In fact, I don’t identify as being “in recovery” at all, even though I could qualify. I have experienced substance use disorder (SUD)—alcohol, to be specific. These days, having had periods of both abstinence and moderation, I’ve learned how to avoid drinking problematically or chaotically.

But my relationship with alcohol does not define who I am. It’s not how I choose to present myself to other people. I don’t even particularly like to talk about it, though I’ve written on the topic because it matters to me, so I tend to get dragged into conversations. On a day-to-day basis, I’m focused on moving forward with my life—not on my reaction to a distressing period of it.

I absolutely respect the right of people who wish to identify as in recovery to do so. But I want to explain why I don’t wish to—and why I think National Recovery Month may set back the cause of harm reduction.

First, it always risks being exclusionary and reductive. “Recovery,” at least in the United States, has almost always meant abstinent recovery in a 12-step program. Many people and organizations in the harm reduction movement have laudably worked to rescue the term—broadening it to include various pathways, including non-abstinence, and people’s self-definitions. But sadly, 12-step based abstinence is still what “recovery” means to most.

Most of us are just moving on—and perceptions that we can never really do so are stigmatizing.

So if you say you are in recovery, people around you will often make certain assumptions.

That you are, or should be, abstinent from all consciousness-altering substances (except nicotine, caffeine and prescription drugs that they approve of).

That you have been, or are, in some kind of “treatment.”

And that there’s something permanently wrong with you.

Let’s spend a moment on that last one. American culture has so internalized the 12-step vision of “Once an alcoholic/addict, always an alcoholic/addict,” that the stereotype of a person who may seem nice, but will turn into a raging monster if they come into contact with even one drop of alcohol, is still pervasive (flashback to the time my stepmother, trying to help, warned me that there might be alcohol in the tiramisu).

But most of us who have previously experienced SUD are not forever teetering on the brink like this. Most of us do not dedicate large portions of our lives to ongoing recovery “work.” Most of us, in fact, are just moving on—and perceptions that we can never really do so are stigmatizing, more subtly but just as definitely as words like “alcoholic” or “addict.”

Common terms perpetuate this. For example, the inherent suggestion of “in recovery”—rather than, say, “recovered”—is of an ongoing condition. The phrase “active addiction” similarly implies that addiction persists whether or not your patterns of use continue.

The related tragedy is that people’s internalization of the disease-model, “always an addict” perspective can become self-fulfilling, as research has shown.

This assumption harmfully feeds into the narrative that rehab “fixes” people and is the right thing to do.

Stepping back to the treatment point, mentioning your recovery will routinely lead people to assume that treatment of some kind, likely residential rehab, has been part of your journey. In my case—disastrously so—it has. But I’m in the minority.

This assumption harmfully feeds into the narrative that rehab “fixes” people and is the right thing to do, when traditional 12-step rehabs aren’t demonstrated to be effective.

“The last study done on the effectiveness of ‘substance abuse’ treatment which included an untreated control group was published by the Brandsma group in 1980,” Kenneth Anderson, a harm reduction colleague of mine who authored of How to Change Your Drinking and a comprehensive series on the history of US addiction treatment, told Filter. “At one-year follow up, the group who were not treated at all were doing just as well as those who underwent treatment … we know that most people who go to rehab do not sustain abstinence, and are not taught the skills of harm reduction or moderate drinking.”

The most recent iteration of the National Survey of Substance Abuse Treatment Services was conducted in 2020. Of 16,066 facilities of all kinds included, 10,517 (65.5 percent) reported using 12-step facilitation as a primary treatment modality. Of 2,427 non-hospital short-term residential rehabs, 90 percent reported using 12-step facilitation.

Natural recovery is the process by which the majority of people with SUD recover as they get older, with no treatment or program involvement.

“When someone has a substance use issue, the knee-jerk reaction is, ‘Go to rehab,’” Anne Fletcher, author of Inside Rehab: the Surprising Truth about Addiction Treatment and How to Get Help That Works, told Filter. “Traditional 12-step rehabs are one-size-fits-all, meaning most of the treatment is group treatment, and there is very little individual counseling. The truth is that most people who recover don’t go to rehab.”   

This reflects the key reality that the rehab narrative ignores: Natural recovery, also known as “aging out” of addiction, is the process by which the majority of people with SUD recover as they get older, with no treatment or program involvement.

The continued suppression of this proven good news is baffling—until you consider the treatment industry’s profit motives, and drug warriors’ vested interests in demonizing drugs.

Then there’s abstinence. Many people who have experienced SUD practice it, and that’s great for those of us who find it works best. But most don’t—not from all drugs at all times.

Acknowledging this can strike some people to whom abstinence is personally important as threatening, in my experience. But it’s absolutely vital that we do acknowledge it—first because failure to do so stigmatizes drugs and people who use them, and second because we otherwise exclude the majority of experiences from the recovery narrative.

Our national fixation with abstinence has deep roots, from Temperance to Alcoholics Anonymous, and it continues to distract and deflect from what should be our overwhelming priority: reducing harms.

The concept of “recovery” draws a sharp dividing line between those who have ever been open about a problem with a substance and the rest of humanity. This is palpably absurd and unhelpful.

On a personal level, publicly identifying as “in recovery,” I have found, can effectively invite anyone you know to police your substance use. Perhaps you had alcohol use disorder but now drink moderately on occasion without problems. Perhaps you had opioid use disorder, but now use cannabis, or buprenorphine, instead of illicit opioids.

Whatever the circumstances, you can bet that unless you’ve spent a lot of time educating them, someone in your life will express concern that you’re not “sober,” and worry that one thing may lead to another. The myth of “gateway” drugs and the specter of “cross addiction” will continue to haunt us, possibly driving us to use in secret.

More broadly, the concept of “recovery” draws a sharp dividing line between those who have ever been open about a problem with a substance and the rest of humanity. This line is palpably absurd and unhelpful.

Substance use issues, as the DSM has begun to acknowledge, exist on a spectrum—not as a binary yes or no. Many cases are borderline and a matter of interpretation, and the quantity of a substance consumed is rightly not considered an adequate determination.

It shouldn’t need saying, but probably does, that many people have been “sober” for years yet are not one bit happier or safer, while many others who reduce or change their use may thrive.

And what about the countless people who experience addictions that somehow aren’t included? Food is an obvious one, with a growing crisis of obesity. And curiously, even though nicotine is a psychoactive drug—and when addiction to combustible tobacco is associated with far more deaths than any other substance—quitting cigarettes is never framed as “recovery.”

People react to life’s stresses in many ways. Some drink too much. Some eat too much. Some take it out on coworkers, spouses or their children. Others practice self-harm. Yet if the problem does not manifest as an issue with certain substances, people rarely identify as “in recovery.” Our use of the term artificially siloes some groups of people from others, in a stigmatizing way—much as US methadone clinics, for example, are separated from the rest of health care.

I have a problem with how SAMHSA privileges one group while ignoring the equally valid, and often better-evidenced, paths taken by many others.

To give SAMHSA some credit, their National Recovery Month messaging this year has some positives. They do, in one tiny blurb underneath “pathways to recovery,” mention natural recovery as a possibility. That means they admit it exists!

They still let you know where they’re really coming from, though. For instance, on their social media “shareable” about their Walk for Recovery, they say, “Recovery begins with the first step!” In what universe is that not a knowing nod to Step One of AA?

Yes, I accept that for certain people on certain recovery journeys, these events and campaigns can be positive and affirming. I just have a problem with how SAMHSA privileges one group while ignoring the equally valid, and often better-evidenced, paths taken by many others.

Of course they can’t help but insist that “peer support” (read: recovery groups) is required. From their social media shareable for Week Four: “Peer support is crucial for people at every stage of their recovery journey. You can find peer-based support groups—online and in person—for people of specific ages and shared experiences. Learn more.”

Some people may find this to be true. Many more of us—at least in the sense of any formal peer program—do not. Remember what you just said about natural recovery, SAMHSA? What about those of us who find it detrimental to spend hour after hour with people talking about substance use problems, even after years of “sobriety?”

And then there’s the insistence on “support” in the form of treatment by those professionals who, even though their track record is abysmal, claim to be necessary. From another shareable: “With the right support, #recovery is possible for every individual facing challenges. This #RecoveryMonth, find health care professionals, programs, or support groups … #RecoveryistheExpectation.”

Beyond the implication here that recovery is not possible without such interventions, these “professionals, programs or support groups,” to me, sound very much like the people who once convinced me that my identity was “alcoholic,” that just one drink would always lead to a binge, and that all of this was my fault and mine alone.

No thanks. Treatment and recovery groups made me worse, not better. And many people I’ve interacted with over the years would say the same.

National Recovery Month messaging has nothing to say, meanwhile, about the direct responsibility of prohibition for many drug-related harms. Indeed, it manages to drive a national drug-related conversation each year that has little to do with harm reduction at all—something that’s hard for me to get my head around in these times.

Instead, it feeds into the drug-war narrative that people who use drugs are diseased, damaged and need “treatment” in order to recover. It obscures harm reduction in the name of certain approved recovery models. As such, it acts as a feeder for a corrupt, ineffective treatment industry. That’s why I want no part of it. 

Image via SAMHSA

The post Why I Won’t Celebrate National Recovery Month appeared first on Filter.

I am not one of those people who believes that everyone’s addiction is rooted in trauma. According to SAMHSA’s 2021 National Survey On Drug Use and Health, only a little under half (44 percent) of people with substance use disorders (SUD) had any kind of co-occurring mental health disorder.

But trauma kicked off my addiction. I did not start drinking to excess until fairly late in life, immediately after a significant traumatic event. Since then, I have spent years searching for a trauma therapy that was both effective and affordable to those of us who can’t drop hundreds in cash on session after session. I personally always found conventional therapy ineffective anyway.

My own first experience, in February this year, was astounding.

Then I discovered accelerated resolution therapy (ART). Developed in 2008 by Laney Rosenzweig, LMFT, ART combines guided horizontal eye movements with a process of using images and sensations to revise emotional memories of  traumatic events.

These specific eye movements, the theory goes, relax the brain so that its limbic, emotional side (the part that rightly tells you to avoid alligators!) can “talk to” the prefrontal cortex, the logical side. (Some think the eye movements’ resemblance to REM patterns in sleep may be significant.)

Once this is accomplished, the idea is that emotional memories can be recoded—enabling you to reimagine the event in a way that is no longer triggering. You remember the facts, but without the overwhelming emotional and physical response.

ART derived from eye-movement desensitization and reprocessing (EMDR), and also borrows from Gestalt, cognitive behavioral therapy (CBT) and brief psychodynamic therapy techniques.

My own first experience with ART, in February this year, was astounding.

I had been vomiting at least three times a day, experiencing panic attacks, and having nightmares and trouble sleeping—classic symptoms of post-traumatic stress disorder (PTSD). Recent events at work had made me recall past traumas, and I was becoming violently ill every day at work.

I felt comfortable sharing my story with my ART therapist, but she did not ask me to go into the kind of detail that traditional therapists do. There was no dwelling on it and certainly no judgment, just facts. Then we got to work.

She asked me to follow her hand with my eyes, making horizontal movements which I found helped me to relax. Then she gradually guided me to imagine the original traumatic situation and to feel the sensations it generated.

I experienced a powerful feeling of tightness in my chest, like someone was pushing on my heart.

We had established in our initial discussion that we were both comfortable with Christian imagery (though this is certainly not necessary, and you could substitute any number of things). So she guided me in imagining angels pushing the pain out.

As we continued to work on these images—both the trauma images and the angels—my therapist creatively reacted to the sensations I described experiencing, helping me to adjust the imagery to address them. We continued with the eye movements throughout.

I began to feel relief from my symptoms. At the end of the session, we went through a closure exercise and I drank a bottle of water.

I felt better already, but what was shocking was what happened the next day at work.

The very activities that had caused violent nausea, vomiting and panic were now possible, I found, without these symptoms. I was suddenly able to get through the day without barfing in work meetings. This was incredible to me. How could it have happened?

Many people might—and with good reason—be skeptical about anecdotal claims of a therapy’s effectiveness. So let’s take a look at some studies.

“Images and sensations cause triggers, so if you erase them, you’ve done your work,” ART creator Laney Rosenzweig told Filter. “That’s why it’s so quick.”

After describing the communication between different sides of the brain that I outlined earlier, she added that this work with “clients’ inner earlier selves” is “simple and effective” because “the client’s brain does all the work.”

Many people might—and with good reason—be skeptical about anecdotal claims of a therapy’s effectiveness from individual patients and practitioners. So let’s take a look at some studies of ART.

A 2012 prospective cohort study involved 80 adult participants, mostly women, with PTSD symptoms. Their traumatic experience was either violence/crime or the loss of a loved one. Of the 79 percent of subjects who initially screened positive for PTSD, after an average of 3.8 ART sessions of ART, 81 percent screened negative two months later. There were no serious adverse events following the therapy, though some minor side effects were reported, such as headaches, lightheadedness and waking in the night.

