CULTURE OF DEATH?

To kill or not to kill? That is the question. It has tentacles into our legal practice of capital punishment, our medical practices of abortion or euthanasia, and our civil conduct of war.

An opinion article by Timothy Kudo—a captain in the US Marines and grad student at NY University—in the February 27, 2015, Friday issue of the New York Times is a thoughtful and thought provoking piece: well worth a careful read.

I saw it in the NYT Sunday Review. After describing his training, and the march of circumstantial logic that required him to answer the question in the affirmative, he invites us to look at the cultural fabric into which his and our answers are woven. Kudo served in Iraq in 2009, and in Afghanistan from 2010 to 2011, according to the article. Appropriately, the title states “How We Learned to Kill.” The final paragraphs read:

… The fog of war doesn’t just limit what you can know; it creates doubt about everything you’re certain that you know.
The madness of war is that while this system is in place to kill people, it may actually be necessary for the greater good. We live in a dangerous world where killing and torture exist and where the persecution of the weak by the powerful is closer to the norm than the civil society where we get our Starbucks. Ensuring our own safety and the defense of a peaceful world may require training boys and girls to kill, creating technology that allows us to destroy anyone on the planet instantly, dehumanizing large segments of the global population and then claiming there is a moral sanctity in killing. To fathom this system and accept its use for the greater good is to understand that we still live in a state of nature.
If this era of war ever ends, and we emerge from the slumber of automated killing to the daylight of moral questioning, we will face a reckoning. If we are honest with ourselves, the answers won’t be simple.
T.Kudo; New York Times Sunday Review; March 1, 2015

All social ethics related to mastery over life flow, fundamentally, from the right of a people to self-governance. 20th Century standup comic Lenny Bruce famously caricatured a basic civics lesson from the needs of people to eat, defecate, and sleep. Common agreements are negotiated about how that should be structured to keep everyone satisfied. After agreements create an equitable solution, someone chooses to flaunt personal power or address perceived injury by breaking the rules.
Then, we, the people, pick a rule enforcer whose authority and sway supersedes individual right, according to Bruce.

That is the beginning, and the definition, of the problem: individual right versus an enforced social standard. If we accept the premise that social values have more weight than individual rights (points humorously made by Bruce) then we must accept that it will end in someone falling victim to society’s management of his or her “excesses.”

If we are ever to get the genie back into the bottle, we must find a way to utilize language to depolarize the extremes between social mores and individual freedoms. Calling the Unabomber’s actions “excesses” may seem atrocious use of language to us. But we must take responsibility for the “surgical bombings” that decimate villages in Pakistan and Afghanistan. These same bombings are creating the rationale for wars not yet begun in the minds of the horrified children in those villages, who witness our unintended “excesses.”

US abortion rates add to the “excesses.” The following was downloaded 05/28/15 from the Center for Disease Control site: http://www.cdc.gov/reproductivehealth/data_stats/ “In 2011, 730,322 legal induced abortions were reported to CDC from 49 reporting areas. The abortion rate was 13.9 abortions per 1,000 women aged 15–44 years and the abortion ratio was 219 abortions per 1,000 live births.” Nearly 18 per cent of all US pregnancies end in abortion.

When abortion has morphed into ‘another form of birth control,’ one has to ask, do those “prevented” children have a voice in the debate over their fate? How may that voice ever be heard? While the maternal mortality rate in the abortion process is higher than for live births, we seem stuck on arguing in favor of this right for the mothers involved, while we conveniently overlook the mortality rates for those women, and completely eliminate the voice of reason that asks, “To whom, exactly, are we denying life?”

The Women’s Movement has chosen to focus on women’s reproductive rights in the abortion/birth control debate. What of male responsibility in the process? Are men being given the message, “It’s not your decision because it is not your body?” Or is that acquiescing to implicit male dominance in the reproductive cycle, by ignoring any male responsibility and continuing a cultural shift making women increasingly responsible for all child bearing and child rearing. This is the very process that has allowed a male-dominant US culture where women are valued for their sexual desirability and men are less and less responsive to any child-bearing or child-care needs. Hilary Clinton in the White House won’t change this picture.

