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Posts Tagged ‘Addiction’

Artificial Intelligence, Robots, Mental Health and Well Being, and the Limits of Efficiency

July 6, 2018 Comments off

As a Buddhist practitioner, a retired educator who witnessed the expansion of technology in public education, and a blogger who has “efficiency is the enemy” as a tag, I was drawn to a Medium interview by Brian Walsh titled “The Chinese Buddhist Billionaire Who Wants to Fix Your Brain“. This billionaire in question is Chen Tianqiao who founded the online gaming company Shanda in 1999 and cashed in a decade later in large measure because he had a cancer scare, multiple panic attacks, and a sense that his life had no meaning.

The article opens with a response to a question that offers a brief biographical sketch of Mr. Tianqiao, which also includes an overview of his perspective of Buddhism.

Mr. Walsh follows with a series of questions that yield some thought-provoking insights. His response to one of the questions posed by Mr. Walsh was particularly compelling:

Right now we teach machines only one value statement: efficiency. The machine optimizes the efficient. The machine always knows how to quickly find the best way. But if the machine ruled the world, it must say, “Kill all the old men and sick people because of their weight on resources,” right? So we have to teach the machines fairness and compassion. But how do we do that when we don’t know how to define them?

Later Mr. Walsh explores Mr. Tianqiao’s ideas on the relationship between technology and our general well being… and Mr. Tianqiao’s perspective is that technology is outpacing humanity’s adaptability and that, in turn, is leading to an increase in mental health problems.. including suicides.

You have a phone in your hand that can connect you to anyone. You can get a thing done in one minute that 10 or 20 years ago would have taken you a month. This is the pace we live at now. But I believe people have a limitation on their capacity for connection. You don’t know how to handle these relationships. The speed of information. There’s so much information flooding into your brain, and your brain has to judge yes or no, because more and more people, with the help of a blast from technology, they also have a voice. There are so many different views flooding in your brain, and you have to judge what you like, what you want.

I say you run too fast. I cannot chase you. I just want you to stop. I want to stop you, right? This is technology. But we cannot just stop.

The article concludes with this question about the future of technology and Mr. Tianqiao’s somewhat pessimistic response response:

Ultimately, do you feel optimistic about the direction we’re going with technology and the brain? Do you think we’ll be able to make ourselves fitter and happier?

I cannot find an answer to this. That’s why I’m a little pessimistic. I think there are so many problems that are generated by technology. What I can do is try to use scientific ways to mitigate the possible consequence of that technology. But if we don’t do that, it could lead to very bad consequences.

When I gave money to an American university [CalTech], the Chinese media criticized me. But I think the current debate or current conflict is not between the people of one country and the people of another. This is our humanity.

In an era of tariff wars, the dissolution of longstanding alliances that stabilized relationships among relatively free countries, and the opportunities for technology moguls to make billions it is east to share Mr. Tianqiao’s pessimism… here’s hoping we can all see the our humanity is at stake as we continue expaning our use of technology.

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Opiod Epidemic Makes Life Even MORE Complicated… and MORE Costly for Schools

June 24, 2018 Comments off

Earlier this week, Politico published a post that described how the opiod crisis is impacting public education, and it isn’t a pretty picture:

SCHOOLS BLINDSIDED BY OPIOID EPIDEMIC: America’s biggest public health crisis since AIDS has seeped into cash-strapped schools. Educators are on the silent front lines of the epidemic at a time when many already feel overtaxed as a result of budget cuts and chronic shortages of school counselors, psychologists and social workers.

Here’s what our reporting found: Teachers console children whose parents have died, gone to jail or disappeared as foster care rates increase, often resulting from drug abuse. Sleep-deprived youngsters come to school hungry and dirty, describing drug busts in their homes. Sometimes, the abusers are the students themselves. Overloaded school counselors struggle to assist hundreds of kids and parents.

Adding to the stress,fights over scarce school funding and teacher pay mark many of the same states engulfed by opioid addiction.Overdose deaths from opioids and other drugs have risen significantly in West Virginia, Kentucky, and Oklahoma — all states where teachers walked off the job this year. In Arizona, another state of teacher labor unrest where school funding dropped more than a third since the Great Recession, heroin overdose deaths are increasing.

“There’s a lot of talk about the opioid abuse and drug abuse in the state, but then we’re not funding the basic programs that would really help with our side, kids at school,” said Patrick Ballard, a school psychologist in Lexington, Ky.

