Thursday, March 26, 2015


Discussions about Substance Use Disorder in its various guises often include ideas about “Rock Bottom”. The notion being that sooner or later the afflicted have to experience a life altering eventoverdose, incarceration, getting kicked out of school, losing a job, getting kicked out of home, to name a fewthat shocks them into lasting change. Our family, too, heard this advice from multiple sources while our son, William, struggled with his use of heroin and we struggled to cope and understand.

The problem is this. The rocks at the bottom are strewn with dead bodies, including that of my son. Death is rock bottom. Anything else is just a serendipitous, albeit uncomfortable, landing on an outcropping on the way down. It may be a tough climb back. There may be other falls. But it’s not death.

I have recently come up with the idea of writing a letter to everyone who helped treat William along the tortuous descent to his rocky demise. I want to ask them whether his death has given them any cause to reflect upon his treatment. If so, what have they learned? Big ideas or tiny changes in practice? What change might they like to bring about so that others might not only avoid his fate, but actually entertain a productive lifelong recovery?

My suspicion is that very few, if any, have reflected much on William and his treatment. Given a lack of time or effort devoted to reflection, I suspect precious little, if anything, has been learned. I am talking about good, well-intentioned people who have dedicated their lives to important work. But is it work so trapped in orthodoxy of practice, work so mired in bureaucracy, that it leaves little time for introspection? How much are those who treat substance use disorder just like those they hope to cure, repeating the same behavior over and over? We ask addicts to look at what they do. We need to ask treatment providers to take a harder look at what they do. Or how about, just a look. 

Recovery is like a pinball machine. Up at the top somewhere, protected by bumpers and barriers is a target, prolonged recovery, hit sometimes by good luck, sometimes by good management. Your ball may land in a hole temporarily and then get spit back into play again. That’s Emergency Rooms or the court system. Points off for the court system. You might get lucky and hit a treatment gizmo that puts two balls in playone for substance use and one for mental health issues. Your ball may just get swallowed up for a while before reappearing somewhere by surprise. That’s insurance coverage. Or relapse. Points off. The ball may disappear down a hole until it pops up in the starting mechanism. You pull back, let go and start over. Inpatient or outpatient. Or relapse. Points deducted. Up toward the top are some flippers to keep you in play. Methadone. Suboxone. Side bumpers bounce you repeatedly into the center of the game. 12 Steps. DO NOT TILT! The lights flash, the bells go off and you do your best to tune out the frenzy in a game slanted downhill. Over time too many balls roll through that last set of flippers and disappear. Rock Bottom. Game Over.

So why don’t we tilt the table? Why don’t we take the whole game and flip it on its end so that all the balls roll toward WINNER!

I can hear someone calling me a bitter, unrepentant enabler right about now. Unwittingly, or even knowingly, maintaining the status quo. I’m tilting the table. Family members are hardly the only enablers, however quickly blame may come our way. When physicians, medical schools, therapists, Twelve Step programs, insurance companies, pharmaceutical companies, inpatient and outpatient treatment providers, politicians, judges, drug courts, police, schools and colleges take a good hard look at themselves and ask how they enable addiction, how their actions and ignorance perpetuate it, then we’ll have taken a step toward a solution. We can’t expect answers and solutions when we resist even asking the questions necessary to solve the problem. I’M FLIPPING THE GAME! Who’s joining me? 

Monday, February 16, 2015

50th - Number 1

My 50th high school reunion will be this June.  Along with other classmates we'll be assembling a collection of reminiscences about our lives then and our lives now.  Below is my first submission.  All you need to know is that Kent School is in the northwest corner of Connecticut and that I began there in 8th grade.

