Answer Addiction

Tag: marginalized communities

  • New Data Show Disturbing Racial Disparities in Combined Opioid-Cocaine Overdose Rates

    The problem is not just increased use of stimulants and opioids, it is also a lack of recovery resources, substance use disorder treatment, and a historical mistrust of healthcare providers.

    An exclusive interview with researcher Tarlise Townsend, Ph.D., reveals a definitive need for harm reduction policies plus investment in treatment in marginalized communities. In these communities, particularly lower-income African American and Latino neighborhoods, the opioid epidemic has combined with stimulant abuse to create a sharp spike in overdoses. These findings, from a study funded by the National Institutes of Health that examined death certificate data in the dozen years before the start of the COVID-19 pandemic, were published last month in the American Journal of Epidemiology.

    Driven by the three-headed dragon of fentanyl, prescription painkillers, and heroin, drug overdoses kill over a hundred thousand people every year in the United States. However, from 2007 to 2019, drug overdose deaths involving more than one substance increased dramatically across the board nationwide. Additionally, these multi-drug overdoses had a more noticeable spike in traditionally marginalized communities that lack substance disorder education, prevention efforts, and treatment opportunities.

    The Fix is honored to interview Dr. Tarlise Townsend about the implications of her study.

    The Fix: Why is the combination of stimulant abuse like cocaine or methamphetamines and opioid use disorder like heroin or prescription painkiller misuse hitting marginalized racial and ethnic communities so hard? As opposed to one or the other, what do you think is the reason for the two-headed dragon?

    Dr. Tarlise Townsend: The overarching response to that question, unfortunately, is that we don’t have an answer. Although we have diagnosed and identified the problem, we still desperately need to understand what’s driving it: Why are marginalized communities, particularly Black Americans, being hit proportionately hard by these combined overdose deaths? At the same time, the reality is that structural racism shapes everything, including access to resources. There is a lack of harm reduction options in this community, a historical lack of trust in healthcare providers, and a profound lack of access to treatment for substance use disorder.

    Also, criminalization is a really big factor when it comes to the increased risk of overdose. It is so much less likely that authorities will be contacted in time to administer overdose antagonists like Naloxone. After all, Black Americans, particularly men, are so much more likely to be criminalized for just being in possession of these drugs.

    As a result, there are many factors contributing to these racial disparities. Also, these disparities may not be specific to just these two types of drugs; stimulants and opioids. It may be a more systemic problem that right now is just manifesting as increased overdose due to the combination of stimulants and opioids. When you put this issue into the context of fundamental cause theory, you realize that the fundamental causes of health issues like socioeconomic status or racism affect health outcomes in almost every context in these communities. These overarching causes fundamentally affect people in so many ways because they basically bleed into everything.

    Even if you try to address other causes of these health disparities, socioeconomic status and racism will find another way to generate other challenges. Indeed, socioeconomic status and racism have been and continue to be fundamental causes of adverse health outcomes in these marginalized communities. The problem is not just the increased use of stimulants and opioids leading to more overdoses. It also is a lack of recovery resources, educational opportunities, and substance use disorder treatment in these communities.

    What drug is playing the driving role in this overdose crisis? Is heroin or cocaine proving to be more destructive in these communities?

    Our study did not look specifically at the type of opioids contributing to these overdose deaths. However, other recent research looking at the problem of opioid-stimulant deaths has found that fentanyl is playing the driving role. The story of this rise in overdoses is due primarily to a surge in fentanyl exposure. There is a contamination of these street drugs that the person who is using does not realize. Despite the increase in combined opioid-stimulant use, the inclusion of fentanyl in that picture is the driving force. 

    In developing countries, particularly in Southeast Asia, methamphetamine use has been connected with working long hours. Is that happening in the U.S. as well?

    I don’t feel like I can answer that question with any expertise or confidence, but it does bring up another perspective. There is evidence of people who use opioids in homeless populations on the street intentionally using stimulants to stay alert. First, these people are more readily targeted and criminalized for using. Second, they cannot afford to be oblivious when living in such extreme conditions. It could be that the stimulants counteract the opioids, allowing these people to avoid what we would describe as loitering and remain aware of external threats.

    Thus, the co-use of these two drugs by homeless populations could be described as an effort to cope with really trying conditions. However, despite such hypotheses about what is going on, there is not a lot of proven research. Thus, we know very little about those specific dynamics. Still, the idea of homeless people addicted to opioids using stimulants as a survival mechanism is a notion that deserves greater investigation.

    Specifically, what kind of harm reduction and evidence-based SUD treatment services are needed in Black and Latino neighborhoods? For example, if you had a billion dollars in funding to fight this crisis, how would you spend it?

    We need to look at both the money is no object question, and money is an object, so what do we do question. For the first, we need all the things. There is no specific policy solution or harm reduction solution that is going to address everything. There is no quick and easy fix to eliminate rising disparities in opioid and stimulant overdose deaths. We would think that when we implement a societal health intervention, the population in our society that needs the most help will receive the most benefit from such an intervention. However, this is not the case because health disparities will often widen unless you specifically target the communities with the greatest needs. If you want to help those communities, you have to target the barriers preventing them from accessing the help they need, like resource barriers, stigma issues, socioeconomic gaps, and racial and ethnic challenges. Often, the people who benefit the most from societal health interventions are the people with the most resources. The lack of resources in marginalized communities results in such health interventions often proving ineffective.

    In general, when we are thinking about policies and programs designed to target disparities in substance use and overdose, we need to be intentional about tailoring those interventions to the communities that need them most. We need culturally informed and competent efforts tailored to address the needs of these specific communities that are being hit the hardest by opioid and stimulant overdose deaths. Highlighting such tailoring, we need education and outreach materials translated into the languages primarily spoken in these communities. Awareness of substance use disorder treatment and harm reduction programs need to be raised in contexts that people in these communities trust. A great example is the role that Black churches are playing in Black communities. Since that setting implies a greater trust, it leads to a greater uptake of these recovery options. There is a lot of distrust in these communities when it comes to traditional healthcare settings.

    Beyond these efforts, I also think we need to be thinking bigger. For example, the safe consumption sites that just opened in New York are encouraging, and initial evaluations are already underway. Researchers are looking at how effectively they reduce opioid mortality and increase the uptake of treatment for substance use disorder and other health intervention efforts. I’m also eager to see what effects decriminalization like we are seeing now in Oregon will have on overdose mortality trends. When it comes to spending money to combat these problems, whether it is the limited funds that are now accessible or an imaginary unlimited amount, researchers need in-depth cost-effectiveness analyses. No matter how much money is being spent, many health interventions that people thought would lead to major results did not give us the greatest bang for our buck. In reality, resources are limited and scarce. Thus, the money spent needs to be used in the best way possible. We need to study which of these programs and policies will prove cost-effective. 

    An example of such a cost-effective study is seen today in the use of Naloxone, the opioid antagonist that can reverse an overdose in an emergency. Distributing Naloxone to people who most likely will experience overdose is highly cost-effective and saves lives. It has proven to be one of the most cost-effective medications on the market. Our experience with Naloxone so far is a good model for figuring out how we can best use limited resources to address this crisis and reduce the health disparities in these marginalized communities.

    View the original article at thefix.com

  • Addiction and Poverty, Dignity and Friendship: An Interview with Chris Arnade

    Addiction and Poverty, Dignity and Friendship: An Interview with Chris Arnade

    Even in harsh situations people can find dignity, and create these beautiful things. Even in the crack houses, even in the drug spots there is beauty. It’s not just all down and out.

    In 2011, Chris Arnade was a successful bond trader, working on Wall Street and experiencing a level of success most Americans only dream of. He seemed to have it all – a degree from a prestigious university, a nice home, and family. And yet just a year later, he began a project that would eventually morph from distraction to obsession: photographing and documenting the lives of the drug addicts who were then denizens of Hunts Point, thought at the time to be one of the roughest neighborhoods in New York’s South Bronx. 

    Arnade had become disillusioned with the financial industry during the mid-2000s financial crisis, and he left Wall Street for good in 2012. In 2013, he published a series of photographs titled “Faces of Addiction” on the image hosting site Flickr.

    In 2014, Arnade began taking long road trips across America, documenting “the back row” – his term for the people who had fallen through the cracks of the Great American Success Story, those who are routinely ignored, marginalized, and demonized. At oases of calm, like local McDonald’s restaurants which often serve as places of refuge for the down-and-out, Arnade found unexpected resilience, dignity, and even humor in the lives of America’s forgotten.

    Photographs, interviews, and observations from these journeys comprise Arnade’s latest book, Dignity: Seeking Respect in Back Row America. I once again had the opportunity to talk with Arnade about how he went from being a cog in the finance industry machine to the lens that strives to expose the worth in people so many think of as worthless.

    The Fix: You’re a scientist, you worked on Wall Street, where you had a very successful career. What made you decide to make the transition from Wall Street to becoming a documentarian? Actually, you’re more than a documentarian. As I recall, you were very much involved in the lives of the people that you met in Hunts Point. What was the catalyst for that transition?

    Chris Arnade: A combination of curiosity and frustration. Frustration with Wall Street and how, especially after the financial crisis, how the industry was, and how much damage it had done, and how closed-minded people on Wall Street were to the fact that they had done damage. So, I kind of, in some way, blew off my job and just starting walking around the town, and that’s kind of what led me to Hunts Point. Not just Hunts Point, but other neighborhoods like Hunts Point where people tell you not to go to.

    Then it became somewhat political, where I was seeing things that are very different to what people had said I would see. Neighborhoods [where] there’s a lot more sense of community. It wasn’t as dangerous as people said it was, it was far more inviting, friendly, than people said it would be. But also people were screwed over, and so the neighborhood had been kind of unfairly stigmatized. And it made me kind of frustrated that people here weren’t necessarily any different that the people on the Upper East Side, but they were treated a lot different.

    It was an area that people judged quite harshly, but you saw another level, you saw the community, you saw other pieces.

    Right. And also…it was the first time I was really spending a large amount of time around hard-core addicts, and so the stereotypes for addicts were all wrong. They were no less intelligent, no less hard working, no less decent than any other people. Here they were, being in this awful situation, and being treated like shit. So, some of that was going on, just being kind of like, “Oh my God, this is so wrong.”

    Did your experience in Hunts Point change your thoughts about and viewpoints of addiction?

    Yeah, I became a lot more sympathetic. I certainly understood a lot better how stigmatized the community is. This is, I guess, seven years ago now. A lot has changed in the seven years, for the better. I think seven years ago, you’d regularly hear people saying, “Addicts deserve this.” I don’t think you hear many people say that anymore, thankfully…The biggest change I saw was, if you had asked me before, I would’ve thought it would’ve been pretty easy to get clean, to get sober. Life sucks for them and this is unfair, but why don’t they just get clean? When I was in Hunts Point, I realized just how hard that is, it’s impossible sometimes.

    Did you have a sense of addiction from the medical model?

