Tag: addiction treatment

Addiction, criminal justice, Drugs, legislature, Uncategorized

In Last-Minute Move, Legislature Adopts New Approach to Drug Possession

By Paul Kiefer

After a last-minute rush to pass legislation in response to the Washington State Supreme Court’s decision in February that rendered the existing drug possession laws void, the Washington State legislature passed new legislation on Saturday re-criminalizing low-level drug possession by making it a misdemeanor and requiring local jurisdictions to provide treatment options for drug users. The bill, ESB 5476, directs law enforcement officers to divert people who violate the new law to “assessment, treatment, or other services” for the first two violations; after the second violation, a violator can be referred for prosecution and, potentially, a fine or jail.

After making compromises to pass the bill before the final day of the legislative session on Sunday, many lawmakers are not fully satisfied with the result. But had the legislature not passed a new law regulating drug possession, some lawmakers worried that a patchwork of local policies and enforcement practices would have filled the vacuum.

The decision that precipitated the scramble to adjust Washington’s drug possession laws, called State of Washington v. Blake, ruled that Washington’s so-called “strict liability” drug possession laws—which made no distinction between intentional and unintentional drug possession—violated the due process rights enshrined in both the state and federal constitutions.

Without new legislation to address the court’s decision, the state can’t enforce any of its existing drug possession laws. But local jurisdictions could have passed new laws if the state legislature had not acted, which could range from de-criminalizing drug possession to classifying intentional possession as a gross misdemeanor—the most severe criminal charge a local jurisdiction can impose.

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The bill at the center of the legislature’s ongoing push to respond to the Blake decision began as the work of a group of Democratic senators led by Sen. Manka Dhingra (D-45, Bellevue), who proposed that the state eliminate all criminal penalties for possessing a “personal use amount” of an illegal drug—up to one gram of heroin or two grams of methamphetamine, for example. In its original form, the bill also proposed a system in which law enforcement could pass the names and contact information of drug users to a “care coordinator,” who would then reach out to the drug user to offer treatment and recovery resources.

But in an effort to pass the bill out of the senate, Democratic lawmakers moved to re-criminalize drug possession to win the votes of some Republicans; when the bill came to a vote on the senate floor, Dhingra voted against it, arguing that it no longer reflected her goal of separating addiction treatment from the criminal justice system. Continue reading “In Last-Minute Move, Legislature Adopts New Approach to Drug Possession” →

Addiction, Health, Seattle magazine

Tech Addiction Is On the Rise In Seattle—But Why?
Photo by Hayley Young for Seattle magazine

This article appeared in the June 2019 issue of Seattle magazine and was produced in collaboration with Crosscut. A full version of this piece is available at Seattle magazine’s website. 

Laura and Dave Johnson* had always known that their older son, Eric, was different than other kids. Diagnosed with severe ADHD at a young age, Eric was smart, sensation-seeking and focused—the kind of kid, his mother says, who has “a brain for coding,” and is “smart in a way that we don’t understand yet.”

If he wasn’t racing his mountain bike downhill, he was bouncing parkour-style off the sides of downtown buildings or watching television with an intensity that unnerved his parents. “He could watch TV all day long,” says Laura Johnson.

Then, like most of his peers, Eric discovered video games—Mario Kart, Splatoon (a third-person game in which players splatter each other with ink), The Legend of Zelda. After that, Johnson says, things were never the same. Unlike most kids and adults who play video games, Eric, now 15, didn’t seem to have an “off” switch. By the time he was in middle school, games were all he could think about. It was like the games were doing the same thing for him that mountain biking did, Johnson says. “He likes that tactile [sensation] and he needs his brain to go fast and he needs feedback from something.”

The Johnsons live in a comfortable brick Tudor in Seattle’s Broadview neighborhood. There’s one TV in their house and just two computers: a desktop in the basement that Dave uses for work and Laura’s laptop. The idea that video games could become a problem, much less an addiction, was completely alien to them. Over time, though, they began to realize that their son’s fascination with games and other screens resembled an addiction. “He rushes through other things if he knows there’s ‘game time’ in his future,” she says. “And that ‘game time’ is on his mind [until] he gets it—regardless of what we are doing.”

While gaming—or tech—addiction is uncommon (and the label “addiction” remains controversial), Eric is not alone. Dr. Dimitri Christakis, director of the Center for Child Health, Behavior and Development at Seattle Children’s Research Institute, estimates that between 5 and 12 percent of young adults show signs of gaming disorder; a 2017 paper in the American Journal of Psychiatry, meanwhile, put the number at less than 1 percent of the general population.

