Category: Discussion of Addiction

“In 2017 alone, 168 people died of drug overdose in Lancaster County, Pennsylvania, 167 of them were not my 22-year old son. I need know no other statistic.” – Doug Cwienk

In January 2017, our son was lying on the floor in our family room, literally dying. He was saved by the quick work of Bart Township Fire Company QRS and three shots of Narcan (generic name; Naloxone). Those two things gave us another 6 months with the terrific young man that our son was when he was attending his meetings and doing his step work. Narcan is very effective at saving lives but it is only useful for opioid overdoses (Nate had snorted heroin that evening), not other drugs. The effectiveness of Narcan is the reason that the Commonwealth of Pennsylvania has established a “standing prescription” so that anyone in Pennsylvania can go into a pharmacy and purchase Narcan without a prescription. I would like to dig into a little deeper discussion of Narcan and medication-assisted treatment (MAT) used to combat substance use disorders. So, please join me in this post, “Narcan and Friends”.

Note: I will use the term opioid throughout this post because it is a more general term. Opiates are derived from opium, ultimately from poppy plants. Opioids includes opiates, synthetic compounds that were developed to function like opiates and mixtures of the two.

How Does Narcan Work?

We discussed in earlier posts that opioid misuse causes a massive flood of dopamine in the brain. For this dopamine production to occur, the opioid molecule must first bind to an opiate receptor which causes other responses such as a pain relieving and sedative effect (that is what opioids were developed for). When you overdose on an opioid, you have too much sedative effect causing you lose consciousness and your respiration to be suppressed or stopped entirely. That is how an opioid overdose kills you, it slowly shuts your breathing down and then your heart stops because it is not getting the oxygen that it needs.

In pharmaceutical terms, Narcan is a competitive antagonist for opioids. This means that Narcan pushes the opioid molecule off of the receptor and the Narcan then occupies the receptor, keeping the opioid molecule from reattaching. What this means in practical terms is that a person in opioid overdose, given Narcan is taken from their extreme high to withdrawal very quickly because the receptors no longer have opioids attached to them. Knowing that withdrawal is extremely uncomfortable, the instantaneous ride from high to withdrawal must be horrible…but the alternative (death) is much worse.

Obviously, we do not want the Narcan to stay on the receptors forever because these receptors serve other functions, such as your brain’s own pain regulation systems. Narcan is designed to be metabolized in less than an hour, so that it is no longer in your body. Unfortunately, this means that if you overdosed with enough opioids, some are still running around in your brain. When the Narcan is broken down by your body the opioids that are still running around in your brain reattach to the receptors. This is very dangerous because it can cause an individual to go back into overdose. That is the reason why someone revived with Narcan needs to go to the hospital for a few hours of monitoring and re-administration of Narcan if necessary.

The Effectiveness of Narcan

Narcan is well designed for its intended purpose and it does its job very well. Some of the stronger opioid compounds, such as fentanyl and carfentanil are resistant to Narcan requiring more Narcan to reverse the overdose. I recently read a statement by the Lancaster County district attorney stating that we are on track to have fewer overdose deaths in the county in 2018 then we had in 2017. More people surviving is obviously good but it doesn’t mean that the opioid crisis is now shrinking. In fact, there have been more overdoses in 2018 than 2017 but more people are being saved by Narcan.
Narcan cannot be abused, it blocks the high of opioids. So, if you have a loved one that may be abusing opioids or you spend time around people that may be using opioids it would be wise for you to get Narcan and keep it with you. As stated above, if you live in Pennsylvania you can get Narcan without a prescription.

The fastest way to get Narcan to work is by intravenous injection, which is what the EMTs will do if they are saving someone. For regular people like you and me, the Narcan that we can obtain is a nasal spray. It is easy to administer and there are many places that will give you training in how to administer Narcan if you wish. In the Lancaster area, one group that provides this training is Project Lazarus. You can find a group in your area by searching on the internet for “overdose reversal training”.

What Narcan Does Not Do

Narcan does not let you down easy, it saves your life. By very rapidly stopping the effect of the opioid, it stops the suppression of your respiration but it throws you into withdrawal. As stated in the “Warm Hand-Offs” post the person revived with Narcan is often very agitated and cannot focus because their brain is screaming for the substance that it “knows” they need to survive. Their brain is trying to save their life using every trick that it can but it is wrong about what is needed. For more discussion of this, please refer back to the science of addiction posts that started this blog.

Narcan does not prevent relapse, in fact, many individuals have been revived more than once. How can you return to the substance that just tried to kill you? This makes no sense to a person that is not suffering from addiction. But, let me offer this analogy:

Suppose you are lost in the desert for a week or more and you are literally dying of thirst. You find a small pool of water and drink from it. The water is not pure. You become very sick and almost die. You survive and continue on but you are still close to death from lack of water. If you find another pool of water, would you drink from it, not knowing if it is pure or not? Of course, you would, you will die without water.

This is how a person with substance use disorder’s mind is working but it mistakenly thinks that the drug of choice is as necessary for survival as food or water. They will use again if they do not get and stay in recovery. They may even use in secret to hide that they have relapsed. That is what happened with Nate. He used in secret so that no one would know he had relapsed and he died alone, without anyone there to give him Narcan.
Narcan does not help a person with substance use disorder get or stay in recovery, that can be done with medically-assisted treatment which we will discuss in the follow-up post to this post. Do you have thoughts or experiences to share? Please comment, let’s work together.

NOTE: I have given more thought to using the term “person with substance use disorder” or “person suffering from addiction” rather than addict. It occurred to me that what is missing with the word addict is the word person. The term addict de-humanizes. It is like the use of Jap for Japanese people during WW2 or Huns for German people during WW1 or savages for native persons. It is easier to mistreat people, to look down on people, to allow people to suffer if we stop thinking of them as people.

I hope that you will join me next week for a discussion of “Narcan and Friends – Part 2”.

“Never forget where you have been.  Never lose sight of where you are going and never take for granted the people who travel the journey with you.”

There is a brilliant technique designed to get people with substance use disorders into recovery, called a “warm hand-off” that I want to share with everyone. Understanding this information helps everyone understand behavior associated with addiction, recovery, and the steps we need to take as a society to combat this horrible disease.  So, please join me in this post, “Warm Handoffs – A Brilliant Idea”.

What is a Warm Hand-off?

A warm hand-off is something that is set into motion by a person arriving at a hospital either because they overdosed, or they were injured in some other way due to their addiction.  Hospitals involved in this program then contact an individual in recovery who comes to talk to that person in order to help them see their need for rehab and to help them find a facility that will take them.  I had heard about this a few years ago, but this was the limit of my understanding.  The idea of having someone with intimate knowledge about addiction (someone in recovery) talk to a person in crisis (immediately after an overdose or serious injury) sounded like a great idea to me.  I knew that there was more to learn but I did not know who to contact.  I found out from a newspaper article a few weeks ago that The RASE Project was active in warm hand-offs in the Lancaster, Pennsylvania area, so I contacted them.

The RASE Project

I called The RASE Project, which is headquartered in Harrisburg, PA and was told that I should speak with Sandy Fisher, the Recovery Specialist Programs Supervisor.  I called Sandy and we had a great telephone conversation that taught me much more about warm hand-offs.  For starters, warm hand-offs are part of a program that is sponsored by the Commonwealth of Pennsylvania.  Pennsylvania requires that within each county in Pennsylvania, there must be an organization that is funded to provide warm hand-offs in that county.  The RASE Project is that organization for Lancaster County.

All of the major hospitals in Lancaster County participate in this program and they call the RASE Project anytime, night or day, that someone comes into the hospital having overdosed or otherwise seriously injured themselves as a result of addiction.  The RASE Project has five people in recovery that are tasked with providing support in the form of a warm hand-off.  Each person takes a turn on call 24/7 for a week at a time to answer the call from the hospital.  Each of the “Recovery Specialist to Warm Hand-Off for Overdose Survivors Program” members is a Pennsylvania CRS (Certified Recovery Specialist).  To become a CRS, an individual must be in recovery, must take many hours of classroom instruction and must pass a test.  Each of these individuals also works as a recovery center monitor, as well.

The individual on call talks to the person in crisis and attempts to get them to agree to go to rehab.  In the best case, this help is desired and The RASE Project staff will attempt to get them in a rehab facility as quickly as possible.  In the worst case, the person refuses to speak with the RASE Project staff member, in which case they are left with a packet of information in hopes that they may change their mind.  Sometimes, an individual is initially resistant to help but they come to the RASE Project facility a few days later seeking help.  The Lancaster facility also provides recovery coaching, recovery support groups, Buprenorphine (Suboxone) Care Coordination, and all day drop-in services.

Up until a few months ago, warm hand-offs were only for those revived from an overdose.  Like any good program, a need was identified to provide this service to anyone seriously injured by their addiction and it now helps them, as well.  I asked about our son’s survival of an overdose and if no one came because they saw that he had our support and was agreeing to go to rehab.  Sandy said that was probably the case but that they are not called 100% of the time.  The good news is that they estimate that they get the call from the hospital about 80% of the time and that number is improving as word gets out.

What is it like to Provide Warm Hand-offs?

Sandy suggested that I should stop by the RASE Project facility at 121 East Orange Street and speak with someone who goes to the hospital and provides a warm-handoff.  I met Brandon Hildebrand and he agreed to speak with me about his role in warm hand-offs.  We had a wonderful conversation that started with the general information provided by Sandy but soon led to a more personal discussion.  The one thing that I wanted to ask Brandon was how difficult it was to go address someone who was in the same position that he had been in years before.  Was this a trigger that might make him want to use?

