Saturday, December 30, 2017

Addict Versus Victim...

Happy, well-adjusted, mentally-healthy people do not shoot heroin...

Before I resume the usual cesspool of consciousness thing, I have to get this out.

A young man of my acquaintance has recently been arrested after a traffic stop in which the police discovered a rather large stash of heroin, some marijuana, a cache of pills, and other drug paraphernalia in his car. The stop was warranted, I'm told, because the young man had violated a minor traffic law.

The young man's family is currently in a state of denial. They claim the stop was not necessary. The subsequent search was illegal (even though the search took place AFTER the young man had failed a sobriety test, exhibited signs of being under the influence of drugs, and was subsequently detained, and a search warrant for the vehicle obtained, which turned up heroin, oxycontin, hypodermics, scales, and other materials).

They claim that while the young man is a drug user, he is not a pusher, despite having a quantity of heroin that suggests differently, and makes the convoluted argument that he only sold drugs (wait...I thought he wasn't a pusher?) to support his own habit.

The family also claims that their son would never have had a heroin habit had a doctor not prescribed him addictive pain medication after a vehicular accident (was he high then, too? Silence on this point, naturally) that occurred three years ago.

The young man is a victim, they say. A victim of doctors pushing pills; a victim of the police performing an illegal search and seizure; a victim of Big Pharma which exists solely to create addicts in the name of profits; a victim of a society which just doesn't understand that his three year love affair with narcotics is not really his fault. He's sick, you see, and just can't get any help.

The family is concerned that the arrest will "ruin his life" (the heroin and pill abuse was apparently something beneficial?), "sully his reputation", and, naturally, because we live in a day and age where no one is responsible for anything, "makes the family look bad...we are NOT 'that' sort of people".


In a former incarnation, I used to write under the pseudonym of The Lunatic. I did this because, well, I was a Lunatic. I was undergoing treatment for mental health issues related to 9/11 at the time, only to discover my crapload of crazy went far deeper than the shock and horror of watching Islamic Nutjobs turn airliners into deadly guided missiles, and being surrounded by the chaos and carnage that resulted.

I had a lot of issues that existed BEFORE 9/11; the attack just served as a catalyst for recognition of them.

I understand mental health issues.

Likewise, I understand addiction, having been a functioning drunk for about a third of my life, a situation caused, in part, by my unresolved mental health issues and extreme lack of maturity into my early 30's.

I also understand the denial that takes root in the people surrounding the addict, mostly stemming from embarrassment, and the belief that whatever was the ultimate cause of someone's nosedive into substance abuse, it certainly WASN'T the family dynamic, the obvious-and-ignored patterns of behavior that constitute a cry for help, the inability to take a personal action that would tend to reflect poorly on one's self just because it would be THE RIGHT THING TO DO that comes with unpleasant consequences, and the need to deflect by blaming an outside source or circumstance for what is, ultimately, a very bad personal choice.

I want to tell you a bunch of very nasty truths that cannot be denied:

Your son/brother/husband is a drug addict. Not a victim.

Your son/brother/husband made a conscious decision to be a drug addict. He does not have "a disease", there is not a problem with his genes, there isn't a doctor with a prescription pad hanging over him 24/7/365, there is no cartoon devil sitting on his shoulder egging him on. To fall into this line of thinking just enables him to continue, because this assumes he is not responsible and can never be responsible for his actions, and is fighting against something that just will never change no matter what he does. You have supplied him with the excuses he needs to justify the behavior, and given him a ready-made excuse to fail, if he does try.

Your son/brother/husband has probably been acutely aware that he's a drug addict, is probably ashamed of it and wants help, but is too stupid or embarrassed to ask for it, and so continues in his self-destructive behavior for lack of any alternative. He's been dropping hints, and you haven't noticed or don't want to know.

This is most likely NOT his first brush with Law Enforcement; he just didn't get away with it this time.

You have been aware that your son/brother/husband is a junkie, and probably for a very long time, but have done nothing except to make excuses for him, and in the process, yourself.

He has probably been asking you for help in not-so-subtle ways -- stealing to support a habit, erratic behavior, violent mood swings, probably at least one hospitalization -- and you have ignored them, which means the chance to help him before it got to this point was presented to you and you have failed him.

This young man was headed to jail long before the police stopped him, and there was only one alternative destination, most likely, in his future...The Morgue.

Instead of blaming everything in existence -- except him and yourselves -- for this state of affairs, you should be very thankful; you have another chance to save his life. It's not an ideal chance, and it will probably take place mostly behind bars, but there is a chance to fix what is broken. As for "ruining his life", it should be noted that actions DO have consequences.