    Yeah. From that perspective, I’m in the minority I think. I don’t want to get people angry and say it’s not a medical condition, [but] I don’t see it that way. I see it as more of a cultural issue, in the sense that you’re surrounded by it. You grew up in these neighborhoods. I see it as a response to basically being either traumatized, or stigmatized. The sense of being cast aside, and feeling like you don’t really fit in anywhere, and that life is kind of meaningless. 

    So, one of the things I write about in the book is: I talk about how— and people don’t want to admit it— there’s a strong community in the drug houses. You walk into a crack house or drug trap, or you crawl underneath a bridge and hang out with people shooting up, it’s a real community. Friends, there’s people, it’s a place where you fit in. And, I think there’s a lot of people who don’t feel like they fit in, or are not accepted in other clubs. Nobody wants to let them in their club, so why not go to the club underneath the bridge?

    McDonald’s became almost a symbol while you were in Hunts Point. Why McDonald’s?

    I think there’s two reasons. One is, well, it’s been the place addicts go. It’s often the only place that is opened to all people, when you’re really pushed to the margins. That’s where the addicts were, that’s where my friends were. People who would spend all day there. They’d go pick up a newspaper out of the garbage can and maybe a soda cup, and refill the soda, sit in the corner, and maybe shoot up in the bathroom, clean up, and just otherwise get lost alone for maybe four or five hours, and no one bothering them. No one telling them “move,” nobody telling them to get out; do this, do that. As I say, a place to regain a sense of dignity, where people don’t stare at you. 

    And the second one, it’s one of the few places that worked. I think Hunts Point’s doing better now. I don’t know, haven’t been there in a while, but I think back then [McDonald’s] was one of the few places that actually was functional, that you could just go to. It was open, and had a bathroom.

    And McDonald’s remained a touchpoint for you in your travels across the country.

    I didn’t really want it to necessarily, but it was for the same reasons as I found myself at McDonald’s in Hunts Point. I found myself in McDonald’s in Portsmouth, I found myself in McDonald’s in other places, because that’s the place where, if your goal was to write about people who were living in the margins, you go to McDonald’s. That’s where they were. I also wanted to be there because I could charge my phone, charge my computer, and I could use the bathroom, and I could clean up. And also, I like the coffee there. You had free WiFi, all those things that people want.

    You also visited many community churches across the country, how did that affect your experience with faith?

    I’m not an atheist anymore, but I’m certainly not religious. I write a lot in my book about how I grappled with thinking about the role of faith, and what I believed before that. I’m a lot more open minded about people. I certainly have a lot more respect for religion, for faith, than I did before.

    It’s interesting, because very often science seems to be at odds with religion and you are a scientist. 

    I’m not doubting that the science community is extraordinarily well-intentioned and does great things, and wants to help the people, the homeless, and they want to help the addicts. Certainly, doctors do and certainly, people do. The average scientist doesn’t understand how, on the street it doesn’t feel like you’re being helped by science. Even a lot of readers won’t understand this. Detoxes, certainly ones that serve the poorest of people, are not necessarily accepting places. They can be sterile cold places, not very welcoming. Hospitals are the same way.

    The places you would think would be the least judgmental, very often are the most.

    The thing is, it’s just a matter of legwork too. If you’re in the worst neighborhood, worst stigmatized, worst drugs, worst crime…the groups that go in there and talk to them on their level and don’t treat them like things they don’t understand are churches. They really go into these communities and do outreach. Some people might be upset with that outreach, but I think the reality is they’re there, they’re boots on the ground.

    And I noticed, in the book, it wasn’t like you visited homeless shelters or spent much time in treatment programs.

    No. I think McDonald’s are the homeless shelters during the day, the day shelter. When people can’t be in the shelter, they walk over to the McDonald’s and hang out there. There are certain McDonald’s that were open 24 hours, especially ones in the inner states. That’s where they hang out. They try to hang out all night there.

    Was your experience of this kind of journey different than what you expected it was going to be? Did you have a sense of what you were going to see or what you might encounter? 

    I didn’t think I would see as much pain as or as much frustration as I saw. Every town has a neighborhood, or multiple neighborhoods that are like – this isn’t a blue-state, red-state or urban thing, it’s everywhere. You go into any town, and there’s going to be a problem, a place where there’re drugs, and where there’s frustration, and where there’s poverty. I guess, what I found, what kind of shocked me or disappointed me in some ways, is just how easy it is to find. You don’t have to go searching for it. And how out of touch politicians are, with what’s going on in their own country. 

    So, the magnitude was greater than you expected yet, it seems like you have hope. In your book, that sense of hope comes across, despite the fact that as you said, the problem was greater, the magnitude larger, but there’s hope, still.

    People are resilient. So, even faced with these awful structural problems that are kind of put on them, they do their best. It’s like in Hunts Point. 

    The things I worried about that didn’t get a lot of attention are like the pigeon keepers, right? People who take pigeons and make beauty out it. A lot of people think it’s nothing, they’re just rats with wings, but if you go up on a roof and watch the pigeons fly, they’re gorgeous. The same with the guys who fix up Schwinn bicycles, which are literally being tossed out by wealthy people, or ignored, they turn them into these really cool things. 

    So, I think what I appreciated is the resilience. Even in harsh situations people can find dignity, and create these beautiful things. Even in the crack houses, even in the drug spots there is beauty. Where there’s people putting together small works of art, and there’s humor. It’s not just all down and out. There are funny moments, people have fun. It’s not just all evil.

    The tragedy of the streets means few can delude themselves into thinking they have it under control. You cannot ignore death there, and you cannot ignore human fallibility. It is easier to see that everyone is a sinner, everyone is fallible, and everyone is mortal. It is easier to see that there are things just too deep, too important, or too great for us to know. It is far easier to recognize that one must come to peace with the idea that “we don’t and never will have this under control.” It is far easier to see religion not just as useful but true.

    From Dignity: Seeking Respect in Back Row America

    View the original article at thefix.com

  • Addiction Treatment in Hispanic Communities: How We Can Do Better

    Addiction Treatment in Hispanic Communities: How We Can Do Better

    Numerous cultural norms and expectations reinforce the collective silence on substance use. Among many Latinx people who are first generation immigrants, there is a desire or expectation to be a “model minority.”

    Evan Figueroa Vargas wears the scars of a hard-knock life in his voice. In gravely intones the Philadelphia native recounts years of criminal justice involvement and chaotic drug use that followed his brother’s sudden overdose death in 2002. It’s not easy to find help when drugs, incarceration, and the streets intertwine, he says. But it’s even harder when you’re Hispanic.

    “In the Latino community you come from a place where machismo rules,” Figueroa explains over the phone. If you admit to mental health or substance use issues, “somebody is going to call you a loco.”

    Culture of Silence Around Drug Issues

    Many people who identify as Latinx (originating from Latin American countries) or Hispanic (from Spanish-speaking countries) describe a culture of silence around drug issues. Particularly for men, asking for help or admitting vulnerabilities can be seen as a weakness to be ridiculed or exploited.

    Numerous cultural norms and expectations reinforce the collective silence on substance use. Among many Latinx people who are first generation immigrants, there is a desire or expectation to be a “model minority.” Communities may emphasize the importance of hard work, education, family loyalty, and showing your new country that you are an asset. Drug use, especially chaotic use of illicit drugs, is seen as running counter to these goals.

    Tanagra Melgarejo, who immigrated to the United States from Puerto Rico at 17 years old and now works for the Harm Reduction Coalition, cites a popular Latinx idiom: Los trapos sucios se lavan en casa. Basically, don’t air your dirty laundry in public. Drug issues are hard to bring up because “you feel like you’re betraying a cultural norm,” Melgarejo explains. “You are exposing something and then you are bringing shame to yourself and other people.”

    The desire to hide drug use may have pragmatic roots. Among immigrants and people of color, who are often the target of police or other state institutions, openness about illicit drug use might attract unwanted attention, including raids, harassment, and incarceration. Avoiding illicit activities or hiding any that may occur becomes a necessity for undocumented immigrants as well, who may fear deportation.

    But reluctance to speak about drug use exists not just within the Latinx community, but in external discussions that focus on this community as well. In the United States, the rhetoric around race and ethnicity revolves around dichotomies, with Latinx populations often excluded from the dominant narrative on drug use and other structural issues such as incarceration, housing, and health care access.

    “Anyone who is not black or white is invisibilized in this discourse,” explains Melgarejo. While culture wars rage about how black Americans were treated during the crack epidemic versus how white Americans are treated during the opioid epidemic, Hispanics, who are affected by both, are often left out of the discussion entirely.

    The silence not just among Hispanics but also about them is what motivated Angelo Lagares, a Florida resident whose family is from the Dominican Republic, to quit his day job in 2015 to found Latino Recovery Advocacy (LARA). LARA’s mission is to provide linguistic and culturally appropriate resources to Latinx people who use drugs and to stimulate discussion about how drug policy affects them.

    “I went through all that shit,” says Lagares, whose passion blazes through his speech. “When you are using cocaine, and the cocaine runs out at 3 a.m., that desperation, that pain [has] no language…People don’t have help. Everything is in fucking English.”

    Now 53 years old and in recovery, Lagares says he is still haunted by the memories of his community decimated by drugs, AIDS, and incarceration when he lived in New York City during the 1980s. He works to honor “the people who died in the barrio.” He says the first step is to raise awareness about how drugs and drug policy are affecting Latinx people.

    Overdose Deaths Increasing Fast

    In general, reports of illicit drug use among Hispanics or Latinos aged 18 and older are lower than the national average, but that is changing. While U.S. overdose death rates are climbing among all races and ethnicities, mortalities are increasing fastest among Latinos, Native Americans and black Americans. From 2016 to 2017, overdose deaths in these groups increased 12%, 13%, and 25%, respectively, compared to an 11% increase among white Americans.

    But despite these increases, few materials on harm reduction or drug treatment programs are crafted to target Latinx people. Even the SAMHSA Behavioral Health Treatment Services Locator, the largest national collection of online resources for people seeking treatment, does not offer a Spanish version of their website (though they do have interpreters available by phone).

    Many programs for people who use drugs claim to offer Spanish-language services on site, but often this consists of one or two employees who speak Spanish. Support groups, guest lectures, and other group programming are almost always in English.

    Language can be an obvious barrier to Latinx populations seeking services, but even that obstacle is more complex than it seems. Not everyone from Latin America speaks Spanish. Some speak Portuguese or indigenous languages. Further, even Latinx people who speak fluent English can be turned off by the lack of services available in their native tongue.

    “I understand English very well but when I speak about difficult issues I prefer to speak in Spanish,” says Haner Hernandez, who is Puerto Rican-born but currently directs a program in Springfield, Massachusetts that trains Hispanics to become certified drug use counselors. He explains that when dealing with issues as sensitive as mental health and substance use, people feel most comfortable speaking their first language.

    Lack of cultural awareness can also be a barrier to effectively engaging with Latinx people. It’s important to recognize the diversity of culture throughout Latin America. Someone of Cuban descent raised in Miami will have a vastly different background than someone who recently fled violence in Guatemala. There are however, some cultural norms that many Latinx people have in common. For example, religion, especially Catholicism, can play a critical role in how the Latinx community views drug use.

