Author Archives: joeschrank

Urine Trouble or Are You?

Urine Testing in Recovery

For many, the metric of success in recovery is the binary urine test. “What was the urine test result?” Is one of the most common question we get from families. It is true, it is an important data point but it isn’t the whole story and maybe it’s not even the most important part of the story. A “clean” test, ironic name that developed given urine is waste, is cause for celebration while a “dirty” test incites anger and feelings of forlorn defeat. So what’s the real value of a urine test? The answer, like almost everything in the recovery world is: it depends.

The first thing to keep in mind is that a urine test is only valid for a very short period of time. Fast acting drugs like adderall or cocaine could easily be out of the body in the gap between tests. So even if a test is clean, it doesn’t mean the individual isn’t or hasn’t used. After many years dealing with urine tests, it’s also important to know that the addiction will pull in individual in to amazing lengths to manipulate a test. At least with the boys. Observing urine tests is one of my least favorite chores of the job but it’s needed if we’re going to get efficacy. Believe it or not I have said on more than one occasion “huh, there seems to be a visine bottle strapped to your ‘situation’, why might that be?”. The idea being, if one fills a visine bottle full of clean urine, one can simulate the act and come up with a clean test. At one point I had a DEA agent work out a deal with a urologist. Urologist would drain DEA agents bladder, replace with clean urine, DEA agent supplied urologist with cocaine. Bartering is a lost art but in this case? Wow, really? So what do they really mean?

Think of sobriety as a pie chart, a urine test is a 20% slice of the pie. We as a culture get very hung up on “total abstinence” which is great but it may take time to get there. A result of “dirty” doesn’t quantify. So in other words, a chronic daily user may have had an episodic use. If they used daily, came into treatment at some level and used once over the last 30 days, in my view, that’s great progress, let’s keep going. The notion of that being “failure” is shaming and shame never helps, not ever. Also, in the mind of those addicted the thought is “if they think I’m using anyway, I might as well”.

The poppy seed bagel defense. At some point, someone googled if poppy seeds could produce a positive result for opiates. The answer is yes– in theory. One would have to eat poppy seeds by the spoonful for hours and hours for that to happen, and yet, we hear “I eat a poppy seed bagel every morning, that must be it” all the time. The issue isn’t poppy seeds the issue is it sets up a cat and mouse dynamic. “You’re using !” “No I’m not” and that goes nowhere. When trying to support someone in regaining their life honesty without anger is key, not always possible but important. If there isn’t a dynamic of safety to self report, very little progress is made. So urine screening is important but what else is?

The greatest indicator of someone doing well in recovery is their actions. When words match actions over time, trust is built. Showing up on time, following through with what was said or agreed upon, new friends and interests, engagement in the community, going back to school are all solid indicators that a urine test just won’t reveal. Sustained recovery is more then using or not using, though not using seems to be the ante. It’s like spring, seeing new growth on barren branches. Lifestyle change is critical or it just won’t work for very long. Plus, urine tests are gross so it’s time we devalue them to being 20% of the pie rather than the whole pie.

America Needs to Rethink Intoxication. America’s Royal Family Could Lead the Way.

Rethinking Intoxication in America

The Kennedy clan has had well-documented travails with demon alcohol. Some members of America’s royal family have even had their destinies redrawn by their use. It could be argued that a drunk driving accident at Chappaquiddick cost the family another Presidency. Perhaps fittingly, then, their long and storied relationship with booze goes back to the very beginning–it was the saloon business that got them started with their unique American experience. To this day, some members of the family are still addled by the stuff, and any conversation about them is riddled with hush-toned tales of the latest escapade, whether it be tragic or merely gossip-worthy.

But not all of them have allowed the family curse to seal their fate. Christopher Kennedy Lawford and his cousin Patrick have taken their family’s commitment to social justice and focused it on furthering the cause of Americans in “recovery” from addiction, a massive group of people still living in shrouded mystery and marginalization. Patrick Kennedy has been a strong supporter of the mental health parity bill, which, in short, would make it mandatory for insurance companies to cover mental health they same way they cover physical health. In other words, insurance companies would no longer be able to feed the myth that many of the conditions that plague man are character-related, and they would have to pay for the treatment of addiction just as they would for diabetes or cancer.

Patrick has taken on the issue of the stigma of addictive disease, and I thank him for that. But I can’t, for the life of me, understand his vehement opposition to legalizing a substance that is safer than the one that not only made his family so wealthy in the first place but which continues to hang around their collective neck like an albatross.

His arguments are weak. For starters, he boldly claims that more people would smoke marijuana if it were legal. I don’t think this is true. The “statistics” might increase, but I think that would be almost entirely attributable to the fact that more people would honestly report that they smoke marijuana. That’s a big difference. But what if a few more people grabbed a joint and took a haul off of it, so what? Intoxication is here to stay, my friends and it is quite simply a government overreach to tell people how they can do it. It’s simply a fact that it would be far better to have a population intoxicated on marijuana than on booze. The data is quite clear in terms of which is better for public safety, for example. When was the last time you saw a bloody bar fight between two people who were stoned on weed?

