Narcotic Detection Dog, Empirical Knowledge Matters

Narcotic Detection Dog

The image of a police dog invokes riot control or something intimidating. When I suggested to my staff that we get a narcotic detection dog for Williamsburg House, they found it “one of Joe’s crazy ideas” and it was, but not without value. The first hurdle was to find an appropriate dog which was actually a matter of grace. Mik, had a career as a narcotic detection dog in Texas until funding dried up and they ended their canine program, leaving Mik in a kennel at the training facility. Without his “working collar” he is a very sweet, very well trained lab, friendly to anyone who offers petting. We weren’t anticipating the added bonus of Mik becoming a house mascot, wildly popular among residents.

Mik is trained to detect any narcotic, from prescription medications to street drugs, he will be able to detect the presence of it. While this can come off as policing, we use Mik’s ability as part of the therapeutic process. We can’t deal with a problem if we are just speculating about the problem. What Mik does is brings all of the questions in self doubts and self deceptions into honesty. Speculating that a loved one may or may not be using is wheel spinning and won’t help move from fact finding into action. When we bring Mik into the field, we can empirically tell someone if there are narcotics in the space. When the doubt is removed, it allows people room to move from speculation into action.

We had received no less than five calls from a worried mom of a young adult. “I just don’t know if he is using again, he says he isn’t.” While the idea of a narcotic detection dog screening took a bit of time for her to process, the result yielded a large amount of heroin in the young man’s room. It was stashed behind an electrical switch plate. Moms snoring in rooms just cannot compete with the nose of a dog. The end result was we were able to help that family get that young man to treatment.

Without the aid of Mik, that family would have been left in worry and wonder. The time that was spent figuring out what was going on could have ended in a lethal dose of heroin. When it comes to battling addiction guessing never pays off. With Mik, we never do.

Is Sex Addiction Real?

We hear much about sex addiction in the modern world. It’s an overused and little understood area of addiction. Make no mistake, humans can develop addictive behaviors that are directed at almost any risk/reward behavior and sex is no exception. Like with many addictions, people get caught in the idea of volume and frequency as the diagnostic indicator but the truth isn’t so much in how much or how often, but in the impairment. Without impairment, there is no diagnosis. With sex as an addictive behavior, context is a large piece of the puzzle and boundaries are very individual. If one’s religion believes sex outside of marriage is wrong, then there is impairment for a single person who engages in sex. This isn’t the case for most people. Taken out of a religious context, sex outside marriage can be seen as a normal, health experience. A newly divorced man’s current sexual activity would be impairing if he were still married. The standard is ever changing and so it is very difficult to diagnose and treat.

Isn’t “sex addiction” just an excuse for cheaters and liars?

As with any addiction there is a massive behavioral element to it. Many, if not all, addicted people can magnify the “disease” concept to their benefit and sex addicts are no exception. That doesn’t mean the illness isn’t real, it is, but it is also something that can be manipulated to the benefit of the individual. Sometimes old people rely too heavily on their walker because it serves them in gaining sympathy and attention. It doesn’t mean they don’t need the walker.

There is help, hope, treatment and success with sex addiction. Like any other addiction, it is highly unlikely it will correct based on a promise. There are many treatment centers that have sex addiction tracts and some that specializes exclusively in the treatment of sexual behaviors. It’s an uncomfortable road for many people to walk and as with any addiction, very hard on the family. Often times, sex addiction is intertwined with other addictions so selecting the best treatment is a critical piece of the puzzle.

You can see more on sex addiction in this interview:

http://galoremag.com/sex-addiction-joe-schrank-rebound-brooklyn-tiger-woods/

Jamie Moyer: Going for the Perfect Game Against Addiction

Jamie Moyer Helps Children Cope with Loss
Jamie Moyer defies logic. In a youth focused game, he was 50 when he pitched an MLB victory. For most professional pitchers, their gift peaks in their late 20’s and an extreme outlier would be in their late 30’s. Now and then, someone will crack 40. Unheard of is 50. Moyer and his wife Karen are deeply committed to service. They have adopted children and given them a home when there weren’t other options. Their concerns for disenfranchised youth extends beyond their own home and into an arena that many never bother to consider. What happens to children who lose a parent to addiction?