    Melgarejo explains that Catholicism teaches about the purity of the body, so drug use is often perceived as morally wrong. “There is this shame [about drug use] that comes with religion,” she says. “If people are not aware of that, it makes it difficult for them to be able to connect with folks in a way that allows them to speak to that and feel safe engaging in services.”

    Cultural views on womanhood also influence how people react to drug use in their communities. Although the Latinx culture may frown on men with mental health or substance use issues who seek help, the worst stigma is reserved for women.

    Latinx people often emphasize marianismo, or female purity, “the dichotomy of the saint or the whore,” says Melgarejo. Women who engage in substance use “are punished for being women, they are punished for being women of color, Latinas, and they are punished for violating that role in the community, for not being pure.”

    Citing the work she did with victims of domestic violence in Puerto Rico, Melgarejo says that when it comes to drug use, the culture is rife with double standards. Mothers who used drugs were often stripped of their maternal rights, while fathers who used drugs were still allowed to interact with their children.

    Programs engaging with Latinx populations should also be aware that many people, especially those who have recently emigrated from Central America, may be fleeing violence and state-sponsored oppression. This trauma can stoke strong fears about any program connected to the government or perceived as such. It can take time and effort to build trust among populations that are initially suspicious. And not all programs are up to the task.

    “We look at these populations and we say ‘Oh they are hard to reach,’” says Hernandez. “They are hard to reach for the people who don’t have experience working in these communities. For those of us who are from these communities, who work in these communities and live in these communities, those populations are not hard to reach.”

    How Programs Can Improve Outreach

    Claiming that a population is difficult to engage is one way for service providers to recuse themselves from having to make the extra effort. But lack of participation or retention of underserved communities may signal not that the population is hard to reach for the program, but that the program is hard to reach for the population.

    The first step towards bridging this divide is humility. It’s easy to blame “them” for “not wanting” to engage with services instead of looking inward. Organizations should conduct a self-inventory of the populations in their community and note those who are effectively engaging and those who are not. Growth can’t happen all at once, but there are many small steps organizations can take to improve their outreach.

    Some questions to ask are: Do staff speak the languages of the community (not necessarily just Spanish)? Do staff practice cultural humility and recognize the diversity in the Latinx population? Does the organization hire Latinx people and place them in positions of leadership? Are program services located in areas easily accessible to Latinx communities? Can the organization partner with others who have built trust in the Latinx community?

    Hernandez stresses the importance of having active and visible Latinx involvement in program development and implementation. Regarding behavioral health, he says, “The majority of people working in the field are white and baby boomers. The majority of the people seeking services are younger and more diverse, so the needs of the people seeking services are not in line with the folks who work in the field.”

    It can be challenging to engage underserved populations, especially those driven underground by various forms of institutionalized oppression. Navigating the diversity and complexity of these communities can seem overwhelming at times. It is easy to give up. But the real measure of an effective program is not how well it serves people who are easy to reach, but how well it engages the ones who need it most.

    View the original article at thefix.com

  • A Space for Grief and Growth: The 12th National Harm Reduction Conference

    A Space for Grief and Growth: The 12th National Harm Reduction Conference

    When we demand answers without a deep, authentic understanding of the problem, we wind up putting band-aids on gangrene.

    As I wandered into the opening plenary at the 12th National Harm Reduction Conference in New Orleans last week, something felt off. It wasn’t just the four white-robed women on stage, solemn and elegant in contrast to the mostly grungy, tattooed crowd. It wasn’t the massive indigo chandeliers, which cast a somber blue over the room. It was an energy I couldn’t quite place at first. Then, slowly, it washed over me.

    Grief.

    Throughout the morning, as various speakers mounted the stage, the story of grief unfolded. The harm reduction movement is grieving the loss of one of our pillars, Dan Bigg, who died suddenly last August. We are grieving the political landscape, feeling vulnerable and scared as overdose deaths continue to mount and hard-won reforms in drug policy are reversed through a tide of drug-induced homicide laws and other punitive policies against drug users. And we are grieving the conflicts, hypocrisies and dysfunction present within our own movement that at times threatens to tear it apart.

    My last report on a harm reduction conference for The Fix was in 2014. At the time, I described harm reduction as a community standing at a crossroads. The 2014 conference in Baltimore embodied the culture clash of a movement that had started as a radical underground community of people who use drugs being overwhelmed by mainstream and professional interests. Tension crackled between old and new, as did fear of co-opting and straying too far from its radical roots. Now, four years later, some of those tensions have boiled over.

    One of the plenary speakers in New Orleans, Micah Frazier of The Living Room Project in Mexico, described the harm reduction community as a family full of love and dysfunction. With gentle admonition, Micah urged the crowd to watch how we treat each other and to be careful of how we engage in conflict.

    Another speaker, Erica Woodland of the National Queer and Trans Therapists of Color Network, offered a blunt account of how he had left harm reduction six years ago over concerns about the lack of black leadership in the movement and the devaluation of black expertise.

    “I got divorced from y’all,” Erica said, to a smattering of laughter. “I came back; we’re dating!” But he warned that the reunion would be brief unless harm reductionists could show capacity for change.

    Harm reduction has changed in the past few years. Several of the largest organizations have experienced a shift in leadership as white, male executives who held power for decades have been replaced by women and people of color.

    In fact every speaker touched on the need for a “changing of the guard” within harm reduction. They pointed out that the movement, supposedly centered around racial justice and recognizing the dignity of people who use drugs, does not always practice what it preaches. They criticized the prevalence of white, male leadership, while queer staff, people of color and active drug users are often reduced to underpaid “peer outreach” positions or token members of panels, trotted out for the public, then silenced once the cameras are gone. They stressed the pitfalls of sacrificing long-term vision for short-term gain, warned against co-opting by the public health system, and urged the crowd not to forget its roots.

    Change is coming. Change must come, the speakers insisted. And transition is not always pretty.

    Their words seared right through me.

    A few months ago, I left my position with the North Carolina Harm Reduction Coalition (NCHRC) after eight years as their advocacy and communications coordinator. The decision was voluntary, but born from a place of pain. The organization had recently gone through its own changing of the guard and the process had, at times, been ugly.

    In fact, the past couple years of my life have been marred by grief as the organization I have loved and helped grow, an organization that has done so much to advance harm reduction in hostile territory, has been tested and torn by the tension between demand for change and resistance to it. These past years have involved a lot of soul searching for me as I have second-guessed past decisions and wondered if I have allowed enough space for the voices of people most impacted by the drug war to lead.

    The plenary was an epiphany. All this time I had bathed in private shame thinking that NCHRC was alone in its struggle, uniquely unable to have tough conversations without dissolving into anger and defensiveness. Now, for the first time, I realized that the movement has been changing and hurting across the whole country. We had never been alone.

    The heaviness of this opening plenary hung over me for the remainder of the four-day conference. Even the siren call of New Orleans—the bright lights of Bourbon Street and hot gumbo spice—could not penetrate the fog. I don’t think I was the only person struggling. Even as other attendees greeted old friends and met new ones in between workshops, you could feel grief and tension hovering over everyone. There was no relief from it, not even in the blizzard of breakout sessions.

    I tried to attend some breakout sessions, of which there were a dizzying number including topics such as fentanyl, friction with police, racial justice, indigenous healing, queer drug use and much more. The breakout sessions seemed designed to ask questions, but not necessarily to answer them. This frustrated a lot of people. I overheard many grumbling conversations in the hallways about how such-and-such a panel had not provided a “solution” to the problem being discussed. Years, perhaps even months ago, I would have felt this way too. Today I feel differently.

    A couple of years ago I attended a town hall meeting hosted by activists and founding members of Black Lives Matter. After over an hour listening to them talk about racism and oppression, a white woman in the audience asked the question that had been burning in my brain the whole time: “How can we fix it?”

    The speaker responded by politely suggesting that the young woman have conversations with family and friends about racism. The woman sat down, seeming dissatisfied with such vague marching orders. I was disappointed myself and, I’ll admit, a little appalled that the speaker didn’t seem aware of the importance of giving people concrete actions so that they stay engaged in the movement. But today I see the wisdom in that answer. The speaker didn’t give that young woman, or me, an easy answer because we weren’t ready for one.

    Lately I have come to appreciate conversations that do not end with solutions. Most societal problems are so complex that any “solution” that can be discussed in a 60-minute panel is probably bullshit. Most of us know surface level things—racism is real, drug policy is killing people, there are too many people in prison—but we don’t truly understand the history or scope of these issues, especially if they don’t directly impact us. We want a quick recap of current affairs and a quick fix, but when we demand answers without a deep, authentic understanding of the problem, we wind up putting band-aids on gangrene.

    This, I think, is what the conference was attempting to do—to encourage discussion and exploration and self-reflection, not to provide instant gratification.

    I left New Orleans without answers, but with a great sense of responsibility to seek them, even if it takes a lifetime.


    Members of Harriet’s Apothecary open the conference with calls to be mindful and present.
    Image: Nigel Brundson

    View the original article at thefix.com

  • Post-Kavanaugh, Women’s Self-Care Needs to Lose the Alcohol

    Post-Kavanaugh, Women’s Self-Care Needs to Lose the Alcohol

    Alcohol, when construed as the first or best line of self-care, actually renders us less effective in resisting an exploitive system that makes legal space for our bodies to be legislated, controlled, and raped.

    “Should we get some wine?” I asked him, pushing a bit of sweet potato around on my plate. I felt my cheeks flush and a weird half smile launch across my lips, the way it always does when I feel embarrassed or awkward or sad or anything really. Whenever I’m feeling anything too much. My partner looked startled.

    “What? Why?” he set his own fork and knife down, leaned back in his chair. “I mean, an IPA sounds really good right now. But I guess, just, what’s the motivation behind it?”

    It had been 62 days since either of us had had anything to drink, thanks to a self-imposed sobriety challenge after I’d watched my already heavy alcohol consumption creep up and up and eventually become overwhelming in the years since Trump’s election, post-Access Hollywood tape, post-everything. Two months was a long time, I reasoned now. A quality effort. And in all likelihood, an accused sexual predator would sit on the Supreme Court when we woke up the next morning. If there was ever a good reason to nurse a nice bottle of beer to ease some of the anxiety, fear, anger and hopelessness I was feeling, both as a woman and a victim of past sexual abuse, now was it.

    Wasn’t it?

    “I mean, would this be about escaping things?” he continued, gently, pushing, asking the question I had begged him, at the start of our not-drinking, to raise when I inevitably said I wanted back off the wagon. Because the answer was, is, will always be: Of course.

    Of course. I have made a lifestyle out of escaping things, of turning away from what’s hard and ugly and painful. Either that or confronting darkness only when I was a couple of drinks in or after I’d settled beneath the protective blanket of Klonopin or during the rush of false energy following a purge, all the food I’d consumed vomited up and flushed quietly away. In a very real way, I can trace my life as a ping-pong game of silences and rages, each assisted along by some substance or behavior I’ve begun to describe as “not me,” in that they’ve all been designed to take me out myself and, as a result, out of proper caring—for this world, its injustices, its humanness, its pain.