A nonrandomized 2016 study involved 23 unhoused veterans and 94 veterans living in the community. Participants received an average of four sessions of ART. Researchers found “substantial” reduction in PTSD symptoms and “improved quality of life”—including at six-month followup.

The randomized controlled trial (RCT) is considered the gold standard of scientific research. The only RCT to date on ART was published in 2013. It involved 29 combat veterans who were treated with two-to-five sessions of ART over two weeks. Twenty-eight matched controls (other, similar combat veterans) could choose either two sessions of fitness assessment and planning with a certified health fitness trainer, or two sessions of career assessment and planning with a professional career counselor.

According to an overview paper on ART research: 

“Although the study relied exclusively on self-report measures, subjects in the ART group achieved a 65% PTSD response rate, compared to 13% in the comparison group … and these results remained unchanged 3 months following completion of treatment. Furthermore, the dropout rate among subjects receiving ART was only 6%, which is significantly lower than that seen in traditional evidence-based treatments for PTSD.”

So evidence exists, and is so far very positive—although more high-quality studies are certainly needed, and (as ever) this form of therapy will not be suitable or effective for everyone.

Rosenzweig herself stresses that a certain amount of buy-in from patients is necessary, and I personally doubt that ART would work in the kind of coercive treatment situation so many of us with SUD have experienced. A client needs to be able to hold onto a thought, move their eyes comfortably, and be motivated to do the full ART protocol to feel better about their issue.

Rosenzweig also pointed out that with issues like SUD or eating disorders, cravings or behaviors may persist even if symptoms of trauma are resolved. This may be because those disorders are not entirely trauma-related, or because, she said, there is a “secondary gain,” or a reason for the person to hold onto the behavior. ART may be very helpful for those of us who have suffered trauma and found our substance use became problematic afterward, but nothing is a cure-all.

All of these factors could indicate huge potential for vulnerable populations who may not have the stability in their lives to commit to, or afford, regular therapy.

One advantage of ART that was immediately apparent to me was that I didn’t have to narrate my story for the therapist in granular detail. That’s fantastic news to those of us who find retelling of traumas to be traumatic in and of itself, or who are just sick of telling our stories.

The small number of sessions required is another plus for me. A session that deals with one traumatic event, as I found, can achieve closure by the end of the session. I have so far only undergone one, and have experienced lasting benefits—any further sessions can be weeks or months apart, or whatever you want.

This keeps costs low. It doesn’t strain your schedule like weekly talk therapy. And it doesn’t demand the effort and vulnerability of building a significant relationship with your therapist. You just need the basic level of trust to adhere to the eye movements and guided thought processes.

What’s more, the client does not have to work with the same therapist every time, or even twice. Therapists are trained according to scripts created by Rosenzweig, and simply match that process, though often with creative additional interventions tailored to a client’s needs.

One of the most exciting things to me about ART is that all of these factors could indicate huge potential for vulnerable populations who may not have the stability in their lives to commit to, or afford, regular therapy.

ART could also improve provider satisfaction, because no one likes watching their clients suffer session after session, and because providers are not subjected to vicarious trauma by hearing stories of violence, abuse and loss over and over again. It could reduce “compassion fatigue.”

As for me, I have quite a few more traumatic past experiences that I wish to address. So I’m going to schedule another session of ART as soon as possible. I know from my own experience that this can work.

I don’t pretend to be objective. Neither do I claim this is proven beyond any possible doubt or suitable for everyone. But it has transformed my life. 

I suffered for years with ineffective therapies I could barely afford, tons of medications with intense side effects, substance use disorder and pain, and suffering for myself and my loved ones. So it breaks my heart to reflect that ART has been around since 2008 and I never knew about it until this year.

If you’re suffering and think you might want to try ART, make sure you do your research. Contact a few therapists who offer it. Find someone you feel comfortable with, and whom you can afford (mine charges less than any conventional therapist I know).

I had given up hope. I nearly died, several times, and my friends and family watched as I suffered through ineffective treatment, or none at all. I don’t pretend to be objective. Neither do I claim this is proven beyond any possible doubt or suitable for everyone. But it has transformed my life. 

The post Accelerated Resolution Therapy Was Transformative for My PTSD appeared first on Filter.

That raises the questions of how employers can know, and what protections employees might have if accused. There’s no breathalyzer for cannabis. And although cannabis metabolites can be detected in urine for over a month after consumption, that does nothing to demonstrate impairment in the workplace.

Drug policy reform advocates might well argue that work performance, not drug use, should be the only thing that matters, at least in jobs without physical dangers. Yet many states are grappling with the question of recognizing workplace impairment as they change their laws.

In November 2020, New Jersey voters emphatically chose to legalize cannabis for adult use. And the resulting Cannabis Regulatory, Enforcement Assistance, and Marketplace Modernization Act (CREAMMA) created—likely in response to employers’ fears—the idea of a Workplace Impairment Recognition Expert (WIRE).

This WIRE could be a company employee who’s trained to recognize, supposedly, whether or not a person is impaired by cannabis to the point of being unable to perform their job effectively or safely. It could also be an outside contractor.

New Jersey is the first state to seek to create such a role. But what CREAMMA did not do is spell out the details of the WIRE. How would this person be trained? How would small businesses afford to employ someone in this role? And critically, what safeguards would exist to protect employees from unfair, subjective determinations of impairment?

On September 9, 2022, the New Jersey Cannabis Regulatory Commission (CRC) issued interim guidance regarding its vision of the WIRE. But according to experts interviewed by Filter, this guidance created more confusion than clarity. It did not explain the curriculum for WIRE training, the duration of training, nor any specifics about the role.

As yet, no one in New Jersey can claim to be a WIRE, because these specifics don’t exist in state law. The CRC is empowered to issue legally binding guidelines, but nobody knows when that will happen.

“In the absence of legal guidance, it’s a morass.”

Given the ambiguity in the statute, even once these guidelines are issued, litigation seems inevitable. So it will probably, in the end, be up to the courts—and ultimately, the New Jersey Supreme Court—to interpret what the legislature intended when it created the idea of a WIRE. Achieving clarification is likely to take years.

Professor David M. White, of the Seton Hall University School of Law, has been at the forefront of discussions concerning evolving cannabis law and policy in New Jersey and New York City. In general, “there is a dynamic tension between workplace rights and workplace safety,” he told Filter. However, “In the absence of legal guidance on how to handle [alleged] impairment, it’s a morass.”

A morass that leaves employees vulnerable to unfair treatment.

If I’m an employee in New Jersey who quite legally consumes cannabis, a positive urine test can no longer be the sole basis for refusing to hire me (making pre-employment cannabis testing pointless, experts agree) or for firing or disciplining me. However, my employer can still test me—and can claim that I was fired because I was impaired by cannabis at work. (They would also have to perform a physical observation, though CREAMMA says nothing about the details of this.)

So if I get fired because my employer claims I was impaired by cannabis at work, and I wasn’t, what do I do?

Prof. White said that CREAMMA provides no private right of action, meaning that technically, a person cannot sue an employer under the act. So employees currently have no obvious avenue to seek redress.

Hugh Giordano, director of organizing for the United Food and Commercial Workers Local 360, a union that represents New Jersey workers in sectors including the cannabis industry, told Filter that he advises employees to use common sense. “Don’t show up to work smelling like cannabis. If you consume, be sure to do so off premises. Never bring cannabis onto your employer’s property, not even in your car.”

He further cautioned that if you’re not covered by a union contract, you are an “at-will” employee and can be fired at any time, for any reason. The only real protection is to organize a union.

Giordano told the story of an employee who was accused of coming to work impaired, but was a member of his union and therefore had protection.

“The employee’s urine test came up positive for THC, and he was fired,” Giordano said. “But he had his medical card, he did not smell like cannabis or look impaired. He didn’t have cannabis on his person or in his car. Since he had the union, he was able to file a grievance. We got his job back, with back pay.”

Zanetich called the department and was informed that his offer was rescinded because of the positive test result. He then filed a lawsuit.

One person chose to take this issue to the courts. In 2022, Erick Zanetich applied for a job in the asset protection department of Walmart in New Jersey. He received a job offer, then went for pre-employment drug testing, as required of all Walmart employees. His test came back positive for cannabis. Shortly thereafter, Zanetich received an email from Walmart’s human resources department stating that his job offer had been rescinded.

He called the department and was informed that his offer was rescinded because of the positive test result. Zanetich then filed a lawsuit on behalf of not only himself, but of all those who had been subject to adverse employment action on the basis of testing positive for cannabis. 

Erick Zanetich vs. Walmart Stores East, Inc., d/b/a Walmart, Inc., is currently winding its way through the federal courts. The litigation could foreseeably continue for several years. It could also settle out of court, which would mean that no legal precedent would be set, and the confusion would continue until another case tests the question.

In the meantime, as we wait for legally binding guidance from the CRC, a New Jersey employee fired for cannabis impairment may be better advised, White said, to bring a complaint alleging violation of the New Jersey Conscientious Employee Protection Act (CEPA) or the New Jersey Law Against Discrimination (NJLAD) before the New Jersey Superior Court. Both avenues contain attorney fee-shifting provisions which would benefit prevailing plaintiffs. But until the law is further clarified, prospects for success are unclear.

Potential Chaos for Employers

White also summed up the potential chaos that this issue, including the WIRE question, could cause from a small business owner’s perspective. His hypothetical scenario involves Larry, who owns a landscaping business, a one-member limited liability company (LLC) with three employees.

One day, in White’s scenario, Larry shows up at a house where his employee is working, and the resident says, “I couldn’t help but notice that the guy riding the lawnmower, Steve, seems to be impaired.”

Larry approaches Steve, and observes that his eyes are glassy, he smells of cannabis, and he’s having trouble staying steady. Believing Steve came to work impaired by cannabis, Larry fires him.

But Steve gets a lawyer and plans to sue. And the lawyer will eventually ask Larry, “Who is your WIRE?”

“Larry will say, ‘Who is my what?’” White continued, “because employers have not been educated about any requirements placed on them to prove that an employee is impaired by cannabis if they take adverse employment action.”

“I would bet a princely sum that few Garden State employers, especially those with modest headcounts, are aware of their prospective responsibilities.”

The only piece of guidance the CRC has published is buried on its website: a form called a Reasonable Suspicion Observed Behavior Report. “It bears noting that the form is not cannabis-specific, but rather serves as an exemplar for what employers may ultimately elect to adopt.” White pointed out.

“In addition to completing this or an equivalent form within 24 hours of taking adverse action,” White said, employers “would also be required to have another managerial employee independently complete the same form within 24 hours.”

White noted that the large majority of New Jersey employers—over 250,000 of them, according to the Q3 2022 Department of Labor and Workforce Development census—have under 10 employees. “How many of those,” he asked, “will have a second managerial employee on site at all times to corroborate the employer’s observations of impairment?”

CRC Interim Guidance also suggests that employers include standard operating procedures for cannabis impairment in an employee handbook. “I would bet a princely sum that few Garden State employers, especially those with modest headcounts, are aware of their prospective responsibilities,” White said.

California and the Wider Picture

How are other states handling this? In California, Assembly Bill 2188, which takes effect on January 1, 2024, will make it illegal to discriminate against an employee for off-the-job cannabis use.

Shay Gilmore, a California attorney whose work includes helping cannabis companies navigate legal and regulatory matters, clarified some aspects of the current situation to Filter. He pointed out that possession and use of cannabis on the job, as well as impairment, remain legal causes for termination even under the new law.

But what about the California employee who, after January 2024, uses cannabis legally off the job but is fired because their employer claims they were impaired at work?

“That employee would have a claim under the Fair Employment and Housing Act as amended by AB 2188,” Gilmore replied.

In the absence of evidence of impairment, the employee should have a good chance of winning. But if the employer had, for example, witness testimony or video of the employee appearing impaired, then that, Gilmore said, combined with a positive drug test, would make the employer more likely to prevail.

“Whoever is first to this space will be very influential. The regulations New Jersey puts together will influence California’s approach.”

Gilmore suggested that California employers use the time before AB 2188 takes effect to revise their handbooks, make sure their policies are consistent with the new law, and communicate them clearly to employees. 

Asked whether he thought California would create a WIRE-like role as New Jersey is attempting to do, he replied, “Whoever is first to this space will be very influential. The regulations New Jersey puts together will influence California’s approach, and that influence raises the stakes for the New Jersey regulations to be as good as they possibly can.”

State Supreme Courts typically look to other states when considering cases where there is no existing legal precedent. In the months and years ahead, they will likely be looking to New Jersey as its courts seek to define the WIRE role and related safeguards and employee rights.  

“The New Jersey State Supreme Court is once again positioned to influence national public policy,” Prof. White said. “Time and again, New Jersey’s high court has assumed the vanguard of forging innovative solutions to novel legal challenges. I am confident the justices’ reasoning on cannabis impairment in the workplace will blaze the trail from coast to coast.”

Photograph via PickPik

The post Fired for Cannabis Impairment? What Recourse Do You Have? appeared first on Filter.

