Tarzana Recovery Center (TRC) is a residential treatment center based in the San Fernando Valley neighborhood of Tarzana that provides treatment for substance use disorder, alcohol use disorder, dual diagnosis, and more. The facility offers an accredited sub-acute detox program certified by Integrated Management Systems. Treatment at Tarzana Recovery Center also features an array of in-residence plans and case management, as well as a partial hospitalization program (PHP) as part of their program aftercare. As their website notes, their inpatient treatment seeks to assist clients in achieving and sustaining long-term sobriety, and to guide clients on "a path of physical, mental, and spiritual health."Surveyed alumni gave a number of reasons for choosing TRC for treatment. The most frequently cited factors were the quality of treatment and accommodations, privacy, price, and location, with quality of treatment ranking highest among respondents. One alum noted that the staff and fellow clients "felt like family, [and] I will remain in touch and some will remain lifelong friends, I hope." Accommodations, which were the second most frequently cited reason, range from shared rooms with roommates to single room options; roommates were "very respectful" and even "awesome." Clients are expected to keep their rooms clean but are not assigned chores. Alumni described their fellow residents as a "refreshingly wide range of people." Clients were a mix of men and women of all ages and ethnicities, and many were described as professional, but there were "college student age people" as well. Alumni considered their fellow clients "regular people looking to address what was holding them back in life." The average length of stay was 30 days, and the most common issue driving respondents to seek treatment at TRC was substance use disorder. Others sought help for alcoholism or "dual addiction(s)," "gender-identity issues," "relationship issues," and "compulsive behaviors."The food served at TRC was described as "very gourmet" but also with a "home meal feeling." Meals were frequently described as "healthy" and clients were allowed to "have choices and input" on the menu selections. Clients with vegan diets were pleased with the range of options available to them, while fresh fish and seafood and Italian food were cited as favorite meals, as was the cookout that is offered as part of TRC's many activities. Coffee was made several times a day, and snacks were both plentiful and healthy. One alum felt the food was "too healthy," while another was "grateful to have a meal."Alumni described their days at TRC as "busy," with frequent involvement in a number of different activities. A couple former residents noted that staying busy is "part of the deal at Tarzana," with an emphasis on "getting and staying involved in your life." The program was "well-structured" and "with an emphasis on recovery through recreation and learning to have fun sober." TRC's treatment includes a "custom treatment plan" developed with the client, as well as one-on-one meetings with a residential treatment case manager – typically, a certified alcohol and drug counselor and a personal therapist. Evidence-based therapies such as cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT) and eye movement desensitization and reprocessing (EMDR) are also offered, as is meditation, equine therapy, pet therapy, music therapy, yoga, and professional massage therapy.While TRC's program does include a 12-step element, alumni viewed it as just one part of their treatment plan. "I think the foundation is somewhat 12-step, but they were really trying to provide me with something I wouldn't find in meetings alone," wrote one alum. Others appreciated the fact that the emphasis seemed to be more on "learning to actually live one's life sober and have fun." Most cited the groups and interaction with the staff as the most memorable element of their stay at TRC. Staff was regarded as "very caring and engaged" and "very understanding," but also with an element of tough love, which many considered "out of love and care."During non-treatment hours, clients had a number of activities and amenities available to them. The latter includes a pool, gym facilities, and fitness classes, while volleyball, cooking classes, bike riding were among the many activities. Clients could also take advantage of numerous off-site activities, including trips to the beach, surfing, bowling, virtual reality gaming, go-kart racing, and other weekend options, which were "super enjoyable."Access to a phone was described by alumni as "liberal" but also restricted while in detox, during group sessions, as well as after 10 p.m. (phones were returned at 10 a.m.). Access to television, Internet, media, and work obligations were "frequent" and the staff was "accommodating" in that regard.TRC's treatment includes 24/7 care from a diverse array of medical professionals, from doctors and nurse practitioners to therapists, mental health counselors, and alcohol and drug rehab technicians. The staff was described as "very helpful" and "always on call." Doctors were even available upon request via Facetime and Zoom, which was "helpful," while counselors at TRC were described as "exceptional."When asked about how they've fared since treatment at TRC, all respondents answered that they had been successful in maintaining sobriety for months, with some approaching their first year without substances. Some found it more challenging that others; as one alumni noted, "It is a daily reprieve. However, the tools they provided me have helped me stay clean for nine months now." Another reported feeling "far better equipped to handle things in my life" and one summed up: "I have never been this proud of myself."When asked to summarize their time in treatment at TRC, many alumni expressed gratitude for the center's staff. "I feel VERY fortunate to have found this treatment center," wrote one alum. Another noted that the staff made them feel "at home," and praised the staff for being "here to help me with whatever I needed." One cited an example of the staff's willingness to help by noting that transportation was arranged for a homeless client to come to Tarzana and stay for free, adding that the client "turned his life around."Another seemed to encompass their fellow alum's feelings by "highly recommend[ing] it to the next addict." They added that "the program helped me become the person I am right now, and I can't thank them enough."
January may be the time for New Year’s resolutions, but for many people September presents another opportunity for a fresh start. Kids return to school, the chaotic summer schedules quiet down, and many people transition into their fall and winter routines. That makes September a perfect time to check in on your routines, evaluate what’s working and what’s not, and make the changes you need to live your healthiest life.Here’s how to get started.Check in with yourselfBefore you make any big changes, take some time to check in with yourself. Journaling can be helpful, but you can also just take yourself on a walk or find another way to have an internal conversation, uninterrupted. Ask yourself what feels good in your life right now? What changes are just screaming to be made? Use these as directions to evaluate what you should do next.Make a listAfter you’ve taken some time to think about what you’d like to keep and change in your life, get out your pen and paper and make a list. The staff at Sunshine Coast Health Centre, a non 12-step drug and alcohol rehabilitation center in British Columbia, recommend making three lists to evaluate different areas of your life. First, start with a list of things you’re grateful for. Next, list your preferred activities, or the ways that you enjoy spending time. This can guide you in deciding how to prioritize and schedule your time. Finally, list the resources that are available to you if needed.Update your routineSummer can be a tough time to keep on schedule. The free and easy living is nice, but can become overwhelming after a while. Think about what you let slip from your routine, and what you would like to reincorporate. This is especially important as society begins opening up again. You might have the opportunity to volunteer, participate in alumni programs or take in-person classes for the first time in more than a year. Look back on your list of preferred activities and determine how you can incorporate more of those into your days.Get organized. Cooler weather means that most people will be spending more time inside during the coming months. To keep yourself happy and healthy, you should start with a clean slate in the house. Removing unnecessary clutter can help you keep a clear head, and knowing that all of your belongings have a physical space where they belong can help you stay organized. If you feel overwhelmed, start with one room at a time, donating things you no longer use and finding systems that work for the things you have left.Reach out for help.Think back to that last list you made: the resources that are available to you. These might be community programs, alumni supports or people you have close relationships with. Now, think about the areas in your life where you could use a bit of extra support. How can you use your resources to build your strengths in those areas? Maybe you’re looking to get more physical activity, and could recruit a friend to be your gym or walking buddy. Perhaps you can utilize a free community credit resources to help get your finances back in order. Remember: we all need support sometimes, and reaching out for help is a strength, not a weakness.Set a sleep routine. What’s the key to good mental, physical and emotional health? For many people, it’s getting a solid night’s sleep. Tweek your routine so that you get the recommended 8 hours of shut-eye. If you are a parent, try to get the kids in bed earlier so that you can have some time to yourself, but still get to bed at a recent hour. If you have trouble sleeping, remember to shut down the screens and turn to an old-fashioned book or bath in the hour before bed.Decide to say no.Sometimes, what you say no to is just as important as the things you decide to do. Especially after a year at home, there’s a temptation to take every opportunity, but that can leave you overstimulated and overtired. Instead of diving back into everything all at once, choose a few meaningful (or preferred) activities to focus on. Set boundaries on things that stress you out, whether it’s joining the PTA or helping with carpooling. Remember, your time is one of your most valuable resources, and you get to decide how to spend it.It’s not a new year, but it is a new start in many areas of North America. At this junction you can decide what you want your fall and winter to be like, and what you would like to leave behind.Sunshine Coast Health Centre is a non 12-step drug and alcohol rehabilitation center in British Columbia. Learn more here.
Statistics regarding the number of overdoses and fatalities involving the synthetic opioid fentanyl continue to paint a grim picture in the United States. The Centers for Disease Control and Prevention released preliminary data showing that overdose deaths in the United States rose 29.4% in 2020 to an estimated 93,331, including 69,710 involving opioid drugs, mainly fentanyl. Every state has reported a spike or rise in fatal overdoses during the COVID pandemic. One prevalent issue is that the COVID crisis is now getting worse due to the abundance of illicit fentanyl and fentanyl analogues on our streets.Furthermore, the Centers for Disease Control and Prevention noted that drugs like fentanyl are the primary reason for a 38% increase in overdose deaths between May 2019 and May 2020. During that same time period, 18 U.S. jurisdictions with available data on synthetic opioids saw increases of more than 50%, while 10 Western states reported a 98% increase. Adding to mounting concerns is the reduced availability of treatment options due to the COVID-19 pandemic.Fentanyl continues to be at the heart of the overdose epidemic, mainly illicit but also in prescription form. Fentanyl analogues are made from raw materials originating primarily in China and manufactured and sold to the United States by Mexican drug cartels. Though both forms are extremely powerful and possibly lethal, variants found in illicit mixtures are far more dangerous and affect users differently.The prescription form of fentanyl is a Schedule II controlled substance, which means that the medication is considered a drug "with a high potential for abuse, with use potentially leading to severe psychological or physical dependence," as noted in the Controlled Substances Act, which is overseen by the U.S. Drug Enforcement Administration (DEA) and Food and Drug Administration (FDA). Prescription fentanyl is used primarily to treat patients enduring severe pain from surgery, cancer, or significant traumatic injuries.Illicit fentanyl comes from two sources: it is diverted from prescription medication and sold on the street, or manufactured from other chemical sources, and then sold. Diverted fentanyl can be obtained by extracting the drug from the patch and then converted to injectable form, or by prescriptions obtained illegally from a medical professional or a person with a valid prescription. While diverted fentanyl poses serious dangers to illicit users, the illegally manufactured form fentanyl has a myriad of ways to harm individuals. The raw materials produced in China are made without quality controls imposed on the pharmaceutical variety; two milligrams of the drug can be enough to cause a fatal overdose, depending on the individual's tolerance and other health factors. The DEA has reported seizing counterfeit medication containing 5.1 milligrams of fentanyl per tablet – twice the lethal amount and more than capable of killing multiple users.Even users who seek to avoid using fentanyl may inadvertently ingest the drug. Numerous state and federal investigations have found fentanyl used as a cheap additive to boost the potency of drugs like heroin, cocaine, MDMA (also known as ecstasy or molly), or methamphetamine. It has also been found in counterfeit analogues of prescription opioids such as oxycodone. Combining such potent narcotics in a single dose has caused fatal interactions in increasingly high and frequent numbers.Symptoms of fentanyl overdose are similar to those experienced with other narcotics: chest pain, labored breathing, vomiting, pale or bluish color to the face, fingernails, and lips. Seizure or unconsciousness frequently follows, and unless treatment is immediately sought and revival is attempted with the opioid overdose reversal drug Naloxone (Narcan), the afflicted individual can lapse into a coma or possibly even suffer a fatal overdose. Additionally, recent scientific data suggests that the toxic effects of fentanyl and its analogues may include compromised pulmonary function due to mechanisms not reversible by naloxone alone. Immediate comprehensive medical care is needed for every suspected drug overdose situation.How to combat this rising tide of fentanyl overdose? Although addiction is a multi-facet condition, Clare Waismann, a substance use disorder counselor, addiction specialist, and the founder of Waismann Method, an opioid treatment program and rapid detox center, believes that mental health care and medically assisted detox should be accessible not just to those who can afford it but also to those who are in need. In today's world, we are living through such an unsettling reality. Additionally, so many people have to deal with the trauma and consequences caused by COVID and its attendant restrictions— medical treatment for opioid dependence must be available in public hospitals along with necessary psychological support, says Mrs. Waismann. Additionally, we need a more substantial commitment to combating the rise of opioids, especially the influx of fentanyl to every corner of our country."We have the medical science and resources to help those suffering from fentanyl addiction. Now we need the right priorities." - Clare Waismann. https://www.ama-assn.org/system/files/issue-brief-increases-in-opioid-related-overdose.pdfhttps://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htmhttps://www.cdc.gov/niosh/topics/fentanyl/risk.html
