Harm Reduction May Have Saved My Life

I didn’t hear about harm reduction until I had more than a decade of 12-step recovery. Like many 12-steppers I found the idea of harm reduction scary and threatening. Still, I strived to be open-minded and to avoid contempt prior to investigation, so I read several books on the topic. In doing so I found that I had actively practiced harm reduction as a young drinker and drugger and that it probably saved my life.

According to Wikipedia, the central idea of harm reduction is the “recognition that some people always have and always will engage in behaviors which carry risks, such as casual sex, prostitution, and drug use,” and the main objective of harm reduction is “to mitigate the potential dangers and health risks associated with the risky behaviors themselves.”  Dangers and risks are considered in terms of affect on the individual, the family, the community, and society at large.

Dr. Norman Zinberg’s model of Drug, Set, and Setting.

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One of the important things I learned while reading about harm reduction was Dr. Norman Zinberg’s model of Drug, Set, and Setting. Zinberg did not believe that drug effects are simply a function of biochemistry. He believed that problems with drugs and with drug experiences result from interaction between the three areas. Solutions can be found by making positive changes in these areas. Let’s look at each of these areas and then I’ll describe the choices I made that kept me alive.  

Drug refers to the type of drug itself, potency, purity or what it is cut with, route of ingestion, legality.

Set (originally “mindset”) refers to the person, including characteristics of race, culture, support, mood, beliefs, emotional strengths or weaknesses, coping skills, motivation, health, gender, body size, etc.

Setting refers to when, where, and with whom one uses, what sort of support exists, stresses in one’s life, attitudes of others toward use - including political and cultural.

Drug

Let’s start with Drug.  I was 14 years old the first time I saw someone passed out with a needle in his arm. He was in a friend’s apartment and I remember looking carefully to see if he was dead. When I saw he was breathing I wondered if I should call an ambulance, but that might not be the right thing to do. Fortunately he woke up moments later. Even so, I decided that I would not shoot heroin or use needles.

I came to the same conclusion about methamphetamines, then called “speed,” which I rubbed into my gums a few times and liked the effects. Several of my friends got strung out on speed. I watched them lose weight and develop paranoia. I quit using speed after my friend Eddie, a splendid fellow, got so crazy he thought we were being followed. We were taking a walk together and he took me through so many alleys and roundabout detours that I got lost. When we got to his friend’s apartment I had no idea where I was. Eddie split soon after and I was in the embarrassing situation of having to ask for a ride home. I wasn’t old enough to drive.

One time when I was eighteen or so, I was drinking in a downtown bar that had an upstairs disco dance floor. Sitting at the bar, I watched a friend climb the spiral staircase only to see him pause halfway up then fall backwards down the stairs. I spent the next twenty minutes asking his friends what he had taken. I wanted to make sure I never took what he had taken. It turned out he had taken “sopers” also known as Qaaludes, a barbiturate-like drug so destructive it was actually taken off the market.   

The one drug I didn’t know to be afraid of was alcohol, though a friend died choking on his own vomit - his friends didn’t know to lay him on his side.

Set

Set, especially mindset, was something I considered when using LSD. The first time I tripped was at a Janis Joplin concert, and while I had a pleasant experience I could see how it could be awful if you weren’t in a good mood. After that I was selective about when, where and with whom I tripped on LSD. I only used LSD occasionally and with careful planning. I didn’t like to drink when I was tripping and I wanted to be in a safe place for the whole experience.  The last time I took LSD I was on a beach in Florida with a friend. Our plan to spend the night in a tent ended around 4 a. m. when the no-see-em bugs invaded our tent and bit us until we left. My friend had been drinking and so I drove until we got onto a very long bridge. Looking ahead, the converging lines of the bridge narrowed down to a pinpoint. I was afraid to drive into the nothingness and came to a stop in the middle of the bridge. I was shaking. My drunk and tripping friend had to take over the wheel. I would be afraid of driving on bridges for the next decade and never used LSD again.

