Tag: Addiction

Addiction, criminal justice, Drugs, legislature

New Drug Possession Bill Emphasizes Coercive Treatment

State. Sen. June RobinsonBy Andrew Engelson

Democrats in the legislature are making procedural moves that will decide what the state’s new drug possession law will look like—an exercise that became necessary after the state supreme court’s 2021 ruling Blake v. State of Washington invalidated existing law. 

Whatever bill emerges will correct the element of current law the court found unconstitutional:  that someone who “unknowingly” possesses drugs could still be convicted. But the legislature is also taking the opportunity to debate what the state’s approach to drug use, and an unprecedented overdose crisis, will be. Various camps in this debate favor a criminal justice approach; a coercive treatment approach; or a public health approach focused on decriminalization.

The bill that has emerged from committee in the senate favors the “middle” option—coercive treatment—and amendments added in the past few days double down on that strategy.

Sen. Manka Dhingra (D-45, Redmond), who chairs the Law & Justice committee, is a strong supporter of decriminalization and safe supply. But her bill moving things in that direction,  which would implement recommendations in a report issued in December by the Substance Use Recovery Services Advisory Committee (SURSAC), didn’t have the votes to pass the Senate and never made it out of committee.

What did survive is a bill sponsored by Sen. June Robinson (D-38, Everett), that would make possession of a “small amount” of schedule 2 drugs (which include cocaine, fentanyl, and methamphetamine) a gross misdemeanor and require prosecutors to offer defendants diversion to treatment instead of jail time. 

“We’re basically saying: Upon conviction, you’re auto-enrolled in a substance abuse treatment program. But if for whatever reason you fail, if you choose to exit the program because you don’t feel like doing it—now there’s going to be consequences.”—Sen. Mark Mullet (D-5, Issaquah)

Last Friday, when the bill was in the Ways and Means committee, vice chair Sen. Mark Mullet (D-5, Issaquah) succeeded in adding a major amendment to the bill empowering (and in some cases requiring) judges to impose jail sentences on defendants who fail to complete treatment.

Mullet told PubliCola he filed the amendment with input from Sen. Jesse Salomon (D-32, Shoreline), whose own drug possession bill, which is more punitive than either Dhingra’s or Robinson’s, failed to make it out of committee.

“We’re basically saying: Upon conviction, you’re auto-enrolled in a substance abuse treatment program,” Mullet told PubliCola. “But if for whatever reason you fail, if you choose to exit the program because you don’t feel like doing it—now there’s going to be consequences.”

This sort of language, focused on pushing drug users into treatment and demanding results, mirrors testimony that Salomon, who works as a public defender, gave during a committee hearing for his bill on Feb 6. Introducing that bill, Salomon expressed concerns about an “unacceptable level of public, open drug use,” and then told a story about seeing people using fentanyl outside his child’s day care, lamenting what he called  “a high level of public disorder and a decrease in public safety.” 

“Our current referral system… “ Salomon said in his testimony, “effectively only asks people to get help, but has no consequences when those folks don’t get help.”

Caleb Banta-Green, a researcher on substance use disorder at the University of Washington— and a member of the SURSAC committee that recommended decriminalization—says this approach ignores the realities of opioid and stimulant use. 

“You don’t treat substance use disorder,” Banta-Green said, “You manage it as a chronic relapsing condition. One of the challenges when the criminal legal system is involved is that if you have a return to use, you’re a failure and you’re committing a crime. Rather than: you’re showing symptoms of your disease and we’re going to continue to provide you care.”

Mullet’s amendment would give judges discretion on the first offense, but on the second offense, those who fail to complete treatment will face a minimum of 21 days in jail, and for a third offense a minimum of 45 days—sentences Mullet said are often be knocked down, with good behavior, to 14 days and 30 days, respectively.

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“Our hope is that in those 14 days, people can go through that kind of challenging withdrawal process where they don’t have access to substances,” Mullet said. “Then hopefully, at the end of those 14 days, now they’re in a better spot to realize: oh, maybe I should get treatment.”

Banta-Green says this is the approach the state has used for decades, and he believes it’s ineffective and harmful. “Incarceration is not innocuous,” he said. “I think legislators think it’s like having to go to a Motel 6 for the weekend and miss out on some parties.” A drug conviction and jail time can be a “scarlet letter” that limits a person’s future opportunities; it also “dramatically increases [the] risk of overdose,” Banta-Green said.

Two academic studies of people released from Washington state prisons have shown that the majority of deaths among those recently released from prison were overdoses and that within two weeks of release, inmates were 129 times more likely to overdose than the general population. 

