housewives of New York City ended with a very poignant argument between Medley and de Lesseps that perfectly encapsulates the bizarreness of this pseudo-reality world, where a sober de Lesseps suggests to a drunk Medley that she is “turning,” as in, having too much to drink and going to the dark side. Medley explodes and the rift between them continues for the remaining four episodes. Medley continues to dig in her heels to the point of ridiculousness. She has even claimed on the recently aired reunion episode of the show, which de Lesseps could not attend because had re-entered rehab, that she wasn’t drunk on the night of the fight with de Lesseps. The other castmates float in and out, at times willing to call Medley on her problem but in the next breath saying that no one on the show has an issue and they all drink a little too much sometimes.

    It is no secret that alcohol is readily available on set while filming these shows to grease the wheels of conflict, and not everyone who drinks alcohol misuses it. But in cases like Medley’s, where there clearly is a problem that she’s unwilling to face, these programs have as much opportunity to direct the narrative towards reducing the stigma as they do to incite drama. As one viewer in Denver, Colorado points out, the cast members on these shows have huge social media followings with “influential platforms that could be used for good to promote recovery.”

    Dorri Olds, 56, is a writer who began using at age 11 and whose idols included Jimi Hendrix and Janis Joplin, both stars who died of drug overdoses. She has been in recovery for 30 years, and thinks that recovery in reality television is a good thing. A former viewer of Celebrity Rehab, Olds has wondered, “what if somebody back then that I looked up to…had gone into recovery?” Olds also points out that “when you’re really that low, and you want to get high, I don’t think anybody’s going to stop you.”

    I agree with Molly Smith, who thinks “it is crucial to see more people in recovery on television, but their stories need to be shared in a multidimensional way to break stigma.” The more the stories are shown, in all of their various stages and forms of recovery, the more recognizable they will become to those who need it the most.

    View the original article at thefix.com

  • Pawn Stars: The Opioid Edition

    Pawn Stars: The Opioid Edition

    If you are at risk for overdose or use needles to shoot up drugs, come see Brandi and she’ll take care of you – no frills, no questions, no judgment.

    On a cold November morning in 2015, Brandi Tanner and her husband stopped to pick up their 10-year-old niece from her grandmother’s house.

    “Grandma’s sleeping funny,” said the little girl when they came to the door. She wasn’t dressed for school, as she usually would be at this time of morning. Concerned, Tanner and her husband stepped into the house and headed for his mother’s bedroom. They knocked on the door, but no one answered. Glancing at each other with wide eyes, they swung open the door. Grandma had rolled off the bed and her body was wedged between the dresser and the nightstand. She wasn’t breathing.

    “I didn’t really have time to process that she was dead,” says Tanner. “The only thing I could think was ‘Damn, I need to call people. I need get the family out of the house so the police can take pictures.’”

    Tanner’s mother-in-law had died of an opioid overdose, an increasingly common cause of death in Vance County, North Carolina. Tanner herself had previously struggled with dependence on opioids and though the years she’d seen the prevalence of addiction rise in her community.

    “It was so hard to see my husband lose his mother,” she says. “I wanted to do something to help him and other people, but I didn’t know what to do.”

    About a month after her mother-in-law’s death, Tanner was working at a pawn shop where she had been employed for several years. It was right before closing and she was tired. Every day people came into the shop to sell items in order to buy opioids. And it seemed like every week she received news of someone else who had lost a family member. She had just started to shut down the register when a tall stranger strode into the shop.

    “There were other employees in the store but he headed straight for me like he knew I was the one who needed him,” Tanner recalls. “He walked up and asked if I wanted to help save lives from overdose. I was like, hell yeah. Where do I sign up?”

    The tall stranger was Loftin Wilson, an outreach worker with the North Carolina Harm Reduction Coalition, a statewide nonprofit that works to reduce death and disease among people impacted by drugs. That year, the organization had received a federal grant to prevent overdose death in Vance County in partnership with the Granville-Vance District Health Department. Over the past few years, the two agencies have worked closely to increase access to harm reduction services and medication-assisted treatment in Vance County.