Just as a reminder, triggers are smells, sounds, places, things, and tastes that remind an person of the times when they used and cause them to want to use again.  Triggers are a “trick” that the addictive part of the brain uses to try to get an someone with a substance use disorder to seek out the substance that their brain thinks it needs to survive.  Triggers lessen with time in recovery, but they may never totally go away.

Brandon said that what he experiences sometimes is not so much a trigger but it can take him back to his using days and all of the pain that he caused people. That is why he works his 12-step program and contacts his sponsor and support group.  In his words, you must have a very strong program to do this work.  Let that sink in for a minute.  The people that provide warm hand-offs willingly go into an environment that will remind them of their past and challenge their recovery, so that they may help others in the same situation that they have worked to put behind them.  Past posts have explored things that make recovery such a tremendous challenge.  These people charge into the teeth of the dragon to help save their fellow man.  Can there be anything more noble?  But still people look down on or fear those in recovery.

Challenges to Warm Hand-offs

So why wouldn’t someone who just virtually died want to get help to get away from the thing that tried to kill them?  Part of the answer to that question is the twisted thinking in the brain of someone with a substance use disorder.  Even though the drug almost killed them, the part of their brain associated with addiction is convinced that the drug is necessary for survival.  So, they don’t want to go to rehab where they cannot get access to that drug.

There is another issue that causes challenges for those trying to help someone get into rehab.  The source of this problem is Narcan/naloxone which I hope to discuss in a little more detail in the next post.  Narcan is what saved the person overdosing but it does so by instantly taking them from high to withdrawal.  When the addicted brain is thrust into withdrawal, it responds by trying everything at its disposal to get the individual to use.

The result of the brain’s efforts is an intense desire/craving to use that is so powerful that it is difficult to focus on anything else.  This is the challenge for the person attempting to help them get into rehab.  Most don’t want that help and even if they are not strongly opposed to it, they have a hard time focusing to understand the help being offered.  Some medical facilities are offering a therapeutic drug such as Suboxone/buprenorphine as the individual is recovering from their overdose and this acts to damp down the cravings and help them focus.

Brandon noted that recently he has seen more people that are happy to see him and want his help than in the past.  He believes (and I think that he is correct) that this is occurring because of the prevalence of fentanyl in street level drugs.  Fentanyl is much more potent than heroin and a fentanyl overdose is resistant to Narcan.  While the availability of Narcan is decreasing overdose deaths, fentanyl is having the opposite affect and that is scaring some people.

I often speak of “drug brain” as if it is all consuming and always present but that is not entirely true.  Remember that I noted people with substance use disorder typically think they can stop when they are high and know that they can’t when they are withdrawing.  Brandon put this another way that I think is very telling.  He said, “I didn’t want to be sick. I wanted to stop but the drug always wins.”

Is it Worth it?

Warm hand-offs are a great idea to help get people into rehab and recovery and they do work.  Warm hand-offs may put those people in recovery that are trying to help at risk of relapse. And they don’t work as often as we would like due to the many obstacles such as:

• The altered part of the brain of someone with substance use disorder believing that their drug of choice is necessary for survival;
• The difficulty that the person has in focusing because their brain has just been thrown into withdrawal; and
• Difficulty getting a willing participant into a suitable rehab facility quickly.

Despite the hard work, risks and difficulties in making warm hand-offs work, I absolutely think that they are worth the time and money.  The concept is excellent and perhaps we will find ways to reduce the obstacles, such as the use of therapeutic drugs to reduce the effects of withdrawal.

Do you have thoughts or experiences to share? Please comment, let’s work together and help each other to understand this problem.

NOTE:  You may have noticed that I stopped using the term addict in this post and I replaced it with “person with substance use disorder”.  I initially did so at Sandy’s suggestion that there is a great deal of stigma associated with the word addict.  I understood Sandy’s point but I feel disingenuous when I use what I perceive to be euphemisms.  I am currently taking the coursework to become a Certified Family Recovery Specialist in Pennsylvania and this same thing came up in that class.  I expressed my reluctance there and the instructor made a very good point.  First and foremost, when we are trying to help people we must be sure that we do no harm.  If the term addict has a strong stigma such that it may be hurtful or may cause the people that we are trying to educate to hold onto their misconceptions and stigmas then we should not use it.  From now on in this blog, I will only use the term addict when I think that it is necessary for the point that I am making.

I hope that you will join me next week for a discussion of “Naloxone (Narcan)”.

“Almost everything you think you know about addiction is wrong.” – Johann Hari

After my last post about stigmas, it was suggested to me that I should listen to an NPR TED Radio Hour podcast entitled “Confronting Stigmas”. The episode was excellent and addressed several areas of stigmas starting with an interviewee named Johann Hari, who discussed the stigma of addiction. When Mr. Hari spoke of the stigmas and how they get in the way of addressing our drug crisis he said many of the things that I said in the last post. In short, addicts need to be embraced, accepted, and helped, not rejected, shamed, and humiliated. I whole-heartedly agree.

Much of Mr. Hari’s interview revolved around his TED Talk entitled, “Everything You Think You Know About Addiction is Wrong”. I was curious about what he was saying and did this mean that I had this whole addiction thing wrong. I must admit that I have my biases based on the research from the NIDA/NIH; my own experiences; my desire to believe that I was a good parent; and let’s face it I’d hate to be wrong, especially a dozen posts into my blog.

I did my best to be objective and I watched his TED talk. The things that Mr. Hari said have changed my view, slightly, but I believe that he does not fully understand addiction and consequently his interpretations are not completely accurate. I believe that almost everything we know about addiction, based on hard science is correct. Please join me in this post, “Counterpoint” as I explain Mr. Hari’s information and conclusions and how I would reinterpret his observations.

Johann Hari and Addiction

Mr. Hari did a great deal of research for a book he wrote that largely centers around how we pursue the war on drugs and the failures in our approach. I am reading this book and I must admit his storyline seems awfully neat and clean for the real world, but I am not about to re-do his research, so I’ll accept his story. I mention this book because I believe that in doing that research he came to the conclusions that he presented in the TED talk. Mr. Hari has a few main premises that he presented including:
• Trying to stop the flow of illicit drugs does not work and in fact, makes the drug traffickers richer, more powerful, and more violent.
• Stigmatizing and disconnecting addicts from society, starting with the legal systems currently in place and including attitudes of the public and potential employers make huge obstacles that addicts must overcome. Removing these obstacles would reduce the addiction crisis.
• Decriminalizing all drugs and providing clean and safe facilities in which to use would save lives, bring order, reduce stigmas, and reduce crime and violence.
• The concept that drugs have “chemical hooks” that get a hold of you is incorrect. People use because they are unfulfilled, unhappy, or in pain. He is in effect saying that there is no addiction as I have described it.

The War on Drugs

By Mr. Hari’s estimation, we have been fighting the war on drugs for one-hundred years and we are currently failing spectacularly. I am less critical of the war on drugs than Mr. Hari because I believe that it has been pursued with the best of intentions and I find it hard to embrace most of the alternatives. We cannot, however, argue that the war has been a success given the length of time it has been going on and our current situation. Mr. Hari makes an interesting statement that I think speaks volumes about how the legal system’s approach does not work for drugs the way it does for crime in general. He said that when you arrest a lot of rapists, you get less rapes and less violence. When you arrest a lot of illicit drug suppliers you still have the same quantity of drugs and you have more violence because there are turf wars over who will get that piece of the market.

One of the things that I like to point out in most discussions in which someone is insisting that “we have to do something about (fill in the blank) now” is the very real possibility of unintended consequences. There are two very clear examples of unintended consequences from the war on drugs. In addressing the recent opiate crisis, we greatly restricted the access to legally prescribed, opiate painkillers. The unintended consequence is that we have more heroin users and there was an expansion of the fentanyl supply as prescription painkillers became expensive and difficult to obtain. In the 80s and 90s we established mandatory minimum sentencing for drug traffickers. The unintended consequence was that our jails got overcrowded and we were forced at times to release violent criminals from prison because mandatory sentencing stopped us from releasing non-violent drug offenders.

I agree that the war on drugs has frequently had the opposite result to the one intended. Unfortunately, I think that drug addiction is too great an issue to just allow the illegal trafficking of drugs to happen.

Decriminalizing Drugs and Clean Needles

Mr. Hari’s solution with regard to the failure of the war on drugs is to do the opposite of the current system that is not working. That is, we should decriminalize drug use, all drug use from pot to crack cocaine to heroin. This will remove the stigma from addiction and permit addicts to become reconnected to society. He cites two examples of countries in which this method worked, Portugal and Switzerland. Mr. Hari has concluded that addicts use because they are unfulfilled with their life, their life lacks meaning, and they are disconnected from society.

If you go back to “Part V – Nature and Nurture Decide” and look at the risk factors identified by NIDA/NIH you will see that they concluded that the same sorts of influences can increase an individual’s likelihood of becoming an addict. The very important distinction here is that Mr. Hari concludes that this is why people use and if you eliminate this, people will stop using. NIDA/NIH says this may help to lead you down the path of addiction. If you conclude as Mr. Hari did then there is no addiction as we know it. I cannot agree with that.

Portugal

In the 1990s, Portugal had a massive cocaine and heroin problem. Estimates are that up to one percent of the population was using drugs. In 2001, Portugal decided to reverse course and adopt a new way of addressing this problem. The use of all drugs was legalized. Needle exchange programs were instituted. Methadone clinics were mobilized in vans to make it easier for addicts to get that help. Programs were started to attempt to get addicts employment and get them contributing to society. Skeptics said that this would cause an increase in drug use as drugs became more available and accepted.

