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It’s no secret that drug and alcohol-related content is some of the most engaging out there. People can’t get enough of content like AMC’s Breaking Bad, Showtime’s Weeds, and USA’s Queen of the South; so much so that they consistently tune in to their favorites, even if the underlying message is questionable. That’s why it’s no surprise that drugs and alcohol have made their way into – and even become central themes – of some of the most popular shows of all time. It’s as simple as this: supply and demand.
Honestly, we get it. Drug and alcohol-related tv shows are interesting and engaging if not always entirely accurate. But when our favorite shows fail to highlight the realistic repercussions of drug and alcohol use, that’s when they fall into dangerous territory.
While we all know that drug and alcohol-related terms regularly find their way into TV shows on the most popular television networks, there’s less conversation surrounding the prevalence of drug and alcohol references in the original shows put out by some of the world’s top streaming services, like Netflix, Hulu, and Amazon Prime. And this sparked our curiosity.
How frequently do these terms really occur in the shows released by our beloved streaming services? And are some streaming outlets more drug-friendly than others?
With these questions in mind, we analyzed the total number of drug and alcohol mentions per season on each major platform’s original shows. We then ranked the shows and platforms accordingly. And we must say, our findings might surprise you!
When it comes to the shows with the most drug and alcohol mentions, we found that the margin of difference between the top shows in each network and the runner-up isn’t that significant. On Hulu, for example, The Mindy Project had nearly thirty-one drug and alcohol mentions per season – only about three more mentions than Deadbeat. Similarly, with Amazon Prime, there’s only a margin of three mentions that separates the top two shows: The Marvelous Mrs. Maisel and The Patriot. The exception to this trend is Netflix, where we found a 26 point gap between Trailer Park Boys: The Animated Series and Murder Mountain.
We also found it somewhat surprising that seemingly lighthearted shows like The Mindy Project and The Marvelous Mrs. Maisel had among the highest number drug and alcohol mentions on their respective streaming services. This goes to show how commonplace substance use is. The “light” tv shows still talk about drugs and alcohol because it’s relevant to a general audience.
Aside from the sheer numbers of drug and alcohol mentions, we were also curious about the differences in drug and alcohol-related terms by platform. And as it turns out, there are several differences worth noting.
First, the term ‘dope,’ must be a Netflix thing, as it tied for the most-used drug or alcohol-related term on Netflix originals, but didn’t make the top ten on either of the other streaming services. Drunk, weed, drinking, drugs, and beer were among the other most frequently used terms in Netflix originals.
With sixty-two occurrences, Hulu original writers must have wine on their minds. Though “beer” ,also made the cut, it ranked much higher on Netflix. Following wine, drunk, and drinking are the second and third-most frequent terms used on Hulu, occurring sixty and fifty-two times, respectively.
As for Amazon Prime, “drinking” and “drunk” occurred most often – forty-seven and forty-six times, to be exact.
It’s also worth pointing out that Amazon also uses a few less-common drug-related terms, like ‘lit’ and ‘acid,’ that weren’t among those on its competitors’ shortlists.
While Hulu and Amazon Prime certainly don’t shy away from drug and alcohol references, neither outlet comes close to the frequency with which Netflix mentions these topics. In fact, Netflix originals include over twice as many drug and alcohol-related terms as Hulu and Amazon Prime do.
For better or for worse, it’s safe to say that drug and alcohol references are, and will likely continue to be, a prevalent subject, infiltrating most of the media we consume in one way or another. And clearly, Netflix, Hulu, and Amazon Prime originals are not immune to this trend. So, the next time you open your favorite streaming service, remember to stop and ask yourself:
What message is this show sending about drug and alcohol use?
Is that message true?
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Drugs are a popular topic in today’s media. From the war on drugs, the widespread legalization of marijuana, or the opioid crisis, it’s hard to miss a conversation that revolves around drugs. This isn’t news, though. Drugs have been around for a long time. In fact, drug use has been ingrained in societies for thousands of years.