Michelle Conley, director of integrated care at REACH, which serves unhoused Seattle residents with substance abuse disorders, says that for many of her clients who end up incarcerated, jail is detrimental to recovery. “People are traumatized by jail,” Conley said. “And then we’re 15 steps back from where they were. As providers we have to engage with them and rebuild trust… to make sure they see us as a provider and not just a part of the system.”

Even the bill’s seeming compromise between criminalization and decriminalization—coercive treatment—is problematic, Conley said.

Conley said the expectation that someone can be pushed into recovery with one session of 30 to 90-day inpatient treatment is unrealistic, especially if they’re released from treatment without ongoing support. “Churning people through this kind of treatment mill, and then sending them back on the streets, really serves as little more than a moment of respite,” Conley said. “Especially when people are released back to the same circumstances that drove them, oftentimes, to aggressive use.”

Not everyone who uses drugs needs to go to treatment, Banta-Green said, and people who would benefit from services “don’t want the treatment we have,” which often takes an all-or-nothing approach to sobriety. Instead of coercing people into conventional treatment with the threat of jail time, Banta-Green believes the state should implement one of the SURSAC committee’s recommendations: aggressively funding “health engagement hubs” that offer a range of services and treatment options to people who use drugs, including comprehensive harm reduction, health care, mental health care, addiction treatment, and medications.

“I absolutely believe that the criminal justice system is not the right place to deal with addiction. It’s just—this is where we are. And we need to move to provide alternatives, to provide other systems, and to fund and destigmatize other ways of helping people through addiction.”—Sen. June Robinson (D-38, Everett)

Banta-Green’s research team has worked with local public health agencies to establish pilot hubs in Seattle, Kennewick, and Walla Walla. He says the state would ideally have one of these hubs for every 200,000 residents, for a total of about 38 such facilities statewide.

Robinson’s bill directs the Washington Health Care Authority to “make sufficient funding available” to create health hubs within a 2-hour drive of all residents at the ratio to population Banta Green recommends. The bill also appropriates a $51 million—much of it from the state’s legal settlement with prescription opioid manufacturers—to fund opioid use disorder medications, crisis relief centers, and grants to LEAD and other programs that offer alternatives to arrest or jail time.  

Among other provisions, the bill legalizes handing out drug paraphernalia (such as smoking supplies) statewide, but an amendment added in the Ways and Means committee by Sen. Keith Wagoner (R-19, Sedro Woolley) would allow cities to opt out of that provision.

Dhingra added language to the bill that would set up a working group to study the creation of a safer drug supply system. Canada has incrementally started to experiment with prescribing pharmaceutical-grade drugs such as fentanyl to drug users to reduce the risk of overdose from street drugs, whose contents are unpredictable. However, that language also got stripped out of the bill in Ways and Means.

Following a year when King County had a record 998 fatal drug overdoses, all options should be on the table, Dhingra said.

 “If you want to help people get to recovery,” she said, “you have to make sure they’re alive in order to do that.”

Sen. Robinson, who sponsored the bill now moving forward, told PubliCola she believes her legislation offers a politically viable balance between restoring some criminal penalties and providing options for treatment.

Robinson, who has a masters in public health, said, “I truly believe all the research” about the need for a variety of approaches to drug use and addiction. “I absolutely believe that the criminal justice system is not the right place to deal with addiction,” she said. “It’s just—this is where we are. And we need to move to provide alternatives, to provide other systems, and to fund and destigmatize other ways of helping people through addiction.”

Robinson’s bill will likely get a floor vote this week, and it’s also likely that supporters of each competing approach to drug policy will offer a frenzy of competing floor amendments to shape the final bill. 

City Council, Drugs, Health, Mayor Harrell, Morning Fizz, Police

Cities Could Lose Out on Opioid Settlement Funds, Non-Police Response Pilot Moves Forward

1. Cities and counties around the state stand to lose more than $500 million in funds for treatment, overdose prevention, diversion, and education on opioid misuse in a settlement between the state attorney general’s office and the three largest opioid distributors earlier this year, if holdout cities fail to sign on to the settlement by this Friday.

The settlement, which resulted from a lawsuit filed by Attorney General Bob Ferguson in 2021, will only be distributed to cities and counties if at least 116 of the 125 eligible jurisdictions, including all 39 Washington counties, sign a form agreeing to participate in the settlement. As of last Friday, 100 jurisdictions had signed on, including all but five counties—Adams, Kitsap, Pierce, Skagit, and Snohomish.