One of the most interesting aspects of the study of early addiction treatment is seeing that so many concepts which are believed to have been originated by AA and the modern disease theory were actually fully developed by the end of the 19th century. Another is that the battle between those who promote pharmaceutical treatments for addiction and those who promote spiritual solutions also dates back to the 19th century.The story of addiction treatment in the late 19th and early 20th centuries is a fascinating story of a battle between medical dogmatism, pragmatism, and profiteering. Orthodox medicine of the 19th century promoted the dogma that the only possible treatment for alcoholism or other addictions was confinement in inebriate asylums for years at a time, where inmates could be remade through moral therapy. The inebriate asylum movement got its start in the mid-19th century with the founding of the Binghamton, New York Inebriate Asylum (opened 1864) and the Washingtonian Home in Boston (opened 1857). The inebriate asylum movement, led by orthodox doctors specializing in mental disease, held that pharmaceutical treatments for inebriety were an impossibility and that inebriates could only be treated by moral means such as work and religion. Their stance was that pharmaceuticals were only to be used during detoxification, and sparingly even then.Then, in 1886, a Russian doctor named Nikolai M. Popoff published an article stating that when alcoholics were given injections of strychnine nitrate, they spontaneously stopped drinking in two to three days. The use of strychnine as a medicine may sound strange to 21st century ears; however, strychnine was an extremely commonly used medicine in the 19th century, one of its most common uses was as a cardiac stimulant.An English-language summary of Popoff's article was published in the May 1, 1886 issue of the British Medical Journal, and this summary was reprinted in countless English-language medical journals. Numerous other Russian doctors replicated Popoff's experimental treatment, and these were also translated and published in many English-language medical journals. However, the Quarterly Journal of Inebriety, America's only specialty addiction treatment journal during this era, pointedly ignored the Russian discovery and did not print a single word about it.However, a railroad surgeon and patent medicine salesman named Leslie E. Keeley, who lived in the dusty little prairie town of Dwight, Illinois, heard about the Russian cure, and decided to give it a try. Keeley had already been selling a patent medicine which he called the Double Chloride of Gold Cure for alcoholism since 1880. The main ingredient in Keeley's Gold Cure appears to have been tincture of red cinchona, and it is questionable how efficacious it was. It contained no gold. But when Keeley added the strychnine injections to his treatment regimen in 1886, he found that he had a miracle cure on his hands. Keeley found that calling his treatment the Gold Cure was a great marketing strategy, so he retained the name, although the treatment still contained no gold.Keeley, of course, never gave any credit to the Russians for the discovery of the cure. Instead, Keeley marketed the cure as a secret formula which he had discovered through years of painstaking research and experimentation. It was a motif which Americans ate up: the simple country doctor who solved a medical problem which had baffled the great and learned doctors on the east coast. The stories of Thomas Edison and the Wright brothers are examples of this same motif.At first, the news of Keeley's miraculous Gold Cure spread by word of mouth, then, in February of 1891, Joseph Medill, editor of the Chicago Tribune, published an endorsement of the Keeley Cure in his newspaper, giving it national publicity. Medill had initially been skeptical of the Keeley Cure; therefore, he had sent several of the worst drunkards in Chicago to Dwight for treatment in order to test the efficacy of the cure. All had returned to Chicago unable to drink whiskey. The floodgates broke, and by the end of 1891, Keeley was treating nearly 1,000 patients a day at Dwight. Subsequently, 126 Keeley Institutes opened worldwide, and at least 300 imitators popped up, running institutes which claimed to offer a gold cure which was as good as or better than Keeley's. By the time the Keeley Institute closed in 1966, half a million people had taken the Keeley Cure.The members of the inebriate asylum movement hated the Keeley Cure. The inebriate asylum movement had never been a success, only a few were ever opened. Moreover, their cure rate was only about 20% to 30%. Dr. Keeley bragged that his success rate was 95%. Although Keeley was clearly exaggerating, it is quite clear that those who completed a 28-day course of injections at a Keeley Institute were unable to drink whiskey when they left the institute, although some made an effort to overcome their aversion and eventually resumed their drinking careers. Many others used the initial treatment as a springboard to permanent abstinence from alcohol. Keeley graduates also banded together to form a mutual support group called the Keeley League, which had over 30,000 members at the height of its popularity. The members of the inebriate asylum movement mounted vicious attacks on the Keeley Cure in medical journals and the popular press; these attacks were, however, filled with specious arguments and logical fallacies. Rather than engage in debate, Dr. Keeley simply ignored them and laughed all the way to the bank.The Keeley Institutes began encountering some stiff competition when the Neal Institutes were opened in 1909. The Neal Institutes offered an early form of conditioned taste aversion therapy which paired an emetic with a drink of whiskey, causing the person to immediately vomit up the whiskey. Although vomiting when intoxicated does not create an aversion, vomiting while sober does. Later research at the Shadel Sanitarium in Seattle Washington in the 1940s would produce statistics which proved that this form of aversion therapy was highly effective for alcoholics. However, Dr. Benjamin Neal and the Neal institutes were satisfied in finding the treatment highly profitable. Whereas the Keeley Treatment took 28 days and required hypodermic injections four times a day, the Neal Treatment only took three days, and no injections were used. About 80 Neal Institutes were opened worldwide.Treatment demand fell precipitously around the time the US became involved in World War One (1917 - 1918), and most of the proprietary cure institutes had closed by the advent of national alcohol prohibition in 1920, although a few managed to survive. After the repeal of prohibition in 1933, many new proprietary treatment facilities such as the Samaritan Institutions and the HALCO institutes sprung up; however, these new institutes all relied on aversion therapy with emetics, which was simpler and faster than the strychnine cure. The Gold Cure was available in only a few surviving Keeley Institutes and by the late 1940s, the Keeley Institute in Dwight had abandoned the Gold Cure in favor of 12-step treatment.When I began researching the early proprietary cure institutes of the late 19th and early 20th centuries, I found that there were no detailed accounts of their history in existence. Most articles written about them had simply and uncritically repeated the diatribes attacking these institutes which had been published in the medical journals of the late 19th and early 20th centuries. Therefore, I felt compelled to write a detailed history of these immensely popular treatments. This required going back to primary sources, i.e., the newspaper stories, medical journals, pamphlets, etc. published during this era. A fascinating and previously untold story emerged which I have published in two books, Strychnine and Gold (Part 1) and Strychnine and Gold (Part 2). Each is over 400 pages in length, and they are available at Amazon.
You probably still remember public service ads that scared you: The cigarette smoker with throat cancer. The victims of a drunk driver. The guy who neglected his cholesterol lying in a morgue with a toe tag.With new, highly transmissible variants of SARS-CoV-2 now spreading, some health professionals have started calling for the use of similar fear-based strategies to persuade people to follow social distancing rules and get vaccinated.There is compelling evidence that fear can change behavior, and there have been ethical arguments that using fear can be justified, particularly when threats are severe. As public health professors with expertise in history and ethics, we have been open in some situations to using fear in ways that help individuals understand the gravity of a crisis without creating stigma.But while the pandemic stakes might justify using hard-hitting strategies, the nation’s social and political context right now might cause it to backfire.Fear as a strategy has waxed and wanedFear can be a powerful motivator, and it can create strong, lasting memories. Public health officials’ willingness to use it to help change behavior in public health campaigns has waxed and waned for more than a century.From the late 19th century into the early 1920s, public health campaigns commonly sought to stir fear. Common tropes included flies menacing babies, immigrants represented as a microbial pestilence at the gates of the country, voluptuous female bodies with barely concealed skeletal faces who threatened to weaken a generation of troops with syphilis. The key theme was using fear to control harm from others.Library of CongressFollowing World War II, epidemiological data emerged as the foundation of public health, and use of fear fell out of favor. The primary focus at the time was the rise of chronic “lifestyle” diseases, such as heart disease. Early behavioral research concluded fear backfired. An early, influential study, for example, suggested that when people became anxious about behavior, they might tune out or even engage more in dangerous behaviors, like smoking or drinking, to cope with the anxiety stimulated by fear-based messaging.But by the 1960s, health officials were trying to change behaviors related to smoking, eating and exercise, and they grappled with the limits of data and logic as tools to help the public. They turned again to scare tactics to try to deliver a gut punch. It was not enough to know that some behaviors were deadly. We had to react emotionally.Although there were concerns about using fear to manipulate people, leading ethicists began to argue that it could help people understand what was in their self-interest. A bit of a scare could help cut through the noise created by industries that made fat, sugar and tobacco alluring. It could help make population-level statistics personal.NYC HealthAnti-tobacco campaigns were the first to show the devastating toll of smoking. They used graphic images of diseased lungs, of smokers gasping for breath through tracheotomies and eating through tubes, of clogged arteries and failing hearts. Those campaigns worked.And then came AIDS. Fear of the disease was hard to untangle from fear of those who suffered the most: gay men, sex workers, drug users, and the black and brown communities. The challenge was to destigmatize, to promote the human rights of those who only stood to be further marginalized if shunned and shamed. When it came to public health campaigns, human rights advocates argued, fear stigmatized and undermined the effort.When obesity became a public health crisis, and youth smoking rates and vaping experimentation were sounding alarm bells, public health campaigns once again adopted fear to try to shatter complacency. Obesity campaigns sought to stir parental dread about youth obesity. Evidence of the effectiveness of this fear-based approach mounted.Evidence, ethics and politicsSo, why not use fear to drive up vaccination rates and the use of masks, lockdowns and distancing now, at this moment of national fatigue? Why not sear into the national imagination images of makeshift morgues or of people dying alone, intubated in overwhelmed hospitals?Before we can answer these questions, we must first ask two others: Would fear be ethically acceptable in the context of COVID-19, and would it work?For people in high-risk groups – those who are older or have underlying conditions that put them at high risk for severe illness or death – the evidence on fear-based appeals suggests that hard-hitting campaigns can work. The strongest case for the efficacy of fear-based appeals comes from smoking: Emotional PSAs put out by organizations like the American Cancer Society beginning in the 1960s proved to be a powerful antidote to tobacco sales ads. Anti-tobacco crusaders found in fear a way to appeal to individuals’ self-interests.At this political moment, however, there are other considerations.Health officials have faced armed protesters outside their offices and homes. Many people seem to have lost the capacity to distinguish truth from falsehood.By instilling fear that government will go too far and erode civil liberties, some groups developed an effective political tool for overriding rationality in the face of science, even the evidence-based recommendations supporting face masks as protection against the coronavirus.Reliance on fear for public health messaging now could further erode trust in public health officials and scientists at a critical juncture.The nation desperately needs a strategy that can help break through pandemic denialism and through the politically charged environment, with its threatening and at times hysterical rhetoric that has created opposition to sound public health measures.Even if ethically warranted, fear-based tactics may be dismissed as just one more example of political manipulation and could carry as much risk as benefit.Instead, public health officials should boldly urge and, as they have during other crisis periods in the past, emphasize what has been sorely lacking: consistent, credible communication of the science at the national level.Amy Lauren Fairchild, Dean and Professor, College of Public Health, The Ohio State University and Ronald Bayer, Professor Sociomedical Sciences, Columbia UniversityThis article is republished from The Conversation under a Creative Commons license. 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In the past eighteen months, more than four million people around the globe have died from COVID-19. This massive loss has shined a spotlight on a normal, but painful, part of daily life — grief. Grief can occur for a variety of reasons: you can grieve the loss of a relationship, or the end of a career. However, the most acute and deep grief often comes around death.Although there’s no prescriptive way to move through grief, there are healthy ways to process loss. If grief begins interfering with your daily functioning and keeps you from healing, you may be experiencing complicated grief. This condition can have a big impact on your life, and often requires medical treatment.Here’s what you should know about grief, especially if there is a history of substance use disorder in your family.Substance Use Disorder and Grief: Risk for ComplicationsGrieving can be incredibly painful. That often leads people to look for coping mechanisms to get through. This can be problematic for people who have a history of substance use disorder. Research has shown that people who have a history of addiction are more likely to experience complicated grief, the type that keeps you from moving on and healing. In addition, when people with a history of substance use disorder experience complicated grief, they’re more likely to turn toward maladaptive coping strategies, like using drugs or alcohol.If you experience a loss, you should try to be proactive about maintaining your sobriety while you are grieving. Talk to trusted loved ones and medical professionals about how to cope with the pain of grieving if you are struggling. Have an emergency plan so that you know what to do if you’re very close to relapse, or if you have used.The Stages of GriefMost people have heard of the five stages of grief. Although people don’t move through the stages in a predictable manner, the stages can help normalize how you feel when you’re grieving. This alone can be helpful, reminding you that many other people have been through what you’re experiencing.The five stages of grief, as explained by researcher Elisabeth Kübler-Ross, are:Denial: When you first experience a shocking loss, you might not be able to comprehend it. The denial phase is characterized by feeling numb, and focusing on just getting through each day.Anger: As you begin to understand the depth of your loss, you may become angry about it. You might feel abandoned by God or the universe, or that the loss is unfair. Although anger might feel like a surprising emotion while grieving, it’s important to feel your anger and move through it.Bargaining: During the bargaining phase, you try to exert control and change the outcome of the loss. You might find yourself saying things like, “I’ll stay sober, as long as I get my mom back.”Depression: At this stage, the reality of loss has settled in. You’ve realized that you can’t bargain a solution or rail against the injustice of the loss. You settle into depression, which may put you at increased risk for relapse.Acceptance: Finally, after moving through the pain of grief, you might find yourself coming out the other side. You may notice that you’re remembering your loved one with joy and gratitude, rather than just focusing on the pain of losing them.The New, Sixth Stage of GriefRecently, David Kessler, a grief expert who worked with Kübler-Ross, introduced a sixth stage of grief: finding meaning. To truly heal from a loss, you must find a way to create a meaningful life, living in a way that honors the person you loved and the meaning of their life.This sixth stage is especially important for people who have a history of substance use disorder. In healing from addiction, it’s important to create a meaningful life. This can give you the impetus that you need to stay sober. Focusing on the components of a meaningful life — self-awareness, positive relationships, and intrinsic motivations — can support you in overcoming grief in a healthy way.A Hand to Hold: When to Get HelpGrief can become overwhelming. Communicating with your healthcare providers and your recovery community can help you navigate the grieving process. However, if you experience any of the following, you should reach out for more immediate help:An inability to recall good, happy memories about your loved one.Being unable to acknowledge or accept a lossHaving thoughts of self-harm or suicideThinking frequently about drug or alcohol use or relapse.Grief never goes away entirely. However, you can learn to incorporate grief and memories into your life in an emotionally healthy way, remembering what was, while continuing to live your life in the present and future.Sunshine Coast Health Centre is a non 12-step drug and alcohol rehabilitation center in British Columbia. Learn more here.