    There’s a lot of rhetoric around the usefulness of women’s rage right now, but what keeps getting left out is how, so often, we (middle-class, white women) use anger to stand in for or erase action. How, so often, anger becomes the justification for harm. And for me—and the rising number of American women turning to alcohol to deal with stress, trauma, and its aftereffects—that often takes the shape of self-sabotage in a bottle to numb out, ease anxiety, filter boredom, help us slip into apathy dressed up as protection and self-care. Let me be clear, and I speak from experience: Drowning your sorrows is the opposite of self-care.

    Wine will not heal your wounds, will not even tend to them, no matter what the patriarchal messaging around alcohol promises you. And I say patriarchal because it’s true: Our American culture of binge-drinking and heavy alcohol consumption is directly and implicitly tied to the capitalist, racist, structural misogyny upon which our country is founded—and through which marginalized groups are subjugated, oppressed, and continually, insistently Othered. We only have to look to history to see the ways in which alcohol was used to keep said groups under the heel of white men in power: White Europeans, for example, notorious for their “extreme drinking” on the frontier, encouraged both alcohol trade and excessive consumption among Native populations, later weaponizing the stereotype of the “drunk Indian” against them. Years later, slave masters on Southern plantations developed strategies to carefully control slaves’ access to alcohol during the week, only to encourage them to drink heavily on Saturday evenings and special holidays. Frederick Douglass later castigated the so-called controlled promotion of drunkenness as a means of keeping black men and women in “a state of perpetual stupidity” that reduced the risks of rebellion. More recently, increased experiences of racism have been explicitly, causally linked to riskier drinking among black women on college campuses. Meanwhile, growing wealth, educational, employment, housing and health disparities between minorities and white Americans have led to a much greater increase in alcohol consumption among those communities between 2002 and 2013, a study published in JAMA Psychiatry suggests (although it’s not much of a stretch to say that increase is significantly greater in our Post-Trump world of racist nationalism, its cruel policies, and resulting demoralization among the people affected the most).

    Alcohol, too, has become the primary coping mechanism for women in America, regardless of race or ethnicity: Overall, female alcohol use disorder in the United States has increased by 83.7 percent, according to that same study. High risk drinking among women, defined as more than seven drinks in a week or three drinks in a day, has increased by 58 percent. We only have to look at mommy or work wine culture to see the ways in which alcohol is used to keep women quiet, dulled, apathetic and convinced they need booze to survive motherhood or employment or both. So perhaps it is no surprise the contemporary rhetoric of white feminism is rife with messages that draw a supposedly intuitive connection from anger to self-care, which is inevitably linked to drinking. We get tired? We pop open a bottle. We get scared? We fill a glass. We get angry? We rage over shots or cocktails or champagne. None of this helps us. In fact, all of this renders us less effective in resisting an exploitive system that makes legal space for our bodies to be legislated, controlled, and raped.

    “The master’s tools will never dismantle the master’s house,” Audre Lorde famously said in her 1984 call to and critique of the internalized patriarchy of white Western women. Alcohol, when construed as the first or best line of self-care, I’d argue, is one of the master’s tools. We indulge in the drinks that American culture (and American feminism) says we deserve, and we get raped while the men who were drinking alongside us get off and then get nominated to the Supreme Court. It’s a double bind—one that bears calling attention to, however hard it is to look at. We should be able to say that it’s absolutely, undeniably immoral for a man to abuse a woman’s body while she is drunk (or sober or somewhere in between). That rape or abuse is never a woman’s fault because of what she was drinking (or wearing or saying or where she walking or what time of night it was, etc., etc., forever, etc.). And we should also be able to challenge the messages that encourage a woman to relax or to rage or to start a revolution only after she has a glass of wine in her hand. 

    Alcohol is a depressant. It anesthetizes our pain and our power, our minds and our bodies, and we will need all of ourselves to fight what will come in the next weeks, months and years as those same bodies become the battleground upon which men’s petty force and overwhelming self-hatred wage war. Look, I’m barely nine weeks sober. I never hit the rock bottom people describe in AA or alcohol recovery programs. I don’t know if I plan on a lifetime of sobriety or if I’ll have a celebratory beer after I finish grading all of my students’ papers over fall break. What I do know? I spent years using alcohol to avoid the work I knew I should be doing. The healing I knew should be seeking. I know many women who don’t drink, who don’t turn to alcohol to deal with exhaustion and fear and heartbreak. I know many, many more who do. I’m not advocating for prohibition or teetotalism. But I am asking women—white women in particular—to take a hard look at what they mean when they say self-care, and what they’re hoping to accomplish by drinking their way through.

    We certainly don’t need #BeersforBrett, the hashtag that surfaced among white, wealthy men celebrating Kavanaugh’s confirmation Saturday. But we definitely don’t need feminist cocktails, either, as I saw recently championed on a Facebook group for women scholars and rhetoricians. Jessa Crispin has warned white women against misconstruing the philosophy of self-care that Audre Lorde conceived of as way for activist women of color to ease some of the burden of dismantling racism and misogyny while living at the very intersection of such oppression. “Now it’s applied to, I don’t know, getting a blowout,” Crispin writes. “And pedicures. Even if your pedicurist is basically a slave.” Especially if you’ve got a glass of champagne to assist you along in ignoring that reality. So, no. We don’t need rage if we’re going to use it as an excuse to drink, to sink into dispassion.

    We need real action. We need true healing. I didn’t need wine on Friday night, and the community of women I want to support through this troubling time didn’t need me buzzed or drunk or hollowly chill. We need the opposite of that. In our activism and in our downtime, we need a clear-eyed, hangover-free commitment to dismantling absolutely everything that violates us—whether through false comfort or force, apathy or abuse.

    View the original article at thefix.com

  • There Was Light A Mile Deep: Interview with Poet William Brewer

    There Was Light A Mile Deep: Interview with Poet William Brewer

    Someone contacted me when the book came out, who had very recently lost a parent to heroin. She said to me, and I’ve held on to this, “The poems gave me a feeling that I had a place to go.”

    The West Virginian landscape exists as one of the great splendors of North America, but beneath the canopies of spruce and maple and folded inside the canyons smolders a public health crisis whose effect has verged on apocalyptic for some communities, both spiritually and literally. Peddled by big pharma, opioids found special traction, furthering the hardships inherited from a history of economic injustice. Like new gears spinning a rusted machine.

    These conditions have sown a very human consequence, which looks out from the porch of William Brewer’s debut book of poems, I Know Your Kind, with lines like: “[I] have placed my lips against the shadow / of his mouth, screamed air into his chest, / watched it rise like an empire then fall.”

    Born and raised in West Virginia, the poet left Appalachia to pursue higher education, but his craft was drawn back towards the hills of his youth, rendering the anguish and ghosts that multiplied rapidly there in the mid-aughts when the state ranked as having the highest overdose rate in the country (it still does).

    With delirious imagery, Brewer uses natural subjects such as flies and logging to express deep emotions, at the same time accessing the past in order to help explain the unbelievable present. His poems have been published in The New Yorker, The Nation, American Poetry Review, and his chapbook Oxyana was selected by the Poetry Society of America for their 30 and Under chapbook fellowship.

    Then, last year Ada Limon selected I Know Your Kind as a winner of the National Poetry Series. A practice in empathy, the book illustrates not only the spirit of a place struggling to stand, but a cross-section of the epidemic timeline on a local level when the national media was just starting to grasp what was happening. Before the big policy responses. Despite all the graves already in the ground.

    Interviewed by The Fix, Brewer hikes into these “terrible truths” and cracks open the question of what drives someone to give themself to an artificial comfort, underlining that rural living can marginalize culturally and politically.

    Estimates place the number of people recovering in the United States around 25 million, and close to the same amount experiencing active substance use disorder. More than ever, there is a need for a strong literature to reflect this population, how we lived and how we want to live. I Know Your Kind stimulates our thinking about the prismatic possibilities of a modern addiction poetry.

    Note: This is sometimes a sad conversation, about suffering caused by substance use disorder. Seek out another interview if you’re unbraced.

    The Fix: Your book opens with the poem “Oxyana, West Virginia,” which establishes the setting of I Know Your Kind as a place where both splendor and suffering co-occur. Can you talk more about the relationship between the people and the land?

    William Brewer: Oceana is a small town in southern West Virginia, a blast site of the opioid epidemic. The nickname Oxyana refers to Oxycontin, the drug that took over. This poem takes the notion of a single place and applies it to multiple regions of the state to create a condensed fictional stage, to build out a landscape. Throughout the book, when I talk about one place, I’m talking about the whole state, because the problem is everywhere. The whole state is a kind of Oxyana.

    Now, with the idea of splendor and suffering, I think the word you used was co-occur—that’s absolutely right in West Virginia. It’s an immensely beautiful state, but it’s a state of contrasts. The ancient hills are beautiful, but that ancientness meant coal, which meant prosperity, but only for a very few until the mid-20th century. Coal, for much of its history, has meant a very hard way of living that has benefited very few. So the thing that gave West Virginia its prosperity is also the thing that has caused most of its destruction environmentally, economically, and to the physical well-being of its citizens.

    Now that the coal industry has died away, people are left in drained away communities, isolated from the outside world by the mountains and rivers, which also prevent jobs like manufacturing from coming in. The landscape becomes a beautiful prison.

    You often manipulate the symbol of light, twisting away from classic associations, or at least complicating them. For example, in “Overdose Psalm,” a tree is cut down and the line goes “Snow committing its slow occupancy, / filling the column like words, the light / saying in so few of them, like all terrible / truths, something here did not survive.” Besides being very very sad, it’s so resonant. How does light function in your book?

    In IKYK, I’m interested in exploring the power opiates have to mimic a kind of divine energy. They aren’t like psychedelics, which connect you to the feeling of a greater universe. Or amphetamines, which accelerate our reality. This is something simple: an optimism, a brightness, a luminosity, therefore light will function in the mind of the speaker as positivity, but for the reader the function is more sinister. Here, our feelings about beauty (which light is often in service of) become less straightforward than they seem.

    Writing has to look carefully at the way certain chemicals make people feel.

    We must recognize the ways substances make you feel fulfilled.

    Yes. And in the case of West Virginia, you have a largely poor, often isolated populace that is, in many respects, ignored by the rest of the country. When the outside world does engage with WV, it’s often through joke and insult. “Trash,” “Hillbilly,” “Did you marry your cousin?” “I’m surprised you wear shoes.” In her essay “The Fog Zone,” Leslie Jamison gets it right: “West Virginia is like a developing nation in the middle of America. It has so many resources and it has been screwed over again and again: locals used for labor; land used for riches; other people taking the profits.” With all that in mind, it’s suddenly a lot easier to understand how big unfulfillment can be as an idea, and how deep unfulfillment can function like a kind of pain. Through that pain comes the chemicals.