    Vance is a rural community of fewer than 50,000 people. Driving through, one can’t help but notice large, pillared villas adjacent to dilapidated trailer parks, a scene that amidst acres of yellowing tobacco fields is reminiscent of plantations and slave quarters. In Vance County, a quarter of the population lives below the poverty line and addiction has flourished. From 2008-2013 Vance had the highest rate of heroin overdose deaths in the state: 4.9 residents per 100,000 compared to the state average of 1.0 per 100,000 (NC Injury Violence Prevention Surveillance Data). But those were sunnier days. By 2016, the heroin overdose rate for Vance County had jumped to 11.2 per 100,000. In 2017, based on provisional data, it was 24.2 per 100,000 (NC Office of Medical Examiners) and 2018 is already shaping up to be the deadliest year yet.

    The chance meeting between Wilson and Tanner at the pawn shop proved to be pivotal to outreach efforts in Vance County. Wilson had years of overdose prevention experience in a neighboring county, Durham, but Tanner knew her community and everyone in it. The two teamed up and began reaching out to people in need. Driving around in Wilson’s rattling pick-up, they visited the homes of people at risk for opioid overdose to distribute naloxone kits.

    The following summer, the North Carolina General Assembly legalized syringe exchange programs, and Wilson and Tanner began delivering sterile injection supplies along with naloxone. By 2018, a grant from the Aetna Foundation to combat opioid overdose had enabled them to purchase a van in which to transport supplies and to expand outreach work in Vance County.

    In July 2018 I visited Tanner at the pawn shop, where she still works. Thanks to Tanner’s efforts, the pawn shop has become a de facto site for syringe exchange and overdose prevention. Walking into the shop, the first thing I notice is that Tanner packs a glock on her right hip. It’s necessary these days in Vance County, which has seen a remarkable rise in drug-related gang violence this year. In March 2018, nine people were shot over a span of two weeks in Henderson, a small town of 15,000 residents. In May, four more people were killed in less than a week, prompting Henderson Mayor Eddie Ellington to make a formal plea to the state for resources. One of the murders occurred at a hotel a stone’s throw from the pawn shop.

    The danger doesn’t seem to faze Tanner. She weaves through displays of jewelry, rifles, and old DVDs as customers drop in to buy and sell. It’s a respectable stream of business for a Monday afternoon. Tanner handles the customers with ease, teasing them in a thick southern twang, inquiring after their kids and families, and discussing the murders, which more than one person brings up unprompted. She calls everyone “baby” and is the kind of person who will buy gift cards and toiletries just so she can slip them unnoticed into a customer’s bag if she knows the individual is down on her luck.

    Later in the afternoon, a young female enters the shop. She and Tanner nod at each other without exchanging words. Tanner finishes up a transaction with a customer and slips out the back door. She is gone for a couple of minutes, then reappears alone. This, I come to find, is what overdose prevention looks like in Vance County.

    “I used to hand out [overdose prevention supplies] from inside the shop, but people were embarrassed to come in and be seen taking them,” explains Tanner. “Now people just text me to let me know they are coming. Sometimes they come in the shop and other times I just leave my truck open out back and they get the supplies and leave.”

    Henderson is the kind of town where everyone knows everyone’s business. News travels fast and so do rumors. Even though almost everyone has someone in their family using opioids, stigma still runs deep, so Tanner doesn’t advertise the exchange. Word travels by mouth: If you are at risk for overdose or use needles to shoot up drugs, come see Brandi and she’ll take care of you – no frills, no questions, no judgment. She sees a couple participants a day on weekdays and nearly a dozen every Friday and Saturday. A couple times a week she drives her truck to visit people who don’t have transportation, just to make sure they are taken care of too.

    I ask Tanner to take me to her truck where she keeps the supplies, and she obliges, leading me behind the store to a dusty parking lot where her SUV is stuffed with naloxone, syringes, and other sterile injection equipment. I pepper her with questions as she moves the boxes around to show me what’s inside.

    Tanner looks younger than her 35 years, but acts much older. Over the next half hour she recounts a life of homelessness, addiction, incarceration, losing friend after friend to opioid overdose, and finding her mother-in-law’s body three years ago. She relates the stories as though we were discussing the weather, completely emotionless, but still, you can tell it hurts.