Cities in the Puget Sound region that have not agreed to participate in the settlement yet include Auburn, Burien, Everett, Mercer Island, Renton, and Tacoma. According to a letter the head of the AG’s Complex Litigation Division sent to local officials last week, cities can choose to hand their settlement money over to a regional body for distribution, send it to their county, or spend it themselves according to a list of approved uses.  

A spokesperson for the attorney general’s office did not respond to a request for additional information late last week.

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2. The city just moved one step closer to setting up an alternative for some calls that are currently dispatched through the 911 system, when Mayor Bruce Harrell’s office and the city council signed a “term sheet” laying out formal steps toward standing up a comprehensive response system for calls that do not require a police response. These calls could include “person down” calls, wellness checks, and low-priority “administrative calls” that currently go largely unanswered.

Among other longer-term commitments, the agreement—signed by Senior Deputy Mayor Monisha Harrell and Esther Handy, the council’s central staff director—says the city will establish a work group to develop a pilot program by next January that can be implemented in 2023, a year  before Harrell’s office has said they’ll be ready to propose and start implementing a more comprehensive plan to use alternative responders for some non-emergency calls. The term sheet requires the mayor and council to come up with “basic costing information” by October 14 so the council can consider the plan during its fall budget deliberations.

As PubliCola reported in July, the council already passed a supplemental amendment to this year’s budget identifying $1.2 million in funding for a civilian response pilot, using the money from former mayor Jenny Durkan’s since-abandoned “Triage One” proposal. Councilmember Andrew Lewis, a longtime proponent of Eugene, OR’s CAHOOTS alternative-responder model, estimated that it would cost a little under a million dollars to fund a three-person pilot program for one year.

City Council, Crime, criminal justice, Drugs, Mayor Harrell, Uncategorized

Harrell Touts Arrests at Longtime Downtown Hot Spot in “Operation New Day” Announcement
City Attorney Ann Davison touts "arrests and prosecutions" as a path to addiction recovery at a press conference on the city's latest targeted policing action.
City Attorney Ann Davison touts “arrests and prosecutions” as a path to addiction recovery at a press conference on the city’s latest targeted policing action, Operation New Day.

By Paul Kiefer

The Seattle Police Department moved a black van known as the “mobile precinct” to the intersection of Third Ave. and Pine St. in downtown Seattle on Thursday morning, scattering the dozens of people gathered there to buy and sell drugs and stolen merchandise.

While the move came a day after the second fatal shooting at the corner in less than a week, the department had started preparing to clear the intersection weeks earlier—the second phase in a crackdown on crime “hot spots” announced by Mayor Bruce last month. That campaign, called Operation New Day, began two weeks ago, when police cleared a similar site at the intersection of 12th Ave. S. and S. Jackson Street in the Little Saigon neighborhood; the mobile precinct van was parked at that intersection until Thursday, when it moved downtown.

On Friday morning, Harrell convened a press conference to tout the first results of Operation New Day, including dozens of arrests. Interim SPD Chief Adrian Diaz stood beside him, as did City Attorney Ann Davison, King County Prosecutor’s Office Chief of Staff Leesa Manion, and two federal law enforcement officials: Nick Brown, the new US Attorney for the Western District of Washington, and Frank Tarantino, the head of the Drug Enforcement Agency’s Seattle office. Leaders from Seattle’s social service providers, who Harrell has promised will eventually become partners in his push to target “hot spots,” were notably absent. No one from the Seattle City Council was at the press conference.

Service providers and non-police responders were a footnote in Friday’s press conference, which centered on the arrests and prosecutions tied to Operation New Day

The stretch of Third Ave. between Pine St. and Pike St may be the most persistently troubled block in Seattle. For at least the past three decades, mayoral administrations have attempted to stem crime on the block by increasing the number of police officers in the area. One such effort in 2015, called “the Nine and a Half Block Strategy,” succeeded in reducing the number of drug-related 911 calls in a small area surrounding Westlake Park, though calls increased dramatically in practically every neighborhood within walking distance of the park during the same period. After a shooting during rush hour in January 2020 killed one person and injured seven others, SPD scaled up its presence on the block once again, only to pull back once the COVID-19 pandemic began two months later. Each time, a market for stolen goods and narcotics reappeared on Third and Pine.

Harrell said that he planned to avoid the mistakes of earlier mayors—and to “revitalize” intersections like 12th and Jackson for the long term—in part by relying on outreach workers and service providers, who he believes will be able to direct homeless people living at or near targeted intersections to substance abuse treatment or housing. “We can’t arrest and jail our way out of this,” Diaz added. So far, no social service providers are involved in Operation New Day; the city relied on police alone to clear both 12th and Jackson and Third and Pine, though diversion groups like LEAD already do outreach near Third and Pine.

