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Trump’s War on Drug Users

Obama made headway in ending failed war-on-drugs policies, but Trump is betraying those suffering addiction and their loved ones.

published in USA Today
june, 2017

During the campaign, President Trump committed to addressing America’s drug crisis. He called it “a crippling problem” and “a total epidemic,” which it is. An average of 144 people a day die of drug overdoses. Trump promised increased funding and comprehensive Medicaid coverage for treatment. In March, he said, “This is an epidemic that knows no boundaries and shows no mercy, and we will show great compassion and resolve as we work together on this important issue.”

Trump’s rhetoric suggested a continuation of President Obama’s approach, which was founded on a rejection of the failed 45-year-old war on drugs, which treated drug use and addiction mainly as criminal problems. Obama called that war “counterproductive” and an “utter failure.” His administration emphasized treatment-and-prevention programs based on scientific advances that have demonstrated that addiction is a brain disease with biological, psychological and environmental determinants. Obama championed landmark legislation that funded mental health and addiction treatment programs and research. He signed the 21st Century Cures Act and the Comprehensive Addiction and Recovery Act, which provides resources for state and community prevention and treatment efforts. A godsend to sufferers of substance-use disorders, Obamacare mandated that insurance plans cover mental health, including addiction care, in parity with other diseases.

The administration made headway toward ending the war-on-drugs approach. Obama’s attorney general, Eric Holder, reversed wartime policies, including draconian mandatory minimum sentencing that filled prisons with people convicted of non-violent drug crimes. His surgeon general, Vivek Murthy, released a historic report — as significant as the 1964 surgeon general’s report on smoking — on alcohol, drugs and health, which made science-based prevention and treatment a national priority. The report is a progressive set of evidence-based policy recommendations for preventing substance use, intervening early in cases of drug misuse, and improving addiction treatment. The recommendations were the result of a 24-month review of the past 30 years of science and policy in this field. In addition, Obama’s recent drug czar, Michael Botticelli, spearheaded a movement that rejected the “failed policies and failed practices” of the past and championed prevention, treatment and harm reduction. For the first time, the drug czar’s budget was tipped in favor of prevention and treatment over interdiction and policing.

Trump’s initial comments regarding addiction appeared to reflect both a personal passion and a sensible policy. However, the president is systematically abandoning the addicted and their families. Last month, Trump abruptly fired Murthy and announced that the odd couple of his son-in-law, Jared Kushner, and Chris Christie will lead an effort to create policies to combat the opioid epidemic.

Fine, but meanwhile, though Trump promised to fund treatment, he has proposed slashing almost $6 billion from health agencies that, among other priorities, address drug use and addiction. He specifically targeted $100 million in block grants for the Substance Abuse and Mental Health Services Administration.

Of immediate concern to the 20 million Americans who meet the diagnostic criteria for the disease of addiction, and the 40 million regularly misusing alcohol and other drugswho are at risk and may require some form of treatment, the president has said that one way or another he’ll end mandates included in the Affordable Care Act.

Trump has said that he’d sign the bill the House passed Thursday that will, if it makes it through the Senate, do just that by allowing states to apply for waivers  of ACA-required benefits, including mental health and addiction care. Without that mandated coverage, it’s likely that millions of Americans will lose coverage for an illness that could kill them.

Meanwhile, Trump’s team has begun a re-escalation of the drug war. Attorney General Jeff Sessions, an old-school drug warrior, criticized Holder’s policies and suggested that he’ll reverse them. “You have to able to arrest people and then you’re intervening in their destructive habit,” Sessions said. “Many people never ever recover from addiction — except by the grave.”

They would recover if they had proper treatment.

 

t’s unsurprising that an administration that has vowed to be tough on crime plans to use battering rams rather than science-based public health efforts — ignoring evidence that the former doesn’t work and that the latter does. In the past, tough on crime was a boon to the prison system, which is filled with hundreds of thousands of people incarcerated for non-violent drug crimes. Any policy that throws sick people in prison is inhumane, never mind counterproductive.

And how about killing them? Doubts about Trump’s compassion toward the addicted were confirmed last weekend when he cozied up to a dictator whose idea of treating drug users is murdering them. According to USA TODAY, his new friend, the Philippines’ Rodrigo Duterte, had at least 6,000 people killed for drug crimes in six months. Duterte doesn’t distinguish between users and dealers. He has exhorted Philippine citizens: “If you know any addicts, go ahead and kill them.”