    “I try not to think about it,” she says with a wave of her hand when asked how she handles the trauma of losing so many people. Later, she admits that some nights she sits at home and writes down her feelings, then tears up the thoughts and throws them away.

    “It’s hard not to get attached to people if you see them every week,” she acknowledges. “But I do the work because I want to help my town and my people. This is the place where my kids are growing up.”

    We go back inside and I take a last look around the store. The blue-screened computers and racks of DVDs create the feeling that you’ve gone back in time, yet in some ways this pawn shop is the most forward-thinking entity in Vance County. Here, people received tools to save lives even before they were legal.

    Before leaving Vance’s open fields to return to the city, I ask Tanner if she has a final message for people at risk for opioid overdose. For a moment, her voice hardens.

    “I know what it feels like to not have anybody give a shit if you are here or not,” she says. Then her tone softens. “But I want people to know they are not alone. There are people out there who care and can help.”

    View the original article at thefix.com

  • A Month of Heart Attacks: Withdrawing from Antidepressants

    A Month of Heart Attacks: Withdrawing from Antidepressants

    My doctor tells me not to worry. The medication is safe. I worry he doesn’t know what he’s talking about. I worry this was a big mistake I made at 18 and am paying for the rest of my life.

    My obsessions start as small thoughts. Random sparks catching kindling in my mind, eventually blazing into a wildfire. I’ve always been this way. I couldn’t run for fun, I had to run marathons. I couldn’t go to school for one degree, I had to get my PhD. I couldn’t write a few articles related to my work in digital design, I had to write a book. I couldn’t drink a little bit of alcohol, I had to drink until I passed out. This same thinking led to my decision to stop taking my anti-depression and anti-anxiety medication.

    I began taking medication to treat depression when I was 18. Melancholy was my constant companion the last two years of high school. It stuck around after my graduation as well. Depression had me incapacitated and numb to self-improvement. My first adult visit to a general practitioner took me 30 seconds to describe how I’d been feeling for years. I left with a prescription for Zoloft. 

    I didn’t start taking the medication immediately. I was smoking and drinking to self-medicate. Taking a pill seemed weak. I grew up as part of a generation over-exposed to and under-educated on anti-depressants. Particularly Prozac, which seemed to enter the lexicon of my peers overnight in the early 1990’s.

    “Quit being a spaz! Take a Prozac.” we’d tease each other. Even worse, “Her parents put her on Prozac.” we’d whisper in the hallway. We didn’t know what that meant. Only that being on Prozac meant you weren’t normal. Commercials and TV shows told us it was used for depression. You had a mental illness if you were depressed. Mentally ill people are crazy.

    I knew crazy was bad. My father had a mental illness. He took lithium for a good part of my childhood. He hallucinated aliens were sent to kidnap him. He was crazy. I constantly worried this secret would be exposed. I was the son of a mentally ill man.

    I struggled with what the decision to take medication would mean for my future. What would my future partner think? What would my future children think? Maybe I’d only need to take if for a few months, I thought. I wanted to feel better. I wanted to live up to the potential I’d always been told I had. I decided to take the medication.

    ———

    Medicated

    Zoloft worked. I could get out of bed easier. I could deal with the ups and downs of everyday life. I functioned. My thoughts dwelled less on negative aspects of life. But the stigma of taking medication for a mental illness was always present in my mind. The elephant in the room when I was getting to know new people. What if they wanted to get closer? Would I have to disclose I took medication? Was it worth it to cultivate relationships if I were going to lose them? Or, should I stop taking the damn medication?

    Over the next 15 years I ran through the alphabet of anti-depressant/anti-anxiety medications. Zoloft stopped working at low doses. Larger doses left me unable to sleep. It was on to Paxil, Wellbutrin, and finally Effexor. I constantly questioned my decision to take medication. During this time, I moved from Maryland to rural Ohio, I got married, had kids, got divorced, worked multiple jobs while attending school, and eventually enrolled in a PhD program. I promised myself I’d stop taking medication when life settled down.