Before bringing the social service component of the operation online, Harrell said that his office is “doing an inventory of community-based organizations that are recipients of city funds to make sure they’re aligned with our vision.” He did not specify what “doing an inventory” would entail, nor would he specify which organizations they’re considering for the task—or what traits would disqualify an existing service provider from working on Operation New Day.

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City Councilmember Andrew Lewis, who represents downtown and chairs the council’s committee on homelessness, told PubliCola on Wednesday that he sees one clear choice for an outreach provider: JustCARE, a pandemic-era cooperation between several social service providers that provides shelter and wraparound care to people who have previously interacted with the criminal justice system.

“I want to be sure we aren’t trying to reinvent the wheel here,” he said, “because we have something that works and works well.” Lewis said he’s willing to be patient as Harrell considers options for incorporating service providers into Operation New Day, although he said he will be concerned if the mayor’s office hasn’t made a decision by the time JustCARE’s contract with the city expires at the end of June.

But non-police responders were largely a footnote in Friday’s press conference, which centered on the arrests and prosecutions tied to Operation New Day. Since January 21, SPD arrested 16 people for felonies—especially commercial burglary, illegal gun possession and narcotics offenses—at 12th and Jackson; nine of those people were later released by King County judges after their first court appearance. Some will face federal charges. The US Attorney’s Office has already filed charges against three people arrested in Little Saigon as part of Operation New Day and is reviewing the case of a fourth, a man initially arrested at 12th and Jackson who was released and subsequently re-arrested at Third and Pine. Continue reading “Harrell Touts Arrests at Longtime Downtown Hot Spot in “Operation New Day” Announcement” →

Addiction, Women

From Medium: I Was a “Fun” Drunk. Until I Wasn’t.

This piece, which has been lightly edited for sexual content, originally appeared on Medium. It was inspired by the responses to Susan Orlean’s recent series of tweets about getting wasted, which were celebrated by thousands of people and featured the following day in a laudatory piece in the Washington Post.

Image for post

When I quit drinking, there was no one around to suggest that I didn’t have a problem.

My friends were gone. My family was distant. My world consisted of an elliptical path between the grocery store, the bus stop, and the 600 square feet of my apartment, full of dirty dishes and half-eaten pizzas and empty bottles shoved into suitcases in the closet in case anyone dropped by.

My drinking took me to that point. But it didn’t start that way. Instead, like many women in their 20s, I started drinking because I wanted to fit in — at work, where everyone seemed so much older and more sophisticated, and in my social circle, which came to consist mostly of other drinkers—women who could shut down the bar, take a guy home, and wipe away the hangover with a few Bloody Marys in the morning.

It wasn’t just that no one ever told me they thought I might have a drinking problem — my drinking, like that of many young women, was celebrated, and the more over-the-top my behavior was, the more “fun” people considered me to be. I remember one night, out at a dive bar called the Jade Pagoda, when I danced on a table while my coworkers cheered, then made out with one of those coworkers on that same table while they cheered some more. What I learned from that experience, and from countless others, was that people liked me more when I was drunk and “fun.” For years, I took the lesson to heart.

I was fun. Until I wasn’t.

The parameters of acceptable femininity are wide enough to accommodate women who have “funny” meltdowns or who take their tops off or who sleep through Sundays. They don’t have room for women who lash out when they’re drunk, or who wonder whether they really gave their consent, or who say, in so many words: “This isn’t fun. Stop clapping. I need help.”

In all that time, no one ever suggested that I might consider taking a break from drinking. Why would they? Women who act out in a certain way — by being a certain acceptable type of “messy,” the type that isn’t too picky about men’s behavior and cracks jokes about her drinking (“Drinking problem” always worked when I spilled my cocktail) and laughs uproariously — are celebrated. Everyone loves a “fun” girl, a “cool” mom, a “wacky” older lady with a martini in hand. (Note that these parameters are not just gendered but aged — a 60-year-old throwing herself at young men is seen as pathetic, while a “wine mommy” who heads out to the bar while her husband takes care of the kid is irresponsible; why isn’t she celebrating “wine o’clock” at home?).

The parameters of acceptable femininity are wide enough to accommodate women who have “funny” meltdowns or who take their tops off or who sleep through Sundays. They don’t have room for women who lash out when they’re drunk, or who wonder whether they really gave their consent, or who say, in so many words: “This isn’t fun. Stop clapping. I need help.”

Women who fall into addiction — a neurological, psychological, and physical brain disorder that many people still consider the result of personal failings — are not celebrated. Strangers don’t show up to cheer when you pass out on the sidewalk, or check yourself into treatment, or say “I need help,” although addictions that lead to these behaviors tend to start benignly, with the kind of drinking women are socially permitted to do.