Perhaps had you, as parents, taught him that to begin with he wouldn't have been arrested in a vehicle full of poison. Perhaps if you had been a better brother, you would have understood that simple premise of action and consequence and done something. Perhaps, as a wife, had you exercised some personal initiative instead of waiting for a cure to magically fall from the sky into his lap, you wouldn't be visiting him through glass.

No one here is a victim.

Having gotten that unfortunate-but-true series of statements off my chest, it's time to take a run at some other aspects of this problem, and perhaps offer some solutions from my own experience.

Addiction springs from a lack of self-esteem. Self-esteem springs from several, important sources: achievement, validation, love, acceptance, ability to learn from one's mistakes. There are more factors involved, but these are the easiest to quantify. Self-esteem cannot be magically bestowed upon you by a puppet show in grade school; you will not receive a diploma in self-esteem from a university; you don't win it like the Lottery; it does not grow on trees.

A well-adjusted, happy adult has self-esteem; he is loved and respected by his family and peers (and this often means criticized by same). He loves and respects back. He is not living under the mistaken impression that he is the center of the universe, and realizes that he is surrounded by people from whom he learns or acquires certain traits and behaviors, to whom he has responsibilities, and from whom he has a right to expect the same. He understands that nothing ever came to anyone who wasn't willing to work for it, and that sometimes, in fact often, he will fail, but always has a chance of redemption (and I don't mean in the religious sense. Religion complicates recovery, see below).

The addict feels no love. Most of all, for himself. He recognizes no responsibility to another because he feels no one has exercised any corresponding responsibility towards him. He is a lonely person desperately seeking attention, and at the same time doing everything in his power to push the ones he wants attention from away. He often fails because he's high, and the gets high again because he's failed. He has no skills or tools to help him cope with the black hole in the center of his chest because he's never been constructively criticized (or, conversely, been unrelentingly criticized unconstructively). He may be/have been mentally physically, sexually abused. His role models, such as they are, did not nurture him but rather passed on very bad habits of thinking or coping -- denial, avoidance, substance abuse.

If you can't fix these, then there is no hope of saving anyone. Because this will never be a functioning human being.

Fixing these problems is supposed to be the realm of the psychological sciences. These leave much to be desired, and are not universally successful, mainly because the practitioners, themselves, are often not very good at it. There are two schools of thought (broadly) concerning mental disorder (as opposed to disease):

1. All disorders are the result of chemical imbalances in the brain or body, which can be "fixed' by creating other chemical imbalances in the brain and body with drugs.

2. All disorders are the result of behavioral problems stemming from acquired or learned behaviors, trauma, emotional upheaval, or all three.

The response of the practitioners of the Chemical Imbalance school is to hand out anti-depressants.

The response of the practitioners of the second school is to leave everything to talk therapy, hoping the patient eventually talks himself into an epiphany of recognition of a pattern of behavior, and then addressing the behavior constructively.

The first school is largely experimentation and trial and error until you find the "right" meds, or mix of meds, the second approach usually has better results, but takes longer, and sometimes, never works at all, based on the premise that you can lead a horse to water but not force him to drink. Some people are just too comfortable with a bad cycle of behavior to abandon it, even when they recognize it as destructive.

I'm sure neither school has much of a chance when the facts of incarceration are added to them.

This is, in my opinion, why most "rehab" regimes fail; handing out drugs that suppress or enhance one chemical, often create an imbalance in another, and come with side effects that make cognition and recognition problematic. The 28 or 60 or 90 day stint in a group therapy dormitory, or in a Club Med for addicts, is neither long enough for most people to get a grip on their issues, nor provides enough of the individual attention that the patient might require. The quest to find a "one-size-fits-all" treatment regime results in mixed -- at best -- results, if only because everyone's underlying mental constipation isn't the same.

The Medical Profession has much to answer for in the problems of addiction -- easy access to pills, far too much reliance on drugs and outpatient therapy -- for sure. But they are in the circumstance of being something like a carpenter who only has a hammer in his toolbox: eventually, everything begins to look like a nail. A more-holistic approach needs to be found to deal with these issues.

The way in which we provide these services leaves much to be desired, as well.

Insurance companies HATE mental health diagnoses. Unlike a broken arm or a bum appendix, there is no formulaic treatment plan that allows them to control costs, or which assures success of treatment. Mental health services cost more because there is no predictability in a treatment regime. A broken bone heals in a few weeks when it is set, and every broken arm can be assumed to heal within the same amount of time with the application of known resources; a broken mind heals on no timetable, and is usually beyond the aid of surgery, splints, or band aids.