Schools must educate children preoccupied by other things. “If you don’t feel safe and you can’t get a warm shelter and meal, how are you going to focus on a math test?” said Jan Rader, the fire chief of Huntington, W.Va., who regularly responds to 911 drug overdose calls to find children on the scene. “We spend a lot of time talking about getting people into treatment and into detox and all of that. But our kids, it’s our next generation, and they are suffering.”

Janine Menard, a high school counselor who serves as board chairwoman of the Arizona School Counselors Association, said prevention programming has become an afterthought in her home state as Arizona’s ratio of counselors to students has slipped to 1-to-924. She oversees about 1,600 students at two schools, where she’s seen engaged parents seemingly slip into what she said she assumes are the trenches of drug abuse.

“It’s like a Band-Aid. You just take care of the student with behavior problems and what’s happening at the moment,” said Menard, who watched in frustration in May at the state Capitol in Arizona as legislators voted down an amendment that would have sought to lower the ratio to 1 to 250.

— Speaking of drug prevention education, Sen. Joe Manchin (D-W.Va.) said in an interview that he believes it should be mandatory for students of all ages, starting in kindergarten. He said he’s frequently approached by teachers and other school employees who describe opioid-related problems.

— “Thank God for the school system, the teachers, the teacher’s aides, service personnel. We’ve almost basically asked them to step in where parents, and communities and the social structure of an area hasn’t been able to do their job, and do it for them,” Manchin said. Read more from your host here.

It is heartening to see a Senator praising the public schools… but it would be even better to hear any political acknowledge the ultimate action needed to solve this problem: more money for public education and public health services. 

Teasing out the ides offered in this post underscores that reality. If voters want public schools and public health agencies to cope with the existing problems and prevent future problems they will need to hire more personnel for BOTH, and that will come at a cost to taxpayers… and from where I sit every dollar we spend on prevention and treatment is a dollar that we do not have to spend on prisons. But, alas, prisons are profitable and public school and public health personnel are a “drain on our tax dollars”.

Teachers in West Virginia Pushing for Better Wages in the Face of Daunting Working Conditions

March 6, 2018 Comments off

For the past several days, teachers across West Virginia have been on strike in an effort to get better wages, a challenge in a state that devalues public education and is increasingly devastated by the decline in coal mining and the resultant opioid crisis. TOday’s NYTimes features an article by Dana Goldstein that describes the history of teacher strikes and the expanding responsibilities teachers assume in regions of our country where poverty and drugs are devastating families and the threat of school shootings casts a pall over every school. As Ms. Goldstein writes:

…Almost every major strike since then has come as teachers have been asked to shoulder society’s biggest challenges, from disease to racial inequality and, today in West Virginia, a drug crisis on top of a growing nationwide fear of bloodshed in the classroom.

“The work is all encompassing,” said Karla Hilliard, a high school English teacher in Martinsburg, W.Va., and one of roughly 20,000 teachers participating in a statewide strike.

“In West Virginia we deal with high levels of poverty and the opioid epidemic,” she said, “but then there are the smaller things, like kids who come in and they don’t have support at home and they just need someone to care about them and love them.”

And the teachers in West Virginia, like teachers who work with kids raised in poverty across the country, are often the primary adult care-givers in the lives of children. And when poverty is combined with opioids it is a toxic combination:

West Virginia has the nation’s fourth-highest unemployment rate and an opioid overdose death rate that is more than three times the national average. All of this plays out in the classroom.

I can’t tell you how many students we have being raised by grandparents because of parents’ drug addictions,” said Jay O’Neal, a seventh-grade English teacher and a leader of the strike. While the immediate demand is for higher pay and more affordable health insurance, “it’s just part of a broader problem teaching here, dealing with the effects of poverty.”

But instead of dealing with poverty, in part by paying the teachers in the state a decent wage, the West Virginia legislature has different ideas:

Today in West Virginia, policymakers have their own ideas about how to improve schools. The State Department of Education has revamped vocational education, while the Republican-controlled Legislature has debated weakening teachers’ seniority protections and providing parents with tax incentives to pay for private school tuition.

Why would legislators want to weaken seniority and give parents incentives to attend private schools? I think readers of this blog know the answer: it reduces the requirement for additional state funding which, in turn, reduces the need for taxes, especially the need for taxes on the wealthy donors who help underwrite the legislators campaigns. Meanwhile, teachers continue doing the little things to help their children despite their parents addictions:

At Mr. O’Neal’s school, Stonewall Jackson Middle School in Charleston, teachers use their own money to stock a closet for students whose clothes are dirty or do not fit, or who come in wearing shorts when it is freezing outside. At faculty meetings each year, they draw some children’s names off an “angel tree” and provide them with Christmas gifts, because otherwise they would not get any.

