Book Review- Addiction Nation Offers a Path to Those in Need

Tom Houseman Harm Reduction

Addiction Nation opens with a deeply personal story told in visceral detail. It describes  the weeks that author Timothy McMahon King spent in an intensive care unit, suffering from pancreatitis, on the verge of organ failure and death. He describes the agonizing pain he suffered, as well as the only resource that brought him any relief: opioids, specifically fentanyl.

Addiction Nation is my story,” he writes, “but it is our story too.” The subtitle of the book is What the Opioid Crisis Reveals About Us. King is not a journalist, nor is Addiction Nation a PhD thesis. The opioid crisis, and the challenges of treating substance use disorder, have been examined by several authors, from Gabor Maté to Beth Macy to Sam Quinones. King references their writing, as well as the mountain of research done on the spread of opioid use disorder, but his approach is unique.

Instead it is King’s personal experience, and his faith-driven approach to recovery, that power Addiction Nation. King experienced opioid use disorder, describing his addiction to opioids that began with his time in the hospital. He is extremely lucky, and he understands that. “My story is one of early detection,” he explains, “of things that went right. It is a story that should be more common than it is… If everyone had what I had, the opioid crisis would not be what it is today.”

King grew up in a religious household, and he has spent his life pondering and understanding the role that faith plays in his life. Few authors have explored the relationship between faith and addiction as deeply as King, or in a way that is as accessible to a Christian audience. Those who do not share this perspective may find the biblical allegories and quotes off-putting, as if King’s religious background detracts from the seriousness of his writing. But for those who share this worldview, it offers fascinating insight into how people treat both themselves and others.

“Addiction is a kind of faith gone wrong,” King posits. King explains how he was able to come to terms with his own addiction and gain control of it. He needed to reckon with his own shame, fueled by the stigma that addiction was a “moral failing,” a sign of a weak will and a weak mind. Using his own experience as a jumping-off point, he tries to explain how complex addiction is, how universal an experience it is, and how shame and “tough love” are often the worst ways to handle it.

King’s goal is loftier than garnering sympathy for people who use drugs, or pushing policy proposals that will save lives, although he does both. He wants to diagnose all of us, and help us understand how our lives have become steeped in addiction. “The idea of addiction as a disease,” he writes, ‘allowed me to let down my defenses and accept help.”

But he also explores the idea of the so-called Disease Model of addiction and finds it imperfect and lacking. King argues that the opioid crisis, and addiction in general, is “more than a disease.” It is a complex hydra of impulses and emotions, a mobius strip of blame, shame, need, and fear, a vicious, self-reinforcing cycle. In order to defeat it, we must first untangle it and understand it.

The drug addictions plaguing communities, cocaine and meth and heroin, have been exacerbated by politicians who, rather than trying to help people in need, choose to “wage war on our citizens.” These “tough on crime” policies have fed on racial stereotypes of “super predators” and “welfare queens,” but they hid the growing problem of drug addiction surging in affluent white communities as well as poor rural communities.

King believes that addiction “reveals something about our culture, our economy, and our world that is very much considered ‘normal’ but is actually destroying what is human.” Opioids, he explains, “are not the cause of addiction, even though they are addictive.” Instead, addiction is driven by a desire to escape pain. For some that pain is physical, as it was for King, but for others it is emotional, psychological, even spiritual. Poverty, isolation, and hopelessness are all types of pain from which addiction offers a momentary escape at a great cost.

There are no easy answers to the addiction crisis, because King explains that addiction itself is the easy answer. Instead, he promotes the idea of slow, deliberate changes made on both the personal and the systemic level. That is what King means when he writes about faith: that faith in ourselves, each other, and the slow process of growth are the only way to overcome addiction. We must grapple with our own shame and fear in order to promote positivity, rather than condemning addicts out of a misplaced superiority.

“To struggle with control of our own actions is at the heart of what it means to be human.” As the opioid epidemic rages, more and more people either struggle with their own substance use disorders or know and love someone mired in addiction. These are the people for whom Addiction Nation is written: people who are afraid, who don’t know what to do, who know that the old answers won’t work and are looking for new solutions.

For Christian audiences, and people who find strength in their faith, King’s story and perspective are inspiring and enlightening. For  anyone scared or ashamed, the ideas explored in Addiction Nation will help them remember the most important message in overcoming addiction: You are not alone. We are all in this together.