Setting

Setting, especially with whom and where I drank and drugged, was an important part of how I avoided harm. As William White describes in his new book, Recovery Rising, I was aloof “from all but a small circle of friends with a high threshold for deviance.” My friends over the years were an interesting assortment of artists, musicians, bikers, lawyers, gays, and hippies. They were typically four to ten years older than me and a bit protective. They didn’t want me to get in trouble (especially when I was a minor) for their sakes as well as mine.

Setting, in terms of where I drank, became a problem for me as I got older.  I was a daily drinker by the time I was seventeen. Men began trying to pick me up in bars and often succeeded. I solved that problem by changing the setting of where I drank. I started drinking in gay bars because the men weren’t interested in me and I wasn’t interested in the women. I had standards for those I chose to drink with. If they couldn’t hold their liquor, if they slurred their words, if they got obnoxious or violent, and especially if they were bad drivers when under the influence, then I wanted nothing to do with them.  Despite those standards I would drink heavily and harmfully until I had drunk myself into early late-stage alcoholism by the age of twenty-nine.

It never occurred to me that it would be alcohol that would take me to my knees. I didn’t think of it as dangerous. I didn’t make sensible rules for myself such as “don’t drink when you’re angry or tired.” That said, I’m lucky to be alive. My drinking buddies (except for two) are either dead or in AA. My drug-using buddies are mostly dead also, including my sister. They died of overdoses, suicide, Hep C, etc. Still, somehow, despite my excesses and the company I kept, I was able to survive. I believe its because I practiced harm reduction—even though I had never heard the words.

A Philosophy About Addiction

I am in the process of articulating a clear philosophy about addiction and its causes and cures.  This is a first draft of that philosophy.

1. People take drugs for a variety of reasons — especially to feel or function better. So many Americans (more than half) use legal or illegal drugs that drug use is now the norm. 

2. The medical society (not the legal system) should be the first responders for those who overuse or get in trouble with alcohol and other drugs. Medical care, not punishment, is needed.

3. Earlier and better care and earlier — and better education — is needed. Useful education, not just warnings, and not punishment, will help drug users make better-informed and safer decisions about their use of drugs. Better care includes recognizing and responding to the brain health needs of our citizens.

4. The explosion of drug use, which started in the 1950’s and blossomed in the 1960’s, reflects societal angst and biopsychosocial needs. When human needs are met, drug use decreases. A reduction of drug use will only happen when our citizens are happier and feel more secure.

5. Not just dealers make money off of drug users. Pharmaceutical companies promote drug use and make billions, as does the liquor industry. Many others owe their living to drug users, especially within the legal and forensic systems, including judges, lawyers, parole officers, privately owned prisons... The same goes for treatment centers.

6. The War on Drugs is a misnomer; it should be called “The War on Drug Users” because it is a war on half of American citizens. War is an alienating activity. It requires making some group the enemy — in this case drug users. We alienate drug users by labeling them as criminals and putting them in a cruel and unusual environment called prison. Prison is a highly stressful environment that causes PTSD and teaches anti-social behaviors. Prison sentences for drug use damages not just individuals but families and communities. Racism is often an element in who gets punished for drug use.

7. There is evidence that a stressful infancy or childhood creates changes in the brain that predisposes many to drug addiction and other diseases. Unless basic societal changes are made — including redistribution of wealth, access to education, meaningful employment, recreation, and safety — we will continue to have rampant drug problems throughout society.

 

 

From Lousy to Pretty Darn Good: The Fine Art of Recovery Coaching

I once got referral from a therapist about “Beth”—a 19 year old who had relapsed after in-patient treatment for drug addiction, including alcohol, pot, and meth. I was told that Beth was on several medications for bi-polar, ADD, etc., that she lived with her divorced mother, was unemployed and currently drinking and smoking pot, and had a history of cutting. Would I be willing to coach her?

Beth doesn’t sound like an ideal coaching client, does she?

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Help with Addictions

People call me when they know someone who needs help with recovery from addiction. I coach people to decide whether they want to stop using alcohol or other drugs, or make a plan to cut back. I coach people to decide if they want to use 12-step or other social support, whether they want to go to treatment, or make changes on their own. I help those who stop, cut back, or are coming home from treatment, to stay on track and achieve goals that are now options in recovery.