In 15 years, drug use fell by roughly 50%, overdose deaths fell, and the incidence rate of diseases such as HIV and hepatis dropped dramatically. By most metrics, the policy in Portugal is working far better than our own policies. Mr. Hari concluded that this outcome was the result of a reduction in the stigma of addiction and that this supports his belief that drug use is a response to trauma or lack of self-fulfillment.

Switzerland

Like Portugal, Switzerland had a massive drug problem. The Swiss took their efforts even further than Portugal. In Switzerland, there are clinics where you can take your heroin, turn in your used needle, and a health care professional will give you a new needle and monitor you as you shoot up to make sure that you do not die from an overdose. Obviously, this saves lives and presumably it reduces some of the stigma, but how much? If Mr. Hari’s conclusion that addiction does not exist, rather it is an expression of unfulfillment, then this technique may be reasonable way to keep people alive until they can find satisfaction in their life.

Drug/Addiction’s Hooks and the Vietnam War

Mr. Hari stated the idea that drugs have “chemical hooks” and grab ahold of your brain is wrong. He says that the idea that if you gave a group of people heroin for several weeks they would all be addicts is wrong. Mr. Hari’s concept of addiction as the result of chemical hooks that will grab anyone is outdated. He is interpreting the information he gathered with an outdated model of addiction, seeing that it doesn’t fit and concluding that everything that we think we know is wrong.

Let’s look at Mr. Hari’s argument based on the Vietnam War. Approximately 10% to 20% of American servicemen in the war were heavily using hard drugs. There was a real fear that when they returned home there would be a massive epidemic of drug abuse. There was not. According to Mr. Hari this supports the idea that they were unfulfilled, unhappy, and traumatized. When these issues were gone, they didn’t use. Well, that isn’t quite true. Many servicemen did stop using but many continued, in fact, the rate of relapse/continuing addiction seemed to match drug use in the general population. (Robins, Lee N., (1993) “Vietnam Veteran’s Rapid Recovery from “Heroin Addiction: A Fluke or Normal Expectation?”, Addiction Vol. 88 pp. 1041 – 1054)

Furthermore, does anyone think that when our guys got home from Vietnam and were despised by many Americans that opposed the war, that their lives were suddenly fulfilled, that the trauma suddenly disappeared? Only someone born several years after our guys returned from Vietnam and raised and educated outside of the USA could believe that things suddenly got better for those who fought a horrendous war without much support from home.

What Do I Think About Mr. Hari’s Ideas About Addiction?

I very seriously considered Mr. Hari’s conclusions and examples because I didn’t want to be wrong but more importantly, I don’t want to spread incorrect information. I believe that Mr. Hari’s interpretations are hamstrung by his lack of understanding of the current science and model of addiction.

I did consider that my own position with regard to addiction might need a little fine tuning. So, let’s fix me first. I have stated that heredity decides if you will become an addict, once you have decided to use and that we each have a different tendency toward addiction. I don’t want to say this within earshot of an adolescent brain but there appears to be a significant portion of the population that can use and not become addicts. I acknowledged this in prior posts, but I now believe that we are really looking at about 10 to 20 percent of the population that will become addicts if they use regularly. To an adolescent brain those may be good odds but the cost of being on the short end is huge.

My simplified path to addiction goes like this; you try it, you like it/want it, then you need it and that is when you become an addict. Apparently, only about 10% to 20% of the population make that last step which physically alters the brain into believing they need it and being an addict. In the past, we believed that if an individual stopped using and had symptoms of physical withdrawal, this indicated addiction. We now know that withdrawal symptoms are a physical response that all users will experience, while addiction is physical and psychological alteration of the brain that is not experienced by everyone.

In all of Mr. Hari’s examples, I believe those individuals using to feel better but who have not turned the corner to needing/to addiction are responsible for the improvements in the rate of addiction. So, those individuals get better, but we are still left with the true addicts. It happened when our guys came home from Vietnam and it is happening in Portugal. If I am right the reduction in addiction in Switzerland and Portugal will plateau, there will be little additional reduction. This is because we significantly reduced the number of people using to self-medicate that are not true addicts. The brains of real addicts have been altered, conditioned, physically changed to support addictive behavior. The addicts need much more help to undo the damage that has been done to their brain by addiction. This is not a conclusion that I pulled from some anecdotes or examples, this is supported by extensive research including brain scans.

Mr. Hari says that drugs don’t have chemical hooks that latch onto your brain, everyone’s brain. He is right, we haven’t believed that for some time now. Your brain physically changes itself in response to the drug’s impacts on the brain, such as, the massive dopamine surge, conditioning, neuroplasticity, etc. So, some individuals have brains that respond to the drug in a way that physically alters their brain but not everyone.

Let’s Get Personal

As I said, I tried to remain objective, but I do have my own experiences to add to this discussion. I believe that the path to drug addiction often starts from pain, trauma, isolation or simply living a life that is not meaningful. I do not believe the addiction itself is that simple. I believe that my son started using because of his own feelings about himself but I saw the dark side of his addiction. I saw the person that did not have the honesty, integrity, or compassion that my son originally had. I also saw those characteristics come back through the long, slow process of recovery. I saw him become very fulfilled. I saw him become very compassionate. I saw a desire to learn that had not been there for a long time. And I saw a very deep, profound connection to the sober community. By Mr. Hari’s model, that would have been the end of it..he was cured (by the way, that’s an AA joke/sarcasm, you’re never cured). Nate relapsed because it takes a long time for an addict to undo most of the changes that have occurred in their brain. He was not simply someone using to damp down some pain or trauma, he was an addict and he died because of it.

My Conclusions

Mr. Hari’s work does some wonderful things, but it also does a great disservice to true addicts, their families and most importantly to the education of the public that we need to solve this problem. When he speaks of stigma, he is right on the mark. When he causes us to rethink our approach to drug addiction, he broadens our vision and perhaps we will see the answer. BUT when he implies that there is no such thing as addiction he is not only wrong he does great harm to our attempts to help addicts. And speaking of stigmas, he is in effect saying that we raised a son so unhappy with his life and himself that he used until he died. He needs to talk to me, I saw something way different. My examples are just as meaningful as his and there is hard science to support the idea that addiction is a physical and psychological disease of the brain.

Do you have thoughts or experiences regarding this post? Do you want to tell me why I am wrong or what else I should read? Please comment, let’s work together and help each other to understand this problem.

I hope that you will join me in two weeks. I may actually get back to more misconceptions and stupid brain tricks, or maybe something better like this will come along.

“Don’t judge me by my past, I don’t live there anymore.” – Anonymous

About two months ago, my post was titled “Misconceptions and Stigmas Part I” but I got too wrapped up in the misconceptions and didn’t write about stigmas.  There is more to say about misconceptions in the future but today’s post I want to focus on the stigma of addiction and its impact.  To a large degree, the stigma of addiction is derived from misconceptions.  It is my goal in writing this blog that we may educate people and bring down some of the barriers to successful recovery, so please join me in a discussion of “Stigma of Addiction and the Damage Done”.

The Stigma of Addiction

As I have written scientific reports for years, I have this compulsion to define my topic.  So, what am I referring to in this post as the stigma of addiction. In this post, we will consider the stigma to be a very negative stereotype from which people make judgements and take actions.  If you were to treat someone based on their race, religion, or sex the way many people treat addicts, you would be branded a racist, sexist, or worse.  Some of the behavior that we see toward addicts as a result of this stigma include:

• Avoiding addicts and their loved ones, as if addiction is contagious.
• Refusing to ever trust addicts in recovery because of “past sins”.
• Refusing to provide help to addicts because “they do this to themselves”.
• Looking down on addicts and their families because “there must be something wrong with them that this happened”.

The Addict

Obviously, the most profound impact of the negative stigma of addiction is felt by those most vulnerable to the damage it can do, the addicts. I shouldn’t need to say this but just to make sure it is clear to everyone, ADDICTION IS NOT CONTAGIOUS.  Your family will not catch addiction from contact with an addict.  Obviously, we want to protect our kids and keep them from hanging out with individuals that are “trouble”. But if your son or daughter goes to school, they have already been in contact with those individuals for a long time.  In my opinion, you will not keep your loved-ones safe from addiction by shielding them from unsavory-types.  You will protect them by educating them.  As I said before, I don’t think that there are many people pushing drugs anymore but there are plenty of people supplying drugs if you want them.

Treating an addict like he/she has leprosy does not protect anyone, but it does harm the addict.  Drugs such as opiates are largely used in isolation.  In discussing when and how he used, our son told me that he didn’t want his friends around when he used because “They get in the way of the high.”  I believe that many addicts, my son included, started using because of low self-esteem and discomfort in social situations.  Isolating these addicts just drives them further into their addiction.

SIDE NOTE: To my son’s friends, this does not apply to you, you were awesome friends.  To Ingham’s Powder Coating in Denver, Pennsylvania none of this applies to you.  You showed Nate that you trusted and valued him and that helped him more than I can express.