Helping Children Cope with Loss Due to Addiction and Overdose

For years I was a therapist in residential rehab and I always felt we didn’t pay enough attention to families, specifically children. SAMHSA reports “6 million American children are living with a parent in need of treatment” (samhsa.gov). That translates into the cycle of addition that is difficult to break. Children steep in alcoholism become alcoholics or marry them, keeping the dance alive and incubating the next generation of substance addled people. Lost even more deeply, are kids who lose a parent to overdose. With 115 deaths daily due to overdose, there are vast numbers of children largely living in shame and secrecy about the demise of their family.

Jamie and Karen Moyer want to change all that. They have a foundation that finds summer camps focused on grief and loss for kids. It’s an oft overlooked issue and major challenge. A few years back, I had the great pleasure of interviewing Jamie Moyer and I am happy to report his foundation is alive and growing. The overdose problem has a ripple effect, one we are ignoring. Well done Moyers, we should all be grateful for you.

https://www.thefix.com/content/jamie-moyer-addition-rockies7345

My Sponsor, the Plumber, Says I Have to Stop Taking Suboxone

Stop Taking Suboxone
Few things kick the hornets nest like a discussion of medication assisted recovery. It’s a stake your claim issue that stirs the pot in the recovery universe like no other. On the purist side are those who say addiction is a spiritual problem and only a spiritual solution can be used to solve it. The other side argues that science has progressed to the point where medication can help people stay sober for longer when they are medicated properly. So who wins? Nobody really but we know who looses, those seeking recovery. The infighting creates an even deeper level of complexity when one is finding their way out of the woods.

12 step programs have a long history in American life. They are largely viewed as a sacred cow institution. Through their history, they have helped millions of individuals, families, and communities improve and rebuild broken lives. There is little question about the potential value of 12 step programs. The issue gets sticky when well meaning people tap into being zealots and evangelicals, closed off to the possibility of other roads to recovery. The issue is further complicated by the deeply held belief that the program itself is infallible. If it isn’t working, there is a flaw in the individual who is attempting to make it work. That doesn’t stand up to any research or science. While nobody really knows, the estimate of 12 step membership is said to be a few million but 20 million Americans report themselves as “in recovery” but little is known about the process they used to get to that destination. Still, many experience 12 step life as cultish, coercive, shame based and intolerable. The truth is, they get to have their own experience. Like evangelical Christians and tea party goers, the belief is “without Jesus, you’re looking at eternal damnation, science notwithstanding.” It sounds a lot like a very common message heard in NA/AA “join us or face jail, institution or death”.

At some point, man figured out how to cultivate intoxicants. Chaos has ensued for some ever since. America has a long history of dealing with the problem. The “Whiskey Rebellion” almost unraveled a new country when George Washington attempted to levy a tax on alcohol to pay down the war debt. It came to gunfire. Prohibition was a nightmare entanglement of violence and crime as well as classism that did little to curb the flow of alcohol. From our very origins the enticement to train farmers to use a musket to fight tyranny was “free beer”. So what has been tried? Prayer is a big one. A problem so deeply saturated in our bones only an act of providence will solve it. Americans love believing God will take care of us because we are always right. We have tried criminalization. So far we have filled prisons while the DEA themselves admits “no meaningful or measurable change in the availability of drugs or drug use on the streets of America”. The “health issue” rhetoric has always circulated in the discourse about drug use but words have seldom matched actions. There is no other health issue that is treated with prayer and incarceration.

Medication Assisted Recovery

Just a few years ago, if one was hopelessly late and stuck in traffic the options weren’t great. Worried people waiting or pull over and find a pay phone. Today, a simple voice activated text will do the trick. Think about dentistry and how much easier and more effective it is now compared to even a decade ago. Even a stripped down economy car has a camera that assists the driver in backing up. So why is addiction still treated with prayer and incarceration? The truth is, it doesn’t have to be. There are more and more medical advancements made that can help people move away from addiction and into recovery and one of the ways is medication. The trouble is the paradoxical need to understand, the solution for some to the drug problem, might be drugs. If not the solution a big leg up in the problem.