Here at Rehabs.com, it’s important for us to look at historic trends to see how drug use has affected people since drug use began. But, since that kind of historical data doesn’t exist, we decided to scale down our research and look at a smaller timeline – the past few decades. We went through the National Survey on Drug Use and Health from 1979 through 2017* from SAMHSA and compiled the data to figure out what the most popular drug is by decade. Take a look at what we found below:
According to SAMHSA reports, the most popular drug by decade (excluding alcohol and marijuana) changed over time. The percentages refer to the number of people who have reportedly used the drug within the last 12 months at the time of the survey response. Cocaine had the highest usage rate by a fair margin in the ’80s. Drug use rates dropped overall in the ’90s, but analgesics/pain relievers were the most commonly used substance for that decade. Pain relievers remained the most popular drug for the next 2 decades, with usage rates rising substantially over the next 20 years.
Included in the research are analgesics/pain relievers, cocaine, hallucinogens, heroin, inhalants, sedatives, stimulants, and tranquilizers. According to the graphic above, analgesics/pain relievers took the lead as the most used drug for the past three decades, while cocaine was the most used at 6.25% from 1979 to 1988.
In every decade, alcohol and marijuana had the highest average usage rates since the late ‘70s. From 1979 to 1988, the average usage rate of alcohol was 63.54%. In the ‘90s, the average usage rate was 54.53%, and in the 2000s, the rate was 59.85%. From 2010 to 2017, the usage rate was 59.31%. The cumulative decade-by-decade change for alcohol went down by 7%, meaning that average usage dropped 7% between the ’80s and the 2010s.
Marijuana use also declined cumulatively from 1979 to 2017. From 1979 to 1988, the average usage rate was 18.37%, but from 1990-1999 the usage rate dropped significantly to 10.17%. However, since 1990, there has been an increase over the following two decades. From 2010 to 2017, the average usage rate rose back to 17.81%. Despite this, there are still 3% fewer people using marijuana from 1979-2017.
The final piece of information we wanted to highlight is the change in usage over each decade. From the 1980s to the 1990s, every drug showed a decrease in usage, with some having a decline of almost 10%. By the 2000s, usage of most drugs (excluding sedatives) increased. From 2000 to 2010, there were increases and decreases, with the majority of drugs showing decreased usage. Tranquilizers were the only drug where usage did not increase or decrease.
Some drugs showed a substantial decrease in cumulative change. Average usage rates for sedatives dropped by over 500% and cocaine usage rates dropped by almost 200%, meaning people were over five times less likely to have used sedatives over the past year, and almost two times less likely to use cocaine. Heroin, hallucinogens, and analgesics/pain relievers are the only drugs that have had a cumulative increase in use.
We can see that analgesics/pain relievers have been the most used drug over the past three decades. This can be closely linked to the opioid crisis, which has become extremely prevalent since the increase in opioid prescriptions in the 1990s. Most drugs have had a decrease in usage cumulatively, while heroin, hallucinogens, and analgesics/pain relievers have increased. Alcohol and marijuana use has been decreasing, however, the change has not been substantial. If you or someone you love is struggling with substance use disorder, our team has the resources to help.
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The information and graphics in this blog post can be used and displayed by all commercial and non-commercial websites without charge. However, use is only permitted with proper attribution to rehabs.com. When using this information or any of these graphics, please include a backlink to this page.
The state of Florida is suing two of the nation’s largest drugstores, Walgreens and CVS, for allegedly contributing to the opioid crisis, reports the Associated Press. The lawsuit argues that these pharmacies have contributed to the opioid crisis in the U.S. by way of inflating the supply and demand for opioids in the state.
This is the latest action the state has taken in the fight against moneyed pharmaceutical interests, and this case will be added to an existing lawsuit against Purdue Pharma, the maker of the highly addictive opioid painkiller, OxyContin, and other pharmaceutical companies who have been accused of contributing to the ongoing opioid crisis in the country.
What do Pharmacies have to do with the Opioid Crisis?
Attorney General Pam Bondi said that CVS and Walgreens had failed to halt “suspicious orders of opioids” and the dispensing of “unreasonable quantities” of these drugs. The lawsuit claims that since 2016, Walgreens has dispensed billions of opioids from Floridian pharmacies. As many as 2.2 million opioid prescriptions were dispensed from a store in Hudson, Tampa, a shockingly high number for a city of just 12,000 residents. Some stores saw opioid sales skyrocket, increasing 6-fold in only 2 years.
