Answer Addiction

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  • Don't Relapse Now

    Time has paused, life has paused, why can’t sobriety pause too?

    Reader, I will make a deal with you. I will talk to you like an adult and say some uncomfortable things. I won’t be your sponsor and I won’t throw the Big Book at your face. But in exchange, you need to promise me you’ll read this to the end. No skips, no tag outs, no skimmy skims. Okay? Okay, great.

    I understand the urge to relapse right now. I’m feeling it too. A lot of us have severely diminished responsibilities – my work has nearly dried up. I hate the Zoom meetings, which feel like impersonal shadow plays where I have to stare at my new fat face. All our other distractions that can’t be done from the couch have been cancelled. My normie friends are mixing up quarantinis before the 5 o’clock news starts. Most importantly, we are all being treated to a daily blast of death, inequity, and press conferences where a poorly tanned moron tells us to shoot up with bleach. It is so much. It is a daily mental weight that is difficult to bear even on the best days.

    If you are saying to yourself, maybe I can’t hold out on this, maybe I am going to break, that is a sane response. It is, in some ways, a rational response. Time has paused, life has paused, why can’t sobriety pause too? The other day I found myself telling a friend that I won’t be jobless, locked down, without the beach (my favorite distraction), and sober. In full Scarlett O’Hara mode, I declared, “Sorry, but I won’t do it!” It felt good to say, the way forbidden things sometimes do. Total, unapologetic narcissism has its pleasures.

    I could probably get away with it, too. I could probably go on a few-days bender and maybe my boyfriend would figure it out (he is sharp!), but no one else would. I could even keep my day count! Why not?!? This is the sort of self-dealing I’ve been doing. I am so good at it. I am the Clarence Darrow of fucking my own shit up.

    But it is wrong. I know it’s wrong. If you are having similar thoughts, you probably know they are wrong too. Even now, with life halted and pain and injustice ascendant, there are reasons both practical and metaphysical that it is crucial for you and me to keep our sober time. Even if every word we ever heard at an AA meeting was false, even if the Big Book itself is a decades-long scam to sell us on religion.

    Practically, you are going to regret it. You know you are! Sorry, but you do. You are going to be annoyed, at the very least, that you need to restart your day count, which yes, you eventually will be forced to do because you won’t be able to lie to your support network for that long. Whatever bender you have in mind is going to come to an end, in what will feel like the blink of an eye, and all you’ll have left is regret and likely, a terrible headache or worse. You also, of course, might take it too far and die.

    If things get really bad, as they very well may, people are going to know what you did and that is going to suck for you. Your family and friends are already extremely stressed out right now (just like you!) – the last thing they need is to hear that you relapsed, in your tiny apartment in some faraway city, and no one can travel to you to make sure you get it together. Your mom is going to cry.

    On that note, if you need hospital care because you overdose or can’t stop, great, you are taxing an already overtaxed healthcare system and exposing yourself to COVID19 at the same time. From a million different standpoints, any decision to relapse right now is selfish, even if it feels like the only person being punished is you.

    Okay, who cares, right? I hear that. When I was first trying to get sober and in a relapse cycle, other people’s problems were some theoretical concern that was a not-close second to my immediate ego gratification. I did not give a shit, and honestly I didn’t care much if I died, either. What worked for me, though, was spite – not giving my enemies the pleasure of seeing me fall.

    Spite could be helpful right now. Picture Donald Trump, in all his 300 pounds of dense mass, standing over you as you take that first drink. “I was always right,” he says without laughing, as he never laughs, “You’re weak. Libs like you, weak, lazy.” Do you want Donald Trump to think he’s better than you? How about the maskless crowds begging states to let them kill themselves, and each other? Should these yahoos and sociopaths be allowed to feel morally superior to you? Or picture a little closer to home. Do you want your douchebag ex to hear that you fucked up again? No you do not.

    The time we’ve all spent cooped up indoors losing our gourds has been an achievement which can be measured in days and lives saved. We’ve been doing this for well over thirty days now. In New York and elsewhere, we’ve flattened the curve. Your sobriety is the same. It’s not some fungible commodity that can be lent out and borrowed back at will – it has a character in itself composed in part of a temporal element. Your sobriety after you relapse is not the same as your sobriety before. When you give it up, you give up effort, sacrifice, things you can never get back. That might not feel important now, but it will feel devastating later.

    Look, I am not Mr. Lockdown. I eat loaves of bread as a snack. I stay up most nights until 5 AM and I sleep till 11. I bleached my hair. I play Nintendo Switch and try to get one or two productive hours into a day. My sheets smell like farts. All of this is fine! You do what it takes to make it to the next day. The people doing pilates every morning, learning a second language, making OnlyFans, whatever – they are fine, too. And it’s even fine to hate them!

    “One day at a time” is a relentless cliché in sobriety circles. But right now, it feels appropriate, as all of the stupid sayings eventually do. The world is a miserable place, maybe always, definitely right now. Don’t add to the misery by giving in to the demons you fought so hard to keep at bay. Be strong, stay home, save lives, stay sober. Good luck.

    View the original article at thefix.com

  • Sober Reflections From the Dance Floor

    One gift of sobriety, along with holding down a job and not losing my kids to the courts, is that I now get to do something I really love, dancing—safely.

    For Mary.

    I got sober here almost thirty years ago. That’s what struck me last December 31, as I danced my butt off in the basement of St. Anthony of Padua’s Roman Catholic Church on Sullivan Street in New York City, welcoming in the New Year with a mob of sober drunks. Yes, here I was dancing under the influence of something more heady than Moet this New Year’s Eve, surrounded by mylar waterfall curtains, and the familiar pull down shades of AA’s Twelve Steps and Twelve Traditions, changing color with every turn of the disco ball.

    In the fall of 1991 I was sitting in the second of sixteen rows of folding chairs, a box of Kleenex on my lap, flanked by massive columns that supported both church above and my shaky sobriety below. Now here in the countdown to midnight, voguing to Madonna with a Woodstock hippie in pajamas, I realized this was the very spot I had counted my first 90 days without a drink or a drug decades ago. This was where the Soho Group of Alcoholics Anonymous met, and still meets today. Flash back to me in gold tights and a green suede mini skirt, crushing on a rockabilly cat across the aisle. Thank you Johnny Cash wannabe in the stretched T, you kept me coming back to AA for that first year—you and my sponsor Cindy, the big sis I never had. After the meeting, Cindy and I would hit the Malibu Diner on 23rd Street for oversized Greek salads with extra dressing and bottomless cups of decaf. Cindy taught me how to stay away from the first drink and how to smudge a make-up pencil to get that smoky eye look. From September to December, 1991, the Soho Group, the boy with the ducktail, and my glamourous sponsor, poured the pillars of my foundation for a life lived without mood-altering substances, one-day-at-a-time.

    . . .

    Around midnight on December 31, 2019, wearing frames I’d picked up at the dollar store that flashed “2020” in three speeds, I felt safe—safe and happy raving with a few hundred personalities swigging seltzer. In my drinking days, going out dancing never felt safe. There was the time I fell off the stage GoGo dancing on the boardwalk at Coney Island, and once I walked home alone over the Brooklyn Bridge, at 3AM, in a red sundress. I meant to take a cab, and had even tucked a twenty dollar bill in my bra for that purpose, but I ended up spending it on more vodka cranberries instead. Staggering barefoot in the pre-dawn down an unlit staircase onto the off ramp of the Brooklyn Bridge, heels in hand, fear overtook me and I started running. For blocks and blocks I ran down the middle of the street, where it felt safer, where I could spot shadows lurking between cars, all the way home, until I reached my building—relieved, ashamed and baffled by my behavior. Scared of waking my landlord, I tiptoed up three flights—this was not new—but every creaky step betrayed me. I dreaded passing Babe the next morning, sitting on the bench in his dooryard, combing the supermarket circulars. He was less like a landlord you write a check out to on the first of the month, and more like an Italian uncle who would scold you for parking too far from the curb, or wasting money buying coffee out, instead of brewing it at home. I knew Babe always heard my key in the lock as dawn broke over South Brooklyn, and I knew he saw those empty bottles of Chianti, tucked under tomato cans in the recycling bin. 

    . . .

    Yes, now I felt safe—here clasping hands with a little girl and her sober mom, twirling around a church cellar at the Soho Group’s New Year’s Eve Dance. I felt safe, happy and damn lucky to be back here on the very spot that I had clung to for that first year, that spot where I first surrendered to sobriety and felt safe, as I cupped warm urn coffee, and took it all in, in small sips. Tonight I knew where I was, and I knew I’d get home safely. I knew I’d remember everything the next day, without remorse or a sour stomach. 