It’s critical that the Trump administration reverse directions and focus on a public health approach. Science has demonstrated that addiction isn’t a choice made by people without willpower who only care about getting high, no matter the impact on society, their loved ones and themselves. It’s a brain disease. We punish people who make bad choices. But people who are ill don’t need censure, stigmatization or jail time. They need quality care for an illness that can, if it isn’t treated, kill them.

David Sheff is the author of Beautiful Boy: A Father’s Journey Through His Son’s Addiction, and Clean: Overcoming Addiction and Ending America’s Greatest Tragedy. Follow him on Twitter: @david_sheff

 

Posted in Articles

Sobering Truth About Addiction Treatment in America

published in Psychology Today
June 2017

Addiction is treatable. So why aren’t more people receiving quality care?

The crisis is well documented and reported: More people are dying of drug overdose than any other non-natural cause—more than from guns, suicide, and car accidents. Politicians have held press conferences, formed commissions and task forces, and convened town-hall meetings. Vivek Murthy, the Surgeon General under President Obama (fired by Donald Trump), issued an historic report on America’s drug-use and addiction crises. Pharmaceutical companies have been blamed. Drug cartels. Physicians who hand out pain pills like Skittles.

In the meantime, the problem worsens. In 2015, 52,000 people died because of overdose, including 33,000 on OxyContin, heroin, and other opioids. Almost three times that number died of causes related to the most-used mood-altering addictive drug, alcohol. The 2016 and 2017 overdose numbers are predicted to be higher. Currently, fentanyl deaths are skyrocketing.

If not politicians, to whom can we turn to address the crisis? Since addiction is a health problem, the logical answer would be the addiction-treatment system, but it’s in disarray.

Currently most people who enter treatment are subjected to archaic care, some of which does more harm than good. Only about 10 percent of people who need treatment for drug-use disorders get any whatsoever. Of those who do, a majority enter programs with practices that would be considered barbaric if they were common in treatment systems for other diseases.

Many programs reject science and employ one-size-fits-all-addicts treatment. Patients are often subjected to a slipshod patchwork of unproven therapies. They pass talking sticks and bat horses with Nerf noodles. In some programs, patients are subjected to confrontational therapies, which may include the badgering of those who resist engaging in 12-Step programs, participation in which is required in almost every program. These support groups help some people, but alienate others. When compulsory, they can be detrimental.

Patients are routinely kicked out of programs for exhibiting symptoms of their disease (relapse or breaking rules), which is unconscionable. They are denied life-saving medications by practitioners who don’t believe in them—as Richard Rawson, PhD, research professor, UVM Center for Behavior and Health, says, “this is tantamount to a doctor not believing in Coumadin to prevent heart attacks or insulin for diabetes.”

Patients are put in programs for arbitrary periods of time. Three or five days of detox isn’t treatment. Many residential programs last for twenty-eight days, but research has shown that a month is rarely long enough to treat this disease. Some of those who enter residential treatment do get sober, but they relapse soon after they’re discharged, with, as addiction researcher Thomas McLellan, PhD, sums, “a hearty handshake and instructions to go off to a church basement someplace.” As he says, “It just won’t work.” Finally, people afflicted with this disease are almost never assessed and treated for co-occurring psychiatric disorders, in spite of the fact they almost always accompany and underlie life-threatening drug use. If both illnesses aren’t addressed, relapse is likely.

The disastrous state of the system suggests that addiction-medicine specialists don’t know how to treat substance-use disorders (or even if they can be treated). It’s not the case. The National Institute on Drug Abuse (NIDA) and organizations of addiction-care professionals like the American Society of Addiction Medicine (ASAM) and American Association of Addiction Psychiatry (AAAP) have identified effective treatments. There’s no easy cure for many complex diseases, including addiction. However, cognitive-behavior therapymotivational interviewing, and addiction medications, often used in concert with one another and in concert with assessment and treatment dual diagnoses, are among many proven treatments. However, most patients are never offered these treatments because of a fatal chasm between addiction science and practitioners and programs.

Illustration by Jasper Sheff
Source: Illustration by Jasper Sheff

Fixing the system requires modeling it on the one in place for other serious illnesses. Most people enter the medical system in their primary-care doctors’ offices, health clinics, or emergency rooms. Currently, most doctors in these settings have had little or no education about addiction. A recent ASAM survey of two thirds of U.S. medical schools found that they require an average of less than an hour of training in addiction treatment.

Primary-care doctors should be trained and certified to prescribe buprenorphine, a medication that decreases craving and prevents overdose on opioids. Currently, there are limitations on the number of patients doctors can treat. Still, in Vermont, for example, almost 50 percent of opioid users in treatment receive care in their doctors’ offices- they don’t have to go to addiction specialists or intensive treatment programs to receive care.