Since the pandemic began, anxiety rates in the U.S. have tripled; the rate of depression has quadrupled. Now research is suggesting the media is part of the problem. Constantly watching and reading news about COVID-19 may be hazardous for your mental health.We are professors who study the psychological effects on people caught up in crisis, violence and natural disasters. COVID-19 surely qualifies as a crisis, and our survey of more than 1,500 U.S. adults clearly showed that those experiencing the most media exposure about the pandemic had more stress and depression.It’s understandable. The intimations of death and suffering, and the images of overwhelmed hospitals and intubated patients can be terrifying. COVID-19 has created an infodemic; members of the public are overwhelmed with more information than they can manage. And much of that information, especially online, includes disturbing rumors, conspiracy theories and unsubstantiated statements that confuse, mislead and frighten.Stress worse for some than othersA June 2020 study of 5,412 U.S. adults says 40% of respondents reported struggling with mental health or substance use issues. This finding did not address whether respondents had COVID-19. Since then, some people who had COVID-19 are now reporting mental health issues that appeared within 90 days after their illness subsided.Taking care of a relative or friend with the virus might result in mental health problems, and even just knowing someone with COVID-19 can be stressful. And if a family member or friend dies from it, anxiety and depression often follow the grief. This is even more likely if the individual dies alone – or if a memorial isn’t possible because of the pandemic.Essential workers, from hospitals to grocery stores, have a higher risk for COVID-related mental health problems. This is particularly true for health care workers caring for patients who ultimately died from the virus.[Get facts about coronavirus and the latest research. Sign up for The Conversation’s newsletter.]Black and Hispanic adults also report more mental health issues, including substance abuse and thoughts of suicide. Having access to fewer resources and experiencing the systemic racism running through much of U.S. health care may be two of the factors. The COVID-19 pandemic also intersected with episodes of police violence toward Black Americans. This alone may have exacerbated mental health problems.Children, young adults and college students also show comparatively worse mental health reactions. This could be due to the disconnect they feel, brought on by the isolation from peers, the loss of support from teachers and the disappearance of daily structure.Setting limits essentialStaying informed is critical, of course. But monitor how much media you’re consuming, and assess how it affects you. If you are constantly worrying, feeling overwhelmed, or having difficulty sleeping, you may be taking in too much COVID media. If this is happening to you, take a break from the news and do other things to help calm your mind.Parents should frequently check in with children to see how they are affected. Listening to and validating their concerns – and then providing honest responses to their questions – can be enormously helpful. If a child is having difficulty talking about it, the adult can start with open-ended questions (“How do you feel about what is happening?”). Reassure children that everything is being done to protect them and discuss ways to stay safe: Wear a mask, socially distance, wash hands.Finally, you can model and encourage good coping skills for your children. Remind young people that good things are still happening in the world. Work together to list healthy ways to cope with COVID-19 stress. Then do them. These activities will help your children cope – and it will be good for you too.J. Brian Houston, Associate Professor of Communication and Public Health, University of Missouri-Columbia and Jennifer M. First, University of Tennessee, College of Social Work, University of TennesseeThis article is republished from The Conversation under a Creative Commons license. Read the original article.
Tara had the body of a runway model with thick blond hair that cascaded down her shoulders to the middle of her back. We had become good friends, pulled together like magnets by our mutual brokenness.It was the late sixties, I was sixteen when Tara and I were sitting on the bleachers together at school. I was etching my initials into the soft, splintery wooden bench with a paperclip. I knew better than to leave my entire name amongst the other scattered names, initials and drawings of hearts or it could be used against me later on.“Look at those stupid girls,” Tara said, glaring off into the distance.“Which ones?” I followed her gaze.“All of them. Those snobby bitches make me want to puke.”She was referring to the loud, happy teenagers sitting on the grass eating their lunches. Some had their hair piled up in beehives, held together by copious amounts of hairspray, while others had short bobs that flipped at the ends. I didn’t think any of the girls were intentionally trying to arouse our envy, but that’s exactly what they did.“Fucking clueless bitches,” I said.I was trying my best to stay out of trouble when Tara made this announcement: “I’m going to run away.”“Really? Why?” “I hate my step dad.” I knew Tara’s mother had recently remarried and the new hubby was strict.“That bad, huh?”“He’s trying to tell me what I can, and can’t do, and he’s not even my dad.”Silence. Then I said, “I’ll go with you if you run away.”“Really? You would do that?”I wanted to show her what real friendship looked like, but I also wanted to get away from the constant drama and craziness going on at home. “Of course,” I said, like it was a no brainer.“Where would we go?”Staring off in the distance I spotted a girl with two long braids, dressed in a bright orange tie-dyed, t-shirt. “We can see where the open road takes us.”Tara and I met by the flagpole in front of school the next day. I was dressed in bell-bottom jeans and a sweatshirt. I’d also brought a back pack stuffed with a toothbrush, a change of clothing and a dozen Twinkies in case we got hungry. Tara was wearing a cool brown rawhide jacket with fringe that hung from the back of her arms like wings. “You sure you want to do this?” Tara’s forehead was crinkled up.“Totally.”That was it. An hour later we were standing on the Pacific Coast Highway with our thumbs out. It took less than five minutes before a green and white Volkswagen van with flowers and a peace sign pulled over. Tara climbed in the back and I got in the front. Instantly I was hit with the smell of stale cigarette smoke and Patchouli oil. Strands of beads hung from the rear-view mirror. The driver was a guy with long brown hair, a straggly beard, and a rawhide vest worn over a linen shirt.“Where you girls headed?” he asked.“That way.” I pointed in front of me.“Well, what a coincidence. I’m going that way too,” he smiled.“Groovy.”“My name is Jeff by the way.”We told him our names.“We just ran away from home,” Tara blurted out.Jeff tilted his head sideways. “Oh really? Runaways?”“Our parents suck,” I said, as if no other explanation was needed.“I dig it man. I left home when I was seventeen.”“Wow. That’s really cool,” Tara said.As we drove up the coast, I watched the waves reaching up like fingers on the shore. I loved everything about the ocean. The mere sight of it could put me at ease. When we came to a red-light Jeff hit the brakes causing empty bottles and beer cans to roll forward from underneath the seat.“Looks like you had a party,” I said.“Oh yeah, sorry about that.”“No problem.”The salty wind was whipping my hair in my face.“What do you do Jeff?” Tara said, leaning forward.“I’m a singer-songwriter.”I liked the sound of that. He seemed like a free spirit.“Right now I happen to be living in the caves.”“What caves?” Tara asked.“In the canyon.”“I’ve never met a cave man before,” I smiled.“You chicks are welcome to come check it out.”Looking around Tara gave an enthusiastic nod.“Yeah. Okay,” I said.A few minutes later the bottles and cans crashed again as we were made a sharp right turn. Topanga Canyon Boulevard was a narrow, windy road, curling through the burnt orange Santa Monica Mountains. As we drove deeper into the canyon, I stuck my head out the window, causing my hair to windmill in my face. The chaparral-covered hills with steep rock out-cropping’s were breathtaking. I gazed down at the creek that rushed over massive boulders and rocks below. The raw beauty and energy of it all caused my blood pressure to drop a good ten points.Pulling my head in, I asked Jeff. “Are we still in L.A?”“Yup.”“I never even knew this place existed.”“Topanga is a well-kept secret,” Jeff smiled.“Well, I’ve had plenty of practice keeping secrets in my life,” I said.“Haven’t we all,” Jeff said, in a matter of fact tone.The van pulled onto a sliver of dirt by the side of the road. “Here we go ladies.” Jeff reached over and picked up his bag.Tara and I grabbed our backpacks and crawled out of the van.“So, where are the caves?” I asked.Jeff pointed. “Down there.”“Looks sort of dangerous.” Tara’s face was all scrunched up.“I climb it every day.” Jeff swung his long leg over the guardrail.Tara and I followed, dropping down onto a narrow clearing that was being strangled off by a thick layer of prickly underbrush and plants. Beyond the ledge was a dramatic drop into what seemed like a dark abyss.“Oh shit,” I said.“I know. I know,” Tara said.“If you start to lose your balance grab onto something,” Jeff said.“Have you ever fallen before?” I cupped my hands over my mouth.“Just once….” he said, without stopping.As we made our way down the loose dirt started to slip beneath us.“Watch out for poison ivy,” Jeff yelled.“What’s it looks like?”“Red and orange with almond shaped leaves.”All of a sudden I lost my balance and fell. I grabbed a handful of shrubbery to keep myself from going further down the hill. I pushed myself up and dusted the dirt off my butt. We see-sawed down the embankment. In some places it was so steep I had to sit down and scoot along on my butt.Out of breath we finally made it to the bottom. I noticed how everything was super quiet except for the water gushing in the nearby creek. The smell of sage and pine hung in the air. “Wow. It’s so quiet here,” I said to no one in particular.“This way, girls.” Jeff wanted us to keep moving.Dry leaves and twigs crunched beneath our feet. I turned to Tara and said, “How the hell are we going to get back up?”“Can’t go up when it’s dark that’s for sure,” she said.As we followed the creek downstream, Jeff abruptly stopped in front of a huge gray boulder. “Camp is on the other side of this,” he said, patting the rock with his hand. My neck craned as I gazed upward. The boulder was the size of a small house.“But how do we get over?” Tara asked.“Just watch me, and do the same thing.” Jeff started to climb with a surprising agility for a man who had to be over thirty. He used the tips of his fingers and toes to shimmy up the side. He made it look so easy, and seconds later he was at the top, cupping his hands over his mouth, he yelled, “Okay, girls, come on up. One at a time.”Tara went first. I bit my lip as she snaked her way up the side. I was afraid she would fall and break a bone. Then what? But Tara didn’t fall and when she made it to the top, I let out a long sigh of relief.“It’s not as hard as it looks,” Tara said, cheering me on.My heart was pounding as I inserted the tips of my fingers into the same dusty crevices that they had both used. I felt the hard, unrelenting rock beneath the front of my body. The toes of my sneakers found a small ledge as I reached my right arm overhead, searching for the next crack. When I found something to hold onto, my thigh and calf muscles tightened as I pushed myself up a few more feet. Reaching with my left arm to a crevice, I pulled myself up again. Twenty pounds over my ideal weight, and a half-pack-a day-smoker, I quickly became out of breath. When I made it the top, I felt a great sense of satisfaction.Standing next to Tara and Jeff, I gazed down at a waterfall with dark water gushing out from between two rocks. I was surprised to see a bunch of naked hippies standing waist high in a swimming hole with a crescent slice of sand encircling a private beach. It was the first time I had seen so much exposed flesh in one place. Embarrassment rippled up my spine. I had to look away.A guy with his dick dangling between his thighs yelled, “Who are your friends, Jeff?”“They’re runaways,” he said.“Well, come on in girls,” Dick man said. “The water is refreshing.”“Ah… No. I’m good, but thanks,” I replied, holding up my hand.We kept descending the boulder, but getting down was much easier than going up. Toward the bottom, I pushed off and landed with a thud on the crunchy gravel. I noticed the shallow caves Jeff was talking about at the base of the jagged mountain. Each opening was stuffed with a sleeping bag and scattered articles of clothing. I could see why all the hippies would want to stay there. It was the ideal place to live off the grid.A big-breasted girl with hair the color of chocolate fondue was stirring a pot over an open fire as smoke drifted toward the sky.“Do you girls want some of my special brewed cowboy coffee?” she asked.“Sure.” I shrugged.Tara and I sat on a log in front of the fire.“How did you guys meet Jeff?” she asked.“We were thumbing it on PCH.”“Groovy.” She stirred the simmering liquid in the pot. “They call me Sunshine around here.”“Do you have parents Sunshine?” Tara asked. “I mean, how do you live down here?”“My parents were always up my ass, so I ran away.”“Yeah, my parents were up my ass too,” Tara said, nodding.A few minutes later Dick man came and sat on a rock, his flaccid penis nearly touching the ground. I averted my eyes as Tara dug her elbow deep into my ribs.“Hello ladies.” He smiled.Making sure to avoid the penis I gazed just over his head.“Welcome to our casa,” he said, smiling directly at Tara.Minutes later Sunshine pulled out a fat joint. It was getting late and the sky had an orange, pinkish glow. By then all the other hippies were joining us. When the pot came around to me I took a hit. The smoke was harsh and burned the back of my throat. Coughing, I passed it on to Tara.As we got buzzed, we listened to stories while the sound of water fell over rocks a few feet away. Smiles emerged in the blurry orange light from the flames. A half-gallon of Red Mountain wine got passed around and everyone took swigs directly from the bottle.I had a good buzz going on when one of the younger guys started playing his guitar and singing, Heart of Gold, by Neil Young. My shoulders swayed to the sound. The sweetness of his voice coaxed everyone else to join in. We all knew the song and it sounded like a chorus bouncing off the canyon walls and reverberating into the ethers.I want to live.I want to give.I’ve been a miner for a heart of gold. …The words never felt truer to me than they did in that moment.We stayed up until the fire started going out. Some of the people said goodnight before drifting off into the blackness. I watched in horror when Dick man took Tara by the hand and guided her to his cave.Suddenly, I was struck with fear. Where am I going to sleep? As if reading my mind Jeff said, “You’re welcome to share my sleeping bag.”I put my palms closer to the fire and took a deep breath. “Okay. Cool,” was all I managed to say.Jeff stood up and I watched him walk away.A jittery feeling took over my entire body.I was trapped. While I had let plenty of guys feel me up or put their fingers inside me I hadn’t actually gone all the way with anyone yet. I was afraid Jeff might want to have sex. After all, weren’t the hippies all about having free love?A few minutes later I found myself fully clothed worming my way into Jeff’s sleeping bag. And while I might have had sex with him had he tried, Jeff only went as far as holding me in his arms. What I remember mostly was how the moon shone like a bleached oyster shell and the zillion silvery stars, flashing like sequins on a black velvet cocktail dress in the sky.“Gorgeous right?” Jeff said.“It’s, it’s so beautiful.” Jeff may not have noticed, but tears had welled up in my eyes. With a mind like a finely-tuned torture-device, it was rare for me to notice such beauty. As I drifted off to sleep, I wondered if my Dad was looking for me, but eventually my entire body merged with the blackness of the night. Excerpted from Incorrigible: A Coming-of-Age Memoir of Loss, Addiction & Incarceration by Wendy Adamson, available now at Amazon and elsewhere.