Tom Houseman, Policy Director

4 Things Christians Get Wrong About Addiction (That We Shouldn’t)

Rev. Alexander E. Sharp Guest Pieces

There are a lot of myths about what addiction is and how it functions. Many of these myths are not innocuous misunderstandings but mistakes that shape cultural opinion and public policy in ways that perpetuate unnecessary pain and suffering. 

PEOPLE WHO ARE ADDICTED JUST COMPULSIVELY AND EXCLUSIVELY PURSUE PLEASURE.

On a neurological level this is wrong. Addiction is associated with dopamine system in the brain. Dopamine is often connected with pleasure but it is fundamentally about wanting, not liking. This is clear when addictions deepen and a person continues in their addictive behavior long after they have lost the pleasure it might have once brought them.  

It is also wrong on a theological level. Biola University professor Kent Dunnington argues “Addiction is not concerned primarily with sensible goods (hedonic pleasures) but rather with moral and intellectual goods…” What does this mean?

When you hear the stories of those struggling with addiction, they might note early pleasure. But what drives the addiction is the moral good that they are pursuing. This might be to ease pain, to experience connection, relieve anxiety or experience transcendence. 

In this case, Dunnington continues, addiction can be understood as a kind of misdirected worship. It is a pursuit of the kinds of moral goods that all humans desire but in a way that can not ultimately fulfill. 

RELAPSE IS FAILURE.

Relapse is the norm. It is a normal part of growth, not the enemy. 

Bad ideas of recovery seem to be wrapped up in bad ideas around conversion. If you believe that conversion is a singular moment in a person’s life after which they never make a mistake again, then you are likely to believe something similar about recovery. 

But, if we recognize that we are all people in process and that each of us will have moments that we go back to old patterns and habits, then we can see recovery in a new light. When a person has a setback, they understanding and support, not judgment and isolation. 

When a person feels the pressure that they either need abstain for the rest of their lives entirely or be cut off from all their friends and loved ones, the pressure is often too great. What it motivates is for people to hide their relapses, which can often make them worse. 

“Harm reduction,” is the term often used in the addiction and recovery world. It is philosophy that recognizes that few people change all at once and forever. Harm reduction encourages, “any positive change.” Over time, these positive changes can add up to large ones. And, it ensures that the relationships of support are there when a person is ready to change even more. 

PAIN AND PUNISHMENT WILL SOLVE THE PROBLEM.

One of the fundamental truths of Christianity is that grace and love, not judgment and punishment, are the most transformative forces in the universe. 

Addiction is, by its very definition, self-harming behavior. And addiction damages the parts of the brain that helps us with long-term decision making. Increasing harm and long term consequences for those struggling with addiction doesn’t make sense. In fact, it actively makes addiction worse. 

A study of more than 1,300 injecting drug users in Baltimore from 1988 to 2000 illustrates the point. The researchers wanted to find out what worked or what could predict recovery and examined demographic factors, drug use patterns, and whether the person sought drug treatment. The authors write, “Of great interest is that only a history of incarceration differentiated persons who successfully stopped using drugs from those who continued to use injection drugs over a 12-year period.” 

Part of a successful recovery isn’t so much about the behavior a person stops doing as it is about the new goals they start working to achieve in their life. Having something worth doing that isn’t your addiction is key to overcoming it. Our current criminal justice system takes away people’s motivation and reason for change by limiting their opportunity and hope for a better life. 

DRUGS ARE BAD.

This probably sounds counter-intuitive if not just plain wrong. But this is a lesson I learned from experience. About 10 years ago I had a medical procedure go wrong and experienced incredibly painful complications. It was bad enough that I was admitted into the ICU and when into acute respiratory distress. I was put on heavy doses of narcotics. 

As my doctor’s explained later, my body was under so much stress that if they hadn’t treated the pain, I might have experienced organ failure and died. One of the drugs they put me on was fentanyl, the synthetic opioid now driving overdoses across the country. 

What can be a life saving medicine can also be a deadly poison. 

Going all the way back to Augustine, Christians have had a theology that teaches everything created is good. What we call “sin” or “evil” is really just a disordering of that good. Fentanyl, while dangerous, isn’t inherently evil. It is our relationship to the drug that is good or bad. 