Not all of that history was bad. Even ideas as outlandish-sounding as a strychnine “cure” were sometimes developed with a sincere belief in the efficacy of the treatment. Yet greed, and the willingness to disempower and punish people with addictions, have been key drivers of the story. Sound familiar?

Those themes are prominent in Sanitariums, Hospitals and the Belladonna Cure, by Kenneth Anderson. It’s the third volume of his Untold History of Addiction Treatment in America. Filter previously interviewed him about the first two: Strychnine & Gold (2021, in two parts) and From Inebriate Asylums to Narcotics Farms (2022).

Anderson is the founder and executive director of HAMS (Harm Reduction, Abstinence and Moderation Support), a group of 20,000 members worldwide who are changing their drinking through harm reduction methods. He’s also the author of How to Change Your Drinking (2010), and he and I co-authored Better is Better: Stories of Alcohol Harm Reduction (2022).

I caught up with him to ask what he discovered in researching and writing Sanitariums, Hospitals and the Belladonna Cure.

April Wilson Smith: What do you think might most catch people’s attention out of the material in your latest book?

Kenneth Anderson: Your readers might be most interested in the belladonna cure at the Towns Hospital in New York City. The Charles B. Towns Hospital and his belladonna cure became famous because Alcoholics Anonymous founder Bill Wilson had his vision of God while under the influence of the belladonna there. 

What is belladonna?

Belladonna is another name for the deadly nightshade plant. However, some helpful medications still in use today are extracted from belladonna. One of these is scopolamine, a medication for motion sickness. Another is atropine, which is what your eye doctor puts in your eyes to dilate them. In higher doses, such as those used in the “belladonna cure,” it is a hallucinogen.  

So I’m not going to get my eyes dilated and think I see God?

Not quite. It’s all in the dosage.  

“The formula was given with heavy doses of mercury-based cathartics, until the ‘characteristic liquid green stool composed of mucus and bile’ appeared, which Towns said was a sign the patient was cured.”

What’s the story of how the Towns Hospital was founded?

It was founded by Charles B. Towns, who was an insurance salesman from Georgia. Towns was a very successful, high-pressure insurance salesman. He had an eighth-grade education and never studied science or medicine. In 1899, he moved to New York City and went into the stock brokering business. Shortly afterwards, he was convicted of embezzling funds from his clients and given a suspended sentence.

After that Towns disappears until 1905, when he shows up advertising a cure for the “opium habit,” using a secret formula. Towns partnered with a physician named Dr. Mariette McGinnis for a couple of years, operating an opium cure business in New York City. Then, from spring of 1908 to 1909, he moved to China to operate an opium cure business, because he thought he would find many people addicted to opium there. Towns told a lot of tall tales about facing down warlords with his trusty six-gun while in China.

Although later promotional materials state that the Towns Hospital was founded in 1901, there is no evidence that it was in operation prior to a January 29, 1905 ad in the New York Times. At this point the Towns family was sharing an apartment with Dr. McGinnis, and the Towns Cure was operating out of her private office. In late 1905, the Towns Cure moved to 119 West 81st Street; in 1914, it moved to 292-293 Central Park West, which had 50 rooms.

After he got back to the US in 1909, Towns decided he could make more money with his hospital if he made his secret formula public.

How did he do that?

He enlisted the aid of Alexander Lambert, who would later serve as president of the American Medical Association, to help him publish the formula in the Journal of the American Medical Association.

Lambert was an interesting fellow. He favored universal health care and health insurance on the European model, and he’d read a lot of medical articles in French and German. Unfortunately, Lambert was also very gullible and not familiar with the addiction literature in the US. Thus he published Towns’ questionable cure.

The formula was two parts tincture of belladonna leaves, one part fluid extract of prickly ash, and one part fluid extract of henbane. This was given together with heavy doses of mercury-based cathartics for several days, until the “characteristic liquid green stool composed of mucus and bile” appeared, which Towns said was a sign the patient was cured.

What happened next? 

Immediately after the Towns formula was published, a doctor named Jacob Albright came forward to say that he had published that formula in a book in 1900, years before Towns and Lambert published in 1909. There’s nothing new here, Albright said. In fact, Albright admitted that he didn’t invent it either; another doctor gave it to him.

Next, a Dr. George Pettey also objected, writing, “I have been using scopolamine which is extracted from belladonna since 1901 to treat the opium habit and the Towns formula that uses belladonna is inferior because you can’t give exact doses the way you can with the alkaloid extracts that I use.” 

“Bill Wilson went there due to its reputation. Its reputation was not backed up by the evidence, however.”

 

How did Towns say that he got the formula? 

At first Towns claimed that he had invented the cure himself. But later he said that he had bought the formula from a mysterious stranger he later identified as Robert Steele, and that he had spent years painstakingly perfecting it.

This is contradicted by the fact that the final published formula, published in 1909, was nearly identical to the formula published by Albright in 1900. It seems equally likely that Towns got the formula from Dr. McGinnis, but would never admit to being indebted to a woman for anything.

Despite all this, Lambert continued to endorse Towns, and the Towns Hospital continued to be in operation until 1965. Although details are scarce, the hospital appears to have phased out the belladonna cure and switched to more modern methods around 1950. Throughout its history, it specialized solely in addiction treatment.

How did the Towns Hospital get so famous? 

Due to endorsements by people like Lambert, who was not only a president of the AMA but also Teddy Roosevelt’s personal physician, the Towns Hospital became quite respectable among the general populace. Most of the medical world, however, did not respect it and viewed its founder with contempt. But Towns’ high-level endorsements gave it good standing in the eyes of the general public.

So that’s why Bill Wilson went there to detox? Was the Towns Hospital actually effective in curing people’s addiction problems? 

Bill Wilson went there due to its reputation. Its reputation was not backed up by the evidence, however. In 1920, the New York City Commission on Addiction reported a follow up of 200 opiate-addicted patients treated with the Towns cure and found that only 5 percent were abstinent during the intervening 11 years since taking the cure. Moreover, most physicians said that belladonna was contraindicated for alcohol withdrawal.

Eventually the Towns Hospital closed, because by 1965 there were a number of facilities offering free treatment and it couldn’t keep making money.  

“He literally advocated for exterminating people—that ‘these people’ should be put out of their misery.”

What else should we know about Charles B. Towns?

In an article titled “How to Eliminate the Alcoholic as an Insane Problem,” published in the 1917 Proceedings of Sixth Annual Meeting of the Alienists and Neurologists of America, Towns advocated for the creation of death camps for people who resumed use after undergoing his addiction treatment. He called these hypothetical camps “the pound.” He literally advocated for exterminating people in this category—he did not specify how, just suggested the camps, and that “these people” should be put out of their misery.

Towns also helped to draft the 1914 Boylan Act in New York City that criminalized syringes and opiates. It was sometimes known as the Towns-Boylan Act. This was before the federal Harrison Narcotics Tax Act, which took effect in 1915 and effectively outlawed opiates and coca products, and it was something of a model for that national legislation.

The Boylan Act had a mandatory treatment provision and allowed the state to pay for treatment at private treatment centers—such as the one that Towns owned.  

Another character you introduce in the book is Harry Hubbell Kane.  Who was he, and why was he important to the history of addiction treatment?

Harry Hubbell Kane opened the De Quincey Home, which offered addiction cures, in 1881, in Washington Heights, New York City. Kane was very well known as the author of a number of books about opium. These included: The Hypodermic Injection of Morphia (1880), Drugs that Enslave (1881) and Opium Smoking in America and China (1882). The De Quincey Home was named after Thomas De Quincey, author of Confessions of an English Opium Eater (1821). It was not in business for very long, only about two years.

Kane liked to live high. He was involved in horse racing and owned his own race horse. He soon needed another source of cash. After the home closed down, he started selling a patent medicine of his own devising, called “Scotch Oats Essence.”

“Kane was arrested because his business was a scam: His patients had taken the medicine to be analyzed, and found that it contained no radium!”

Soon, this concoction was exposed in the Druggists’ Circular and Chemical Gazette. It was one-third alcohol, and each ounce contained half a grain of morphine. Kane advertised it as “safe for everyone from infants to octogenarians.” He claimed that it cured everything from paralysis to impotence to insanity to the morphine habit. After Scotch Oats Essence was exposed, Kane filed for bankruptcy.

But he then started a business operating a radium cure, which was very popular because in 1903 Marie Curie won the Nobel Prize for her pioneering work in radioactivity, and for a time radium was considered a cure-all. In 1905 Kane was arrested because his business was a scam: His patients had taken the medicine to be analyzed, and found that it contained no radium!

Kane and his business partner, William Henry Hale, pleaded guilty to swindling a patient, John McCallum, out of his life savings. They had told him he was dying of kidney disease, although there was nothing wrong with him. They sold McCallum medication which they said contained extremely expensive radium, but he sent it for analysis, which showed no such thing. Kane was sentenced to four months in prison and Hale to eight—their sentences were lighter because they returned the money.

Kane died in 1906. Hale was last reported as being the personal physician to Francisco “Pancho” Villa, the leading figure in the Mexican Revolution. 

These are fascinating stories. But what do you think they tell us about addiction treatment today?

What they tell us is that nothing has really changed: It’s still a crooked and corrupt business, the same as always.

Photograph of Atropa belladonna (“deadly nightshade”) by GT1976 via Wikimedia Commons/Creative Commons 4.0

The post Belladonna and Bad Actors: The Telling History of Addiction Treatment appeared first on Filter.

These range from housing to banking, food assistance, educational opportunities, immigration status and more. When it comes to employment, while some states have “ban the box” laws, making it illegal to ask on a job application if you’ve been arrested or convicted of a crime, many more do not. The barriers formed can be lifelong—disproportionately in the communities of color that bear the brunt of the drug war.

For cannabis convictions at least, work is under way in many states, in the wake of spreading legalization, to eliminate such discrimination.

New Jersey legalized cannabis in 2021. After that, the state automatically expunged hundreds of thousands of eligible cannabis records. But hundreds of thousands more records were not included in that automatic process. Because of this, and the complications of the legal system, a person with a record will often need someone to fight for them in court.

That’s where Michael Hoffman, Esq., comes in. He’s an attorney dedicated to pursuing expungements of cannabis convictions in New Jersey, having previously served as a municipal public defender in his hometown of Vineland. He’s received accolades for his work, and has created a way to provide his services at no cost to people in need.

“I’ve had clients who’ve been denied a stay in an Airbnb, and had their deposits taken away, when the owner discovered a prior conviction.” 

“Michael is the go-to advocate for those who have borne the disproportionate burden of low-level cannabis convictions in the Garden State,” Professor David M. White, a former defense attorney who serves on the Executive Committee of the New Jersey State Bar Association Cannabis Law Special Committee, told Filter. “No other New Jersey practitioner has done more to right these social justice wrongs.”

I sat down with Hoffman to ask him about his work.

April Wilson Smith: What is expungement?

Michael Hoffman: Expungement is an order by the court that treats a case against someone as though it never occurred. The court essentially places the fact that someone was arrested and all of the information related to conviction into a box. The only people who can see into that box are the courts, the police, the federal government and the person involved. If any of those three entities are asked what’s in the box by anyone else (such as a landlord, employer or credit bureau), they must say nothing, that there’s nothing in the box.

Does that mean that the conviction goes away forever? 

That would be an erasure. An expungement is not an erasure because if the person is arrested in the future, that box can open.

What does having a cannabis conviction that hasn’t been expunged mean practically for an individual?

The psychological scar of having a criminal record stays with someone for their entire life, but the practical effects are like small cuts that you would never expect.

If you have a prior cannabis arrest or conviction, you are disqualified from public housing under federal law. That public housing can include dormitory housing, so if you go to college, you might not be able to live in the dorm.

It can affect your credit because lenders may look up your criminal record, so it may affect your ability to get mortgages, etc. Where it most often raises its head is that landlords will refuse to even consider potential tenants who have a criminal record.

“I’ve considered myself a glorified janitor. I’m cleaning up after the drug war.” 

In New Jersey, as of February 2021, it was made illegal to use a former cannabis conviction to discriminate in banking, housing and employment. If it is substantiated, there are civil and potential criminal penalties for discriminating that way.

The multiple layers of expungement … are tools to completely deal with all of the past wrongs. I have had clients who have been denied a stay in an Airbnb, and had their deposits taken away, when the Airbnb owner discovered a prior conviction. 

How did you get involved in this work? 

I’ve been a practicing attorney for a little over 20 years. I came into the space of doing expungements after having been in municipal court for the better part of those years. I was representing people in minor drug charges and seeing the direct effect of those charges on them.

The ACLU did a study in 2017 of the criminal cases in NJ. They found that with equal levels of cannabis consumption, people of color were 3.45 times more likely to be arrested than white people.

Now that cannabis is legalized, there is still the mess of all of the records of arrests and convictions against hundreds of thousands of people. That mess needs to get cleaned up. I’ve considered myself a glorified janitor. I’m cleaning up after the drug war. 