I thought about all this when celebrated writer Susan Orlean posted a series of increasingly incoherent tweets on Friday night, in which she acknowledged being “falling-down drunk,” embarrassing her husband in front of their neighbors, and apparently infuriating her family. “I am@being shunned by my family because I am drunk. Yes ok I am fine with that FUCK YOU YOU FUCKING FUCKERS,” she wrote. As I write this, the most recent responses — of thousands in this vein — are “Cheers to you!! This is definitely not the right time to be sober(within reason)I’m having a few with you!!,” “How wasn’t I following you until now? Best 2020 Friday night entertainment” and “Hey Family, leave her alone! Let the girl drink and tweet! 😜. Got your back”

These people piling praise onto a celebrity’s timeline are ostensibly “celebrating” Orlean for “living her best life,” as many of them put it. But in reality, they’re projecting a narrative that’s as American as Lucille Ball.

We celebrate women — particularly famous women — when they embarrass themselves, or get falling-down-drunk, or go on harmless-seeming tirades against their families. “No one on my house is talking to me right now ok!! YeH whatever I hzte you too.” We stop celebrating them when their behavior tips over into problematic territory — when Britney shaves her head, or Lindsay passes out in her Mercedes. Being a “fun” drunk is a trap, but you won’t know that until you get down off the bar, or stop live-tweeting your life like it’s a sitcom, or say something publicly that’s just a no-two-ways-about-it bummer, like expressing shame, helplessness, or regret. Watch how fast the crowds dissipate then.

Read the rest of this essay on Medium.

Addiction, Featured

Launch Day for QUITTER, My Memoir about Drinking, Relapse, and Recovery!

My book Quitter: A Memoir of Drinking, Relapse, and Recovery (Viking), is finally out and available on Amazon, at your local independent bookstore, and everywhere else books are sold! (Eventually, when we all have access to libraries again, it will be available at your local library as well). You can buy Quitter in hardcover, electronic, or audio form—and if you buy from Elliott Bay Book Company, which sponsored my virtual book launch at Town Hall late last month, there’s a very good chance you can snag a signed copy! (I’m signing them tomorrow, so I suggest jumping on this one)

If you don’t follow me on Twitter or Facebook (or haven’t read my posts about the book here), Quitter is a memoir about my experiences drinking, relapsing, and eventually finding recovery after years running the gauntlet of the treatment industry.

Quitter is an unusual recovery memoir—one that rejects tropes like “rock bottom” and talks bluntly and unflinchingly about relapse as part of recovery. I went through many rock bottoms, and more relapses than I can now count, before checking myself into detox for the last time in February of 2015. My story isn’t the kind of story we’re used to hearing about women who get sober, although it’s more typical than you might think—my drinking was ugly and messy and made me impossible to be around, and it took me a long time to get where I am today: Happy and stable and glad to be more than five years removed from the time when my addiction was spinning me out of control.
Claire Dederer, the author of Love and Trouble, called the book “relentless” in its portrayal of relapse and the grim work of maintaining a late-stage addiction when she interviewed me at my book launch event. But my story is also a hopeful one, because every time I relapsed, I learned more about myself and the deadly brain disease that is addiction, until I was finally able to cobble together my own version of recovery.
Buy Quitter, tell a friend about it, and share photos and thoughts about the book on social media using the hashtag #QuitterBook. And keep an eye on this site, on Twitter, and on my Press and Events pages for info about upcoming events, interviews, podcast, TV, and radio appearances, and much more!
Addiction

I Quit Drinking. Suddenly, Alcohol Was Everywhere.
From marketing phrase to actual wine.

This is the first in an occasional series of essays about my experience as a person in recovery. If you came her looking for local news only, scroll up or down and you’ll find it.

It’s easy to laugh, in 2020, about people who drank the fizzy malt beverage Zima in the ’90s, and harder to remember how heavily Zima was marketed to young people as a lighter, sparklier alternative to beer — literally, clear beer.

Read the rest of this post at Medium.

Read an excerpt from my forthcoming book, Quitter: A Memoir of Drinking, Relapse, and Recovery, and preorder your copy here.

Addiction, Drugs, Featured, Health, homelessness, King County

Using Private Funding, King County Provides Alcohol and Cigarettes to Patients at Isolation Sites
Beer, Mug, Refreshment, Beer Mug, Drink, Bavaria
Image via Pixabay.