The inability to complete treatment for addiction or remain sober after treatment can have a damaging impact on the individual seeking recovery. Failure, for whatever reason, in recovery can leave those struggling with addiction with a host of negative emotions and thoughts (also known as "stinking thinking" ): people might think that because they failed drug treatment, they are also incapable of succeeding in other areas of their life. They might also start believing that recovery programs are not a solution to addiction and there's no point in trying other treatment programs. Such thoughts can place an individual fresh from recovery in a precarious position that, in many cases, can lead to relapse and further danger to their physical, mental, and emotional wellbeing.One significant component of the unsuccessful result of those in treatment is the overinflated promises attached to it. When those struggling with addiction or their loved ones call treatment centers, they are often oversold by the treatment professional or facility. Patients may believe that treatment is a "golden ticket" to instant sobriety, mental health healing, social rehabilitation, and more, without further work on their end once they leave the facility. Usually, this inaccurate message is not delivered with malicious intent on the part of the treatment provider, but more often than not, due to a lack of complete information and a need to affect positive change in a manner that may not be immediately available to both provider and patient."I believe it's really important for us as treatment providers to be realistic about what we can and cannot offer," says Clare Waismann, RAS/SUDCC and founder of WAISMANN METHOD®, an opioid treatment program and rapid detox center, and Domus Retreat on a recent episode of the Waismann Method podcast. "When patients say, 'I failed treatment so many times,' more often [than not], the treatment failed them. They failed the treatment because they and their families were promised that their personalities would change, their lives and their realities would change, and their mental health issues would be solved. So I think it's really important [for] treatment providers to tell [patients] exactly what you will be provided, exactly what your ability is as a provider, and what their responsibility [will be] not only during treatment, but after treatment."What creates these inaccurate narratives between patient and treatment professional? The issue is often due to a lack of clarity regarding each individual's unique needs and the scope of what a recovery treatment can actually provide. Outlining the limits of a program and managing realistic expectations can be vital to connecting a patient with subsequent success. "My goal is to give people real, personal insight into some of the specific things that are causing [the] compulsivity," says David Livingston, LMFT and psychotherapist at Waismann Method, who joined Clare on the podcast. "And then we try to put together a plan that will address that. That often includes continued therapy, and we go through the positives and negatives of that. I'll even talk about the 12-step [programs]. I try to give them a realistic understanding of what treatments, the difficulties [that are inherent] in them, and what [they] need to look for in terms of finding and sustaining a successful treatment."Another stumbling block for treatment professionals is the "one-size-fits-all" theory regarding recovery. For Waismann, this idea that one single recovery track applies to all patients is a "red flag." As she notes, "You're not treating the condition, you are treating a patient. Not every treatment is effective for everybody. People tend to push patients to receive what they have to offer. That's a mistake. It's really important to hear the patient's history and needs, and make sure that they – and you – know that there are different options."Hand-in-hand with this peg-and-hole approach is the idea that treatment will completely "cure" the patient. "That's impossible," says Waismann, who notes that this particular perspective will always lead to unrealistic expectations that prove disastrous for patients and professionals. "Individuals often feel unseen, when professionals focus on a certain (addiction) diagnosis." she says.As patients and families search for a solution in the face of an often challenging and intense situation, they lack an understanding of their condition, which causes them to lose the ability to distinguish credible from unreliable sources. Additionally, vulnerable situations lead people to seek hope or the impossible-to-guarantee promise of a positive treatment outcome, however unlikely those outcomes may be. "If you're just getting pushed into things that don't make sense to you, that don't feel helpful to you, and that you're resenting, that will drive up your frustration," adds Livingston. "I don't see that as productive treatment."Livingston also suggests that the failure to provide a complete picture of recovery expectations – which sometimes involves challenges after treatment – can also lead to inflated expectations. "Compared to most [facilities], we have a shorter program, because we get people detoxed quicker, and they feel better faster," he says. "That is really the strength of our program. We do it to try and minimize the length of suffering involved – a suffering that I see as neurotic suffering because it does not help you grow. It's just suffering to get something done that needs to get done."After the detox, the next level of work begins, and it's here that Livingston notes that attention and flexibility can produce actual results. "We go a step at a time addressing the most relevant needs as they surface," he says. "If you understand what those needs are, and you're not loading them up on your own program, and you're talking about the limitations [of the program], it's a great comfort – it actually aids in the treatment. "What's therapeutic for them is that patients actually feel what it means to have their needs met and to have a handle on their lives. But [as a therapist], you have to do your part and delineate and specify what exactly [needs to be done], and then make sure it's getting done."
One of the bigger issues in the recovery community is the idea of god. Is a belief in one necessary to getting clean and sober? If so, does that god have to be one spelled with a capital “G,” as it is in The Big Book, or a lower-case “g” that allows for a more open dialogue? The following is excerpted from Writing Your Way to Recovery: How Stories Can Save Our Lives.Chapter SixOh No, Is He Talking About God Again?My sponsor hates it when I talk about feeling like an agnostic, or an atheist, or just conflicted and confused. He definitely believes in God, capital “G” and all. But you know I’m not so sure about god. In truth I had, and sometimes still do have, a lot of trouble with the concept of a higher power.For a lot of us the god part of A.A. was a roadblock we had to navigate around if we wanted to remain in the fellowship and stay sober. Unfortunately quite a few of us had religion shoved down our throats as children, typically of the sort that damned you for being who you were. Then we showed up at our first meeting, and boom, it’s god all over again. Not so oddly the statistics say A.A. loses a large percentage of newcomers due to its thinly veiled Christianity.I grew up in a very conflicted household, especially when it came to religion. My mother was a quasi-Catholic-sometime-Protestant that would force us kids to go to church on a not so regular basis. My father was a Marxist. On Sunday, he’d say, “you can go to church if you want, but I’m going out to hike in the woods and then eat doughnuts and drink hot chocolate. You want to go, too?”I’m laying odds you could easily guess what a six-year-old wanted to do more than go to Sunday school. So every time I read “God” in the Big Book I’d think of my dad. Which brought up all those old conflicting feelings of wanting to please an authority figure as opposed to rebelling.In the beginning I had a sponsor I would later learn was what they called a “Big Book Thumper,” and he didn’t really care or understand my issues with religion and god. Anytime I expressed doubt and a lack of faith he would tell me to read, “We the Agnostics” because he said, “A.A. is a spiritual, not a religious program.” But then two seconds later he was telling me I had to pray.As a newcomer it seemed impossible to separate religion and spirituality.So what does all this talk of a higher power and spirituality have to do with writing your way to recovery? Well if you read a lot of addiction memoirs, or just memoirs in general, you’ll notice there’s a connecting tissue that most of them have. Memoir often embraces seemingly un-embraceable subjects such as death, loss, illnesses, catastrophes, squandered opportunities, horrific events, addiction, broken dreams, and then chronicle the protagonist’s ability to overcome adversity and persevere.But the memoirs that really resonate are when the authors reflect on their “journey” and use their story as an opportunity to look inside themselves. It’s not just everything that they have experienced, but how everything has helped change them into who they are today — the person that is writing the memoir. That “internal change” is by definition spirituality, “the quality of being concerned with the human spirit or soul.”Whew, that took a long way to get here, right? Okay so again, you may be wondering, what the hell is he talking about now? And if I haven’t lost you yet, here it is. Spirituality is not just what we need in a memoir; it’s also what we need for our program of recovery.Yet for me the concept of spirituality was a bit too ambiguous. Okay, so it’s not god. It’s not religion. It’s... oh shit, I don’t know what the hell it is.Then one sunny afternoon I was driving on the freeway in Los Angeles and I passed a broken down and very overloaded station wagon on the side of the road. The hood was up, gray smoke billowing out, and a family huddled together on the shoulder. For a nanosecond I locked eyes with the mother as she hugged her child and I swear I could feel her sadness and absolute despair.I was hemmed in between two lanes of speeding traffic and I couldn’t stop to help. Yet the fear in that woman’s eyes haunted me and I remember thinking, let those people be all right. Let that woman get her kids home safely.Now that might not seem like a big deal to you, and I understand. But for someone that used to drive by similar situations and think, better you than me, sucker, it was a huge departure. And in that moment I came that much closer to understanding spirituality. It wasn’t that I had to attain nirvana, or make some magnanimous gesture, or even perform a miracle. I just had to give a shit about someone other than myself.Chapter SevenGod? Not God?Like Patrick, I had trouble with God. Since the ripe old age of seven, when my mother was arrested and thrown in jail, I sat on the lawn outside our apartment complex, looked up at the sky, and cursed Him. Or Her. Or It. I think I actually said “fuck you,” fully expecting to be struck dead by lightening. It didn’t happen. And in the mind of a child this was only further proof that He didn’t exist. And if He did, as my older sister firmly believed and tried her best to make me believe, then what sort of God was He to allow our mother to be taken from us?So began my life as an atheist, or, at best, an agnostic.Believing or not believing in God didn’t seem to present any problems for me until my forties. I got by just fine on my own, or so I thought, because by then I was a total mess. Nevertheless, when I first walked into the rooms of Alcoholics Anonymous, the “God thing” almost sent me running. By now I’d come to accept that I was “powerless over alcohol,” and when push came to shove, though I resisted it for as long as I could, I also eventually had to admit that my life had “become unmanageable.” Of course this is the First Step in A.A. and there’s no point in attempting the next if you honestly don’t think that you’ve fucked up just about everything in your life because you couldn’t stop drinking and drugging.But that Second Step?It says that we have to believe in a “Power greater than ourselves,” and it capitalizes the P in power, which is a dead giveaway that it’s referring to God, thereby assuming that God exists. And that, as I said earlier, was a problem for me. Actually it’s a problem for a lot of people, and I’m not just talking about A.A.Patrick wrestles with this same issue, empathizing with those who had “religion shoved down [their] throats as children,” predisposing them to later reject god. Especially the one spelled with a capital G. Even today, with 20 years of sobriety, his definition of spirituality continues to evolve.I understand that. I respect that.In time, however, I changed, but this doesn’t mean that I don’t or can’t still identify with those who either downright don’t believe in a God or are struggling to embrace one. For me the change occurred slowly, over a period of a couple years, when my sponsor kept after me to pray, to whom or what didn’t matter, just pray, even if I only saw it as a one-sided conversation with myself.“Open your mind to the possibility of a God,” he said. “That’s all I’m asking. And when you pray, keep it simple. At night, if you got through the day sober, hit your knees and say ‘thank you.’ And in the morning, when you wake up, hit your knees and ask for ‘the strength’ to do it again. What’s that take out of your day? Thirty seconds? A minute? Don’t tell me you can’t do that.”Allowing for the possibility of a God involves an openness toward faith, and as the sober days began to accumulate, the simple act of prayer combined with a little faith eventually turned into a belief in God. Once that happened, the conversation was no longer one-sided. Obviously it’s more complicated than this, requiring much soul-searching and willingness, confronting looming questions and doubt, but it’s how the process began for me.But that’s just me.What about you?Is there a God, and, if so, who is He or She or It?***In two-to-three pages, describe the God of your own understanding. Do you picture Him as Christians picture Jesus? Is He or She or It different than the God of traditional world religions? Do you see this Power in terms of Mother Nature? The Great Spirit? The Collective Consciousness of Human- kind? Does It defy personification? What strengths, virtues and qualities does your God possess? Kind- ness? Love? Is He forgiving or punishing or both?For the non-believers, for the sake of argument, if you were to have a God, what would you like Him or Her or It to be? Again, you don’t have to believe in a God, but you do have to pretend that if by some chance there was one, what might He or She or It mean to you? What would be Its strengths, virtues and qualities?What we’re after with this exercise is nothing more than a better grasp of a God of our own understanding. And we do it by articulating and describing who and what He or She or It means to each of us. Writing Your Way To Recovery: How Stories Can Change Our Lives, by James Brown and Patrick O’Neil, is now available on Amazon and elsewhere.
“If you are someone who has struggled with addiction, you are excellent at forming habits.”The first time my friend Dr. Darlene Mayo said that sentence to me, I was a little taken aback, and very intrigued. She was right: addicts are great at forming habits, and that propensity, when applied for good, can be life-changing.During our conversation on The Recovered On Purpose Show, I shared with Dr. Mayo the story of my past as a homeless heroin addict, and my present as someone seeking to change other people’s lives through the power of the lessons I’ve learned on my journey to recovery.I wanted to know if building solid habits was one of the keys to unlocking the kind of life I had always dreamed –– the kind of life I built for myself, and wanted to help others build as well.And Dr. Mayo, neuroscientist and neurosurgeon who has spent decades studying the brain and how it’s wired, was absolutely right.Don’t get me wrong, this isn’t my way of glamorizing addiction. My addiction ruined my life, and it was only when I realized I had nothing left to give but my life that I resolved to turn my life around. However, if Dr. Mayo’s wise words, and the habits I’ve built on my path to recovery, can ring true for even one person, it will have made my journey worth it.My StoryWhen I was 26, I had it all: a 2,400-square-foot ranch home 10 minutes from the Central California beach, a girlfriend, a motorcycle, two cars, and a dog. My sales job working for DirecTV provided me with a comfortable living on about 25 hours a week, so I had plenty of time to do what I loved, like taking my girlfriend out on dates, swimming in the ocean, riding that motorcycle…And shooting up with heroin.At this point, my habit of shooting up before going to work and then shooting up when I got home hadn’t taken over my life. In fact, no one noticed anything was off. I was able to maintain my lifestyle, my home, and my relationships, and I thought I was truly capable of having it all.A year later, when I was 27, I had lost that job, my house, all my vehicles, my girlfriend, and the dog. I was living on the streets – I had been kicked out of homeless shelters – and was severely underweight. Three years ago, I realized I had nothing left to give my addiction and resolved to get clean.But, as I’m sure you know, that’s much easier said than done.I got clean and sober in November 2017, and stopped smoking cigarettes a month later. Since then, I’ve built an online following of over 40,000 people, run a mile in under six minutes, published a best-selling autobiography, and created a seven-figure company.But between 2017 and now, and between the lowest low of my addiction and the height of my success (so far), there was one key component that shaped my future:My habits.The Habits that Changed My LifeWhether you want to recover from an addiction, a breakup, a psychological or spiritual upset, or just want to re-set your life, cultivating new habits to replace the old, negative cycles you’re used to is a lifelong practice. These three habits changed my life – and they’ll change yours too.Prioritize LearningWhat are you interested in? What are you passionate about? Where in your life do you feel you’re lacking? Once you answer those questions, you’re well on your way to understanding what you should be learning about in your free time. Not only is lifelong learning a great practice for your mental health and agility, it also ensures you stay humble. No one can possibly know everything about everything, after all.If you don’t have time to read, or know you take in information better through other means, that’s okay. We all learn and grow differently; the important thing is that you intentionally set aside time – at least 10 minutes – every day to invest in your growth.Invest in Your MorningsThere’s a reason why morning routines are hailed by successful people all over the world as the key to unlocking your potential: you can spend your morning hours taking control of your day and investing in yourself before even starting to serve other people.There’s no right or wrong way to craft your perfect morning routine; it all depends on your priorities and what you know is healthy for your mind, body and spirit. These are a few of the things I’ve incorporated into my morning routine:Brushing my teethMaking my bedDrinking lemon-flavored salt waterTaking vitamins and supplementsReading my BibleJournalingGoing to the gymI also practice what I call the “list of six” every night. Before bed, I write down six things I want to do in the morning before my work day starts. My brain will work on them while I sleep and I’ll be ready to go the moment my eyes pop open the next morning.Invest in YourselfYou’re no good to anything or anyone if you don’t take care of yourself first. And, while mastering yourself through self-discipline, healthy eating, exercise and more are all important, taking an hour a day to have fun and unwind is equally so.I think we overestimate how much one hour will take away from our schedules, and underestimate what one hour can do for our lives. Setting aside time dedicated to enriching your spirit and bringing you joy is a great habit to establish, not only because it staves off burnout, but because everyone needs fun in their lives.