    What about the power dynamic between other parts of the U.S. and West Virginia? In your poem “Oxyana, West Virginia” you have those lines about river beds being wine glasses for the Roosevelts. It seems to me this dynamic could compound with the marginalization of the state, worsening the epidemic, distancing external aid.

    You’re absolutely right. That Jamison quote again. This is a place that gave everything to America during its rapid rise through the last century, and then when it was finished America turned its back on them. This was and continues to be a form of erasure. When people are told they don’t matter or feel like they don’t exist—that’s going to worsen a problem like the epidemic. The drug problem has been going on for over 10 years, but it’s only just now garnered attention. That’s in part because a lot of people—a lot—still don’t know WV is its own state. A few months back I was seated at a dinner beside an Ivy League graduate who kept referring to my home as Virginia, even after I corrected them multiple times.

    Yeah, that’s a completely different state.

    And when your country doesn’t know you exist, it’s like your suffering doesn’t exist. Then it’s like, who are they to tell you how you handle your suffering?

    All of this leads to the larger point, the key point about the book. IKYK is not about the opioid epidemic, and it’s not about WV, it’s about how these two subjects are bound together through a continuation of history. The history of WV is the history of massive industry making gargantuan profits off the lives of WV citizens. Timber, minerals, oil, coal, gas, and now: pharmaceuticals. They pumped 780 million pills into a state of 1.8 million people. By doing that, those companies, that industry, made a conscious choice: The lives of West Virginians aren’t as important to us as money; this is a population we can afford to kill.

    Leads me to think of “Daedalus in Oxyana.” There’s a line… “I gave my body to the mountain whole. For my body, the clinic gave out petals inked with curses.”

    I want to hear more of how you funneled real life places and people into this book. What was your research process like?

    The research was living and seeing the issue grow. The research arrived. But I don’t necessarily like that word, “research,” because it suggests I went looking for it. It’s more that the problem appeared. Things snowballed very quickly. Sometimes I didn’t realize it, other times I did. In conjunction, at one point someone came to my fiancée and me and told us they were a heroin addict and they were terrified. I got angry, thinking they got themselves into the mess and didn’t care about anyone else. Ten minutes later I realized this reaction was repulsive. I wrote the person off at their most vulnerable. A flip switched, and I realized this was something deeper I wanted to sit with and look at. That meeting between personal interrogation and social observation is how the book came to be.

    I like how the initial motivation for this book was a reaction to the stigma you had fallen into initially. You were like, “Wow, this is the way I think, so I’m going to do some work and examine it.”

    The disease of addiction has taken a toll on my family throughout my life and my parents’ lives, so I’ve seen how people come to reckon with it. I thought I had developed sophisticated responses, but in that moment those responses failed when presented with this new problem. I’d seen what alcoholism can do, and how as a culture we accept it as a problem. But we were turning away from opiate abuse and denying its reality, and I felt I needed to resist that turning away.

    I think it’s stunning for someone who hasn’t experienced addiction himself, how you put words to those unique feelings and moments. There’s a line from “Resolution,” “…I stood in the yard // and decided that sometimes / you have to tell yourself / you’re the first person // to look out over / the silent highway / at the abandoned billboard // lit up by the moon / and think it’s selling a new / and honest life.”

    There are details about the way of life that can accompany opioid use disorder, which echo the conversations I’ve had with people. “Leaving the Pain Clinic,” you write “…and though the door’s the same, / somehow the exit, like the worst wounds, is greater / than the entrance was. I throw it open for all to see / how daylight, so tall, has imagination. It has heart. It loves.” Like, how did these lines come to be in such striking detail?

    For me, the writing of a poem is an impulsive act. But there’s a lot of gestation and thinking that goes on behind the scenes, before I write—a lot of thinking. And there’s living that goes into them, too. When I was in college I had an accident that required some heavy surgery and a long rehab period. Opioids were a big part of that period, I was on them for a long time. The power of those drugs, what they could do, has remained vivid in my mind, and always will. That passage about daylight comes from that.

    In regard to the former passage: I’ve dealt with serious depression my whole life. Depression and substance abuse are often bedfellows. What depression can unleash in someone—hopelessness, dependency, fear, recklessness towards how we feel about our lives, suicidal impulses—can certainly be unleashed by substance use disorders, too, with the volume turned up to 11. To be clear, I do not mean in any way to suggest that depression and substance abuse are the same thing. Rather, what I mean to articulate is that I brought every bit of myself to every poem. This is not just a matter of aesthetics. It’s me doing my best to extend myself out, to say, “Dear Person X, the possibility that your pain may feel even remotely similar to my pain is why I’m trying to do my absolute best to recognize you in hopes that you may feel less alone, but even more importantly, so that you may feel loved. Loved.”

    I come from a spoken word community that preaches sticking to your own story. Personally, I think your book is an important addition to literature, both generally and in the addiction/recovery sub-genre. But throughout it you often speak through the persona of someone with substance disorder. I worry other poets will take this as license to do the same, without possessing the knowledge or respect you have for the subject. What are some potential hazards here?

    First, thank you for saying that. I appreciate it greatly and don’t take it lightly.

    While you come from a spoken word community, my literary life is rooted in fiction. The literary texts we had in my house were Herman Melville, Mary Shelley, Jane Austen, Nathaniel Hawthorne. They sat on a single shelf at the top of the stairs. I can still see them. Likewise, at school, literature = fiction. I read maybe two poems in high school, so my life in books began, and in many ways persists, through fiction, and so because of that, the root of my literary practice has always been—to use Roth’s (for better or worse) definition of fiction writing—“the crafting of consciousness,” with the understanding that this requires immense care, thought, patience, and humility. Do as much work as you can to get it right, and then do more. IKYK is very much a book that attempts to synthesize this quality of fiction, in addition to its immense capacity for world building and social examination, with poetry’s sense of deeply distilled emotional and psychological textures, its power to challenge language, and its unique ability to find unexpected connections. 

    As for other poets taking my work as license, I’m not sure what to say about that. It would seem to me that the potential for bad poetry, and bad poems about this subject, was there long before any of my poems came into the world. At the same time, for as long as that potential for faulty work has existed, there’s been a concurrent tradition of very valuable work being done in persona, poems by Bidart and Ai being just two gleaming examples (not to mention what has been done in fiction). So, maybe we could reframe the thinking in more positive terms, i.e. maybe this book can stand as an example of what persona can do? What the poem can do?

    What eats at me is how there aren’t a lot of poets writing about their personal experiences with substance recovery, at the level where they’re prominent within the poetry industry or community. Are these poets dead from overdoses? Did their time go towards using instead of writing? Or maybe they’re not writing openly because of stigma? Can you speak on the importance of us all lifting up and listening closer to people who have personal experience with these issues?

    I’m not sure about this, though it’s a wise question, one of huge importance. I don’t know of a clear answer. But it seems like the work you do in your day to day is connected to this and is very valuable. That’s something to be optimistic about. People have reached out and told me how they have brought my poems or the book into spaces like meetings, support groups, halfway houses, and that has been very humbling to hear. Just getting poems into spaces where maybe they’ve never been before—maybe that’s part of how we turn it around? As for the importance of lifting people up and listening closely—it is the most important thing. At the same time, the responsibility to write about this problem, which is now a national problem, shouldn’t rest solely on those suffering, should it?

    What do you hope your book accomplishes?

    Someone contacted me when the book came out, who had very recently lost a parent to heroin. She said to me, and I’ve held on to this, “The poems gave me a feeling that I had a place to go.” This was the greatest response I could have received. I hope that on a larger level, the book can extend the realities of the epidemic in WV to people who maybe had no idea what was going on, or didn’t believe it, or didn’t think it mattered—i.e. didn’t think the lives of West Virginians mattered.

    To graft onto that statement, I think the book is educational for people who don’t understand West Virginia, and how the opioid epidemic has taken root so deeply in this specific place.

    I surely hope so. That’s one of the book’s largest aims.

    I also want to add, while it’s a needed pursuit to write a place for pain to feel seen, it’s also necessary to create sites for recovering peoples to draw strength, hope, and triumph. What are some lines in your book that are doing this work?

    I think strength is an impulse that runs through much of the book—books about WV are inherently about strength. I think “Resolution” is a poem that leans toward a sense of hope or even triumph, even if it may be the first of a few failed attempts toward a larger triumph. Overall, though, I don’t think hope or triumph are large elements in the book, again this is because it’s a book about a specific situation in a specific place, and when I was writing it and editing it, things didn’t seem very hopeful or triumphant. I turned my book in to my editor in the fall of 2016. At that time, it felt like a situation that no one much cared about. The New Yorker hadn’t yet run its large profile about the state, the Charleston Gazette-Mail hadn’t yet run its now Pulitzer Prize-winning expose that gained national attention, Netflix’s Heroin(e) hadn’t yet been released, etc. etc. That said, I agree wholeheartedly that these sites and books are necessary, and I’m confident that they are coming, especially as our relationship to this epidemic, and our ability to help those afflicted by it, changes. So, while some of those elements may not be as present in my book, I don’t believe every book can or should do everything. Moreover, this subject, and its impact on our country, is vast. Perhaps, when it’s all said and done—if it’s ever all said and done—this book will be seen as one part of the larger record and discussion.

    Last question. What’s next for you? Anything that involves substance use disorder?

    I’m working on a novel that looks at the larger social, political, and economic networks that can be at play in making something like the opioid epidemic thrive in a place like West Virginia. I’m also working on a second book of poems about paranoia, suicide, and the idea of inherited death. And let me say thank you for taking the time to talk to me, your generosity toward the work, and for everything you do.

    More poems by William Brewer:

    “In the New World,” Southern Indiana Poetry Review

    “Oxyana, WV: Exit Song,” Diode Poetry

    Other interviews in this series about poetry and addiction:

    Lineages of Addiction: Interview with torrin a. greathouse, a Trans Poet in Recovery

    Addiction and Queerness in Poet Sam Sax’s ‘madness’

    Kaveh Akbar Maps Unprecedented Experience in “Portrait of the Alcoholic”

    View the original article at thefix.com

  • Microaggressions: How Subconscious Biases Affect Recovery

    Microaggressions: How Subconscious Biases Affect Recovery

    An example of a microaggression in the recovery universe: someone from NA asks someone who’s considering Suboxone: “Are you in denial? A drug is a drug is a drug.” No malicious intent is involved, but the fellow member is left feeling disparaged.

    Politics and Religion: we’re encouraged to avoid these conversations, socially. Conviction can escalate to hostility, hurt feelings and polarization, turning a fun-loving conversation into… “Awkward.”

    Has anyone noticed polarization-creep migrating from political intercourse into our addiction/recovery discussion? A diversifying recovery community means different tribes and subcultures with differing views on recovery and addiction. Many Fix readers are members of a mutual-aid group that gives a sense of identity and belonging. Being tribal is human nature; so, what’s the problem? Maybe it’s a hangover from the current political climate but I’m feeling a little microaggression-fatigue. It’s great to cheer hard for the home-team; but does that mean diminishing the other(s)?