King County has been providing alcohol, tobacco, and, until two weeks ago, cannabis products to some patients with diagnosed or potential COVID-19 infections who are staying at the county’s isolation/quarantine and assessment/recovery sites, The C is for Crank has learned. These sites serve people who are homeless or who cannot isolate safely at home.

The program, which is not funded through public dollars, is similar to efforts in other cities, including San Francisco, to enable patients who have tested positive for COVID-19 or have been exposed to the virus to remain isolated safely while mitigating or preventing withdrawal symptoms.

“Limited and controlled quantities of alcohol and nicotine have been provided by the health and behavioral health clinicians on site as part of clinical management of withdrawal symptoms and harm reduction practices to support patients to safely stay in isolation,” Department of Human and Community Services spokeswoman Sherry Hamilton says. “In all cases, this clinical review and approval for a requested item is required.”

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While programs like King County’s have been controversial in other cities, they are based in the principles of harm reduction, a set of strategies at reducing the negative consequences of drug and alcohol use. Other examples of harm reduction include methadone clinics, needle exchanges, and the Downtown Emergency Service Center’s 1811 Eastlake project—not to mention things like nicotine gum and marijuana as an alternative to heroin.

Hamilton did not say how many people had received alcohol, nicotine, and cannabis products, but said that the department’s director, Leo Flor, has been paying for these items out of his own pocket while the county secures “private foundation funding as a more sustainable approach to funding moving forward.” It’s illegal to spend public funds on alcohol, tobacco, or marijuana. Hamilton was not able to immediately provide details about how much these “initial harm reduction supplies” had cost.

Providing people with substances they would otherwise seek out makes it easier to keep people from spreading COVID-19 in the community surrounding the county’s quarantine and isolation sites, and makes it more likely that people will stay at those sites for their entire isolation period instead of leaving against medical advice. In the case of alcohol, it also may be saving lives—for heavy, daily drinkers, withdrawing from alcohol without specialized medical intervention can cause seizures, heart failure, and death.

“For those who cannot do so, or who do not have a home, the County has created isolation and recovery sites,” Hamilton said. “We try to keep guests safe, stable and comfortable so they will stay the entire time, and harm reduction is one strategy that helps to achieve that goal for some of our guests.”

I have asked for more details about funding for this program, including how much DCHS director Flor has spent out of his own pocket, and will update this post when I learn more.

Addiction, Featured

Addiction Treatment Centers Struggle To Serve Patients As COVID-19 Spreads

This excerpt originally appeared at HuffPost, where you can read a full version of this story.

The spread of COVID-19 has presented a unique challenge to those fighting another life-threatening epidemic: substance use disorders, which affect about 20 million American adults each year. Residential treatment centers, which are based on a model of group therapy and interaction among patients, are scrambling to adapt to the Centers for Disease Control and Prevention’s guidelines.

Those treatment centers are also facing a more existential threat: As potential patients stay away for fear of contracting the coronavirus, many smaller and publicly funded centers could run out of money and close their doors at a time when social isolation is driving many people with addictions to relapse.

“Historically, whenever there’s a crisis in the U.S., alcohol sales and illicit drug sales increase dramatically,” said Dr. Marvin Seppala, the chief medical officer at the Hazelden Betty Ford Foundation in Beaverton, Oregon. “Day-to-day things are suddenly stressful …. In the long run, there’s going to be an increased need for treatment.”

Treatment centers are considered “essential critical infrastructure” under the federal guidelines that most states are using to determine which services are exempt from requirements to shelter in place. But in order to keep people safe, they’re being forced to adapt in ways that go against normal methods of treatment, forgoing things like group meetings, family visits and open-door policies.

Melody McKee, who until last week was the clinical program director for Olalla Recovery Services in Olalla, Washington, said her treatment center made “the difficult decision” to implement a triage system for admissions.

“The way it will work is, like, ‘Is this person literally not going to make it if they do not enter this location?’” said McKee.

A person experiencing homelessness with no ability to access tele-health would rank high on the triage list, as would someone leaving detox who seems likely, based on their medical history, to go out and drink or use again.

Other factors that might push someone to the front of the line: frequent falls, past failure to follow through with opiate replacement therapy, suicide attempts and meth-induced psychosis. Those who don’t rank high on this kind of triage list may be turned away from treatment.

It’s a brutal calculus and a stark shift for treatment providers and advocates who have spent decades arguing for treatment on demand.

“No one can just walk up to a treatment center anymore,” said Dr. Paul Earley, president of the American Society for Addiction Medicine, which put out its own COVID-19 guide for providers. “The overarching issue here is to balance the risks of the two illnesses: the risk of contracting coronavirus and developing COVID-19 versus the risk of not getting treatment for the disease of addiction.”