No one has yet defined what exactly constitutes the “life” to which we cling as a right in our Declaration of Independence, and which we want to be able to shrug off when the pain of being US outweighs the pleasure we get from it. Is there any longer such a thing as “suicide” in a state that allows one to administer the death “penalty” to oneself? Let’s face it, death is not usually a penalty to a sixty-something or older citizen whose creaky old body takes a while to come to life in the morning, and to whom the work of living one more day often precludes many other activities once enjoyed in the course of 24 hours. However, death is a penalty.

If death is not a penalty, why would any state debate its use? Generally, it is a penalty to the loved ones left behind, whose rights to be actively related to a living elder are terminated by death. I would argue that it is also a penalty to the state where the benefit of the experience and perspective of the most blighted serial killer may be useful in understanding ourselves, our lives, and the value systems that our culture upholds.

Initially the “death penalty” was given by a state intent on cutting its losses in the secure imprisonment, care, and feeding of a citizen who had committed a heinous crime. Today, we stand to gain more from studying the person like a bug under glass. That person’s actions have given him or her no right to a say in the matter because s/he has broken faith with the community whose laws s/he so grievously flaunted. Any society that wishes to name “life” as a right must necessarily provide humane treatment of persons imprisoned for life—though the prisoner’s ultimate punishment is the knowledge that s/he will live for the state’s benefit as long as life endures.

I would suggest that we use some of our vaunted wealth and knowledge in an ongoing debate on the meaning of “life, liberty, and the pursuit of happiness” since our forefathers framed that conundrum. Put war, abortion rights, capital punishment and euthanasia on hold until we have learned the results of our bellicose politics; and until we understand what we mean in our debates over “equal rights, capital punishment, and euthanasia”—until we better understand the subtle logic by which we call ourselves “US.”

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Lets be friendly with our friends…

I recently read an article entitled, “The irrationality of Alcoholics Anonymous.” In it, the author ascribed to the 12-Step way of life beliefs, a philosophy, and practices that are often discussed by individual 12-Step members but certainly not “Conference Approved” as any official tenet of a 12-Step programs must be. There are over a hundred12-Step programs. Most are modeled on AA who generously offered the use of their steps and traditions as public domain to any who might need them. Conference approval, or similar vetting processes in fellowships other than AA, means that the item in question stands for all of their particular membership. There are 12-Step groups in India, China, South America—in fact, all over the world who have won the right to call themselves by the name of the parent organization because they band together for mutual help, avoid using a specific substance or substances, and carry a message of hope to others who wish to stop excessive use of those substances.

I am a Certified Alcohol and Drug Counselor, having assisted two states in establishing the protocols for establishing that profession. In full disclosure, I am a recovering person with nearly 35 years of recovery which I define as not having to use, a day at a time. Early on in my 43 years of professional practice, I saw 12-Step programs in the same yellow light as that running in the article. I told persons that I counseled that they could overcome their addiction and put it behind them if they would just do as I suggested. I downplayed the need for using 12-Step recovery programs. I did not have the experiences, then, that I have now. I have come to realize that the disorder called addiction is progressive. I have seen evidence of that in family members who stopped using only to pick up again, later, and be quickly slammed into the worst physical and mental health that they had ever experienced, as if their period of recovery had done nothing to restore them to health.

Eventually, I turned to a teetotaling substance use disorder counselor by the name of Colleen Dill working in a community mental health setting, for help, with an out-of-control addicted family member. I name Colleen here because I have lost touch with her and would love for her to know the immense difference she has made in my life and the lives of those I love. She surprised me when she referred me to a 12-Step program for family members of addicted persons, When I refused to attend, on principle, she refunded my fee money, sent me home, and suggested that I only return when I had tried the program “in good faith,” and could show her proof of my attendance! After working with her for two years and attending those meetings, I surprised her by owning my own addiction and began to attend those other meetings. All these years later, my family member continues to struggle with attempts to control the damage done by use of substances, perhaps because of my initial self-righteous heavy-handedness before I sought help. I have had to learn a thing or two since I tried that approach, Colleen was my first teacher.