It is Bondi’s belief that thousands of Floridians have suffered because of the actions of these pharmacies.
This isn’t the first time these pharmacy chains have gotten into trouble. Just 5 years ago, Walgreens was said to have paid $80 million to resolve a federal investigation into violations of record-keeping and dispensing requirements. According to related documents, Walgreens’ negligence resulted in controlled substances such as opioid painkillers being diverted for abuse and for sale on the black market.
What was the Response from the Accused Companies?
Walgreens declined to comment on the lawsuit. CVS, however, pushed back in a recent statement. Spokesperson Mike DeAngelis said the lawsuit was “without merit.” DeAngelis continued, “Over the past several years, CVS has taken numerous actions to strengthen our existing safeguards to help address the nation’s opioid epidemic.”
De Angelis assured the public that CVS trains its pharmacists and assistants how to responsibly dispense controlled substances. He also said that they are trained to detect potentially illegal sales. But is it enough?
While we have seen some progress in Florida—largely focused on the crackdown on pain mills, a system in which drug dealers send people to clinics to get illegitimate prescriptions for opioid painkillers—the opioid crisis shows few signs of relenting. According to the Centers for Disease Control and Prevention, the number of drug overdose deaths in the U.S. continues to rise and is largely driven by opioids. An estimated 130 people die each day from an opioid overdose. We must do more.
Our universal acceptance of the medical myth of addiction is deadly.
The following was live-blogged from my presentation at Galway, Ireland, including material from my forthcoming book with Zach Rhoads, Outgrowing Addiction: With Common Sense Instead of “Disease” Therapy.
Harm reduction treatments and strategies like long-term MAT and reducing painkiller prescriptions have been accepted across the board, from the AMA and the National Institute on Drug Abuse (NIDA) and other leading addiction-as-disease advocates to prominent harm reduction groups.
Yet these so-called harm reduction approaches have failed to stem the tide of drug deaths. Their failure is because they identify and address addiction as a brain disease to be treated medically. There is no sign that the failure of this perspective is causing or will cause any prevailing actors to change their thinking. They simply can’t.
In my recent presentations, I have begun by warning audiences that I will undercut all of their fundamental beliefs about addiction — but that if that prospect seemed alarming, they shouldn’t worry. They wouldn’t change their thinking no matter what evidence I presented, even if the consequences of their not doing so took the form of continuing spiraling drug death rates.
I began speaking in Galway before the Western (Ireland) Region Drug and Alcohol Task Force by establishing four criteria on which to decide the truths of addiction: common-sense logic, evidence, personal experience, and meaning. I then confronted eight myths about addiction imported largely from the U.S.
Myth I: Opioids Cause Addiction
I asked the group of 180 people whether any of them had ever taken a painkiller. Virtually every person in the audience raised their hand. I then asked if any of them had become addicted. No one raised their hand.
“Isn’t that remarkable?” I asked. “Opioids are the sine qua non of addiction. Experts like Sam Quinones in his best seller Dreamland detail how the opioid molecule envelops the receptors in the brain and nervous system, trapping even the most resilient people in addiction. Yet not one person here who was exposed to this molecule became addicted. WHY didn’t you become addicted?”
I got less of a response – none – than I had hoped for. I prodded further: “Isn’t the question of who becomes addicted, and under what circumstances, the fundamental question we need to ask? Do you have no ideas about why none of you became addicted?”
One man finally said, “I stopped taking the painkiller when my pain went away.”
“You mean people quit using painkillers when they no longer feel pain?” I reacted, with mock incredulity.
That was all I got. Later, my host at the conference, Liam O’Loughlin, told me over dinner how he had badly hurt his hand, but stopped taking the powerful opioid and anti-inflammatory he had been given after just three days. “I didn’t like becoming groggy at two in the afternoon.” In other words, he had other matters to attend to with which narcosis interfered, and therefore he wasn’t inclined to savor the drugs’ effects.
Back to my interacting with the audience, I asked, “So why, then, do you believe opioids are special agents of addiction to which everyone must succumb? After all, not you nor anybody you know – if this audience is typical of your acquaintances – became addicted when they consumed an opioid.”