ADHD in adults: what it’s like living with the condition – and why many still struggle to get diagnosed
Many of us think of ADHD (attention deficit hyperactivity disorder) as a childhood condition – which is typically when it’s diagnosed. But a growing number of people are sharing their experiences of being diagnosed with ADHD in adulthood. Social media has even played a role in this, with reports of people going to see their doctor after first learning about symptoms on TikTok. In fact, around 2.5% of adults are thought to live with ADHD – including us.Yet despite this growing awareness, many adults continue to struggle to get a diagnosis.ADHD is a genetic neurodevelopmental disorder, in which the brain grows differently, lacking action from specific chemicals involved in pleasure and reward. This means ADHD brains often search for ways to stimulate these chemicals, which is why people can experience inattentiveness, hyperactivity and impulsivity.Common traits of ADHD include:Not following through on longer tasks (or not starting them)Getting distracted by other tasks or thoughtsSeeking out risk or activities that provide immediate rewardRestlessness (either outwardly or internally)Interrupting other people (without wanting to)Symptoms are similar for both adults and children, although elements of them differ or change as we age. For example, inattention is the most persistent symptom in adults.ADHD can be debilitating and is associated with higher likelihood of lower quality of life, substance use issues, unemployment, accidental injuries, suicide and premature death. In addition, ADHD can cost adults around £18,000 per year because of things like medical care or paying for social support.It’s also commonly associated with a wide range of co-existing conditions in adults.For example, depression is almost three times more prevalent in adults with ADHD. And nearly half of all adults with ADHD also have bipolar spectrum disorder.Around 70% of adults with ADHD also experience emotional dysregulation, which can make it more difficult to control emotional responses. It’s also thought that almost all adults with ADHD have rejection sensitive dysphoria, a condition where perceived rejection or criticism can cause extreme emotional sensitivity or pain.On top of this, adults with ADHD may have poor working memory – such as being unable to remember a simple shopping list – and “time blindness” (the inability to perceive time). Some may also have oppositional defiant disorder, which means they often react poorly to perceived orders or rules.While none of these co-existing conditions are used to diagnose ADHD, they can make ADHD feel all the more difficult to live with.Being diagnosedGetting an ADHD diagnosis as an adult in the UK is notoriously difficult – with reports of some people waiting up to five years.This is because you can only be diagnosed by a specialist psychiatrist. But even with a referral to a specialist, a person has to show clear evidence of almost all ADHD traits, having had these traits since childhood, and that they’re having a serious affect on their life – such as causing issues with work, education, or maintaining relationships.For us, our experiences of being diagnosed with ADHD aren’t all that different from what other adults have gone through.Like many people I (Alex) was only diagnosed with ADHD “by accident” after being referred to an NHS psychiatrist to get help with (what I now know to be) alcohol self-medication. Because of my ADHD, my brain demands quite extreme inputs most of the time.Ironically, I’ve published scientificpapers on ADHD and – probably due to a classic ADHD lack of self-awareness – it didn’t cross my mind that I could have it. The “label” has since helped me move away from feeling broken toward an understanding of my behaviour.My main challenges remain prioritising tasks based on importance (instead of excitement) and quite extreme anti-authority behaviour (sometimes called oppositional defiance). I am also a terrible spectator, struggling to attend conference talks or sit still at the theatre – it can feel like physical pain.On the other hand, I (James) was diagnosed pretty quickly because I used a private clinic – though there was still a long wait for medication. Yet I’d known for five years before this that I probably had ADHD, but coped with it well until the pandemic. The added pressure of isolation and increased workload impacted my mental health, so I sought a diagnosis.Now diagnosed and medicated, life is getting easier to cope with – although there are still many challenges every day. I frequently get anxiety about the silliest things, like talking to a friend, but appearing on television is fine.On a daily basis I forget many simple things, such as where I left my keys, or that I am running a bath. I struggle immensely with controlling my emotions and with rejection especially. For example, when no one responded to a joke I made about my ADHD on a senior management messaging group I was tempted to quit my job. I am utterly unable to pay full attention in meetings or seminars and cannot control my impulse purchasing.While there’s a growing recognition of ADHD in adults, many people still live with it undiagnosed for any number of reasons – sometimes even because they’re unaware that what they experience is actually different from other people.Understanding the condition in adults, taking it more seriously as a disorder, raising awareness of it, and investing in services to improve diagnosis times are key. Diagnosis opens the door to treatment, which can have a marked impact on living with the disorder – such as improving self-esteem, productivity and quality of life.James Brown, Associate Professor in Biology and Biomedical Science, Aston University and Alex Conner, Associate Professor in Biomedical Sciences, University of BirminghamThis article is republished from The Conversation under a Creative Commons license. Read the original article.
In the U.S. legal system, some say money - good, cold cash - talks far louder than the court judges or the prosecuting district attorneys can manage, and it appears this form of “justice” has been applied to the villainous criminals of the U.S. opioid epidemic - the Sackler family, proud owners of Purdue Pharma and the even prouder creators of OxyContin - who can now look forward to a future of unabandoned liberty and unreal, vast sums of personal wealth.On July 8th, an additional 15 U.S. states, including those attorney generals who had been the most vociferous in their previous rejections, like Massachusetts and New York, agreed to Purdue Pharma’s revised opioid crisis settlement proposal in a bid to access the promised funds as soon as possible.The newly revised proposal includes a new business model for the company, the release of tens of millions of internal documents, and (yes, you’ve guessed it) a further $1.5 billion of that good, cold cash. Additionally, if the plan is certified by Judge Robert Drain as expected, both the family and the company would be shielded from further opioid-related lawsuits.Let’s repeat that. “Shielded from further opioid-related lawsuits.” Money does indeed talk - and loudly, too.Among those who reneged on their previous promises to the families of opioid drug overdose victims (sadly, yes, they have) is the once-vocal Massachusetts AG, Maura Healey, who was the first to sue individual members of the Sackler family.She stated, “While I know this resolution does not bring back loved ones or undo the evil of what the Sacklers did, forcing them to turn over their secrets by providing all the documents, forcing them to repay billions, forcing the Sacklers out of the opioid business, and shutting down Purdue will help stop anything like this from ever happening again.”If you didn’t know, only four months ago, that’s the same lady who once said (on WBUR’s Morning Edition, Boston’s NPR radio news show), “There are many things that I don't like about this plan. It's not enough money. It's also a plan that doesn't provide what our families deserve, which is transparency and accountability. So this is not the end, and this deal is nowhere near acceptable.”Only last month, Healey again stated her disdain for Purdue’s plan in an interview, “The Sacklers are not offering to pay anything near what they should for the harm and devastation caused to families and communities around this country.”Well... apparently, now, they are paying enough and the deal is acceptable - certainly to the Massachusetts’ AG, at least.The Sacklers’ True Legacy: Over Half a Million U.S. DeathsOxyContin, and many other prescription opioids like it, have resulted in a man-made, yet totally needless national public health crisis and epidemic in the U.S. (and beyond, for that matter) that will continue for generations to come.Opioid-related drug overdoses are now the leading cause of accidental death in the U.S., overshadowing deaths by motor vehicle accidents and even gunshot wounds. In fact, more Americans have died from opioid overdoses than those lives lost in every war since World War II.And OxyContin? Well, that one little pill - “Oxy,” for short - did make the Sackler family a sizable amount - a colossal $35 billion, thanks to the huge criminal deception that fooled doctors, the law courts, and the unsuspecting U.S. public for way too long.Their own personal wealth? Much of that good, cold cash is now sitting happily, both earning interest or being used to purchase even more global real estate, in various off-shore bank accounts in paradisiacal locations such as the Cayman Islands. How? The Sacklers quickly made siphoning company profits an art form as soon as they realized the proverbial stuff was about to hit the fan.Over Half a Million Families: Mothers, Father, Sisters, BrothersAsk any parent who loses their child - through the clear and criminal fault of someone else - what they really want, and they’ll reply “justice.” Among other things, like the “5-minutes-in-a-locked-room” scenario… But always justice, too.As the U.S. opioid epidemic continues to claim too many lives every single day in the U.S., and turn good, hard-working people into backstreet heroin users, many will be wondering, as I certainly am:“Why didn’t they legally nail this family to the wall?”“No jail time, and not even an admission of their guilt?”“How have they legally kept all of their criminally-gotten gains?”Here’s the proof, according to the American Society of Addiction Medicine (ASAM) and The Centers for Disease Control and Prevention (CDC), of the damage opioid prescriptions have done to the U.S.:A massive 80% of the world’s opioids are consumed in the U.S.The #1 cause of accidental death in the U.S. is overdoseFurthermore:21-29% of patients prescribed opioids for chronic pain will misuse them8-12% will go on to develop an opioid use disorder (OUD)4-6% who misuse such opioids will transition to heroinFatal opioid overdoses among females have risen by a staggering 450% in the last 10 yearsThe CDC estimates that the "economic burden" endured in the U.S. from the misuse of prescription opioids stands at around $78.5 billion a yearLet’s look at more of the publicly available evidence. Firstly, what is the drug at the very heart of all this?What is OxyContin?Purdue Pharma’s OxyContin is the brand name of controlled-release oxycodone, a powerful, morphine-like opioid painkiller available only by prescription. It is primarily used for the relief of severe pain that is unresponsive to less potent pain-relief medicines (analgesics).Oxycodone binds to the brain’s mu opioid receptor, although it can bind to other opioid receptors at higher dosages. It is known as a “full agonist,” and belongs to the group of drugs known as opioids or opioid analgesics. Oxycontin can also be called a narcotic analgesic.Purdue began selling OxyContin just over 25 years ago, encouraging doctors to forget their reservations about opioids, and focus fully on easing the pain of patients. Court documents have shown that company officials continued to push to maintain sales even after it became clear to all concerned that the drug was highly addictive, and, furthermore, was actively being abused.The facts (and they are facts) speak for themselves...Purdue Pharma’s Fraudulent Activity Marketing OxyContinPurdue Pharma knew that OxyContin was more powerful than morphine - a highly addictive opioid drug used medically in cases of severe chronic pain, and with a wide range of strict warnings even about its directed use. However, they actively exploited the fact that medical doctors, such as family physicians, thought the reverse was actually true. In fact, a Purdue Pharma official once advised the company, “It is important that we be careful not to change the perception of physicians.”Purdue Pharma claimed OxyContin posed little risk of addiction, even though they had carried out no tests - zero - to that effect at all.Purdue Pharma knew they were relying on only a small amount of ambiguous medical literature (such as a short letter to an editor by a couple of doctors at Boston University) to reassure physicians about the safety of OxyContin, and not a peer-reviewed study, as such claims normally require.Purdue Pharma knew that OxyContin could actually be effectively injected into a recreational user’s body in the form of a solution, but they never made it public.Purdue Pharma argued that OxyContin’s slow-release mechanism was a barrier to possible abuse. However, at the same time as they (continually) made this statement, they also owned another company that made immediate-release oxycodone - the primary ingredient of OxyContin tablets.Purdue Pharma found that, by scrutinizing their sales data, they could find, locate and then maintain a secret list of doctors who regularly over-prescribed OxyContin. They did little to alert the relevant authorities to these “pill mills,” as they are legally required to do. Instead, Purdue Pharma were content to grow rich off the proceeds.These numerous criminal (and, at the very least, completely unethical) deceptions devised by the Sackler family and their company, were extremely successful, and Purdue Pharma subsequently earned at least $35bn from the sales of OxyContin.The Sacklers: Currently Guilty of NothingHowever, it came at a tragic, huge cost to the U.S. and the families who had to endure the loss of a loved one. To date, more than 500,000 Americans have now died from overdoses of both prescription and illegal opioids. The Sacklers? The family continues to refuse to accept the pivotal role they have master-minded in this horrendous crime, and, so far, they have been found guilty of nothing.For people in the business of supposedly alleviating pain, they continue to be the root cause of an unspeakable amount of it...“Those members of the Sackler family who were involved have endured nothing more distressing than a social downfall. Only in a deranged world can the erasure of their names from museum galleries be considered punishment enough for OxyContin.”- from Empire of Pain review by Patrick Radden Keefe – the dynasty behind an opioid crisis (The Guardian, May 13th, 2021)Knowing that the sales of OxyContin earned the Sacklers $35 billion makes their settlement proposal figure of $4.5 billion a little on the lean side, don’t you think? In fact, it’s about an eighth - 12.85%, to be exact - of the profits from their most profitable drug. Of course, the Purdue Pharma medicine cabinet is packed full of other types of opioid tablets, too.No Strangers to the U.S. Courts: The 2007 Plea AgreementPurdue Pharma, steered and guided by the Sacklers, are no strangers to criminal charges or litigation. Back in 2007, they were faced with both criminal and civil charges for “misbranding” their prescription drug OxyContin. Purdue were allowed and subsequently accepted a plea agreement - they, their parent company, and three top executives were fined a total of $600 million.A mere matter of months after the 2007 plea agreement took place, Mortimer Sackler wrote an email to cousins which stated, "While things are looking better now, I would not count out the possibility that times will get much more difficult again in the future, and probably much sooner than we expect."Kathe Sackler: The Deposition - Spring, 2019In the interests of fairness, it is only right that we share some of the legally sworn comments made by at least one member of the Sackler family.The beginning of O'Keefe's book, Empire of Pain, describes the scene in a packed conference room of the New York headquarters of legal firm Debevoise & Plimpton. With around 20 lawyers in attendance, the conference room would witness the deposition of reclusive billionaire, Kathe Sackler - her sworn, out-of-court testimony, a part of the discovery process in thousands of lawsuits involving herself, her family, and her company, Purdue Pharma.Asking the questions was one of the plaintiffs’ lawyers, Paul Hanley. It didn’t take long for Hanley to start asking the tough questions:Hanley: “Dr. Sackler, does Purdue bear any responsibility for the opioid crisis?”[Immediate shouts of “Objection!” from her lawyers]Sackler: “I don’t believe Purdue has a legal responsibility.”Hanley: “That’s not what I asked. What I want to know is whether Purdue’s conduct was a cause of the opioid epidemic?”