12-Step programs have a policy of being “friendly with our friends,” namely doctors and addictions counselors. Some recovering individuals are so grateful to escape sure death that they will advise anyone to stay away from doctors and drugs…blaming people and substances rather than genes, habitual access, and environmental influences for the problem. For me, the thought of using was more comfort than beginning to open the bottle for another run: I knew I would have to sober up, sooner or later to pay the bills. Personally, I was just happy to find something that rescued me from the awful connundrum of loving the thought of a feeling I could no longer find, in using my chosen poison.

What strikes me as irrational today is the consistent 12-Step bashing, done by professionals, of programs that make no claims on having the market cornered. It has been my experience to see many folk try that way of life and move on. It has also been my unfortunate experience to see folks try it, find nothing else helpful, and die miserably from the effects of untreated addiction. Nor are those 12-Step programs “in the market.” That is precisely what makes them affordable to a huge segment of our addicted population who arrive at treatment penniless. (The standing joke is: “Are you kidding, If I had any money left I would have bought something [to use] instead of coming to…” a 12-Step program.) 12-Step programs will not even debate their beliefs in a public forum to avoid the taint of self-promotion, preferring person-to-person recommendations. Even their PSAs are a new development and very low key, meant only to be informative.

I believe that most treatment is out of reach of the newly recovering person. Several years ago, national medical coverage was provided to persons with addiction who were disabled by virtue of their addiction. And they were required to get help to keep their income. Congress soon realized how expensive that proposition was going to be and rescinded that rationale for disability. Today, addiction is the leading killer of every segment of our population. The Affordable Care Act has opened some treatment doors, and promises to open more. Many treatment centers and providers are still scrambling to position themselves as providers under the ACA. Given our experiences from the days of the Welfare Reform Act (that relied on Congress to see the importance of covering addiction treatment costs) we must not rely on government largesse to fund this growing health care problem.

I propose that we find a way to fund treatment outside of the traditional medical funding streams. I suggest legislation that creates an entity, similar to Social Security, funded by a dedicated premium from drug sales, including alcohol. In this way, users of substances would begin to pay the freight for whatever problems might occur from the drugs used. This entity would underwrite all addiction treatment as a standard of coverage in all health and accident insurance. Addiction treatment, at every level, must have a dedicated fund, safe from easy manipulation by a marauding Congress bent on covering its excesses. The Substance Abuse & Mental Health Services Administration would become incorporated into this entity, and cease relying on special Congressional funding initiatives. This entity would regulate treatment and treatment providers according to researched and proven protocols, to assure the efficacy of treatment. This funding must be available to all residing in our borders. It’s that, or prepare to watch as our families suffer terrible losses from deaths caused by addiction.

12-Step programs are self-supporting. Are the rest of us who hope to help in that arena prepared to shoulder all of our own costs? If not, we may want to be friendly with our friends in finding a new approach to substance use disorder services funding. People who live in glass houses should not throw stones…it’s irrational.

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NARCAN and Citizens United

I received a call from a freelance reporter to ask me how the Kentucky All Schedule Prescription Electronic Reporting (KASPER) is working to protect persons from drug overdose in Eastern Kentucky, as well as new Federal and state legislation aimed at closing pill mills and ensuring a greater degree of accountability from doctors. I responded that I did not believe that KASPER was proposed to curtail the overdose death rate or that the rate of death has been slowed much by any legislation passed since that time—though KASPER makes prosecution of “doctor shoppers” who get multiple scripts for medication easier.

However, since the inception of KASPER, a favorite trick of drug dealers has been to load a van and go to a state where information may or may not be shared with Kentucky’s system. These vans travel north or south, wherever a willing pill mill may be found. Certainly, recent state and federal legislation aimed at making doctors more accountable for the prescriptions they write has put the medical establishment on notice that they are not without responsibility. Several persons in early recovery were recently overheard discussing this new medical establishment awareness: “Why, there’s not a doctor in [a city once famous for its pill mills] who will prescribe opiates for you if they know you are an addict: they’re afraid of coming to the attention of the feds…”

I noted some of this for the reporter, and commented on a recent projection by the Partnership for a Drug Free America, or another anti-drug group, that overdose rates are expected to “begin dropping in 2017 to earlier (read ‘lower”) rates…as if that will be evidence of an important change in the status quo. In fact, it will represent the dying off of a cohort of older users, whose replacements are now in high school and college in greater numbers. I explained that the medical establishment, and the advertising and pharmaceutical industries have created a cultural imperative that pain is unnecessary and better living comes through chemistry and chemical use. This has been good for business and is often presented as the way to make certain that an individual will be productive. Working under the influence is the norm. Only use of some “recreational drugs” (alcohol is the greatest of these) is really frowned on in the workplace.