Sunday afternoon of Parents’ Weekend, in October of 1960, Second Form year, I kissed my parents, stoically waved goodbye, and watched our 1953 robin’s egg blue and white Buick Roadmaster roll out of the North Dorm parking lot and cross the bridge into Kent.  I ran back to the window at the end of the Middle Dorm South hallway where I could look out across the river, beyond the wide field with a single barn sitting in the middle of it, and wait for a last look at the Roadmaster making its way down Route 7, tears streaming down my face. 
It’s taken years to realize how lonely and unhappy I felt during much of my early time at Kent.  Back then I played into the notion that I wanted to go away, unaware of my own feelings or too afraid to speak up and tell my parents I’d rather be at home.  How could I speak up given the sacrifices they were making to give me the best education they could afford, to give me opportunities they’d never had?  Sacrifices that included driving that old Roadmaster into the ground, until one Christmas Eve after a midnight service it refused to go into reverse in a snowy church parking lot and mastered roads no more.
For me the forced purchase of a new car prompted great relief.  I could return to Kent after Christmas break secure that the antique Roadmaster was no longer fuel for taunts. My family would arrive at Kent in something new and shiny.  One less chink in my armor for tormentors to exploit.  My relief was short-lived.  Tormentors continued unabated with clever new and recycled old material. 
Third Form remains the absolute nadir of my existence on this planet.  Having endured the prior year where I arrived as the smallest boy in the school (4’ 11” and 87 lbs.) and shouldered the eponym Embryo (earned while scriming for food – thanks Perry Wroth!), as well as sharing sufferings, humiliations and deprivations with all my classmates, I naively believed a new era would dawn, relieved from bullying and oppression.  For me, Algo’s haze was never rent that year.  Rather, as I waded through Pilgrim’s Progress in English class learning about the Slough of Despond, I never fully connected to my own hurt, angry, lonely, up-to-chin-level deep slough.  Yes, there were French fries at a soccer banquet, a kind reward for being a ball boy.  Yes, there was Junior hockey.  Most everything else felt like a re-run of the initiation rite we’d withstood the year before.  The sky seemed always grey, my mood always blue, no matter what I might have tried to pretend outwardly.  I recall one teary meltdown in a German class after lunch.  I’d just gotten the worst grades I’d ever received in my life, far worse.  I have no idea what comment, what rebuke, what slight set me off, but there I was – in front of Bill Kurtz, in front of Steve Alpern, in front of George Harvey, in front of Herr Cartwright, in front of the WORLD crying out of control until I got to leave class to pull myself together in a Schoolhouse bathroom.
Fourth Form Year I returned late from a hockey practice in a rush to clean up for Friday night inspection. Peter Lewine and I began to argue over who should do what, or who hadn’t done what. Failing the inspection was imminent.  Words turned to wrestling.  I remember rolling around on the floor when a thumbtack (which should, of course. have been swept up) pierced my back.  Then more thrashing around and my leg kicking the large blue and yellow Triple S Stamps sign that decorated our room.  It rang like a gong and crashed to the floor.  The hullabaloo attracted our floor inspector, George Bourne.  Sadist that he was, he stood there and egged us on for his own entertainment, baiting us while knowing full well we were forfeiting any chance to pass the inspection.   He’d get the double pleasure of watching a fight and then stinging us hours. In short order Phil Davis, Senior Prefect, arrived to inspect.  One more time my eyes welled to overflowing, as I couldn’t hold back my frustration while trying to reason with adolescent authority.  No luck.  But I’d begun the practice of speaking up and taking care of myself. These were neither tears of self-pity nor remorse, but pent up passion and rage breaking through.
Some of the worst moments of my life were at Kent.  How could they not have been, given adolescence?  I recently listened to a TED talk by the writer and lecturer, Andrew Solomon, about how the worst moments in our lives make us who we are.  Solomon has led me to ponder how I, or we, may have forged meaning over the past fifty years from our experience at Kent.  He mentions avoidance and endurance, two tactics I employed generously in navigating my early Kent years.  Solomon says, “Avoidance and endurance can be the entryway to forging meaning.   After you’ve forged meaning you need to incorporate that meaning into a new identity.    You need to take the traumas and make them a part of who you’ve come to be, and you need to fold the worst events of your life into a narrative of triumph, evincing a better self in response to things that hurt. “
Fifty years later we are clearly, and blessedly, not the same people.  I speculate on what Kent made out of us, and what we made out of Kent.  Never a chemistry student, I struggle to understand the molten amalgam that helped form us, may have galvanized us in some way, and created bonds between us.     
A little over two years ago Kent would bring me to tears again.  Our son, William, died of a heroin overdose.  I arrived early at the church where his memorial service was held.  As people began arriving, I found myself walking down the aisle to greet them, touched over and over by the outpouring of support.  My trips up and down the aisle became a reunion.  Classmates going to great lengths, in distance traveled, inconvenience put aside, or both, to be with us.  In a way life had come full circle.  A boy separated from his family. Only now I was the father, missing that boy so very sorely.  
As I rose to deliver a eulogy for William, there they were.  Dear friends.  Lifelong friends.  Kent friends, providing the comfort necessary to carry on.  We’d been through so much together, beginning with our dawn at Kent and on into the fullness of our lives.  As I began perhaps the most difficult task of my life, celebrating my son’s far too short life, there was no better support, no finer evidence of the better selves we’ve become than the compassionate faces letting me know how much they were there for me.      