Not trusting addicts because of things that they did in the dark depths of their addiction may be just self-preservation, so isn’t that okay?  I understand self-preservation and I don’t blame people for caution, but I do believe in a thing called FORGIVENESS.  Things that addicts do when their brain is being twisted by active addiction can be bad.  My son would say “We lie, we steal, that’s what we do when we are using”.  But a large part of the 12-steps of AA involve acknowledging what you did, forgiving yourself, and making amends.  That is a huge challenge, especially the forgiving yourself part, made that much harder when they feel that no one trusts them. Last week, someone ran into my car in the parking lot.  He came to get me, owned up to his mistake and has arranged to get my car fixed.  Should I hold a grudge against him because he wasn’t more careful?  That would be ridicules, so let’s cut a break to those that were in a terrible place and are trying to get better/be better.

I have already hammered on those that would look down on addicts and refuse them reasonable help in past posts.  If you don’t see what is wrong with treating addicts that way, go back to the earliest posts and start reading.  Actually, if you don’t see what is wrong, then you probably stopped reading long ago.  One thing to note is that I used the term “reasonable help”.  Some of the most difficult decisions that we had to make were framed by the question, “are we helping our son or are we aiding/facilitating his addiction?”  I frequently won’t give money to a homeless person if I suspect that they are an addict because I fear that I may be continuing their addiction when they need to be forced into seeking help.  How we treat people need not be all or nothing.  Please educate yourself about addiction before it directly impacts you and let’s work to bring this crisis to an end.

The Family

When we found out that our son was an addict, we had some very difficult choices to make that were piled on top of the nearly impossible decisions that we had to make daily regarding his addiction.  We decided that the best course of action was to keep his addiction to ourselves.  This decision was driven by our fear of the stigma that would be placed on our family, our house, and our addicted son.  We feared the judgement that “they must not be the good family that they seem to be because their son is a drug addict”.  We live in a small town/rural area and rumors can run wild.  Who knows what explanations might get passed around to explain what happened.

I believe that one reason that people don’t learn about addiction is that it is more comfortable to believe that your family is safe because you are good people and have strong character.  Those thoughts reduce your anxiety, but they may make you judgmental and they get in the way of solving the problem.

We feared the way that people would treat us, knowing that we had raised an addict.  To this day, people still avoid us sometimes and it is difficult to tell if they are judging us or just don’t know what to say.  Let me clue you in, talk to us.  Talk about Nate, talk about something else but talk to us.  You won’t catch what we have, and it hurts to feel alone.  Give my wife a hug if you feel close enough, she needs it.

We also decided to keep quiet about Nate’s addiction so as not to hinder him in the future.  Like every family, we clung to the hope that someday, preferably soon, his recovery would be strong enough to stop him from ever relapsing again.  We did not want him to have his future opportunities hindered by a statement like “are you sure you want to hire him, you know he is an addict, right?”

Isolation is difficult and painful, whether you imposed it on yourself because you thought it was what was best at the time or because people are judging or fear you.  I don’t think that I can say this too much, get educated about addiction so that you are not uncomfortable around those impacted by addiction and they don’t feel like they have to hide in the shadows.

The Impact

The Addict and Society

Why should you care about tearing down the stigma of addiction if you are not impacted, don’t know me or anyone like me?  The simple answer is that we are all impacted, this is a societal issue in addition to an individual issue.  Likewise, I live in rural Pennsylvania, in my township over 95% of the residents are of European/white decent.  Does this mean that I don’t need to be concerned with racism, that it does not impact me?  Hardly.

Addiction is killing people, destroying people, destroying families, destroying the very fabric of our society.  When you judge or isolate addicts, you make their recovery so much more difficult.  Alcoholics Anonymous is anonymous for a very good reason, they frequently are not accepted by people despite the arduous journey that they are taking.  I look forward to the day when the anonymity is solely that you don’t have the right to reveal another’s struggles not that you fear judgment of your own.  Staying in recovery and managing your addiction is a nearly impossible challenge, must we make it even more difficult?  Are addicts not people just like you and I?  I have my faults just as you do.  We are just lucky that we were blessed to not be burdened with a mind inclined toward addiction.

Another impact of stigmatizing addiction is that it makes many addicts reluctant to seek help.  Getting an addict into recovery can be very difficult, made all the more difficult by the fear that “everyone will know” when I disappear for 30 days.  How do I explain the gap in my employment history when I try to get a job again after time in rehab and recovery?  These are just more obstacles thrown in the path of recovery.

The Family

Families of addicts need support and need to not feel judged for their loved-one’s affliction.  I still think that we made the right decision by sharing our journey with Nate’s addiction with very few people at the time.  I think that our fears of what people would think and say were valid.  But the isolation was very difficult.  Most families either become closer or fall apart.  We became closer.  The community of friends that help us now that Nate is gone, and we can speak out is a tremendous help.  I wish that we could have reached out to these people while we were struggling with his addiction..before we began struggling with his loss.  This is not a comment on our friends, I know that they would not have judged us.  It is society as a whole that drove us into isolation and that needs to change.

Fear of being judged for your loved-one’s addiction keeps people from sharing and that keeps people from learning.  We are free to talk to you about our journey now, the worst has already happened to us.  Most people do not see addiction that is all around them.  Many people judge all addicts based upon the addicts that they see on the street.  If people understood the how’s and whys of addiction they would be less inclined to judge any addicts.  They would be more inclined to help and perhaps less help would be needed if fewer obstacles were placed in front of recovering addicts.

Do you have thoughts or experiences to share? Please comment, let’s work together and help each other to understand this problem.

I hope that you will join me in two weeks.  I may actually get back to more misconceptions and stupid brain tricks, or maybe something better will come along.

“It is often in the darkest skies that we see the brightest stars.”  ~ Richard Evans

I intended to write about misconceptions again on today’s post but a reader, that I now consider a friend, suggested that I do a post on spirituality and recovery. I do not have personal experience and I suggested a guest post or collaboration. What I received was a complete post that is an excellent read, provides meaningful insight, and it is profoundly moving. Everyone’s story of recovery is unique, yet many will relate to this story as I think that spirituality is critical in the lives of most people that remain in recovery. Here is Augustus Feleccia’s experience in his own words.

I remember the exact date of the day that I was cured of my obsession to use drugs and alcohol. On January 11th, I was changed from the inside out. After being helplessly addicted for 6 years, I was desperate. My relationship with my family was falling apart and was extremely strenuous. I was depressed and would sometimes not leave my room for days. I had had my right arm taken from me when it became paralyzed in a college football drill that knocked the nerves from my spinal cord. With this came hundreds of doctor’s visits that led me to an abundance of prescription medication. I was ashamed and regretful of my past, I was fearful and hopeless about my future, and my present was filled with doing whatever would make me feel momentarily better despite who it hurt. Like a rat, I had been digging a hole for myself through drug use that seemed insurmountable. Every night I would go to bed high and be determined to quit. In the morning I was in withdrawal and that promise was out the window.

When my best friend visited from North Carolina, he was a different person than from when I had last seen him. He was filled with joy and love and would not stop talking about the Bible. I became frustrated by it by the end of his visit, telling him “you don’t need to shove it down my throat. I’m glad it helps you, but it just isn’t for me.” Years later, Sean would tell me that he knew I would say that, but he was trying to help me. The idea of Jesus dying on the cross for my sins always confused me, but when I reached my point of lowest desperation, Sean’s words stuck with me. “Without God we cannot do much. But with Him, we can do anything.” This helped me immensely in not using for a few days, but it would always come back when I forgot about God. The logical, rational brain was doing just enough to get me by. I finally discovered that there was something greater than just that on January 11th, 2015. Beaten down and scared, I decided that I was desperate enough to beg God for help. I got on my knees in front of my crucifix and began to cry. I didn’t know what prayer to say, and finally I just blurted out “God, help me!” What happened next has been described by nearly every culture and religion. At once, I felt an intense feeling that something was with me. This being-if you like to call it that-loved me deeply. It accepted me for who I was and wanted the best for me. When I looked up at the cross, I saw Jesus’ arms extended on the crucifix, almost as if he were saying “come here and embrace me. You are with me now” I felt intense joy and knew that nothing would ever be the same. I then thought about how I had been living my life and felt so sorry for all of it. However, almost as soon as it came, it was gone as I finally understood the forgiveness of God. I knew intrinsically-almost as if you know you’re hungry-that my soul would live forever with God. I began living my life with a fresh pair of eyes, and the world looked and felt very different. I checked myself voluntarily into rehab shortly after and have not used since. The experience is still the single most important moment of my life.

This may sound like crazy pseudoscience nonsense to the more logical, 3-dimensional thinker, but experiences like this are a lot more common than you think. Bill Wilson had a very similar experience and thus created the 12 steps of Alcoholics Anonymous as a way of getting alcoholics (who just couldn’t warm up to the J or G words) to that same experience.

Here, we see how the 12 steps are directly from the framework of the Gospel.