Medication assisted recovery is without a doubt a viable intervention for some people. It should be available without shame or hurdles. The idea of withholding all options to drug addled people because of an individually held belief is simply wrong. In my view, it’s malpractice. I have reached a point where the selection of treatment must include centers that will work with medication. Treatment centers “forbidding” medication are obsolete and ineffective. The spirituality argument is a falsehood. Scientific inquiry and discovery are God given gifts and don’t exclude spiritual practice or so say and live the Jesuits and I buy it. If we are on one side of a river and need to get to the other, absolutely pray…but row like hell.

If we truly believe that addiction is a health problem then medication must be considered by the individual seeking help and work out the best plan with their doctor. Medication may or may not be the right path for you but if you have diabetes, another chronic health issue, you wouldn’t just consider prayer or a 12 step program, though peer support may help. Like all chronic health issues, addiction requires change. Change in lifestyle, peers, sleep, diet, and yes, medication. Not examining the possibility of the need for and benefits of medication is wrong. Addiction is complex, tricky, and needs every possible advantage to stabilize the wound. Parents who refuse medication for prayer when they have a sick child are arrested. Don’t make that mistake.

Is AA the Only Way?

Finding Other Alcohol Recovery Options
This is an age old question and certainly depends on who you ask. AA old timers will say “yes, without God and AA, there is no hope”. While that may be true of their anecdotal experience, it certainly isn’t true from a scientific perspective. The truth is, AA doesn’t allow for any kind of scholarly research, that violates the tradition of “primary purpose is to stay sober and help others achieve sobriety” so nobody empirically knows what AA does or doesn’t do. AA has become a cultural sacred cow, a pillar of health, wellness, hope and healing–and it is but only if that is your individual experience with it. For every person who has become a zealot laden member of the converted there are untold numbers of people who AA just didn’t help. The AA literature will label them “unwilling to go to any length”. So what is the real answer? Like many things regarding addiction and recovery, nobody really knows. There are many self ordained gurus who will claim they know but their sample size is usually 1, themselves. Consider the perspective of SAMHSA,(substance abuse and mental health service agency) the largest research body available on the topic of addiction and recovery. Samhsa reports that “more than 20 million Americans identify as being in recovery” (samhsa.gov). AA reports a fraction of that as global membership. So, who are these other people and what was their road?

Somewhere long the way “recovery” and “AA” became synonymous. That’s a falsehood that permeates the entire culture. When I first launched “Thefix.com” I received numerous letters from AA asking me to stop because “it violates the tradition of anonymity”. It took them a while to get their heads around the idea that by writing about addiction and/or recovery, it wasn’t a site about AA, although there may be references to AA with regard to the traditions. The truth is, there is no wrong way to find what works for you as an individual, it may be AA. People find it a great irony that I am both critical of and a proud member of AA. As a system it’s been great for me and tremendously helpful, so is Catholicism but that doesn’t make 700 million Hindus wrong. AA works of it works for you. If it doesn’t, find something that does.

Finding Other Recovery Options

A new era in addiction treatment is offering more diversified options rather than a 30 day AA meeting. Consider the picture in this article, it’s from a era long since past and yet it’s an accurate depiction of modern 12 step life. There are many ways to go, including harm reduction. Total abstinence is one framework for recovery and it may be the best one. Just like losing 50lbs may be the best bet but losing 25 is a great start and inherently valuable in and of itself. If you’re resistant to 12 step programs, abhorred by them or just curious about options, I can certainly help with that. Don’t let “I hate AA” be the thing to keep you from getting solid help and a new life. This story originally from Salon.com offers the perspective from a leader in the 12 step alternative world.

http://www.salon.com/2012/09/03/how_should_we_recover_from_addiction/

Drinko de Mayo

Cinco de Mayo Alcohol Use
If we are to believe Jimmy Kimmel’s man on the street interviews, it’s always astonishing what everyday Americans don’t know about America. Stranger yet, is what Americans don’t know about other countries. Most Americans don’t hold a passport and believe that all parts of the world aspire to be us and can’t believe that much of Europe thinks we’re are badly dressed fat people with excessive TV channels, a total lack of culture, and notoriously racist and violent. Of the 1/3 of Americans who hold a passport, most of those won’t ever use them. We are happy right here near a Walmart, with the safety of guns at our fingertips. So why is Cinco de Mayo so wildly popular? In a word: booze.