    “Some don’t make it back.” I’ve heard that said often in the rooms of A.A. After sobering up in my mid twenties at the Soho Group, I stayed alcohol-free for thirteen years, making Brooklyn Heights my home group for years, until just after the birth of my first son. The promise of A.A. as “a bridge back to life” had come true. I had a life: a husband, a house, and now a fat baby at the baptismal font. But I was doing zero maintenance on that bridge—my connection back to AA was crumbling. I’d drifted. I’d moved deeper into Brooklyn with my non-alcoholic husband and away from my homegroup. I’d lost touch with my sponsor and most of my sober friends. And then it happened. I slipped. But I was one of the super lucky ones. I didn’t have a full out sloppy slip, with blackouts and benders and smash-ups with the family KIA. It started with just a sip. In my mind I’d decided it was safe to start taking communion wine with my wafer at Sunday mass. No matter that countless practicing Episcopalians take the host but pass on that sip from the silver chalice. And for years, this was the extent of my drinking, one sneaky sip I looked forward to on Sunday mornings. Then other things happened. I’d heard that beer was good for breast-feeding. I latched onto that rumor, like a babe at the breast. I started downing O’Douls “non-alcoholic” ale at our weekly mommy nights. When I went to my dentist for a routine filling, I insisted he tap the tank of laughing gas, when novocaine would have numbed well enough. I remember that buzz which settled over me in the dentist’s chair. Relief, I thought. From everything.

    Soon after I woke up and realized my marriage was over. I was a wreck. Day drinking seemed like an option. A friend offered me a mimosa in her home. I took one sip—panicked—snuck to her bathroom and poured the rest down the drain. Soon after that, I climbed up one flight of stairs over a fish store and entered a crowded room with flies circling. I started counting days, for the second time around. At forty-eight, I was a humbled newcomer again. My sponsor was twelve years my junior. It was awkward, yes, but it felt honest and right to reset my sobriety clock. And thanks in large part to these no-nonsense oldtimers of Old Park Slope Caton, my kids have never seen me drunk.

    . . .

    In my twenties, before I poured that last bottle of Four Roses whiskey down the kitchen sink, my twin loves were drinking and dancing. I started drinking fairly late, at 19, when I’d help myself to my father’s scotch, put on his headphones, raise the volume on his Ohm speakers, and burn rubber to The Gap Band. Booze and boogie shoes quickly became my dream couple, allowing me to float in a fantasy stupor where all care and self-doubt slipped away. From there I went on to be a “maniac on the dance floor”—a self-destructive eighties girl flash dancing her way through four years of college—squeezing that last cup of beer from a warm keg.

    For fun, my alcoholic brain sometimes likes to play this game where I remember fondly (but falsely) occasions where liquor paired perfectly with certain activities like ball games with Budweiser, or tailgate parties with pina coladas, picnics with blushing Zinfandels, or art gallery openings with jugs of Gallo red. But the winner of this stagger-down-memory-lane game is always dancing with drinking. Evenings out started the same: plug in the hot rollers, mix a cocktail, and get down while dolling up, still in my underwear, to the Saturday night line-up of DJs on WBLS and Hot97. A whiskey sour next to my make-up mirror was the kick-off. Stepping out an hour later, with coral lips and cat eyes, and Run-DMC in my head, I felt just fine. And that’s how it went, in my twenties. But over time, nights out ended in close calls with questionable characters and near scrapes in unknown neighborhoods. Every one of those nights, however, had started out just fine. From Halloween dance parties in Bushwick lofts with Solo cups of mystery punch, to doing the twist on the Coney Island Boardwalk while taking nips from a hip flask of Jack Daniels, it was always a good time. Until it wasn’t—until someone flicked a cigarette and started a fire, or until I fell off the band stage on that Coney Island boardwalk.

    . . .

    If only evenings could have ended as safe and fun as they had started out. It really only ever felt safe to drink at the start of my drinking, as a teen, in front of my dad’s turntable, moving to Stevie Wonder coming from his Koss headphones, in the safety of my childhood home. And if only my drinking and dancing partner Mary was still here. Mary, who dared me to put down my rum and Coke and never-finished Times crossword, and climb up onto the bar with her at Peter McManus Pub in Chelsea. Dear, departed drinking playmate and party girl Mary. Quirky, curly-haired writer Mary, in rhinestone glasses and GoGo boots. Loyal friend Mary, who helped me through heartbreaks and hangovers. Subversive yet wholesome Mary from Michigan, who baked soda bread, wrote thank you notes, remembered nieces’ birthdays and snorted lines of heroin. I never made the connection between her non-stop runny nose and her habit until years later, when her boyfriend called me to say he’d found Mary dead from an overdose. I pictured her slumped in a fake Queen Anne armchair, pale as parchment, her dark curls against floral upholstery. She was forty-six.

    Indeed, I danced my way through my drinking twenties, but I was hardly dancing with the stars. I was working as a waitress at the LoneStar Roadhouse near Times Square. At closing time I’d do lines at the end of the bar with the manager, and once, with a customer who talked me into leaving with him. I went home with this grown man who, as it turned out, still lived with his parents somewhere way the hell out on Long Island. I remember feeling increasingly unsafe passing exit after exit on the LIE, riding unbelted in the death seat of a stranger’s Toyota. I remember turning up the volume on the radio and singing along to Chaka Khan: “I’m Every Woman… It’s all in MEEE…” Any drug that can delude you into believing you’ve got the pipes of a 10-time Grammy Award winner, well, that’s a great drug. Until it isn’t. He led me to a mattress on the floor of his parents garage. I’ve heard it said in the rooms of A.A. that God watches out for children and drunks. Which maybe explains how I got myself out of that one—while still fully clothed—and was able to call a cab to take me all the way home in those pre-Lyft late-eighties.

    . . .

    One gift of sobriety, along with holding down a job and not losing my kids to the courts, is that I now get to do something I really love, dancing—safely. I’ve hit many an A.A. group anniversary, where I’ve joined Friends of Bill W. on subterranean church linoleum, cleared for dancing. I still start getting ready at five, with my own creation: The Magoo (cranberry juice, sparkling water and two wedges of lime, served up in a fancy glass.) I still tune into WBLS. I wear less make-up now, but still move to the music. At six I head out to scoop a friend in my KIA beater. The koolest legend, Kool D.J. Red Alert, is blowin’ it up over the airwaves and through my car speakers. I pull up, safety-belted and chair dancing in the driver’s seat. My date is tall and her dress is short and sparkly. “Damn girl, who’s your target? These all gotta watch out!” Beatrice has all the head boss and eye looks as Mary. And a wit just like Mary’s too, drier than a Wasa cracker or top-shelf vermouth. It’s going to be a fun night, I think. Throw your hands up.

    I really love Alcoholics Anonymous group anniversaries. They are feel good phenomena that pretty much follow the same format: a meeting, followed by a potluck, then sometimes, dancing. I gravitate to the ones where there’s dancing. Everyone shows up bathed and beaming to celebrate the founding of their “homegroup,” the group they most regularly attend, where they know other people, and are known in return. Sober drunks with sixty years and sixty days come to these. A church basement or parish hall is dressed up in balloons and crepe garland; Hershey kisses scatter folding tables, covered in plastic cloths. The speakers are often old-timers with good stories to tell, pulling in outrageous details of their “drunkalogues” or firsthand details about the group’s early days. The dinner spread is legit. A line of volunteers dish out baked ziti, collards and fried fish from foil casseroles set up over sternos. Urn coffee and birthday cake for dessert. I’ve developed a taste for those giant sheet cakes with piped icing. The ritual of eating that 2” square of cake, along with every alcoholic in the room eating theirs, is a highlight for sure. A centered feeling comes over me as I lick frosting off a plastic fork under twinkle lights. I am safe. And this is fun. Details may vary from group to group, but every space feels hallowed on these nights. The people who populate it are thankful for their lives, freed from the hamster wheel of addiction, just for today. 

    Then dancing happens. I bring the DJ a bottle of Poland Spring and I’m “setting it off” to one-hit-hip-hop wonder Strafe, while folks are still on the food line. When the clean up crew starts collecting cola cans and rolling up tablecloths, I’m still on the linoleum with any takers I can pull up off their folding chairs. I can’t say Beatrice and I have shut down every A.A. party from northern Manhattan to the outer banks of Brooklyn, but the bulletin board of Alcoholic Anonymous’ Intergroup is a good place to start for leads on sober dance happenings.