I offered the audience my one-word explanation for their resistance to opioid addiction – their “connectedness.” They had too many points of contact with life to allow them to sink under the drug’s effects; instead, they found ballast from the world around them to hold to their life course.
Myth II: People Can’t Quit Addictions On Their Own
I then asked the group to name the most difficult substance addiction to quit. They (correctly) shouted “tobacco” or “smoking.”
“Has anyone here quit smoking?”
From a third to 40 percent of the audience – 60 to 70 people – raised their hands.
“How many of you relied on a medical treatment – like Chantix or a nicotine gum or patch – to quit?”
Three or four people raised their hands – say five percent of quitters.
There was the usual grumbling that cigarettes are not “really” addictive, reversing decades of addictionology history, because they aren’t mind-altering. In fact, on the evidence provided by the massive NESARC study of recovery from substance dependence, smoking was the least likely and slowest to remit:
Lifetime cumulative probability estimates of dependence remission were 83.7% for nicotine, 90.6% for alcohol, 97.2% for cannabis, and 99.2% for cocaine. Half of the cases of nicotine, alcohol, cannabis and cocaine dependence remitted approximately 26, 14, 6 and 5 years after dependence onset, respectively.
“Given that smoking is the hardest substance addiction to quit, haven’t you just disproved in your own lives the two basic received opinions about addiction; first that opioids are irresistibly addictive, and in this instance that treatment is required to overcome addiction?”
Myth III: America is the Leading Edge in Thinking About and Dealing With Addiction
“The reason I ask these questions is that ideas you have about addiction, which come largely from America, control your thinking. Yet how well would you say that we in the U.S. are doing vis-a-vis addiction?”
I then presented the NIDA’s chart of drug deaths in America through 2017: As I summarized: ”Last year, deaths from every major class of drug peaked in the U.S.: that’s synthetic opioids, heroin, natural opioids, cocaine, and methamphetamine. In fact, they left out another major category of drug for which that was true: benzodiazepines.”
Myth IV: The Current Drug Epidemic in America is Caused By Pill-Pushing
“Why did this occur? Before answering that, please note that deaths began skyrocketing in 2012-13. Do you know what has happened to painkiller prescriptions since that time? They’ve plummeted.”
Three people then gave the same explanation for this unhalting rise in drug fatalities – the go-to-one in America – “drug companies are pushing pain pills and doctors are overprescribing them.”
I responded, skeptically, “Overprescription of opioids accounts for why the number of prescriptions has fallen dramatically, and yet drug deaths of all types have accelerated – really?”
Finally one woman answered that people were turning to street drugs when they failed to get prescribed painkillers.
I answered that this was a logical and true answer, since getting drugs on the street was always more deadly than taking drugs under medical supervision. But I added that this was not a sufficient explanation for drug deaths due to everything from stimulants to the whole array of depressant-analgesic drugs rising in lockstep.
Myth V: Public Health and Addiction Groups Are Driven By Bottom-Line Success in Attacking Addiction
But return to my claim that no one would change their minds due to logic, evidence, experience, and the lack of efficacy of our efforts to curtail drug addiction and death, as indeed my audience wasn’t prepared to do.
So what of policy-makers? I quoted the head of the AMA’s task force on opioids, Dr. Patrice Harris.
Reckoning that between 2013 and 2017, there was a 22% decrease in opioid prescriptions nationwide, Dr. Harris noted that, “While this progress report shows physician leadership and action to help reverse the epidemic [by limiting prescriptions], more than 115 people in the United States die daily from an opioid-related cause.”
In other words, doctors were doing wonderfully, although opioid and other drug deaths continued to surge. The clear path forward based on Dr. Harris’s remarks was for physicians to redouble their efforts to curtail painkiller prescriptions.
How could I fault my audience for their unwillingness to accept logic, evidence, experience, and lack of efficacy as spurs to reconceive addiction and how we respond to it when the leading medical body in America refuses to do so?
Myth VI: All People Are Equally Susceptible to Drug Addiction
I then turned to a popular myth brought over to Ireland in a reverse migration: that addiction is “an equal opportunity destroyer.” This is the fantasy that the socioeconomically well off become addicted to opioids as readily as the poor and disenfranchised do.