Inpatient Facilities Make Tough Choices

McKee said the need to implement social distancing — for example, by reducing the number of patients who sleep in the same room — can be hard to balance with the desire to take care of as many patients as possible.

“Do you know what kind of burden it is to say, ’We know this person needs this level of care, but we also have people right here who are sitting ducks [for infection]?” she said.

If tests for COVID-19 were available, she said, her treatment center would be able to admit or reject patients. For now, all they can do is screen for symptoms and hope for the best.

The tight quarters at residential treatment centers and the medically fragile condition of most people with serious, long-term addiction make them ideal breeding grounds for infection. Long-term intravenous drug users often suffer from a heart infection called endocarditis; people who smoke crack, meth or marijuana may have diminished lung capacity; and heavy drinkers may have multiple organ failure and a suppressed immune system.

“These are not healthy individuals,” said Lauren Davis, executive director of the Seattle-based Washington Recovery Alliance. “People whose disease is advanced enough that it would necessitate inpatient treatment are pretty much universally in the high-risk category.”

To keep the virus out, treatment centers are cleaning more thoroughly and often, checking both staffers’ and patients’ temperatures regularly, and implementing social distancing in all group activities. That means putting space between chairs in group therapy, spacing out or canceling mass lectures, discharging some patients early if they seem stable enough to leave without relapsing, banning hugs and eliminating visits from friends and family, among other measures that fundamentally change the nature of rehab.

Read the rest of the story here.

Addiction, Featured

Recovery in the Time of Coronavirus
Image via Pixabay

This piece originally appeared at HuffPost. 

“Keep coming back, it works if you work it, and we’re all worth it!”

That’s the chant at the end of most meetings of Alcoholics Anonymous in the Seattle area, done while everyone is still holding hands after saying the Serenity Prayer. It’s an affirmation that a program rooted in mutual, in-person support can keep people sober, as long as they keep coming back to meetings.

But here at the epicenter of the coronavirus crisis in the United States, where county officials have officially banned all gatherings of more than 50 people and imposed strict requirements on smaller gatherings, mutual support groups like AA, Narcotics Anonymous and Smart Recovery are struggling to cope.

Meetings that were once held in churches, hospitals and retirement homes have been canceled or moved online. Those gatherings that continue to take place are sparsely attended as residents hunker down. Several regional events for AA and NA members have been canceled or postponed.

Brian, an AA member in Snohomish, Washington, just northeast of Seattle, said he hasn’t gone to his usual weekly meeting since the outbreak hit the area a few weeks ago, and he’s feeling the effects.

“Anytime I don’t get to go to meetings, it impacts me, whether I think so or not,” said Brian, who asked that we use his first name only. “The meeting where I usually go is in a hospital, so that’s canceled.”

Amir Islam, a Seattle NA member who works in the music business, said he’s still going to meetings despite warnings to stay away from groups. On Friday, he said he had just chaired a meeting where people tried to avoid touching at the beginning but ended the meeting with their arms around each other — the NA equivalent to AA’s hand-holding ritual.

“People were doing the elbow bump and the fist bump at the beginning, and then it goes from that to everyone hugging at the end,” he said. “It was like, ‘Really? Are we avoiding each other or not?’”

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Addiction, Featured

Can You Drink (and Puke) Your Way Sober? A Seattle Rehab Says Yes.
Image via Pixabay.

 

This piece originally appeared at HuffPost.

By the time Tara wound up at Schick Shadel Hospital, a 10-day inpatient rehab facility just south of Seattle, she had hit a personal low. She’d always been a drinker — alcoholism runs in her family — but things had spiraled over the past few years. More than once, she found herself sobering up in jail, trying to remember what made her husband call the cops the night before.

She had already tried traditional rehab at an inpatient facility in Eastern Washington, as well as Antabuse, the drug meant to help patients stay sober by making them violently ill when they drink. Neither kept her sober for more than a few days. Alcoholics Anonymous was a bust, too: “I went to my first meeting, cried all the way through it, then went out and proceeded to get massively wasted.”

Tara, who is being referenced by a pseudonym to protect her privacy, realized that if she didn’t do something, she was going to lose her family. It was her husband who pushed her to try Schick Shadel, a treatment center in Burien, Washington, that promises to eliminate cravings within 10 days and claims a success rate of nearly 70%.

There, Tara found a type of treatment altogether different than the spiritual transformation emphasized in most 12-step-based programs. Schick Shadel treated addiction with brute force, like a physical foe. “It was nice to have permission to reject AA,” Tara said.