    We head home a little after eleven. DJ Chuck Chillout has pulled out his airhorn. I drop Beatrice off, she bends into the passenger window and smirks: “I had a great time tonight. Maria N. gets a second date.” 

    . . .

    Group anniversaries and sober New Year’s Eve parties aside, I dance mostly on my yoga mat, to the line-up of Saturday Night DJs on WBLS, or to my own ‘80s Hip Hop and New Wave playlists. I’m still self-conscious when I share in meetings, or read at open mics, or take my top off to new a lover, but at home or in public, I’m comfortable on the dance floor, even if I’m the only one dancing. I don’t claim to quite find my Nasty with Miss Jackson anymore, but even well into middle age, and without a craft beer in hand, dancing still brings on my happy—more than ever. Clear-headed, I tap into that elusive “conscious contact” with my higher power. I feel everything in the present moment—neurons firing through my fingertips, the beat beneath my bare feet. I am a consenting adult at my own one-woman rave, enjoying this gift of sobriety: a healthy body doing what it loves, and hurting no one, especially not itself. Of course, when I’m out dancing, there’s the bonus of connection with other abstaining alcoholics. Doing the Electric Slide with fifty friends of Bill—in-sync, or close enough—well, It’s Electric.

    . . .

    “We drank alone. But we don’t get sober—then stay sober—alone.” 

    It’s 1:30AM and I’m still on the dance floor, throwing hands up with oldtimers and seven-year-olds. The Woodstock hippie shuffles in his drawstring polar fleece, cotton wadded in his ears. But no amount of cotton can drown out the cheer that went up at the stroke of midnight and echoes even now.If it’s in the cards, in twenty years, on New Year’s Eve, 2040, I’ll be 75 and I’ll be here, surrounded by these poured cement columns, getting what’s left of my groove on with a beautiful group of sober drunks. 

    . . . 

    Where can you go to dance yourself happy? For one thing, the International Conference of Young People in Alcoholics Anonymous of New York City (ICYPAA NYC) throws a serenity dance cruise on the Hudson in July. But if AA dances aren’t your thing, consider “Conscious clubbing,” a term coined by Samantha Moyo, founder of Morning Gloryville, a sober breakfast rave phenomenon launched in East London in 2013, and which has spread to cities worldwide. Some Morning Gloryville events have been postponed due to the COVID-19 outbreak, but online raves are happening right now. And LOOSID a sober social network, with a mission to make sobriety fun, puts out playlists, and pairs subscribers to events of interest too.

    Tonight, still sheltering-in-place here in The Baked Apple, New York City—one hot spot of the COVID-19 pandemic—Beatrice invited me to Reprieve, a clean & sober non-stop dance party. I registered for free through Eventbrite and joined the dance floor, courtesy of Zoom. By the end of it we were doing backbends over our sofas to Total Eclipse of the Heart. Before signing off, I reached out to Beatrice in the comment thread : “Let’s do it again,” I typed. “Totes.” she typed back. Sure, I’ll return this Saturday night to dance with sober drunks. It looks like it’ll just become the latest turn in my healthy sober dance move.

    View the original article at thefix.com

  • Coronavirus, ‘Plandemic’ and the seven traits of conspiratorial thinking

    Learning these traits can help you spot the red flags of a baseless conspiracy theory and hopefully build up some resistance to being taken in by this kind of thinking.

    The conspiracy theory video “Plandemic” recently went viral. Despite being taken down by YouTube and Facebook, it continues to get uploaded and viewed millions of times. The video is an interview with conspiracy theorist Judy Mikovits, a disgraced former virology researcher who believes the COVID-19 pandemic is based on vast deception, with the purpose of profiting from selling vaccinations.

    The video is rife with misinformation and conspiracy theories. Many high-quality fact-checks and debunkings have been published by reputable outlets such as Science, Politifact and FactCheck.

    As scholars who research how to counter science misinformation and conspiracy theories, we believe there is also value in exposing the rhetorical techniques used in “Plandemic.” As we outline in our Conspiracy Theory Handbook and How to Spot COVID-19 Conspiracy Theories, there are seven distinctive traits of conspiratorial thinking. “Plandemic” offers textbook examples of them all.

    Learning these traits can help you spot the red flags of a baseless conspiracy theory and hopefully build up some resistance to being taken in by this kind of thinking. This is an important skill given the current surge of pandemic-fueled conspiracy theories.


    The seven traits of conspiratorial thinking. (John Cook CC BY-ND)

    1. Contradictory beliefs

    Conspiracy theorists are so committed to disbelieving an official account, it doesn’t matter if their belief system is internally contradictory. The “Plandemic” video advances two false origin stories for the coronavirus. It argues that SARS-CoV-2 came from a lab in Wuhan – but also argues that everybody already has the coronavirus from previous vaccinations, and wearing masks activates it. Believing both causes is mutually inconsistent.

    2. Overriding suspicion

    Conspiracy theorists are overwhelmingly suspicious toward the official account. That means any scientific evidence that doesn’t fit into the conspiracy theory must be faked.

    But if you think the scientific data is faked, that leads down the rabbit hole of believing that any scientific organization publishing or endorsing research consistent with the “official account” must be in on the conspiracy. For COVID-19, this includes the World Health Organization, the U.S. Centers for Disease Control and Prevention, the Food and Drug Administration, Anthony Fauci… basically, any group or person who actually knows anything about science must be part of the conspiracy.

    3. Nefarious intent

    In a conspiracy theory, the conspirators are assumed to have evil motives. In the case of “Plandemic,” there’s no limit to the nefarious intent. The video suggests scientists including Anthony Fauci engineered the COVID-19 pandemic, a plot which involves killing hundreds of thousands of people so far for potentially billions of dollars of profit.

    4. Conviction something’s wrong

    Conspiracy theorists may occasionally abandon specific ideas when they become untenable. But those revisions tend not to change their overall conclusion that “something must be wrong” and that the official account is based on deception.

    When “Plandemic” filmmaker Mikki Willis was asked if he really believed COVID-19 was intentionally started for profit, his response was “I don’t know, to be clear, if it’s an intentional or naturally occurring situation. I have no idea.”

    He has no idea. All he knows for sure is something must be wrong: “It’s too fishy.”

    5. Persecuted victim

    Conspiracy theorists think of themselves as the victims of organized persecution. “Plandemic” further ratchets up the persecuted victimhood by characterizing the entire world population as victims of a vast deception, which is disseminated by the media and even ourselves as unwitting accomplices.

    At the same time, conspiracy theorists see themselves as brave heroes taking on the villainous conspirators.

    6. Immunity to evidence

    It’s so hard to change a conspiracy theorist’s mind because their theories are self-sealing. Even absence of evidence for a theory becomes evidence for the theory: The reason there’s no proof of the conspiracy is because the conspirators did such a good job covering it up.

    7. Reinterpreting randomness

    Conspiracy theorists see patterns everywhere – they’re all about connecting the dots. Random events are reinterpreted as being caused by the conspiracy and woven into a broader, interconnected pattern. Any connections are imbued with sinister meaning.

    For example, the “Plandemic” video suggestively points to the U.S. National Institutes of Health funding that has gone to the Wuhan Institute of Virology in China. This is despite the fact that the lab is just one of many international collaborators on a project that sought to examine the risk of future viruses emerging from wildlife.

    Learning about common traits of conspiratorial thinking can help you recognize and resist conspiracy theories.

    Critical thinking is the antidote

    As we explore in our Conspiracy Theory Handbook, there are a variety of strategies you can use in response to conspiracy theories.

    One approach is to inoculate yourself and your social networks by identifying and calling out the traits of conspiratorial thinking. Another approach is to “cognitively empower” people, by encouraging them to think analytically. The antidote to conspiratorial thinking is critical thinking, which involves healthy skepticism of official accounts while carefully considering available evidence.

    Understanding and revealing the techniques of conspiracy theorists is key to inoculating yourself and others from being misled, especially when we are most vulnerable: in times of crises and uncertainty.

    [Get facts about coronavirus and the latest research. Sign up for The Conversation’s newsletter.]

    John Cook, Research Assistant Professor, Center for Climate Change Communication, George Mason University; Sander van der Linden, Director, Cambridge Social Decision-Making Lab, University of Cambridge; Stephan Lewandowsky, Chair of Cognitive Psychology, University of Bristol, and Ullrich Ecker, Associate Professor of Cognitive Science, University of Western Australia

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

  • Capitalizing on Smoking Cessation Could Curb Coronavirus Deaths

    The data we have so far show that smokers are over-represented in COVID19 cases requiring ICU treatment and in fatalities from the disease. 