I saw a lot of red flags with Beth. I’m a professional coach, a recovery coach, and so I screen every client. The screening standards I learned is that to be considered coachable, the potential client must be able to participate in the generation of solutions and strategies and be able to engage in self-discovery. They also need to be able to relate to the coach as an equal partner, or, if they are young as Beth was, and not inclined to see adults as their equals, to understand that equality is inherent to the coaching relationship and over time recognize and cultivate the power of their equality. Beth agreed to meet by phone. The first time we talked she was scraping out a pot pipe, hoping to get a buzz.

Getting High—Choice or Compulsion?

We talked for a few minutes about the futility of trying to get high on the residue from a pot pipe, and also about the difference between choice and compulsion in regard to drugs. We set a time to talk about the possibility of working together. Neither of us were sure that coaching was suitable or a good idea, Beth because she already had a therapist and a psychiatrist, me because I didn’t know if she was coachable.

To Coach or Not to Coach?

Many coaches assume that a person who uses alcohol or other drugs addictively is simply not coachable. They think coaching is about helping people get from good to great, and they forget that addiction affects all levels of society. Addiction is not restricted to any class, race, religion, or level of intelligence. There are many high functioning people who drink too much, or use other drugs excessively. How can a coach know who is coachable? By screening each prospective client.

A Place of Her Own

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I teach my Recovery Coach students to screen all their clients. Here is how I screened Beth: When we met I asked her what she would most like to change about her life; what, if she achieved it, would make her feel satisfied with her life. Beth thought for a moment and said that if she lived in her own apartment, rather than with her mother, she would feel much better about her life. I asked her what would need to happen for her to live on her own. Beth said she would need to take her own meds (her Mom was waking her up to take them on time) and get a job.

Beth was jazzed about getting help to move to her own place so we talked about how we might work together. We discussed what was expected in coaching and agreed to give it a try. I let her know that I would not be able to coach her if she came to calls intoxicated, missed calls, or did not seem to benefit from coaching.

Progress Report

That was four years ago. It took a few months to get her on her feet and employed. Today Beth lives on her own and has three full years of abstinence and participation in Alcoholics Anonymous. She is an excellent employee and last year she finished a yearlong trade school with high marks. She still has a psychiatrist and a therapist; I am still her Recovery Coach. I am proud to have coached her from lousy (using drugs, sleeping all day, unemployed) to pretty darn good (drug-free, industrious, employed). Beth loves being clean and sober and having a Recovery Coach. We are working on the next phase of her life. I think of it as the phase from pretty darn good to great.

The Personal and Professional Potential of Addicts

The ICF defines coaching as “partnering with clients in a thought-provoking and creative process that inspires them to maximize their personal and professional potential.” Active addiction drastically interferes with reaching personal and professional potential. Recovery Coaching helps people deal with the barriers caused by active addiction and move forward personally and professionally. Those who resolve their addictions have the potential to get from lousy to great. It may take time to get to great, but it is entirely possible, and with the help of a trained Recovery Coach, it happens more quickly with fewer setbacks.

The Advanced Skills of Recovery Coaching

To be effective as a Recovery Coach it is important to have advanced skills in coaching to increase motivation and confidence. People whose lives have been affected by addiction often have below average self-esteem. Their motivation can waiver along with their confidence. Persons facing addiction or in recovery need to be coached by persons who are effective at finding and leveraging strengths and can be patient with those whose beliefs about themselves change from day to day and week to week.

Coaching From "Who Me?" to "Free at Last"

It is also important to be able to coach change effectively all the way from denial (“Who me?”) to thinking about it (“Yes, but…”) to setting recovery goals (abstinence, harm reduction, etc.), and on to planning, action, and maintenance (“I’m free at last”). And sometimes relapse and starting over. Relapse is common in persons trying to change their habits with alcohol and other drugs, yet there is promising clinical evidence that coaching reduces relapse.

Developmental Coaching

Those who want to work with addiction recovery clients must also be prepared to coach both general development and awareness. People who have spent years living in active addiction often have gaps in their development. They may be very good on the job but a poor communicator at home. Or they may have great interpersonal skills but be lousy at handling money. Recovery Coaches work with their clients to leverage their strengths while identifying the places where they struggle. We also coach to increase awareness of choice and responsibility so our clients can identify and meet their needs, rather than turning to addictive substances when uncomfortable feelings come up.