But Schick Shadel’s treatment involves some strategies experts consider fringe, even borderline unethical. The center administers high doses of alcohol combined with a nausea-inducing drug or mild electric shocks‚ a method called “aversion therapy.” It also involves interviews with counselors when the patient is under sedation. A 10-day stay at the center costs roughly $22,000.

And although Tara and others say they have benefited from the program, Schick Shadel’s unconventional methods don’t appear to be any more effective than other kinds of treatment. The most comprehensive long-term study of Schick Shadel’s success over time showed that 77% of former patients had returned to drinking after 10 years.

Drinking — And Puking — At ‘Duffy’s Tavern’

Dr. Charles Shadel founded Shadel Hospital outside Seattle in 1935 offering aversion therapy in a “homelike setting” — the same year Bill Wilson started Alcoholics Anonymous in Akron, Ohio.

Decades later, a stay at Schick Shadel includes mandatory counseling, aftercare planning and other trappings of traditional treatment. But its most distinctive feature remains aversion therapy, which is based on the idea that if you associate a substance with an unpleasant experience, you’ll want to avoid it.

Schick Shadel patients are given a nausea-inducing drug followed by a cup filled with their drink of choice, which is repeated over and over again, and again, and again. If a patient’s body can’t handle vomiting, they can opt to swirl alcohol in their mouths while getting a series of mild electric shocks; if a patient is a drug user, Schick Shadel offers authentic-looking simulacra to snort or smoke.

The treatment room is like a bar from a nightmare — fluorescent lighting turned up to 11, a rolling cart stocked with warm gallon jugs of Fireball and vodka, and a giant mirror over a stark steel basin that is easy to imagine brimming with 85 years’ worth of vomit.

Although other former patients say the process of repeatedly drinking and throwing up was miserable, Tara was willing to try anything. “I was a serious bulimic for like 10 years, and they asked, ‘Is that going to be a concern?’ and I was like, ‘I don’t care about throwing up,’” she said. “I had done enough unsavory things that I never thought I would do that I said, ‘Fuck it, [my husband] really wants me to do this; maybe it’ll work.’”

Schick Shadel refers to these vomiting sessions as “duffies” — a reference to a fictitious bar that doubles as an in-joke among people in the program. On days when patients aren’t doing “duffies,” they have “sleepies” — interviews under sedation that are supposed to give counselors direct contact with a patient’s subconscious mind.

Until fairly recently, Schick Shadel used sodium pentothal, the so-called “truth serum,” for these sessions, but that drug became unavailable in the U.S. after European suppliers objected to its use in executions. Schick Shadel switched to propofol, a drug commonly used in general anesthesia.

“There’s a reason that they don’t put in the advertisements that you’re going to be given a duffy or an electric shock,” said Pete, another former patient using a pseudonym who went to Schick Shadel after his 12-drink-a-day habit started giving him morning shakes. “They know that if you knew that going in, you probably wouldn’t go.”

In the hospital, the aversion sessions are treated like a kind of shared trauma. Many wear navy “I had my last drink at Duffy’s Tavern” hoodies, which are available for $30 near the reception desk, over their green hospital scrubs.

“People say they need something more physical,” said Mark Woodward, Schick Shadel’s director of business development and marketing. People come here because of the promise behind all that suffering: that they will lose the compulsion to drink by permanently turning off brain receptors that lead to cravings.

“We are confident that we can help a patient lose their cravings in 10 days,” Woodward said.

Does Aversion Therapy Work?

The research on aversion therapy for addiction is sparse, and much of it has been funded or conducted by people associated with Schick Shadel, including its longtime medical director, the late James Smith, and Schick Razor Company founder Patrick Frawley, a onetime Shadel Hospital patient who purchased the hospital through a spinoff company in 1965.

Like most studies that treatment centers conduct, the results are limited to self-reporting from former patients who responded to surveys, and rarely include results beyond one year after treatment. The most comprehensive modern study of Schick Shadel’s method was in 1993, and suggested that about 65% of former patients surveyed said they were still sober after a year; however, 29% of the patients contacted did not respond to researchers at all, so the real “success” rate was likely much lower. Studies show that reported one-year relapse rates vary from 30 to 70% for all kinds of treatment, including one-on-one therapy. A more meaningful number would be the number of people who manage to get and stay sober over a longer period, but treatment centers, for various reasons, don’t typically track patients long-term.

Fred Muench, the president of the nonprofit Center on Addiction in New York, considers aversion therapy “outdated” and said it only works as long as the negative reinforcement is present. “When you’re in treatment, almost anything works, because you’re in a controlled environment,” Muench said.

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