    My quest to live medicine free started in May of the last year I was getting my PhD. I always feel positive in springtime. Sunshine removes my spirits from winter’s chest of darkness. You should stop taking medication, an inner voice whispered. At first a dew-covered bud, the thought bloomed alongside my uplifted mood. I have to admit these thoughts were assisted by the confidence of nightly drinking. Soon it was all I could think about. I’m a man earning a PhD. I’d been through marriage, divorce, and poverty over the years and not cracked.

    My life wasn’t perfect. It never would be. I had two kids with my ex-wife. She had custody. Worrying about them was my most ingrained behavior. But I should be able to handle things. I’m a good dad. I didn’t need medication to stay that way. The pills were a crutch. I’m strong. Medicine is for the weak. These thoughts cycled in my head for weeks.

    ——–

    Unmedicated

    I didn’t contact my doctor when my Effexor prescription ran out. I went cold turkey. I immediately found, to my surprise, my depression wasn’t as severe as it had been when I started taking medication. I also found out the medication had been masking crippling anxiety I’d developed.

    I wasn’t a stranger to the nausea and dizziness that accompany the first 72 hours not taking Effexor. I’d missed doses more than a few times. Forgetting to take medication for a day or two was not unusual. I’d realize I’d missed a dose when my gums would start feeling numb near the end of the day. Not taking a dose for another few hours would lead to what I called the snaps in my head. Bright pops that brought me in and out of reality. Micro explosions of light going off behind my eyes. I imagined it was my synapses going nuts. I have a powerful imagination.

    I figured I’d get over the brief withdrawal period and move on to whatever normal was. I powered through work keeping to my daily routine with manageable discomfort. Kind of. I laid my head on my desk quite a few times as the snaps passed over in waves.

    A few nights into my new life as an unmedicated, unstigmatized member of society I woke from an unsettled sleep. My first thought: my finances are in ruins! I had gone to bed thinking about bills I had coming due. I would need to dig into my savings. This fact disturbed me. But by no means would I have no money.

    My worry about finances had festered and grown while I slept. I felt it crushing me. Sitting on my chest. I inhaled and exhaled through my nose counting 10 second intervals. My brain wouldn’t stop. My body was exhausted. I looked at the clock. 2:15. More inhaling and exhaling. I fell back asleep.

    I woke again at 3:15. I felt pricks of stinging pain throughout my brain and body. As if fire ants had been biting me in my sleep. I’d stood in a fire ant nest once as a teenager. My legs burned for days. The pain I currently felt wasn’t enough to distract from the panicked thoughts – I’m going to be poor. How will I survive? How will I pay child support? I’m going to go to jail. I inhaled and exhaled slowly.

    I woke up hourly for the remainder of the night. My eyes popping open as intense fire-tingles raged throughout my body. Repeatedly falling back asleep while trying to assure myself dipping into my savings wouldn’t lead to my financial demise.

    The next few nights unfolded in much the same way. I broke the cycle with a binge drinking session that left me passed out and then hung over the next day. The alcohol washed away my anxiety. My anxiety resurfaced as vomit in the light of day.

    Still, I refused seeking more medicine. I was going to be normal. Not weak. This pain was temporary. Being strong and off medication would last forever. I knew I’d feel better once I had a few weeks under my belt.

    ——–

    A Week Off Medication

    I’m having a heart attack. This is it. I’m going to die. I was staring at a murder mystery show on Investigation Discovery. I’d stopped taking medication a week ago. Constant noise comforted me. Living alone, I craved hearing voices. I kept talk radio on, or the TV set to this channel constantly playing murder mysteries. My favorite. The show did not comfort me as I thought I was dying.

    I’m having a heart attack. The thought grabbed my throat, choking me. I’d never felt powerless over my survival. I’d been feeling tight in my chest all day. Sure, I’d been lifting weights and doing pushups throughout the week. This tightness was coming from deeper than my muscles. Tightness that started to burn. This is what dying feels like. Battery acid surged up my esophagus.

    Should I go to the hospital? I thought. No. Hospitals are the only thing I hate more than dying. I felt a surge of adrenaline as I imagined dying alone on my living room floor. It was still a better option than dying in a hospital room. Surrounded by the nauseating smell of sterilization and cleaners. Hospitals crystalized the concept of mortality. I stayed away at all costs.

