Tag: addiction treatment

Planned Overdose Recovery Center Will be Run by DESC, Located on Third Avenue

Photo of DESC's Morrison Hotel building on Third Avenue in downtown Seattle, with people hanging around on the sidewalk outside.
DESC’s Morrison Hotel building on Third Avenue in downtown Seattle

By Erica C. Barnett

The Downtown Emergency Service Center, which operates shelters, housing, and mobile crisis response teams, will operate a new opiate overdose response center, serving up to 20 people a day, inside its Morrison Hotel building on Third Avenue in downtown Seattle. DESC director Daniel Malone says the new facility will share the second floor of the Morrison, which housed the agency’s congregate shelter prior to COVID, with an expansion of DESC’s existing outpatient behavioral health clinic and serve people looking for services and a place to physically recover immediately after an overdose.

Currently, if someone overdoses in Seattle and emergency medical services (EMS) responds, they generally face two options: Go to the hospital in an ambulance, or walk away. A post-overdose stabilization site would create a third option where people could rest, receive IV fluids or medication to get them through the early stages of withdrawal, and initiate treatment for opioid use disorder. Patients could also access DESC’s outpatient behavioral health clinic, which connects patients with psychiatric care, counseling, and case management.

Methadone—an opiate that effectively replaces more harmful drugs like heroin and fentanyl, allowing people to resume normal lives—remains one of the most highly regulated drugs in the nation; patients typically have to show up in a physical location to take a single dose at a specific time every day, although lawmakers temporarily loosened those restrictions during COVID. Buprenorphine, which works by partially occupying the brain’s opiate receptors, is more widely accessible, and a new injectable form of the drug, trademarked Sublocade, lasts a month.

“It’s extremely important to us to make sure that we won’t have that kind of chaotic and disruptive activity happening on the sidewalk in front of the building, and part of our plan is to really enhance our capacity to have a much stronger presence to help ensure that the environment is calm and conducive to people coming and going safely.”—DESC Director Daniel Malone

“Methadone introduces a set of additional regulatory complications that the other medicines don’t have, but methadone would be an important tool in the toolbox,” Malone said.

Between January and July of this year, according to data from the King County Department of Public Health, emergency medical services responded to 2,546 nonfatal overdoses in Seattle, out of 4,918 countywide. Both fatal and nonfatal overdoses have increased steadily over the past five years, as fentanyl—a powerful opioid first developed as a pain medication in the 1960s—has worked its way into the street drug supply.

Funding for the new facility would come from the city of Seattle, King County, private grants, and the University of Washington’s Addictions, Drug & Alcohol Institute (ADAI). In July, the King County Council approved spending $2 million in unspent CLFR (federal COVID) funds to help renovate the second floor of the Morrison to accommodate the expanded outpatient center and the opiate recovery site.

The city of Seattle is expected to provide another $2 million for construction, out of $7 million in unspent federal funding that Mayor Bruce Harrell announced as part of his plan to “invest $27 million toward facilities, treatments, and services to address the opioid crisis.” As we’ve reported, the $27 million is actually $7 million in unspent federal grants for capital projects, plus a little over $1 million a year from state settlements with opiate manufacturers and distributors. That million dollars could could help fund the day-to-day operations of the new overdose recovery site over the next two decades, but it won’t be enough to keep the new site open full-time, Malone said.

“If there’s not enough money to [operate] 24/7, then some version where it’s only open certain hours may have to be implemented,” Malone said. Overdoses happen at all hours, so having only a part-time facility “would seriously limit the ability of this facility to meet all the community’s needs over the course of the day.”

Harrell expressed support for a post-overdose recovery center back in April, when he signed an executive order expressing the city’s commitment to site and “explore funding for” a new facility “where EMS can bring people after non-fatal overdoses to recover, get stabilized on medications, and access resources.” However, his office would not comment on the plan to open the site on Third Avenue, and would not confirm that DESC was the intended recipient of the funds Harrell announced last month. “There is [a request for proposals], and no decisions have been made,” Harrell spokesman Jamie Housen said. “It is a competitive process, and we expect DESC will apply.”