While Americans are pretty oblivious to and happy with our ethnocentrism, we also love a good party. Cinco de Mayo has now surpassed St. Patrick’s day in liquor sales. That’s a dubious honor considering the history of the Irish people. Google Cinco de Mayo and the history of it is and what it celebrates is pretty low on the first page, well beneath many recipes for various margaritas. The Americanization of the holiday is just another reason to get drunk, as if a regular old Tuesday wouldn’t do. It looks like we have tequila, tecate, Dos Equis, and Corona to thank for the wildly popular holiday. It’s easy to see what is really important by the sales of items on May, 4. Essentially, avocado and tequila sales spike. Let’s get drunk and have some guacamole to support our neighbors to the south! Well played liquor companies, yet another marketing masterpiece to spike the sales of your damage inducing product. Cinco de Mayo is the Olive Garden of holidays. It’s like a bad taco with ground beef and iceberg lettuce off the .99 menu at any number of Mexican fast food restaurants.

The media is awash with the typical “designate a driver” “use responsibly” and “buzzed driving is drunk driving” rhetoric all of which is a good reminder but is a reminder needed? Is there anyone out there who is defending the act of drinking and driving? What about all the other things that will go wrong tomorrow during the tequila soaked piñata fiesta? Alcohol use sees a rise in many things, among them, sexual assault and no where is this more true then on a college campus.

According to a Kent State study on college campus alcohol abuse, every year 500,000 students will have unprotected sex, more than 100,000 will be too intoxicated to know whether they consented to sexual intercourse and more then 70,000 students will experience alcohol related sexual assault. The reminders not to drink and drive don’t address this problem in any way. Holidays like Cinco de Mayo see a spike in all of the collateral damage with a rise in alcohol use. As a side note, guess who doesn’t pay a cent for all the wreckage? Alcohol companies.

I am often asked, “when is drinking a problem?” “when should I seek treatment?”. Questions of that nature. Holidays like Cinco de Mayo won’t give you the answer but they may provide some insight. Using things like fabricated holidays to rationalize excessive drinking isn’t diagnostic criteria but it may give pause to be honest about how important alcohol is to your life and what problems arise from it. The truth is, most people are better off without intoxication and the numbers don’t lie, alcohol is very dangerous stuff. I like to use this simple test “would I go if they didn’t have a bar”. My answer was always “no”. I’m going because I can get sloppy drunk and hide among all the other people getting sloppy drunk. I like guacamole and all but it’s not the guacamole that would be enough to get me out midweek. From a cultural level, Cinco de Mayo is a made up reason to get drunk. On an individual level, if one is making up reasons to get drunk, give me a call.

Oklahoma, Where Insanity Comes Sweeping Down the Plains

Oklahoma Court Decision Yesterday in a bizarre ruling, an Oklahoma court found forced oral sex with someone too intoxicated to consent, legal. Huh? Can that be possible? “Yes” is the sad and inexplicable answer. The case that produced the ruling involved a 17 year old boy and 16 year old girl. A later hospitalization showed the girl had a blood alcohol content of .34, which could produce death. She was drunk, bone saturated drunk beyond recognition and certainly beyond any ability to consent to anything. There were no reports regarding the boy’s level of intoxication, if any. Rightfully so, there are numerous public outcries from advocacy groups and just about anyone with a a sense of humanity. Think about the message here: pesky courtship and dating rituals, consensual decisions are way too bothersome, all you need is a 12 pack and a passed out date. There are so many issues with this that should be examined and the media is alive with condemning the court’s decision. Much of the attention is focused on the boy. That he was a calculating sexual predator. He might be but there is a massive oversight when discussing the problem and that is the alcohol. Of course the alcohol doesn’t excuse the behavior and certainly doesn’t let anyone off the hook but it’s playing a big role here and we should take a look at it.

Link Between Alcohol Use and Sexual Assault

For years and years we have said “don’t drink and drive” and “designate a driver”. That’s good policy but doesn’t do anything to address the many other things that go wrong when alcohol is poured freely. One of those things is sexual assault. Research is clear on this very simple point: rise in alcohol use, rise in sexual assault. The vast majority of sexual assaults on campuses are when both parties had been drinking. It’s not that the boy who did this isn’t responsible, he is, but alcohol shares in his culpability.