    The pain in my chest continued through the afternoon. I’d been invited to meet up with a group of friends for a sushi dinner to celebrate a birthday later that night. I wanted to live long enough for that. I’d go to the hospital if I still felt chest pain after dinner. 

    I looked around the table at dinner. Everyone else seemed so happy. I’d been able to choke down a few edamame. I felt terrible. Maybe I should mention the fact that I was having chest pain. My jaw felt tight. My arm tingled. Classic heart attack symptoms. I knew this from WebMD and numerous medical-topic message boards I’d checked out to see what my symptoms meant. Unfortunately, I could make my symptoms match both a drop-dead heart attack, or a panic attack, depending on which outcome I thought it should be.

    I didn’t bring up my troubles over dinner. Verbalizing a fear was often the final step off a cliff into a panic attack. I’d learned that from my previous experiences with milder anxiety. Expressing my fears made them real. Bottling them up kept my mind racing, too busy for full blown panic. I kept my mouth shut and avoided eye contact with my friends.

    My chest still hurt after dinner. I didn’t go to the hospital. It must be something else. Surely a heart attack can’t last hours. I fell asleep convinced I’d never wake up. But I did, again and again. My chest still hurt a week later. I started referring to it as my week-long heart attack with my inner-voice. A week later it became my two-week heart attack.

    I was unable to sleep for more than an hour straight during this time. I’d stopped worrying as much about my finances. I was dying of a heart attack! I worried I’d never wake up. I also found other things to worry about. This wasn’t hard for a divorcee with two kids. I stayed up worrying about their future if I were to die. About our future relationships if I were to live.

    ——–

    Five Weeks Off Medication

    It was 11 pm. I was dying. I stood in front of my bathroom mirror. I stared at my bare chest. I watched my chest muscles pulsing in rhythm with my heart. Was this normal? I’d never noticed before. Never had a reason to. I imagined my heart fluttering to a stop.

    The joke was on me. You really can have a heart attack lasting an indefinite period of time. Four weeks to be specific. I knew this was the grand finale. Time to go to the hospital.

    I called up the girl I’d been dating for a couple years while I walked to my front-door. I’d made her aware of my panic and that I’d stopped taking medication during the first week I’d stopped. She was concerned I wasn’t doing well. She said I should take medication. I should look at it as part of who I am. I take antidepressants, like a diabetic might take insulin. She didn’t like who I was when I didn’t take medication

    “I’m having a heart attack.”

    I slid down to the floor with the phone at my ear.

    “What? Are you OK?” she asked.

    “I don’t know. I’m so confused.”

    I laid down with my head on the ceramic-squares making up my front doorway. They felt cool. So refreshing. My mind stopped racing. I caught a whiff of lemon scented floor cleaner. A familiar scent. Not one I usually found pleasant. Tonight was different. The scent smothered me in comfort while the floor’s coolness eased my tension.

    “I need to hear your voice.” I mumbled. “I’m so tired.”

    I rolled my head to the side to distribute the coolness across my forehead. “Will you keep me company for a bit over the phone?”

    I woke up at 3 am. The phone had fallen from my hand. The screen was lit. I was still on a call with my girlfriend. The timer stated 4 hours and 24 minutes had elapsed.

    “Hello?” I asked into the phone.

    Nothing. I hung up. I couldn’t believe she had been kind enough to keep the line open. I noticed my chest felt better as I slunk up the stairs to bed.

    ——–

    My Last Day Off Medication

    I made an appointment to see my doctor as soon as the office opened. I couldn’t handle what my life had become. I was falling apart in ways I didn’t know were possible. A constant feeling of having a heart attack. Fixating on small problems until I can’t see a way past them. I was used to overcoming adversity daily in my medicated life. I couldn’t face an uneventful day without a panic attack while unmedicated.

    “It’s going to take a couple of weeks to really feel the effects.” my doctor said. He scrawled Effexor XR 150 across his prescription pad.

    “I think I can handle it.” My body flooded with a sense of relief. I knew I’d feel better the next day. The placebo effect is strong with me.

    I stayed at the pharmacy while they filled the prescription. I took the pill while downing a bottle of acai berry juice. Promotes heart health boasted the bottle’s label.

    Just in case, I thought.