1. We admitted we were powerless over alcohol—that our lives had become unmanageable. This is what I admitted, but to painkillers instead of alcohol. I admitted that I was “licked” and that I truly needed help. My prayer was literally just a sincere “God, help me!”. I “repented”, or changed my mind, to the way that I had been living my entire life thus far.
2. Came to believe that a Power greater than ourselves could restore us to sanity. This is where I had my white light moment. He showed Himself to me immediately after asking.
3. Made a decision to turn our will and our lives over to the care of God as we understood Him. After having this experience, Jesus had entered my life and He would never leave. I would now live through and for Him.
4. Made a searching and fearless moral inventory of ourselves. I realized all of the wrongs that I had ever done-especially the ones that made me uncomfortable and I didn’t want to think about.
5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs. God already knew all of these and forgave me. Admitting them was for my well being, not just His.
6. Were entirely ready to have God remove all these defects of character. I knew that He could. I knew that I was forgiven. At that point, I had no trouble at all talking about my wrongs in life to anyone. As I did, I was further freed from their emotional chains.
7. Humbly asked Him to remove our shortcomings. As I admitted them, God began to live through me and I lived out His will for me. My shortcomings were me acting selfishly, not through God.
8. Made a list of all persons we had harmed and became willing to make amends to them all. This was a natural response to my spiritual transformation.
9. Made direct amends to such people wherever possible, except when to do so would injure them or others. Again, this became natural. I wanted the whole world to see God and this was how I showed that love.
10. Continued to take a personal inventory and when we were wrong promptly admitted it. Everyday was spent in prayer, attempting to do the right thing and asking for God’s guidance and forgiveness when I screwed up.
11. Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out. Being as though “conscious contact” with God was a better high than any drug, I tried for it every chance I could.
12. Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics and to practice these principles in all our affairs. This is also what keeps us sober. Helping others and service is the main instruction in the Bible as well as in the rooms of AA.
So, what is going on in my brain, and why do we see this same experience helping so many of those in recovery?

Scientists at Yale University recently did a study* where they discovered that the part of the brain responsible for the awareness of ourselves and others lights up when going through a “spiritual experience.” What this explains is that during these moments, the brain starts to slowly not recognize itself as an individual separate from others, but rather a part of the larger whole. This concept is found in Christianity, Buddhism, Islam, Judaism, Hinduism and just about every other major religion of the world. The brain effectively becomes more selfless-exactly what AA teaches us to be.

These studies may be showing us that the way we think as a culture as well as individuals may be wrong. I personally find it odd that of all the science and medicine we have (which are both incredible and important) the most effective treatment we have for addictions of any kind lay in the stepwork filled with words like Higher power, prayer, and God’s Will. Could it be that maybe pure logical Science is not all of what it takes? Could it be that just maybe, there is more to the effectiveness of 12 step groups like Alcoholics Anonymous than just trading a drug addiction for a meeting addiction and white knuckling it through life? Can we be figuratively born again as new people with a new perspective on the world? Most importantly, can our world be reborn from one that uses a pill to fix everything to something more; something deeper? I believe that the answer is yes. With more studies coming out confirming this theory, it may be time that we start treating addiction completely different from the way we have been seeing it as a choice that needs punishing into a ‘spiritual malady’ that requires love. Whether you believe in religion or not, there is now evidence that it’s teaching have very real effects on those who practice them.

Augustus J.F. Feleccia is now two years sober and still doing well. He is eight years post-injury and has learned to get by without much use of his right arm. He works for a non-profit telling his story at schools and community centers in hopes that he can prevent any kid from becoming addicted to drugs. He also offers evidence-based prevention programs in Delaware County, PA.

You can reach him at afeleccia@childandfamilyfocus.org

* Lisa Miller, Iris M Balodis, Clayton H McClintock, Jiansong Xu, Cheryl M Lacadie, Rajita Sinha, Marc N Potenza; Neural Correlates of Personalized Spiritual Experiences, Cerebral Cortex, , bhy102, https://doi.org/10.1093/cercor/bhy102

“Angel of darkness is upon you, Stuck a needle in your arm, So take another toke, have a blow for your nose, One more drink, fool, will drown you.” – Lynyrd Skynyrd, That Smell

I am back to posting on schedule, but I am going to change the schedule to posting every other Monday morning.  I decided that this post will be about song lyrics that shed light on the dark side of addiction.  I wanted this to be a little lighter since my last post was pretty difficult for me to write.  If you look up songs about drug use, you will find many.  Some glorify drugs, some require a lot of interpretation and many if they don’t glorify drugs, they don’t add much to the conversation, such as Neil Young’s “The Needle and the Damage Done” or Lynyrd Skynyrd’s  “Needle and the Spoon”.  I have chosen two songs that I find very relatable and insightful.  Please join me in today’s topic “Song Lyrics – Insight into Addiction”.

She Talks to Angels

Even songs that do not glorify drug use tend to sound like drug use is pleasant or cool until you look deeper.  One such song that really covers many aspects of addiction is “She Talks to Angels” by The Black Crowes.  The song is about heroin use and the expression “talks to angels” sounds both fitting and pleasant.  Who wouldn’t want to talk to angels? But the expression is actually acknowledging that when high on heroin, you are very close to death, close enough to talk to the angels.  Unlike many songs about drug use, this song announces its subject from the start, “She never mentions the word addiction in certain company”.  You might also consider that this speaks to the stigma of addiction.  Let’s look at some other quotes:

“Yes, she’ll tell you she’s and orphan, after you meet her family” – This clearly speaks to the alienation that comes with ongoing drug abuse as your friends and family pull back to protect themselves.  Watching someone you love destroy themselves is exceedingly difficult, not to mention the unethical behavior that tends to accompany active addiction.  She has family, yet she is orphaned.

I remember when our son was in high school, he knew a young man in his grade that was heavily abusing drugs.  Our son was appalled that this young man’s parents chose to kick him out of their house when he was still in high school.  I explained that he had younger siblings and his parents probably figured that if he would not change, they should at least protect their younger children.  He understood somewhat but what we didn’t realize was that he was appalled/scared because he was headed down the same path.

“Oh yeah, there’s a smile when the pain comes. Pain’s gonna make everything alright, alright yeah ” – To those that are not familiar or are younger, this statement might sound cool at first, like you are tough if you use.  That is not what it is saying.  What this statement is pointing out is that the conditioning of addiction is so strong that the pain of the needle and the burn of the drug bring a smile because she is conditioned that the high comes next.  She is controlled by the drug (the addicted part of her brain) such that this particular pain is pleasant.

“And the cross from someone she has not met, well, not yet” – This statement is obviously saying that she has not met Jesus/God, yet.  This is open to some interpretation but my first thought is that she has not met Jesus/God yet because she has not died yet.  But she is close, “she talks to angels, says they all know her name”.  Another thought that occurred to me requires an even deeper understanding of addiction and recovery.  Most 12 step programs, AA being the model, stress spirituality and turning your life over to a higher power.  They refer to God as you perceive Him or as he reveals Himself to you. Perhaps the song is saying that she has not met Jesus/God because she has not seriously undertaken recovery.  For many addicts, they will meet God (as they perceive Him) either when they get serious about recovery or when they die.  Or in the case of our son, he did the first and the second happened anyway.

“She don’t know no lover, None that I ever seen. Yeah, to her that ain’t nothing but to me it means, means everything.” – This line chokes me up every time I hear it because it cuts so close.  This line is highlighting the fact that addiction alters your brain such that the most important thing in your life is getting your next fix.  “She don’t know no lover” because she has no room for anything but the drug and “to her that ain’t nothing” because her brain is so twisted that she sees nothing wrong with that.  To the singer, however, “it means everything” because he understands her empty life.  My son was an alcoholic by about the time he hit high school and was using heroin by the start of his senior year.  He never knew the joy of falling in love because his brain was preoccupied with his addictions.  As parents, the knowledge that our son died without ever experiencing falling in love causes us great pain.

Angel by Sarah McLachlan

Angel by Sarah McLachlan is a beautiful performed, wonderful song that the ASPCA is doing its best to ruin with their commercials.  I know she chose to allow it because she values their work, but must I hear it so often with pitiful scenes of neglected and abused animals.  Reminds me of the end of A Clockwork Orange, but I digress.  Even if you don’t know the underlying meaning of this song, it is very touching.  Sarah revealed in an interview that she wrote the song for or about the drummer from Smashing Pumpkins who died of a heroin overdose while on tour.  She said that she didn’t use drugs but could relate to the feeling of loneliness on the road, the pressures of the music business and the need for escape.

This song is not as quotable as She Talks to Angels, but it captures the mood and feelings of inadequacy that I suspect haunts many addicts.  The song sets this tone clearly from the start:

Spend all your time waiting
For that second chance
For a break that would make it okay

There’s always some reason
To feel not good enough
And it’s hard, at the end of the day

And continues later in the song with:

The storm keeps on twisting
Keep on building the lies
That you make up for all that you lack

Sarah’s incredible voice and the stripped-down performance, just piano, bass, and her voice, reinforces those feelings.  Lines like “Memories seep from my veins” give you some indication that this is about heroin.  To me, the underlying theme in the song that relates most to addicts is the need to escape the pain that drove them to use in the first place.

From about the time that I was in junior high, I always wished for serenity and I felt a very strong connection to the Serenity Prayer.  I learned from my son that the Serenity Prayer plays a big role in AA and recovery.  I think that this search for peace and serenity, by escaping the things that plague them, plays a big part in most addict’s lives.  The song hits on this thought many times with lines like:

“I need some distraction, Oh, beautiful release”;

“And the endlessness that you fear”;

“Escape one last time. It’s easier to believe in this sweet madness. Oh, this glorious sadness”

All of the feelings of inadequacy, emptiness and the need to escape them culminate in the end of the song with, “You’re in the arms of the angel, May you find some comfort here”.  Perhaps the comfort in the arms of the angels is like talking to angels in The Black Crowes’ song but given the motivation for the song, I suspect you are in the arms of the angels when you die.  I hope that Nate and all those that lost their battle with addiction find some comfort there.

I guess that I didn’t do a very good job of keeping this light.  Do you have thoughts, songs, or experiences to share? Please comment, let’s work together and help each other to understand this problem.

I hope that you will join me in 2 weeks for a discussion of “Misconceptions, Stigmas Part 2?”.