Can all cannabis-related charges be expunged in New Jersey, or are there some that you can never get off a record?

A minor drug charge that can be expunged would normally be considered  possession of under 50 grams, but it could extend all the way up to possession up to about 5 pounds. If you have a conviction for a first- or second-degree offense, it can never be expunged.

New Jersey actually uses different words based on the weight of material an individual possesses. If it’s over 6 ounces, it’s called marijuana. If it’s under 6 ounces, it’s called cannabis. And if either has less than 0.3 percent THC, it could be classified as hemp.

Why do you think that is?

The terminology is very important to those of us involved in social justice because of the racist history of cannabis enforcement.

Going all the way back to the 1930s and the Marihuana Tax Act, Harry Anslinger, who was the director of the Federal Bureau of Narcotics and could be called the racist father of the drug war, began using the term “marijuana” for cannabis. Anslinger, whose racism is well documented, used the term to make people associate cannabis with people of Hispanic origin. He knew this would resonate with the generation who had been around during Spanish-American War times.   

Why is work like yours needed, when New Jersey has implemented automatic expungements?

Five months after the [legalization] statute was passed, 362,000 cases related to cannabis were automatically expunged. An additional 88,000 cases were automatically dismissed. These were cases that were solely cannabis-related, meaning that there was no other charge involved.

But if you had a cannabis charge at the same time as another charge, even something as minor as a motor vehicle-related charge (like you were speeding), the charge wasn’t deemed eligible for dismissal or automatic expungement.

“I can measure how many people’s lives we’ve changed. As of today, that number is 64.” 

There are so many ways to get two charges at once. For example, if you live in an inner city, almost everywhere you go is within a “Drug Free School Zone,” so being caught with cannabis in that zone would count as two charges. There are so many ways in which the system is rigged against the urban poor.  

How does your work get funded? 

I spent months working on a funding model that would allow me to do this work without charging my clients anything.

The cannabis companies need to show that they are engaged in social equity activities. The companies sponsor me to represent people and file their expungements. An expungement can be measurable proof of social equity [engagement].

I can measure how many people’s lives we’ve changed. As of today, that number is 64. 

What obstacles do you encounter in your work?

Each case is reviewed by a county prosecutor in the county where it occurred. In most circumstances, the county prosecutor has the opportunity to object to the expungement. In some counties, the prosecutor objects to all expungements.

Most of the time, the county prosecutor has a significant amount of time to object. However, if there is nothing else on the person’s record and it’s just a cannabis case, the petition can go straight to the judge for approval. Then the prosecutor has 30 days to make a motion to vacate it.

Usually the prosecutor won’t make that motion, but in some cases, such as if the person had six drug charges and one was heroin, they could.   

“They can now answer the question ‘Have you ever been arrested?’ with ‘No.’”

How can we get more people’s records expunged? 

I think there needs to be more awareness. People need to know that it is possible to get their records expunged, what the process is, and to get help doing it. This is an accomplishable goal.

Articles like this help raise awareness. Expungement clinics, where attorneys set up a time and place for people to pre-register or just come in off the street to file the expungement petition, help. I’ve held expungement clinics everywhere from Jersey City to Atlantic City to Camden to Trenton.  

How do you feel about what you do?

This is the most rewarding work I’ve ever done. I sent out two orders this morning to people, and when they get those they are more thankful than you can imagine. Each has had their life changed. They can now answer the question “Have you ever been arrested?” with “No.”

Top photograph via pxhere/Public Domain. Inset photograph courtesy of Michael Hoffman.

The post “Cleaning Up After the Drug War”—the Work of an Expungement Attorney appeared first on Filter.

I came to know Anderson through HAMS, which I joined in 2016. He absorbed the harm reduction principles on which it’s based after working at syringe programs in Minneapolis and New York City. His own prior journey took him from county detoxes and a “drunk house” in Minnesota to the New School of Social Research, where he earned an MA in psychology.

Anderson’s prolific writing includes dozens of articles setting the record straight about the science of addiction treatment and its failures. His past books include How to Change Your Drinking (2010), a practical guide that’s still widely read today, and Better Is Better: Stories of Alcohol Harm Reduction (2020, which I coauthored), chronicling HAMS members’ success stories.

The march toward locking up and abusing people with addiction was well underway.

But his current focus is the startling and often-troubling history of addiction treatment in the United States—a history with lessons for today. In 2021 I interviewed him for Filter about Strychnine & Gold, the first part of his grand project: The Untold History of Addiction Treatment in the United States. Strychnine & Gold introduced us to proprietary cures, some of which actually worked well and encouraged patients to return to their communities and go on with life.

Anderson’s new volume—From Inebriate Asylums to Narcotics Farms—paints a much less appealing picture. From asylums meant to confine “incurable drunks” for life, to federally funded “narcotics farms” where some residents were tortured, the book sheds light on the deep roots of cruel and dehumanizing treatments.

While some places, such as “inebriate homes,” pioneered a “curing with kindness” model that prefigured modern harm reduction, the march toward locking up and abusing people with addiction was well underway. I asked Anderson to tell me more.

April Wilson Smith: How would you summarize the context and purpose of From Inebriate Asylums to Narcotic Farms?

Kenneth Anderson: As in my first book in this series, we see that the history of American addiction treatment foreshadows the present-day treatment industry. Some of the dominant themes behind today’s rehabs, such as the idea that people who drink in a manner that is socially unacceptable should be locked up, existed long before the Minnesota Model. Tension between the interests of people who suffered from alcohol problems and those who proposed to treat them is nothing new. Despite the lack of evidence for medical necessity or efficacy of confinement for people who use alcohol or “narcotics,” the move toward medicalized imprisonment has continued from 1810 to today.

Where did the idea of “inebriate asylums” come from?

The first mention we see is from Benjamin Rush, who was the surgeon general of the colonial army during the Revolutionary War. In 1810, Rush made a note in his notebooks about something he called “sober house.” He expanded on this in 1812 in his book, Medical Inquiries and Observations Upon the Diseases of the Mind.

Rush recognized moderate drinking as being different from inebriety. He only condemned drunkenness; he did not condemn moderate drinking. But he felt “drunkards” were even more dangerous to the community than “the insane,” and that they should similarly be locked up in asylums. He implies in his articles that the confinement would be indefinite, possibly lifelong.

Later, in the 1830s, Samuel Woodward, the founder of what later became known as the American Psychiatric Association, wrote a series of articles about inebriate asylums. Woodward did not recognize moderate drinking and thought all drinking was equally bad. He also thought there should be lifetime confinement for incurable drunkards (I use this term, and others, anachronistically here, to reflect the terminology of the times). So far, all the discussion of inebriate asylums was theoretical—no steps had been taken to create them.

So when did they become reality?

The first “inebriate homes” appeared in the 1840s. Inebriate homes were very different from asylums. They came out of the Washingtonian Temperance Movement. Unlike the earlier temperance movements, which tried to impose abstinence from above, the Washingtonians were former drinkers who had quit, and wanted to help others do so. They were also working class, unlike other groups, whose members owned the means of production.

Their movement only lasted a few years, although there was a branch in Massachusetts until the 1860s. But its ideas were extremely influential for decades to come. At the early inebriate homes in various US cities, drunkards could come in, get sobered up and get fit to find employment. There was no confinement at the homes—staying there was entirely voluntary.

Most of the inebriate homes established in the 1840s and 1850s lasted only about a year. The exception was the Home for the Fallen, established in 1856 in Boston. It later became the Boston Washingtonian Hospital, and was in operation until 1980.  

When did inebriate asylums appear? 

The first was the one in Binghamton, New York. Incorporated in 1854 and opened by the state in 1864, it was the brainchild of Joseph Edward Turner, MD. It had a capacity of 440 people, but it was always nearly empty. Nobody wanted to go there. People were confined behind bars, so the asylum didn’t get many voluntary patients.

Judges were not committing people to inebriate asylums because they did not want to pack people away for months on end; they basically thought the idea was crazy. They might send people to jail for a few days for drunk and disorderly conduct, but not to asylums for long periods of confinement.

By the late 1870s, there were just 24 residents at the Binghamton inebriate asylum, all of whom were rich drunkards who had reserved rooms to come in to recover from what was then called a “spree.”

There was also a huge amount of political corruption in the system, with politicians using asylums as a cash cow. They would sell products from companies they owned to the asylums, and to the Kings County Inebriates’ Home in Brooklyn, at exorbitant prices.

It failed. No one liked the idea, and New York government would not pass laws mandating confinement.

By 1879, the state government had lost patience with the Binghamton inebriate asylum. The state insane asylums were severely overcrowded, and here was this gigantic building with 24 people in it.  The government decided to turn it into an insane asylum instead.

Other asylums were created, such as Walnut Hill Inebriate Asylum in Connecticut, which lasted two years before it was closed down. The superintendent, Thomas Davidson Crothers, became the de facto leader of the inebriate asylum movement in the United States, and he continued for the rest of his life to try to establish a nationwide chain, which would confine people for life or until they were cured.

It failed. No one liked the idea, and New York government would not pass laws mandating confinement after they saw the abysmal failure in Binghamton. No state ever passed a law to confine incurable inebriates for life. When new inebriate asylums opened, they went out of business in a few years.  

Aside from involuntary confinement itself, were there abuses at the inebriate asylums or homes? 

The Dashaway Home in California was probably the scene of the worst patient abuses. It was founded in 1859 by the Dashaway Temperance Society, whose members pledged to “dash the cup which inebriates away from their lips.” It was in operation until 1898.

The Dashaway Home started out as an inebriate home and did quite well until it started getting government-committed patients near the end of its lifetime. In the 1890s, Dr. Samuel Potter was in charge and it got the nickname “Dr. Potter’s Prison.” As well as an inebriate home, it became a temporary holding facility for people being evaluated for their sanity.

Potter took charge in 1893, and the cases that made the papers were people awaiting their insanity evaluations. The newspapers ran exposés on this “chamber of horrors.”

“She died shortly thereafter from injuries she had received at the home.”

Horrifying quotes include: “Mrs. Bernard Riley had been strapped to a bed for two weeks. When she was finally rescued from the home by her husband, her back was a mass of festering sores, her wrists were raw from the restraints, and her clothing was infested with vermin.”

And: “Mrs. Mary B. Brown was sent to the home because she had been drinking. Her sister stated that ‘She went there a strong woman in good physical condition. She came out in one week a bleeding broken mass of disfigured flesh. She is so horribly hurt and bruised that I could have looked at her for hours without knowing her. Her teeth are knocked out, her hands have been frightfully burned, her ears are torn, and her whole body is one mass of revolting hurts and bruises.’ She died shortly thereafter from injuries she had received at the home.”

The Dashaway staff also stole the money patients brought in with them. Another patient reported, “Dr. Potter came at me with an oath, saying ‘I’ll fix you,’ and with that he grabbed a coarse crash towel and choking me with one hand to make me open my mouth, stuffed the towel with the other hand between my jaws. When I grew black in the face and felt that I was choking to death, Potter released my throat and jerked the towel out of my mouth, pulling out two of my front teeth. Then he struck me with his open hand across the face and on the side of the head cursing me in the profanest language.”

Then there was the gag—a horrible instrument of torture that the Dashaway Home utilized. It consisted of a piece of iron covered with leather, which fitted the mouth up to the palette. 

How did we go from inebriate asylums to narcotic farms? 

Despite the failure of inebriate asylums, the Temperance movement continued to gather the steam that would eventually lead to alcohol Prohibition. And sadly, the idea that people who used substances needed to be confined did not die out.

Eventually the federal government created narcotic farms in Lexington, Kentucky and Fort Worth, Texas. These came into existence because, in the decades following the passage of the Harrison Narcotics Act of 1914, federal prisons became overcrowded with people whose only “crime” was using drugs. In the Kentucky and Texas narcotic farms, people were confined away from other prisoners. 

They were almost the only places people could be treated for opiate addiction with medications, because doctors were being arrested for doing this in other settings.

How were narcotic farms supposed to work?

The plan was similar to the earlier inebriate asylums: Take people with drug addiction, confine them for six months and have them work on a farm, instilling in them the ethic of hard work. Detainees who used opiates were tapered off with morphine, or later methadone, in two weeks or less.

The narcotic farms were in existence from 1934 until 1974. Like the inebriate asylums, they were a dismal failure. But they were almost the only places people were allowed to be treated for opiate addiction with medications, because doctors were being arrested for doing this in other settings.

Did any good come of the narcotic farms?

The Lexington facility conducted considerable and important clinical research. Much that we know about drugs today originates in research from the Lexington Narcotics Farm. They tested marijuana, for example, and found that unlike alcohol or opiates, it had no physical withdrawal syndrome. They also found few ill effects from marijuana use. The Farm was the scene of some of the first clinical trials of LSD in a controlled setting. It was there that they developed a methadone taper to take people off of opiates. They also ran the first trials of naloxone and naltrexone.  

Beyond confinement, were there further abuses at the farms?