Summary

Professional Recovery Coaches are highly trained coaches with advanced coaching skills that make it possible to help persons facing addiction make significant progress towards good and great lives. We screen our clients for coachability and only work with those who can identify achievable goals and co-create the coaching relationship. Recovery Coaches have advanced coaching skills in building motivation and confidence, and in coaching for awareness and development.

Learn more about me and my experience as a coach.

Learn more about Recovery Coaching and upcoming trainings

The Weird Way We Treat Alcoholics

To understand the weird way we treat alcoholics lets imagine how diabetics would be treated if they got the same care as alcoholics.

First of all, diabetics would get no help until they were ready to accept abstinence. They would need to agree to eat no carbs at all. Their diet would be limited to meat, eggs, vegetables, and yogurt. If they refused to accept the MEVY diet we would say they are in denial. They would need to hit bottom: perhaps a diabetic coma or losing a toe will convince them to avoid all carbs. There would be no help early on. Pre-diabetic symptoms would be ignored, and the diabetic would be on their own until they were ready to accept the carb abstinence diet.

It sounds ridiculous doesn’t it? Who would expect a diabetic to never eat another carbohydrate? Yet that is how the disease of alcoholism is treated. We have a “one size fits all” approach to the treatment of alcoholism. We don’t help alcoholics unless they are willing to quit. According to the Center for Disease control, as reported in the CASA study Addiction Medicine: Closing the Gap Between Science and Practice, 73.2% of diabetics receive treatment for their disease, while only 10.2% of alcoholics ever receive treatment.

There were approximately 88,000 alcohol-related deaths in 2016. I wonder if there were more options available, over-drinkers might seek help earlier. As a former over-drinker, I could have used some early education about alcohol. Here are two things I wish I had known.

1. Females do not process alcohol as well as males.

If a woman and a man of the same body weight drink the same number of drinks per hour, she will become more intoxicated. Women who over-drink are more likely to become pregnant, and to pick up sexually transmitted diseases.

2. I would have liked to have been taught the basics of moderate drinking.

Like many, I tried for years to control my drinking — without the basic knowledge of how to do that successfully. I did not know how to track my blood alcohol level, or how to measure and track my drinks. I will never know if I could have successfully moderated my alcohol intake. If I’d had that information when I drank, I could have figured out in a few months if I was capable of it. To me this is an important point, that most over-drinkers do try to manage and control their drinking, but without some basic education they often flounder for years on end. With education, a problem drinker can give moderation a try and see if they are capable of controlling the amount they drink. If they succeed, great! If they learn that they cannot, most will opt for abstinence. A minority will choose to continue heavy and harmful drinking and for them some education about reducing harm would be useful.

There are other reasons why over-drinkers don’t seek or get help sooner. One reason is that the medical field ignores the problem. According to the CASA study, 2/3's of over-drinkers are in contact with a primary or emergency care about twice a year, yet physicians neither notice nor respond to the identifiable and treatable signs of addiction. This means that the person with the disease of alcoholism has to advance to late stages before the problem is noticed or addressed by the medical system.

Alcoholism is more likely to be noticed by the penal system. 44% of referrals to publicly funded treatment come through the court system. Employers make less than 1% of referrals to publicly funded treatment, while private insurance covers only 20% of the total costs of treatment for addiction.

Getting help for alcoholism is a challenge for most. Early help is practically non-existent. 90% of the treatment centers are abstinence-based and 12-step oriented. Even if a person is willing to go, the cost of private pay treatment is prohibitive for most. For publicly funded treatment there are often long waiting lists, lack of childcare, and numerous rules and regulations to be followed. And if treatment is available, practitioners with little or no medical training provide it.

If we treated diabetics like this it would be considered unethical. They would have to wait until their symptoms are dire to be noticed. They would have to break a law to get help. They would have to agree to eat no carbs in order to get in or stay in a treatment program. As the CASA study concludes,

“There simply is no other disease where appropriate medical treatment is not provided by the health care system and where patients instead must turn to a broad range of practitioners largely exempt from medical standards.”

