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

July 13, 2017 Leave a comment

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.

Drugs in Graphing Calculators and Teddy Bears? The DEA Wants Parents to Be Wary!

April 29, 2017 Leave a comment

In an article whose content would not be out of place in the Borowitz Report or The Onion, Christopher Ingraham’s Washington Post op ed piece describes a bizarre tweet from the Drug Enforcement Agency (DEA) that provides a link to a page entitled “Hiding Places” at getsmartaboutdrugs.gov, “a DEA resource for parents, educators and caregivers.”

And where does the DEA think your child be hiding drugs? In alarm clocks, graphing calculators, highlighters, shoes, candy wrappers, posters, heating vents, teddy bears, car interiors, and game consoles. As Ingraham writes:

The general take-home message of the page — and of the “getsmartaboutdrugs” website in general — is that seemingly innocuous objects and behaviors can be signs of a life-ruining drug habit. Candy wrappers, belt buckles, ski caps, glow sticks and pacifiers are all potential pieces of drug paraphernalia, according to the site.

Warning signs of teen drug use include “disinterest in school,” “lack of interest in clothing,” new friends, and “excessive attempts to be alone.”

The categories are so broad as to be practically meaningless, a reflection, in part, of the DEA’s worldview that drugs are everywhere and everyone is a potential criminal.

Ingraham takes a light-hearted approach to this, underscoring it’s preposterousness by noting that “Among teens, use of illicit drugs other than marijuana is near historic lows and marijuana use is flat or falling.” and concluding with this quip:

So parents, take heart: If your kid seems really into her graphing calculator, all it really means is that she’s well on her way to a career as a successful engineer.

I wish I found this to be humorous, but instead I see it as part of the insidious direction our government has taken us for decades, one that preys on our fears and suspicions instead of our faith in our fellow man.

Because we are fearful that isolated incidents of terrorism we are subjected to ever more invasive scrutiny in our travels. Because one terrorist used a shoe bomb we ALL remove our shoes to board planes. Because one terrorist used some kind of gel-like explosive we need to remove our shampoo from our carry on luggage. Because one individual used an underwear bomb we are now subject to body scans and on occasion pat downs. And in order to provide this security we have spent millions of dollars on security technology and millions annually on trained TSA personnel.

Because of isolated incidents of school shootings, we now lock the doors to our schools, provide surveillance cameras, and often provide police officers to monitor students. We also place strictures on the information students can access while they are under the supervision of schools and ask schools to assume responsibility for “bullying” communications that take place outside of school. And in order to provide this security we have spent millions of dollars on security equipment and millions annually on non-instructional staff in schools. Worse, we are effectively training our youth to be comfortable in a world where their every move is monitored and their communications might be limited.

Because of isolated incidents of armed robberies we provide 24/7 surveillance on many of our streets and because of isolated incidents of violence by police we are providing body-cams to ensure the safety of innocent citizens. And in order to provide these additional layers of security we have spent millions of dollars on equipment. Worse, we are reinforcing the notion that neither our fellow citizens nor the police can be trusted.

I look at the billions spent to promote fear and reinforce docility and contrast it with the relative pittance spent on mental health, addictions counseling, and the safety net programs and wonder where our country is headed. As one who read and valued George Orwell’s insights, I think I know.

 

The Opioid Epidemic Hits Schools On Multiple Levels

February 21, 2017 Leave a comment

I just finished reading “The Opioid Epidemic and the Face of Long-Term Unemployment”, Yves Smith’s post in Monday’s Naked Capitalism. It draws heavily from what she accurately describes as “a must-read story at Bloomberg“, This Is the New Face of American Unemployment. The Bloomberg article profiles five examples of individuals facing long term unemployment, all of which, Ms. Smith contends, are directly or indirectly caused by addictions to opioids.

Two items related to education policy jumped out in the first profile, about a 23 year old from West Virginia who dropped out of school, got a GED, but is finding it difficult to land a job:

“….(the Bloomberg story includes) a factoid that indicts the performance of our ruling classes: “Nearly half of U.S. children now have at least one parent with a criminal record.”

 

As Nobel Prize winner James Heckman has found, a GED isn’t equivalent to a high school diploma. GED holders do worse in terms of lifetime earning that high school graduates. Heckman posits that the socialization of going to class makes a difference in being able to hold jobs.

