Category Archives: drugs

America’s Prison Problem

This article about a reporter who worked as a guard at a private prison in Louisiana is long, but it is a must read. Reading it so soon after that last season of Orange is the New Black, it was really grueling (there’s nothing about the show in the article). If you were wondering if for profit prisons are as bad as they are depicted in the show, the answer unfortunately is, they are worse. And the most enraging thing? For profit prisons are designed to keep people in the criminal justice system so they can continue to get paid for warehousing people.

We as a country need to ask if we want to continue spending millions to imprison people in depraved circumstances indefinitely, or if we want to set up a society that focuses on prevention and rehabilitation. There are many ways to do this. Improve our schools. Decriminalize drugs. Make sure every woman who wants birth control has affordable access to it. Increase funding for mental health services and respite care for people caring for family members with mental illness. Raise the minimum wage and tie it to inflation.

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Twisted Morality

Before modern times, a laboring woman faced three choices if the baby was unable to descend through her pelvis. A cranioctomy could be performed on the fetus, where a hole is drilled into its skull and it’s brain removed to allow the head to come out. The mother would live, the fetus would not. The second option was a c-section, which would undoubtedly be fatal to the mother as, before the invention of modern medical techniques, there was no way to suture the uterus to prevent her from bleeding out. The baby would live, the mother would not. Of course, the work around solution would be to perform a hysterectomy along with the c-section, which would both save the mother and the baby. But while this solution was know about, it was condemned by the Catholic Church.

The reason? It would enable couples to have non-procreative sex.

Yes, to prevent people have having non-procreative sex, the Catholic Church would have rather the mother died during childbirth. Better a woman should be dead than engaging in sex for non-procreative reasons!

And here is what I want to stress. The focus of the Catholic Church, conservative protestants and others in the so-called pro-life movement is not about the health and well being about the baby as they have spun it, it’s about people have sex for pleasure. If the pro-life movement was about preventing abortions, then they would be backing LARCs.

Haven’t heard about LARCs? These are otherwise known as Long Acting Reversible Contraceptives. Essentially birth control that lasts for years so you don’t have to worry about taking a pill every day or slipping on a condom that could break. These are also reversible so if you decide to have a baby, they can be removed and you can procreate at your leisure. And the failure rate is less than 1%. They are extremely reliable. Examples include the IUD and implants.

In Colorado, they were responsible for lowering the teen pregnancy rate by 40% in 6 years (and the abortion rate fell by 35%) GOP “pro-life” Republicans refused to continue funding this successful program, because “morality.”

It’s not just teens in Colorado. In the US, the rates of unintended pregnancy are at an all time low thanks to the IUD.

Birth control has achieved what years of abstinence programs and attacks on abortions have not, drastic drops in the rates of unintended pregnancies AND abortions. Birth control works. And all of the arguments I’ve seen against birth control are based on a person’s religious beliefs and that whole morality thing about fears of people having non-procreative sex.

Here’s the thing, this moral panic about people having non-procreative sex? Its getting in the way of implementing policies that are good for the health and well being of the nation. And unplanned pregnancy is a situation that is not good for anyone and which, despite the promoting of adoption, there is no perfect choice.

Recently the CDC got into a flap about the risk of alcohol use during pregnancy. Having worked with substance use and seen the effects of FASD first hand, as well as the tragic situation women who are addicted to opioids find themselves in when they get unexpectedly pregnant.Alcohol use is extremely detrimental to a developing fetus, and the worst time to drink is when most women don’t realize that they are even pregnant! This can cause severe mental retardation and a host of other complications. Women addicted to opioids who become pregnant are at an increased risk of miscarriage if they try to STOP using drugs, and therefore have to continue using drugs (hopefully while monitored by a doctor). Unfortunately, the baby is born addicted to opioids and has to go through detox. This is not a great first start in life: being born addicted to a drug, and spending weeks detoxing at a hospital and not a nurturing home. For women who have gone through this, it is agonizing.