I hope someday there is earlier and better care for alcoholics. I hope there is education that will help over-drinkers determine earlier whether they can control their drinking. I hope that someday the medical system, not the penal system, will notice, provide, or refer over-drinkers to better sources of care. I hope that moderation and harm reduction education will be commonly available for those who are not ready for abstinence. Mostly I hope that the weird way we treat alcoholics will end. 

Sponsor-caused Relapse

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A friend in AA told me recently how a woman in his home group relapsed. Let’s call her Sue. Sue had completed an inpatient treatment program, found work and a place to live and had six months of abstinence when she took her first trip in recovery, all the way to Alaska. The flight layover was in Seattle, Washington where the gal saw her first pot shop and legally bought a marijuana brownie, which she ate later in her hotel room.

The next morning Sue caught an early flight to Alaska, visited friends, enjoyed nature, went to meetings, and had a great ten day trip. She was pleased to have made it home safe and sound and excited to tell her sponsor about her trip. She even mentioned the marijuana brownie and was stunned when her sponsor said she had lost her sobriety. The sponsor told Sue that her six months off alcohol no longer counted because she had used a mind-altering drug. Sue was shocked, got flooded with adrenaline, and said, “In that case I might as well drink.” She hasn’t drawn a sober breath since.

I wish this were the only sponsor-caused relapse that I have heard of. Unfortunately this kind of thing is fairly common. Let’s look at what happened here, consider the sponsee’s losses, and think about how a sponsor could handled this situation in a way that didn’t lead to relapse.

Desire and Unity

In my opinion the sponsor forgot the third and first traditions. The third tradition says that the only requirement for AA membership is a desire to stop drinking. This sponsee had six months of continuous abstinence from alcohol. She had a desire to stop drinking and so was a member of AA-- even as she ate the pot brownie.

The first tradition states that personal recovery depends on AA unity. There was nothing unifying about telling a new comer that she had lost her sobriety when she had not had a drink. There is no step or tradition that suggests sponsors should punish or humiliate their sponsees. In fact it is quite the opposite. The first tradition says AA “jealously guards the individual’s right to think, talk and act as he wishes.”  So why was a member shunned over a marijuana brownie? How could a situation like this be handled differently? How could this sponsor have corrected an erring sponsee in a way that doesn’t result in relapse?  

A Softer Voice

The sponsor could have thanked Sue for having the courage and honesty to tell her about the marijuana brownie. She could have congratulated her on staying away from alcohol during her trip but let her know that the brownie was a bad idea. She could also tell her sponsee that many would not consider her “clean and sober” since she had used pot. She could have said the important thing was that Sue had not taken a drink, and warn her that using pot again would interfere with her recovery.  

First Do No Harm

Why is it so important that sponsors be gentle with their sponsees? Well, research shows that the more confrontational a counselor is with an alcoholic client the more that client is drinking a year later. A year later! I believe the same applies to AA sponsors. Sponsors should avoid taking a hard or judgmental line with their sponsees. If a client gets drunk after you have confronted them you need to change your methods. As Sue’s story shows, a sponsor can badly harm a newcomer.

Before telling her sponsor about the pot brownie, Sue had an AA home-group, a community she belonged to, a job and safe place to live, six months of sobriety from alcohol, and pride and dignity. Now she is drunk, unemployed and living on the street. That’s an awfully high price to pay for a marijuana brownie. I believe that sponsor-caused relapse is preventable and avoidable. Sponsors have a responsibility to help not harm those who come to them for support. Judgment and confrontation have no place in sponsorship

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Waiting for Good Enough

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I’ve finally noticed a pattern that I have had for my 30+ years in recovery: waiting to get my shit together before I take action. That’s a problem for me because the truth is I may never become the idealized person I’d like to be. I haven't yet. What I know at long last is that if I put off opportunities I may miss my chance. I can think of two people that I wanted to meet and could have met, but didn’t because I wasn’t ready, because I wasn’t good enough, because I didn’t have my shit together–yet. Both those people died while I was waiting to be a better person.