After 1969, the Lexington Narcotics Farm instituted therapeutic communities based on Synanon.  Some of the residents formed their own patient-led therapeutic community, called Matrix House, which got totally out of hand. In Matrix House you were awake 18 hours a day, they didn’t give people adequate sleep time, and the patient leadership kept people constantly doing the Synanon program and reading Synanon books.  

Fill us in on what Synanon was. 

Synanon originated therapeutic communities for addiction in the 1950s. They got shut down after their founder put a rattlesnake with its rattles cut off in the mailbox of a lawyer who was suing him. Their basic therapeutic tool was something they called “The Game,” where they would put a person in the center of a circle, and everyone would scream obscenities at them and tell them what a piece of shit they were. During the 1960s and ‘70s, many people doing drug treatment thought this was great and introduced it. In fact, it just gives people PTSD and doesn’t help them in any way. 

So what happened at Matrix House?

A patient named Jon Staten Wildes took control of Matrix House and got absolute control over the lives of the other patients. He liked to subject people to sexual torture. He audiotaped interviews with patients regularly. In one of these interviews, his fellow patient said he was considering suicide. Once Wildes that had on tape, he said to the other patient, “Now I can hang you in the basement anytime and everyone will think it was suicide.”

Eventually the Synanon adherents got ordered off the property and a Grand Jury sent Wildes to prison. The Grand Jury wanted to indict the medical director of the program but were told that there was no law under which he could be charged.

What about hospitals? Were they also involved in treating people who used alcohol and other drugs?

My book also covers public facilities, either government- or city-run. Bellevue Hospital in New York City was the first in the United States to treat alcoholics, as they were termed, for delirium tremens.  Bellevue opened in 1736 as a one-room infirmary located in the public workhouse. They were regularly treating DTs from at least the 1850s on. The typical treatment for delirium tremens during this era was potassium bromide, which was fairly effective, although it has been replaced by better sedatives such as barbiturates and benzodiazepines in today’s pharmacopeia.

The philosophy at Bellevue was “treat ‘em and street ‘em.” As soon as patients were over acute withdrawal, they were released.

We have good records from the 1850s, when the city reorganized the governing structure of Bellevue and began requiring annual reports, although Bellevue was no doubt treating people for DTs before then. The philosophy at Bellevue was “treat ‘em and street ‘em.” As soon as patients were over acute withdrawal, they were released.

Clinical research also took place at Bellevue. It was there that researchers discovered that deficiency of vitamin B1 (thiamine) caused Korsakoff’s syndrome, and that other alcohol-related neurological disorders were caused by a lack of B3 (niacin). Bellevue did a number of clinical trials on addiction treatments in the 1920s and 1930s. They found that Towns-Lambert Cure, also known as the Belladonna Cure, had a 5 percent success rate, with 95 percent either lost to follow-up or resumed drinking or drug use. The Belladonna Cure was used at the Towns Hospital, where AA founder Bill Wilson was treated.

And the Boston Washingtonian Hospital, which had grown out of the Home for the Fallen inebriate home, was the site of 1970s clinical trials of naltrexone (sponsored by NIDA) to treat heroin addiction. They found very few people wanted to take part, as naltrexone kills the high achieved from heroin.  

What are some of the other treatments covered by your book?

It also discusses the ambulatory municipal morphine clinics. Most of these were in operation in 1919 and 1920; a few started before that and a few extended later, but this was their heyday. These were reduction clinics. You came in and you got your dose, but your dose got reduced every day until you were tapered off. They didn’t want to maintain people’s habits.

It seems fairly clear that we have failed to learn from the past and continue to repeat the same mistakes over and over again.

The Jacksonville, Florida clinic that opened in 1912 was actually a morphine maintenance clinic that gave people the dose they needed, and it kept them out of trouble. However, generally these clinics tried to do reduction, even though reduction didn’t work very well because people didn’t want their dose reduced. Most were closed down by the Federal Bureau of Narcotics in 1920, though some lasted until 1924.  

What are some of the lessons we can learn from all this?

It seems fairly clear that we have failed to learn from the past and continue to repeat the same mistakes over and over again. We have effective addiction treatments, such as methadone maintenance, which can reduce overdose mortality rates by 50-75 percent. Yet we make methadone extremely difficult to access and prefer ineffective treatments which involve confining people in rehab facilities or halfway houses instead. Moreover, rehabs and halfway houses lack any proper oversight, and still frequently turn into “chambers of horrors” where residents suffer terrible abuses. 

As the philosopher George Santayana said, “Those who cannot remember the past are condemned to repeat it.”

Image of woodcut illustration of the Binghamton Inebriate Asylum from the book State of New York (1882) via Wikimedia Commons/Public Domain

The post Inebriate Asylums to Narcotic Farms: Addiction Treatment’s Cruel Roots appeared first on Filter.

I know him in part through my own work with HAMS. He brings to his role a unique combination of lived experience—he has worked for syringe programs and successfully used harm reduction to change his own drinking habits—and academic rigor, holding MAs in the psychology of addiction and in linguistics.

Besides harm reduction techniques and support, much of Anderson’s work has concerned stigma and abuses inflicted on people who use drugs or alcohol in the name of treatment—again, he has firsthand experience of this, having gone through addiction treatment programs himself.

In this context, he recently published (in two parts) Strychnine & Gold, the first volume of The Untold History of Addiction Treatment in the United States. I wanted to ask him about the book’s purpose—and how history repeats itself in today’s controversies.

Many of us might assume that the addiction treatments of the past were invariably cruel and dehumanizing. Some were. But Anderson’s book shows that other practitioners had a more enlightened attitude. That casts the abusive and humiliating practices that persist today in an even worse light; more optimistically, it suggests that cruelty against people with addiction doesn’t have to be a permanent part of our culture. 

April Wilson Smith: What is this book about and why did you decide to write it?

Kenneth Anderson: This volume covers the propriety cure institutes, founded by entrepreneurs who sold “cures” for alcohol addiction, that existed roughly between 1890 and 1920. A proprietary cure is essentially a “secret formula.” The methods of these institutes varied but their philosophy was to get people well and send them on to live their lives—unlike either the “inebriate asylums” of the time or today’s 12-step movement.

It is part of a much longer series about the evolution of addiction treatment in the US from its start to the present. I decided to write this because I wanted to look at the economic forces that led the US to evolve its current, extremely bizarre treatment system.

People who use substances are just people. That has too often been forgotten.

For example—since we know that countries like Switzerland give away methadone, allow doctor’s office and pharmacy dosing and have seen an 80 percent drop in overdose deaths—why does the US still have for-profit methadone treatment clinics that often charge people $400-$500 dollars a month, forcing people to travel long distances and stand in long lines instead of giving them free methadone where it’s safe and convenient? Our system has led to a five- or six-fold increase in overdose deaths over the past 20 years, yet it persists.

In the history of addiction treatment, we can see many parallels with today’s ideological battles. For example, the conflict between 12-step treatment that wants lifelong participation and is opposed to any pharmaceutical assistance and harm reduction forces that embrace whatever methods actually work, some of which are pharmaceutical.

People who use substances are just people; some may have a substance-related problem but are not fundamentally different from other people. That has too often been forgotten.

When did these proprietary cures get their start?

The story begins in 1886 when a number of Russian doctors began publishing stories in medical journals that showed that strychnine injections led “chronic inebriates” (people who drank to excess) to spontaneously stop drinking alcohol. These papers were translated into English and widely published in English-language medical journals.

At this time, treatment for alcohol addiction in the US was basically the monopoly of an organization called the American Association for the Study and Cure of Inebriety. This organization was composed of orthodox physicians who totally rejected the concept of any type of pharmaceutical treatment for alcohol addiction.  They believed that inebriates could only be cured by locking them up for years in inebriate asylums. The organization completely ignored this Russian research and did not mention it once in its journal.

People began flocking to Dwight seeking “the Gold Cure.” 

Meanwhile, in Dwight, Illinois, an enterprising railroad doctor (a doctor employed by a railway company) and patent medicine salesman named Leslie E. Keeley read about the Russian strychnine cure and decided to give it a try. Much to his surprise, the strychnine cure seemed extremely successful, and his patients stopped drinking.

Keeley, being a very savvy marketer, never told anyone that his injections contained strychnine or that they came from Russia and had been published in medical journals. Instead, he claimed that his secret ingredient was gold, and that he had spent decades of painstaking research developing “the Gold Cure.”

First, news of this spread by word of mouth, and people began flocking to Dwight seeking “the Gold Cure.”  Then, in February of 1891, Joseph Medill, editor of the Chicago Tribune, began running articles praising the Keeley Gold Cure and giving it national exposure. Within a few months, Keeley was treating nearly 1,000 patients a day with a battalion of doctors.

Can you describe how the Keeley Cure worked?

The Keeley Cure consisted of injections of very small doses of strychnine and atropine (a belladonna alkaloid) four times a day and drinking a teaspoon full of a tonic (of which the main ingredient was extract of red cinchona bark) eight times a day. In the early days the treatment lasted 21 days; later it was extended to 28 days. (I think that rehabs stole “28 days” from Keeley, but that’s just my personal opinion!)

Patients undergoing the treatment were allowed to drink all the alcohol they wished and were free to come and go as they pleased. The only requirement was that they show up on time for their injections. These elements, and the agency they afforded patients, might be seen as compatible with modern harm reduction approaches.

After about three days of treatment, patients developed a total disgust for alcohol and spontaneously stopped drinking.  

To what do we attribute this?

No one really knows. All we have is the empirical data, which was replicated by studies by multiple American doctors, including at the State Inebriate Ward at Rochester, Minnesota. All we know is that after about three days of these injections, patients spontaneously stopped drinking.

It’s difficult to tell what percentage of people stopped drinking permanently; however, it seems clear that a reasonably large percentage did use the treatment as a springboard to lifetime abstinence.

The Keeley Cure was also adopted in the National Old Soldiers’ Homes and for a short period by the US Army. The National Old Soldiers’ Homes were required to keep statistics and were reporting long-term cure rates (meaning total abstinence) of 90 percent.

We are unlikely to get a randomized controlled trial anytime soon.

Another study was done by the Christian Advocate, whose editor had no opinion one way or the other. The editor wanted to know if it was worthwhile to recommend people to the Keeley Cure or not. The Keeley Cure was very controversial because the orthodox doctors were constantly publishing articles in medical journals and the popular press which claimed it was a scam. The Christian Advocate polled clergymen and doctors about people they knew who had taken the Cure. They reported that 50 percent maintained long-term abstinence. Those are our two sources for long-term follow-up.

Needless to say, no one should attempt this method in unregulated settings now. Its apparent efficacy might be worthy of further study, but there’s not really any reason to think that the strychnine cure is better than conditioned taste aversion. We are unlikely to get a randomized controlled trial anytime soon.

Isn’t using strychnine as a medicine a really bizarre idea?

Not really. Nux vomica, seeds which contain strychnine, have been used as a medicine in India since ancient times. Strychnine was isolated from nux vomica in 1818 and was a very commonly used medicine throughout the 19th century and up into the 1920s. Strychnine is a very effective cardiac stimulant. However, by the 1920s, equally effective and far less toxic cardiac stimulants had been discovered, and the use of strychnine as a medicine fell out of style.

This was the time of the Temperance Movement. What did they say about the Keeley Cure? 

The Temperance Movement, already actively lobbying for Prohibition in the 1890s, was very much pro-treatment and endorsed all forms of treatment—including both the traditional forms favored by the American Association for the Study and Cure of Inebriety and proprietary treatments like the Keeley Cure.

Contrary to common belief, the Temperance Movement was not about punishing “drunkards”—it promoted Prohibition (enacted in 1920) as a public health law to stop the sale of alcohol. It did not outlaw consumption and purchase of alcohol, only manufacture and sale. Unfortunately, Prohibition backfired when it was enacted, in similar ways to the later prohibitions of other drugs.

Many people who graduated from various cures for alcohol addiction joined Temperance societies and used them as support groups to stay abstinent. The Temperance Movement was very popular, so you got a lot of social support if you didn’t drink. 

Did the Keeley Cure spread? 

Eventually 126 branches of Keeley Institutes were in operation worldwide, including Great Britain, a Scandinavian branch, Mexico, several in Canada, and elsewhere. Countless imitators also sprang up, some of which were very short-lived. The longer-lasting ones each have a chapter in the book.

What was life like at the various institutes?

The Keeley Institutes did not board patients. The patients all rented rooms in boarding houses. The institutes supplied all the whiskey so they could track how much you drank and did not allow outside liquor. No cigarette smoking was allowed at all, on or off the property, but cigars were allowed up to 15 minutes before your shot. Everyone had to take a bath at least twice a week. No gambling was allowed.

About 95 percent of the clients were men. For women, the doctors went to the women’s residence to give them the injection instead of making them stand in line exposed to public view.