When a patient requires a higher level of care, doctors must refer them to addiction specialists, which excludes many current practitioners whose only qualification to treat addiction is their own experience in recovery. Instead, patients must be seen by psychiatrists and psychologists trained to diagnose and treat the wide range of substance use disorders. There’s a shortage of these doctors; there needs to be a concerted effort to fill the void.

According to Larissa Mooney, MD, director of the UCLA Addiction Medicine Clinic, “Individuals entering treatment should be presented with an informed discussion about treatment options that include effective, research-based interventions.  In our current system, treatment recommendations vary widely and may come with bias; medication treatments are either not offered or may be presented as a less desirable option in the path to recovery. Treatment should be individualized, and if the same form of treatment has been repeated over and over with poor results (i.e. relapse), an alternative or more comprehensive approach should be suggested.”

When determining if a patient should be treated in physicians’ offices, intensive-outpatient, or residential setting, doctors should rely on ASAM guidelines, not guesses. The length of treatment must be determined by necessity, not insurance. If a patient relapses, is recalcitrant, or breaks rules, treatment should be reevaluated. They may need a higher level of care, but sick people should never be put out on the street. In addition, all practitioners must reject the archaic proscriptions against medication-assisted treatment; Rawson says that failing to prescribe addiction medications in the case of opioid addiction “should be considered malpractice.”

Programs must also address the fact that a majority of people with substance-use disorders have interrelated psychiatric illnesses. Patients should undergo clinical evaluation, which may include psychological testing. Those with dual diagnoses must be treated for their co-occurring disorders. Finally, initial treatments must be followed by aftercare that’s monitored by an addiction psychiatrist, psychologist, or physician. In short, the field must adopt gold-standard, research-based best practices.

People blame politicians, drug dealers, and pharmaceutical companies for the overdose crisis. However, that won’t help the millions of addicted Americans who need treatment now. Even the most devoted and skilled addiction professionals must acknowledge that they’re part of a broken system that’s killing people. No one can repair it but them.

To follow on Twitter@David_Sheff

Posted in Articles

The New York Times: “David Sheff is a skilled journalist on an urgent mission.”

This review by Mick Sussman was published in The New York Times.

Sunday Book Review: A Disease, Not a Crime

It must be the purest agony to be the parent of a child succumbing to drug addiction. David Sheff’s previous book was an account of his son Nic’s descent from a thoughtful boy to a sullen pothead to a self-destructive methamphetamine fiend, and of his own tormented and bewildered reaction.

If that book, “Beautiful Boy,” was a cry of despair, “Clean” is intended as an objective, if still impassioned, examination of the research on prevention and treatment — a guide for those affected by addiction but also a manifesto aimed at clinical professionals and policy makers. Sheff’s premise is that “addiction isn’t a criminal problem, but a health problem,” and that the rigor of medicine is the antidote to the irrational responses, familial and social, that addiction tends to set off.

Sheff, a journalist, writes that America’s “stigmatization of drug users” has backfired, hindering progress in curbing addiction. The war on drugs, he says bluntly, “has failed.” After 40 years and an “unconscionable” expense that he estimates at a trillion dollars, there are 20 million addicts in America (including alcoholics), and “more drugs, more kinds of drugs, and more toxic drugs used at younger ages.” Continue Reading →

Posted in Recent Press

New York Times – Science: Clean is a reference work and a manifesto

An excerpt of the review by Abigail ZugerR, M.D.  in The New York Times.

Addict’s Father, Now Advocate

“Beautiful Boy” was a page turner, a dark fable that spoke to worried parents everywhere. “Clean” is a reference work and a manifesto, an annotated map of the same frightening territory where dragons still lurk at the edges.

Ruth Fremson/The New York Times

Ruth Fremson/The New York Times

In “Clean,” Mr. Sheff changes perspective, writing as advocate and journalist rather than distraught father. Still, his story line recreates that of “Beautiful Boy,” tracing the trajectory of addiction from cradle to rehab and beyond with the same question in mind: How does a promising cleareyed kid from a good family wind up in an inconceivable sea of trouble?

