Hi guys…I’ve missed you. I’ve missed putting up regular posts for the last couple of months and I’ve kept mostly out of the discussions and debates in the comment sections….but scanned them enough to see that you are still in top form. I encourage all readers to take a look at the comments on the last few posts. There are some really valuable views, arguments, and insights being posted.
Anyway, for now, I wanted to wish you all a good year and maybe touch on some current controversies that will affect us in the coming months.
What have I been up to? Mostly editing and proof-reading a couple of articles, updating a talk that I plan to give next Saturday in London on sex addiction, planning a new talk circuit, and zillions of little things that I can’t name or categorize or even remember half the time. Paying backlogged bills, replying to emails buried in my inbox, trying once more to learn Dutch, changing light-bulbs, driving or biking (with) my kids around to various lessons, shopping, etc., and doing a fair bit of psychotherapy. Remember I mentioned that I’m starting a Skype-based counselling/psychotherapy practice for people “in addiction”? Well, it’s happening. I have about six clients so far, and I really like it. Sometimes I feel like I’m good at it, and sometimes I even seem to be helping people, which of course feels great. And relaxing…a bit more than usual…especially over the holidays. That was gooooood.
So what are some topics that should be addressed in this year’s postings? Here are some thoughts:
The “opioid epidemic” in the US. This is obviously a big issue, it’s on the front page half the time. I even get asked by people why I haven’t contributed to the debate yet. Well partly because it’s so complicated, partly because I’m not sure I understand it, and partly because it makes me sad. One avenue of debate involves prescription vs. street drugs. And that divides into two sub-themes, addiction and overdose.
First comes the evidence that most people who end up on heroin started off on prescription painkillers. What does this mean? Does it mean that getting opiates for pain is the cause of long-term addiction and all that goes with it? Not according to Johann Hari, as revisited in his recent op-ed piece. He reminds us (despite a spat of criticism) that by far the majority of people who take prescription meds for pain don’t get addicted. Carl Hart pounds out the same message. So is this just a rehash of the gateway drug idea — remember how they used to blame smoking weed for graduation to hard drugs? Most people ride bikes before they learn to drive cars. Does this mean that bike-riding is a dangerous precursor to auto deaths? Or is it smart for addicts to avoid heroin if they possibly can? How do we extricate the logic from the rhetoric here?
Obviously prescription opioids have to be handled with great care. Yet prescription opioids are often mixed with each other and/or with heroin, by people who want to get high, not pain-free. So how do we balance their risks against the needs of the millions who really need these drugs for pain control?
Which brings us to the overdose epidemic. Which is obviously highly interwined with the above. Although overdose deaths are reported to result from the use of prescription drugs more than from heroin, these deaths have everything to do with mixing drugs, as I’ve reported elsewhere. And this issue has taken on deadly significance now that fentanyl has entered the scene. Stanton Peele has a few things to say about that. With fentanyl so widely available (it’s entirely synthetic, you know), and with doctors getting increasingly tight-fisted (partly due to pressures from regulating bodies), what choice will addicts have other than street drugs (or abstinence)? So is legalization the only other answer? With all the problems that entails? But even without fentanyl…why exactly do people take so much dope? What does it tell us when they’re mixing heroin and methadone? I’ve touched on that one as well.
So those are a few of the headline topics that we can deal with this year. And there are others. With Trump in the US, Duterte in the Phillipines, and Putin in between, getting arrested for using drugs is starting to look more lethal than overdosing. What is going on in terms of the international pendulum swing between draconian repressive approaches and the ever-more-enlightened drug policies of countries (like the UK, Canada, and Australia) where people are stepping away from the “brain disease” model and the nasty habit of throwing addicts in jail? Cannabis will soon be legal throughout both Canada and the US! And it seems they’re finally about to close Tent City — that horrible concentration camp for addicts in sunny Arizona — if they haven’t already. Are things getting better or worse?!
And there’s so much more to talk about. More acceptance of the validity of “controlled drinking,” as we heard about from James Morris a few posts ago. Ongoing turmoil but also some radical new perspectives regarding 12-step approaches and AA. See next post. And sure enough we keep learning more about the addicted brain. In a radio interview with KABC Los Angeles last week, I fell back into this interminable squabble between the brain disease model and my (alternative) no-it’s-not-a-disease-but-yes-it-still-involves-the-brain model of addiction, and all I really wanted to say, by the end of it, was: it’s time for a truce! We’re not listening to each other! Well maybe this year, on this blog, we can find a way to do that.
Please suggest other topics you’d like us to explore. That would be very welcome.
So Happy New Year, welcome back, and let’s hope it’s a good, better, maybe even best year for those of us who care so much about addicts and addiction.