Thursday, February 12, 2015

The Baby and The Bathwater

In late January Johann Hari wrote a piece on The Huffington Post titled The Likely Cause of Addiction Has Been Discovered and It Is Not What  You Think.  Almost immediately several friends contacted me to see what I thought about it. Not a great deal, in short.  I fumed and fussed a bit, but didn’t write about it until I saw this essay by a friend of mine, David Cooke. Go here both to read David’s essay and to learn about his good work through 100 Pedals.  While you’re at it check out his podcasts.  I’m proud to say I was a guest of his recently.
Dave’s writing moved me to learn about Mr. Hari’s work and to respond to Dave.  There is a fair amount of reading involved here.  The original Hari piece.  Some well thought out responses by Dave and Peg O’Connor, plus my response to Dave below.  I think it’s worth your time as we continue to sort out what substance use disorder is, how it should be treated, and its impact on individuals and their families. 

 My response:

I am responding to Dave Cooke, a man I admire and consider a friend.  We’ve shared similar, if not congruent, journeys with our sons.  I write here to Dave, but also to others who have read any or all of the essays and articles mentioned.  I am NOT; repeat NOT attempting to start an argument with Dave here. 
If I understand Dave correctly, or Peg O’Connor, or Dr. Drew, their message in response to the Hari essay is “Don’t throw out the baby with the bathwater.” Hari makes useful and valid points.  Unfortunately the title of his piece is ill conceived.  By stating that  “The Likely Cause of Addiction Has Been Discovered…” he both oversimplifies and misleads.  
As a father who has lost a son to heroin addiction, I can vouch from personal experience to the complexity of the disease.  No sooner had Hari’s article appeared in The Huffington Post than I had friends asking for my opinion of what Hari had to say.  In turn, I corresponded with more friends and family about the article.  One, Barry Walsh wrote the following, which I thinks explains nicely how Hari oversimplifies.  Barry wrote me:  Anything as complex as addiction is multi variate. People like simple solutions - especially the press because it's always move on to the next story... Some people have brains that are especially vulnerable to addiction and then there are all the psychological and environmental contributors. As a therapist for 40 years I've found people are more complex than rats ... Thank god...”
The key to what Barry is saying, as do Dave and Peg O’Connor is that addiction is multi variate.  Neither the cause nor the treatment for each and every individual is as simple or easy as we might like to make them.  My son has been dead for over two years and our family still wrestles with identifying the various causes and actions that led to his overdose death.  We’ll never know it all, but our attempt to gain clarity might help others.  We do know there are things he could have done differently and things he had no control over.  The same goes for his parents and those who treated him along the way.  We might gain easy satisfaction in assigning blame.  We do better to find out what we can learn from a personal tragedy, a tragedy becoming all the more common in other households in this country.   
Unfortunately the bathwater with Mr. Hari’s baby is murky.  He makes it difficult to spot the baby and hang on to it.  What do I mean?  He is a sloppy journalist.  An easy trip to Wikipedia yields this:  Johann Eduard Hari (born 21 January 1979) is a British writer and journalist who wrote columns for The Independent (London) and The Huffington Post and made contributions to other publications. In 2011, he was suspended from The Independent after charges of plagiarism. He was also accused of making improper edits to several of his critics' Wikipedia pages under a pseudonym. [2][3] The news led to his returning his 2008 Orwell Prize[4] and later was a contributing factor in his leaving The Independent.”  We all make mistakes, and Mr. Hari has worked hard publicly at atoning for his.  He says as much on the website for his new book Chasing The Scream: The First And Last Days of the War on Drugs.  In particular he and his publisher go to great lengths to document all his sources properly.
That said, I believe he is making some new mistakes.  The Rat Park experiments were conducted and published in the late 1970’s.  To suggest “the likely cause of addition has been discovered” leads readers to perhaps believe that the discovery is fresh, not work done 35 or more years ago. The Wikipedia entry for Rat Park includes the following:  “The two major science journals, Science and Nature, rejected Alexander, Coambs, and Hadaway's first paper, which appeared instead in Psychopharmacology, a respectable but much smaller journal in 1978. The paper's publication initially attracted no response. [4] Within a few years, Simon Fraser University withdrew Rat Park's funding.”  To extrapolate from work done with rats decades ago to the likely cause of addiction is a leap of gigantic proportion.
Mr. Hari sidesteps mainstream science.  Or current science.  On his own website he refers to Bruce Alexander and Gabor Mate, both of whom he cites in his article, as “dissident scientists.”  Nora Volkow, the current head of the National Institute on Drug Abuse (NIDA) rejected his request for an interview.  I’d like to know more about that story.  I think it is safe to say that NIDA’s research over the span of time since the Rat Park experiments is exponentially wider and more sophisticated than the evidence Hari marshals to support his claim. There are many places to hear Nora Volkow speak on addiction science.  She recently spoke before the U.S. Senate Forum on Addiction and Collateral Damage.  Go here:
Hari does attempt to incorporate NIDA into his argument by consulting Robert DuPont, the first director of NIDA.  DuPont is a medical doctor, a psychiatrist.  He served from at NIDA from 1972 to 1978 and was also the second White House Drug Czar from 1973 to 1977 under former Presidents Richard Nixon and Gerald Ford.  It was President Nixon who launched the War on Drugs, shortly before DuPont became Drug Czar.  It is also worth noting that much of the brain imaging capability now being used to help understand addiction either did not exist or was in its infancy during DuPont’s tenure. I have no idea how conversant Dr. DuPont is with current NIDA research or how wedded he may be to the prevailing ideas of his time.  It would be helpful to have some clarity in this regard.    
On his book’s website Mr. Hari states:  “I would be very happy to include the response of the current head of NIDA to these theories, alongside those of the previous head that are described here. I am keen to offer the fullest possible response, and to explore all sides of this really important debate about what causes addiction.”  I submit that the greatest failing of his article, and indeed his book, is that he has failed in his exploration or, at the least, jumped too quickly to a conclusion.  If we throw out the bathwater, we might want to give this baby a clean rinse. 