    Politicians have been hyper-focused on the drug hydroxychloroquine lately, hoping it will be a silver bullet for curbing deaths from coronavirus. Physicians, on the other hand, are less convinced it will be helpful. But we’ve already got a medical intervention that could dramatically alter the course of the pandemic: smoking cessation. Fighting the smoking pandemic could curb coronavirus deaths now and save lives in the years to come. 

    Many people smoke and vape to stay calm. So with rising rates of coronavirus anxiety, it’s no surprise that cigarette and vaping sales are booming. But emerging evidence shows smokers are at a higher risk of serious coronavirus infection. If there were ever a time to quit, it’s now. 

    The data we have so far show that smokers are over-represented in COVID19 cases requiring ICU treatment and in fatalities from the disease. One study from China estimated that smoking is associated with a 14-fold increased odds of COVID-19 infection progressing to serious illness. This might be because smoking increases the density of the lung’s ACE2 receptors, which the coronavirus exploits to infiltrate the body. On top of this, smoking weakens the immune system’s ability to fight the virus, as well as heart and lung tissue. All of this damage increases one’s risk of severe coronavirus infection and death. 

    While less is known about vaping’s relationship to coronavirus, research suggests that it impairs the ability of immune cells in the lung to fight off infection. This appears to be related to solvents used in vaping products and occurs independent of their nicotine content. Vaping also shares another risk factor for coronavirus with smoking—it involves putting something you touch with your hands into your mouth over and over. Unless you’re washing your hands and cleaning your vape religiously, you’re putting yourself at risk. On top of this, we know that many people—especially those who are younger—like to share their vapes, which really increases the chances of catching the virus. 

    Most smokers want to quit and find that their stress levels drop dramatically when they do. Many vapers want to stop too. Quitting alone can be nearly impossible though. Luckily, support is available. Primary care physicians are still working via telehealth, and they have a wide range of effective treatments for what doctors call “tobacco use disorder.” If you can’t reach your doctor, The U.S. Centers for Disease Control has created a national hotline for support and free counselling: 1-800-QUIT-NOW.

    Psychotherapy is one approach to quitting. However, medications such as bupropion and varenicline are also effective and can be obtained with a phone call to your doctor. Nicotine replacement products like gum, lozenges, patches, and inhalers also greatly increase the odds of success and are available over the counter. Few people are aware that you can purchase these with your health savings and flexible spending accounts. 

    34 million people in the US smoke, and there have already been nearly 700,000 documented domestic cases of coronavirus. Given the number of deaths we could face from people smoking during this pandemic, lawmakers should be doing everything they can to make it easier for people to quit. When patients have better insurance coverage for smoking cessation treatments, they’re much more likely to use them and quit smoking. 

    Federal law requires insurers to cover cessation treatments, but they get around this by restricting access through the use of co-pays and limits on the amounts covered, while also forcing physicians to spend hours on the phone getting them to authorize coverage of medication. With people dying by the tens of thousands, Washington needs to close these loopholes now.

    Amid the widespread panic around coronavirus, it’s important that we stay clear-headed and not overlook easy fixes that could save lives. We know that smoking cessation interventions could prevent deaths, so let’s make sure we’re taking advantage of them.

    View the original article at thefix.com

  • A Lesson from Sobriety: You Are Allowed to Feel Hopeful

    Having hope during a terrible situation isn’t the same as false hope. Hope is a fundamental ingredient of human resilience, a mechanism that sets our brains apart from other species.

    Imagine waking up one day and everything has changed. Overnight you’ve lost the ability to go to work. All the places you eat, drink, and socialize are closed. You walk down the street and people cross over to avoid your path. You are living the definition of empty. Void. Vast nothingness. You have no idea what tomorrow will bring, but if it’s more of the same, you might not want to have another tomorrow.

    Welcome to the reality of COVID-19. Many of us are currently living under stay at home orders where the situation feels similar to what I’ve described. Overnight, jobs lost or sent to work from home, daycares and schools closed, the few restaurants remaining open offer take out only, and, for some reason, toilet paper has become the national currency. I’ve noticed life during a pandemic has some clear parallels to life when contemplating going from substance abuser to sober.

    Fortunately, most of us can survive this pandemic if we practice some safety guidelines and weather a storm that has an uncertain end date. Again, the same can be said for sobriety. When I first contemplated sobriety, the uncertainty of what the future would look like kept me from moving forward. Eventually, I had to embrace this. I looked at what my life had become versus what I wanted it to be and I knew even uncertainty was better than the present.

    I made the decision to become sober six years ago. For me, sobriety meant losing a routine I’d become comfortably habituated to. A destructive routine that involved daily consumption of alcohol, often until I couldn’t drink any more on any given night. Right now, we are being told our normal routine could lead to a worsening of the pandemic, the potential to spread the disease and expose those most vulnerable to its fatal effects. We’ve been asked to willingly adjust our routines with the absence of an end date.

    In sobriety, I had to define a new normal. This happened both purposely and organically. Part of what I did was attend counseling and AA sessions. That was on purpose. I also started writing more and performing better at work. That was more organic. I didn’t order alcoholic beverages while out with clients and colleagues. That was on purpose. I fell in love with ice cold seltzer water. That was organic.

    We don’t know what our new normal will look like after this first round of COVID-19. There are some behaviors many of us have adopted that will probably persist: wearing masks, avoiding handshakes, increased hand washing. We will adopt other behaviors or adapt in ways we can’t foresee in the coming months. Many of these will bring us joy, or at least decrease potential future situations like our present condition.

    The Present and the Presence of Hope

    Everyone–sober, drunk, or indifferent–is facing some unexpected hardships right now. We’ve been told by experts we are experiencing loss and should feel permission to grieve. This is true. But we have permission to feel hopeful as well. Hope is what led me to embrace and eventually thrive in sobriety. Hope will get us through this pandemic.

    I could have never imagined the wonderful things waiting for me on the other side of sobriety. A marriage (later a divorce, but hey), a child, Saturday mornings, physical health, mental clarity, reduced anxiety, and vomit-free carpets are only some of the things I wouldn’t have accomplished if I were still drinking.

    Having hope during a terrible situation isn’t the same as false hope. Hope is a fundamental ingredient of human resilience, a mechanism that sets our brains apart from other species. Hope has kept individuals and societies moving forward to better ourselves since the time our external gills disappeared, and our tails fell off. Or we were fashioned from dust. Whatever you choose.

    Hope is what countered the fear and uncertainty I felt initially entering sobriety. Excitement for a future without the shackles of alcohol. We are in the same situation now; there’s no other motivation to go through this if we have no hope the future will bring something better than the present.

    We have some time before this will pass. Spend some of it dwelling on hope. Make a list of things that might be better post-pandemic. Plan your dream vacation (we will travel again). Do something you’ve always wanted to do for yourself. Along with anxiety, fear, or grief, you are allowed to feel hope and excitement in our current situation. Something different is waiting for you. Potentially something better than you can imagine.

    View the original article at thefix.com

  • Physicians Fear For Their Families As They Battle Coronavirus With Too Little Armor

    “With emergency rooms and hospitals running at and even over capacity, and as the crisis expands, so does the risk to our healthcare workers. And with a shortage of PPE, that risk is even greater.”

    Originally published 3/29/2020

    Dr. Jessica Kiss’ twin girls cry most mornings when she goes to work. They’re 9, old enough to know she could catch the coronavirus from her patients and get so sick she could die.

    Kiss shares that fear, and worries at least as much about bringing the virus home to her family — especially since she depends on a mask more than a week old to protect her.

    “I have four small children. I’m always thinking of them,” said the 37-year-old California family physician, who has one daughter with asthma. “But there really is no choice. I took an oath as a doctor to do the right thing.”

    Kiss’ concerns are mirrored by dozens of physician parents from around the nation in an impassioned letter to Congress begging that the remainder of the relevant personal protective equipment be released from the Strategic National Stockpile, a federal cache of medical supplies, for those on the front lines. They join a growing chorus of American health care workers who say they’re battling the virus with far too little armor as shortages force them to reuse personal protective equipment, known as PPE, or rely on homemade substitutes. Sometimes they must even go without protection altogether.

    “We are physically bringing home bacteria and viruses,” said Dr. Hala Sabry, an emergency medicine physician outside Los Angeles who founded the Physician Moms Group on Facebook, which has more than 70,000 members. “We need PPE, and we need it now. We actually needed it yesterday.”

    The danger is clear. A March 21 editorial in The Lancet said 3,300 health care workers were infected with the COVID-19 virus in China as of early March. At least 22 died by the end of February.