What if there were no drinking involved. Maybe the two teens would have gone to a movie and he would have nervously tried to kiss her. Maybe it wouldn’t have been that wholesome of a scene, who knows. As Americans, our relationship with alcohol is so woven into our lives that we seem to forget to take a look at the role it plays when things go south.

This is an insane ruling in the state of Oklahoma, my sincere hope is there are efforts in place to change this. The alcohol problem has long reaching tentacles and it’s a problem we all share.

Senator “No Grass(ley)” has Plenty of Hypocrisy

For the co-chair of the Senate Caucus on International Narcotics Control, Chuck Grassley has some really antiquated beliefs about Marijuana. In a recent hearing to determine if the justice department is doing their job with enforcing federal marijuana laws in the states, Grassley proclaimed “bad people smoke marijuana”. He is correct, bad people do smoke it, so do good people, fat people, mediocre people, and just about the entire bouquet of humanity. If you’re one to believe research, Marijuana use crosses all demographic lines. The statement made by Grassley shows just how out of touch he is with current trends and research relying on “just say no” culture to inform his leadership in a really important arena. To be fair, the senator is from a different generation and he is a republican from Iowa, so it stands to reason the Marijuana use wouldn’t be his thing but he doesn’t have to use it, he does have a responsibility to govern based on fact, not his opinion or desire for a weed free Iowa.

Chuck Grassley
Here’s where this gets really sticky for Grassley and company. As much as he hates Marijuana, he loves booze, maybe not on a personal level but certainly on a policy level. Emails and calls to the senators press office with the simple question “does the senator drink alcohol?” went unreturned, so I cannot confirm or deny the senators personal habits with intoxicants but we can find out certain things. Iowa, by state law, can not tax alcohol more than 1% (tax.iowa.gov). The last change in taxes on alcohol in the state was in 1986. To put that into context I was drinking at beer parties with Madonna blaring trying to talk to girls in neon mini skirts. Iowa taxes beer .19 cents a gallon. Effectively, all of this means a few things, alcohol gets to preserve its low tax monopoly on legal intoxication and amass wealth while the tax payer gets to clean up the metaphorical broken glass and puke. One thing is for sure, Iowa wants Iowans to be able to get drunk on the cheap. Additionally, it’s worth noting that Iowa grows corn. Lots and lots of corn and corn is critical to distilling many kinds of spirits. Take a step further and Grassley takes contributions from beer, distilled spirits, and wine, not to mention presiding on the agriculture subcommittee (again, think corn).

Alcohol is sloppy stuff. It contributes to violence between partners, families, and communities. Alcohol is cause for many uninsured ER visits, loss of life, and the erosion of family life. Marijuana, while not without risk, doesn’t come with the collateral damage of alcohol. For one, there is no known lethal dose of the stuff. That alone is a vast improvement considering the numbers of people who drink themselves to death, many of them 18-25 years olds. Marijuana is way less likely to produce the damage that alcohol does. The senator’s policy doesn’t allow for choice in the matter and it supports people drinking. What gives, senator? Often times, this type of policy is steeped in the disproven fantasy of a “drug free America”. Americans aren’t going to give up intoxication any more than they are going to give up guns so why not be honest about it and let them choose a safer form? The great hypocrisy of all of this is that often this moral posturing is pontificated at a cocktail party, scotch in hand.

I’m with the senator. I wish people, especially young people with developing minds and bodies would avoid intoxication in any form altogether. Given, that seems as likely as regaining my wash board abs, the question becomes reducing harm and managing risk. Maybe he doesn’t even know it but the message from Grassley to Iowans and any other policy geeks who pay attention is “drink up, kids!” And that, quite simply, is bad policy.

Cunning, Baffling, and Powerful…Even for Moms

Mother's Intuition

It was a mom’s gut intuition. I had to fly to Maui to see my son who I envisioned flailing in desperation due to excessive alcohol consumption. He moved there with the dream of being a dive master, but I felt he was taking a different type of dive.