Games (and social media such as Instagram and Twitter) have an additional characteristic that makes them habit-forming: They provide that kick of dopamine at unpredictable intervals, providing an incentive to stay glued to the screen.

The jury is still out on whether tech addiction is more prevalent in places like Seattle, where a higher-than-average number of people work in the tech industry, but anecdotal evidence suggests there could be a correlation. Hilarie Cash, the founder of a Fall City–based inpatient tech addiction treatment program called ReStart, says that when she started treating people for gaming disorder, back in the mid-1990s, most of her patients were adults working in the tech industry; today, she says, many of her clients have parents who work in the industry and who “tend to be very surprisingly oblivious to the impacts of screens on child development.”

Experts generally agree that too much screen time can inhibit kids’ ability to focus, develop social skills and engage in activities that don’t produce an immediate reward the way screens do. Cash also points to school districts in large, highly connected cities that, she says, have “drunk the Kool-Aid and are trying to get tablets and computers in the hands of every student, even in elementary school.”

In recent years, there has been significant interest in recognizing gaming disorder as a formal diagnosis, spurred largely by an international uptick in people seeking treatment for the disorder. Last year, the World Health Organization officially recognized gaming disorder as a condition in its International Classification of Diseases, and the American Psychiatric Association, which publishes the Diagnostic and Statistical Manual of Mental Disorders (DSM), has recognized “internet gaming disorder” as a “condition for further study” for possible future inclusion in what’s often called the bible of psychiatry. The state of research remains in its infancy, however, and experts disagree on everything from the best course of treatment to whether compulsive gaming should be classified as an “addiction” at all.

For the Johnsons, their attempts to curtail Eric’s obsession with gaming began by trying to restrict his access to technology. They established boundaries, one after the other—no games until he’d done something creative, or no more than an hour of gaming a day—but Eric broke every rule. “I tried so many different scenarios,” Johnson says. “No boundaries ever worked. Nothing ever worked.”

Over the course of Eric’s seventh-grade year, this “very smart, very savvy…fascinating” kid transformed into a person his parents barely recognized—a kid who spent all his time “speedrunning” (playing through games as fast as possible) and throwing fits when his parents tried to restrict his access to games. “He would run away,” Johnson recalls. “He jumped out of the car once while it was moving.” After the Johnsons took away his smartphone, Eric stole money from his brother, who is three years younger, got off the bus on the way to school and bought a second phone. (Then, when they took that phone away, he did it again.)

Over the course of Eric’s seventh-grade year, this “very smart, very savvy…fascinating” kid transformed into a person his parents barely recognized—a kid who spent all his time “speedrunning” (playing through games as fast as possible) and throwing fits when his parents tried to restrict his access to games.

At their wits’ end, the Johnsons sought advice from Ann Steel, a counselor who specializes in gaming addiction. Following her advice, they sent Eric to a wilderness camp on the Olympic Peninsula—an increasingly common, if still unproven method of treating kids whose gaming or screen time starts to negatively impact their lives—shortly before his 13th birthday. On his final night before he left for camp, Eric stole his mom’s laptop and stayed up all night surfing the web, like someone getting a last fix before going to rehab. After 10 weeks in the wilderness, Johnson says, Eric “did seem clearer in his head.” On the other hand, the day after he returned, he broke Johnson’s windshield.

Last year, after doing more research about its options and hiring an education consultant, the family sent Eric to Cherry Gulch, a therapeutic boarding school outside of Boise, Idaho, that offers individualized education and treatment to kids struggling with various issues, from grief to ADHD to digital addiction. Johnson says her son is doing well. After a year at Cherry Gulch, she says, “his growth has been huge. The most growth we’ve had in his 15 years of life.”

Still, it’s unclear what his parents will do when Eric graduates from Cherry Gulch this summer, and how they’ll keep him from slipping back into his old habits when he returns. He’s just coming to terms with the fact that he has an addiction to gaming and screens, Johnson says. “He isn’t quite at the acceptance phase.”

The notion that it’s possible to be addicted to video games, or any type of technology, has gained mainstream acceptance in recent years. Like gambling—the only behavioral addiction currently included in the DSM—video games seem to trigger some of the same chemicals in the brain as alcohol and illicit drugs, including dopamine, the so-called “reward neurotransmitter” of the brain. But games (and social media such as Instagram and Twitter) have an additional characteristic that makes them habit-forming: They provide that kick of dopamine at unpredictable intervals, providing an incentive to stay glued to the screen.

Think of it as a lab experiment, says Christakis. “If you try to condition a rodent to push a lever when a stimulus comes, and they get a reward every time, it doesn’t create an obsession,” Christakis says. Make the rewards unpredictable, and the rats are “much more likely to become compulsive. The reward could come at any second, and they might miss it if they aren’t paying attention.”