    ——–

    Six Years Later

    I’ve continued taking Effexor. I frequently think about stopping. I’ve expressed my concerns to my doctor each time I’ve had my prescription renewed. My doctor tells me not to worry. The medication is safe. I worry he doesn’t know what he’s talking about. I worry this was a big mistake I made at 18 and am paying for the rest of my life.

    I’ve spent over 20 years on some type of anti-depressant/anti-anxiety medication with only the one month break. I’ve spent more years alive taking medicine than not. I wonder what the medication is doing to my mind. Will I have memory loss at an early age? I wonder what the medication is doing to my body. Am I poisoning my liver?

    It’s been six years since my month-long heart attack. It’s been six years since I stopped taking medication for slightly over a month. I haven’t had any more everlasting heart attacks or phone calls lasting till 3 am. I haven’t fixated on a small problem like my finances until I become incapacitated. I haven’t had my body feel like fire ants had spent the night gnawing on me. I am functional. I love my job. I am remarried with another child. I am generally happy.

    Anyone taking an antidepressant has been told it takes more than medication to properly treat a mental disorder. Counseling, behavior modification, meditation, and other self-help activities need incorporation into your life. However, I use medicine as my main line of defense against depression and panic attacks.

    I understand the importance of going beyond medication to treat depression and anxiety. I know and occasionally practice many anti-anxiety techniques. Nothing I’ve committed to doing on a regular basis. Perhaps I’d try harder at these activities if medication wasn’t such an easy and accessible option for me. I feel good most days. I love many more aspects of my life than I don’t. The medication seems a fair price to pay.

    View the original article at thefix.com

  • Suboxone: A Tool for Recovery

    Suboxone: A Tool for Recovery

    With medication-assisted treatment (MAT), people with opioid addictions are given the chance to rebuild their lives—often from the ashes and debris of drug-induced destruction—without having to fight cravings and withdrawal.

    Suboxone is a prescription medication that treats opioid addiction. It contains buprenorphine and naloxone, active ingredients that are used to curb cravings and block the effects of opioids. Although a major player in addiction recovery today, and often referred to as the gold-standard of addiction care, many in the recovery community remain resistant and even wary, including a large portion of rehab facilities and many members of the 12-step community.

    How does Suboxone work? When an opioid like heroin hits your system, it causes a sense of euphoria, reduced levels of pain, and slowed breathing. The higher the dose, the more intense the effect. Buprenorphine and heroin are both considered opioids, but the way they bind with the opioid receptors in the brain differs. Heroin is a full agonist, meaning it activates the receptor completely and provides all of the desired effects. Buprenorphine is a long-acting partial agonist. While it still binds to the receptor, it is less activating than a full agonist, and there is a plateau level which means that additional doses will not create increased beneficial effects (although they may still cause increased adverse effects). In someone who has been addicted to opioids, buprenorphine will not cause feelings of euphoria—the sensation of being “high.” Naloxone is paired with the buprenorphine to discourage misuse; if Suboxone is injected, the presence of the naloxone may make the user extremely ill.

    Jail Physician and Addiction Specialist Dr. Jonathan Giftos, M.D. offers this analogy: “I describe opioid receptors as little ‘garages’ in the brain. Heroin (or any short-acting opioid) is like a car that parks in those garages. As the car pulls into the garage, the patient gets a positive opioid effect. As the car backs out of the garage, the patient experiences withdrawal symptoms. Buprenorphine works as a car that pulls into the same garage, providing a positive opioid effect—just enough to prevent withdrawal symptoms and reduce cravings, but unlike heroin, which backs out after a few hours causing withdrawal—buprenorphine pulls the parking brake and occupies garage for 24-36 hours. This causes the functional blockade of the opioid receptor, reducing illicit opioid use and risk of fatal overdose.”

    Critics and skeptics of medication-assisted treatment (MAT) believe that using Suboxone is essentially replacing one narcotic with another. While buprenorphine is technically considered a narcotic substance with addictive properties, there are important differences between using an opioid like heroin or oxycontin and physician-prescribed Suboxone. Similarities between using heroin and Suboxone are that you have to take the drug every day or you will experience withdrawal and likely become very ill. Aside from the physical dependency, which is without a doubt a burden, Suboxone offers people in recovery the opportunity to live a “normal” life, far removed from the drug culture lifestyle they may have been immersed in while using heroin.