My cousin joined me and with feet on the ground, we tracked him to a hotel – only to have a security guard have to open the door of the room he was staying. I turned a corner to find my 29 year old son in a precarious situation on the bed with eyes glazed staring at the ceiling. I quietly whispered his name, thinking he was dead, and he blinked. My cousin and I went into flight mode, trying to pick him up off the bed – watching him crawl on the floor – hearing him spout clear jibberish – and we made a phone call to 911.

Police and paramedics showed up and as the former talked a ‘yep just another drunk’ conversation, I caught the eyes of one of latter, a paramedic who clearly understood that was not acceptable to me. While my son could talk surprisingly in the alcoholic state, he did not want help. So, in a compassionate voice, the paramedic said,” buddy let’s go”. And, I climbed into the passenger side of the ambulance with gratitude that the paramedic understood no was not an option.

We paced the hospital ER floor until the head ER doctor called me in and proceeded to tell me if I drank as much as my son, I’d be dead. “Well, this is not about me, so what are you going to do? ” I responded. With crossed arms he told, “nothing” because miraculously my son was talking and he didn’t want help, so it was impossible to help him.

I heard, I’m possible – and that answer is my number one lesson. Never, ever, let a hospital official say they can’t help your child because they are over age and said no. Impossible, I think not!

It was my cousin who said let’s call Joe. On the other side of the country, he got on plane in Brooklyn. I clearly thought he would head to the beach, but he headed to our hotel, where he asked to see my son. Back from the hospital and with a bottle we couldn’t pry from his hands, I had left him in the room to welcome Joe. I opened the door to see him slumped on the couch. Joe looked in, turned and said to me, “you are no longer here.”

Even writing that, I start crying with my heart in my throat as Joe explained he will be the only lifeline. In a hotel room down the hall my cousin and I waited, for days while Joe called paramedics twice more, with an intention to get my son sober enough to get him off the island avoiding seizures and getting some kind of confirmation that he would agree to leave, and get help.

And, my son, who doesn’t even remember I had been in Maui for almost two weeks, still didn’t want help. He was so still under the influence that he thought the hotel assigned Joe as another person in his room. So, it was time to make another decision.

So lesson number two, don’t wait for someone to hit rock bottom – set it up. Excruciating, based on the premise that he has two choices, to live or die – and it is not only him who will do either, but his family and friends as well.

So, with a call to my former husband and friend, I got consensus – to sell my son’s truck, take most of his clothes and leave him with a pair of shorts and a top and flip flops, to take his wallet and only leave his driver’s license and medical insurance card, and leave his phone. Then I went to the front desk and checked him out of his room. He still didn’t know I was there. While getting more sober, Joe was his lifeline. More than excruciating.

With Joe back on a plane to Brooklyn, and it being a total of 13 days, my cousin and I got ready to head to the airport as well. Time for us to go home, such a hard decision.

About two hours before our flight, I got the first call. “Mom, I can’t find my truck.” I told him I was sorry and I loved him, then hung up and cried. About a half hour later, I got the second call, “Mom, I had to check out of the hotel and can’t find another to stay at and I don’t have my wallet.” I told him he might want to find a shelter before it got dark. I told him I loved him, then hug up and cried some more. About another half hour later, I got the third call, “Mom, I don’t know what to do.”

I suggested he look at his phone – there were two numbers to call. One to dear friends of ours (that I was with at that exact time) who would pick him up off the streets and bring him to the airport, and the other Joe, to meet him in Brooklyn at the sober living home. A minute later, my friend’s phone rang, and it was my son, ready to be picked up off the streets in Maui and head to Brooklyn.

Of course, I wanted to run to him, to hold him, to tell him life is worth living, but I had to let go of that lifeline. And because I did, he is alive.

My son is alive because of excruciating decisions validated by the depth of wisdom of Joe, the steadfast love of my cousin, the loyal support of our Maui friends, the incomparable belief of our family…and my son making the choice not only for him to live, but all of us to live.

He’s coming to visit for Mother’s Day…and I am sobbing with joy as I write that. There were a few other people that were steadfast realistic in this journey, and I thank them profoundly. They know who they are.

It is possible; don’t accept ‘we can’t help because he/she doesn’t want help’ – and you might have set up rock bottom – because our kids are always our kids and sometimes through life they need our help, even when they don’t want it.

A lifeline, Joe saved yet another life.

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.