Recently, Mr. O’Neal said, teachers have noticed that some students with attention deficit hyperactivity disorder, or A.D.H.D., have been coming to school unmedicated and disrupting an entire class; the teachers suspect parents are selling their children’s medications.

The 5% wage hike the teachers are seeking will not move West Virginia higher in the pay rankings in the nation… but it just might keep some of the best and brightest teachers from looking elsewhere for work.

You Can’t Help Someone Who’s Not There… And Without a Change in Focus, You Can’t Even Help Someone Who IS

February 16, 2018 Comments off

Here’s a short but powerful post I pasted from Facebook describing the circumstances that contributed to the ill-being of the student who shot and killed 17 of his former classmates at a FL high school on Wednesday:

“So the killer’s father died 3 years ago. He started posting scary racist images of guns and hurting animals. Then his mother died 3 months ago. His girlfriend broke up with him and got a new boyfriend. He started telling people he wanted to shoot up the school. He got expelled. Why expel a messed up kid whose parents just died? What do we do with people who cannot handle immense pain and loss? Kick them to the curb and let them buy guns?” – Sarah Schulman

You can’t help a student who is not in school… yet as a society we seem unwilling to raise the funds we need to provide the kind of intensive counseling children like this young man require. At some juncture the needs of 3000 children forced the school administrators to permanently expel the shooter. Once the shooter is out of school, he is out of the only safety net that could conceivably help him cope with the stresses associated with the loss of parents and his inability to relate to others.

Disconnection and alienation manifest in other ways as well. Teens who feel socially ostracized turn to drugs and other detestable behaviors that make them hard to love and relate to. If we hope to use public schools as a means of connecting with alienated and troubled youth, we need to change the focus so that relationship building is taught and learned the same way conformance to rules is taught and learned.

VP Biden’s Domestic Advisor Advocates for Foster Children… But in Doing So Undercuts Real Problem and Reinforces Private Sector “Power”

December 31, 2017 Comments off

Yesterday’s NYTimes  op ed piece featured an by former VP Biden’s Domestic Advisor Sherry Lachman that drew attention to a devastating consequence of the opioid epidemic: an increase in the number of foster children. The article offers statistics like these on the impact of opioids on foster care and the impact of foster care on the later lives of children:

As more Americans struggle with opioid addiction and find themselves unable to perform their duties as parents, children are pouring into state and county foster care systems. In Montana, the number of children in foster care has doubled since 2010. In Georgia, it has increased by 80 percent, and in West Virginia, by 45 percent. Altogether, nearly 440,000 kids are spending this holiday season in foster care, compared with 400,000 in 2011..

…Children who have been in foster care are five times more likely to abuse drugs. As many as 70 percent of youths in the juvenile justice system have spent time in the child welfare system. One-third of homeless young adults were previously in foster care. Black children are twice as likely as white children to wind up in foster care and face its devastating effects, a symptom of our country’s disparate treatment of black and white families who experience similar challenges.

The article offers heart wrenching examples of how foster children are shuttled from home to home or, even worse, into warehouse-like dwellings full of other foster children. Near the end of the article, Ms. Lachman offers some ideas on how best to fix the problem that this increase in foster care is creating:

Children in foster care desperately need their help. We cannot put the entire burden of fixing the system on the backs of overworked, underpaid social workers. Our government must treat the child welfare crisis like the emergency it is and respond with more funding and better policies. We need more philanthropists, advocates and celebrities to champion this cause and more families to open their homes and hearts.

We particularly need companies and professionals with private-sector expertise to partner with child welfare agencies and bring the system into the 21st century. Marketing experts can help recruit foster parents and spread the word about the 100,000 foster children who are available for adoption. Customer service specialists and user-centered designers can help children and families better navigate the system. Data scientists can use analytics to predict and prevent child abuse and reduce the number of kids who enter the system in the first place.

Had Ms. Lachman elaborated on the need for more funding and better policies, she would have my wholehearted support. But her call for companies and professionals with private-sector expertise and her notion that …Data scientists can use analytics to predict and prevent child abuse and reduce the number of kids who enter the system in the first place are completely wrongheaded.