King County just approved spending $2.2 million in unspent federal COVID relief dollars to help renovate the site, which used to house DESC’s congregate shelter, last month.

Map of Morrison Hotel and DESC’s current behavioral health drop-in center

The Morrison Hotel, which also includes 190 permanent supportive housing units, is located directly across from the King County Courthouse. The sidewalk around the building’s Third Avenue entrance is often occupied by people who are unhoused, have untreated behavioral health conditions, or are actively using and selling drugs, making the building a target of frequent complaints and a perennial subject for conservative local media such as KOMO News, which infamously blamed DESC for crime on Third Ave. in its followup to the agitprop film “Seattle Is Dying.”

In addition to funds for the overdose site itself, King County approved $200,000 for a “client engagement team” that will “manage client presence and prevent conflicts on Third Avenue in front of DESC’s renovated facility,” according to a King County Council memo.

“It’s extremely important to us to make sure that we won’t have that kind of chaotic and disruptive activity happening on the sidewalk in front of the building, and part of our plan is to really enhance our capacity to have a much stronger presence to help ensure that the environment is calm and conducive to people coming and going safely,” Malone said. The new staff will “be present not just inside, but in the immediate external sidewalk area… to connect with people who are out there and deal with anything that may be happening that is contributing to an undesirable environment.”

Judges and other courthouse officials have complained for years about safety issues around the courthouse, which also borders City Hall Park—a compact greenspace that recently reopened after a lengthy closure. King County Superior Court Judge Patrick Oishi, who has repeatedly raised alarms about the safety of jurors and courthouse staff, told PubliCola he hopes the opioid recovery center will have a positive impact on the street scene around the courthouse.

“Although it is difficult to predict what impact an opioid recovery center will have on the courthouse area, the Court commends Mayor Harrell, the City of Seattle, and King County for taking critical steps to address this significant public health crisis,” Oishi said. “It is our hope that responding to the opioid crisis will enhance public safety in the courthouse area.”

Council Member Wants to Know: Why Isn’t Harm Reduction Abstinence-Based?

By Erica C. Barnett

City Councilmember Sara Nelson, a vocal advocate for abstinence-based treatment for addiction, argued publicly yesterday with advocates for harm reduction over their approach, which emphasizes keeping people who use drugs alive and helping them address underlying conditions, such as homelessness and health care issues, without judgment or pressure to quit using drugs. Why, Nelson wanted to know, were these organizations focused on reducing harm from drug user rather than “encouraging” them to understand that total abstinence should be their goal?

“What [is] Public Health… doing to move beyond the harm reduction phase and how much money, if any, do you spend on agencies or for treatment that is geared toward abstinence?” Nelson asked. “And as a corollary of that, I guess the more basic question is, does Public Health agree that it has a responsibility to change behavior beyond meeting people where they’re at? Do you feel as thought’s important to help people change their use patterns in ways that they can go into abstinence-based recovery?”

Nelson’s (rhetorical?) questions came during a presentation by three longtime service providers—REACH, the People’s Harm Reduction Alliance, and the Hepatitis Education Project, along with King County Public Health—about how they have used funding from a small grant aimed specifically at reducing harm related to drug use. For years, the city council has also allocated funds for this purpose but the mayor’s office has refused to spend it.

“We’ve got ‘meeting people where they’re at’ covered, I think, when we’re looking at the treatment services that are provided right now,” Nelson said.

The county, strategic advisor and drug policy specialist Brad Finegood assured Nelson, spends “hundreds of millions of dollars” on abstinence-only services; the point of also funding harm reduction, he said, is to “keep people alive” and give them entry points for services amid an overdose epidemic that claimed more than 700 lives in King County last year. Those services, the direct service providers explained, include handing out the overdose prevention drug naloxone, connecting people to health care, offering medication-assisted treatment, and handing out supplies for safer use, including pipes for smoking drugs rather than injecting them.