Nothing done by Congress or by the FDA or the DEA is really aimed at changing that cultural imperative that both celebrates and upholds the bottom line for the pharmaceutical industry. Nor do they make any changes that would be opposed to the upward trending of the bottom line for the medical establishment. And nearly every innovation in the drug prescribing, storing, shipping, manufacturing, and licit selling processes has been aimed at improving that bottom line and ascribing blame for harms done to persons who take drugs. At the same time, the pharmaceutical industry manufactures substances in amounts to keep up with licit and illicit consumer demand. No one seems to find anything wrong with this, though at least one third of their profit derives from illicit sales. That same diversion of licit to illicit drug use may account for as much as 50%, or better, of all illicit drug sales. In Kentucky’s depressed economy, diverted licit drugs add much to the local economy. Coal may keep the lights on, but illicit drug trafficking pays the bill. Thank you, Purdue-Pharma!

No real change in the status quo may be anticipated, as long as the American Medical Association and the pharmaceutic lobbies continue to buy the laws that make sense for them—particularly not when they are increasing dollars and cents for their interest groups, too. With the US Supreme Court ruling that ascribed personhood to companies, no enlightened citizens’ group will have its life-saving agenda supported in our Congress or General Assembly.

That said, every parent of a child who has ever experimented with alcohol or another drug is betting against human nature if he and she does not contact legislators at every level and insist that first responders carry, and be trained in the use of, Narcan where the nature of the call is drug-overdose-related. Narcan, administered in time (often when the person who has overdosed is non-responsive), will cancel out the opiate in the bloodstream, as Narcan circulates. It will plunge the user into a withdrawal syndrome—and get them breathing again on their own. First responders who have used it tell chilling tales of watching a roomful of overdosed persons begin to move and breathe. They also talk about the fact that some of the freshly responsive persons are angry because “You ruined my high…” not realizing that they were in fact minutes or seconds away from death and brain damage.

The pharmaceutical lobbies and the medical lobbies had their chance last year to weigh in at depth, when such a bill came up in our General Assembly. They might have made a difference where it counted to save human life, but that is clearly not their bottom line. The Narcan bill did not pass and we have another year of 1000+ overdose deaths racked up to our credit. Our children who experiment frequently grow into poly-drug users, and the earlier they start, the more serious the problem is likely to be. More to the point, we have done nothing as a state to protect our citizens. Oops, I stand corrected. We have improved the bottom line for pharmaceutical companies and the medical establishment. When a company with a board of directors, or a non-profit corporation, can multiply the voting power of it’s members through a lobbying effort to outweigh your voice or mine, our democratic form of government is considerably undermined. In this instance, our power and the value of our lives as citizens is called into question.

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Requiescat In Pace, SJR

SJR, my nephew, died at 47. He and I shared this disease: the disease of addiction. This is a tribute to him. This is a tribute to all who have addiction and endure the rotten behavior and insults that others throw their way. The others I have in mind are civilized folk, in most respects. They are folk whose lives are not directly affected by their targets for abuse. They are not family or friends. They are not employers of these suffering souls with addiction.

It is understandable that families, friends, and employers get frustrated by the poor choices that persons with addiction inevitably make: choices that ultimately erode their health and shorten their lives. So our families have earned the right to be upset with us, even if they do not understand the disease we have.

No. The folk I have in mind stand to profit from the harm that addiction does to those who have it. They are caretakers, first line medical staff. I have to admire the alcoholic in withdrawal who sits on his or her hands when a nurse or doctor lectures, berates, and gives rough handling while providing some palliative for the illness that happened to bring the person to the Emergency Department for care. I have a lot of contempt for those abusive folk.