    The virus has also stricken health care workers in the United States. On March 14, the American College of Emergency Physicians announced that two members — one in Washington state and another in New Jersey — were in critical condition with COVID-19.

    At the private practice outside Los Angeles where Kiss works, three patients have had confirmed cases of COVID-19 since the pandemic began. Tests are pending on 10 others, she said, and they suspect at least 50 more potential cases based on symptoms.

    Ideally, Kiss said, she’d use a fresh, tight-fitting N95 respirator mask each time she examined a patient. But she has had just one mask since March 16, when she got a box of five for her practice from a physician friend. Someone left a box of them on the friend’s porch, she said.

    When she encounters a patient with symptoms resembling COVID-19, Kiss said, she wears a face shield over her mask, wiping it down with medical-grade wipes between treating patients.

    As soon as she gets home from work, she said, she jumps straight into the shower and then launders her scrubs. She knows it could be devastating if she infects her family, even though children generally experience milder symptoms than adults. According to the Centers for Disease Control and Prevention, her daughter’s asthma may put the girl at greater risk of a severe form of the disease.

    Dr. Niran Al-Agba of Bremerton, Washington, said she worries “every single day” about bringing the COVID-19 virus home to her family.

    “I’ve been hugging them a lot,” the 45-year-old pediatrician said in a phone interview, as she cuddled one of her four children on her lap. “It’s the hardest part of what we’re doing. I could lose my husband. I could lose myself. I could lose my children.”

    Al-Agba said she first realized she’d need N95 masks and gowns after hearing about a COVID-19 death about 30 miles away in Kirkland last month. She asked her distributor to order them, but they were sold out. In early March, she found one N95 mask among painting gear in a storage facility. She figured she could reuse the mask if she sprayed it down with a little isopropyl alcohol and also protected herself with gloves, goggles and a jacket instead of a gown. So that’s what she did, visiting symptomatic patients in their cars to reduce the risk of spreading the virus in her office and the need for more protective equipment for other staffers.

    Recently, she began getting donations of such equipment. Someone left two boxes of N95s on her doorstep. Three retired dentists dropped off supplies. Patients brought her dozens of homemade masks. Al-Agba plans to make these supplies last, so she’s continuing to examine patients in cars.

    In the March 19 letter to Congress, about 50 other physicians described similar experiences and fears for their families, with their names excluded to protect them from possible retaliation from employers. Several described having few or no masks or gowns. Two said their health centers stopped testing for COVID-19 because there is not enough protective gear to keep workers safe. One described buying N95 masks from the Home Depot to distribute to colleagues; another spoke of buying safety glasses from a local construction site.

    “Healthcare workers around the country continue to risk exposure — some requiring quarantine and others falling ill,” said the letter. “With emergency rooms and hospitals running at and even over capacity, and as the crisis expands, so does the risk to our healthcare workers. And with a shortage of PPE, that risk is even greater.”

    Besides asking the government to release the entire stockpile of masks and other protective equipment — some of which has already been sent to states — the doctors requested it be replenished with newly manufactured equipment that is steered to health care workers before retail stores.

    They called on the U.S. Government Accountability Office to investigate the distribution of stockpile supplies and recommended ways to ensure they are distributed as efficiently as possible. They said the current system, which requires requests from local, state and territorial authorities, “may create delays that could cause significant harm to the health and welfare of the general public.”

    At this point, Sabry said, the federal government should not be keeping any part of the stockpile for a rainy day.

    “It’s pouring in the United States right now,” she said. “What are they waiting for? How bad does it have to get?”

    Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

    View the original article at thefix.com

  • Addiction Is ‘A Disease Of Isolation’ — So Pandemic Puts Recovery At Risk

    Addiction Is ‘A Disease Of Isolation’ — So Pandemic Puts Recovery At Risk

    “We consider addiction a disease of isolation…Now we’re isolating all these people and expecting them to pick up the phone, get online, that sort of thing — and it may not work out as well.”

    Before the coronavirus became a pandemic, Emma went to an Alcoholics Anonymous meeting every week in the Boston area and to another support group at her methadone clinic. She said she felt safe, secure and never judged.

    “No one is thinking, ‘Oh, my God. She did that?’” said Emma, “’cause they’ve been there.”

    Now, with AA and other 12-step groups moving online, and the methadone clinic shifting to phone meetings and appointments, Emma said she is feeling more isolated. (KHN is not using her last name because she still uses illegal drugs sometimes.) Emma said the coronavirus may make it harder to stay in recovery.

    “Maybe I’m old fashioned,” said Emma, “but the whole point of going to a meeting is to be around people and be social and feel connected, and I’d be totally missing that if I did it online.”

    While it’s safer to stay home to avoid getting and spreading COVID-19, addiction specialists acknowledge Emma’s concern: Doing so may increase feelings of depression and anxiety among people in recovery — and those are underlying causes of drug and alcohol use and addiction.

    “We consider addiction a disease of isolation,” said Dr. Marvin Seppala, chief medical officer at the Hazelden Betty Ford Foundation. “Now we’re isolating all these people and expecting them to pick up the phone, get online, that sort of thing — and it may not work out as well.”

    Emma has another frustration: If the methadone clinic isn’t allowing gatherings, why is she still required to show up daily and wait in line for her dose of the pink liquid medication?

    The answer is in tangled rules for methadone dispensing. The federal government has loosened them during the pandemic — so that patients don’t all have to make a daily trip to the methadone clinic, even if they are sick. But patients say clinics have been slow to adopt the new rules.

    Mark Parrino, president of the American Association for the Treatment of Opioid Dependence, said he issued guidelines to members late last week about how to operate during pandemics. He recommended that clinics stop collecting urine samples to test for drug use. Many patients can now get a 14- to 28-day supply of their addiction treatment medication so they can make fewer trips to methadone or buprenorphine clinics.

    “But there has to be caution about giving significant take-home medication to patients who are clinically unstable or actively still using other drugs,” Parrino said, “because that could lead to more problems.”

    The new rules have a downside for clinics: Programs will lose money during the pandemic as fewer patients make daily visits, although Medicare and some other providers are adjusting reimbursements based on the new stay-at-home guidelines.

    And for active drug users, being alone when taking high levels of opioids increases the risk of a fatal overdose.

    These are just some of the challenges that emerge as the public health crisis of addiction collides with the global pandemic of COVID-19. Doctors worry deaths will escalate unless people struggling with excessive drug and alcohol use and those in recovery — as well as addiction treatment programs — quickly change the way they do business.

    But treatment options are becoming even scarcer during the pandemic.

    “It’s shutting down everything,” said John, a homeless man who’s wandering the streets of Boston while he waits for a detox bed. (KHN is not including his last name because he still buys illegal drugs.) “Detoxes are closing their doors and halfway houses,” he said. “It’s really affecting people getting help.”

    Adding to the scarcity of treatment options: Some inpatient and outpatient programs are not accepting new patients because they aren’t yet prepared to operate under the physical distancing rules. In many residential treatment facilities, bedrooms and bathrooms for patients are shared, and most daily activities happen in groups — those are all settings that would increase the risk of transmitting the novel coronavirus.

    “If somebody were to become symptomatic or were to spread within a unit, it would have a significant impact,” said Lisa Blanchard, vice president of clinical services at Spectrum Health Systems. Spectrum runs two detox and residential treatment programs in Massachusetts. Its facilities and programs are all still accepting patients.

    Seppala said inpatient programs at Hazelden Betty Ford are open, but with new precautions. All patients, staff and visitors have their temperature checked daily and are monitored for other COVID-19 symptoms. Intensive outpatient programs will run on virtual platforms online for the immediate future. Some insurers cover online and telehealth addiction treatment, but not all do.

    Seppala worried that all the disruptions — canceled meetings, the search for new support networks and fear of the coronavirus — will be dangerous for people in recovery.

    “That can really drive people to an elevated level of anxiety,” he said, “and anxiety certainly can result in relapse.”

    Doctors say some people with a history of drug and alcohol use may be more susceptible to COVID-19 because they are more likely to have weak immune systems and have existing infections such as hepatitis C or HIV.

    “They also have very high rates of nicotine addiction and smoking, and high rates of chronic lung disease,” said Dr. Peter Friedmann, president of the Massachusetts Society of Addiction Medicine. “Those [are] things we’ve seen in the outbreak in China [that] put folks at higher risk for more severe respiratory complications of this virus.”

    Counselors and street outreach workers are redoubling their efforts to explain the pandemic and all the related dangers to people living on the streets. Kristin Doneski, who runs One Stop, a needle exchange and outreach program in Gloucester, Massachusetts, worried it won’t be clear when some drug users have COVID-19.