Thomas Leonard, pioneering how to coach “restoratives”

One was Thomas Leonard, the “father of coaching.”  I knew people who could have introduced me to Leonard. I wanted to talk with him because he knew a lot about coaching those he called “restoratives,” people who have experienced problems with addiction, trauma or mental health—the very people I work with as a professional coach with expertise in addiction. Thomas Leonard died in his forties of a heart attack. I missed my chance to hear his thoughts about how best to coach restoratives. I regret that. And there’s another person I missed, G. Alan Marlatt.

G. Alan Marlatt, pioneering prevention with Harm Reduction

I would have liked to have met G. Alan Marlatt. He did ground-breaking research on addiction at the University of Washington. I lived in Washington for twenty-one years, twelve of them in Seattle, nine in Port Angeles. I had a friend who knew Marlatt well and offered to introduce me, but I turned her down because I wasn’t ready. I’d gotten sick doing hospice work and didn’t have my shit together. I would have liked to talk about harm reduction with him. I would have liked to have talked about brief interventions with him. He was a pioneer in prevention, bringing Harm Reduction (HR) concepts to reducing campus drinking.  

Change is always an inside job.

I’ve missed my chance with Leonard and Marlatt. And I will miss other chances unless I change my thinking. I may never become the woman I want to be (darn it!) but I do have opportunities and need the courage to show up for them imperfectly. I need to be willing to show up as I am and let that be good enough.

No time like the present. I am more than good enough.

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There is one person I have wanted to meet for almost twenty years, another addiction professional. He is currently alive and well. I’m going to make a plan to meet him. Let’s face it, I may never feel like I have it all together. But rather than waiting until I’m a better, healthier, more ideal person, I need to recognize that I am good enough now to have a cup of coffee, good enough to have a conversation, smart enough to learn something and to contribute something. Just plain fine enough while the opportunity exists. Because opportunities are time-limited, and I don’t want to waste anymore of them waiting to be a better person.

 

No Matter What

Written 9/09/2016

No Matter What

Last month I celebrated thirty-three years of continuous abstinence from alcohol. Then a week ago I slipped going down a spiral staircase and descended to the bottom step on my bum. Quite a metaphor I thought, and it made me ask myself how I managed to stay sober all these years without slipping. I don’t think I would have lasted if I hadn’t made a decision—a decision to be on my own side no matter what.

Shame & Co.

The decision was made from shame, desperation, and determination. I was having an affair with a married man and struggling to stay sober and spiritually fit through all of it. I was discouraged that I could be so stupid stone cold sober.  How could I have fallen in love with the husband of a dear friend? Should I get drunk? Kill myself? What should I do?

Head Up

What I did was make a decision to be on my own side despite my stupidity and compulsiveness. I decided to save my own life for my own sake. I ended the affair to keep my recovery. And with the decision to be on my own side, I began to hold my head up, if only a little bit. I realized that I was an adult and that my recovery was my responsibility, that my life and well being were my responsibility—no one else’s. I decided that no matter what I did, said, thought, or felt that I would be compassionate to myself and be on my own side. I would hold my head up no matter what.

A Dirty Rag

It wasn’t easy being on my own side. I was a mess. An intuitive who met me at that time told me years later that when she met me she saw an image of dirty rag that had been used and tossed in the corner.  It was an apt metaphor. I did feel dirty and used, discouraged and lonely. But I had made a decision and I began to take care of myself. I stayed sober, began therapy, and kept myself very busy. I wrote and recorded affirmations and listened to them each night as I went to sleep. I went to meetings and didn’t drink. Slowly I healed.

The Biggest Difference

Of all the things I did to stay sober, I believe that my decision to be on my own side no matter what has made the biggest difference. When I am confused I ask myself, “What would I do if I were on my own side?” It isn’t that I don’t care about others. I do and make win-win decisions whenever possible. But I don’t forget the bottom line—that I am responsible for my own well being, and it is I who will live out the consequences of my choices. By taking responsibility for my recovery and the decisions I make and the actions I take, I know I have grown up. I am a full-fledged adult.