Remember, I told a story in this blog about the male nurse who told my 98 pound Mickey to sit still while he inserted an IV. She was shaking because that’s what folks do in withdrawal. When I finished signing her in and caught up with her, it was late at night on the unit where she would be treated. I had to bully my way past a bunch of administrators to tell her “goodbye” and that I would see her in the morning. She was crying pitifully. That nurse had smacked her because she couldn’t be still. And hospital staff had rushed her away to prevent a scene by me. To their credit, they sent the nurse home right away.

60% of Emergency Room (ER) admissions suffer from some alcohol or other drug accident or illness when we arrive for help. As much as half of the business done by the medical community is generated by the various drug problems visited upon our citizens. That same medical community is in such a hurry for the next clinic fee that it quickly prescribes pills when a short conversation might suggest some other treatment. I won’t deny that some of us go out of our heads–pursued by the demons of withdrawal and hallucinations–and strike out rashly at some of our helpers. I will say that never have I been so rash with such brother or sister sufferer that I provoked that response.

Acknowledging a sufferer’s pain has a greater palliative effect, in most cases, than the prescribed meds. I have seen many a nurse or physician curl their lip and summon “security” at the first sign that a drug-affected patient might be a bit riled. “Safety first” is good policy when applied appropriately. I watched an admissions nurse who was so rattled that she had security stand next to the patient before she would process him. She insisted that he, and not I, answer her questions. He began drunkenly mooning over what a beautiful and kind angel she was–mistaking her angry insistence that we do her bidding, for urgent concern. “it’s all right, honey…” “I am not your honey, I need you to sign this paper.,,Security!” I had transported him to the ER and did not want to see him go to jail, so I hurriedly had a little conference with him about “Just answer ‘yes or no’ and tell me what to tell the nurse.”

That worked pretty well until he got a better look at the nurse: “Hell, she ain’t that good looking after all.” I nearly lost it, except that I saw the guard get a mean look in his eye. I cautioned my buddy to keep his mind on the business at hand. I caught that nurse on break a little later and apologized to her, and thanked her, and said, “I have a hunch that somewhere in your life, some drunk has run over you.” Without missing a beat, she replied, “My daddy…” and stopped. I nodded and reminded her that we professionals have to remember what we know, when we remember what we can’t forget. We sometimes can’t forget old harms done us; but we may not transfer our anger to others just because they have the illness.

The week before last, my nephew had himself hospitalized after finding himself unable to go to work because of the pain. A hard drinking man, he rarely missed work, making sure that his work shone well enough that bosses would have to overlook what was in his coffee thermos. Finally, pancreatic pain was so intense that he had himself admitted to the hospital, complaining of gut pain. They saw a drunk in withdrawal, and treated him for withdrawal. Finally, after nearly a week where he lay racked in pain, the treating physician looked deeper and ran him to surgery where they removed his pancreas, gall bladder, stomach and parts of his upper and lower intestine.

His pancreas had ruptured and damaged all of those organs. Thinking he was just another drunk, medical folk used that impression to tell his family about his ‘critical’ condition. My nephew’s last conscious choice turned out to be the worst he ever made: he trusted medical folk to listen to him as he described where it hurt. He could have gotten the pills they gave him anywhere. He sure as hell didn’t have to go to the hospital for them.

SJR wasn’t a saint. He was a beloved brother, son, nephew, daddy, and a working man. He had a pretty tough row to hoe in life. He never laid down his hoe. He lived with the disease as best he could. He was young and thought he had more time. He and I get a pass for the using part of our past: God loves drunks and children. When actively using, our brains are hijacked. Even drug free, that disease controls many of our choices and behaviors. As for children, children just don’t know any better. Ohh…that smile of his…. Requiescat in Pace.

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Save Social Security: Legalize pot use.

Following the second death of a loved one by overdose, I surveyed all the deaths in two thirds of the counties of Hal Rogers’ Congressional District 5, and discovered that there were 1860 of them between the years of 2006-2011 or 370 in those counties each year, or an average of 17.6 deaths per county. I didn’t have a population breakdown, so I am sure it did not average that in each county, but the death rate in some of the counties must have been catastrophic. Coroners are often funeral directors and they were saying to me when we went around, “We’ve (funeral directors in their county) been wondering when somebody was going to look at this…”

I published the study privately and made sure that folks at various government levels heard the results. There has been a resounding “Thud” as the information fell on deaf ears. The news you sometimes hear about the rate of death declining is a temporary downturn that has happened in each county one or more times—simply awaiting the next cohort to find the available poisons, when the “harvest” starts over.