I bring this up as an example of the value of having a planned pregnancy. When a woman chooses to get pregnant, she usually pays a lot of attention to her life choices, eliminating alcohol and other harmful substances from her diet.

Drug exposure is not the only thing we have to worry about. Zika has recently exploded as a public health crisis. Exposure to zika while pregnant is likely linked with microcephaly and Guillain-Bare syndrome and a host of other birth defects. There have been cases of zika in the US and my husband who works for the city government is privy to the measures that they are starting to take to prepare for it here in Texas. In fact, I’m dismayed that with this new public health crisis more isn’t being done to make sure women in those areas have access to LARCs, which, in the case of Texas, would mean not fighting Planned Parenthood and working with them to make sure women who wants LARCs have them! But, as we have defunded Planned Parenthood, pregnancy rates are up. Further, the Texas government was so unhappy with this report that they have attacked the researchers. Once again, concerns about moral indecency vs public health is what is influencing policy here, and when research flies in the face of morality, rather than changing our policies, we’re attacking the people doing the research.

I’m about finding solutions that work that protect the health and well being of women and enable them to bring healthy infants into this world. LARCs dramatically reduce the unplanned pregnancy rate, AND they dramatically reduce the abortion rate. They allow a woman to decide when she is ready to have a baby, and therefore allow her to make sure her environment and her body is health when she chooses to get pregnant. This increases the chance of healthy moms having healthy kids.

Fretting about “morality” is not doing anything for the health and well being of women and their babies. In fact, it is doing a lot of harm. This so-call morality is not morality, it is ultimately about control. This is about the church dictating when it is okay to have sex and when it is not.

My morality is about putting policies and resources in place to make sure every woman who wants one has access to LARCs. It’s better for women, it’s better for men, and it’s better for the babies.



Substance Use Treatment

I’ve been trying to write about the problems with substance use treatment in the US since I quit the field in November but haven’t been able to. I’ve been so burnt out from the topic that I even removed songs about drug and alcohol use from my MP3 list. Before I got a job at an outpatient substance use clinic about four years ago, I never had any interest in the subject. I was never interested in trying illegal drugs. I’ve never even smoked a cigarette. I have the occasional drink, but always stop at one drink per evening, and the only time I deliberately tried to get drunk was during my bachelorette party, and I really didn’t succeed because I didn’t like the feeling of being buzzed and stopped there.

The only history of substance use disorder in my family is my great-grandfather, who I never met.My parents don’t drink, not for moral reasons but because my dad, the pickiest eater of all time, just can’t stand the taste of alcohol. Aside from contending with asthma attacks triggered by second hand smoke, substance use did not affect me or my family growing up. Because of this, all of those contentious political questions about substance use that get everyone else so fired up didn’t interest me. As opinionated as I am, I didn’t have any opinions about legalization or 12 steps groups. I didn’t know enough or care enough to have an opinion about them.

Four years later, and I maintain that all of the issues are more complex than either side makes them out to be. But one thing I believe most people can agree on is the state of substance use treatment in the US is in shambles. NPR had an article about it today that just barely touched the tip of the iceberg.

So what do we need to do to improve substance use treatment in this country?

