Thursday, July 5, 2012

Addictions: They Happen To The Nicest People

I've been thinking hard about the decision of three Southern states to require drug testing for potential welfare recipients. I get the obvious intent: making sure welfare money isn't spent on illegal drugs.

However, I get the hidden intent as well: shaming and punishing people with addictions. It's that one that bugs me. It's that one that's been lighting up Facebook with self-righteous cheers of, "If you can buy drugs, you can buy groceries!" It's that one that shows just how little empathy there is for the most vulnerable Americans. This lack of empathy translates into policies that are about moral posturing, not about improving the conditions that create vulnerability to drug use.

I use the word "vulnerability" for a reason. I want to be clear that addiction often happens to the nicest people. People who are unusually sensitive to deprivation, abuse, and violence in their environments. People who want a way out of hurt and hopelessness, who may be depressed or have other untreated mental illnesses. People who don't know what else to do in order to cope. How can imposing continued poverty and isolation on such vulnerable people possibly teach them a useful lesson? The only lesson there is, "Nobody gives a crap about you. Go die."

The sad truth is that effective substance-abuse treatment programs are hard to find, particularly if you are uninsured or live in a resource-poor area. I will never forget waiting six hours in an emergency room with a Thresholds client who was withdrawing from alcohol. This man had been denied Medicaid for two years because his depression was deemed secondary to his alcoholism--thus, not a real disability. In the absence of Medicaid-funded detox, which would have at least been a start, he sat in that ER, trembling and vomiting and jerking until it got so bad that the ER staff were forced to notice. They hooked him to an IV and kept him overnight, with no follow-up care. There was none to offer.

This guy happened to be one of my favorite clients. He was sensitive, funny and gentle, but he carried a huge burden of shame: his father had been a prominent pastor, with high expectations for his children. An alcoholic in the family was unacceptable. So, the guy worked odd jobs when he could, rummaged in garbage cans when he couldn't, and lived in a dangerous, bug-infested transient hotel. He obtained alcohol by begging and bartering.

Boy, how much worse could someone's priorities be? Shouldn't he at least have begged for food or clothes--or a job?

Sure--and he, more than anyone, tortured himself with those very questions. He didn't want this to be his life. But he was physiologically hooked. Going without alcohol was medically dangerous for him. He needed the sort of intensive, multi-pronged treatment for substance dependence that experts in the field have advocated since the mid-1980s. That sort of treatment can make the difference for people with substance dependence--particularly if they also have a mental illness. But treatment is an investment, and legislators don't want to invest in services for those despicable "others" who seem unable to make something of their lives. In fact, governments generally prefer to offer those "others" less and less help with every passing year.

One fact about treating addictions is, on its face, genuinely unsettling. Most people require numerous attempts to finally get clean. This is especially true with people who use highly physically addictive drugs, such as crystal meth and heroin, and with people who have co-occurring mental illnesses. During relapse, addicts often exhibit self-centered, dishonest, drug-seeking behavior. They may endanger their own life, or someone else's. It is hard to view someone like this as a sympathetic character.

In a quick-fix, bang-for-your-buck culture, repeated relapses doesn't go over too well. People often wonder, "What's the point?" In their minds, they relegate addicts to the category of "lost cause" and stop caring. But drug addiction is not that different from other public-health issues. Most weight-loss diets ultimately fail--some even do more harm than good. The average smoker requires 7-10 attempts to quit permanently. People with various chronic diseases often struggle to follow their doctors' advice. Nonetheless, there is an unusually strong stigma placed on those who abuse drugs and alcohol. So strong, in fact, that in addition to prisons housing violent and pathological criminals, they also serve as costly, inefficient detox facilities for non-violent drug users.
 
I worked with a client who was imprisoned nine times for illegal possession and crimes related to drug use (ie, prostitution, theft). I once stood next to this guy in court as he was handed a five-year sentence. I remember being surprised at his facial expression: it was relieved and calm. My boss, who had known him for years, explained that prison was the only way this client had ever gotten clean for any period of time--what's more, it was a source of reliable food and shelter. Our agency couldn't meet this man's needs for intensive treatment; all of our residential programs had long waitlists. For him, prison was the next step up, even though he had to relinquish his personal freedoms. I hope I never lose my outrage over that situation.
 
So many people do so much grandstanding about drug addiction that individual stories are devalued and, thus, lost. One of the things I love most about Erasing the Distance is that it brings audiences back to the intense, compelling, illustrative stories of real people in real situations. People not so different, in the end, from themselves. Addictions happen to nice people, smart people, hard-working people. They happen because personal will and intelligence are insufficient to cure them. And addictions will go on destroying lives so long as addicts are seen as "others"--swept from public view and public concern. Treatment does work, but it has to be available to all who need it. This will only happen when substance abuse is no longer considered a matter of personal moral character. And that change is long overdue.
 
Lisa
 
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Lisa Sniderman, LCSW received her M.S.W. from the University of Chicago in 2003 and has been a licensed clinical social worker since 2005. She is a past member of ETD's Mental Health Advisory Board and one of our storytellers. Click here to read more posts from Lisa.

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