I cited a comprehensive study by West Virginia’s health commissioner, Dr. Rahul Gupta, who examined every drug fatality in his state, one that leads the country in opioid deaths by a wide margin. Gupta found a shockingly prevalent template for such deaths: “If you’re a male between the ages of 35 to 54, with less than a high school education, you’re single and you’ve worked in a blue-collar industry, you pretty much are at a very, very high risk of overdosing.”
I asked the group what it meant that those dying were nearly always older rather than younger: “Are these fatalities due to drug overdose, which would be more likely for young and naive users? This profile instead tells us that those who are dying are isolated people on the underside of society who are suffering long declines in spiritual and physical health.”
In fact, other data sources have highlighted this deep association between drug deaths and social class and education, to wit: “deaths have grown increasingly more concentrated among those with lower levels of education, particularly among non-Hispanic whites.”
“Why,” I then asked, “do we insist on ignoring this profile? Because doing so allows us to believe the first myth, that drugs themselves cause addiction, which has the side advantage of removing for society any need to examine and to improve the conditions of the lives of people most susceptible to addiction and death. And, frankly, we don’t seem to care that much if these people die. We worry only about our own.”
The easy solution we seek instead of facing reality is to label addiction a medical problem. The one thing I and two distinguished speakers also presenting to the group – Dr. Shane Butler, sociology professor emeritus at Trinity University and Pauline McKeown, CEO of Coolmine TC in Dublin – were unified around was that any treatment for addiction must embody a holistic approach that attends to the human essentials of health, housing, purpose (as through education and work), and community. And it is these things that my online Life Process Program for addiction addresses.
By not doing so, and instead focusing on some imagined brain mechanism to account for addiction, one that neuroscience not only has failed to find but that research indicates cannot possibly exist, we have lost any chance of helping the most susceptible populations.
Myth VII: MAT is the Solution to Drug-Related Mortality
Which returns us to the subservience of even supposedly radical drug policy reformers who buy the medical model hook, line, and sinker – most notably in proposing MAT, medicine assisted treatment, as a remedy for addiction. MAT replaces street opioids for illicit drug users with prescribed Suboxone, buprenorphine, or methadone.
And while it is true that people maintained medically on narcotics are less likely to die, this substitution in no way addresses their addictions, leaving them perpetually vulnerable to relapse and drug crises when they depart from their medical drug regimens.
In fact, drug reformers and mainstream agencies now argue that MAT would end our drug crisis were it not, they claim, for the unfortunate difficulty of administering MAT in rural settings. Nonetheless, according to a study of ten leading opioids, “prescription opioid use peaked in 2011 and has declined rapidly since then. . . But buprenorphine bucked the trend by being the only opioid that showed an increase.”
And it is the largest American cities — which are most thoroughly served with MAT options – that are experiencing the greatest rise in opioid deaths (in this case due to heroin and fentanyl, et al.), thus balancing the findings of Gupta and others that the opioid epidemic is concentrated in poor white regions of the U.S. With both vulnerable populations, black and white, dismal failure is the constant companion of our “best” efforts in the addiction field.
Myth VIII: A Medical Approach to Addiction is Effective Because it Removes Human Agency As a Factor
I ended my talk by noting, “Underlying a recovery model based on health, home, purpose and community – a model created through the Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) surveying mental health and addiction researchers — is the crucial, essential role of personal agency: ‘Recovery is person-driven. Self-determination and self-direction are the foundations for recovery as individuals define their own life goals and design their unique path(s) towards those goals.’”
And nothing refutes personal agency like the so-called medical model that addiction is a disease invading from outside the person, a point of view propounded for decades by the National Institute on Drug Abuse. Standing for the government position through Democratic and Republican administrations, the NIDA defines addiction “as a chronic, relapsing disorder characterized by compulsive drug seeking … It is considered a brain disorder.” This too is the view on which the leading drug reform organizations now base their own “best” practices, such as MAT. And no one in a power or policy advocacy position in the U.S. seems to notice, or care about, the negative consequences of this approach.
Contra the NIDA, addiction is a disorder of the lives and lived experience of human beings, the remedy for which is that people must develop a sense of personal agency within a supportive setting and community. Unless and until we recognize and approach addiction in this light, we will never reverse its lethal hold on America and its most vulnerable citizens.