If you think that you know what all junkies are like, you should read this. Not all addicts are the same, in fact many would surprise you. This post will tell you more about our son, Nate, so that you can get a more personal view of an addict. This will not be a memorial. I am not one for memorials but there are things in Nate’s life that will help you understand addicts better and there are so many people who helped our son that deserve to be thanked publicly.

Nate would have turned twenty-three tomorrow and in a couple of weeks it will be a year since he died. This is a very difficult time for us. In Nate’s eulogy, I spoke of the greatness within him. How he had tremendous integrity, work ethic, honesty, compassion and loyalty. I spoke of how those traits much more than fame or power or wealth define greatness. This sounds like the same old “don’t speak ill of the dead” b.s. that we always hear. The mother of every gangsta that gets killed says what a wonderful boy he was. BUT if you were at Nate’s service..If you knew Nate, you already knew what made him great and you loved him for that. I would be lying if I said that he always exhibited those traits. There was a time, about a year and a half, when his brain was so twisted by addiction that he was not great. We prefer not to remember that time, the Dark Time.

How I Think Nate’s Downfall Started

Nate was born a very fun, smiling child. We nicknamed him “Happy Jack” after a Who song that ironically was about someone who never let things get him down. At about the time Nate started school, he began to have feelings that he was not good enough, smart enough, handsome enough, etc. We all have feelings like that now and then but for Nate they were constant. I am not sure where those feelings came from because we were always very encouraging, but he did have attention deficit disorder (ADD), and a very smart, handsome older brother that set the bar high for him. Nate was a fighter. No one pushed him around and he never allowed someone to pick on some one vulnerable in his presence. But being a fighter didn’t work on his own thoughts about himself. In middle school, he discovered that alcohol would quiet those thoughts and make him more comfortable in social settings. We didn’t learn this until many years later. In high school, he sought out something that would do the job better and he found opiates, his drug of choice. To an emotional, adolescent brain, using drugs to feel better made sense and without a fully developed prefrontal cortex (see Part I – The Adolescent Brain), he could not fully comprehend the risks he was taking.

“Addiction begins with the hope that something “out there” can instantly fill up the emptiness inside.” – Jean Kilbourne

THANK YOU to Nate’s Friends

Nate had a tremendous group of friends that cared for him deeply. Some friends he spent a lot of time with. They tried to help him get straight and stay clean, but he was an alcoholic and then a drug addict before they recognized it. He had other friends that he saw less often but they were always there for him. Nate knew that he had great friends, but he never understood how much they cared for him. His low self-esteem and then his addiction stopped him from seeing that. Whether you, his friends, saw him often or occasionally, you never turned your back on him despite his addiction driven behavior. We owe you so much because you supported him and made Nate’s life better despite his poor choices.

“The truth is that almost two-thirds of Americans have friends or family members who have struggled with addiction. – William Cope Moyers

A Little About the Dark Times

Even in the worst of times, Nate still had the support of family and friends. He always held a job and was a valued and relied upon employee. He always had a place to live, whether it was home or later in a recovery house, half-way house, or place he shared with others in recovery. He took classes at community college (HACC), that he paid for himself. This is not what you probably envision as a junkie but that is what he was. He used opiates at home, late at night when we were asleep. On occasion, I think he used between classes at HACC. When he struggled to get free of opiates on his own, he substituted with alcohol. But your addicted brain does not heal when you are just substituting with another drug. To the outside world he would appear to be just another under-performing 19/20-year-old. Nate was an addict, a functioning addict like so many that manage to live a somewhat normal life and fly under the radar.

Maybe being a functional addict isn’t so bad. NO! There is a hidden price that the addict is paying that is not obvious to a casual observer. As we discussed in the science sections of this blog, addiction consumes you. Getting the drug that your brain is convinced you “need”, is the most important thing in an addict’s life. Nate said that the high from heroin was better than falling in love. I am certain that he never fell in love. There is not room in an active addict’s life for true love. Even though he was the most honest person I knew, he lied frequently when he was controlled by his addiction because you must lie to remain an addict. He stole from me occasionally even though he had a job, because he lost his moral compass to addiction. I know that there are other things, things that I don’t want to know that he did because his brain was twisted by the addiction (we called it drug brain). I know that the things he did would eat at him even when he had drug brain and that made him feel worse about himself and pushed him to use again. It is a vicious cycle that, as we know, the addict cannot break through alone.

We found out that Nate was snorting heroin early in his senior year of high school. We worked with him. We got him help and we naively believed that he was handling it on his own. He was not and those were the dark times during which he began to inject heroin. In an addict’s twisted mind, going from prescription opiates to snorting heroin to injecting heroin is just an economic decision. He was 19-years old when we learned of this and it was amazing how casually he spoke of this. His addiction was in full bloom and he was going to need serious help.

“You need to be bold enough and strong enough to let your loved one’s recovery unfold or not unfold as it is meant to, not as you want it to.” – Carole Bennett

Rehab and the Start of Recovery

We took a lot of money from our retirement to pay to put Nate in a quality rehab facility and step-down counselling program that our insurance wouldn’t cover. Once again, we were naïve and thought that one time in rehab, quality rehab, could bring our son back. While in the step-down program, living in a recovery house, and attending AA meetings, he relapsed. I have frequently heard that it takes an average of six trips to rehab before an addict finds lasting recovery. That is AVERAGE, some it takes many more times, some die before they ever succeed. We naively thought that we/he were special. We were wrong. Nate went back to in-patient rehab in a facility that insurance would cover. When he got out, we pushed hard, very hard, and got him to live in a halfway house. A halfway house has tighter restrictions and more requirements to attend meetings than a recovery house and he hated it. But the halfway house (Gatehouse for Men in Lititz), the AA meetings, and the support of the sober community helped Nate’s brain heal. By age twenty, Nate was on his way to fixing his drug addled brain.

THANK YOU to the Sober Community of Lancaster

By the time Nate moved back home from the halfway house we could see the signs of the old Nate, the Nate that we were so proud of returning to us. We had remained very supportive and saw Nate often, his friends were still there for him, but we know that it was the support and guidance of the sober community that allowed Nate to gain ground in recovery. There is no way that we can repay those people in the sober community that helped Nate, especially his sponsors and “grand-sponsor”. THANK YOU!

Nate was young, bright, caring, and honest. Everyone wanted to see him succeed. I learned from people in AA that he was a very inspirational speaker, a side of him that we were never fortunate enough to see. Nate also reconnected with his friends, who were happy to see the old Nate back. They stood by him even though they were all turning 21 and wanted to hit the bars and he could not. Usually someone stayed back to spend time with Nate while the others went out.

THANK YOU to Bart Fire Company QRS

While living at home, Nate began to relapse again. He was doing so well, we have no idea what triggered his relapse. We had no idea that he was having a problem again. Honesty fell by the wayside but for the most part he remained “our Nate”. We never saw it coming when he OD’d in in our family room, before dinner. It was January 2017 and we found ourselves beside two State Troopers in our family room, our youngest son sprawled on the floor while five EMTs kept him breathing and three shots of Narcan brought Nate back. Nate had returned to heroin and as often happens to someone in recovery, he overdosed because abstinence had lowered his “dose” and he overshot it. Opiates suppress respiration and as we called 911 his respiration slowed to almost none at all. Lucky for us, Bart Fire Company QRS was close and they started breathing for Nate. His heart was still beating so this action literally kept him alive until the Narcan kicked in. Bart Fire Company QRS saved Nate’s life and they gave us something so great, I doubt that they will ever understand. THANK YOU!

THANK YOU to the Ingham’s Powder Coating

Before his relapse, Nate had been working for Ingham’s Powder Coating in Denver, PA. Nate was a very hard worker and Ingham’s did not hesitate to show him how much they appreciated him. After Nate OD’d he called his boss, the owner, to explain. He told Nate to get himself better and call them, he would have his job back. His boss said that they loved having him work for Ingham’s but he couldn’t work there if he was using. Nate went into rehab for the third time. When he got out, he dove back into AA on a mission and Ingham’s stood by their word and gave him his old job back. We know how much the people at Ingham’s loved Nate, they told us. But I doubt that they can understand how much they helped Nate’s self-esteem by taking him back. THANK YOU!

“Recovery is not simple abstinence. It’s about healing the brain, remembering how to feel, learning how to make good decisions, becoming the kind of person who can engage in healthy relationships, cultivating the willingness to accept help from others, daring to be honest, and opening up to doing.” – Debra Jay

The End

After his third trip to rehab, Nate tore into his recovery with a vengeance. While away and in rehab he lost a very good friend of his that had been sober for three years to a relapse. This inspired him, he told me that the only difference between himself and his friend is that there was no one there to find his friend when he OD’d. He went to meetings frequently and even helped establish an AA meeting near home. We saw signs that Nate’s recovery was doing very well. He was more empathetic than he had been, more curious, more caring. He even had a friend of ours start teaching him to weld. He bought a welder and practiced between lessons. We had our old Nate back, even better and saw a potential bright future that we had not been able to envision for a long time. During this time Nate lived at home for a time, he lived in a recovery house, and he lived in a house with three other people who were in recovery/sober. All that I had read about the science of the how’s and why’s of addiction and recovery, we saw in him.

Then one Friday night in late July, after receiving his 6-month token, Nate overdosed on Oxycontin. He was alone in his room. If you need proof of how addiction alters your brain, consider this: Nate told me six months prior that the difference between his being alive and his friend being dead was that his friend was alone when he used. Nate joined him for the same reason. The “need” to use and to keep it a secret overwhelmed any thought about the ultimate potential risk.