[Further shouts of “Objection!” from her lawyers]Sackler: “I think it’s a very complex set of factors and confluence of different circumstances and societal issues and problems and medical issues and regulatory gaps in different states across the country. I mean, it’s very, very, very complex.”During the course of the deposition, Sackler continued to insist that the family had nothing to be ashamed of or even to apologize for, because they believed that there was nothing wrong with OxyContin.Sackler: “It’s a very good medicine, and it’s a very safe and effective medicine.” If that were really the case, would we really have so many deaths attributable to the opioid crisis? Remember, as O’Keefe himself comments, “Before the introduction of OxyContin, America did not have an opioid crisis. After the introduction of OxyContin, it did.”Oh, the Sacklers’ deception gets worse, by the way…The Story of the Fast-Tracked Approval for OxyContinAccording to author Patrick O'Keefe, one significant aspect of OxyContin’s approval by the Food and Drug Administration (FDA) looks decidedly questionable, to say the very least. The actual FDA official who granted OxyContin its various approvals in 1995 did so in an astonishingly short time - just 11 months.However, here’s the real kicker:The same “helpful” official promptly quit the FDA soon afterwards, and, within a year, was found to be working… (yes, you guessed it again) at Purdue Pharma, earning a remarkably improved salary, too. Around $400,000 a year.Furthermore, Oxycontin’s rapid approval was based on it being “safe and effective” when used only in the "short-term." However, six years later, in 2001, the FDA, under more pressure from “Big Pharma” (the entire U.S. pharmaceutical industry, in other words), took the ill-perceived decision to widen the use of Oxycontin to just about anyone, such as those with chronic arthritis and back pain.The FDA did this by simply changing a few words on the label - the “label” being the small, folded piece of paper full of the drug’s small print accompanying the pill bottle. The label change proudly stated these morphine-like pain pills were now effective for "daily, around-the-clock, long-term… treatment." Unfortunately, this meant any drug company could now market the similar drugs differently, and even allow them to sell more and more pills at higher and higher doses.In a 2016 interview with mainstream media, Dr. David Kessler, who was in charge of the FDA from 1990 to 1997, when asked about the opioid crisis, stated, "FDA has responsibility, pharmaceutical companies have responsibility, physicians have responsibility. We didn't see these drugs for what they truly are."When Dr. Kessler was asked about his own responsibility as the head of the FDA, he said the crisis began after he left the agency in 1997; however, he does admit he should have pushed for stricter prescription practices when he was still in charge.The rest, as they say, is history...“While some progress has been made - especially around the public document depository - this plan is far from justice. Purdue and the Sacklers have misused this bankruptcy to protect their vast wealth, and evade consequences for their callous misconduct. This deal alarmingly allows the Sacklers to still walk away with their personal wealth intact.”- William Tong, Attorney General of ConnecticutOnce Purdue had approval for OxyContin, in 1996, a company head salesman told company sales reps in Tennessee to now convince doctors to prescribe stronger OxyContin doses to pain sufferers. These are the words he used: “It’s bonus time in the neighbourhood.”However, as soon as the legal authorities eventually started taking a closer and more detailed look at the “bonus time” sales and information practices of Purdue Pharma, the end result was their court case appearance and plea agreement in 2007. For the Sacklers, it meant one thing only - move their money, and quickly.Oregon’s current lawsuit sums it up; it alleges, “Between 2008 and 2018, they directed Purdue to make nearly $11 billion in total distributions (including tax distributions) to partnered companies, foreign entities, and ultimately to trusts established for the benefit of the Sackler families.’’And the U.S. Opioid Crisis Goes On...All in all, the whole story of how the Sacklers’ strove to build their very real empire of pain should have resulted in very real justice for the victims, justice for their families and their loved ones, justice for the communities so badly affected by the opioid epidemic, and justice for the U.S. as a nation.However, as we said at the beginning of this article - money talks. It now appears to be speaking as loudly to the various state attorney generals spread across this nation of ours as it has always done to the Sackler family.Let’s give the last word to plaintiffs’ attorney Paul Hanly - the man with the tough questions that still remain unanswered. He believes the states who have now agreed to the revised settlement plan simply considered it the better option. The alternative?He referred to that as “probably a decade or more in the bankruptcy court, at the end of which will probably be a ham sandwich left over for our clients, the communities that are suffering.”
Cassandra Rollins’ daughter was still conscious when the ambulance took her away.Shalondra Rollins, 38, was struggling to breathe as covid overwhelmed her lungs. But before the doors closed, she asked for her cellphone, so she could call her family from the hospital.It was April 7, 2020 — the last time Rollins would see her daughter or hear her voice.The hospital rang an hour later to say she was gone. A chaplain later told Rollins that Shalondra had died on a gurney in the hallway. Rollins was left to break the news to Shalondra’s children, ages 13 and 15.More than a year later, Rollins said, the grief is unrelenting.Rollins has suffered panic attacks and depression that make it hard to get out of bed. She often startles when the phone rings, fearing that someone else is hurt or dead. If her other daughters don’t pick up when she calls, Rollins phones their neighbors to check on them.“You would think that as time passes it would get better,” said Rollins, 57, of Jackson, Mississippi. “Sometimes, it is even harder. … This wound right here, time don’t heal it.”With nearly 600,000 in the U.S. lost to covid-19 — now a leading cause of death — researchers estimate that more than 5 million Americans are in mourning, including more than 43,000 children who have lost a parent.The pandemic — and the political battles and economic devastation that have accompanied it — have inflicted unique forms of torment on mourners, making it harder to move ahead with their lives than with a typical loss, said sociologist Holly Prigerson, co-director of the Cornell Center for Research on End-of-Life Care.The scale and complexity of pandemic-related grief have created a public health burden that could deplete Americans’ physical and mental health for years, leading to more depression, substance misuse, suicidal thinking, sleep disturbances, heart disease, cancer, high blood pressure and impaired immune function.“Unequivocally, grief is a public health issue,” said Prigerson, who lost her mother to covid in January. “You could call it the grief pandemic.”Like many other mourners, Rollins has struggled with feelings of guilt, regret and helplessness — for the loss of her daughter as well as Rollins’ only son, Tyler, who died by suicide seven months earlier.“I was there to see my mom close her eyes and leave this world,” said Rollins, who was first interviewed by KHN a year ago in a story about covid’s disproportionate effects on communities of color. “The hardest part is that my kids died alone. If it weren’t for this covid, I could have been right there with her” in the ambulance and emergency room. “I could have held her hand.”The pandemic has prevented many families from gathering and holding funerals, even after deaths caused by conditions other than covid. Prigerson’s research shows that families of patients who die in hospital intensive care units are seven times more likely to develop post-traumatic stress disorder than loved ones of people who die in home hospice.The polarized political climate has even pitted some family members against one another, with some insisting that the pandemic is a hoax and that loved ones must have died from influenza, rather than covid. People in grief say they’re angry at relatives, neighbors and fellow Americans who failed to take the coronavirus seriously, or who still don’t appreciate how many people have suffered.“People holler about not being able to have a birthday party,” Rollins said. “We couldn’t even have a funeral.”Indeed, the optimism generated by vaccines and falling infection rates has blinded many Americans to the deep sorrow and depression of those around them. Some mourners say they will continue wearing their face masks — even in places where mandates have been removed — as a memorial to those lost.“People say, ‘I can’t wait until life gets back to normal,’” said Heidi Diaz Goff, 30, of the Los Angeles area, who lost her 72-year-old father to covid. “My life will never be normal again.”Many of those grieving say celebrating the end of the pandemic feels not just premature, but insulting to their loved ones’ memories.“Grief is invisible in many ways,” said Tashel Bordere, a University of Missouri assistant professor of human development and family science who studies bereavement, particularly in the Black community. “When a loss is invisible and people can’t see it, they may not say ‘I’m sorry for your loss,’ because they don’t know it’s occurred.”Communities of color, which have experienced disproportionately higher rates of death and job loss from covid, are now carrying a heavier burden.Black children are more likely than white children to lose a parent to covid. Even before the pandemic, the combination of higher infant and maternal mortality rates, a greater incidence of chronic disease and shorter life expectancies made Black people more likely than others to be grieving a close family member at any point in their lives.Rollins said everyone she knows has lost someone to covid.“You wake up every morning, and it’s another day they’re not here,” Rollins said. “You go to bed at night, and it’s the same thing.”A Lifetime of LossRollins has been battered by hardships and loss since childhood.She was the youngest of 11 children raised in the segregated South. Rollins was 5 years old when her older sister Cora, whom she called “Coral,” was stabbed to death at a nightclub, according to news reports. Although Cora’s husband was charged with murder, he was set free after a mistrial.Rollins gave birth to Shalondra at age 17, and the two were especially close. “We grew up together,” Rollins said.Just a few months after Shalondra was born, Rollins’ older sister Christine was fatally shot during an argument with another woman. Rollins and her mother helped raise two of the children Christine left behind.Heartbreak is all too common in the Black community, Bordere said. The accumulated trauma — from violence to chronic illness and racial discrimination — can have a weathering effect, making it harder for people to recover.“It’s hard to recover from any one experience, because every day there is another loss,” Bordere said. “Grief impacts our ability to think. It impacts our energy levels. Grief doesn’t just show up in tears. It shows up in fatigue, in working less.”Rollins hoped her children would overcome the obstacles of growing up Black in Mississippi. Shalondra earned an associate’s degree in early childhood education and loved her job as an assistant teacher to kids with special needs. Shalondra, who had been a second mother to her younger siblings, also adopted a cousin’s stepdaughter after the child’s mother died, raising the girl alongside her two children.Rollins’ son, Tyler, enlisted in the Army after high school, hoping to follow in the footsteps of other men in the family who had military careers.Yet the hardest losses of Rollins’ life were still to come. In 2019, Tyler killed himself at age 20, leaving behind a wife and unborn child.“When you see two Army men walking up to your door,” Rollins said, “that’s unexplainable.”Tyler’s daughter was born the day Shalondra died.“They called to tell me the baby was born, and I had to tell them about Shalondra,” Rollins said. “I don’t know how to celebrate.”Shalondra’s death from covid changed her daughters’ lives in multiple ways.The girls lost their mother, but also the routines that might help mourners adjust to a catastrophic loss. The girls moved in with their grandmother, who lives in their school district. But they have not set foot in a classroom for more than a year, spending their days in virtual school, rather than with friends.Shalondra’s death eroded their financial security as well, by taking away her income. Rollins, who worked as a substitute teacher before the pandemic, hasn’t had a job since local schools shut down. She owns her own home and receives unemployment insurance, she said, but money is tight.Makalin Odie, 14, said her mother, as a teacher, would have made online learning easier. “It would be very different with my mom here.”The girls especially miss their mom on holidays.“My mom always loved birthdays,” said Alana Odie, 16. “I know that if my mom were here my 16th birthday would have been really special.”Asked what she loved most about her mother, Alana replied, “I miss everything about her.”Grief Complicated by IllnessThe trauma also has taken a toll on Alana and Makalin’s health. Both teens have begun taking medications for high blood pressure. Alana has been on diabetes medication since before her mom died.Mental and physical health problems are common after a major loss. “The mental health consequences of the pandemic are real,” Prigerson said. “There are going to be all sorts of ripple effects.”The stress of losing a loved one to covid increases the risk for prolonged grief disorder, also known as complicated grief, which can lead to serious illness, increase the risk of domestic violence and steer marriages and relationships to fall apart, said Ashton Verdery, an associate professor of sociology and demography at Penn State.People who lose a spouse have a roughly 30% higher risk of death over the following year, a phenomenon known as the “the widowhood effect.” Similar risks are seen in people who lose a child or sibling, Verdery said.Grief can lead to “broken-heart syndrome,” a temporary condition in which the heart’s main pumping chamber changes shape, affecting its ability to pump blood effectively, Verdery said.From final farewells to funerals, the pandemic has robbed mourners of nearly everything that helps people cope with catastrophic loss, while piling on additional insults, said the Rev. Alicia Parker, minister of comfort at New Covenant Church of Philadelphia.“It may be harder for them for many years to come,” Parker said. “We don’t know the fallout yet, because we are still in the middle of it.”Rollins said she would have liked to arrange a big funeral for Shalondra. Because of restrictions on social gatherings, the family held a small graveside service instead.Funerals are important cultural traditions, allowing loved ones to give and receive support for a shared loss, Parker said.“When someone dies, people bring food for you, they talk about your loved one, the pastor may come to the house,” Parker said. “People come from out of town. What happens when people can’t come to your home and people can’t support you? Calling on the phone is not the same.”While many people are afraid to acknowledge depression, because of the stigma of mental illness, mourners know they can cry and wail at a funeral without being judged, Parker said.“What happens in the African American house stays in the house,” Parker said. “There’s a lot of things we don’t talk about or share about.”Funerals play an important psychological role in helping mourners process their loss, Bordere said. The ritual helps mourners move from denying that a loved one is gone to accepting “a new normal in which they will continue their life in the physical absence of the cared-about person.” In many cases, death from covid comes suddenly, depriving people of a chance to mentally prepare for loss. While some families were able to talk to loved ones through FaceTime or similar technologies, many others were unable to say goodbye.Funerals and burial rites are especially important in the Black community and others that have been marginalized, Bordere said.“You spare no expense at a Black funeral,” Bordere said. “The broader culture may have devalued this person, but the funeral validates this person’s worth in a society that constantly tries to dehumanize them.”In the early days of the pandemic, funeral directors afraid of spreading the coronavirus did not allow families to provide clothing for their loved ones’ burials, Parker said. So beloved parents and grandparents were buried in whatever they died in, such as undershirts or hospital gowns.“They bag them and double-bag them and put them in the ground,” Parker said. “It is an indignity.”Coping With LossEvery day, something reminds Rollins of her losses.April brought the first anniversary of Shalondra’s death. May brought Teacher Appreciation Week.Yet Rollins said the memory of her children keeps her going.When she begins to cry and thinks she will never stop, one thought pulls her from the darkness: “I know they would want me to be happy. I try to live on that.”Subscribe to KHN's free Morning Briefing.