    “We tribal humans have a ‘dark side,’ ironically also related to our social relationships: We are as belligerent and brutal as any other animal species,” says author and UC San Diego Professor Emeritus Saul Levine, MD, in “Belonging Is Our Blessing, Tribalism Is Our Burden.” “Our species, homo sapiens, is indeed creative and loving, but it is also destructive and hostile.”

    Levine cautions that for all the psychological good that belonging offers us, “Dangers lurk when there is an absence of Benevolence. Excessive group cohesiveness and feelings of superiority breed mistrust and dislike of others and can prevent or destroy caring relationships. Estrangement can easily beget prejudice, nativism, and extremism. These are the very hallmarks of zealous tribalism which has fueled bloodshed and wars over the millennia.”

    How does “zealous tribalism” present in the recovery community? Abstinence-focused tribes have dearly held views that differ from our harm-reduction fellows. Inside the abstinence-model tribe, it’s not all Kum Ba Yah, either. Refuge Recovery clans, SMART Recovery, Women for Recovery and the 12-step advocates may feel a superiority/inferiority thing that comes out in how we talk about each other. SMART followers may look down on 12-stepping as stubbornly old-fashioned. 12-steppers might see Life Ring or other new tribes as acting overtly precious with their dismissal of tried-and-true methods. Focusing in even more, we see NAs, CAs and AAs each rolling their eyes at each other’s rituals or slogans. In AA, secular members and “our more religious members” finger point at each other about who’s being too rigid and who’s watering down the message. These are examples of what Levine calls “belonging without the benevolence.” Finding “our people” is great. Part of what makes us feel included might also over-emphasize the narcissism of small differences.

    “Meeting makers make it!”
    “That’s not sober; that’s dry. The solution is clearly laid out in the 12 steps—not meetings!”
    “AA’s a cult that harms more people than it helps!”

    These are tribal battle cries—sincerely held feeling based in part on our unique lived experience and in part on an ignorance we’re not conscious of.

    If you love the fight and you don’t care what others think of you, this article might not hold your attention. We’re going to talk about how to get along better. On the other hand, if you see yourself as empathetic and regret falling prey to us vs. them conflicts, let’s talk about cause and corrective measures.

    Recovery professionals curb their own biases through professional practices; we can borrow their best practices to avoid getting defensive or dismissive with people who hold divergent worldviews. If our goal is to connect with others, an increasingly diverse world of others presents challenges.

    “In my early career, I was adamant about abstinence as the only viable solution to alcohol and other drug problems,” recalls William White, author of Recovery Rising: A Retrospective of Addiction Treatment and Recovery. As a historian and treatment mentor, White learned from lived-experience, clinical practice, study and research. His 2017 book advocates for treatment professionals to exercise “professional humility and holding all of our opinions on probation pending new discoveries in the field and new learning experiences. Many parties can be harmed when we mistake a part of the truth for the whole truth.”

    If 100% of my knowledge about harm reduction is from harm reduction failures who tell their story of decline in a 12-step meeting, I could “mistake a part of the truth for the whole truth.” What would I know about harm reduction success stories if I only go to 12-step rooms?

    Treatment professionals are adapting to cultural diversity in their practices. Bound by a Code of Ethics, NAADAC (the Association for Addiction Professionals) has embraced the concept of “cultural humility.” Cultural humility is a fiduciary duty for professionals to be sensitive to client race, creed, sexual orientation, gender identity and physical/mental characteristics when providing healthcare.

    “Cultural humility is other-oriented. Cultural humility is to maintain a willingness to suspend what you know or what you think you know based on generalizations about the client’s culture. Power imbalance between counselor and client have no place in cultural humility. There is an expectation that you understand the population you’re serving and that you take the time to understand them better,” explains Mita Johnson, the Ethics Chair for NAADAC, who teaches cultural humility to addiction/treatment professionals. Dr. Johnson says, “Addiction professionals and providers, bound by ethical practice standards, shall develop an understanding of their own personal, professional and cultural values and beliefs. Providers shall seek supervision and/or consultation to decrease bias, judgement and microaggressions. Microaggressions are often below our level of awareness. We don’t always know we are doing it.”

    Microaggression—today’s buzzword—google it. In The Atlantic’s “Microaggression Matters,” Simba Runyowa elaborates on the insidiousness of this behavior: “Microaggressions are behaviors or statements that do not necessarily reflect malicious intent, but which nevertheless can inflict insult or injury. … microaggressions point out cultural difference in ways that put the recipient’s non-conformity into sharp relief, often causing anxiety and crises of belonging on the part of minorities.”

    Here’s how that might look in our recovery universe: someone from NA, a complete abstinence-based fellowship, asks someone who’s thinking about medication-assisted treatment with Suboxone: “Are you in denial? A drug is a drug is a drug.” No malicious intent is involved but the fellow member is left feeling disparaged. Maybe the well-intended NA had a negative experience with medically assisted treatment (MAT) and has a visceral feeling about it, “Taking drugs to stop drugs isn’t clean.” But NA doesn’t work for everyone. Yours or my anecdotal experience will bias us. Maybe expressing my own personal experience, or just listening without commenting, would be more culturally humble.

    The same is true of the MAT fan who says, “12-steppers are deluded by a faith-healing 80-year-old modality; only five-percent of people get helped from the 12 steps.” These types of arguments are not other-oriented. This is tribalism. 

    A simplistic solution to avoiding lane-drift is to listen more and share in first person. Prescriptive communicating—as opposed to a descriptive narrative—will, inadvertently, engage us in microaggression.

    Just when “Why can’t we all just get along” seemed hard enough, there’s more than one subconscious microaggression we need to be aware of. Derald W. Sue, Ph.D., a psychology professor at Columbia University, describes three microaggressions: micro–assaults, micro–insults and micro–invalidations.

    Micro–assaults are most akin to conventional discrimination. They are explicit derogatory actions, intended to hurt. Here’s an AA example: disparaging a humanist AA in a meeting by quoting Dr. Bob’s 1930s view, “If you think you are an atheist, an agnostic, a skeptic, or have any other form of intellectual pride which keeps you from accepting what is in this book, I feel sorry for you.” No one feels “sorry for” their equal. Inferiority is implied.

    “A micro–insult is an unconscious communication that demeans a person from a minority group,” Dr. Sue reports. Using another 12-step creed-based example, “CA includes everyone; it’s ‘God as you understand Him.” Who is likely to feel demeaned by Judeo/Christian-normative language?

    We could rightfully credit 1930s middle-America Alcoholics Anonymous founders for their progressive—always inclusive, never exclusive—posture; “everybody” in 1939 America meant Protestants, Catholics and Jews. The AA of the 1930s was culturally humble. Today, inadvertently, this same language is less effective at gateway-widening. Today, just 33% of earthlings embrace this interventionist higher power of the early 12-step narrative. According to the Washington Times, globally, 16% of people have no religion and 51% have a non-theistic, polytheistic faith. Sikhs or Muslims may share monotheism, but they worship a genderless deity; no room for “Him” of any understanding. Cultural humility accommodates all worldviews, without asking others to speak in the language of the majority.

    “Minimizing or disregarding the thoughts, feelings or experiences of a person of color is referred to as micro–invalidation.” This is how the American Psychiatric Association rounds out Dr. Sue’s three types of microaggression. “A white person asserting to minorities that ‘They don’t see color’ or that ‘We are all human beings’ are examples.”

    Disregarding or minimizing in our community might be telling someone: “You can participate in your online groups if you like but don’t treat InTheRooms.com like real meetings. Face-to-face is the only way to connect with real people.” If expressed in first person, instead of disregarding the other, the message could relate a personal experience and an informed belief. Have we learned everything about the person we’re talking to? Social anxiety disorder or a dependent partner, parent or child at home could be reasons why the online meeting is the superior option for them.

    To William White’s point, what do I really know about the comparative benefits of online community vs. traditional meetings? Maybe I could consider his informed advice of “holding all of our opinions on probation pending new discoveries in the field and new learning experiences.”

    Mita Johnson identifies a challenge with microaggression—it’s subconscious. How do we correct subconscious behaviors? Dr. Sue authored a couple of books to help combat microaggression at an individual, institutional and societal level: Microaggressions in Everyday Life: Race, Gender and Sexual Orientation and Microaggressions and Marginality. Sue offers five steps to help connect us with more varieties of addicts/alcoholics. “Microaggressions are unconscious manifestations of a worldview of inclusion, exclusion, superiority, inferiority; thus, our main task is to make the invisible, visible.” Here are Dr. Sue’s five practices:

    1. Learn from constant vigilance of your own biases and fears.
    2. Experiential reality is important in interacting with people who differ from you in terms of race, culture, ethnicity.
    3. Don’t be defensive.
    4. Be open to discussing your own attitudes and biases and how they might have hurt others or revealed bias on your part.
    5. Be an ally. Stand personally against all forms of bias and discrimination.

    I gave it a try. Taking inventory—in these five ways—of my prejudices and preconceived ideas helps identify my insensitivities. It helps thinking/acting more other-oriented. Secondly, more than ever, it’s a good time for more active listening and less instruction. Getting defensive, even to microaggression coming my way, escalates the divides. Admitting my assumptions and the faulty conclusions is a version of “promptly admit it” that is so familiar. Finally, how can I “Be an ally?” It’s not hard, today, to stand up for myself when I’m being disrespected. Now will I say something when someone else is being invalidated, insulted or dismissed? Yes, there’s a time to mind my own business but if I’m committed to “be an ally,” can I stay silent when another is being ganged up on by the tyranny of the majority?

    When I’m tempted to be tribal when confronted with other individuals or recovery groups, I try to remember that all people who suffer from process or substance use disorder have been subjected to microaggressions. William White identifies a few of the more cliché slights we all face:

    • “Portrayals of the cause of substance use disorders as personal culpability (bad character) rather than biological, psychological, or environmental vulnerability.
    • Imposed shame, e.g., being explicitly prohibited by one’s supervisor from disclosing one’s recovery status out of the fear it would harm the reputation of the company.
    • Misinterpretation of normal stress responses as signs of impending relapse.”

    In this regard there is no us vs. them. Just “us.”

    Not everyone believes that shining a light on microaggression will solve hostilities towards each other. “There are many problems with studies of microaggressions, technical and conceptual. To start, its advocates are informed by the academic tradition of critical theory,” Althea Nagai argues in “The Pseudo-Science of Microaggressions.” Nagai identifies confirmation bias found in almost all focus groups and the problem of unintended consequences when institutionalizing anti-microaggression policy.

    Nagai’s National Association of Scholars article continues, “There is nothing in the current research to show that such programs work. I suspect most fail to create greater feelings of inclusion. Research suggests they create more alienation and sense of apartness. The recent large-scale quantitative studies suggest that increased focus on ethnic/racial identity exacerbates the problems they are supposed to address. In other words, ‘social justice’ and diversity programs may actually backfire, creating less inclusion, more polarization.”

    Dr. Sue cautions us about weaponizing microaggression; other-oriented cultural humility is to take inventory of my microaggressions—not to fault-find other’s behaviors. Social psychologist Lee Jussim in Psychology Today says keep it personal—not global: “To understand how we can all unintentionally give offense through our own ignorance or insensitivity—thereby increasing our ability to make the same points without being hurtful.”