I am certain the “overworked, underpaid social workers” posses the kinds of “private-sector expertise” she values, but given their hectic schedules and the emotionally drain that comes from overwork and the nature of their assignments they are unable to apply those skills because they are doing everything humanly possible to meet the demands of their job. As one who worked for decades as a public school administrator I know how overwork and relatively low compensation can debilitate and demoralize individuals who possess the same skill sets as individuals who work in the private sector. Instead of calling in consultants who work in the private sector, it would be far better to provide more jobs in the public sector see that public sector employees can unleash their own talents for recruitment, marketing, and means for navigating the system. 

Similarly, if social work agencies were staffed adequately they would not need data scientists to “predict and prevent child abuse”. The factors that lead to opioid abuse are known to anyone who examines our economic and judicial system. Our current economy provides only dead-end jobs for those lacking a post-secondary degree and virtually no jobs whatsoever for those who have been convicted of crimes of any kind. If we had better policies for education, if we insisted that the minimum wage was a living wage, if we stopped imprisoning people for being unable to pay fines for petty violations we just might reduce the number of our citizens who turn to opioids out of despair and the number of citizens who sell opioids in order to make ends meet.

Ms. Lachman’s notion that private sector expertise and technology will save the day is classic neoliberal thinking. It endorses the idea that “government can’t solve problems” and “private-sector expertise” can. It sees technology as the deus ex machina that will free us from the need for more public sector employees and the higher taxes that would result from hiring more people.

This just in: private sector expertise and technology will not end opioid addiction and the collateral damage it brings. Economic and social injustice creates the environment that leads to addiction…. and those problems can be solved by more funding and better policies. Those problems can be solved by government.

 

 

Public Schools Need to Prepare for Opiod Cohort… Or Dig a Little Deeper to Offer Support

December 20, 2017 Comments off

The opiod crisis that is sweeping our nation has one long-term consequence that has been ignored, perhaps because the “crack baby” scare of the 1990s was oversold, but more likely because it is easier to ignore a pending crisis than it is to face it.

Our local newspaper, the Valley News, had an AP article by Michael Casey that reported that 10% of the children born at Dartmouth Hitchcock Medical Center faced complications from opiods. The article noted a marked increase in the number of infants suffering from a drug-related condition known as neonatal abstinence syndrome or NAS. Mr. Casey reported on how NAS is on the rise in New Hampshire:

Those babies are often born premature and underweight, and their mothers’ drug use increases their risk for exposure to hepatitis and HIV.

Infants diagnosed with NAS also remained in the hospital for 12 days, compared to three days for other newborns.

The University of New Hampshireand New Futures Kids Count found the number of infants diagnosed with the condition has gone from 52 in 2005 to 269 in 2015. That’s consistent with the nationwide trend, according to the Centers for Disease Control and Prevention. In a 2016 report , the agency found that rates of NAS increased 300 percent nationwide from 1999 to 2013, with the highest rates in West Virginia, Maine and Vermont, which reported more than 30 cases per 1,000 births.

Nearly 24.4 of every 1,000 babies in the Granite State were diagnosed with NAS in 2015.

“I expected to see a rise in neonatal abstinence syndrome because I’ve heard in the news about the rise in opioid use and opioid drug deaths,” said Kristin Smith, a family demographer at the Carsey School of Public Policy at UNH and the report’s author.

This reminds me of the reports our district read about “crack babies” in the 1990s… but the wave of problem children we anticipated never occurred. As it turns out, the anticipated problems never materialized because the data used to forecast this “epidemic” was too limited: it was based on a study of 23 infants and blown out of proportion. THIS “epidemic”, however, is based on widespread collections of data and appears to be more grounded in hard evidence. Mr. Casey’s indicates that there IS a means of limiting the problems children might occur when they enter school IF intervention happens at an early point:

The good news is that the condition is treatable and that hospitals, according to the report, are responding with programs that wean newborns off the drugs and help their recovery with cuddling programs and efforts to increase skin-to-skin contact.

There is also a greater emphasis to help the pregnant moms get off drugs, including a program dedicated to mothers in recovery that was started four years ago at Dartmouth Hitchcock. Offering treatment and mental health services, the report said, has been found to reduce the numbers of babies needing treatment.

The report points out that the state needs to do a better job of responding to the needs of these woman, which means more treatment and support services for them and state policies that aren’t solely focused on punishing the addict.

But here’s the rub: if we as a society continue to view addiction as a moral failure instead of a disease we will not apply the resources needed to treatment and instead use resources to incarcerate individuals whose moral failings need to be redressed. And if we continue to limit treatments to “X” number of days in rehab or “X” dollars of services we will be condemning a generation of babies born with addictions to a lifetime of misery. We should find the money needed for the treatment and support services even if it requires us to dig a little deeper in our pockets. We should act out of compassion for those who suffer from addiction instead of responding with anger.