Since the first diagnosed case of COVID-19 in the United States on Jan. 20, 2020, news about infection rates, deaths and pandemic-driven economic hardships has been part of our daily lives.But there is a knowledge gap in how COVID-19 has affected a public health crisis that existed before the pandemic: the opioid epidemic. Prior to 2020, an average of 128 Americans died every day from an opioid overdose. That trend accelerated during the COVID-19 pandemic, according to the Centers for Disease Control and Prevention.We are a team of health and environment geography researchers. When social distancing began in March 2020, addiction treatment experts were concerned that shutdowns might result in a spike in opioid overdose and deaths. In our latest research in the Journal of Drug Issues, we take a closer look at these trends by examining opioid overdoses in Pennsylvania prior to and following the statewide stay-at-home order.Our findings suggest that this public health response to COVID-19 has had unintended consequences for opioid use and misuse.History of the opioid epidemicOpioid misuse has been a major U.S. health threat for over two decades, largely affecting rural areas and white populations. However, a recent shift in the drugs involved, from prescription opioids to illegally manufactured drugs such as fentanyl, has resulted in an expansion of the epidemic in urban areas and among other racial and ethnic groups.From 1999 to 2013, increasing death rates from drug abuse, primarily for those from 45 to 54 years of age, contributed to the first decline in life expectancy for white non-Hispanic Americans in decades.There was a modest national decline in overdose mortality from prescription opioids from 2017 to 2019, but the COVID-19 pandemic has upended many of these advances. As one of our public health partners explained to us, “We were making progress until COVID-19 hit.”We believe this presents an urgent need for research on the relationships between COVID-19 policy responses and patterns of opioid use and misuse.Opioid use increases during the pandemicPennsylvania has been among the states hardest hit by the opioid epidemic. It had one of the highest rates of death due to drug overdose in 2018, with 65%, a total of 2,866 fatalities, involving opioids.The state’s stay-at-home order, implemented on April 1, 2020, mandated that residents stay within their homes whenever possible, practice social distancing and wear masks when outside the home. All schools shifted to remote learning, and most businesses were required to operate remotely or close. Only essential services were allowed to continue operating in person.In the following months, the public’s overall cooperation with these mandates contributed to measurable declines in coronavirus infection rates. To learn how these mandates also affected people’s use of opioids, we assessed data from the Pennsylvania Overdose Information Network for changes in monthly incidents of opioid-related overdose before and after April 1, 2020. We also examined the change by gender, age, race, drug class and doses of naloxone administered. (Naloxone is a drug widely used to reverse the effects of overdose.)Our analysis of both fatal and nonfatal cases of opioid-related overdose from January 2019 through July 2020 revealed statistically significant increases in overdose incidents for both men and women, among whites and Blacks, and across several age groups, most notably the 30-39 and 40-49 groups, following April 1. This means there was an acceleration of overdoses within some of the populations most affected by opioids prior to the COVID-19 pandemic. But there were also uneven increases among other groups, such as Black people.We found statistically significant increases in overdoses involving heroin, fentanyl, fentanyl analogs or other synthetic opioids, pharmaceutical opioids and carfentanil. This is consistent with previous research on the main opioid classes contributing to increases in drug overdose and death. The results also affirm that heroin and synthetic opioids such as fentanyl are now the major threats in the epidemic.When a pandemic and an epidemic collideWhile we found significant change in opioid overdoses during the COVID-19 pandemic, the findings say less about some of the driving factors. To better understand these, we have been interviewing public health providers since December 2020.Among the important factors they highlight as contributing to increased opioid use are pandemic-driven economic hardship, social isolation and the disruption of in-person treatment and support services.From March to April 2020, unemployment rates in Pennsylvania shot up from 5% to approximately 16%, resulting in a peak of more than 725,000 unemployment claims filed in April. As workplace shutdowns made it harder to pay for housing, food and other needs, and the opportunities for in-person support disappeared, some people turned to drugs, including opioids.People in the early stages of treatment or recovery from opioid addiction may be particularly vulnerable to relapse, suggested one of our public health partners. “They might be working in industries that are closed down, so they have financial problems … [and] they have their addiction issues on top of that, and now they can’t like go to meetings, and they can’t make those connections.” (Under our clearance with Penn State for doing research with human subjects, our public health informants are kept anonymous.)[Like what you’ve read? Want more? Sign up for The Conversation’s daily newsletter.]An addiction treatment counselor told us that especially for those with past or present opioid use problems, or histories of mental health issues, “It’s not a good thing to be alone in your own thoughts. And so, once everybody was kind of locked down … the depression and anxiety hit.”Another counselor also pointed to depression, anxiety and isolation as driving increased opioid misuse. The pandemic “just spun everything out of control,” they said. “Overdoses up, everything up, everything.”One question is whether states like Pennsylvania will continue to support telehealth in the future. While the transition from in-person to telehealth services has increased access to treatment for some, it has raised challenges for populations like the rural and elderly. As one provider explained, “it’s really hard for that [rural] population out there” to utilize telehealth services due to limited internet and broadband connection. In other words, flexible modes of addiction treatment might work for some but not others.The goal of our research is not to criticize efforts to mitigate the spread of COVID-19. Without the mandatory stay-at-home order in Pennsylvania, both infection and death rates would have been worse. However, our research shows that such measures have had unintended consequences for those struggling with addiction and emphasizes the importance of taking a holistic approach to public health as policymakers work to confront both COVID-19 and the addiction crisis in America.Brian King, Professor, Department of Geography, Penn State; Andrea Rishworth, Postdoctoral Fellow in Geography, McMaster University, and Ruchi Patel, Ph.D. Student in Geography, Penn StateThis article is republished from The Conversation under a Creative Commons license. Read the original article.
If you scroll through social media, #selfcare is likely to pop up, alongside pictures of people lounging in the tub, having a mocktail, or spending time in nature. While all of these things are great for making yourself feel better, true self-care goes beyond just chasing happiness. On International Self-Care Day, July 24, (7-24), people are urged to think about how they craft a self-care practice that lasts 24 hours a day, 7 days a week.According to the International Self-Care Foundation, self-care is defined as “a practical, person-centred set of activities that we should all be undertaking to maintain our health, wellness and wellbeing.” These activities are “a normal part of everyday life,” the foundation says, and are critical not only for feeling good, but also for staying healthy physically, emotionally and mentally.To help further the idea of true self-care, the International Self-Care Foundation created seven pillars of self-care. Here’s what you should know about each, and how it can be implemented in your life.Knowledge and Health LiteracyThe first pillar of self-care might be a bit unexpected. This pillar focuses on education. People who have knowledge and health literacy are able to understand the health challenges facing them, and how an unhealthy habit in one area of life can affect other areas. They know how to access treatments and resources that help them practice true self-care.Consider this in the context of substance use disorder and mental health. Having good healthy literacy might mean that you understand the ways that trauma can fuel substance use. It could also mean that you understand treatment options, and are able to seek out help when you need it.Mental WellbeingMental wellbeing is about more than just keeping it together by a threat. True mental wellbeing means being able to respond to life’s curveballs and stressors. It’s about being able to pursue fulfillment and contribute to your community.A critical part of mental wellbeing is self-awareness, or the ability to recognize when you’re struggling. According to the International Self-Care Foundation, self-awareness goes hand-in-hand with agency, or the ability to take action based on your understanding of your needs. For example, if your past trauma is causing you to drink too much, you might recognize that you need professional guidance. You could therefore use your agency to pursue trauma-informed care.Physical ActivityThis one is no surprise. Being physically active is linked to a host of mental, emotional and physical health benefits. Most adults should aim for 150 minutes of exercise a week. Although that might seem like a lot, you still get the benefits of exercise if you work out in short ten-minute increments, like on your lunch break or while dinner cooks.Healthy EatingSpeaking of dinner cooking, healthy eating is essential to self-care. While indulging in a slice of cake or a brownie now and then might feel like self-care, the more realistic way to take care of yourself is to nourish your body by eating a well-rounded selection of fruits and vegetables.This is particularly important for people with a history of substance use disorder. Using and abusing drugs or alcohol can deplete key nutrients in your body. Once you get your substance use under control it’s time to replenish those building blocks of health by eating lots of whole foods, fruits and vegetables.Risk Avoidance or MitigationWhen you’re actively practicing self-care, you do what you can to make sure that no harm comes to you. While we can’t control everything, we can do things to reduce our risk of harm, like wearing a seatbelt in the car, not using drugs or alcohol, and avoiding places and people that we find triggering.This is hugely important for people who are in recovery from substance use disorder. Abusing drugs or alcohol is risky in and of itself, and often leads to other high-risk behaviors like unprotected sex or drunk-driving. Everyday steps for risk mitigation, like wearing sunblock or using a helmet when you ride a bike, are simple ways to retrain your brain and remind yourself that you are worth protecting.Good HygieneSince the pandemic, there is a renewed focus on good hygiene. Although simple hygiene like washing your hands thoroughly might seem basic, it can help prevent disease and illness. Oftentimes, during active addiction, personal hygiene slips as a person becomes focused solely on finding their next fix. Once you’re in recovery, it’s a good time to reestablish a personal hygiene routine, including showering, brushing and flossing your teeth, and washing your hands frequently.Rational and Responsible Use of Self-Care Products and ServicesThese days, we’re all inundated with products and services that promise to make self-care easy. This might be a supplement that claims to help you sleep better, or a wellness program designed to help you drop weight.Remember — if something seems too good to be true, it probably is. Unfortunately, there are no shortcuts when it comes to self-care. Be a skeptical consumer and remember that true self-care starts with you taking the initiative for your own health and well-being.Sunshine Coast Health Centre is a non 12-step drug and alcohol rehabilitation center in British Columbia. Learn more here.
With COVID-19 vaccines working and restrictions lifting across the country, it’s finally time for those now vaccinated who’ve been hunkered down at home to ditch the sweatpants and reemerge from their Netflix caves. But your brain may not be so eager to dive back into your former social life.Social distancing measures proved essential for slowing COVID-19’s spread worldwide – preventing upward of an estimated 500 million cases. But, while necessary, 15 months away from each other has taken a toll on people’s mental health.In a national survey last fall, 36% of adults in the U.S. – including 61% of young adults – reported feeling “serious loneliness” during the pandemic. Statistics like these suggest people would be itching to hit the social scene.But if the idea of making small talk at a crowded happy hour sounds terrifying to you, you’re not alone. Nearly half of Americans reported feeling uneasy about returning to in-person interaction regardless of vaccination status.So how can people be so lonely yet so nervous about refilling their social calendars?Well, the brain is remarkably adaptable. And while we can’t know exactly what our brains have gone through over the last year, neuroscientists like me have some insight into how social isolation and resocialization affect the brain.Social homeostasis – the need to socializeHumans have an evolutionarily hardwired need to socialize – though it may not feel like it when deciding between a dinner invite and rewatching “Schitt’s Creek.”From insects to primates, maintaining social networks is critical for survival in the animal kingdom. Social groups provide mating prospects, cooperative hunting and protection from predators.But social homeostasis – the right balance of social connections – must be met. Small social networks can’t deliver those benefits, while large ones increase competition for resources and mates. Because of this, human brains developed specialized circuitry to gauge our relationships and make the correct adjustments – much like a social thermostat.Social homeostasis involves many brain regions, and at the center is the mesocorticolimbic circuit – or “reward system.” That same circuit motivates you to eat chocolate when you crave something sweet or swipe on Tinder when you crave … well, you get it.And like those motivations, a recent study found that reducing social interaction causes social cravings – producing brain activity patterns similar to food deprivation.So if people hunger for social connection like they hunger for food, what happens to the brain when you starve socially?Your brain on social isolationScientists can’t shove people into isolation and look inside their brains. Instead, researchers rely on lab animals to learn more about social brain wiring. Luckily, because social bonds are essential in the animal kingdom, these same brain circuits are found across species.One prominent effect of social isolation is – you guessed it – increased anxiety and stress.Many studies find that removing animals from their cage buddies increases anxiety-like behaviors and cortisol, the primary stress hormone. Human studies also support this, as people with small social circles have higher cortisol levels and other anxiety-related symptoms similar to socially deprived lab animals.Evolutionarily this effect makes sense – animals that lose group protection must become hypervigilant to fend for themselves. And it doesn’t just occur in the wild. One study found that self-described “lonely” people are more vigilant of social threats like rejection or exclusion.Another important region for social homeostasis is the hippocampus – the brain’s learning and memory center. Successful social circles require you to learn social behaviors – such as selflessness and cooperation – and recognize friends from foes. But your brain stores tremendous amounts of information and must remove unimportant connections. So, like most of your high school Spanish – if you don’t use it, you lose it.Several animal studies show that even temporary adulthood isolation impairs both social memory – like recognizing a familiar face – and working memory – like recalling a recipe while cooking.And isolated humans may be just as forgetful. Antarctic expeditioners had shrunken hippocampi after just 14 months of social isolation. Similarly, adults with small social circles are more likely to develop memory loss and cognitive decline later in life.So, human beings might not be roaming the wild anymore, but social homeostasis is still critical to survival. Luckily, as adaptable as the brain is to isolation, the same may be true with resocialization.Your brain on social reconnectionThough only a few studies have explored the reversibility of the anxiety and stress associated with isolation, they suggest that resocialization repairs these effects.One study, for example, found that formerly isolated marmosets first had higher stress and cortisol levels when resocialized but then quickly recovered. Adorably, the once-isolated animals even spent more time grooming their new buddies.Social memory and cognitive function also seem to be highly adaptable.Mouse and rat studies report that while animals cannot recognize a familiar friend immediately after short-term isolation, they quickly regain their memory after resocializing.And there may be hope for people emerging from socially distanced lockdown as well. A recent Scottish study conducted during the COVID-19 pandemic found that residents had some cognitive decline during the harshest lockdown weeks but quickly recovered once restrictions eased.Unfortunately, studies like these are still sparse. And while animal research is informative, it likely represents extreme scenarios since people weren’t in total isolation over the last year. Unlike mice stuck in cages, many in the U.S. had virtual game nights and Zoom birthday parties (lucky us).So power through the nervous elevator chats and pesky brain fog, because “un-social distancing” should reset your social homeostasis very soon.[Understand new developments in science, health and technology, each week.Subscribe to The Conversation’s science newsletter.]Kareem Clark, Postdoctoral Associate in Neuroscience, Virginia TechThis article is republished from The Conversation under a Creative Commons license. Read the original article.