That was what I learned as the months went by and what began as a medically needed dosage developed into an addiction. The drug I was on started doing more harm than good and instead of just giving me control over my pain I was starting to lose control. 

It wasn’t that I simply pursued pleasure but was seeking relief from pain and the anxiety of being near-death in the hospital. When I struggled to abstain and relapsed, it wasn’t abject failure but another opportunity for growth. And it was never judgment, blame or confrontation that helped me along the way. Always empathy, compassion and grace. 

Attacking a particular substance, or the people who use it, misses the point. We can make the most progress by focusing on the demand side of the equation more than the supply side. We need to understand the role an addiction plays in a person’s life and figure out how to help meet those needs. For some people, that could be access to housing or employment. Others might need medically assisted treatment (MAT) or therapies like Motivational Interviewing or Cognitive Behavioral Therapy or connection to relationships and communities of mutual support. 

These lessons aren’t foreign to the Christian tradition but at the heart of it. Sadly, too often Christians have been a part of creating a culture of unrealistic expectations and shame around addiction. Some have focused on simply condemning a substance and those who use it instead of asking what pain, trauma or need might have driven someone to use in the first place. 

We need to change how we talk about addiction and treat those who are struggling with it. Christians should be at the front line of reducing the stigma and shame around addiction, not increasing it. 

This article was posted on the website of Relevant on July 10, 2019.  We are grateful for their permission to use it here.  

Clergy Join Suit to Keep Drug Users Safe

Rev. Alexander E. Sharp Harm Reduction

“Dead People Can’t Recover: Support Overdose Prevention Sites”- Advocates stand in support of Safehouse. (Heather Khalifa/The Philadelphia Inquirer via Courthouse News Service)

In Philadelphia, the city of Brotherly Love, community leaders, service providers, and key public officials have joined together to bring safe injection to their city. At the proposed facility, aptly named “Safehouse,” individuals struggling with addiction could use drugs under medical supervision.  This would be the first such program in the United States.

But on February 6, the U.S. District Attorney in the Eastern District of Pennsylvania sued to keep Safehouse from opening its doors. William McSwain argued that it would violate the Controlled Substance Act, which is intended to ban the operation of “crack houses.”

When Clergy for a New Drug Policy was asked recently to join an amicus brief rejecting efforts to block Safehouse, we couldn’t say “yes” fast enough.  Here is why.

The United States is woefully and shamefully lacking when it comes to supervised injection facilities (SIFs).  Worldwide, there are over 120 in 12 countries, including Australia. As we reported last month, the score in North America is:  Canada 44, U.S. 0.

The arguments on behalf of Safehouse are strong.  Evaluations of SIFs have demonstrated that they: reduce both overdose deaths and infections due to unclean needles; increase access to health care; and provide opportunity for treatment without requiring it.  Nor have there been negative consequences such as an increase in crime or public disorder where facilities are located.

The amicus brief invokes the Religious Freedom Restoration Act of 1993 (RFRA).  It argues that in moving against Safehouse, the U.S. attorney is “substantially impair(ing) the ability of its Christian and Jewish Board Members to practice at least two tenets that they sincerely hold.”  

It raises an interesting and important question:  if you were asked to draft a brief that supported an SIF based on your faith, how would you make the case?  What would you consider to be the religious values at stake? The amicus brief offers two fundamental concepts.

First, all humans are created in the image of God.  We have “a unique and unrivaled status in creation.” (All quotes are from the brief.) This special status lies at the heart of the commandment to love others as ourselves: “all therefore have value and significance and are worthy of others’ time, understanding, and advocacy.” 

Guided by this concept, the brief argues that “In attempting to prevent adherents from providing care to those affected by the opioid crisis, the U.S. Attorney has dehumanized those in need and thus tainted God’s image… (and ) has also put the affected outside the reach of the community…thereby distancing neighbors from each other and God’s love.  The end result demeans the affected and strips them of their dignity, leaving God’s image in tatters.”

Second, the brief asserts the inherent dignity and immeasurable worth of each human being. It argues that “in recognizing the dignity and humanity in all, Jesus announced that everyone, including the poor, the sick, and the sinners, are worthy of salvation and protection.”  It follows that “all humans, even opioid addicts, possess an intrinsic, sacred worth that adherents must honor with respect.”

