Sentences to ponder

wpid-wp-1406109969456.jpegFrom Jamie Holmes in the NY Times:

Presenting ignorance as less extensive than it is, knowledge as more solid and more stable, and discovery as neater also leads students to misunderstand the interplay between answers and questions.

People tend to think of not knowing as something to be wiped out or overcome, as if ignorance were simply the absence of knowledge. But answers don’t merely resolve questions; they provoke new ones.

(Hat tip: Debra Jay)

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Drug crimes and incarceration reform

fenceA very smart interview with Senator Corey Booker on criminal justice reform and the role of drug crimes in incarceration rates:

One concern I’ve heard from activists and academics is that there’s a conventional wisdom forming that the reason our prison population is so huge is because of nonviolent offenders. Even President Obama, during his big criminal justice speech in July, said, “Over the last few decades we’ve also locked up more and more nonviolent drug offenders than ever before, for longer than ever before, and that is the real reason our prison population is so high.” When I heard that, I just thought, “That’s not true.”

Well, look, the drug war certainly has driven an explosion in incarceration, and drug crimes do make up a very large percentage of what we have. But again, we’ve been doling out harsher and harsher penalties for all crimes.

I’ve seen research that says only 17 percent of the inmates in state prisons are there for drug charges. Just 17 percent! Whereas 50 percent or so are there for crimes that are classified as violent. Does that mean talking about the problem in the way Congress has been talking about it puts a pretty low ceiling on how much of a reduction in the prison population we can achieve?

Right, but there’s some other data that we should talk about. Michelle Alexander [author of The New Jim Crow] talks about how much marijuana arrests have fueled the explosion in arrests in our country. Her point is that we end up sending so many young people, particularly young African-Americans and Latinos, into the system. And what happens once you get a felony conviction? Now you are entering this American caste system where you can’t get a job, you can’t get a loan, you can’t get a Pell grant, you can’t get public housing. And then those people often feel that they have no other options, so they go back and commit crime again. And again, and again. And what we saw in Newark, through a Rutgers study, was that about 84 percent of our murder victims had been arrested before an average of 10 times.

Victims?

Victims. So what I’m saying is that, because of these low-level drug crimes, people get stuck in this world that eventually turns violent. So I’m very concerned about how we’re treating the drug war. And while I definitely want to deal with a more expansive view of who should be eligible for a lot of this legislation, please understand that the drug war has really fueled so much of our problem. The drug war has been a war where the direct casualties have primarily been America’s poor; America’s minorities; and often, unfortunately, America’s vulnerable, in terms of people with disease and addiction and mental health.

There is some debate around the Michelle Alexander book—there are people who say she overstates the role of the drug war in the mass incarceration boom. And there is data that says the percentage of drug offenders in the prison population peaked in like, 1990, at 22 percent. So even when it was at the highest it has ever been, 4 out of 5 people in prison were there for offenses that didn’t involve drugs. That’s something I hear from folks who are worried that the focus is too much on drug crimes right now.

I guess I’m not into the tyranny of the “or”— either this or that. This system is broken along many, many dimensions. And to ignore the crisis of America’s drug policies and the devastating impact it’s having in America is a very significant problem. That’s not to say there’s not a problem with high mandatory minimums as a whole—which have shifted our whole criminal justice system from courts and judges to prosecutorial discretion. But the situation is bad all over.

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half-measures are not enough

PathsBill White provides a great summary of a recent review of research on opioid addiction, treatment and recovery.

Bottom line:

  • opioid addiction is deadly
  • opioid addicts can recover
  • treatment that’s long enough and intense enough is associated with better outcomes

Unfortunately, most opioid addicts seeking treatment never get offered care that meets these criteria.

Read the rest here.

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Shame, methadone and recovery

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The Boston Globe has an article on the shame that successful methadone patients carry.

It makes me sad to hear of anyone doing the deal feeling shame about being a recovering addict.

People with opioid addiction ought to have access to methadone, if that’s what they want. Without shame.

They also ought to have access to the gold standard for addiction treatment—the same care that an opioid addicted health professional gets.

They also ought to get accurate information about the various pros and cons of each approach.

For example, they ought to know that the gold standard demands a lot of the patient, and existing models have relied on using the health professional’s license as a contingency to maintain compliance with these demands. They also ought to know that the approach hasn’t been studied on the general population of opioid addicts because no one has been willing to invest in it.