    “When folks are in withdrawal, a lot of those symptoms can kind of mask some of the COVID-19 stuff,” said Doneski. “So people might not be taking some of their [symptoms seriously], because they think it’s just withdrawal and they’ve experienced it before.”

    Doneski is concerned that doctors and nurses evaluating drug users will also mistake a case of COVID-19 for withdrawal.

    During the coronavirus pandemic, needle exchange programs are changing their procedures; some have stopped allowing people to gather inside for services, safety supplies, food and support.

    There’s also a lot of fear about how quickly the coronavirus could spread through communities of drug users who’ve lost their homes.

    “It’s scary to see how this will pan out,” said Meredith Cunniff, a nurse from Quincy, Massachusetts, who is in recovery for an opioid use disorder. “How do you wash your hands and practice social distancing if you’re living in a tent?”

    This story is part of a partnership that includes WBUR, NPR and Kaiser Health News.

    View the original article at thefix.com

  • When Purell is Contraband, How Do You Contain Coronavirus?

    Handwashing and sanitizers may make people on the outside safer. But in prison it can be impossible to follow public health advice.

    This article was originally published on March 6th by The Marshall Project, a nonprofit news organization covering the U.S. criminal justice system. Sign up for their newsletter, or follow The Marshall Project on Facebook or Twitter.

    When Lauren Johnson reached for a squirt of hand sanitizer on her way out of the doctor’s office, she regretted it immediately.

    In the Central Texas prison where she was housed, alcohol-based hand sanitizer was against the rules—and the on-duty officer was quick to let her know it.

    “He screamed at me,” she said.

    Then, she said, he wrote her up and she lost her recreation and phone privileges for 10 days.

    The incident was a minor blip in Johnson’s last prison stay a decade ago, but the rules hold true today and underscore a potential problem for combating coronavirus: Behind bars, some of the most basic disease prevention measures are against the rules or simply impossible.

    “Jails and prisons are often dirty and have really very little in the way of infection control,” said Homer Venters, former chief medical officer at New York City’s notorious Rikers Island jail complex. “There are lots of people using a small number of bathrooms. Many of the sinks are broken or not in use. You may have access to water, but nothing to wipe your hands off with, or no access to soap.”

    So far, the respiratory virus has sickened more than 97,000 people worldwide and at least 200 in the U.S. More than 3,300 people have died. As of late Thursday there were no reported cases in American prisons, though experts say it’s just a matter of time. (Ed Note: These were the numbers as of March 6th, 2020. At time of this publication, they have increased. See current stats here.)

    To minimize further spread, the Centers for Disease Control and Prevention suggests things like avoiding close contact with people who are sick, covering your mouth with a tissue when you cough or sneeze, disinfecting frequently-used surfaces and washing your hands or using alcohol-based hand sanitizer.

    But these recommendations run up against the reality of life in jails and prisons. Behind bars, access to toilet paper or tissues is often limited and covering your mouth can be impossible if you’re handcuffed, either because of security status or during transport to another facility.

    Typically, facilities provide some access to cleaning products for common areas and individual cells, but sometimes those products aren’t effective, and Johnson recalled women stealing bleach and supplies so they could clean adequately.

    Hand sanitizer is often contraband because of the high alcohol content and the possibility for abuse (the alcohol can be separated out from the gel). A spokesman clarified Thursday that the Texas prison system now sells sanitizer on commissary, though it is a non-alcohol-based alternative, which is not what the CDC recommends.

    Even something as basic as hand-washing can be difficult in facilities with spotty water access or ongoing concerns about contamination, such as in the recent Legionnaires’ outbreak at one federal prison complex in Florida. (Legionnaires is caused by contaminated water, though the source of that water is not clear in Florida).

    Aside from all that, prisons and jails are large communities where a sicker-than-average population is crammed into close quarters where healthcare is often shoddy, and medical providers are often understaffed. In an infectious disease outbreak, health experts recommend separating sick people from well people to prevent the disease from spreading, but in prison that can be nearly impossible, since prisoners are already grouped according to security and other logistical considerations.

    Given all that, correctional facilities often respond to outbreaks with the same set of tools: lockdowns, solitary confinement and visitation restrictions. That’s what some prisons and jails did during the 2009 swine flu pandemic, and it’s what happened more recently in the Florida federal prison complex struck by Legionnaires’. In Texas and other states, prison officials regularly shut down visitation or institute partial lockdowns during mumps and flu outbreaks.

    This time, though, some public health officials—including former Rikers health official Venters—are proposing a different solution: large-scale releases, like those already underway in Iran. There, officials approved the temporary release of more than 54,000 prisoners in an effort to combat the spread of the new virus.

    “That’s a gauntlet for the U.S.,” said Jody Rich, a professor of Medicine and Epidemiology at Brown University. “ Really? Iran’s going to do it better than we are?”

    Advocates in Indiana on Thursday called on the governor to consider releasing large numbers of elderly and sick prisoners, who are at highest risk of complications from coronavirus. People with chronic illnesses are vastly overrepresented in U.S. prisons and jails, and elderly inmates are the fastest-growing share of prisoners.

    Some in law enforcement immediately criticized the proposal.

    “I don’t think a viable solution for the safety of our community is to have mass releases from jails,” said Joe Gamaldi, president of the Houston police union. “As much as we have to balance the dangers that coronavirus poses to the community, we also have to balance that against the danger of letting violent criminals back out on the streets.”

    It’s not yet clear whether any prisons or jails are seriously considering widespread releases. A spokeswoman for the federal prison system did not respond to questions about the idea, instead saying that the isolating nature of prisons could be an asset in handling any potential outbreak.

    “The controlled environment of a prison allows the Bureau of Prisons to isolate, contain and address any potential medical concern quickly and appropriately,” said Nancy Ayers, the spokeswoman. “Every facility has contingency plans in place to address a large range of concerns.”

    View the original article at thefix.com

  • As The Coronavirus Spreads, Americans Lose Ground Against Other Health Threats

    As the world struggles to control Coronavirus (COVID-19,) U.S. health officials are refighting battles they thought they had won, such as halting measles outbreaks, reducing deaths from heart disease and protecting young people from tobacco.

    For much of the 20th century, medical progress seemed limitless.

    Antibiotics revolutionized the care of infections. Vaccines turned deadly childhood diseases into distant memories. Americans lived longer, healthier lives than their parents.

    Yet today, some of the greatest success stories in public health are unraveling.

    Even as the world struggles to control a mysterious new viral illness known as COVID-19, U.S. health officials are refighting battles they thought they had won, such as halting measles outbreaks, reducing deaths from heart disease and protecting young people from tobacco. These hard-fought victories are at risk as parents avoid vaccinating children, obesity rates climb, and vaping spreads like wildfire among teens.

    Things looked promising for American health in 2014, when life expectancy hit 78.9 years. Then, life expectancy declined for three straight years — the longest sustained drop since the Spanish flu of 1918, which killed about 675,000 Americans and 50 million people worldwide, said Dr. Steven Woolf, a professor of family medicine and population health at Virginia Commonwealth University.

    Although life expectancy inched up slightly in 2018, it hasn’t yet regained the lost ground, according to the Centers for Disease Control and Prevention.

    “These trends show we’re going backwards,” said Dr. Sadiya Khan, an assistant professor of cardiology and epidemiology at Northwestern University Feinberg School of Medicine.

    While the reasons for the backsliding are complex, many public health problems could have been avoided, experts say, through stronger action by federal regulators and more attention to prevention.

    “We’ve had an overwhelming investment in doctors and medicine,” said Dr. Sandro Galea, dean of the Boston University School of Public Health. “We need to invest in prevention — safe housing, good schools, living wages, clean air and water.”

    The country has split into two states of health, often living side by side, but with vastly different life expectancies. Americans in the fittest neighborhoods are living longer and better — hoping to live to 100 and beyond — while residents of the sickest communities are dying from preventable causes decades earlier, which pulls down life expectancy overall.

    Superbugs — resistant to even the strongest antibiotics — threaten to turn back the clock on the treatment of infectious diseases. Resistance occurs when bacteria and fungi evolve in ways that let them survive and flourish, in spite of treatment with the best available drugs. Each year, resistant organisms cause more than 2.8 million infections and kill more than 35,000 people in the U.S.

    With deadly new types of bacteria and fungi ever emerging, Dr. Robert Redfield, the CDC director, said the world has entered a “post-antibiotic era.” Half of all new gonorrhea infections, for example, are resistant to at least one type of antibiotic, and the CDC warns that “little now stands between us and untreatable gonorrhea.”