D.A.R.E. is NOT the Solution to Drug Abuse… Interagency Cooperation IS!

July 13, 2017 Comments off

I just finished reading two articles in succession that illustrate the right way and wrong way to prevent and treat the use of drugs. Matt Ferner’s Huffington Post article, “Jeff Sessions Wants to Bring Back D.A.R.E”, describes the Attorney General’s throwback solution to dealing with drug abuse, resurrecting D.A.R.E., an idea developed in the 1980s and promoted by Nancy Reagan and many Chambers of Commerce and local police forces. The idea behind D.A.R.E. was appealing: have local police officers come into schools and teach children about the evils of drug use, the kinds of drugs that are available, and how to Just Say No to drugs when someone is trying to encourage you to use them. Here’s Mr. Ferner’s description of the program:

D.A.R.E., originally created in 1983 by the Los Angeles Police Department, placed uniformed police officers into classrooms around the nation to speak to children about the dangers of drug use and to tout the benefits of a drug-free life.

It was immensely popular and remained so for years, eventually reaching 75 percent of U.S. school districts and 52 countries around the world, according to the program’s website. Black T-shirts and bumper stickers with D.A.R.E. splashed across them in bright red lettering became iconic symbols of the 1980s and Nancy Reagan’s broader “Just Say No” to drugs campaign.

But D.A.R.E. had one big problem: it didn’t work. As Mr. Ferner summarized later in his article:

But despite Sessions’ advocacy, research over several decades has found that the program didn’t actually make much of a difference in preventing drug use by youth.

“D.A.R.E. does not work to reduce substance use,” a 1998 National Institute of Justicereport to Congress reads. “The programs’s content, teaching methods, and use of uniformed police officers rather than teachers might each explain its weak evaluations.”

A 2003 report from the U.S. Government Accountability Office, which analyzed six long-term evaluations of D.A.R.E.’s elementary school curriculum at the time, found “no significant differences in illicit drug use” between students in the fifth or sixth grade who received the program and students who did not. GAO also reported that five of six evaluations reviewed found “no significant differences” between the students’ attitudes toward “illicit drug use and resistance to peer pressure.”

While two of the evaluations did find D.A.R.E. students showed “stronger negative attitudes about illicit drug use and improved social skills about illicit drug use” about a year after receiving the program, those effects diminished over time.

In an administration that cares little for evidence based decision making and a lot about optics, the return of D.A.R.E. with police cast as “good guys with guns” makes good political sense. But if we had government leaders who cared about results, they might take a look at what has happened over the past few years in Laconia NH and try to replicate what has transpired there. As reported by Benjamin Rachlin in the NYTimes, the police department in that small city has assigned one individual, Eric Adams, to be “Prevention, enforcement and treatment coordinator” for the community, a position they created and funded when they realized that drug addiction was a disease and not a legal problem. The result?

In the nearly three years since, as overdose rates have climbed across New Hampshire, those in Laconia have fallen. In 2014, the year Adams began, the town had 10 opioid fatalities. In 2016, the number was five. Fifty-­one of its residents volunteered for treatment last year, up from 46 a year before and 14 a year before that. The county as a whole, Belknap, had fewer opioid-­related emergency-­room visits than any other New Hampshire county but one. Of the 204 addicts Adams has crossed paths with, 123 of them, or 60 percent, have agreed to keep in touch with him. Adams calls them at least weekly. Ninety-­two have entered clinical treatment. Eighty-­four, or just over 40 percent of all those he has met, are in recovery, having kept sober for two months or longer. Zero have died.

How did this happen? Inter-agency collaboration and coordination. The article doesn’t state it this succinctly, but here’s a description of Mr. Adams’ first days on the job:

As soon as he began the job, Adams researched what social-­service organizations the region had to offer and drove to their offices to introduce himself. A few employees at places like these knew one another from previous referrals, but many didn’t, so Adams went about acquainting them. At health conferences, he arrived to the quizzical frowns of social workers and realized that, of some 200 attendees, he was the only police officer. A network gradually sprouted around him. 

I have long advocated the need for greater interagency cooperation, particularly between law enforcement, social workers, and public schools (see this, for example). In my experience, it is rare for formal communication channels to be established among these agencies and as a result the services and support provided to children in need are disconnected and uncoordinated.

My advice to Mr. Sessions: Instead of spending time and money resurrecting a program with a proven record of insignificance, find ways to replicate the Laconia Police Department’s efforts to coordinate efforts among those local agencies trying to address addiction.