There were no restraints placed on patients socializing, but it was not required. In 1891, several patients got together and decided to form a Keeley Club while they were undergoing treatment. The idea became very popular and soon there were Keeley Clubs in cities all throughout the US, primarily of graduates of the treatment. They supported each other in not drinking and raised funds to send indigent “high-class drunks” to treatment.

There was also a Keeley Club Women’s Auxiliary. It was initially wives of Keeley graduates but rapidly accepted any woman who wanted to help raise money and spread the word. A couple years in, they changed their name to the Women’s Keeley League to broaden their purpose, because they realized that in several places there was a women’s organization but no men’s organization. The Keeley Club membership peaked at 30,000. About half a million people took the Keeley Cure.  

Were there other proprietary cures? 

Keeley’s biggest competitor was the Neal Three-Day Liquor Cure, which paired emetics (medicines that make people vomit) with alcohol to make people throw up and give them an aversion to drinking. People would be given an emetic roughly at the same time as alcohol, so would develop a conditioned response that alcohol would make them throw up. Today we call this conditioned taste aversion.

In the 1940s it was refined into a science by the Shadel Sanitarium in Seattle, Washington, and published in many medical journals. The Neal Cure was founded in 1909 and approximately 80 Neal Institutes were established worldwide.  

Wasn’t the Keeley Cure also conditioned taste aversion?

No. People getting the strychnine injections rarely reported vomiting as a result. The mechanism by which strychnine produced an aversion to alcohol remains unknown.

What happened to the proprietary cures? 

Demand for treatment for alcohol addiction largely disappeared in the second half of the 1910s. This could possibly be attributed to World War I. Drinking—or at least getting drunk—had become very unpopular at this point. There were also a number of state prohibition laws in effect, and treatment demand dried up.

The majority of alcohol addiction treatment cures, both proprietary and orthodox, shut down prior to national alcohol Prohibition. A few managed to survive, and the Keeley Institute at Dwight did not close until 1966.

What about the orthodox treatments of the times you cover? 

The orthodox cures were at state-run inebriate asylums, private hospitals and sanitariums and inebriate homes. This is the subject of volume 2, but as a preview, at the Foxboro State Hospital in Foxboro, Massachusetts, patients were committed for two years. Their therapy consisted of farm labor and gymnastic exercises; religious services were held on Sundays, and about every other week they had an educational lecture on such topics as “The Hawaiian Islands” “Japan and Its People” or “The Earthworm and its Work.” They also gave musical entertainments.  

Were the “inebriate asylums” locked down the way today’s rehabs are? 

At Foxboro, one of the wards was locked. The other was not locked, but people were not free to come and go—they were incarcerated. The open ward was for people they thought would not run away.

If you worked on the farm and did your gymnastic exercises faithfully for six months, you got out on parole. If you stayed abstinent until your two years were up, you were free. If you got drunk again, you got sent back to hospital.

The court system initially sent people to these places for public drunkenness, drunk and disorderly conduct, domestic violence while drunk, etc. This kind of behavior, prior to the existence of inebriate asylums, would have gotten you sent to jail, but for a much shorter period than two years. 

Did the proprietary institutes change public perception of people with drinking problems?  

They convinced a lot of people that addiction was a curable disease. Keeley wrote a book called The Non-Heredity of Inebriety, which proposes many ideas of the modern disease theory. The title is misleading because Keeley believed that there could be genetic predispositions to alcohol addiction, but what he was rejecting is degeneration theory. Degeneration theory was based in Lamarckian evolution and proposed that acquired traits could be inherited, as opposed to Darwinian evolution, which said they’re not.

Keeley said that normal people who have this habit can be cured—they’re not fundamentally morally corrupt.

According to degeneration theory, if someone became a “drunkard,” they would pass down drunkenness to their offspring, who would give birth to “thieves,” “idiots,” etc., which would lead to the end of the line. T. D. Crothers, the de facto leader of the Inebriate Asylum movement, was a believer in degeneration theory.

Keeley said acquired traits were not passed down. He said that normal people who have this habit can be cured—they’re not fundamentally morally corrupt.

Were there any negative long-term health effects of the Keeley Cure? 

The people who ran the inebriate asylums said the Keeley Cure made everyone “insane” and that they ended up in asylums, but at the Soldiers’ Homes, out of 600 people who took the Keeley Cure, only one went to such an institution—the same rate as the general population. There were no actual reported long-term side effects.

Why do you think no one does conditioned taste aversion now? 

They are still doing it at Schick Shadel hospital. There was a big chain in the 1980s of aversion treatment hospitals called Raleigh Hills. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) was run at the time by 12-steppers who hated all non-12-step treatments, so they targeted Raleigh Hills to shut them down in the mid-1980s; unfortunately, the NIAAA caught Raleigh Hills double-dipping from Medicare. This was a scandal reported in the LA Times and other newspapers in 1982.

No doubt 12-step rehabs also double-dipped from Medicare, but they weren’t being targeted from Washington. That was the end of any large-scale aversion treatment in the US—all due to politics, nothing to do with science.  

Detail from a 1909 Keeley Institutes advertisement via Wikimedia Commons/Public Domain

The post Strychnine and Vomit: The Untold Story of Past US Addiction Treatments appeared first on Filter.

I was curled up in a fetal position, in terror, in the emergency department of an urban hospital in northern New Jersey, awaiting news about when—or if—I would be let go.

I had been awakened that April morning in 2014 by repeated pounding on my door. I got out of bed and opened the door to find a crew of EMS workers standing there. They pushed their way in, and said that someone had called saying I might be suicidal.

I assured them I was not suicidal, and asked who had told them that, but they wouldn’t say. Days later, I found out that an ex, on whose voicemail I had left a sad message, had made the call. Little did he know what he was condemning me to.

Despite my assurances, they said they were taking me to the hospital so I could be “checked out.” When I told them I didn’t want to go, they said I could either go willingly or they would strap me down to a stretcher and take me out in front of all of my neighbors.

I said I’d get dressed and go with them.  

When I needed to use the bathroom, they had a female EMS worker go in with me and observe. I was not allowed to take anything with me (including essential medication) as I was rushed out the door.

The hospital was terrifying: the screams, bleeding and unattended to pain of an urban emergency room. I was panicked from my kidnapping and already suffered from severe post-traumatic stress disorder. But I managed to remain polite and cooperative. At no point was I combative. I assured multiple personnel that I was not thinking of hurting myself, and that I just wanted to go home.

My ex had reported that I’d been drinking heavily, and EMS had seen a bottle of wine on my counter. I had been drinking for several days, but had not had a drink since the night before. It was already late morning in the ER, so my blood alcohol level wouldn’t have been high. I was not acting drunk, nor did I feel drunk.  

“If you don’t sign these papers, we will strap you down to this bed until a psychiatrist comes. That will be hours.”

People came in and out. A nursing assistant, the one who advised me to cooperate, was assigned to sit by my bed. My phone was dying but I texted my boss that I was in the hospital. That was the last communication I was allowed with the outside world until the next day.

Eventually, a nurse came in with a clipboard and said I had to sign into the hospital for a four-day alcohol detox. I said I did not want to, that I needed to get some rest and then get back to work.

She said words I will never forget. “If you don’t sign these papers, we will strap you down to this bed until a psychiatrist from [another local medical center] comes to evaluate you and commit you. That will be hours.”

I was not allowed to call my parents, friends, a lawyer, anyone. I was alone and terrified. I signed the papers.

Is threatening me with being restrained in an ER for hours if I don’t sign commitment papers legal? As I later verified, it is not. But they did it anyway. And because I was extremely vulnerable and didn’t know my rights, they got away with it. 

I told the next nurse who came in, a nicer one, that I had a panic disorder and was terrified. She gave me a shot of Ativan. I stayed curled up in the bed, freezing in the cold ER and listening to other patients’ screams, until they wheeled me up to the detox unit. There, they gave me a huge dose of Librium (a benzodiazepine that is used for alcohol detox) and I fell asleep.  

When I woke up, I wanted to contact my parents and my job. But they had taken my phone, and I was not allowed to access it.  

The only option was a public phone right next to the nurses’ station, where anything you said would be overheard. The one number I could remember was my mother’s cell, where eventually I reached her. I found out later that I sounded confused and over-medicated, which I was. I told her I was in the hospital and that they were going to keep me for a few days.  

She was hours away, with no way to quickly come to see me. Knowing that I could be overheard, I didn’t do what I wanted to do, which was say, Mommy, come rescue me! I was following that nursing assistant’s advice to cooperate. I played along, pretended everything was okay.

Nothing was okay. And nothing was okay again for a long, long time. 

How the Hospital Broke the Law

The hospital’s actions violated the federal Department of Health and Human Services Patient’s Bill of Rights on several levels. For example, it states: 

“A hospital must inform each patient, or when appropriate, the patient’s representative (as allowed under State law), of the patient’s rights, in advance of furnishing or discontinuing patient care whenever possible.”

I was given no information about what sort of “care” I would be given. I was not informed, for example, that once I signed the papers, the hospital’s physicians could decide when to discharge me. I was told that I would be discharged automatically after four days, which I found out the next day was a lie. Had the physicians decided to keep me longer—in fact, they did release me at that point—the only escape would have been to be discharged “AMA” (Against Medical Orders). Health insurance typically does not pay for treatment if a patient is discharged AMA. Unless I wanted a ruinous bill, I would have remained a hostage. 

The Patients’ Bill of Rights also states:

“The patient or his or her representative … has the right to make informed decisions regarding his or her care. The patient’s rights include being informed of his or her health status, being involved in care planning and treatment, and being able to request or refuse treatment.”

I had no voice whatsoever. I was given medications without being informed of what they were or consenting to their use, even though I was awake, alert and completely oriented to my environment. I was denied my legally prescribed medications, including psychiatric meds, and not allowed to contact my psychiatrist. I was clearly denied the right to refuse treatment. 

The nurse’s threat was clearly coercive, and clearly illegal.

The Patients’ Bill of Rights states that a patient also “has the right to have a family member or representative of his or her choice and his or her own physician notified promptly of his or her admission to the hospital.”

Because my phone had run out of charge by the time I was forced to sign the papers, and then the staff took it away from me. I was not given the chance to notify a family member or friend. So my mother had no idea where I was, my boss had no way to contact me after one mysterious text that I was in the hospital, and I had no access to local friends who might have helped.  

And the nurse’s threat to have me restrained to the bed until a doctor showed up hours later was clearly coercive, and clearly illegal. The Patients’ Bill of Rights states that a patient “has the right to be free from restraints of any form that are not medically necessary or are used as a means of coercion, discipline, convenience, or retaliation by staff.”

The DHHS sets strict conditions for the use of restraints, which are defined as drugs used to control behavior, as well as physical restraints. These conditions include that restraints should be:

* selected only when other less restrictive measures have been found to be ineffective to protect the patient or others from harm.

* [used] in accordance with the order of a physician or other licensed independent practitioner permitted by the State and hospital to order a restraint.

Neither of these conditions applied to me, and the threat to restrain me “for hours” was also against the law. The DHHS also states:

* The treating physician must be consulted as soon as possible, if the restraint or seclusion is not ordered by the patient’s treating physician.

* A physician or other licensed independent practitioner must see and evaluate the need for restraint or seclusion within 1 hour after the initiation of this intervention.

In addition to the Patients’ Bill of Rights, various states, including New Jersey and New York, have their own laws under which one can sue if restraints are improperly used. Your state may do too. Regardless, federal law puts such strict limits on use of restraints that unless a patient is truly violent, there is never a justification for them.

Why I Didn’t Sue

I knew nothing of my rights at the time, and was already coping with PTSD—brought on by an even more traumatic, earlier incident at a neighboring hospital.  

I had seriously considered fighting back through legal means then. Breaking state and federal laws or regulations represents evidence of a violation of the hospital/practitioner’s duty of care in a malpractice action.

But I had decided, with considerable input from my family, friends, therapist and psychiatrist, that I would be “re-traumatized” by the process and should just try to go on with my life. I applied that conclusion to my illegal forced detox. 

I am still afraid whenever I see EMS. Six years later. 

My attempts to go on with my life were in part successful. I went on to earn a Master of Public Health degree from a prestigious university. I worked in alcohol harm reduction, primarily through HAMS—helping to lead an organization that supports thousands of people worldwide who want to change their drinking according to their own goals.

In retrospect, I wish I had fought. The statute of limitations on filing a lawsuit has long passed, but the fear has not gone away. 

I am still afraid of seeking medical care, and have refused to go to the hospital at times when I probably needed to. I have delayed seeking physical care that has nothing to do with alcohol or mental health, due to my fear of the system.  

And even though I walk around the streets of Philadelphia stone-cold sober, I am still afraid whenever I see EMS. Six years later. 

Not Only Me

I wish my incident was isolated, but in talking with hundreds of people, mostly women, over the last four years in HAMS, I’ve found similar situations.  

One woman told me, “I didn’t give in, but a hospital saw that I had a history of SUD pre-pregnancy and was a single mom on welfare, so they spent my entire labor trying to force me to sign into detox and let them take my baby. Then they tried to discharge me and keep her (a perfectly healthy nine-pound baby) for an extra week for ‘evaluation.’ I knew if I left, they would say I’d abandoned her and not give her back, so I refused to leave. It was horrible.” 