  1. Ditch the 12 Step Model and move to more evidence based techniques. OK, Alcoholics Anonymous and Narcotics Anonymous works very well for some people, but it does not work for the majority of people with substance use problems. Further, there are several aspects of these programs that conflict with modern findings about substance use and are dangerous for people in recovery. For a complete break down, see The Sober Truth.
  2. Primarily, the people providing treatment are LCDCs. LCDCs are poorly trained and tend to be in recovery themselves. I am an LPC and went to school for 6 years, have a Masters, and can treat the whole mental health spectrum. An LCDC goes to school for two years post high school at most (some with just a high school degree are grandfathered in, and the ones who tend to work in jails just have a certificate). They can only treat substance use, yet as substance use tends to be co-morbid with other disorders and, face it, substance use IS mental health, there’s a lot they can’t address. Further, counseling is more than just listening and giving advice (in fact, if your counselor is giving you advice I’d recommend finding a new counselor). And the sessions lead by and LCDC that I’ve set in on were not counseling. Some were cringe worthy. And further, a lot, but not all, LCDCs have serious mental problems themselves. There was one I was training when I was about to go on maternity leave in a week, and I had to tell my boss there was no way I could leave my clients with her. The least harmless thing she did was, when I gave her a list of referrals that I give to clients for case management purposes, she went to live at one of the women’s shelters listed. Knowing that we send clients there. Can you imagine going to live at a shelter and finding your counselor living there?
  3. As the NPR article addressed, the pay is poor. Especially for what the counselors have to deal with. People who go to substance use treatment are often forced into it. In our case, most of our clients have had their children removed by Child Protective Services. So we’re dealing with people feeling a lot of grief and shame because they lost their children AND who are in withdrawal. Some people come in very eager to cooperate and put their best face forward. Others, I can’t begin to describe the depths of their anger. Maintaining your cool and helping them to defuse that anger is draining. $40,000 a year does not begin cover the mental toil this takes on a person after awhile.
  4. The burn out. I was aware I was burnt out, but I wasn’t aware of just how bad it was until I got away from working there. And in my case I will say my boss did a lot to help us manage burn out. It’s why I lasted there as long as I did. We had work retreats about once a year. Last year, though, the Monday after my work retreat I spent an evening on the phone with a suicidal client who would not tell me her location (I did successfully talk her down). All of the relaxation I got from the retreat was undone by that Monday and I was even worse than before I went on the retreat. Suicide calls are emotionally draining and extremely anxiety provoking for counselors because we’re put into a confidentiality trap (if we break confidentiality and call the police, we could be sued successfully and lose our license, but if we don’t call the police and they kill themselves, then we can also be sued successfully and lose our license). Add to it that I, like most counselors I know, struggle with anxiety, it put me in a real bad spot. Really I think there needs to be a counselor contracted with clinics that counselors who work there can go to free of charge. The other thing my boss wanted to do but she could never get the staff to do it was have a counselor rotate among the staff so the counselors could have a break to develop curricula or do research or something else, but have a break from working with clients while still doing work vital to the company. I think having these role changes would have helped. And here’s the thing, having counselors who are energized and clear headed helps the clients. So it is vital the make sure the counselors are kept emotionally healthy.
  5. Increase the length of stay for people in treatment. It takes time for the brain to heal from substance use. Outpatient programs are about three months long. When a person stops using drugs, one of the times they are most likely to relapse is three months after getting clean. See a problem? Further, a lot of the times the problems a person coming in for treatment faces are so complex it’s going to take a lot more than three months to fix.
  6. Get as much of the family in treatment as possible. When one member of the family has a problem, the whole family has that problem. A lot of times I would feel like I put a fish in the bag, taught it some nice coping skills, and then threw it back in with the sharks. People with substance use disorders tend to come from families who have problems with substance use. Very few of them are willing to say good bye to their family forever or to tell them they can’t use drugs around them. So that individual completes treatment, and most of the time I think they genuinely believe they will be strong enough not to use around their family, and then BOOM, they’re back in treatment.
  7. Evidence based treatment, evidence based treatment, evidence based treatment. This means cognitive behavioral therapy. This means accepting that medication may be useful for some people rather than treating that medication as another addiction. However, it also means not going the opposite extreme and expecting to give a pill as a solution to every problem (as I said above, the reality is more complex than any side would maintain). Here’s what we do know, though. Addiction is not about will power. There is a biological competent. There are maladaptive thought patterns. A person’s environment plays a strong role in whether or not they will relapse. Good treatment needs to take all of those factors into consideration.

OK, that’s all I can do about this topic today. May be in another three months I’ll write more.