The drafters of the amicus brief make clear that it draws upon the core tenets of the Judeo-Christian, Islamic, and other traditions.  But in the final analysis, perhaps it does not entirely matter what its supporters call themselves and which faiths are represented.

When Safehouse is finally up and running, it will embody the fundamental injunction that we love our neighbor. To love our neighbor is to know God. In this sense, Safehouse is a religious organization.  This is why it is worthy of our support.

Rev. Alexander E. Sharp, Executive Director

Reckoning with the People Who Sell Illicit Drugs

Tom Houseman Decriminalization

In her superb new book Until We Reckon: Violence, Mass Incarceration, and A Road To Repair, Danielle Sered makes the case that lengthy sentences for violent criminals are misguided. Sered is a pioneer in applying concepts of restorative justice to violent, not just non-violent offenders.

In order to truly end mass incarceration, she argues, we have to focus not just on drastically reducing the sentences of people charged with violent crime, but on creating “a justice system that is not just smaller, but is truly transformed into the vehicle for accountability, safety, and justice that everybody deserves.”

Sered’s arguments are equally applicable to people who sell drugs. In recent years there has been a change in how politicians discuss people with substance use disorders. The narrative has shifted from a criminal justice to a public health issue. If people have an illness, they should not be punished, but instead offered a chance to heal.

Yet this shift has heightened a dichotomy that mirrors the distinction between “non-violent” and “violent” criminals: people who use drugs and people who sell drugs. With one hand legislators and law enforcement offer help to those who use drugs, while with the other they punish those who sell them.

Almost a year ago we wrote about Kristen’s Law, a Rhode Island law (named after a woman who died of a fentanyl overdose) that allows prosecutors to charge dealers who sell heroin laced with fentanyl with first degree murder. Similar laws have recently been passed in Florida, North Carolina, and Connecticut. There has even been talk at the national level of ceding control over fentanyl sentencing to the DEA.

The arguments for long prison sentences generally include punishing the guilty, protecting the public, deterring crime, and helping victims heal from the harm done to them. Yet as Sered explains, our current systems of law enforcement and incarceration are woefully ineffective at producing any of those outcomes.

Long mandatory minimum sentences for both violent and drug selling crimes are shockingly ineffective deterrents. Sered points to studies showing that a swift and consistent punishment is far more effective than a longer punishment handed out inconsistently. This applies particularly to people who sell drugs at the “street level,” usually in small quantities to regular customers. Because they have no hand in the production of these drugs, they usually don’t even know if their drugs contain fentanyl. It is impossible for them to know the likelihood that the person they are selling to will overdose.

Another argument in favor of long punishments is that locking up wrongdoers will reduce drug selling. However, targeting low-level dealers does nothing to reduce supply because they are so easily replaced. Police officers refer to the task of locking up low-level dealers as “playing whack-a-mole” because of how quickly a new dealer will pop up.

Increasing punishments for “causing” a drug overdose death makes drug use less safe. If somebody overdoses, their survival is dependent on how quickly they receive medical care. One tool most states use to increase emergency medical care for people overdosing is “Good Samaritan Laws.” These laws ensure that somebody who calls for medical help in the event of an overdose will not be prosecuted for a drug violation. The hope is that knowing they will be protected by the law will make people more likely to call emergency medical services.

Laws targeting drug sellers will have the opposite effect. Often drug users will share drugs, which could categorize somebody as a “dealer.” Aggressively prosecuting people who sell or provide drugs makes those people less likely to seek medical help in the event of a drug overdose.

If the goals are fewer people selling drugs and fewer drug overdose deaths, there are solutions that we know will be successful. Safe consumption facilities around the world, including several in Canada, help people use drugs safely. In the United States such facilities are illegal, but there are other harm reduction tools that can be provided to drug users. When people have access to Naloxone, an opioid antagonist that reverses the effects of an overdose, they are able to save not just their own lives, but the lives of people around them.

To stop people from selling drugs, Sered believes that “the solution lies in developing more tools, not in eliminating the person we fear.” If people sell drugs to survive, providing economic resources, whether it is education and job training or assisted housing, will create opportunities to financial stability.

Putting people in prison only takes those opportunities away, labeling people as criminals for the rest of their lives. Sered notes one study  found that “those who received a formal label [such as convict or felon] were more likely to recidivate than those who did not.” Locking a person up for as long as possible will accomplish nothing besides destroying that one life as punishment for accidentally being party to another person’s death.