Nelson (like many local right-wing commentators) zeroed in on safe smoking supplies, suggesting that providers should measure their success by tracking how many people who take pipes end up in treatment.

“I know it can be controversial,” Hepatitis Education Project program director Amber Tejada responded, but “one of the keys that I see is we want to facilitate the autonomy of people that use drugs. There are folks that don’t want to stop using drugs. There are folks for whom abstinence is not how they measure success in life. … Our mission, what we have been able to do really successfully with this program, is to show that people can use drugs safely, and we can help folks get access to resources if that is something they are interested in.”

Last week, Nelson joined her colleague Alex Pedersen and City Attorney Ann Davison to propose new legislation that would enable the city attorney, rather than the King County Prosecutor, to begin prosecuting people for simple drug possession and public drug use. In 2018, King County Prosecutor Dan Satterburg stopped pursuing charges against people for possession of small amounts of drugs while expanding programs like LEAD that work to provide case management and service connections to people who use drugs.

The legislation, if adopted, would represent a profound change to the city’s approach to drug use and a return to war-on-drugs policies that the region has largely abandoned in favor of more compassionate and evidence-based approaches.

Last year, Nelson inserted language into the 2023-2024 budget to fund “facilities” for abstinence-based residential or intensive outpatient treatment using the city’s portion of a state settlement with opioid manufacturers. However, the language of Nelson’s statement of legislative intent leaves wiggle room for other evidence-based types of treatment, such as medication-assisted treatment or contingency management, as a presentation from council central staff at yesterday’s meeting also made clear.

Yesterday, Nelson expressed her frustration that the “private provider community,” which has “more availability for people who have insurance or can pay out-of-pocket,” has not been directly involved in the group that will make recommendations on what kind of treatment to fund with the money she proposed setting aside.

The point of her budget amendment, Nelson said, was “to establish a pilot program that would allow the city to directly contract with treatment facilities, private or public, in order to [help] people who are at the phase of really wanting to go into rehab, get into rehab, especially if they don’t have medication” as an option, as opioid users do.

“We’ve got ‘meeting people where they’re at’ covered, I think, when we’re looking at the treatment services that are provided right now,” Nelson said.

Drug Possession Bill Moves Forward with Less Punitive Approach

By Andrew Engelson

The legislative battle over Washington’s new drug possession law took another turn last week when Democrats in the house Community Safety, Justice, and Reentry committee offered a new version of the bill, which would make drug possession a simple misdemeanor, offer more options for treatment and diversion instead of jail, legalize harm reduction paraphernalia like syringes statewide, and eliminate punitive jail time for those who fail to complete treatment.

Legislators have been in a vigorous debate this session over the state’s drug possession law after a 2021 ruling called Blake v. Washington. Although the case concerned a fairly narrow question about “knowing” possession, the court ended up tossing out the state’s possession law altogether, prompting legislators to pass a temporary law that expires in July.

Last month, in a surprise move, moderate Democrats significantly modified a proposed replacement for the expiring law with a series of amendments that increased drug possession to a gross misdemeanor and in most cases required judges to impose minimum jail sentences for those convicted who failed to complete treatment.

Rep. Roger Goodman (D-45, Kirkland), who chairs the committee, told PubliCola his striker amendment removes some of the more punitive aspects of the original senate bill, which would have made drug possession a gross misdemeanor—a charge that carries a penalty of up to 364 days in jail and a maximum $5,000 fine.

“Even when your possession was a felony, you could have three or four prior offenses and it still wouldn’t allow up to 364 days in jail,” Goodman said. “[The Senate version] actually increases the confinement time from what it used to be as a felony. So that’s not acceptable.”

“The House Democrats are horrified–including myself—by the prospect of returning to the war on drugs,” he said. “Ninety days in jail, which is what a simple misdemeanor brings, is certainly more than enough.”

“[Prison] was traumatic not only for me, but for my children,” who were 8 and 18 at the time, State Rep. Tarra Simmons said. “When you’re in jail, it’s not a trauma-informed therapeutic environment. Nobody’s getting better in jail.”