They also ought to know that despite all of the arguments that research proves “methadone maintenance is the most effective treatment for opioid addiction”, the evidence base for methadone focuses on reduced drug use, reduced OD, reduced criminal activity and reduced disease transmission.

Bill White, a researcher and methadone advocate, summarizes the evidence this way:

As a professional field, we know a great deal about what methadone maintenance treatment can eliminate from the lives of patients, but we know very little from the standpoint of science about what it adds. In fact, we know very little about the stages and styles of long-term medication-assisted recovery.

This lack of quality of life evidence is exemplified by the Boston Globe article:

They come to this methadone clinic . . . at around 6 in the morning — a time set aside for working men and women to get doses before heading to their jobs. About 400 of the 4,000 patients here work full time.

10% work full time?

In the article, a successful patient points to the dosing line that forms after the employed patients have gone to work.

Josh, 29, gestured at the line of men and women waiting outside. Workers’ hour had passed. Some of the people there now looked broken and wasted, like the stereotype that persists even though we’re constantly hearing that addiction can strike anyone.

“Would you want those people in your house when you’re not home?” asked Josh, who installs central air. “Hell, no. People don’t see the flip side — the dental assistants, the lawyers, the doctors.”

I don’t want to interfere with access to maintenance and I don’t want methadone patients living with shame. At the same time, all the advocacy for maintenance treatments misses that there are real reasons for the persistent skepticism about them. When a lot of people look at the population of patients, they don’t see an outcome that they’d want for themselves or loved ones.

via Shame of methadone use clouds heroin addicts’ recovery – Metro – The Boston Globe.

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Treatment Works, IF . . .

ROSC-modified Treatment Works Poster

Courtesy of Bill White. Visit williamwhitepapers.com

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Drug money

From the Forbes list of the richest U.S. families:

SacklersThe richest newcomer to Forbes 2015 list of America’s Richest Families comes in at a stunning $14 billion. The Sackler family, which owns Stamford, Conn.-based Purdue Pharma, flew under the radar when Forbes launched its initial list of wealthiest families in July 2014, but this year they crack the top-20, edging out storied families like the Busches, Mellons and Rockefellers.

How did the Sacklers build the 16th-largest fortune in the country? The short answer: making the most popular and controversial opioid of the 21st century — OxyContin.

It’s worth noting that this wealth was amassed with a drug whose marketing resulted in $635,000,000 of fines and lawsuits are still pending. The total cost of fines and lawsuits is expected to reach $1,000,000,000. In pure financial terms, it still looks like a pretty good deal. That seems like a problem, no?

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Why wasn’t my love enough?

This post was a followup to Seth Mnookin’s review of Hari’s book. It highlights one of the harms of misunderstanding addiction as a product of lack of connection, purpose and enriching environments.
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grief by maryn0503

grief by maryn0503

Yesterday, I posted a link to Seth Mnookin’s review of Chasing the Scream. Mnookin has been open about his addiction recovery for a long time.

In 1999, his mother wrote a piece about her experiences during his years of using. She does a great job illuminating the secret suffering of many loved ones. It’s actually a powerful rebuttal to Hari’s notion that a lack of love and enriching environments are the cause of addiction.

Our fears about Seth absorbed the family’s energies. My husband and I were often preoccupied. It was hard to concentrate, it was hard to sleep, it was hard to pay attention to our other children. We were exhausted, and though we tried to continue family activities, it was often an effort, and they could see this. We became stricter with them, wondering if we had been too lenient with Seth, and also less demanding, thinking that any behavior short of drug use was not worth correcting. They had their own fears for Seth’s safety. Once, when our younger son was in high school, my husband left a message for him to call. He needed to change a plan about the car, but our son could only imagine one reason for his father to call him at school: Seth had died.

When I heard this story, I tried to imagine our younger son getting the message — the blood drains from his cheeks as he leaves the classroom and walks to the office. How many halls does he pass through, clutching his books, thinking his brother is dead? How much time passes before he hears his father’s calm, everyday voice? I had tried so hard to protect my children, and I couldn’t even protect them from each other.

Everyone seemed to have better parenting skills than I did — anyone whose child was not using drugs, anyone whose child could call home without imagining disaster. Leafing through the book review section of the Sunday Times, I happened upon the advertisement for a novel, “Cloud Nine.” Even the reviewer’s words accused me, proclaiming that “the strength of family ties can ultimately set things right.” So why couldn’t my love set things right? Why wasn’t my love enough to save my son?

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