Bottom

When I landed at the bottom of the spiral stairs I was grateful that I hadn’t broken any bones. I was grateful that I wasn’t drunk, and that I could stand up and walk. I knew I would be sore and I was, but I got to have some quiet time. And so I noticed that I still make mistakes in recovery, even after thirty-three years. But I also noticed that no matter what happens, I am on my own side. That’s the bottom line—and it has made the biggest difference.

Some Thoughts about Opiate Deaths

I met my first opiate addict in the late 1960’s. We called them junkies back then. I was about 14 and “Crazy Al”, a disabled Korean War veteran, lived in the apartment below my friends. Crazy Al was the first person I saw shoot up, and in the next few years I would get to know five or six other junkies.

As a young female I rather liked junkies. They were kinder and calmer than speed freaks, more predictable than drunks, and they didn’t hit on me for sex. One guy had a steady job selling music records at a department store, one was a Vietnam veteran, a few were hippies, including a brother-in-law. I spent long afternoons listening to Nina Simone with one, and took walks with another opiate- addicted man. They all seemed pretty harmless to me and I’ve never understood why opiate addicts are so despised. What interests me now is that none of them overdosed and some are still alive today.

Why are so many opiate users dying of overdoses today? My belief is that it’s because the supply of opiates is far more variable. What you got in the 1960’s, ‘70’s, and ‘80’s was heroin, and heroin got weaker as it passed through the drug dealer chain, cut it with benign fillers.  One shipment might be a little stronger than the last, it wasn’t ten or fifty times stronger. That changed in the mid-1990’s when the fentanyl, a synthetic opiate said to be 50 to 100 times stronger than heroin, was approved by the FDA for “break through pain.” Illegally manufactured fentanyl is now commonly added to low quality heroin to improve its boost. Opiate products sold on the streets often contain unknown amounts of fentanyl and methadone (a longer acting synthetic opiate) as well as heroin. It’s the variability from dose to dose is killing even experienced opiate users today.

A gal I know lost her brother, a competent businessman and pilot, when he crashed his plane. He got hooked on painkillers after a car accident. After his doctors cut him off he started on street drugs. He died in his first year of shooting heroin.

Opiate and heroin-related deaths have tripled since 2010.  During 2014, 47,055 drug overdose deaths occurred in the United States. 61% of those were opiate-related. Some were prescription drug overdoses and some were related to street drug overdoses. Opiate overdoses occur when high amounts of opioids act on the part of the brain that regulates breathing. Opioids in high dosage cause respiratory depression whether the person is addicted or not. Fentanyl is known to produce more respiratory depression that other opiates, yet it is now commonly mixed with heroin. Naïve users may overdose the first time, especially if they mix in alcohol, benzodiazepines, or other central nervous system depressants. There are a lot of new opioid users. The number of opiate prescriptions issued in the U.S. soared from 76 million prescriptions in 1991 to 207 million prescriptions in 2013. But even careful and experienced opiate users now die due to the variability in street heroin.

There has been little mention or in news of the variability of opiates. There has been little effective public response to the opiate epidemic. Fortunately naloxone, an opiate antagonist, is becoming more widely available.  If naloxone is given soon enough it can bring someone back from an overdose.

Naloxone is available to hospitals, police departments and first aid responders, but still not available to drug users or their families. Many people object to helping opiate addicts. But imagine being the parent or friend of an opiate user and watching your child or loved one die before first aid responders arrive.  A European study reported that over half of the opiate users surveyed had witnessed at least one overdose. In Italy naloxone is available in pharmacies without prescription. Wouldn’t it make sense to make naloxone easily available to opiate users and their friends and family? The World Heath Organization recommends that naloxone be made available to anyone who might witness an opiate overdose.

Most people were horrified by Philippine President Duterte’s recent comments. He said, "Hitler massacred three million Jews. Now there are three million drug addicts. I’d be happy to slaughter them.” And he is doing just that. In the USA we don’t want to slaughter opiate addicts but we are allowing them to die in large numbers. The junkies I knew when I was a teenager would most likely have died of overdoses if they were using today. It didn’t used to be like that. But it is now.

Someone told me recently that Janis Joplin traveled with a man who bought and tested the heroin she used and let her know how strong a dose to take. Janis overdosed and died on a night when he was away. If naloxone had been available she’d still be singing. If we can’t stabilize the supply of street opiates the least we can do is make naloxone available.