In their notes on some of these deaths, Coroners sometimes commented: “known addict.” To their credit, coroners always drew drug toxicology on any death they perceived to have been overdose—though they often ruled it otherwise. That was how our count became so much larger than the official counts. Drugs-on- board and dead = OD, to us, for the purpose of the study. (For instance, “Morbid Obesity and Positional Asphyxia” with a BAC of 2.5 became “Overdose” in our count. So we looked for tox reports before considering the death certificate.) However, in our findings, there is a large and unexplored question that came to light. Toxicology reports of… “marijuana” only. This becomes pretty critical right now, in 2014.

Five of the deaths to “known addicts” were caused by…marijuana! “Not possible” I thought, so I googled what was usually listed as a cause of death when ‘undetermined’ is not used: “myocardial infarction, and marijuana.” What I found surprised me. It seems that marijuana competes in the heart for the heart’s own oxygen supply, and causes death when the heart goes into fibrillation and doesn’t stop. While we were surveying all those death certificates and files, we came across an inordinate number of ‘myocardial infarctions’ in their 20s to 60s—seeming to be pretty evenly spread through the age cohorts.

However, there were not toxicology reports because 1) the circumstances did not suggest use of other drugs; 2) marijuana is not thought to be a deadly substance; and 3) most of these folks are not ‘known addicts.’ Following its own research about this, one cardiac care hospital is now warning its post cardiac care patients to avoid marijuana.

But…, who wants to hear that in a state that is considering marijuana for legalization with all those available taxes, and all that “medical marijuana” drivel being touted?! We need to have drug tox drawn on every tenth myocardial-infarction-death to gauge the actual rate of drug death being caused by marijuana. Most folks think I am hysterical when I suggest that, but the question begs an answer, and I am willing to be wrong about it. “Cost” of all those tox reports is the reason given for not doing it—that, and the fact that Frankfort’s coroner’s toxicology lab is already inundated by the status quo.

I take pride in being a survivor of the great Social Security rescue sacrifice. I now tell the addicts I know that, as a subset of the population, addicts have done more to save Social Security than any other group—and the government is so grateful that it is doing absolutely nothing about the problem. When was the last time you heard a sitting President or a member of Congress moan about the dwindling reserves put aside for Social Security? Who knew? Peace!

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I came, looking for me…

I came, looking for me… On the occassion of my 43 anniversary as a Substance Use Disorders Counselor–I am reflectiing on the trip. (I have been called a lot of names over the years and so has my profession. SUDs Counselor is what they call me now.)

43 years ago this August, in 1971, I began to volunteer at Shalom Et Benedictus in Stephenson, Virginia. About three years later, I became that Commonwealth’s first Substance Abuse Program Director for the Drug Awareness Program (DAP), centered in Culpeper, Va. In 1978 my marriage fell apart, “because of my wife’s drinking and drug use,” and less than three months after that, I sought help at a nearby Community Mental Health Center (CMHC), in Winchester.

“Colleen Dill,” my counselor, was willing to help me do an intervention—but she ‘saw me coming’ and engineered my own entry into recovery by referring me to a 12-Step recovery program for family members. I refused to go, at first. I ‘hated’ 12-Step programs and wasn’t going to have anything to do with them. (Remember, I was a program director with 3 staff, by this time.) Colleen discussed my reservations with me one session and then got me to agree to ‘try it.’ When I had not done so, by the next session, she refunded my payment and sent me home, saying, “Call for an appointment, when you are ready to accept the help I am offering.” I did what she suggested.

Colleen also recommended me for a scholarship to Rutgers Summer School for Alcohol and other Drug Studies (1979). While there, I lost my fear of 12-Step recovery after rubbing elbows with so many insightful and talented people doing treatment who were themselves recovering. I remember crying through a course on intervention featuring Johnson Institute film on the subject–I identified with the main character in the film.