It’s not just the US. A woman from Australia wrote:

“I spent 28 days in an involuntary detox unit. They caught me at 8:15 am. I was sitting on my couch in my pyjamas, just woken up, sober, and contemplating breakfast. I had 20mins to get ready. I had to beg them to wait outside so I could have some dignity whilst showering and dressing. If I had refused, they would have had me arrested. The idiots were so incompetent they gave me my first seizure, cause they messed up the benzo taper (you have to taper off of the strong benzodiazepines they administer in a hospital detox, or else risk seizure) and yes, I have the ED report to prove it. Both my mum and I put in separate official complaints, which probably did nothing, other than hopefully I am on the ‘never to return’ list.”

Protect Yourself

Rights mean nothing if you don’t know about them or don’t have the power to enforce them. Based on my experiences and research (I am not a lawyer), here are some ways you can protect yourself:

* Never be combative or in any way physically resist medical personnel. This gives them an excuse to use restraints.

* Demand to have contact with people who can advocate for you. If possible, have a friend or family member who lives close by ready to show up and advocate for you if you are involuntarily taken to any sort of medical facility. 

* Refuse to sign any consent forms for commitment. It is actually very difficult to forcibly commit someone legally, and it requires proof that the person is a danger to themselves or others. Here is an excellent description of the laws surrounding involuntary commitment in Pennsylvania, for example. Look up your state laws: You may find it comforting to know how difficult it is to get you locked up, in spite of the threats you may hear.  

* If you are threatened, demand to see the facility’s patient advocate. It is that person’s job to speak up for you. Often, simply showing that you know something about how the healthcare system works is enough to back down hospital staff who disregard laws and policies.  

* Have a Psychiatric Advance Directive. The National Alliance on Mental Health Issues (NAMI) defines this as “a legal document that details a person’s preferences for future mental health treatment, services, and supports, or names an individual to make treatment decisions, if the person is in a crisis and unable to make decisions.”  This is especially good to have if you might end up in a hospital unconscious (from an overdose, alcohol poisoning or any other reason). Unfortunately, not all states legally recognize these documents, but whether yours does or not, it is advisable to create one and have it put it in your medical records—and make sure trusted family or friends have copies.

* If you do not trust your next of kin to make medical conditions for you in an emergency, give someone else medical power of attorney. (This only comes into play if you are incapicitated.) 

* And last but never least, have a malpractice attorney’s number memorized, if not tattooed somewhere on your person! 

Even before my most traumatizing experiences, I already knew far too much about what happens to people who use substances once they enter the medical system.  

Too often, the stigmatization we encounter there is so intense that it might as well be a personal vendetta. We lose our power once we enter these spaces. By learning and exercising our rights, we take back as much as we can.

Photograph via Unsplash

The post “We Will Strap You Down”—A Hospital Illegally Forced Me Into a Detox Ward appeared first on Filter.

In retrospect, I wish we had taken more time to explore our options. But I was not coerced. This article is primarily for those who are.

Thousands of Americans are coerced into rehab every year—by the criminal justice system, employers, professional licensing boards or family courts, as Stanton Peele has described for Filter. Too often, attending a 12-step rehab is a condition of staying out of jail, maintaining the ability to work, or keeping custody of, or contact with, your children.

If this is your situation, your best move would be to consult with an attorney (this article is not legal or medical advice). No one should be forced or threatened into rehab. And the Fourth Amendment of the US Constitution, which prohibits false imprisonment or unreasonable search or seizure, should prevent this—despite the many waivers rehab reps get you to sign during the admissions process.

But if all else fails and you are coerced into rehab, here is a short guide—based on my personal experiences and viewpoints, those of people I know, and my research—to what to expect and how to survive.

Before You Go In

Inform yourself: 

I hope this article will help. But also get a copy of Inside Rehab (2013) by Anne Fletcher and read it as fast as you can. It tells you exactly what to expect in a traditional 12-step, Minnesota Model rehab, which the vast majority of US rehabs still are. The more information you have, the better.  

Be sober—but only if you safely can: 

Many people understandably feel the need for one last night of getting wasted before going into rehab. The trouble is, this usually guarantees that you’ll get locked in the detox ward, which is not where you want to be. You will have no control over what medications you are given, and no family or friends there to advocate for you.

If alcohol has been your issue, for example, steering clear of it for three-to-five days prior to entering rehab will allow you to pass the urine test.  Then you can be a “direct admit,” meaning you skip the detox ward and go straight to the normal floor, where you are likely to have more comfort and rights.

However, a big caveat is that if you’re drinking very heavily or using certain other substances—such as benzodiazepines, GHB or others—imposing sudden withdrawal on yourself can be dangerous and even lethal, and should not be attempted. 

Again, you should always seek medical advice whenever possible. Failing that, carefully research the possible consequences of immediate sobriety from the substances you use before attempting it.

Plan for medication management: 

Particularly If you have been on opioids, try to research your options as much as possible and find a facility that supports gold-standard medications like buprenorphine or methadone. These medications are often known as medication-assisted treatment (MAT) or opioid replacement therapy (ORT).

There are many more resources for this than when I was in rehab, when I watched young women go through heroin withdrawal with no medical support at all.

Rehabs may insist on taking control of your medication. Here is a place to draw a line in the sand. Many rehabs’ cookie-cutter approach to how medication should be handled (both psychiatric and physical) can put patients with complicated medication regimens in danger. Plan to demand that your own physicians continue to manage your medication, and that you be able to take your medication on schedule and at the doses you are prescribed. Inform your current doctors of this plan. Most rehabs will want to keep your medications and give them to you at “med time,” under the supervision of a nurse. This is fine as long as you get the medication you need, when you need it.

Prepare for possible pushback. For example, the rehab I went to was as vehemently opposed to Xanax as it was to heroin. I had been on Xanax for a raging panic disorder for years. I knew that this rehab’s practice was to put benzodiazepine patients on a “taper”—a patch that contained a combination of barbiturates and who knows what else, designed by their in-house psychiatrist.

I was sufficiently terrified of this mystery patch that I detoxed myself off of a major alcohol binge, using Xanax, in four days. Then I tapered myself off of Xanax… in four days.

My current psychiatrist is probably having a seizure right now realizing what high seizure risk I was at. I didn’t sleep or eat for at least six days, threw up constantly, and had strange hallucinations involving meeting Bill Wilson in a bar. Do not try this at home.

Denial of prescribed medication can incapacitate people. I remember watching a woman with severe back problems writhe in agony for hours on the couch in our rehab common room until the facility got around to giving her some medication—and even that wasn’t sufficient. Proactively plan to stand up, calmly but clearly, for your rights. Don’t let their ideology get in the way of your health.  

When You Go In

Being searched: 

You are walking into a situation that is unusual for most adults who have not been to jail. Most likely, your belongings and perhaps even your person will be thoroughly searched.

This is not like an airport screening. They take out all your things and search them for “contraband.” Not just alcohol or drugs, but any medications (even Advil or other over-the-counter drugs), mouthwash with alcohol in it and even some hand sanitizers! Who knew you could get drunk off of hand sanitizer?

If you find this objectionable, I agree. But this is how rehabs typically operate, and you need to be ready. In your own interests, stay as polite and professional as you can. Sadly, a key to surviving rehab without serious harms, as I and many others have found, is to never, ever lose your cool. If you do, you can make yourself a target for people who have great power over you.

I coped by pretending the search of my bags was a concierge service in a fancy resort. I thanked the young woman who searched my bags and put my things in the drawers of my little two-person room for her help unpacking.

Most facilities will send you a list of rules beforehand. Do your best to read them and make sure you pack nothing that is not allowed. If they insist on taking an object, let them. Don’t start a fight you can’t win; they will usually return it at the end.

“Blackout time”: 

In what is, again, a situation completely alien to most adults, most rehabs have a period of four days or longer when you are not allowed to have any contact (phone calls, visits or mail) with the outside world. This can be terrifying, but you can get through it.

In some ways, I found it a relief not to talk to my (understandably) freaking-out parents, my concerned-but-controlling boyfriend, or anyone wanting to sell me something. But the idea that another person controls to whom you can speak and when can feel horrifying.

This is another of the many moments where it’s best to just play the game if you can. It will be easier if you know this is coming and are mentally prepared. There’s no point in arguing⁠—they’ll just mark you down as “non-compliant” and give you a harder time.  Keep your cool and remember that the missed or not-so-missed people in your life will be back soon enough.

Rules, rules, rules: 

Rehabs have a lot of rules. They are based on the stigmatizing idea that we “addicts” and “alcoholics” cannot control ourselves. These rules go much further than you might imagine, and there is probably a dress code. Most are much more restrictive for women than for men (surprise!).

Mine required that women wear a bra at all times when out of their room, and that all shorts or skirts be below the knee. There was a sign on the wall that actually said, “If you’re wearing yoga pants, make sure your shirt covers your BUTT!”

There are also rules about when you can eat, when you can sleep, and where you have to be when. This is both annoying and exhausting. At my rehab you had to attend meal times even if you weren’t hungry and didn’t want to socialize. Those who didn’t socialize—which at my rehab meant sitting outside with the smokers while they smoked for mandatory secondhand smoke inhalation—were accused of “isolating.” They were often watched more carefully by counselors.

My advice: Pick your battles. Control of your medication is a battle worth fighting. Many others are not.  

Discrimination:

A big exception I would make is if you are being harassed on the basis of race, religion sexual orientation, gender-identification or something else that is an essential part of your identity. You still have human rights in rehab.

My master’s in Public Health research was on the experiences of LGBTQ individuals in 12-step rehabs, and many of their stories of discrimination were harrowing. More options, tailored for different populations, are available now, but you have the right to stand up for yourself wherever you are.

The psychological damage that can be done by accepting psychological violence can be much harder to repair than addiction. 

“Group therapy”: 

This was the hardest part for me, and for most. At my rehab and many others, people are put into small groups of eight or so, almost always gender-segregated, for what is passed off as therapy.

There is tremendous pressure in these settings to share your innermost stories, secrets and shame with complete strangers and counselors—who frequently have little more training than self-reported sobriety and time in a 12-step program.  

Our group therapy was five days a week, for 90 minutes.  During that time, we were not allowed to go to the bathroom or drink water. We had to read out our “First Step Prep”—a long list of all the bad things that we had done or that had happened to us while we were in active addiction. The purpose was to convince us that we were “powerless” over alcohol, drugs, whatever.

For me, the effect was to sear in shame that I still can’t shake.

When my turn came to read my long list of sins and bad events (including multiple sexual assaults) to a group of eight women I had met only two weeks before, I dutifully read it.

The women were then told, as they were with everyone, to repeat back to me everything I had said I had done. I was not allowed to speak⁠. Even as they got the details of my story wrong. Even as they talked about my sexual assaults as though they were my fault for drinking.

Afterwards, the “counselor” asked, “How do you feel?”

For just one moment, the woman whose rehab persona had me labeled “Recovery Supergirl” for my excellent performance broke character. I said, “I can tell you how I’m supposed to feel.”

The counselor ignored this. I said little more and withdrew into my perpetual state of mild dissociation, making myself seem to be quite normal, even happy and very, very nice. But I was gone.

My personal advice would be: Do not do what I did. Share nothing you don’t wish to share. Leave out anything you’re uncomfortable talking about in that setting. Do not confess, unless it truly makes you feel better to do so.  

The right to privacy in your most intimate, most painful emotional places should never be violated. But you will likely need to assert that right, discreetly, for yourself.

Meetings:

In most US rehabs, you have to go to 12-step meetings every day or night. Sometimes you get to go off campus for these. My advice: If you enjoy the meetings or find them helpful, go ahead. You may find that people who are at 12-step meetings by their own choice have a lot of wisdom to share, and you may find comfort in the stories of others who have been through issues with addiction.

But beware of sexual predators: Meetings where women in rehab go are well known hunting grounds for those seeking out vulnerable people.

If you find the meetings annoying, as I did, just go along and ignore what’s said. You don’t have to share. Maybe the coffee will be good, though I wouldn’t get my hopes up.

When It’s Almost Over

As you’re about to be discharged, the staff will want to make an “aftercare” plan for you.  

I can almost guarantee that this will involve either a) suggesting you stay for another 90 days, at tremendous cost to your family or your insurance; b) suggesting you go to a “sober living home” where you are isolated from your family, education and career and effectively imprisoned in another, less costly rehab; or c) suggesting that you subscribe to some kind of first-year program that involves mandatory random drug tests, frequent phone check ins with someone from the facility, and a hefty fee.

Unless you genuinely feel that for some reason you need these things, or they are required by your licensing board or parole conditions, I can only advise that you do not spend one more dime on this process or obligate yourself to any further connection with the rehab or the rehab industry.