    “I’d rather step on your toes than walk on your grave,” is a rationalization we hear in the rooms. How do I neither pussy-foot around and avoid being a dick? Beyond intellectualizing, cultural humility is introspective. In “Cultural Humility versus Cultural Competence: A Critical Distinction in Defining Physician Training Outcomes,” cues from professionals show me how to re-frame how I interact with others: “Cultural humility incorporates a lifelong commitment to self-evaluation and self-critique to redressing the power imbalance in the patient-physician dynamic and to developing mutually beneficial and non-paternalistic clinical and advocacy partnerships with communities on behalf of individuals and the defined population.”

    For me, this nails how to stay other-focused: Professionals (or anyone who wants to relate to others better) should “relinquish the role of expert and become the student of the patient with a conviction and explicit expression of the patient’s potential to be a capable and full partner in the therapeutic alliance.”

    I don’t need a course or a degree to “become the student” of others. Instead of acting like I know what’s best for others, I can be a fellow traveler; think about other-focused approaches globally; but act locally.

    View the original article at thefix.com

  • Embracing Pride and the LGBT+ Community in Recovery

    Embracing Pride and the LGBT+ Community in Recovery

    “The sense of having two selves was the root of my addiction, especially in the beginning. It was exhausting to play a role I didn’t want.”

    Ten years ago, I was both terrified and ecstatic to go to my first ever LGBT Pride Parade. I knew that I was attracted to both men and women, but I had always kept this hidden. Being raised in the Catholic Church and in a conservative town, I was told it was a sin to act upon “homosexual desires.” To smooth out the edges of my mental tug of war, I took pulls of vodka and chased it with cherry Sprite.

    Broadway was bursting with vibrant seas of color and glitter. Rainbow flags replaced American flags, much to the dismay of the town bigots. A float rolled by with drag queens dressed like Beyoncé and Dolly Parton, hair teased as big as their ta-tas. Then I heard the roar of Harley Davidsons as a throng of denim-clad lesbians cruised by with signs that said, “DYKES ON BIKES.” Next, another group chanted: “hey-hey, ho-ho, homophobia has got to go!”

    I know this all sounds like a stereotypical version of Pride, but this was truly how it appeared to me as a newbie. Over time, I began to peel apart the layers and examine the nuances within the community. Pride showed me the power of embracing and celebrating your identity, even when it is associated with stigma, discrimination, and stereotypes. I realized that Pride gave me kindling for my desire to fight stigma, even long before I was in recovery.

    *

    As author of My Fair Junkie and Fix Contributor Amy Dresner wrote in (Re) Claiming Language: “I think the addiction/recovery movement needs to model itself on the gay rights movement and be vocal, out there, shameless and visible: parades, glitter, boas. Bring it all on.”

    After admiring Dresner’s writing for years on The Fix, then her memoir, I finally had the courage to message her. She sent me a kind response and we had an amazing actual phone conversation! Okay, I swear that my fan-girling has a point. She also spoke with me in more depth about the parallels between our communities: the stigma, the struggle with health issues like HIV, Hepatitis C, and losing friends to overdoses or suicides. Amy can speak to these similarities since she has experience with the LGBT+ community in L.A. “Even though I’m straight, I often attend and speak at LBGT meetings. I like the vibe there. They feel more real and more celebratory. They get my humor and irreverence. I feel like I can be more open about my crystal meth use and being promiscuous without them judging me, because they’ve been there too,” she said. We also share an immediate kinship with each other over burrowing our way from the trenches to light.

    *

    My first small-town Pride parade only lasted fifteen glorious minutes. After all, my city, Fargo, was famous for the Coen brother’s cult classic film and being the highest binge drinking city in the country, not LGBT rights. I wandered to a beer garden for another Pride event. A girl with hot pink hair asked for my signature for a human rights petition. I signed and wanted to flirt with her, but I realized that I didn’t know how. At the line in the bathroom, a woman noticed that I was shaking with anxiety and offered me a little blue pill she said was Xanax.

    “This will help chill you out,” She said. It worked. She led me down the street to the only gay bar, where scantily clad men grinded to Katy Perry under pulsing neon lights. Later that night, I drunkenly wrote in my journal: “we’re here, we’re queer. We’re junkies and drunkies.” I also realized that alcohol and pills were the easiest way for me to “break bread,” in the LGBT community. They were magical potions that could teleport me from being an outsider to an insider, give me the courage to flirt with women, to numb the shame. I’m not alone. For many, Pride and being part of the queer community is synonymous with drinking and drug use.

    Charlie* is a 24-year-old graduate student who is bisexual and is ambiguously trans. They are from a school district in Minnesota with the one of the highest suicide rates in the country. At their high-school, gay and “gay-coded” students were bullied, peed on, and called faggots. Charlie said, “For myself, the intersections of addiction and LGBT identity are so complex. It’s so ingrained in our daily lives, in our community lives. Our history. We weren’t given the social or political power to have public space. So, bars and underground clubs were our space…so addiction can sometimes become a learned behavior. For me, it was alcohol. I used it to suppress my identity.”

    According to a 2015 study by the Substance Abuse and Mental Health Service Administration (SAMHSA), 30 percent of LGBT people struggle with some form of addiction compared to 9 percent of the heterosexual population. Bisexual women and trans people face the highest risk of drug use and abuse.

    I spoke with a 30 something freelance writer from the Midwest named Morgan, who said she had known she was “next-level” gay long before she even knew the word. “The sense of having two selves was the root of my addiction, especially in the beginning. It was exhausting to play a role I didn’t want. I think it was originally a combination of easing the pain of not being able to love the people I loved openly and resentment toward the society I felt excluded me. There was an ease and confidence about being my true self when I was drunk though.”

    Charlie said they have managed their drinking without the help of outside groups, but if they did need one they would prefer an LGBT-oriented recovery group. Meanwhile, Morgan lives in an area that does not have LGBT meetings. Morgan said she felt very uncomfortable at her first 12-step meeting and definitely didn’t feel comfortable disclosing that she is lesbian, because her home is near the birthplace of the notoriously bigoted Westboro Baptist Church. Her first meeting “was full of a Confederate-flag wearing, chain smoking old school crowd that didn’t have much experience with LGBTQI people.”

    What about people who want to connect with other queer folks in recovery, but live in a rural area or don’t connect with 12-step meetings? I spoke with Tracy Murphy, who is lesbian and founded a blog called LGBTeetotaler, which aims to “create community and visibility for queer and trans people in all forms of recovery.” Murphy is an inspiring example of the power of connection through the internet, which she said is “life-changing.”

    “Many times, when I’m dealing with cis hetero members of my recovery community, I end up feeling like I’m doing education while I’m also just trying to process an experience I’ve had… Having a group of queers to reach out to takes away that layer of education and emotional labor. We’re free to discuss and process without having to also explain why or how an experience is difficult,” Murphy said.

    *

    Talking to Murphy and Dresner inspired me to reflect upon my nearly ten years in and out of the recovery community- as an alcoholic/ addict in recovery and then as a social worker. Throughout those years, I’ve noticed a universal theme that weaves us addicts together. We all felt like misfits, outsiders. Like many others, I first went to meetings flashing my outsider identity like a badge of honor. I was surprised to discover the very thing that made us feel like misfits and lone wolves is often what connects us most in recovery. There’s a glorious alchemy that happens when a bunch of misfits unite for a shared goal of recovery.

    But sometimes, the alchemy doesn’t happen. I’ve heard this to be true especially among people in the LGBT community.

    Since Morgan didn’t feel comfortable in the AA group, she stopped going and eventually relapsed. Desperate to get sober and with no other options in her small-town, she decided to give it another try. She was happy to befriend another lesbian in the group, but surprised when the woman advised Morgan to keep the “personal information under wraps.” By that, she meant not to come out to the group.

    Morgan said, “It felt like going backwards to be in the closet after 15 years of being openly gay everywhere and that contributed to the feeling that maybe this program wasn’t going to work for me. It feels strange to do that and to fear judgement in a group that is all about acceptance and guidance and love… I have a feeling that I will eventually come out at least in the women’s group…My gut tells me I can’t have true recovery if I’m not being my true self.”

    How can mainstream 12-step meetings and groups be more inclusive of LGBT people? While this could be an entire book in and of itself, I wanted to ask others to see what they thought.

    Murphy said: “I think that some of the easiest and most effective ways for the recovery community to be more inclusive of LGBTQ+ folks are to really be aware of language and not make assumptions about the people they are addressing. For me, personally, I immediately get the message that I am not someone’s intended audience when the message being presented assumes that all women are feminine and attracted to men. Heteronormativity is ingrained in every part of mainstream society and, for people who want to make sure they are being inclusive of queer and trans folks, making sure that they’re not assuming people are heterosexual or cisgender is a huge step in the right direction.”

    While I think that Murphy has valuable advice, she has had very different experiences; she has not been interested in attending AA and was able to get sober with the support of an online community called Hip Sobriety.

    Josh* is a trans man from the Midwest who has gone to several rehabs, jails, and attended AA off and on for 20 years. He said that it’s hard to change an old institution like AA, but pointed out that they released the brochure: “AA and the Gay and Lesbian Alcoholic” in 1989. This omits others on the LGBT spectrum, but he said: “As for being included as an LGBT person, I don’t want to be treated any differently, just respected. Greeting goes a long way for me. Having people smile, shake hands, introduce themselves. Sounds simple but that’s where it all starts.”

    *

    I won’t be able to attend Pride this year. Ironically, I will be in a Catholic Church at my godson’s baptism. I will be thinking of my friends in Minneapolis and across the country as they march through the streets on floats, gathering signatures, and celebrating. But most of all, I will be thinking of the invisible misfits of the LGBT community- the ones struggling with addiction, the ones passed out before the dance even starts, the ones who are in rehab or detox.

    I will be sending the brightest beams your way, knowing that one day you will finally be seen and embraced the way that I have been.

    View the original article at thefix.com

  • Lineages of Addiction: Interview with torrin a. greathouse, a Trans Poet in Recovery

    Lineages of Addiction: Interview with torrin a. greathouse, a Trans Poet in Recovery

    “I always compare myself now to a night when I was drinking and I looked in the mirror. I saw a lie, wearing a suit and full beard, and…I tried to kill myself.”

    A point on a map is the product of two dimensions, the x and the y, or longitude and latitude. For example, a liquor store or your plug’s house is located at the intersection of two streets. For example, one street might trace back to your childhood home. Or maybe trace to a moonless night in a park, your peers starting to circle up. Maybe one of your streets crisscrosses the inertia of a fist. Or the colored lights in a club filling your eyes like cups. Etcetera. Etcetera.

    Everything, including us, our identities and our addictions, exist at the intersections of other things. The human landscape is a network, and this interview series has sought to delve into the complexities by dialoguing with poets who write from personal experience, and by giving purposeful attention to how substance misuse can overlap with marginalized lives and histories.