    People are dying every day from heroin overdoses, especially now in the nightmarish age of fentanyl. People in recovery from opioid addiction are living, free from the risk of overdosing, on Suboxone. Suboxone is a harm reduction option that while initially raised some eyebrows is gaining more traction, and considered an obvious choice for treatment by addiction medicine professionals. While someone using heroin is tasked daily with coming up with money for their drugs, avoiding run-ins with police or authorities, meeting dealers and often participating in other criminal activity, someone using physician-prescribed Suboxone is not breaking the law. They are able to function normally and go to school or get a job, and they are often participating in other forms of ongoing treatment simultaneously. People are given the chance to rebuild their lives—often from the ashes and debris of drug-induced destruction—without having to fight cravings and withdrawal.

    There is a common misconception about Suboxone, and medication-assisted treatment in general, that it is a miracle medication that cures addiction. Because of this idea, many people use Suboxone and are disappointed when they relapse, quickly concluding that MAT doesn’t work for them. When visiting the website for the medication, it reads directly underneath “Important Safety Information” — “SUBOXONE® (buprenorphine and naloxone) Sublingual Film (CIII) is a prescription medicine indicated for treatment of opioid dependence and should be used as part of a complete treatment plan to include counseling and psychosocial support.”

    So, as prescribed, Suboxone is intended to be only part of a treatment plan. It is but one tool in a toolbox with many other important tools such as counseling or therapy, 12-step meetings, building a support system, nurturing an aspect of your life that gives you purpose, and practicing self-care. It is medication-assisted treatment, emphasis on the assisted.

    With that being said, the type of additional treatment or self-care a person participates in should fit their own individual needs and comfort level and not be forced on them. Like a wise therapist once said, “Everybody has the right to self-determination.” Twelve-step meetings, although free and available to everyone, are not the ideal treatment for many people struggling with addiction. Therapy is expensive. People using Suboxone or other MAT shouldn’t be confined to predetermined treatment plans that have little to do with an individual’s needs and more to do with stigma-imposed restrictions.

    It’s unlikely that you’ll find a person claiming that simply taking Suboxone instead of heroin every day saved their life. It is not the mere replacement of one substance for another that is saving lives and treating even the most hopeless of people who have opioid use disorder; it is the relentless pursuit of a new way of life, a pursuit which includes rigorous introspection and a complete change of environment, peers, and daily life. Through the process of therapy, 12-step, using a recovery app, or whatever treatment suits you best, a person can face their demons, learn healthy coping mechanisms, and build confidence without the constant instability of cravings and withdrawal. Suboxone is giving people a chance that they just didn’t have before.

    So why is there such a stigma tied to the life-saving medication? Much of it comes from misinformation and is carried over from its predecessor—the stigma of addiction. It is hard for people who have a pre-existing disdain for addiction in general to swallow the idea that another “narcotic” medication may be the best form of treatment. In addition to addiction-naive civilians or “normies” as 12-steppers might call them, many members of the Narcotics Anonymous community are not completely sold on Suboxone’s curative potential either. Some members of the 12-step community are accepting of MAT, but you just don’t know what you’re going to get. You may walk into a meeting and have a group that is completely open and supportive of a decision to go through the steps while on Suboxone, or you may walk into a meeting of old-timers who are adamant that total abstinence is crucial to your success in the program.

    Another reason people are unconvinced is the length of time Suboxone users may or may not stay on the medication. Again, there is a stigma that shames people who use Suboxone long-term even though studies have shown long-term medication-assisted treatment is more successful than using it only as a detox aid. If Suboxone is helping a person live a productive life in a healthy environment, without the risk of overdose, that person should have the right to do so for however long they need without the scrutinizing gaze of others. While their critics are tsk-tsking away, they may be getting their law degree or buying their first home.

    Suboxone is a vastly misunderstood and complex medication that has the potential to not only save the lives of people with opioid addictions, but also allow them to recover and rebuild lives that were once believed to be beyond repair.

    View the original article at thefix.com