Still Think You Know What All Addicts Are Like?

Nate was not unique. There are many addicts that you would never guess are addicts unless you knew them very well. There are many addicts who are now dead from their addiction. Nate was a hardworking, caring, contributing member of society. There are many addicts like that. You don’t see them. You see the addicts that are on the street, panhandling. They are suffering the same fate but perhaps they do not have the support network, perhaps there are underlying psychological hurdles, perhaps they are just not as good at hiding their addiction.

If everyone would take the time to understand addiction. Read about the science of addiction to really understand. There would be more compassion. There would be a better understanding of what needs to be done. And, hopefully, someone smarter than me will find a better answer than the ones that we have now.

Do you have thoughts or experiences to share? Please comment. Like I said in the beginning, this is a difficult time for us. I will probably miss next Monday’s deadline but please continue to check back there is still much to be said.

“If one oversteps the bounds of moderation, the greatest pleasures cease to please.” – Epictetus

Today’s installment is about Rehab, Recovery, and Treatment.  There are many people more knowledgeable on these topics than I, but I have several thoughts and experiences that I would like to share.  I had intended to discuss what addiction is like, but I feel that I should gather more information before I address that topic.  Recovery is a lifelong journey that tests individuals to their limits in the earlier phases but can lead to a rewarding life of understanding and compassion.  This post will only scratch the surface of this topic, so I welcome your thoughts and experiences.

What are We Fixing in Rehab and Recovery?

The addict, in the words of the warden in Cool Hand Luke, needs to “get their mind right”.  What specifically does this mean?  As we discussed in the science of addiction posts, the addict’s brain has been changed as a result of the addiction.  Conditioning has caused the addict’s brain to change such that the parts of the brain that reinforce addiction have been strengthened and those parts that would stand in the way of addiction have been diminished.  Therefore, we need to help the addict avoid the drug and focus on the morals and ethics that have been ignored.  To bring back the analogy that I used before, the addict needs to avoid the highway (neural pathways) that has been built and reinforced by the addiction and rebuild the neglected roadways of their former self.  Before the addict can accomplish this task, there are many dragons that they must slay.

Withdrawal and Detox

When an addict enters rehab, the first aspect of rehab is called detox, short for detoxicification.  Detox involves the physical withdrawal that the addict must get through before the real work of recovery can begin.  Trying to avoid the experience of withdrawal is one of the things that keeps an addict returning to the drug or at a minimum replacing the drug with another. Most drugs to which you can become addicted cause both a physical and psychological addiction.  Both of these aspects of addiction are horrible and while the physical withdrawal takes a terrible toll on your body, it is acute, short-lived.

When your loved-one goes into a facility for rehab, you are usually expected to attend a seminar at the facility.  Much of this seminar focusses on the need to help and support your loved-one without facilitating their addiction (more on this later in this post). There was, however, other information in those seminars that I found interesting.  One statement that particularly struck me was that physical withdrawal from alcoholism can kill you.  Heroin withdrawal won’t kill you, but it will make you wish you were dead.  To some degree, the physical effects of withdrawal are the opposite of the effects that the drug induced. This is because your body has developed a tolerance for the drug and then it doesn’t have it anymore.  For example, when opiate use that calms and relaxes you is halted, you are agitated and full of anxiety, to the point of panic attacks.

Our son fought our attempts to get him in rehab for a long time for reasons that he would not share with us.  Finally, one night he overdosed (just shy of killing him) and I sat up with him all night as he nodded.  Through much persuasion (otherwise known as nagging) we got him to understand that he was not going to survive if he kept on using and he agreed to enter rehab.  He was terrified of the physical withdrawal that he would experience during detox.  We never discussed what he experienced in detox but before he went in to rehab for the first time, he told me what he had heard from others.  In Nate’s words, “you lie in bed for a few days in tremendous pain throughout your whole body, chills, cold-sweats, shitting and puking on yourself.”  No wonder he was scared.  No wonder addicts will do anything to avoid withdrawal.  Before an addict will be able to take this on, they must genuinely want to get clean.

Oftentimes, addicts are given opiate replacement drugs, like methadone or suboxone, to ease some of the symptoms.  With or without therapeutic drugs, detox is a horrendous experience for everyone.  While battling the overwhelming physical withdrawal, the addict has to deal with the psychological effects, as well.  One of the worst experiences we had as parents occurred the second time that our son was in rehab.  This particular facility allowed patients to make outside phone calls.  We and other son experienced almost a week of nightly phone calls where our son, in sheer panic, was telling us he had to get out of the facility.  He thought that he couldn’t stand the confining nature of rehab, but we knew it was his “drug-brain” panicking because it could not get what it knew it needed to survive.

Recovery and Treatment

Treatment for addiction after the detox phase is completed can be done on an outpatient basis, short-term rehab or long-term rehab. In addition to therapy, one of the primary purposes of inpatient rehab is to keep the addict away from their drug of choice.  Probably the most common treatment is a short-term (30 days or more) as a continuation after detox.  The most effective treatment is a long-term stay of 6 to 12 months.  This long-term stay gives the addict more time to focus on recovery without distractions.  Unfortunately, the cost of long-term housing, therapy, and the lack of income causes this option to be out of reach of most individuals.  Given the scale of the drug abuse epidemic, society as a whole could not even bear the economic impact of getting all addicts into long-term rehab.

Treatment of addiction can take many forms.  The addict may choose to use a therapeutic replacement drug such as methadone, buprenorphine (suboxone), naltrexone (vivitrol) and others.  These drugs reduce the symptoms of withdrawal and reduce the cravings to use.  This treatment is most effective when combined with cognitive behavioral therapy.  While the use of a replacement drug is frequently not condoned by 12-step programs, it appears to be the only way that some addicts can remain clean.  Another form of treatment usually involves cognitive behavioral therapy also referred to as talk therapy.  Cognitive behavioral therapy helps the addict in recovery to explore behavior and thoughts that led to drug use, explore the impacts of their addiction and find coping skills to remain clean.  I include 12-step programs such as Alcoholics Anonymous (AA) in this heading even though AA offers much more support than just discussion.

For an addict to remain in recovery for the long haul, I believe that the addict must address the underlying issues that may have helped lead to addictive behavior and must rebuild the person that they once were.  This is the role of cognitive behavioral therapy and 12-step programs.

The process of becoming an addict was the result of extremely powerful conditioning that caused extensive changes in the addict’s brain.  The addiction occurred rapidly because of strong, active forces in response to the drug, whereas, recovery is a long slow process because the brain is being changed back by the much less powerful force of cognitive behavioral therapy.

Facilitating Addiction

One if not THE greatest challenge for the friends and loved-ones of an addict is to walk the very fine line between helping and supporting the person, while not helping or supporting their addiction.  As parents, we had to make very difficult choices such as:

–          Do we allow access to a car so that he could work, knowing that same car may be used to go meet “his man”?

–          Do we allow him to have a cell phone which we all seem to need these days, knowing that the same phone could be used to arrange a buy?

–          Do we allow him to live at home, knowing that home is where he frequently used and so it may be a trigger for him to use again?

–          And too many other questions to list.

The answers to these questions depends on the addict’s state of mind.  You may also think that it depends on your relationship with the addict but be careful, addicts are great manipulators. The advice that we were always given was to error on the side of being too tough rather than too easy.  If you are too tough, the addict will eventually see that you did this out of love for them as he/she advances on recovery.  But too easy and it is unlikely that the addict will stay in recovery.

Do you have thoughts to share? Please comment.

“Attack the evil that is within yourself, rather than attacking the evil that is in others.”
― Confucius

I wanted to change things up a little in today’s installment and share my views regarding addiction and probably the most common question in our culture today. Who’s to blame? Unfortunately, I think that we expend way too much effort looking for the one individual or organization that is to blame for whatever problem or recent disaster that we see. There will always be a limit to our resources, so it is counter-productive to expend effort berating/shaming/suing the “responsible party” when we could be trying to solve the problem. So, let’s settle this once and for all (sarcasm) with today’s addiction topic, “Who’s to Blame for the Opioid Crisis?”.

The Addict?

I think that in every installment that I have written, I have stated that addicts need to accept responsibility for their initiating mistakes/actions, with the understanding that addiction then rapidly changed their thought processes.  I believe, and that belief comes from people who are much more knowledgeable and experienced than I, that accepting responsibility is essential to recovery.  As discussed in previous installments though, we cannot hang all the blame on the addict as there are factors that lead to addiction that are outside of an individual’s control and addiction itself overwhelms self-control.

Is the addict to blame?  Somewhat, but let’s hold off on the torches and pitchforks.  As a family, we suffered tremendously from our son’s addiction, but not nearly as much as he suffered.  He never wanted to hurt us, and he certainly never wanted to suffer the way he did.  Initially using drugs was a big mistake that he made, with consequences that are far greater than the rewards.

Dealers and Suppliers of Illegal Drugs

Back in the seventies, you had to “watch out for the pusher” that person that would tempt you or trick you with drugs.  Maybe that was real or maybe that is what we told ourselves, but now we have dealers.  Dealers may tempt you, but it seems that they don’t have to work as hard as the pusherman did.  Most street-level dealers are just users supporting their own addiction, it is the suppliers that make the big money at our expense.  Most of our illegal hard drugs are brought in from south of the border.  Fentanyl precursors are manufactured in China and sold to drug cartels south of the border where they make the fentanyl, package it and ship it north to destroy our society.  Now that we have made it hard to get the supplies to cook crystal meth locally, it is being manufactured by drug cartels that ship it north and sell it cheaply.  It really is a win-win situation for them because they make lots of money and they destroy the USA at the same time.