Tuesday, January 27, 2015

The Kingfisher Project

The Kingfisher Project is a community information and radio project based at public radio station, WJFF, Jeffersonville, NY, 90.5 fm.  The project was established in 2014 to honor the life of a young woman, Rebecca Pisall, 20, who was shot and killed on June 20, 2014, due to her addiction to heroin.  For more on The Kingfisher Project, go here:

Radio segments produced for the Kingfisher Project are part of the Making Waves public affairs program which airs 8 to 9 p.m. Mondays on WJFF. I was honored to be a part of the January 26th program, which included my presentation to the U.S. Senate Forum on Addiction and Collateral Consequences. 

The January 26th segment was titled “The Stigma Is Deadly.” It is a half hour long. To hear the episode, to support WJFF, and most important, to help launch the fledgling Kingfisher Project, listen to the episode here:

Thanks.  We WILL prevail.


Thursday, December 11, 2014

SantaCon Redux

I first posted this on my blog a year ago. William’s memorial service was December 15th, 2012.  An update seems appropriate.    

“As we emerged from William’s memorial service in Midtown Manhattan exactly a year ago, Saturday, December 15th, we were embraced by a swarm of drunken Santas. The irony of leaving the memorial for someone who died due to a substance use disorder, only to encounter the obscenity of a mob of drunken Santas, reindeer, and elves was not lost on us.  SantaCon was in full swing. 
Fortunately the New York Times has spared me having to reflect on this event.  I’m happy to say that Lee Seinfeld, the owner of my local watering hole, wants nothing to do with the event.” 

Here is an op-ed piece that captures my feelings nicely.  Thank you Jason Gilbert.    

You can also go here to find Times reportage on the event:

Or, for that matter, try the LA Times:

This year, add this piece by Meredith Hoffman in The Village Voice:

Wednesday, October 8, 2014

The Fox Watching the Chickens

On July 9th the office of New York Attorney General Eric T. Schneiderman make the following announcement:

NEW YORK – After an investigation uncovered widespread violations of mental health parity laws by the company, Attorney General Eric T. Schneiderman today announced a settlement with New York City-based EmblemHealth, Inc., requiring the health insurer to reform its behavioral health claims review process, cover residential treatment and charge the lower, primary care co-payment for outpatient visits to mental health and substance abuse treatment providers. The settlement also requires the health insurance plan -- which has 3.4 million members in its HIP and GHI divisions -- to submit previously denied mental health and substance abuse treatment claims for independent review. That review could result in more than $31 million being returned to members wrongfully denied benefits.

An investigation by the Attorney General’s Health Care Bureau found that since at least 2011, EmblemHealth, through its behavioral health subcontractor, Value Options (My bold.), issued 64% more denials of coverage in behavioral health cases than in medical cases. The agreement with EmblemHealth is the third reached by the Attorney General’s office so far this year enforcing the mental health parity laws and stems from a broader and ongoing investigation into health insurance companies’ compliance with the laws.

For the full text of the Attorney General’s announcement – go here:

Today I wanted to learn more about Value Options.  Those that know me understand I have more than a casual interest in their performance and behavior.  The first thing I saw on their website, at the very top of the screen was an announcement about S.O.S. – Stamp Out Stigma. See for yourself here: 

PLEASE correct me if you think I’m wrong.  Value Options, which has clearly demonstrated prejudice against mental health and substance use disorder claims, is now trying to pretend that it wants to end the stigma against mental health and substance use disorder, even as its actions serve to reinforce and perpetuate that stigma by denying proper claims.  The fox is watching the chickens. At the least, Value Options, should say nothing until their practice matches their “policy.”  Until then they come across as the cynical and deceitful business I believe them to be.