QAnon is often viewed as a group associated with conspiracy, terrorism and radical action, such as the Jan. 6 Capitol insurrection. But radical extremism and terror may not be the real concern from this group.QAnon followers, who may number in the millions, appear to believe a baseless and debunked conspiracy theory claiming that a satanic cabal of pedophiles and cannibals controls world governments and the media. They also subscribe to many other outlandish and improbable ideas, such as that the Earth is flat, that the coronavirus is a biological weapon used to gain control over the world’s population, that Bill Gates is somehow trying to use coronavirus vaccinations to implant microchips into people and more.As a social psychologist, I normally study terrorists. During research for “Pastels and Pedophiles: Inside the Mind of QAnon,” a forthcoming book I co-authored with security scholar Mia Bloom, I noticed that QAnon followers are different from the radicals I usually study in one key way: They are far more likely to have serious mental illnesses.Significant conditionsI found that many QAnon followers revealed – in their own words on social media or in interviews – a wide range of mental health diagnoses, including bipolar disorder, depression, anxiety and addiction.In court records of QAnon followers arrested in the wake of the Capitol insurrection, 68% reported they had received mental health diagnoses. The conditions they revealed included post-traumatic stress disorder, bipolar disorder, paranoid schizophrenia and Munchausen syndrome by proxy – a psychological disorder that causes one to invent or inflict health problems on a loved one, usually a child, in order to gain attention for themselves. By contrast, 19% of all Americans have a mental health diagnosis.Among QAnon insurrectionists with criminal records, 44% experienced a serious psychological trauma that preceded their radicalization, such as physical or sexual abuse of them or of their children.The psychology of conspiracyResearch has long revealed connections between psychological problems and beliefs in conspiracy theories. For example, anxiety increases conspiratorial thinking, as do social isolation and loneliness.Depressed, narcissistic and emotionally detached people are also prone to have a conspiratorial mindset. Likewise, people who exhibit odd, eccentric, suspicious and paranoid behavior – and who are manipulative, irresponsible and low on empathy – are more likely to believe conspiracy theories.QAnon’s rise has coincided with an unfolding mental health crisis in the United States. Even before the COVID-19 pandemic, the number of diagnoses of mental illness was growing, with 1.5 million more people diagnosed in 2019 than in 2018.The isolation of the lockdowns, compounded by the anxiety related to COVID and the economic uncertainty, made a bad situation worse. Self-reported anxiety and depression quadrupled during the quarantine and now affects as much as 40% of the U.S. population.A more serious problemIt’s possible that people who embrace QAnon ideas may be inadvertently or indirectly expressing deeper psychological problems. This could be similar to when people exhibit self-harming behavior or psychosomatic complaints that are in fact signals of serious psychological issues.It could be that QAnon is less a problem of terrorism and extremism than it is one of poor mental health.Only a few dozen QAnon followers are accused of having done anything illegal or violent – which means that for millions of QAnon believers, their radicalization may be of their opinions, but not their actions.In my view, the solution to this aspect of the QAnon problem is to address the mental health needs of all Americans – including those whose problems manifest as QAnon beliefs. Many of them – and many others who are not QAnon followers – could clearly benefit from counseling and therapy.Editor’s note: This article was updated to correct the description of the people whose post-insurrection court records were examined.[Deep knowledge, daily.Sign up for The Conversation’s newsletter.]This article is republished from The Conversation under a Creative Commons license. Read the original article.
You may recall reading alarming stories in the media about the synthetic opioid fentanyl in the last few years. The Centers for Disease Control and Prevention noted that the drug was responsible for a spate of overdose deaths that rose dramatically from 2013, when the first cases made headlines, to 2019.More than 36,000 overdose deaths from fentanyl took place during that year, which federal, state, and local officials battled through resources guides, community action, and efforts to expand access to naloxone, the opioid antagonist drug that can reverse the effects of a fentanyl overdose, to first responders.By 2020, fentanyl stories appeared to drop from the media spotlight, supplanted by news about the presidential election and the COVID-19 pandemic. But don't think that the drug went away. On the contrary: fentanyl use, and overdose deaths related to the drug, is steadily on the rise again.According to the CDC's National Center for Health Statistics, synthetic opioids like fentanyl were at the heart of a recent and dramatic spike in overdose deaths during a 12-month period ending in May 2020. Approximately 81, 230 drug overdoses involving synthetic drugs occurred during this time period, which is the largest number of such instances ever recorded. The increase after a relative decline in overdoses from 2017 to 2018, which began to reverse in June 2019 and climbed rapidly by May 2020. Drug overdose deaths increased in more than 25 states and the District of Columbia; in some states and major metropolitan areas like New York City, the increase was between 10 and 19%.How has fentanyl managed to retain a grip on the U.S. population? Part of the reason is its potency: fentanyl is a legal drug, used to treat severe or "breakthrough" pain, especially after surgery, or for patients who have a tolerance to other opioids. When prescribed by a doctor, fentanyl can be given as an injection, patch, or as a lozenge. Though similar in composition to morphine, it's actually 80 to 100 times more powerful, and equally as addictive. As little as two milligrams of fentanyl has the potential to be fatal.The other reason for fentanyl's longevity is that it's relatively cheap and easy to produce an illegal street version of the drug, and its potency makes it a frequent choice to be mixed with other opioid narcotics like heroin or cocaine for a cheap and powerful high. Many individuals with substance dependency issues are unaware of the presence of fentanyl in these narcotics, which can overwhelm their systems and lead to an overdose.While China has been in the past the primary source of fentanyl and dangerous analogues, or imitation drugs, like carfentanil, which were sold primarily through illegal web sites on the "dark web," the majority of fentanyl in 2021 enters the United States through Mexico. U.S. authorities estimate that 90% of all fentanyl entering the country originates in Mexico, where it's produced by drug trafficking cartels who buy the chemicals to produce the drug from China and India.Data from the United Nations found that while seizures of marijuana smuggled into the U.S. from Mexico dropped in 2020, seizures of fentanyl rose nearly 500%. COVID-19 has done little to halt the cartels' smuggling operations; as the DEA noted, they've simply sent larger shipments of fentanyl and methamphetamine to meet the growing demand in the States.The third factor in the recent fentanyl surge was undoubtedly the global pandemic. Experts predicted that quarantine conditions would cause a host of issues that would negatively impact mental health, from isolation and anxiety over financial and medical worries to the inability to access proper treatment from both doctors and treatment facilities. Studies corroborated these fears, as did data from the CDC's National Vital Statistics System (NVSS), which found that overdose deaths skyrocketed throughout 2020 before declining at the start of 2021: the center has estimated that the final total of such deaths could ultimately surpass 90,000 – the highest annual number on record. How to combat this rising tide of opioid and fentanyl overdose? At Waismann Method, an opioid treatment program and rapid detox center, they believe that mental health care should be accessible not just to those who can afford it, but also to those who need it most. In today's post-pandemic world, in which so many people are dealing with trauma caused by COVID and its attendant restrictions, it is critical that medical treatment for opioid dependence be available in public hospitals along with necessary psychological support. Additionally, we need a stronger commitment to combating the rise of opioids (and the influx of fentanyl in particular) at local and government levels. "We believe that additional resources need to be put into decreasing the availability of fentanyl in our communities and the demand for drugs by our citizens,” Clare Waismann, RAS/SUDCC, founder of Waismann Method and Domus Retreat, explains. “By protecting our borders and focusing on the root causes behind addiction, we can reduce overdose risks, crime, homelessness, and suicide."Sources:https://www.ama-assn.org/system/files/2020-12/issue-brief-increases-in-opioid-related-overdose.pdfhttps://jamanetwork.com/journals/jamapsychiatry/fullarticle/2775991?resultClick=1http://publichealth.lacounty.gov/lahan/alerts/CDC-HAN-00438%20Opioids12172020.pdfhttps://www.commonwealthfund.org/blog/2021/spike-drug-overdose-deaths-during-covid-19-pandemic-and-policy-options-move-forwardhttps://www.ft.com/content/a667a8b6-a306-4656-b153-b83897df323ehttps://www.wilsoncenter.org/publication/mexicos-role-the-deadly-rise-fentanylhttps://www.camh.ca/-/media/files/guides-and-publications/straight-talk-fentanyl.pdfhttps://www.kqed.org/news/11874651/fentanyl-is-killing-more-people-in-the-pandemic-in-santa-clara-county-victims-are-getting-younger
Sobriety is a major pathway to good mental health, but it does not secure it. Instead, having your brain and body free and clear of addictive substances allows you to make the best choices necessary for mental health, and gives you the strength to do the necessary work. The trauma resulting from the pandemic and a year of social isolation have brought these issues into sharp focus, and this opens up important conversations by releasing the stigma around mental illness as a whole.For some, the conversation could be around acknowledging a mental health issue, whether it is PTSD, bipolar disorder, depression, or something else. It’s common knowledge that undiagnosed and diagnosed mental health issues are often present in people who struggle with addiction. Acknowledging the presence of the issue allows for the beginning of healing--sound familiar?Those in sober living homes, rehabilitation centers such as The Sunshine Coast Health Centre in British Columbia, or therapy already have an easy gateway to receiving help for a mental health issue. Opening up to a trusted person in this environment is the first step to receiving proper care for your particular issue.Sobriety is impacted dramatically by unaddressed mental health issues. Once sobriety begins, there is a freedom from the immediate effects of drugs and alcohol but the the struggle with addiction remains. A true mental health issue does not resolve with a better attitude, a gratitude list or giving back-- it persists despite the circumstances of your life and must be treated specifically in order to be managed effectively.It’s known that there is a link between trauma and addiction, and trauma can lead to PTSD, panic disorder, and other severe mental issues. PTSD, or post-traumatic stress disorder, is the direct result of a trauma experience, and includes a variety of symptoms such as avoidance of movies or talk that triggers the traumatic memory, changes in mood, and nightmares. In sobriety, this barrage of negative emotions cannot be numbed with drink or drugs, and so must be managed with professional care.Sunshine Coast Health Centre has been “developing licensed and accredited mental health programs with an extraordinary record of high-quality care since 2004, as they state on their website. Sunshine Coast HC recognizes that without treating existing mental health issues, a person’s sobriety is tenuous, regardless of how hard they work.To address this truth, Sunshine Coast provides medical withdrawal (“detox”), psychiatric care, rTMS, meaning-centered psychotherapy, family counseling, and post-treatment coaching as part of their roster of evidence-based therapies.Meaning-centered psychotherapy refers to the Sunshine Coast’s focus on meaning throughout their program’s modalities. Viktor Frankl founded logotherapy, a school of psychotherapy, which describes a search for a life meaning as the central human motivational force. While struggling with a mental health issue, the focus on meaning over happiness can be empowering and hopeful; happiness may be temporarily out of reach but creating meaning is not. Based on this work, Paul Wong created Meaning-Centred Therapy, which is the basis for the version Sunshine Coast uses.The clinical staff at Sunshine Coast Health Centre is trained in numerous therapeutic techniques from Narrative Therapy, Cognitive Behavioral Therapy, and Dialectical Behavioral Therapy.Narrative therapy falls under psychotherapy, and helps clients identify their values and the skills associated with those values and how their unique history can be used to further understand themselves and their path forward. This type of highly individual approach gives the patient knowledge of their unique abilities so they can build a stronger psyche and self-image.Cognitive Behavioral Therapy is a tried and true approach that focuses on challenging and replacing cognitive distortions and maladaptive behaviors; cognitive distortions are a common issue in sobriety, and it’s crucial to recognize these faulty thinking patterns, while addressing behavior reinforces a more positive thought process. CBT also works to improve emotional regulation and develop coping strategies for life issues.Dialectical Behavioral Therapy is known to be specifically useful in those with substance use disorder. It is an evidence-based psychotherapy that originally was used to treat suicidal women with borderline personality disorder but is now also used in the treatment of mood disorders, self-harm and suicidal ideation, as well as substance use issues. This therapy relies heavily on techniques to manage and process painful emotions without destructive behaviors, and specific techniques to communicate with the people in your life.“The Wellness Toolbox” offers free toolkits for assisting in coping with and managing stressful situations and negative thinking and emotions. This kind of reading can be the first step toward getting the help that you need for better mental health, and stronger sobriety, centered in a meaningful and unique life.Sunshine Coast Health Centre is a non 12-step drug and alcohol rehabilitation center in British Columbia. Learn more here.