On Tuesday, the house Appropriations committee passed an additional striker amendment stipulating that if someone is convicted of possession and either completes treatment or has a clean criminal record for one year, the conviction will be removed from their record. Rep Lauren Davis (D-32, Shoreline) introduced the striker, and wrote the amendment to vacate convictions with help from  Rep. Tarra Simmons (D-23, Bremerton), who is the first person to serve in the legislature who has also served time in prison.

“When you have that stigma of the criminal record on your record forever, it limits where you can go in the future,” Simmons said. 

Simmons also said she’s working with Goodman, Davis, Rep. Nicole Macri (D-43, Seattle), and others on a floor amendment that would require prosecutors to divert a person’s first drug possession conviction to services and/or treatment. That  needs to  happen sometime before next Wednesday, the cutoff date for bills to pass in their opposite chamber.

The current version of the bill eliminates a provision added in the Senate that would require the Washington State Patrol forensic lab to deliver tests of drugs held in evidence within 45 days, and creates new misdemeanor offenses for “knowing” possession and public drug use. The provision on public use could be a carrot for centrist Democrats such as Sen. Jesse Salomon (D-32, Shoreline) who talked at length in testimony for his more punitive drug possession bill about seeing public drug use near his child’s school.

Simmons, who was first elected in 2020, has been actively involved in the drug possession bill in part because of her own experience with substance use and the criminal justice system. After experiencing childhood trauma and teen pregnancy, Simmons struggled with substance abuse disorder, using opioids and methamphetamine. She was convicted of drug possession, possession with intent to deliver, and theft in 2011 and served 20 months in prison. 

“It was traumatic not only for me, but for my children,” who were 8 and 18 at the time. “When you’re in jail, it’s not a trauma-informed therapeutic environment. Nobody’s getting better in jail.”

A nurse by training, Simmons went to law school and successfully challenged a Washington State Bar rule that wouldn’t let her practice law because of her felony conviction. Of the current version of the bill, Simmons said, “I strongly believe that substance use disorder is a health issue”—one that coercion and punishment fail to address. 

“In the house, we may have a number of Democrats who can’t stand to vote for a bill that has any criminal penalties. And you may have Republicans who are not happy with the mandatory jail sanctions being removed and they may not vote for the bill.”—State Rep. Roger Goodman

The bill is likely to pass the house. The next step will be negotiations between the house and senate about which version will ultimately move forward. Goodman is confident the less coercive version will prevail, and Simmons says if it doesn’t, she won’t vote for it. 

“The Senate version had absolutely no mandatory options for diversion or post-conviction vacation or any of that,” she said. “The Senate version is the worst that we would get anywhere in the state. And so I could not vote for that.”

It isn’t just progressive Democrats who may balk at a compromise bill, Goodman said.

“In the house, we may have a number of Democrats who can’t stand to vote for a bill that has any criminal penalties,” he said. “And you may have Republicans who are not happy with the mandatory jail sanctions being removed and they may not vote for the bill.”

If the legislature fails to pass a law this session (unlikely, but not outside the realm of possibility), the existing temporary law will expire on July 1, leaving Washington in the same place it was immediately after the Blake ruling–with no law on the books regarding drug possession. Simmons expressed concern that in that absence, counties and cities could pass their own possession laws with stricter penalties than any of the proposals legislators are currently debating. “If we don’t do something, then the local jurisdictions will create their own ordinances and we’ll have a patchwork across the state,” she said.  

In the meantime, Goodman says he’s committed to moving away from the war-on-drugs mentality of previous decades. “We need to learn what we did three years ago [passing the temporary possession bill], by starting to build up behavioral health infrastructure and more evidence-based interventions,” he said.

Proposal Would Prevent Mayors from Burying Complaints Against Police Chief; Nelson Cherry-Picks Study to Claim Forced Treatment Works

1. The actions of Seattle Police Department officers during the protests against police brutality in 2020 led to more than 19,000 complaints against officers and then-police chief Carmen Best, which the city’s Office of Police Accountability subsequently consolidated into just 143 cases.