    This new installment welcomes torrin a. greathouse, a trans woman in recovery from both bipolar disorder and substances, and who self-describes as a cripple punk (more on that below).

    Despite only being 23 years old, she’s already well into a strong career, having landed publishing credits on Poets.org and Submittable’s journal, Frontier, and garnering a shoutout from poetry star Kaveh Akbar in The Paris Review. torrin’s forthcoming chapbook called boy/girl/ghost is a winner of The Atlas Review poetry contest, and this past year she published her debut Therǝ is a Case That I Ɐm on Damaged Goods Press.

    torrin has an inclination towards bravery in the way she does the work of transforming pain. It’s an exemplary case of someone using poetry to chew through toughness, to make sustenance out of issues that would otherwise choke us or rot and become pestilent. Even when her poems seem to conclude in a surrender, it feels like torrin achieves a type of mastery over the monster by at least naming it. Furthermore, displaying an energetic craft, she reaches for sophistication in form and concept, hewing down the opaqueness of personal uncertainties into sculptural elegance. Through processing her own story, she asks us to think about how the causes of addiction can be much deeper than the individual suffering.

    During the interview, we discuss how different lineages of addiction alternately rob and empower torrin, while we take a close look at some of her poems. We talk about soundtracks to gender transition. And more. Throughout our conversation she is candid about her struggles, and the violences that happened within her family while growing up in the Pacific Northwest. Before you read, it should be emphasized that the content traverses a number of sensitive topics, including suicidality, domestic abuse, and of course, substance misuse.

    The Fix: Can you tell me about some of your experiences, where transness intersected with addiction?

    torrin a. greathouse: Like many things that bring people into states of addiction, it became a method of coping. To be drunk or high allowed me to feel outside my body. And also, drugs allow you to disconnect not just from the physical body, but from life.

    An experience that is common among trans communities, is not necessarily being able to survive in the same ways as other people; having to turn to alternate forms of income creation like sex work. I was doing certain types of sex work that were not always conducive to my emotional wellness. I used alcoholism to cope with that as well.

    More often than not, conversation about coping focuses more on dealing with emotional or mental stressors, like trauma, for example. But there are also physicalities that people seek displacement from. Which makes me think about body dysphoria.

    You can’t feel dysphoric about your body if you can’t feel your body, was a point that I hit. I always compare myself now to a night when I was drinking and I looked in the mirror. I saw a lie, wearing a suit and full beard, and…I tried to kill myself. I think of myself now, in comparison to that moment.

    Wow. That’s so real. I know it’s such a tender subject and I value your sharing. A common characteristic of personal histories with addiction is that substance use “works” until it doesn’t. Sounds like you are describing one of those pivotal moments.

    I’m interested in recovery spaces, and I don’t know what your experience is with treatment or peer support, but I don’t hear as many stories from trans folk, or even queer folk.

    I wish going into rooms was easier. I’m lucky in a sense, that when I got sober, it was because of a DUI. I was in a collision, driving drunk, and went to jail, and then the court mandated I attend a peer support group. Had it not been court-mandated, I don’t think I could have managed to keep going, because those spaces are harder for folks that aren’t a specific subset of culture, primarily straight and middle-aged and male. Trying to get my pronouns used was pretty much impossible. Eventually I gave up and stopped presenting as trans.

    There are peer support groups meant for queer folks, but again, unfortunately, this ends up being cis-gay, middle-aged men. I’ve faced a lot of transphobia in those rooms as well. Luckily, there are new spaces opening up, like one in Long Beach, specifically for trans folk.

    My recovery consists of—and poet Kaveh Akbar also talks about this in the other interview—we can allow something else to subsume the addictive part of you. For both he and I, poetry has become that thing. We throw the same addictive energy at something healthier.

    Ok, now let’s talk poetry! Where are you at right now in terms of writing about addiction?

    Right now I’m in a double-headed mode in how I want to talk about the intersections of addiction. A big interest for me is the idea of alcoholism as lineage, as familiar bloodline and form of inheritance. My father was a drunk. My grandfather and grandmother on my mother’s side are drunks. My father’s father was a drunk. I’m thinking about how addiction ties into cyclical abuse; how leaning into it allows a lineage of violence to continue.

    And then the other direction I’m looking in is the ways in which queerness, transness, and addiction intersect with the prison industrial complex. Those violences. My father growing up was a prison guard, and so the familial abuses I faced were intrinsically linked to this other separate system of violence I wouldn’t experience personally until much later in my life.

    This is stuff you are tackling in an upcoming release? Like a collection?

    I’m working on a full-length manuscript. Also, a pet project tentatively titled Cell, meant to observe the different definitions of the word. Cell as a space, a physical confinement, a unit of memory, a telephone network, a part of the human body.

    I think of your poem, “Burning Haibun.” There’s the line about cells, how when alcohol is used to disinfect a cut, the scarring is worsened and made thicker, which you liken metaphorically to a blackout. It’s a brilliant poem, and I’d love to usher it into our conversation.

    Utilizing the form of the haibun, which is traditionally just a prose poem followed by a haiku, I began working from this moment when my mother accused me of throwing alcohol and gasoline on my emotions.

    The poem was a process of peeling off layers of trauma, the night of my DUI, and the night my father tried to kill himself by driving through a telephone pole. Then, I started writing about the ways addiction is not just a lineage I carry from my parents, but also a prevalent condition in queer communities because of the ways we are forced to survive.

    The first erasure narrows down to thinking about how I’ve been indicted by my father’s blood. I’m told being an addict makes me like him. “Once I just watched the wound accuse me of my blood. My father’s possessing the body. How each drink too is not mine, or I claim guilt.”

    But the bottom of the first two stanzas calls out my separate lineage. “My father hidden in an erasure of me. Each drink mine, my faggot blood.” So even if this is a lineage I carry from him, it is something my own, and it is something that belongs to another lineage, of queer addicts that have been a part of my life, some who have helped me in recovery.

    If I understand what you said correctly, by acknowledging the different threads of lineages that twist together, you deny your father from being the main contributor to your addiction. There is no single lineage.

    This poem allows me to access an identity as an addict and an addict in recovery that doesn’t make me like my father. My addiction doesn’t make me him.

    It’s interesting to think of lineage as biological, but also behavioral, which you are talking about, like the nurture from your parents, but more specifically, queer culture passed down between communities and generations.

    Tracing a lineage that is not genetic is inherent to queerness. Creating found family. Many queer and trans folks don’t have access to a genetic source of lineage, a family that supports and cares for them.

    I think this is a good time to talk about your poem “Inheritance.” What are some of the things happening inside that poem?

    This past year was the first time I was able to access mental healthcare, and I was diagnosed with a rapid cycling form of bipolar disorder. “Inheritance” is part of a series that, once again, recontextualizes experiences of lineage. Actions my mother and grandmother have taken. Actions I took. Because bipolar tends to be inherited from the mother’s side, she denied any family history. So this poem is responding, “Yes. Yes. There is a history of broken objects, shards, and of alcohol being a method of coping with the disorder.”

    Your opening lines are about your mother buying plates marketed as unbreakable. Within the poem, does the denial of breakability or the aspiration towards unbreakability become not only a symptom of mental illness, but also a path to it?

    No one seeks out something unbreakable unless they know they break the things around them. This poem is very much about my family’s denial of mental illness. In the poem I shattered one of these unbreakable plates by throwing it at my brother’s head while in a manic rage. I remember all the things my mother broke when I was a child, throwing them at my father. My grandmother smashing wine glasses. I tried to introduce this litany of evidence, but never put the reader inside the moment of breaking.

    That’s interesting, because I sensed this distance during my first read. I felt like I was looking at a pile of shattered memory, piecing together what happened. I felt removed. It’s almost paradoxical, but does your embracing of breakability and mental illness give you the best chance at being as unfractured as you can be?

    This poem ends, “My mother and I both know the slow ballet a glass shard makes beneath the skin.” Despite denial, all of this breaking is in our blood. For me, it’s interesting to be in a dual state of recovery, because recovery is also a term used in the treatment of bipolar disorder. Living with the disorder, when I’m manic, I feel invincible. Often times, also, addicts in the height of their addiction feel superhuman. So to turn away from these two modes of invincibility, you have to embrace or open yourself up to being broken.

    Wow, there are so many things I want to talk to you about haha. But let’s touch upon “wind-chime aria [for four hands].” I’m curious about the musical component, and about how the wind-chimes act as a vehicle. What is the music of this poem?

    I come from a pretty musical family, sharing music, singing songs together. It’s also as simple as the opening line, “My mother has always loved windchimes.” The house I grew up in, in Portland, was surrounded by windchimes. Music connects so much to memory in this poem, the spirit of Mozart, and the parental trauma in his experience.

    If this poem was a song, what would it be?

    Probably performed by Tori Amos. High energy, but creepy feeling. Maybe “Cornflake Girl.” I adore that song. This poem is from my forthcoming chapbook, called boy/girl/ghost, and written during a time when I was leaning into a feminine energy, after coming out as a trans woman, and needing to claim a softness that I hadn’t been previously allowed. Tori Amos was part of a soundtrack to that period of my life. There’s a line in my poem, “he became wind or light bulbs / began bursting on their own becoming a confetti of blades…” Even this violence is trying to find its own softness.

    The last thing I want to talk to you about…your bio includes the label cripple punk, and I know the term cripple holds political significance for the disability justice movement. Do you think mental health and substance use disorder have a place within this movement?

    I identify as a cripple punk specifically because I’m physically disabled. I have a spinal deformity. As a teenager, I hurt all the time and didn’t know why, and this began my abuse of painkillers. One of the hardest things about being clean and sober, I have no pain management anymore. Describing myself as a cripple punk is a sharpening of my identity, a fuck you to people who look at me and can’t imagine someone as both young and needing a cane.

    I’m only one individual and cannot speak for the entire community. As someone who is both mentally ill and physically disabled, I know both require a similar sort of activism and space. At the same time, many spaces where mental health is allowed to take on the same texture as physical disability, physical disability gets so erased. The conversation becomes dominated.

    So solely for the purpose of creating space for physical disability, I don’t personally like to see the picture overlap too much, but at the same time it becomes important to talk about the comorbidities, and intersectionality. So it’s a tough question. I think there needs to be room for both.

    Again, thank you so much for sharing about all the experiences and intersections that inform your writing. What’s on the horizon for you?

    My chapbook boy/girl/ghost is coming out through The Atlas Review chapbook series. Then also the chapbook Cell, which I plan on spending the upcoming month writing. Also just finishing up my undergraduate degree and surviving.

     

    This interview was condensed and edited for clarity.

    More poems by torrin a. greathouse

    Erwin Schrödinger Speaks on Dead Fathers, The Rising Phoenix 

    Haunting with Alcoholic, Riverbed, and Handcuffed Magician, Nat.Brut

    Other interviews in this series about poetry, addiction, and intersectionality:

    Addiction and Queerness in Poet Sam Sax’s ‘madness’

    Kaveh Akbar Maps Unprecedented Experience in “Portrait of the Alcoholic”

    View the original article at thefix.com