    That news comes as the CDC also reports a record number of combined cases of gonorrhea, syphilis and chlamydia, which were once so easily treated that they seemed like minor threats compared with HIV.

    The United States has seen a resurgence of congenital syphilis, a scourge of the 19th century, which increases the risk of miscarriage, permanent disabilities and infant death. Although women and babies can be protected with early prenatal care, 1,306 newborns were born with congenital syphilis in 2018 and 94 of them died, according to the CDC.

    Those numbers illustrate the “failure of American public health,” said Dr. Cornelius “Neil” Clancy, a spokesperson for the Infectious Diseases Society of America. “It should be a global embarrassment.”

    The proliferation of resistant microbes has been fueled by overuse, by doctors who write unnecessary prescriptions as well as farmers who give the drugs to livestock, said Dr. William Schaffner, a professor of preventive medicine at Vanderbilt University Medical Center in Nashville, Tennessee.

    Although new medications are urgently needed, drug companies are reluctant to develop antibiotics because of the financial risk, said Clancy, noting that two developers of antibiotics recently went out of business. The federal government needs to do more to make sure patients have access to effective treatments, he said. “The antibiotic market is on life support,” Clancy said. “That shows the real perversion in how the health care system is set up.”

    A Slow Decline

    A closer look at the data shows that American health was beginning to suffer 30 years ago. Increases in life expectancy slowed as manufacturing jobs moved overseas and factory towns deteriorated, Woolf said.

    By the 1990s, life expectancy in the United States was falling behind that of other developed countries.

    The obesity epidemic, which began in the 1980s, is taking a toll on Americans in midlife, leading to diabetes and other chronic illnesses that deprive them of decades of life. Although novel drugs for cancer and other serious diseases give some patients additional months or even years, Khan said, “the gains we’re making at the tail end of life cannot make up for what’s happening in midlife.”

    Progress against overall heart disease has stalled since 2010. Deaths from heart failure — which can be caused by high blood pressure and blocked arteries around the heart — are rising among middle-aged people. Deaths from high blood pressure, which can lead to kidney failure, also have increased since 1999.

    “It’s not that we don’t have good blood pressure drugs,” Khan said. “But those drugs don’t do any good if people don’t have access to them.”

    Addicting A New Generation

    While the United States never declared victory over alcohol or drug addiction, the country has made enormous progress against tobacco. Just a few years ago, anti-smoking activists were optimistic enough to talk about the “tobacco endgame.”

    Today, vaping has largely replaced smoking among teens, said Matthew Myers, president of the Campaign for Tobacco-Free Kids. Although cigarette use among high school students fell from 36% in 1997 to 5.8% today, studies show 31% of seniors used electronic cigarettes in the previous month.

    FDA officials say they’ve taken “vigorous enforcement actions aimed at ensuring e-cigarettes and other tobacco products aren’t being marketed or sold to kids.” But Myers said FDA officials were slow to recognize the threat to children.

    With more than 5 million teens using e-cigarettes, Myers said, “more kids are addicted to nicotine today than at any time in the past 20 years. If that trend isn’t reversed rapidly and dynamically, it threatens to undermine 40 years of progress.”

    Ignoring Science

    Where children live has long determined their risk of infectious disease. Around the world, children in the poorest countries often lack access to lifesaving vaccines.

    Yet in the United States — where a federal program provides free vaccines — some of the lowest vaccination rates are in affluent communities, where some parents disregard the medical evidence that vaccinating kids is safe.

    Studies show that vaccination rates are drastically lower in some private schools and “holistic kindergartens” than in public schools.

    It could be argued that vaccines have been a victim of their own success.

    Before the development of a vaccine in the 1960s, measles infected an estimated 4 million Americans a year, hospitalizing 48,000, causing brain inflammation in about 1,000 and killing 500, according to the CDC.

    By 2000, measles cases had fallen to 86, and the United States declared that year that it had eliminated the routine spread of measles.

    “Now, mothers say, ‘I don’t see any measles. Why do we have to keep vaccinating?’” Schaffner said. “When you don’t fear the disease, it becomes very hard to value the vaccine.”

    Last year, a measles outbreak in New York communities with low vaccination rates spread to almost 1,300 people — the most in 25 years — and nearly cost the country its measles elimination status. “Measles is still out there,” Schaffner said. “It is our obligation to understand how fragile our victory is.”

    Health-Wealth Disparities

    To be sure, some aspects of American health are getting better.

    Cancer death rates have fallen 27% in the past 25 years, according to the American Cancer Society. The teen birth rate is at an all-time low; teen pregnancy rates have dropped by half since 1991, according to the Department of Health and Human Services. And HIV, which was once a death sentence, can now be controlled with a single daily pill. With treatment, people with HIV can live into old age.

    “It’s important to highlight the enormous successes,” Redfield said. “We’re on the verge of ending the HIV epidemic in the U.S. in the next 10 years.”

    Yet the health gap has grown wider in recent years. Life expectancy in some regions of the country grew by four years from 2001 to 2014, while it shrank by two years in others, according to a 2016 study in JAMA.

    The gap in life expectancy is strongly linked to income: The richest 1% of American men live 15 years longer than the poorest 1%; the richest women live 10 years longer than the poorest, according to the JAMA study.

    “We’re not going to erase that difference by telling people to eat right and exercise,” said Dr. Richard Besser, CEO of the Robert Wood Johnson Foundation and former acting director of the CDC. “Personal choices are part of it. But the choices people make depend on the choices they’re given. For far too many people, their choices are extremely limited.”

    The infant mortality rate of black babies is twice as high as that of white newborns, according to the Department of Health and Human Services. Babies born to well-educated, middle-class black mothers are more likely to die before their 1st birthday than babies born to poor white mothers with less than a high school education, according to a report from the Brookings Institution.

    In trying to improve American health, policymakers in recent years have focused largely on expanding access to medical care and encouraging healthy lifestyles. Today, many advocate taking a broader approach, calling for systemic change to lift families out of the poverty that erodes mental and physical health.

    “So many of the changes in life expectancy are related to changes in opportunity,” Besser said. “Economic opportunity and health go hand in hand.”

    Several policies have been shown to improve health.

    Children who receive early childhood education, for example, have lower rates of obesity, child abuse and neglect, youth violence and emergency department visits, according to the CDC.

    And earned income tax credits — which provide refunds to lower-income people — have been credited with keeping more families and children above the poverty line than any other federal, state or local program, according to the CDC. Among families who receive these tax credits, mothers have better mental health and babies have lower rates of infant mortality and weigh more at birth, a sign of health.

    Improving a person’s environment has the potential to help them far more than writing a prescription, said John Auerbach, president and CEO of the nonprofit Trust for America’s Health.

    “If we think we can treat our way out of this, we will never solve the problem,” Auerbach said. “We need to look upstream at the underlying causes of poor health.”

    View the original article at thefix.com

  • They Fell In Love Helping Drug Users. But Fear Kept Him From Helping Himself.

    Beeler worried that a failed drug test — even if it was for a medication to treat his addiction (like buprenorphine) — would land him in prison.

    She was in medical school. He was just out of prison.

    Sarah Ziegenhorn and Andy Beeler’s romance grew out of a shared passion to do more about the country’s drug overdose crisis.

    Ziegenhorn moved back to her home state of Iowa when she was 26. She had been working in Washington, D.C., where she also volunteered at a needle exchange — where drug users can get clean needles. She was ambitious and driven to help those in her community who were overdosing and dying, including people she had grown up with.

    “Many people were just missing because they were dead,” said Ziegenhorn, now 31. “I couldn’t believe more wasn’t being done.”

    She started doing addiction advocacy in Iowa City while in medical school — lobbying local officials and others to support drug users with social services.

    Beeler had the same conviction, born from his personal experience.

    “He had been a drug user for about half of his life — primarily a longtime opiate user,” Ziegenhorn said.

    Beeler spent years in and out of the criminal justice system for a variety of drug-related crimes, such as burglary and possession. In early 2018, he was released from prison. He was on parole and looking for ways to help drug users in his hometown.

    He found his way to advocacy work and, through that work, found Ziegenhorn. Soon they were dating.

    “He was just this really sweet, no-nonsense person who was committed to justice and equity,” she said. “Even though he was suffering in many ways, he had a very calming presence.”

    People close to Beeler describe him as a “blue-collar guy” who liked motorcycles and home carpentry, someone who was gentle and endlessly curious. Those qualities could sometimes hide his struggle with anxiety and depression. Over the next year, Beeler’s other struggle, with opioid addiction, would flicker around the edges of their life together.

    Eventually, it killed him.