When a parent has a criminal record, it is virtually impossible for that parent to secure a decent job because most employers will not hire someone with a record, especially a felony record for drug possession. Yet drug addiction is viewed by medical professionals and— in most cases— by politicians and the public as an illness. The result of criminalizing a medical condition is that those who suffer from the condition find it difficult to land a decent job, which throws them into despair, which then creates a situation where they are inclined to use drugs again. It is a vicious cycle that undercuts the ability of a parent to support his children and thereby diminishes the social mobility that education is intended to promote. The way out of this would be to expunge the criminal records of individuals who remain clean and sober for a set amount of time. This would provide an incentive for the former addict to remain clean and enable them to achieve higher earnings as a result of their hard work.

The connection of socialization and job retention is often overlooked by those who view technology-based learning as the best means of attaining a degree and those who seek to home school their children to avoid subjecting them to the “values” promoted in public education and/or the peer groups and peer they are likely to encounter in public schools. The GED is often offered as an alternative to those students who don’t fit in to school, like the gay young man profiled in the Bloomberg article. But what if schools compelled students to be inclusive instead of accepting a culture that forces LGBT students to seek an alternative to the “traditional” school? Wouldn’t such an inclusive and welcoming atmosphere benefit all children in the school? And wouldn’t such an atmosphere help reduce the possibility of students feeling the need to use drugs to deal with their despair?

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If “Competitive Self-Interest” and “Extreme Individualism” ARE Harmful, How Should Schools Respond?

October 15, 2016 Leave a comment

In Guardian writer George Monbiot’s thought provoking article, “Neoliberalism is Creating Loneliness. That’s What’s Wrenching Society Apart”, he describes the epidemic of mental illness besetting young women in Britain:

recent survey in England suggests that one in four women between 16 and 24 have harmed themselves, and one in eight now suffer from post-traumatic stress disorder. Anxiety, depression, phobias or obsessive compulsive disorder affect 26% of women in this age group. This is what a public health crisis looks like.

And what is the root cause of this? Mr. Monbiot posits the following:

There are plenty of secondary reasons for this distress, but it seems to me that the underlying cause is everywhere the same: human beings, the ultrasocial mammals, whose brains are wired to respond to other people, are being peeled apart. Economic and technological change play a major role, but so does ideology. Though our wellbeing is inextricably linked to the lives of others, everywhere we are told that we will prosper through competitive self-interest and extreme individualism

The parallels between what is happening in Britain and our country are clear: statistics show that roughly 1 in 5 adults have some form of anxiety disorder and the consequences of the self-medication that accompanies that problem plague our country and the isolated adult child playing video games in the basement is a trope cited by pundits and politicians, often in derisive terms. Mr. Monbiot’s description of the cycle of physical distress that emerges from loneliness paints a different picture:

It’s unsurprising that social isolation is strongly associated with depression, suicide, anxiety, insomnia, fear and the perception of threat. It’s more surprising to discover the range of physical illnesses it causes or exacerbates. Dementia, high blood pressure, heart disease, strokes, lowered resistance to viruses, even accidents are more common among chronically lonely people. Loneliness has a comparable impact on physical health to smoking 15 cigarettes a day: it appears to raise the risk of early death by 26%. This is partly because it enhances production of the stress hormone cortisol, which suppresses the immune system.

Studies in both animals and humans suggest a reason for comfort eating: isolation reduces impulse control, leading to obesity. As those at the bottom of the socioeconomic ladder are the most likely to suffer from loneliness, might this provide one of the explanations for the strong link between low economic status and obesity?

And as I read Mr. Monbiot’s article I was struck by how our public schools contribute to the ideology that Mr. Monbiot links to the onset of mental distress experienced in Britain and how little we are doing to combat it. The premium placed on getting good grades and developing a good resume to get into college discourages the kind of social bonding that overcomes loneliness and implicitly encourages the consumerist mentality that attempts to address problems with the acquisition of “stuff” and/or the use of some kind of medication. Schooling today, with it’s emphasis on competition between students and the need to get to a good school so that they become wealthy or retain their economic standing reinforces the message that they will prosper through competitive self-interest and extreme individualism

Schools that wanted to focus on well being would place a greater emphasis on developing healthy social relationships, on developing self-awareness in students, and on developing empathy for others. Instead, as Monbiot notes, schools respond to the message given by:

…men who have spent their entire lives in quadrangles – at school, at college, at the bar, in parliament – (who0 instruct us to stand on our own two feet. The education system becomes more brutally competitive by the year. Employment is a fight to the near-death with a multitude of other desperate people chasing ever fewer jobs.

THAT message, one of Social Darwinism, is an ideological one, and is a message that divides people, pits them against each other, and leads to the mental distress we are witnessing now. It might be time to find a new ideology.