Most of those cases are now resolved. About 10 are still being processed, with “completion” rates, according to the OPA’s Demonstration Complaint Dashboard, between 75 and 90 percent. Just three complaints remain stalled at 50 percent complete. All are from 2020, and all three name former police chief Carmen Best as a subject.

City law empowers the OPA, which is an independent office within the police department, to decide whether investigating a complaint would create a conflict of interest, which the office did in these three cases involving Chief Best. Because the three complaints would have essentially investigating the boss, OPA referred them to then-mayor Jenny Durkan, who initially wanted the Office of the Inspector General, an independent police accountability agency, to do the investigation.

When the OIG declined, the case went back to the OPA, which asked to assign the investigation to an outside agency. Instead of acting, Durkan apparently sat on the complaints against Best, leaving them to languish until her successor, Bruce Harrell, forwarded them to an outside agency. Harrell’s spokesman, Jamie Housen, said the administration found out about the languishing cases in January and referred them to an external investigator late that month.

Legislation filed by city councilmember Lisa Herbold would prevent the mayor and OPA director from burying complaints against the police chief in the future by setting up a formal process, and deadlines, for the OPA to refer complaints against the police chief to an outside investigator.

Under the proposed new process, which Harrell supports, if the OPA decided a complaint against the police chief merited an investigation, the bill would require the OPA director to decide whether the complaint should be investigated by the city’s Department of Human Resources or an entity completely outside the city.  The OIG would review OPA’s recommendation and decide where to route the complaint, based on a process laid out in the legislation. The proposal would also give the OIG a stronger oversight role in complaints and investigations involving the police chief.

The first of the three cases the city failed to investigate involves Chief Best’s claim (later retracted) that armed people were running an extortion racket at the Capitol Hill Autonomous Zone (CHAZ) during the protests. As the South Seattle Emerald reported this week, Best apparently knew the claim was a hoax when she repeated it to officers in a videotaped statement to officers working at the protests.

The second unresolved case accuses Best of lying about errors made by Seattle police and fire officials that prevented emergency responders from reaching a man who had been shot in the protest zone; Best told reporters (falsely, according to reporting by KUOW) that protesters had blocked the path of emergency vehicles, contributing to the man’s death.

The final case involves the police department’s use of tear gas against demonstrators in early June, 2020, after Seattle Federal District Judge Richard Jones granted a temporary restraining order against the department.

One goal of the bill is to “protect against any abuse of discretion that might occur if the Mayor or OPA Director are involved in the complaint or seek to conceal the complaint” in the future, according to the bill text.

A spokesperson for the OPA declined to comment for this story. The outside investigation into the three cases is reportedly wrapping up.

2. City Councilmember Sara Nelson told a constituent in an email last week that her own experience going to treatment convinced her that mandatory treatment is an effective response to homeless people who commit crimes because of their addiction—and “less expensive than most housing options,” too.

The email, which Nelson forwarded to all her council colleagues, came in response to a constituent who sent a link to a study finding that out of 160 people in an employment-based treatment program, the 131 who were required to go to treatment by a court were more likely to complete treatment than the 29 who went voluntarily.

“If a person stays sober for even six months, that’s less expensive than most housing options and far less deleterious to a person’s ability to find future housing and employment than having a record.”—City Councilmember Sara Nelson

“I’m not surprised by its argument that mandating (or ‘stipulating’ as used in the paper) treatment is more effective than commonly thought because I’m in recovery myself and when I went to a residential treatment program, I met many people who were in treatment for the first time and only because court-ordered,” Nelson wrote, adding that about half of the people she kept up with from treatment were still sober.

“A month of private in-patient or 6 months of outpatient treatment costs about $10,000,” Nelson continued. “If a person stays sober for even six months, that’s less expensive than most housing options and far less deleterious to a person’s ability to find future housing and employment than having a record. And treatment leads to better health outcomes than jail.” Continue reading “Proposal Would Prevent Mayors from Burying Complaints Against Police Chief; Nelson Cherry-Picks Study to Claim Forced Treatment Works”

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”

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.

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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