Gaming also gives people something of value that they may be missing in their lives—whether a person is a smart kid craving stimulus and mental challenges, like Eric, or an adult who lacks a sense of accomplishment in life. Alok Kanojia, a Boston psychiatrist who specializes in gaming disorders and says he was once addicted to video games himself, says, “People will play 40, 60, 100 hours of World of Warcraft”—a massively multiplayer online game, or MMO, in which people cooperate and compete with each other in real time— “and they derive a sense of value out of it. You may feel like you’re no one in the real world, but you’re someone in the game.”

Read the rest of this story at Seattle magazine.

Addiction, Drugs, King County

After Two-Year Gap, Detox Center Will Open on Beacon Hill
King County Executive Dow Constantine stands next to a detox bed at the soon-to-open Recovery Place.

The new detox and inpatient treatment center that will open later this year on Beacon Hill doesn’t look like much from the outside. A low-slung institutional building surrounded by a black iron fence and fronted by a small parking lot, it looks somewhat out of place in a residential neighborhood where brightly colored townhouses have sprouted like dandelions in recent years.

Even from the inside, you have to squint to imagine the transformation—from what Valley Cities Behavioral Health Care CEO Ken Taylor called a “ghastly” institution, run by Recovery Centers of King County, into a modern, brightly lit facility with fitness rooms, two large kitchens, and rooms for group meetings and private counseling.

The opening of the new facility, called Recovery Place, marks a significant milestone for detox and treatment in King County—the restoration of 32 beds for people needing medical detoxification from alcohol, heroin, and other drugs, and the first residential detox center in King County where people can access treatment for addiction and mental health issues simultaneously. (Most treatment centers do not deal with dual diagnoses).

The city’s Navigation Center, a new low-barrier shelter less than a mile away, will direct clients to Recovery Place, which will also take patients directly from emergency rooms and (eventually) on a walk-in basis. In addition to detox and a traditional two-to-four-week inpatient treatment program, the center will offer medication-assisted treatment with drugs like buprenorphine to heroin and opiate addicts. “We’re embracing a harm-reduction approach as much as an abstinence-based approach,” Milena Stott, Valley Cities’ director of inpatient services, said.

Valley Cities CEO Ken Taylor in the detox wing of Recovery Place

The last tenant to occupy the building, Recovery Centers of King County, went bankrupt and shut down abruptly in 2015, and since then, the 27 detox beds they provided have been distributed all over King County through contracts with institutions like Fairfax Hospital in Kirkland and the Seadrunar long-term treatment center in Georgetown.  Before RCKC closed down, Taylor said, the building “was dark and damp, and all throughout the central corridors there was plumbing and electrical running literally right down the middle of the corridor.” Outreach workers told me last year that RCKC was known for treating clients rudely and asking “inappropriate” personal questions in earshot of other patients; the new facility, in contrast, will have private consultation rooms. After RCKC closed, the building itself was taken over by squatters and stripped bare, with everything from the toilets to the copper wiring stolen and carted away.  Morgan Irwin, a Republican state representative (R-31) and Seattle Police Department officer who was on hand for yesterday’s tour, said that the last time he was inside the building, which is on his beat, “It was literally flashlight and gun out.”

The building cost $4 million to buy, plus $9 million to renovate. A million dollars of the budget to buy and fix up the building came from King County; the rest came from a combination of state and grant money and a $4.5 million loan that Valley Cities took out from Bank of America to cover the remaining costs. The state’s capital budget, which remains in limbo, is supposed to provide about $2 million toward the cost of repaying the loan, but Taylor said Valley Cities “is going to be able to repay the loan” ion its own if state funding doesn’t come through. “We’re very fortunate. Not every agency can do that.” Ongoing operations will cost about $5 million a year; that funding will come from the state and federal governments as well as from patients’ insurance payments. RCKC went bankrupt, King County Human Services Department director Adrienne Quinn told me, in part because of unfavorable state reimbursement rates, which she was quick to add have been addressed.

Contrary to common belief, not every person with addiction needs detox, although medication can ease the suffering and make it less likely that people withdrawing from opiates, for example, abandon treatment. (Severe alcoholism does require detox because going cold turkey can cause seizures, DTs, and fatal heart conditions.) Buprenorphine, and other opiate substitution medications, can help short-circuit the withdrawal process and get opiate addicts on a path to stability. “I hope that everyone for whom buprenorphine is appropriate will elect to do that,” Taylor said, “but sometimes it takes them time to get to that point.”

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