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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

 

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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

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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 →

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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 →

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Nic and David Sheff Speak at the Family Action Network

With Nic Photo by Eric Dynowski

Nic and David Sheff
Photo by Eric Dynowski

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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 →

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Calling 911 Shouldn’t Lead to Jail

This article by David Sheff was originally published at The New York Times.

PARENTS of drug-addicted kids learn the hard way that when we think things can’t get worse, they do. As a teenager, my son, Nic, was addicted to methamphetamine, heroin and other drugs. At 20, he had used most of the illicit drugs known to man. But one night, partying with a couple of friends in his basement apartment in Brooklyn, the combination and volume caused him to overdose. One of his friends called 911.

Nic was rushed to the emergency room, where he was resuscitated. When I spoke to a doctor there, I was told that if another 15 minutes had passed before Nic got to the E.R., he wouldn’t have survived. My son has now been sober for five years. I don’t know who called the paramedics, but not a day goes by when I don’t thank him.

Other parents haven’t been so lucky. Continue Reading →

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Fashionably Stoned

This article by David Sheff was originally published at Medium

A “Celebrity Boutique” Celebrates Drug Use at Children’s Expense

The banner on the website of Kitson, the self-described celebrity boutique whose customers include Taylor Swift, Reese Witherspoon, and Paris Hilton, reads, “Pop one on and you’ll feel better. Just what the doctor ordered.” The prescription is for customers to check out the company’s line of jerseys and sweatshirts emblazoned with the words VICODIN, XANAX, and ADDERALL, three of the most misused prescription medications, the class of drugs now killing more people than any other nonnatural cause, even traffic accidents.

Pop references to drugs are nothing new. Miley Cyrus’s twerking at MTV’s Video Music Awards was talked about more than Syria, but not much was said about the song she sang that made “dancing with Molly” sound pretty great. Molly is MDMA—Ecstasy, the drug that killed two kids and left others in critical condition at the Electronic Zoo music festival in New York City on August 31. (The New York Times has reported more deaths since then.) Nicki Minaj, Madonna, Kanye West, Rihanna, and Rick Ross also sing the praises of Molly, but those endorsements are simply the latest in the tradition of countless songs, movies, TV shows, and products that make drugs seem awesome.

Continue Reading →

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Immorality or Illness?

Article by David Sheff originally appeared on Medium

When my teenage son was raging out of control on drugs — wasted on crystal meth and heroin, careening toward death — I finally got him into treatment, the first of a dozen rehab programs he would go to. This program included lectures for family members, like one titled “The Disease of Addiction.” By then Nic had lied to me, broken into our home, and stolen from me — and even from his little brother, too. I thought I’d raised a kind, moral, and loving child, but something had gone horribly wrong. As I listened to the speaker talk about addiction as a disease, Nic was in a lockdown ward in a wing of the hospital. Getting him there had been hell — he almost leaped out of our moving car and had tried to kick out the window. My son wasn’t ill. He was selfish, reckless, and remorseless, a narcissistic teenager obsessed with being high, with no concern for his family.That was the first time I heard what is sometimes termed “the disease theory” of addiction, but it wasn’t the last. I tell about my struggle to understand that addiction is a disease in my book Beautiful Boy, about about my family’s struggle when Nic became addicted. The disease theory was repeated in more lectures at more rehabs, in countless therapists’ offices, and in many Twelve Step meetings I attended. I’d become enraged by it. People with leukemia have a disease. Those with Alzheimer’s or lymphoma have a disease. Nic was choosing to use and could stop if he wanted to. There was no such option for cancer patients. Continue Reading →
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The Lost War

This article by David Sheff was published at Medium

The war on drugs was lost because the war on addiction was never begun

The death last month of the Glee star Cory Monteith was tragic. All deaths are. But it is even more tragic when it could have been prevented — like Monteith’s.

Because of Monteith’s death from an overdose of heroin and alcohol, addiction is having its latest fifteen minutes of fame. Fifteen minutes, however, are better than none to serve as a reminder of the prevalence and perniciousness of this disease. It’s unfortunate that it takes the death of a TV star—a Canadian in this case, but beloved in America and thought of as one of our own—to talk about a disease that kills three hundred and fifty people every day.

In the ubiquitous coverage of Monteith’s overdose, I haven’t heard any commentator express the fact that this death isn’t merely sad. It is appalling­—because it might have been prevented if it weren’t for failed drug policies. Continue Reading →

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