Kennedy also argues that marijuana isn’t harmless. He’s correct about that–what is harmless? — It is less harmful than other methods of intoxication and it goes on regardless of its legal status. He also worries about marketing toward kids. But that’s not a reason to make people who use it criminals. it’s a reason to have careful regulation of sales and marketing. If Kennedy wants to take on the risks of marketing to kids, why not take on alcohol–where we already see it happening–rather than worry himself silly about what might happen with marijuana. Alcohol is a frequent sponsor of college sporting events. Why does alcohol get a free pass, Patrick?

But the thing that concerns me most about Kennedy’s position is that he and his cousin Chris are among of the very few self-disclosing “sober” members of the American elite. We need them, their voices, their ability to open doors , and their leadership. What we don’t need is pandering to established useless policy that does nothing about the problem of intoxication or the challenges of entering a life of recovery. Of course, if there is one thing a Kennedy likes more than scotch and chasing skirts, it is running for office. Patrick sounds like a candidate–but not a recovery and mental health advocate. What is worse is he sounds like a candidate on the take from the powerful and unscrutinized alcohol lobby hell bent on keeping their monopoly on intoxication. His efforts to keep alcohol as the only legal form of intoxication hurt families, communities, and recovering people. I am a massive fan of the Kennedy clan, particularly of Bobby Kennedy and their tradition of using their prestige for social justice causes. Patrick would do well to read some of his uncle’s writings and give it some sincere thought.

Yea, Man, Got Any Spare Carrots?

Easter has come and gone and with it, the Easter Bunny has some downtime. Who doesn’t love a fluffy bunny? Clearly the DEA has taken their love of the  long eared creature to a level we never imagined with concerns of not just being road kill but genuine concern for their addictive tendencies. No, not to carrots but weed. According to Matt Fairbanks, veteran DEA agent in Utah, among the environmental concerns would be “rabbits develop a taste for it”.  This is a bunny love we haven’t seen before. Why be concerned with ailing cancer patients and racist incarceration rates when the DEA thinks medical marijuana will get  Mr. whiskers getting high? Keep it moving folks, this is a red state, no wasteful government spending here. I wanted to believe this weren’t true that it was a quote out of context but have a listen to the testimony here: http://www.washingtonpost.com/posttv/c/video/49429b26-c11a-11e4-a188-8e4971d37a8d. This man clearly knows what’s best for you and for bunnies.

Wasteful DEA Spending
This is just the kind of red herring drug policy that keeps people sick. Policy to create recession proof government agencies with no defined role or purpose. The DEA is struggling to justify its existence if stoned bunnies are worthy of comment. What isn’t the GOP all over this? Aren’t they opposed to big wasteful government? Could there be more wasteful government that protecting rabbits? Maybe it’s not even protection, maybe the rabbits like it and it doesn’t harm them? Nice work DEA.

Make it Right, Bud Light

Bud Light’s Marketing Campaign

Bud-Light“The perfect beer to remove ‘no’ from your vocabulary” was the tag line on bottles of Bud Light as part of their “up for whatever” campaign. This is the height of irresponsibility in the alcohol industry. It’s patently offensive that the beer, wine and distilled spirits lobbies inject this substance into the culture with low tax and recession resistant impunity. Alcohol companies are notorious for “drink responsibly” messaging, only to counter it with this, showing their true intention.

The CDC estimates 88,000 deaths annually from alcohol and a staggering 2.5 million years of potential life lost by shortening lives due to alcohol use. (Alcohol fact sheet cdc.gov).

Taking Action Against the Beer & Wine Industry

Alcohol is a very dangerous psychoreactive substance with massive consequences and somehow, it never pays the piper. Contrast this with an alternative form of intoxication, marijuana, with a death toll of ZERO annually. It matters that the beer and wine industry facilitate alcohol moving stealthy among us, taking lives and wrecking havoc in families and communities. It matters that we demonize marijuana users and distributors when it is by any measure, safer than alcohol.

Alcohol TaxationFor years we have been told to “designate a driver” an innocuous message and one that may save lives but it presumes that is the only thing wrong with excessive alcohol use is impaired driving. The “designate a driver” culture doesn’t take into account that rates of sexual assault rise with the use of alcohol. Bud Light issued an apology and will stop this ad campaign but you can’t unring a bell. The posturing about safety doesn’t really help the social problems associated with alcohol. Today, Bud Light showed their cards, it’s time to hold alcohol companies accountable for the damage done by the product that makes them rich. The state of Virginia hasn’t seen a tax raise on Alcohol since the 70’s. A .10/100 tax per unit of beer sold in the state would yield $169,000,000 annual revenue. That would mean positioned drop in centers throughout the state and admission for state of the art treatment for the asking. When families struggle to find treatment, yes, insurance companies are scum but we are all complicit in this insanity. Write your congressman and demand a tax raise on beer dedicated for alcohol abuse services. It can be done.

Paradise Lost

Paradise Lost
On a happy note, the young man in this story is over a year sober, has a job, and building a life. It happens.