So, is it all the fault of the illegal, foreign drug suppliers?  Somewhat, but if no one was buying they wouldn’t be selling.  I don’t think that it is commonly the pusherman that starts the problem, they just exploit it.

Big Pharmaceutical Companies

Pharmaceutical companies make money by manufacturing, marketing, and selling legal drugs that make our life and life expectancy much better.  We know that some pharmaceutical companies marketed the use of opiate pain killers for chronic (long-term) pain, when they knew it was only effective for acute (short-term) pain like you have after surgery.  Some companies sold opiate pain killers in quantities that were far too great for the area in which they were sent.  In other words, they knew or should have known that some of what they sold was not being used as intended.  When we cracked down on the sale of legal opiates, the unintended consequence was that many addicts turned to heroin because it was cheaper.  In the addict’s twisted thoughts, it becomes an economic decision to use heroin.

Are big pharmaceuticals to blame for the opiate crisis because they caused the demand and made money continuing to supply opiates when they knew that they were being abused?  Somewhat, they probably have a role in the problem, but they are not the main cause. Sure, there are some addicts that inadvertently got hooked but I suspect that many if not most addicts had some idea what they were doing when they started abusing the drug. The pharmaceutical companies make drugs that help us in so many ways, but greed may have caused some to turn a blind eye to the abuse.

The Government

You may believe that the Government is responsible for making sure that we are all safe, so they fell down on the job when they let legal drugs get abused and illegal drugs come across the border.  I can’t accept that argument.  I believe that we must accept responsibility for our own safety.  Here come my political leanings.  The Government should provide things like national security, disaster relief, the police, courts, and common things that we all use like roads, but we are only truly free when we accept responsibility to take care of ourselves.  On the other hand, many of the drugs that are abused come across the border so doesn’t that make it a national security issue.  Can’t the Government do more to help with recovery?  In my opinion, of course they can but first we all need to understand the problem and that is what this blog is all about.

Is the Government to blame for our problems?  The whole national security/drugs crossing the border thing is an interesting spin, but in my opinion, it is just that spin.  In my opinion, the Government must continue to try to stop the flow of drugs into this country, but you will never stop the supply until you stop the demand.  So, like our current administration or hate them, like our former administrations or hate them, it doesn’t matter, let’s stop wasting our energy scapegoating them for something that is not their fault.

Doctors and (Impatient) Patients

This one may not make me too popular but let’s be honest.  Sure, there are some bad physicians out there who overprescribe, run pill mills, but most doctors are conscientious and truly care about the well-being of their patients.  The problem as I see it is that many people have become impatient and lazy.  Many don’t want to put up with whatever malady they have and don’t want to put effort into their treatment or recovery.  “I am uncomfortable, can’t you just give me a pill for that.”  Our expectations of the health care system are too high.  We want something outside of ourselves to “fix what ails us”, rather than putting forth the very heavy effort of working through it ourselves.  This is one reason that I strongly favor physical therapy.

Are we to blame for the opioid crisis?  No, I never made anyone use drugs or even suggested that they should.  I doubt that you did either.  BUT our attitudes and expectations toward health care may be contributing to the addiction crisis.  My son began using because he was looking for a way to quiet the thoughts in his head that made him feel that he was no good and he was far from unique.  Turning to something outside himself is what society showed him is the way to fix it.

So, Who Is to Blame for the Opioid Crisis

I am sure you saw this conclusion coming from a mile away.  To some degree we are all to blame.  So, it is settled, quick pointing a finger, quit wagging a finger, put that finger away and use your hands to help end this crisis.  Make some effort to understand what is going on, to understand addiction and the addict, so that you can see the changes that we need to make, then do something about them.

It is obvious that we need to do what we can to cut off the supply of drugs that are being abused and we have made great strides in that area.  But to solve the problem we must stop making more addicts and help those that are already in addiction’s grip.  The supply only exists because the demand exists.  And my personal opinion, the government needs to take a big role in addressing supply and demand but we (and I mean everyone) needs to make an effort to understand and we need to roll up our sleeves and help where we can.  Maybe you feel strongly that you should put some effort into a problem other than addiction like poverty, cancer, etc. Good for you, do it.  What I am saying is let’s be more understanding, less judgmental, and do something to make things better for everyone.

Do you have thoughts to share? Please comment, let’s work together and help each other to solve this problem.

I hope that you will join me next week for a discussion of “You Should Know What Addiction is Like”.

“Rock bottom became the solid foundation on which I rebuilt my life.” – J.K. Rowling

“Don’t judge me by my past, I don’t live there anymore.” – Anonymous

Now that we have covered the science, welcome to the first discussion topic of this blog. I would like to present my thoughts on various topics related to addiction to start a discussion. I would like to hear your thoughts and I hope that these topics will spur on conversations with your friends and family. Today’s topic is “Misconceptions and Stigmas Part 1”.

They Just Want to Get High. I Have Responsibilities.

This statement is probably one of the most offensive statements that I have heard regarding addicts. It manages to reveal both the ignorance and the self-righteousness of the speaker in just nine words. They just want to get high shows that this person does not understand what addiction does. The underlying thought here is that addicts are just enjoying themselves and doing what they want. I cannot speak from my own knowledge but from listening to addicts, I don’t believe that using is what they want to do because it is fun. It is what they need to do to avoid withdrawal and because their brain is using every resource it has to drive them to use what they (think they) need to survive. I have heard addicts say, “I am so tired. I just want to stop.” That doesn’t sound like someone having fun to me.

It is the self-righteousness that gets under my skin the most. I can deal with ignorance. You can learn and not be ignorant about the topic anymore. Self-righteousness, though, stands in the way of learning, of understanding, of empathy. “I have responsibilities” says I would like to have fun but I am not weak-minded like you. I do what needs to be done because I am upright and moral. The addict is doing what needs to be done also. It is just that the addict’s brain has been altered to believe that using is what needs to be done. Go back and reread the science, once addiction has set in, this is a physical change not a character issue.

Narcan Is a Waste of My Tax Dollars, They Will Just Use Again

This one hits close to home for me, but I also understand because I would rather pay less taxes, too. It hits close to home because in January 2017 we found our son overdosed in our family room and he was revived using Narcan. He had been in recovery and had relapsed. We were unaware of this. We got him immediately back into rehab and he got back to work on his AA steps and meetings. He was doing so well. We were so proud. He was a terrific young man. Six months later he relapsed. He was alone this time and we lost him. Without Narcan and Bart Fire Company QRS, we would not have had those six months and we would not have seen the man he could become. In his eulogy, I spoke of his greatness. Greatness that we saw so much of during those six months. If you don’t think that Narcan is worth it, come talk to me about my son.

It is true that addicts frequently use not long after they have been revived with Narcan. This makes no sense to us because we cannot understand the way that their brain is functioning. You just died and were brought back, and you are going to return to the thing that killed you? Try thinking about it this way. You are starving to death, literally. You found some food, ate it and it turned out to be spoiled. You got very sick and nearly died. If the only food that you could get might also be spoiled, would you eat it? Of course you would, you are starving to death. You will die without it. This is how the addict’s brain views the drug. Their brain knows, that they need the drug to survive. Their brain is wrong, but what your brain believes is your reality..right or wrong.

Narcan Makes Addicts Feel Safe to Use Again

There may be a kernel of truth to this misconception. Of course, knowing that you can be revived makes you feel safer but addicts are generally not considering that they may die when they are using. When an addict is being driven to use, that is the entire focus of the brain. At that moment, they are not thinking of any of the potential impacts of what they are about to do. They are focused on getting what they need. When they have gotten their fix, when the need to use has been satiated, they may consider the potential impacts of what they have done. But when their brain is once again screaming that they must use, nothing else matters, not even death.

Three Strikes, You’re Out! They Are Probably Just Committing Suicide

This is a concept that I have heard floated and I think it comes from those that want to be compassionate but don’t quite understand how addiction works. There is a frustration that comes from not understanding how someone can keep doing things that kill them. I don’t think that we can ever fully understand that, but it is one of the reasons that I feel so strongly about educating everyone. Perhaps in some instances, an addict has had enough, and they have tried to check out. I don’t, however, believe that someone who has been revived with Narcan has tried to end their life. Addicts are quite resourceful, and creative about hiding what they are doing. If an addict wants to die, they will succeed. They know what will kill them and they know how to hide it.

Addicts overdose because they need to hit an ever-narrowing window between satisfying their need and death. As their tolerance builds, the distance between high and dead keeps getting smaller. Not only that, but they are using something with varying potency to try to hit that window. There is no FDA standard for heroin. Going back to the starvation analogy, if it might kill you but you will starve without it, you’ll eat it.

Please don’t think that I am making excuses. I believe that to succeed in recovery, an addict must accept what they have done. BUT

• Addicts do not choose to continue to use, they need to use.
• Willpower will not get an addict to stop because all of the willpower that they have to stop is also being used against them by their altered brain, to protect their addiction. Likewise, there is no threat that can be used to make an addict seek help.
• If you are not an addict, congratulations you got lucky. You don’t get to look down on addicts because you were born into a healthy environment and you won in genetic roulette.
• Addicts can succeed in managing their addiction but it requires help, support, understanding, and lots of time.

Do you have thoughts or experiences to share? Please comment, let’s work together and help each other to understand this problem.

I hope that you will join me next week for a discussion of “Who’s to Blame?”.