The aftercare plan will doubtless include attending 90 12-step meetings in 90 days, finding a sponsor, and working the Steps. You can do this if you want, but unless you are under the duress of a licensing board or court, you don’t have to. You can politely thank your counselors for their suggestions, and then forget about them once you leave rehab.

If you find meetings and a sponsor helpful, by all means, try it! But remember that there are other groups too, ones that are not necessarily based on abstinence or faith, such as SMART Recovery and HAMS (Harm Reduction, Abstinence and Moderation Support, which I personally help to run).  

Moving On

Once again, no one should ever be coerced into attending rehab. But if you are, the advantage to a 28-day rehab is that it gives your mind 28 days to clear out from the influence of alcohol or other drugs and make some decisions.

Your family’s emotions, threats, tears, cajoling all seemed like life-and-death when you were in crisis. You may well want to make your apologies and perhaps even amends⁠ (though that’s your choice, and yours alone). But now is the time to focus on moving on with your life.

Overcoming addiction is not about quitting a substance; it’s about finding a meaning or purpose in life that is more important than your involvement with an addictive behavior.

Most people outgrow addiction naturally, without treatment of any kind. This is called “natural recovery” and is the norm for the vast majority, not the exception.

So you played the rehab game and you survived: Congratulations! Getting your life back on track—with work, school, raising your children, or doing whatever you need or want do to have a fulfilling life—should be your priority now.

Finding the support you need, not pleasing others, is what will keep you safe, sane and maybe sober… if that is your choice. 

Photo adapted from Scott Webb on Unsplash.

The post Coerced Into Rehab? Here’s a 28-Day Survival Guide appeared first on Filter.

Most people who drink—as for people who use any drug—experience no significant problems. According to SAMHSA, 67 million Americans engaged in “binge alcohol use” (defined as consuming four or more drinks on one occasion for women, or five or more for men) in 2018. A much lower figure of 16.5 million engaged in “heavy use” (binge drinking five times or more in a given month). Many people in these categories will still not experience serious harms, and at a whole-population level, as Stanton Peele has argued in Filter, alcohol probably conveys a net health benefit.

Despite these caveats, alcohol-related harms—including deaths (combining alcohol with other drugs, like opioids, is particularly risky), disease, many negative personal impacts and harm to others, such as through drunk-driving accidents—are real and severe for a minority of millions.

An estimated 13.9 percent of adult Americans met criteria for alcohol use disorder in the past year and 29.1 percent will meet these criteria at some point in their lifetime. (Note that alcohol use disorder is defined by the American Psychiatric Association according to the life problems people experience, rather than any set amount of consumption).

So why is alcohol so often ignored in harm reduction conversations?

One answer is the traditional focus of many harm reduction groups on illegal drugs—although alcohol was notoriously criminalized during Prohibition and many punitive restrictions on its sale and use remain. Many harm reduction workers are unfamiliar with alcohol harm reduction strategies—although, in my experience, they eagerly embrace these strategies once they learn about them.

Another is the dominance of Alcoholics Anonymous. Founded in this country in the wake of the Temperance movement, AA takes an abstinence-only approach to problematic drinking and boasts over 1.4 million members in North America, together with huge cultural traction. AA’s problems include its religious nature and its role as a hunting ground for sexual predators, the ways it is used coercively—and the simple fact that it doesn’t work, with a “success” rate estimated at between 5-8 percent.

“We’re getting the word out that you have rights, whether you drink or not.”

There are harm reduction alternatives—and they need to be amplified. One of them is the nonprofit HAMS (Harm Reduction, Abstinence and Moderation Support), for which I am the director of organizational development.

HAMS is a free-of-charge, lay-led support group for people who want to change their drinking habits. Unlike AA and many other groups, it doesn’t insist on abstinence. Members are instead encouraged to set their own goals, which range from abstinence, to moderation, to drinking the same amount more safely.

To illuminate the work of HAMS, I had a conversation with its founder and my colleague, Kenneth Anderson.

April Smith: What does HAMS do? 

Kenneth Anderson: HAMS offers support through a closed Facebook support group with over 5,000 members, and an online forum.  There, members can get support anytime, day or night, for their alcohol-related issues.  If you’re up at 3 am in New York, you can post to the group and get responses from people as far away as Australia, Denmark or South Africa.

We also have a book called How to Change Your Drinking: A Harm Reduction Guide to Alcohol. This is a user-friendly guide to setting your own goals, addressing the issues that keep you from achieving those goals, and tracking your progress.

HAMS also works to inform the public that there are options other than the traditional approach to alcohol problems. We are about to launch a 99 cent e-book of success stories of HAMS members.  This shows that people can succeed without AA, rehab or abstinence (though we respect abstinence if it is freely chosen—it’s our middle name!).  

How did HAMS get started?

I was the online director for Moderation Management, a group that advocates for drinking according to specific limits (no more than three drinks per day and nine per week for women, and four per day and 14 per week for men) from 2002-2006. During that time, I was also volunteering at a needle exchange in Minneapolis.

The two groups gave me a kind of cross-fertilization between harm reduction approaches. Meanwhile, I voraciously read everything published in the field. I am an autodidact: although I hold a master’s degree in this field I have studied the scientific literature constantly for two decades whether in school or not.

I noticed that many of the people coming into Moderation Management wanted to reduce the harm their drinking caused or decrease the quantity they consumed, but they weren’t interested in sticking with strict limits Moderation Management required.

I had personally been drinking about four fifths of whiskey a week, and that was quite a bit too much—enough to cause problems. I tried going to AA and that did not agree with me at all. I drank more when I was in AA than I ever had before. I drank five liters of whiskey in five days and had to check into county detox to keep from dying of alcohol withdrawal. It was at that point that I left AA and started to get better.

Through reading and self-experimentation, I taught myself how to control my drinking. I was effectively doing a harm reduction program for alcohol. I cut down from four fifths of whiskey a week to one fifth per week, and found that most of the drinking-induced problems in my life were solved. I do not abstain, and I have had no lasting negative consequences from my drinking in 17 years. I have not met any diagnostic criteria for alcohol dependence in that time.

A group of other Moderation Management members and I started to develop a harm reduction program, hoping to implement it within Moderation Management. Unfortunately, the people in charge there weren’t interested in that. They wanted to stick with moderation programs, and with their strict limits.

I had learned from needle exchange that you’ve got to support all positive change. As we say in HAMS, “Better is better!” So we left to form our own organization in 2007.

Kenneth Anderson. Photo via HAMS.

How does the HAMS approach work? How is it different from AA or other programs? 

HAMS has 17 Elements, based on evidence-based interventions published in scientific journals. (We also have short videos explaining the Elements on our website, and much more helpful, scientifice-based information.)

They are not new ideas at all. Most have been around since the ‘60s or before, such as writing down the pros and cons of your drinking versus the pros and cons of the changes you want to make.

Another Element involves counting your drinks and using a drinking diary to chart your consumption. People have been doing this for years with food: Write everything you eat and count your calories. We apply these tools to alcohol.

We call the parts of our program Elements and not Steps because one is not required to do all or any of them. They do not have to be done in any particular order. Most people pick one or two, or several, and find them quite useful. You put the elements together, and design your own program. Our book contains many worksheets to help readers set their goals, make a plan and achieve the change they want.

Is there any scientific evidence that says that people with alcohol problems (“alcoholics”) can just reduce their drinking?

Yes. The US government’s National Institute on Alcohol Abuse and Alcoholism conducted a giant, three-wave study called the National Epidemiologic Study on Alcohol and Related Conditions (NESARC). Starting in 2001, NESARC surveyed over 40,000 people per “wave.”

Unlike previous studies, this one surveyed the general population—not just people who had been in treatment. That gives a much clearer picture of what is happening in the real world than focusing solely on those who have, for whatever reason, joined AA or gone to rehab.

The most important thing learned from NESARC is that of people with alcohol dependence as defined by the DSM-IV [Diagnostic and Statistical Manual, the book clinicians use to label psychiatric disorders], 90 percent recover. Of all those people, only about 14 percent ever get any sort of treatment or attend AA. Those who go to AA represent only about 10 percent of those who recover.

Recovery is the normal outcome of alcohol dependence. You don’t have to go to AA to recover. The vast majority of people who recover do it on their own. Moreover, just over half of those who recover do so via controlled drinking rather than abstinence.

Hundreds, if not thousands, of papers were written based on this NESARC data. One of them looked at patterns of recovery from alcohol dependence. “Progressing”—i.e., getting worse—is the least common outcome. “Jails, institutions and death”—a scare-phrase AA likes to repeat—are the least likely outcome. Very few people get worse. Almost all get better.

Those who do get worse are sometimes called “chronic severe.” One of the interesting things about chronic severe individuals is that they are the ones who utilize treatment the most. The ones who go to rehab again and again. Those who went to AA, drank again, but “kept coming back.”

Aren’t people’s brains hijacked once they become addicted? Many people think that those who are addicted lose the power to choose once they pick up that first drink.

People’s brains are not hijacked. People do not become automata when they drink. It’s a myth used to promote treatment centers who make a lot of money out of sucking you in and sucking your bank account dry. Moderation and safer drinking are the most common outcomes in scientific literature—contrary to popular mythology.

One other thing that we see is that when people make small changes for the better, they tend to go on and continue to make more and more changes and get better and better.

What are some concrete strategies that HAMS suggests for members to change their drinking?

Giving your car keys to your partner before you go out. Taking a limited amount of money to the bar when you go, and when it runs out, you’re done. Eating before drinking, and staying hydrated. Drinking at home instead of drinking out to avoid driving home drunk or getting into a bar fight. Avoiding drinking to deal with strong emotions. I always say, “Sad drinking is bad drinking.” The 17 Elements go into more detail, and the Facebook group is filled with suggestions from members on how they change their drinking.  

Our Facebook groups also provide a place for members to talk about the issues that drive their drinking. I hear that the HAMS for Women group talks a great deal about life stressors that make them feel like drinking more than they want, but I don’t read that group because it’s a closed group solely for women.

As an administrator of that group, I can verify that. Also, we love to post pictures of our pets! We’re not just about drinking: We talk about life. What do you say to AA’s Step One: “We admitted we were powerless over alcohol?”

I found the message that alcohol is more powerful than human beings to be extremely harmful to me. AA tells me that I have no power to stop after the first drink, but that I can only be saved by a “Higher Power.” This makes no sense. God doesn’t swoop down and cure cancer, so how can he swoop down and cure alcoholism?

Having the constant message that we have no power got ingrained in my subconscious and it was extremely damaging. Many people have a similar experience.

I respect the decision of those who want to join AA. I respect all choices. If you want to say you’re powerless, more power to you. But people should know that there are other choices as well. I know several people who joined the Hare Krishna movement and quit alcohol. I’d rather do that than sit in a church basement saying I’m powerless. The only problem is I don’t believe in it and I don’t want to give up pork chops. Nor do I want to give up alcohol. I enjoy certain things, and why not?

I would prefer it if we were the standard and AA was the alternative but we haven’t reached that point yet. There are several other alternatives for people who don’t find AA useful or palatable. There’s SMART Recovery, Life Ring, Women for Sobriety. HAMS if a lot like SMART, but they are focused on abstinence. Both are based on Cognitive Behavioral Therapy—an approach that has been standard in all kinds of therapy for decades. 

HAMS provides social support primarily online. Don’t people need meetings to recover?  

Live meetings may have made sense at a time when there was no other way to communicate in real time, but now, almost everyone communicates online. An online platform provides the opportunity to reach out anytime, day or night, when you need help or just want to talk. People don’t have to take an hour (not including travel time) away from their work and family lives to get support from HAMS the way they do for AA meetings. They can log on for a minute, an hour, or however. They can check the page three times a day, once a week, or never. Again, it’s all about choices.

There’s also much more anonymity in an online group. While privacy is never guaranteed on the internet, you’re less likely to run into your neighbor on the HAMS Facebook group than at the AA meeting down the street.  

What do you see as the future of HAMS? 

HAMS is ripe for growth. People are learning about Narcan for overdose reversal.  People are learning about harm reduction. The general public is becoming more supportive of alternatives to AA and complete abstinence. Our program is based on science and common sense, not religion. That resonates with an increasingly-secular public more now than a philosophy born in 1935.

There is a desperate need for support for people trying to change their drinking. We provide that. The challenge is getting the word out that they have an option. There is a place where free, non-judgmental support and rational, evidence-based tools are there for the taking.

We are also working to get our message out to the public. We have an ongoing project to get How to Change Your Drinking into prison libraries and start live HAMS meetings in prisons, where people don’t have internet access.  We’ve just begun an initiative to educate people about their rights within the medical system.

People with substance use issues are routinely treated in ways that are unethical, against government regulations and profoundly traumatizing when they seek healthcare. Stories of unnecessary use of restraints, forced medication and coerced commitment abound within our community. We’re getting the word out that you have rights, whether you drink or not. 

Photo by Johann Trasch on Unsplash

The post Alcohol Must Be Part of the Harm Reduction Conversation  appeared first on Filter.