Following Rutgers, I attended the Willow Oak Farm Concerned Person’s Program. At that program, in my turn on the ‘hot seat,’ I confessed that I no longer knew if my ex-wife had a problem or not—but I was pretty sure I did. When I shared that revelation with Colleen at our next session, I remember she blurted: “O thank God!” at which I laughed. She knew all along! My recovery date is May 2, 1980.

I dropped out of direct services for a year, while I worked on my own recovery and developed a better and more collegial supervisory structure in the DAP. During that time I also helped spearhead Regional/Community-based Treatment Services (RCTS), with other program directors in Virginia’s HSA1. (Mo Moore of Charlottesville was our first chair.) With this program, we were able to offer public indigent clients a private bed in some of Virginia’s finest treatment programs at a sliding fee cost way below the per diem for those programs. I began then to oppose tiered treatment based on income. Classism should find no home in recovery.

A further accomplishment of RCTS at that time was to force state level cooperation with community programs—moving the power to the community level where needs were represented and utilizing the state coordinators’ connections to best effect for the communities they represented—an excellent service/funding design for utilizing public funds in a transparent manner.

Eventually, I changed jobs to follow my children, Megan and Tara, so that our visits would not be interrupted by distance. I worked in a Job Corps Center and became the Substance Abuse Programmer, as one aspect of my job. After that, I supported myself by carpentry and doing addiction consulting for a time. After that, I worked for another CMHC, doing Drug Counseling for 10 years, focused on what was termed “dual diagnosis .” At its startup, I became the clinical director of a medication assisted treatment (MAT) program utilizing methadone, and assisted that program in becoming Commission on the Accreditation of Rehabilitation Facilities (CARF) accredited. Since August of 2004, I am working at the KY Department of Vocational Rehabilitation’s Carl D. Perkins Vocational Training Center, in Thelma, Kentucky, as the SUDs Counselor.

Looking back over my career and store of information, I had begun writing this blog in April of 2011—undopedcut.com—just to have my say. I was particularly worried about a problem that was gaining momentum after 20 years: drug-related overdose. The purpose of the blog is to try to start a community dialogue about drug issues and to see if we can’t find a policy that will work for us to save lives and slow the rate of addiction in our community. But I am getting ahead of myself.

I’d met a woman, Mickey, nearly 14 years previously. We met in the rooms and began dating after about a year. Her children—Bobby, Traci, and Kellie—came into my life, too. Mickey had real problems staying free of drugs—and that problem accelerated when her/our daughter, Traci, died of overdose in April of 2004. Mickey moved out to stay close to her grandchildren by her/our other daughter, Kellie. Mostly, Mickey wanted to die, and did not want to be living with someone dedicated to recovery from addiction. She began using drugs and drinking as hard as she could. While we never stopped communicating, we were apart for nearly four years. Somewhere in there, Mickey found a doctor who prescribed the type of drugs in the quantities she wanted; and ‘Mick’ maintained at that level for quite a while.

Eventually she and her/our surviving daughter and the grandchildren moved back in with me. She began to use less and less—and finally stopped in December of 2010. She was not stopped long when we decided it was time to formalize our ‘marriage.’ We did that on January 13, 2011. Old patterns re-emerged, possibly in response to her changed marital status, specifically because of the loss of “her own” income from a disability check, and the sense of independence that check had given her. After years of living in abject marital poverty, having to ask for every dime she would spend, her change of partner did not matter. Both she and I had specifically asked Social Security representatives if her changed marital status would affect her check. “No” became “Yes” when they factored in my income—something neither of us were told when we asked prior to getting married. That deception cost her the will to live, and cost me my wife . When she lost her check, Mickey began to get her drug supply again—not keeping me in the know. Why? Did our marriage trigger old PTSD issues? Was she trying to replace lost income from a check she no longer received? Who knows why?