His answer, bludgeoned home with the repetitive eloquence of the missionary, is entirely straightforward: The child is ill. Addiction must be considered a disease, as devoid of moral overtones as diabetes or coronary artery disease, just as amenable as they are to scientific analysis, and just as treatable with data-supported interventions, not hope, prayer or hocus-pocus. Continue Reading →

Posted in Recent Press

David Sheff is Receiving the Media Award for 2017 from the American Society of Addiction Medicine (ASAM). In 2013, he was the Media Award from the College on Problems of Drug Dependence/National Institute on Drug Abuse

David Sheff is receiving the ASAM 2017 Media Award to recognize a person or entity that improves the public’s understanding of addiction, addiction treatment, recovery, or the profession of addiction medicine through the use of a media or publication source.

http://www.asam.org/education/live-online-cme/the-asam-annual-conference/program-schedule/annual-awards-luncheon

David Sheff is awarded the 2013 Media Award from the College on Problems of Drug Dependence/National Institute on Drug Abuse Media Award (CPDD/NIDA).

Posted in Recent Press

David Sheff interviews artist and dissident Ai Weiwei

Ai Wei Wei - David Sheff

PHOTO BY AI WEIWEI - INSTAGRAM
PHOTO BY AI WEIWEI – INSTAGRA

Interview with Ai Weiwei

by David Sheff

The artist Ai Weiwei is the Chinese government’s worst nightmare: an internationally revered art star who uses his work and celebrity to advocate for democracy and free speech in a nation with neither. The government has employed a draconian campaign to silence him. Ai is under constant surveillance. He has been threatened, placed under house arrest and physically attacked by a police officer. Ai’s incendiary blog, read by thousands of Chinese citizens, disappeared one day. And so did he: In 2011, state police grabbed him at the airport, threw a black bag over his head and drove him to an undisclosed location, where he languished for 81 days in a tiny prison cell. Despite these attacks, Ai has continued his virulent criticism of the Chinese Communist leadership, which he deems repressive, immoral and illegitimate. 

continue reading →

Posted in Articles

At the Yale Department of Psychiatry Grand Rounds Lecture: David Sheff talks about Addiction, America’s Greatest Tragedy

Article by Susan Gonzalez was published in the Yale News

Journalist shares his anguished journey through son’s addiction — and what he’s learned from it

There was a time early in his son’s addiction to methamphetamines and heroin that David Sheff reacted with disbelief when told that addiction is a disease.

“My son isn’t ill,” the freelance journalist and author recalled thinking. “He’s a selfish, reckless, remorseless, narcissistic teenager obsessed with being high.”

The first time he forced Nic into treatment, said Sheff, the youngster tried to kick out the car window in an effort to escape.

Sheff — author of the bestselling “Beautiful Boy: A Father’s Journey Through His Son’s Addiction” and the subsequent (and also bestselling) “Clean: Addressing Addiction and Ending America’s Greatest Tragedy” — recounted some of his journey before a packed audience during a psychiatry grand rounds lecture in the auditorium of 55 Park St. His talk, co-sponsored by the Poynter Fellowship, was also the Department of Psychiatry’s annual Ribicoff Lecture.

Today, following a decade of personal experience and years of journalistic research, Sheff is convinced that addiction is, in fact, an illness, and believes that it cannot be prevented and successfully treated until that fact is commonly accepted and understood. He said the addict should be treated with as much compassion as someone with cancer or any other disease.

Continue Reading →

Posted in Articles

Presenting Research on Addiction at National Institute on Drug Abuse

nida-david600

Posted in Recent Press

Nic and David Sheff Speak at the Family Action Network

With Nic Photo by Eric Dynowski

Nic and David Sheff
Photo by Eric Dynowski

Posted in Articles

The Hidden Ten Percent

This article by David Sheff was originally published on Medium.

Our Children’s Drug Problem and What Parents Can Do To Solve It

A mother writes:

My son ______ was addicted to prescription drugs. At twenty one he was introduced to heroin. Two years later heroin took his life…. I found him in the bathroom in respiratory arrest. I started CPR until the paramedics arrived and transported him to the hospital. He was on life support for five weeks. He passed away on 12/11/2010. Some days the pain is so unbearable that I don’t think I’ll make it.

A father told me about his daughter, “so smart and kind and loving.”

She was 20. For the last 4 years, she was using marijuana and drinking. Then she tried meth, and that’s when I lost her. She had begun college — an ivy league school. She had good friends who loved her. After her third rehab, she was clean for six months, but then she relapsed. This time someone gave her pills. She was at a park when they found her. I can hardly write these words. We lost our beautiful girl.

More letters arrive. And more. Attached to many e-mails are pictures. Or when I open envelopes that come in the mail, photographs fall out like petals falling off a flower that has died. Parents sending pictures of their children. Their beautiful boys and beautiful girls. And they are beautiful. Every one. Continue Reading →

Posted in Articles