Problem Drinking: The Help I Could Have Used

Sometimes I think about what sort of help might have shorten my years of active alcohol addiction, and what sort of help I would have accepted and found useful. I wasn’t trying to stop. I would have liked some help moderating my drinking—from someone who didn’t try to tell me to quit. Because I didn’t want to quit.

I wanted to drink like my parents who enjoyed several martini’s each night but never got drunk, and who never woke up with hangovers. That’s what I wanted when I drank, to drink without having problems. Learning about moderation would have been helpful—even if I found out I couldn’t do it. Because on my own it took years to determine and accept that I couldn’t control my drinking. With help I would have figured it out in months rather than years.

But no one offered me that kind of help, and it’s a shame because I barely survived my last years of drinking. In my last year of drinking one drunken man pounded my head into a concrete wall and bit me as I tried to escape. Another man, a Vietnam veteran trained in special forces thought he should kill me. And I could have killed someone myself, because I often drove drunk. Sometimes in a blackout. I really could have used some help.

It’s still hard for people to get the type of help they need when they need it. The USA gave birth to Bill and Bob and the 12-step abstinence movement. This movement gave rise to the belief that there are only two kinds of drinkers: alcoholics who can’t drink at all, and normal people who can drink safely. Addiction professionals now know that there is a continuum of problem drinking that ranges from experimentation and risky drinking to alcohol dependency to chronic alcohol abuse. We now know that problems with alcohol can be mild, moderate, or severe. But regardless of the nature of an individual’s drinking problems, the only solution typically offered today is abstinence.

Abstinence is not an attractive solution for most problem drinkers, so they don’t get help at all. They are left to find solutions on their own, or to drink until they “hit bottom” or die. We don’t make diabetics wait until they have a diabetic coma to get help, and we don’t make those with heart disease have a heart attack before they can get help—but that is how we treat problem drinkers. We only offer them help when we think they are ready for abstinence. We don’t offer problem drinkers the help they want. Here’s the help I would have liked.

I would have liked to been given William R. Miller’s book “Controlling Your Drinking” for my eleventh birthday. It would have gotten me off to a better start as a drinker, and if I had gotten it on my 17th birthday I would have understood why I was having multiple problems related to heavy drinking. As it was I spent years trying to figure out whether to stop between my 6th and 7th drink, or between my 4th and my 5th drink. I tried to avoid harm. I drank in gay bars to avoid being picked up by men. I didn’t mix alcohol with opiates. I learned to be mean and keep people away from me. But if I’d had a copy of Miller’s book I would have learned how to track my drinking and my blood alcohol level (BAL).

It’s a lot of work to track your drinking. And you have to do it while drinking! I might not have been able to moderate my drinking. I might have found that I couldn’t do it at all. But the point is I would have learned that sooner using Miller’s book.

By the way there good research has been done on Miller’s moderation program. In the previous year one in seven problem drinkers (15%) were able to maintain moderation by staying under 3 standard drinks per day and averaging only 10 drinks per week.  23% were able to reduce their drinking significantly to average 14 drinks per week, some still experiencing occasional alcohol-related problems. Nearly one in four (24%) had been abstinent for the previous year. Most quit either because tracking drinks and BAL was too much bother, or because they found that drinking wasn’t worth it if they couldn’t get drunk. Another 37% had continued heavy and harmful drinking.

I’ll never know if I could have stopped sooner, or learned to moderate my drinking. It’s a moot point for me since I have been continually abstinent from alcohol for 33 years. (And Miller recommends that those who are successfully abstinent stay that way.) I managed to live through 18 years of heavy and dangerous drinking, but many of my friends didn’t. I wish we all could have gotten the help we needed. So for those now struggling to manage their drinking I highly recommend Miller’s book, “Controlling Your Drinking.”

And if you need more help, hire a professional recovery life coach. They won’t tell you what to do, but they will help you sort out what will work for you. We’ve trained some really good coaches at Crossroads Recovery Coaching & Training. Get in touch if you are interested. We’ll tailor your coaching to the help you want now.