On May 6, 2011 Mickey had an outpatient test that involved being anesthetized. After the testing, we went out to eat, and spent the day doing things Mickey wanted to do. By that evening, I realized that she was using. The next morning I confronted her about it and Mickey told me she no longer had any pills. We patched things up before I went out to a meeting that evening. I brought back pizza for Mickey from my/our daughter, Megan. I talked to her when I came in, showed her my most recent 31-year anniversary token. She seemed ok. Mickey was busy and told me she would “Be right along.” I went to sit in the living room and find us a movie. She promised to be right in. She never got to eat that pizza. Looking back, I can see that it was the residual impact of anesthesia with her drug use that hit her so heavily. I’d had little sleep the night before, and had fallen asleep as I was eating pizza. When I woke a few hours later, it was too late. She died of overdose, in the wee hours of May 8, 2011. The remaining pills fell out of her pocket when I attempted CPR.

I am overjoyed to be in long term continuous recovery for 34 years. I am very grateful for the recovery community folks who keep me on my toes, even in rough weather. I don’t like being an addict. I didn’t want this for me or for anyone in my family. It just happened to us. At this point, there are two deaths in my generation, and two in our children’s generation because of addiction In my/our extended family, there are many more candidates for that kind of death.

I think that The Harm Reduction Model holds more promise for eventual solutions than any other comprehensive model for addiction programming—simply because no one controls public perceptions of the problem, or the number of new addictive substances that may be invented/discovered, or the use preferences of the general public. The weakness of that model is that it implies that only replacement therapies are valid methods for treating addiction. Addiction treatment is a continuum with interrupted use and replacement therapies on one end, and continuous abstinence and recovery on the other.

Today, in addition to my daily job, I provide supervision for counselors in two local MAT programs utilizing suboxone. I expect I will keep my hand in, until I have passed my job on to enough other folk that I can say, “It’ll happen without me now…” Then, I’ll retire to my wood shop and teach my grandkids some tricks…

Peace! Til next time…

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Rage, rage against the dying of the light: a call to action.

I have been using a term: “treatment on demand.” Why, treatment on demand? “Why not?” should be the question, by now. For twenty years, perhaps more, we have been watching an escalating overdose death rate climb until it outstrips every other form of death for persons 18 to 60 years of age. Most, though not all of those who are dying, are persons with addiction. Given that the Substance Abuse Mental Health Services Administration (SAMHSA) has said that nearly 93% of those with addiction are not receiving treatment or benefitting from recovery—this has become a plague that operates with our nearly dumb acquiescence. This is the modern version of a “slaughter of innocents.” Folks are dying without ever realizing that the disease is treatable and death might be forestalled.

If most of the dying belonged to a minority population of any other kind, legal action would have begun, civil disobedience protests would be underway, boycotts organized, and the actions of the movement would be prominent in the news. As it is, even the September Recovery Day Celebration has trouble finding page one at the news stand. I am sickened by the numbers of people slipping shamefully un-noticed into the grave. Well, this article is a call to action: in Dylan Thomas’ words, “Rage, rage against the dying of the light.”

No politician running for even the most humble office without substantive thought on this issue will get my vote. At political events and rallies, I am going to demand their views on the overdose death problem. I want them to understand that this issue must be the major focus of their health agenda. They need to understand that they can meet their constituents more frequently by mourning with them at funerals for loved ones than they can by attending their children’s weddings. I want saving Social Security to be a problem again. The death rate has taken that debate off the table for anyone paying attention. Abortion? Your stand on abortion is immaterial if you ignore this issue. “Tinkling bell, sounding cymbal.” And I don’t care who marries who. There are fewer dollars at stake there for individual tax payers than there are for the thousands whose overdose medical costs have to be paid whether they live or die. Typically, there are five overdoses, with the last adding a funeral expense. Want to bring down medical costs? Really? Then what is your plan to reduce overdose rates? How are you going to fund treatment on demand?

I understand that men of faith must deal with issues like caring for an aging population, abortion, and gay marriage. Try as we might to pretend that we have no social obligation to deal with these issues—they will continue to press into our every-day living and demand from us a moral response. What I do not understand is how anyone can ignore, as we have, the immoral and downright shameful loss of so many of our citizens, cut down in their prime by overdose death. If you believe that our morality is slipping—I will tell you it went off the rails when we began to barter with death for taxes on liquor, drugs, and gambling—without making any accommodations for treating persons who might come to harm as a result of their use. Providing for treatment on demand is an attempt to right a poorly run and badly listing ship of state.

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