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Posts Tagged ‘Addiction’

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 Leave a comment

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.

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

December 31, 2017 Leave a comment

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 Leave a comment

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 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.