    People on parole and under supervision of the corrections system can face barriers to receiving appropriate treatment for opioid addiction. Ziegenhorn said she believes Beeler’s death is linked to the many obstacles to medical care he experienced while on parole.

    About 4.5 million people are on parole or probation in the U.S., and research shows that those under community supervision are much more likely to have a history of substance use disorder than the general population. Yet rules and practices guiding these agencies can preclude parolees and people on probation from getting evidence-based treatment for their addiction.

    A Shared Passion For Reducing Harm

    From their first meeting, Ziegenhorn said, she and Beeler were in sync, partners and passionate about their work in harm reduction — public health strategies designed to reduce risky behaviors that can hurt health.

    After she moved to Iowa, Ziegenhorn founded a small nonprofit called the Iowa Harm Reduction Coalition. The group distributes the opioid-overdose reversal drug naloxone and other free supplies to drug users, with the goal of keeping them safe from illness and overdose. The group also works to reduce the stigma that can dehumanize and isolate drug users. Beeler served as the group’s coordinator of harm reduction services.

    “In Iowa, there was a feeling that this kind of work was really radical,” Ziegenhorn said. “Andy was just so excited to find out someone was doing it.”

    Meanwhile, Ziegenhorn was busy with medical school. Beeler helped her study. She recalled how they used to take her practice tests together.

    “Andy had a really sophisticated knowledge of science and medicine,” she said. “Most of the time he’d been in prison and jails, he’d spent his time reading and learning.”

    Beeler was trying to stay away from opioids, but Ziegenhorn said he still used heroin sometimes. Twice she was there to save his life when he overdosed. During one episode, a bystander called the police, which led to his parole officer finding out.

    “That was really a period of a lot of terror for him,” Ziegenhorn said.

    Beeler was constantly afraid the next slip — another overdose or a failed drug test — would send him back to prison.

    An Injury, A Search For Relief

    A year into their relationship, a series of events suddenly brought Beeler’s history of opioid use into painful focus.

    It began with a fall on the winter ice. Beeler dislocated his shoulder — the same one he’d had surgery on as a teenager.

    “At the emergency room, they put his shoulder back into place for him,” Ziegenhorn said. “The next day it came out again.”

    She said doctors wouldn’t prescribe him prescription opioids for the pain because Beeler had a history of illegal drug use. His shoulder would dislocate often, sometimes more than once a day.

    “He was living with this daily, really severe constant pain — he started using heroin very regularly,” Ziegenhorn said.

    Beeler knew what precautions to take when using opioids: Keep naloxone on hand, test the drugs first and never use alone. Still, his use was escalating quickly.

    A Painful Dilemma 

    The couple discussed the future and their hope of having a baby together, and eventually Ziegenhorn and Beeler agreed: He had to stop using heroin.

    They thought his best chance was to start on a Food and Drug Administration-approved medication for opioid addiction, such as methadone or buprenorphine. Methadone is an opioid, and buprenorphine engages many of the same opioid receptors in the brain; both drugs can curb opioid cravings and stabilize patients. Studies show daily maintenance therapy with such treatment reduces the risks of overdose and improves health outcomes.

    But Beeler was on parole, and his parole officer drug-tested him for opioids and buprenorphine specifically. Beeler worried that if a test came back positive, the officer might see that as a signal that Beeler had been using drugs illegally.

    Ziegenhorn said Beeler felt trapped: “He could go back to prison or continue trying to obtain opioids off the street and slowly detox himself.”

    He worried that a failed drug test — even if it was for a medication to treat his addiction — would land him in prison. Beeler decided against the medication.

    A few days later, Ziegenhorn woke up early for school. Beeler had worked late and fallen asleep in the living room. Ziegenhorn gave him a kiss and headed out the door. Later that day, she texted him. No reply.

    She started to worry and asked a friend to check on him. Not long afterward, Beeler was found dead, slumped in his chair at his desk. He’d overdosed.

    “He was my partner in thought, and in life and in love,” Ziegenhorn said.

    It’s hard for her not to rewind what happened that day and wonder how it could have been different. But mostly she’s angry that he didn’t have better choices.

    “Andy died because he was too afraid to get treatment,” she said.


    Beeler was services coordinator for the Iowa Harm Reduction Coalition, a group that works to help keep drug users safe. A tribute in Iowa City after his death began, “He died of an overdose, but he’ll be remembered for helping others avoid a similar fate.” (COURTESY OF SARAH ZIEGENHORN)

    How Does Parole Handle Relapse? It Depends

    It’s not clear that Beeler would have gone back to prison for admitting he’d relapsed and was taking treatment. His parole officer did not agree to an interview.

    But Ken Kolthoff, who oversees the parole program that supervised Beeler in Iowa’s First Judicial District Department of Correctional Services, said generally he and his colleagues would not punish someone who sought out treatment because of a relapse.

    “We would see that that would be an example of somebody actually taking an active role in their treatment and getting the help they needed,” said Kolthoff.

    The department doesn’t have rules prohibiting any form of medication for opioid addiction, he said, as long as it’s prescribed by a doctor.

    “We have people relapse every single day under our supervision. And are they being sent to prison? No. Are they being sent to jail? No,” Kolthoff said.

    But Dr. Andrea Weber, an addiction psychiatrist with the University of Iowa, said Beeler’s reluctance to start treatment is not unusual.

    “I think a majority of my patients would tell me they wouldn’t necessarily trust going to their [parole officer],” said Weber, assistant director of addiction medicine at the University of Iowa’s Carver College of Medicine. “The punishment is so high. The consequences can be so great.”

    Weber finds probation and parole officers have “inconsistent” attitudes toward her patients who are on medication-assisted treatment.

    “Treatment providers, especially in our area, are still very much ingrained in an abstinence-only, 12-step mentality, which traditionally has meant no medications,” Weber said. “That perception then invades the entire system.”

    Attitudes And Policies Vary Widely

    Experts say it’s difficult to draw any comprehensive picture about the availability of medication for opioid addiction in the parole and probation system. The limited amount of research suggests that medication-assisted treatment is significantly underused.

    “It’s hard to quantify because there are such a large number of individuals under community supervision in different jurisdictions,” said Michael Gordon, a senior research scientist at the Friends Research Institute, based in Baltimore.

    A national survey published in 2013 found that about half of drug courts did not allow methadone or other evidence-based medications used to treat opioid use disorder.

    A more recent study of probation and parole agencies in Illinois reported that about a third had regulations preventing the use of medications for opioid use disorder. Researchers found the most common barrier for those on probation or parole “was lack of experience by medical personnel.”

    Faye Taxman, a criminology professor at George Mason University, said decisions about how to handle a client’s treatment often boil down to the individual officer’s judgment.

    “We have a long way to go,” she said. “Given that these agencies don’t typically have access to medical care for clients, they are often fumbling in terms of trying to think of the best policies and practices.”

    Increasingly, there is a push to make opioid addiction treatment available within prisons and jails. In 2016, the Rhode Island Department of Corrections started allowing all three FDA-approved medications for opioid addiction. That led to a dramatic decrease in fatal opioid overdoses among those who had been recently incarcerated.

    Massachusetts has taken similar steps. Such efforts have only indirectly affected parole and probation.

    “When you are incarcerated in prison or jail, the institution has a constitutional responsibility to provide medical services,” Taxman said. “In community corrections, that same standard does not exist.”

    Taxman said agencies may be reluctant to offer these medications because it’s one more thing to monitor. Those under supervision are often left to figure out on their own what’s allowed.

    “They don’t want to raise too many issues because their freedom and liberties are attached to the response,” she said.

    Richard Hahn, a researcher at New York University’s Marron Institute of Urban Management who consults on crime and drug policy, said some agencies are shifting their approach.

    “There is a lot of pressure on probation and parole agencies not to violate people just on a dirty urine or for an overdose” said Hahn, who is executive director of the institute’s Crime & Justice Program.

    The federal government’s Substance Abuse and Mental Health Services Administration calls medication-assisted treatment the “gold standard” for treating opioid addiction when used alongside “other psychosocial support.”

    Addiction is considered a disability under the Americans with Disabilities Act, said Sally Friedman, vice president of legal advocacy for the Legal Action Center, a nonprofit law firm based in New York City.

    She said disability protections extend to the millions of people on parole or probation. But people under community supervision, Friedman said, often don’t have an attorney who can use this legal argument to advocate for them when they need treatment.

    “Prohibiting people with that disability from taking medication that can keep them alive and well violates the ADA,” she said.

    This story is part of a partnership between NPR and Kaiser Health News.

    View the original article at thefix.com