Sadly, there is no way to heal the damage done to somebody who dies of a drug overdose. But the wounds caused by violence go beyond the victim themselves. When somebody dies it impacts their family and their communities. A prison sentence makes it impossible to heal the damage done to a community, by taking away “the very power people should be obligated to use to make things right, thus rendering the possibility of repair nearly impossible.” Instead, it often doubles the harm initially caused. People who sell drugs also have families who rely on them, and children who will grow up with a parent in prison.

We cannot think of prison or the War on Drugs as tools for, in Sered’s words, “managing monsters.” The goal must be, above all, safety, and creating communities and spaces where people can make safe choices. While it may be politically popular to demonize people who sell drugs, or even to argue that they receive the death penalty, these policies destroy lives, including the lives of people they are designed to protect.

Until We Reckon lays bare the contradictions and hypocrisies of these policy and provides a roadmap to undoing their damage. Hopefully, that reckoning will begin soon, and we can find a better, safer path forward.

Tom Houseman, Policy Director

Supervised Consumption Facilities: Canada 44 U.S. 0

Rev. Alexander E. Sharp Uncategorized

A Memorial to Drug Overdose Victims in Toronto 

Both the U.S. and Canada are in the throes of a deadly opioid epidemic. But there is a major difference.  Canada has life-saving sites where individuals are able to consume drugs under medical supervision. The U.S. has none.

Last week, under the auspices of the Chicago Recovery Alliance, I traveled to Toronto as part of a group of service providers, state and county legislators, and law enforcement officials.  It was an extraordinary opportunity to view Canada’s supervised consumption facilities (SCFs) first hand and learn from them.

The sheer number of Canadian facilities is striking. When I visited Insite in Vancouver three years ago, it was still the first and only SCF in North America.  Now 44 have been authorized in Canada. There are nine in Toronto alone.

This did not happen overnight. The election of a liberal federal government in 2015 helped to open the door. Although conservatives gained power in Ontario in 2017 and have raised regulatory barriers and threatened to reduce funding it seems likely that SCFs are in Canada to stay.

On the first day of our visit, we gathered at Moss Park OPS, an overdose prevention service much like a SCF.  Its staff have consulted closely with the surrounding business leaders and residents. They report that “Moss Park OPS has not received any direct complaints from neighbors or the stakeholders.” They add that “Toronto Police have been supportive of the establishment of overdose prevention facilities operating in the Moss Park Neighborhood.”  

According to the Moss Park OPS, there is “long-standing and strong support in Toronto for the establishment of permanent supervised injection/consumption services…In March 2016 more than 50 Toronto community leaders signed a statement calling for the city to establish supervised injection services within existing community health and social service sites.”  

Two of the three facilities the Chicago delegation visited were community health service centers, offering a broad array of services. The space for supervised consumption seemed one part of a continuum of health care responses.  

That said, there is no requirement that those consuming drugs under supervision at an SCF accept other services.  For staff this is perhaps the essence of the harm reduction approach. They treat overdoses and prevent the spreading of disease.  Their approach is consistent with Jesus’ warning, “Judge not lest ye be judged.”

What does this accomplish? During our visit, Thomas Kerr, Professor of Medicine at the University of Columbia, shared data showing that SISs save lives by preventing overdose deaths and they stem the spread of infectious diseases such as hepatitis. They have led neither to increased drug use nor to other crime. “The evidence is indisputable… in Canada there is no serious evidence against these facilities.”

Something else of profound significance is happening as supervised consumption facilities gain traction. Drug use is increasingly being framed as a health rather than a criminal issue.  A service provider we met posed this question: “If someone is in our facility with drugs, we try to help them. If they possess drugs and are sitting on a park bench, they get arrested. How does that make any sense?”

It does not, of course.  That is why the Canadian HIV/AIDS Legal Network has just issued a report in which its most prominent recommendation states, “The federal government should decriminalize activities related to drug use.”

What I learned in Toronto is that supervised consumption facilities save lives, prevent disease, and respect human dignity.  Even without requiring behavioral change, these facilities can be an avenue to treatment. They have broad public support.

When will this happen here?

Rev. Alexander E. Sharp, Executive Director