Insufficient Alcohol Abuse Treatment Options on Maui

It’s no secret why 2.2 million people visit the island of Maui each year: the beauty, the weather, the recreation. That tourism is supported by a residential population of just 163,000, most of whom work in service industry jobs. And it’s not the locals that are consuming what the Maui county liquor authority reports as $250 million in annual liquor sales. The island is awash in millions of drunk visitors. And the problem cases are all supported by a tiny hospital with an ER staff that sees cases of alcohol poisoning daily. They’re so busy that they’re forced to turn away patients who are not stable enough to be out of a hospital setting. It’s a crisis situation, nothing less.

I’m the founder of Williamsburg House, the first sober house in NYC (in Williamsburg) as well as a long-time practitioner of interventions and crisis management. I know my craft, and I know how to talk to ER nurses, paramedics, police, and judges. I thought I was capable of negotiating any system — I operate a residential sober facility in Brooklyn, for God’s sake — but I have never seen anything like I saw in Maui.
Called in May 2015 to help a man in crisis, I arrived in Maui after a 17-hour journey to find my identified patient, and his harried mother and aunt. They told me a tale of bringing their alcoholic 26-year-old son/nephew to this one hospital on Maui at 6am, only to be turned away with no medication and no referral. In my arrogance, I thought, “The calvary is here, step aside ladies. Maybe go to the spa or take a walk on the beach while I get this young man sober.” What I found was a 26 year old man in acute intoxication, the kind of bone-saturating drunk that you’d see in a cartoonish depiction of alcoholism in a black and white movie. He was incoherent, rambling, and clutching a bottle of Captain Morgan. After a few hours of sparring with him I made the call to 911 to get him admitted to the ER for detox. The Maui police showed up, annoyed, and without compassion. “You should have taken him to rehab before this,” said one of the officers. “Be that as it may, ‘surfer dies of alcohol poisoning in rat hole Maui hotel room, after police left annoyed’ sounds like a shitty headline, wouldn’t you say?” I replied with NYC snark that did nothing to help my cause. Nevertheless, the paramedics did eventually take my client to the ER which started a process of discovery about this island paradise.

Seeking Safe Alcohol Detox

The charge nurse told me that she literally cannot care for the high numbers of cases of alcohol poisoning she sees every single day. She refers most of them to a treatment center that provides detox. But the treatment center told me their next available bed was in July. “July?” I asked incredulously. “He’ll be dead by then.” “More then likely” was the matter of fact response laced with frustration and a spoonful of sadness. Alcohol detox is a very dangerous process and can result in death. There are 88,000 deaths annually chalked up to alcohol and the detox is one of the primary causes. While the culture demonizes heroin use, the truth is, a heroin detox won’t kill you, but an alcohol detox will. So why, on an Island with 2.2 million visitors per year and $250 million in annual liquor sales are services to treat the byproduct of all this fun so abysmal?

With the huge number in liquor sales, a safety net would seem not only feasible but a moral imperative. Maui is likely not unique in this problem. While we focus on other drugs of abuse, and well we should, we seem to lose sight of alcohol. We can do better than this. We must do better than this. Alcoholics are not disposable people. We are not a blight on society who deserve substandard care because we “did it to ourselves”. There was a happy outcome in this case. The family was thrilled when six months after these events, the young son came on time, sober, and appropriately dressed for his sister’s wedding. Sadly, that is an all too rare outcome.

Heroin is Terrifying for More Reasons Than You Think

Terrorism
While a jittery Brussels gets back on its feet and the world speculates “who’s next,” the theories are flying about who is to blame and what to do. The right looks to assign blame to a lack of guns and a religion, while the left is scurrying to indict radicalized individuals; but there may be a culprit that stealthy sneaks out the back door: addiction and a voracious appetite for drugs.

Making the Link between Terrorism and Addiction

As Westerners look to insulate themselves from the insatiable demands of modern life, many of us have turned to chemicals, and for some of us that means heroin. The once shadowy mysterious culture around heroin use has found its way to suburban malls. As the tide of gentrification swells in American life, even heroin is becoming as common as a Starbucks or Gap. “Treatment not incarceration” is an embryonic, but growing battle cry but America is still steeped in a “just say no” mentality that is about as effective as “abstinence only” birth control. Seldom, if ever, do Americans look at the ripple effect of what addiction does to other systems: families are destroyed, finances consumed, prisons overflow and yes, terror networks are funded.

Recent estimates from the UN show that Afghanistan produces a staggering 90% of the worlds opium poppies (http://www.unodc.org/documents/crop-monitoring/Afghanistan/Afghan-opium-survey-2014.pdf). That translates into billions of untaxed, unregulated, and untraceable funding for terror networks. Certainly a family in crisis with active addiction in their household has other things to consider than the global implications of the drug trade, so where does the responsibility lie?

Terrorism is an abstract concept, difficult to define and wage war against. Like any effort, it doesn’t work well without funding and the funding is from the drug trade. In all the actions given to ending terrorism, little seems to be done to address the chain of money. The net result? Well funded terror cells and an America dropping 100 bodies daily to overdose. Anyone who has loved someone caught in the tight grip of addiction knows, it’s pretty terrifying. Maybe the terror is more than we think.