And yet insurance companies insist that "standard" treatments applied over a predictable timetable, should yield positive results, despite all the evidence to the contrary. Hence, insurance companies tend to treat the mentally ill as nuisance patients -- they will get only what their "experts" (incidentally, if your experts were any good, they'd be in private practice making a fortune, not on the insurance company payroll) say they will get, and no more. If you're out of time, according to the insurance company, you're out of luck. And, really, when the primary motivations are keeping shareholders happy and making your "numbers" look good to admins, who cares if the patient isn't recovered? You're still getting paid.

Which leaves the heavy lifting of mental health treatment , and especially drug addiction, to government, and since government tends to do things badly and expensively, we should not be surprised that it fails so often in this regard. It's primary tools, after all, are incarceration -- either in jails or within a state-run facility staffed by people who only have a job because they passed a test, or by doctors who, by-and-large, are not good enough for private practice -- and administrative imperative, which is much like the sort of thing the insurance companies do. The impetus here is driven as much by metrics -- number of patients served, number of cases closed -- as is the insurance company's. The idea is to do the barest minimum, at the least expense, in the fastest way possible, and so long as all the right boxes are checked, who cares if you're sending an addict back out to use again? You still got paid for failure.

And now we get to religion, which is just another drug.

Yes, I know people who have recovered after acknowledging the existence of "a higher power", and yes, I'm well-aware of people whom Jesus has "saved", but I'm here to tell you that it's all crap from a realistic point-of-view.

If I'm correct that what causes an addict is a lack of self-esteem resulting from a poor self-image and self-hatred, then religion would seem to address these problems quite well: it's basic premise that God loves us all, and accepts us all just as we are, and understands that we all fuck up every now and again, but, hey, He forgives you, and you don't need to be ashamed, and just confess, and you can join a greater community of fucked-up individuals just like you who gave up cocaine, but took up God in it's place, is an appealing thing.

This is a powerful high, too. It is, in fact, exactly what these folks want to hear; it's what they've been waiting for all of their lives.

But praying and quoting scripture doesn't erase the trauma of watching Daddy beat Mommy. It does not actually solve any of your internal problems. It doesn't address the cycle of behavior that led you to whatever it was that led you here. You still have the same mental issues; you're just ignoring them better. If telling the addict "you have a disease" is an excuse for failure, telling him "the invisible man in the sky will fix your problems by not addressing them in any meaningful way" is just as bad. Even worse, since a lot of churches actually depend on bringing in addicts to keep the pews full and the funds flowing (it's why many start "Outreach programs", an amazing number of them led by former addicts who "Found Jesus" -- funny how that happens, right? -- to begin with), it's almost a direct correlation to the pusher-addict relationship.

One final note. If there's anything more annoying than a libertarian, it's a libertarian who insists that  drug use is really "a victimless" crime.

People who believe this need to be taken out and beaten to death with their own intestines.

There is no such thing as a "victimless" crime, and this is just the excuse you use to justify your own addictions. The peasant in Columbia who stands in a vat of acid and gasoline stomping on coca leaves before being killed in order to protect the location of the processing lab is a victim; the people killed by rival drug factions on the distribution routes through Central America are victims; the four year olds caught in crossfires in Chicago or Baltimore as rival drug gangs fight over turf are victims; the people killed by stoned drivers, left homeless by fires caused by an addict who nods off while freebasing (it happened to me!), injured while someone under the influence operates heavy construction equipment, the cops who don't come home trying to keep this shit off the streets, are all victims.

You consider it a "victimless crime" because in the tony suburbs where you pontificate about "liberty" and regurgitate Rand and consider yourself "enlightened" (Rand is a fucking comic book writer), you don't see the results.

So, how to solve this problem?

Ultimately it can only be solved at the individual level. Any system of standardized treatment, any system of stratified law, any religious conviction, any constipated political ideology of surrender to vice for the fun of it, leave much to be desired. The individual is both the cause of the problem and it's solution. However, getting those individuals the tools they'll need to recognize their issues, react to them positively and effectively, and then providing them with the services they will require to maintain the positive reaction, is problematic. There are just too many people, for instance, who have a vested interest in maintaining a status quo.

Prisons exist and employ people, even thought they don't work. Treatment centers exists and employ people, even though they are mostly ineffective. The War on Drugs has led to millions of jobs for administrators, police officers, judges, public defenders, and millions of votes for politicians who support them, even though they fail. There's too much money floating around in keeping the cycle alive, and not enough in breaking it for good.

I would say the best defense and treatment against addiction is a strong family, which includes people strong enough to understand their own culpability in the creation of an addict, their own responsibility in helping to fix one, and who understand that churning out excuses is about as useful as a democrat at a MENSA meeting.

Without this, the rest of it is simply useless.

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