In the Face of the Opiod Addiction Crisis We Worry About Test Scores

September 28, 2016 Leave a comment

An article in today’s NYTimes describes one of the under-reported by-products of the opiod crisis effecting New England and the entire nation: child abuse and neglect. The article, by Kathryn Seelye, offers one incident as an example of the impact drug abuse by adults is having on children. The article opens with these paragraphs:

It was a horrific video — a young mother who had overdosed was lying unconscious on the floor of a Family Dollar store in Lawrence, Mass.

Adding a gut-wrenching kick to the scene was that the woman’s 2-year-old daughter, wearing purple footie pajamas, was tugging at her mother’s limp arm, trying to wake her up. The girl was wailing. The mother looked lifeless.

A store employee recorded the scene while waiting for medics. When they arrived, they revived the mother and took her and her daughter to a hospital. The video, which became public two days later, spread across the internet.

Sadly, the police said, the opioid epidemic in New England and elsewhere has reached such proportions that it is no longer a shock to see drug users collapse in public. In Massachusetts, more than four people a day die from drug overdoses.

What is new, they said, is that addicts are increasingly buying drugs, getting high and passing out with their children in tow.

The article goes on to report that Lawrence police estimate that children are present in 10% of the cases involving heroin busts and that it was a risk factor in 7.6% of the child abuse referrals in New Hampshire, up from 4.8% in previous years.

The article doesn’t describe how this plays out in schools… but the adverse affect on the children who are placed in foster care, taken in by friends and relatives of the addicted parent, or who witness their parents nodding off in a drugged stupor are obvious. A child who is taken from his home, no matter how bad the home, is not likely to be as focussed on his or her schoolwork as a child who returns home to an intact family where meals are served at predictable hours and parents are caring and nurturing. And when that child goes to school, the staff at that school will not necessarily know or understand the child’s background and, as a result, may not be able to provide the kinds of physical and emotional support that child needs.

And here’s what I find especially sad: in the face of the drug epidemic schools are measured by test scores and not their efforts to provide help and support to children who suffer the ravages of the opiod crisis or their efforts to provide help and support to children who suffer the ravages of poverty or their efforts to provide help and support to children who suffer the ravages of abuse and neglect by parents. Often the opposite is true. If a child is troubled and attending a charter school they can be removed and increasingly schools using “no excuses” policies expect children to bear the problems inflicted on them in the name of developing “resilience”. Schools need a better understanding of the nature of the problems children bring with them to class, more services to deal with those problems, and a chance to be valued for the help they provide to all children who struggle. Getting higher test scores should be the least of their problems.

NH Taking Steps to Address the Impact of Opioids on the Children of Addicts

April 13, 2016 Leave a comment

Today’s Valley News includes an article by AP writer Holly Ramer describing the ongoing deliberations in the NH House on a bill passed by NH’s Senate that “…would add a parent’s abuse of opioids or a baby’s diagnosis of drug addiction to the state’s definition of child abuse and neglect unless the parent was being treated for addiction.”

The House Committee reviewing this bill wants to eliminate the link between child abuse and addiction on the theory that such a linking would diminish a parent’s willingness to seek treatment for fear they would lose their child.

“The word on the street will be that DCYF will swoop in and take infants from their mothers shortly after birth if they’re not in treatment,” said Rep. Skip Berrien, D-Exeter.

Berrien and other members of the House Children and Family Law Committee on Tuesday recommended an amendment that would leave the definition of child neglect alone, but would give the division more leverage in court to use opioid abuse as evidence of neglect.

Under current law, DCYF can’t take actions such as overseeing supervision of children or placing them in foster care unless it can show actual harm resulting from the drug abuse.

The article later quotes the head of NH’s DCYF who notes that if a parent refuses treatment and insists their children aren’t impacted because the injections or consumption of opioids takes place outside the home their hands are tied. They believe that making the retention of a child’s custody contingent on seeking treatment is a better way to go than forcing the DCYF official to seek proof of “actual harm” to a child.

I wholeheartedly agree with DCYF’s perspective on this for several reasons:

  • A child exposed to a parent using drugs is ipso facto abuse and neglect. A parent who is addicted to opioids has one goal and one goal only: feeding their habit. Even if an opioid addict has the financial wherewithal to feed their child three square meals per day, the effect of opioid addiction is to diminish the attention they can pay to their child and the money going toward the opioids is not providing any well-being whatsoever to the child.
  • NH’s DCYF is underfunded and undermanned and, therefore, incapable of performing the kind of through analysis needed to “prove” that opioid use is creating actual harm. In NH, which stubbornly refuses to raise revenue through income or sales taxes is invariably operating in crisis mode when it comes to budgeting. Consequently their schools are funded inequitably, their social service safety net is tattered, and their physical and personnel infrastructure is deteriorating. Asking DCYF to take on additional work without providing additional staffing would set that agency up for failure, a set up that is already in place given the crushing effects of opioid addiction on child abuse and neglect.
  • Opioid addicts, like all drug addicts and alcoholics, will likely remain in a state of denial unless some kind of high impact shock occurs. It is the rare drug or alcohol abuser who abandons their use through self-awareness and sheer will-power. Most often addicts seek treatment to avoid paying a substantial fine, to avoid a prison sentence, or because they end up in a hospital bed or lose their job because the effects of their addiction. The threat of losing one’s child might serve as the impetus for a parent to seek treatment.
  • Treatment is the ultimate goal of the legislation. By making treatment the ultimate goal in this case, the legislature is effectively accepting the medical model for addiction and spending its scarce resources on restoring its citizens to good health instead of incarcerating them because of their illness.

Having lived in NH for the past 13 years and four years in the mid-1980s I know that if this bill is passed it will be underfunded and very challenging for DCYF, the police, and the courts to implement… and even more daunting for treatment facilities who are unlikely to receive the funds they need to provide the kind of long term treatment and after-care required to address additions. Nevertheless it is important to frame addiction as a disease, to acknowledge its unquestioned impact on children and families, and help those who are suffering from this medical problem. Kudos to the legislature for getting the debate on the correct plane.

 

Meditation, Medication, or Cognitive Behavioral Therapy? The Answer is Clear to Me

February 20, 2016 1 comment

Earlier this week the NYTimes “Well” blog reported on a study that provided scientific evidence that formal training in mindfulness meditation relieved the stress adults experienced as the result of extended unemployment. The study compared two groups of unemployed individuals who had no background in mindfulness meditation: half of the 35 participants “were taught formal mindfulness meditation at a residential retreat center; the rest completed a kind of sham mindfulness meditation that was focused on relaxation and distracting oneself from worries and stress.” The result? All expressed relief from their tensions immediately following their training experiences, but those who received the formal meditation training had a substantial change to the way their brains functioned:

…follow-up brain scans showed differences in only those who underwent mindfulness meditation. There was more activity, or communication, among the portions of their brains that process stress-related reactions and other areas related to focus and calm. Four months later, those who had practiced mindfulness showed much lower levels in their blood of a marker of unhealthy inflammation than the relaxation group, even though few were still meditating.

This gibes with my own personal experience and the experience of many mindfulness practitioners I know. I began engaging in meditation practices nearly a decade ago and since doing so have had the longest stretch of relief from colitis, a stress-related auto-immune condition, in my lifetime. I was initially drawn to mindfulness meditation practice intellectually. Unlike traditional religions, Buddhist practices value direct experience more than mythology. For example, there is no future “heaven and hell” that will result from one’s accumulation of life experiences or spiritual awakening. These “mental formations” are seen as intellectual constructs that divert our attention from the present moment which is invariably precious. Through meditation one learns to be a witness to the thought patterns that govern our habitual behavior and create narratives about our personal experiences… narratives that ultimately delude us. I stayed with the practice because I witnessed how it was favorably effecting my well-being.

As indicated in earlier posts (including this one from two days ago), I am distressed by the reliance on medication to control the behavior of young children and have advocated the use of other interventions like cognitive behavioral therapy. But if this study can be replicated among children and teens— and I see no reason why it would not result in the same findings— it is conceivable that three day mindfulness meditation retreats followed by daily sessions of mindfulness meditation would be far superior to a lifetime of medication and the development of self-discipline through cognitive behavioral therapy.

Alas, even if impartial scientific analysis proved the effectiveness of mindfulness meditation beyond a doubt it would face an uphill battle in our culture. As some school districts have already seen, religiously minded parents and community members see mindfulness meditation as  “religious” training. Religiously minded groups have pushed back against mindfulness meditation and even yoga programs in public schools. There would also be formidable opposition would come from the pharmaceutical industry who benefits mightily from managing the behavior of children and adults. If children and adults attended three day meditation retreats instead of taking ritalin or the array of stress-relieving medications offered to adults the pharmaceutical industry would experience substantial challenges to their bottomline. Finally, the most daunting challenge: our culture’s belief that there is a quick and easy way to relieve suffering… a belief that leads us to accept get-rich-quick schemes, to buy lottery tickets, and to repeatedly seek short-term relief through drugs— prescription drugs or recreational ones. Alas, until one accepts that suffering exists and the end of suffering can only occur through hard work we will continue the cycle of spending countless dollars on worthless medications.