In the December 4 issue of NYRB, Harvard Medical School faculty and former editor-in-chief of NEJM, Marcia Angell, addressed America, “Opioid Nation.” Angell reviewed four books, Pain Killer, Dope Sick, American Overdose, and American Fix. She found all of them inadequate to the task of explaining America’s 2017 72,000 plus drug deaths – the first three because their “pill pusher” account (Myth IV) fails, and the fourth because it relies on the author’s addictive “disease” as an explanation. (Let it be noted that Angell is a critic of the pharmaceutical industry.)
Angell is especially concerned to refute the idea that drug availability, rather than the demand for drugs among disillusioned whites, is the cause of our epidemic (Myth VI). Instead, she believes “As long as this country tolerates the chasm between the rich and the poor, and fails even to pretend to provide for the most basic needs of our citizens, such as health care, education, and child care, some people will want to use drugs to escape.”
This is a critical insight that America misses – “to end the epidemic of deaths of despair, we need to target the sources of the despair.” But Angell too embodies many of the myths of addiction. She considers drug, including opioid, use itself – as universal as it is – to be the result of despair (Myth I). This is no truer than saying drinking alcohol, shopping, playing video games or using mobile phones, sex, or love are signs of despair.
Addiction, not its various manifestations in activities that may or may not be used addictively, is a sign of despair.
To say severe addiction strips away or erodes a person’s agency is a viable candidate for statement of the most obvious. Work with enough clients, be connected to people in the deepest throes of addiction, or live with your own, and you’ll see that rational capacities become increasingly compromised.
Means-ends thinking may go on the fritz. Patterns of justification and explanation defy any regular sense of logic (but may make sense to others struggling with addiction). People may also lose the ability to regulate their emotions. Emotions may become overly muted or outrageously overblown and directed in the wrong directions. A person’s emotional palette shrinks significantly. Understandably, these losses have captured most of the attention of addiction and treatment researchers and professionals.
The Essential Arts of Personhood
Humans are beings who can imagine and hope. These two capabilities belong to what philosopher Annette Baier calls “essential arts of personhood.” Severe addiction can destroy these, but their destruction often goes unnoticed. Their destruction may be a significant impediment to reducing harmful use, being in remission, or in recovery.
Imagination has fascinated philosophers for centuries. More recently, hope has become an important topic in moral psychology.
Imagination is the ability to consider things not as they are, but how they could be.
Imagination may involve possibilities in the past, present or future. Imagination enables us to consider actualities and do all sorts of interesting things to them. To imagine something doesn’t necessarily involve trying to make it be so. In fact, one may not want our imaginings to be the case.
Consider the fact that many of us can imagine worse case scenarios in a millisecond. People struggling with addictions may be very adept at imagining those scenarios. Others will be equally adept at flights of fancy where they are able to stop using easily and instantly and all the troubles that plague them disappear. Imagination is so very powerful because of its relationship to our agency, that is our ability to act in a deliberate way.
Hoping – or more specifically hoping well – is equal parts gift and skill. Hoping is also an important component of human agency. We humans learn how to hope, not unlike how we do to a host of other activities. We can do it well, or we can do it poorly in at least two ways.
Philosopher Victoria McGeer describes “wishful hope” as a failure because it relies on external forces/realities to realize hope. A wishful hoper is one who doesn’t really act enough/responsibly to bring about what he hopes for. Someone who hangs around waiting for good things just to come his way is a wishful hoper. “Willful hope” is more complex since it involves questionable action. The “willful hoper” is the person who invests all his energies in his hopes regardless of the cost to others. He may try to bend external reality to his hopes. In this sense, he fails to be responsible to others because his hopes always carry the day.
People who struggle with severe addiction may be prone to either of these two failures of hoping. The person who wishes the urge to use will simply go away overnight and all her problems be solved is a wishful hoper. Willful hopers are perhaps a little harder to identify when it comes to addiction. The person who blames his drinking on his stressful job, nagging wife, and demanding children who quits his job and abandons his family fits the profile of a willful hoper.
To hope well is, at minimum, not to hope wishfully or willfully. Hoping well involves having aspirations that are appropriate and don’t require others to make them come true or trod over the aspirations of others. Hoping well involves acting in a responsible way to make the hopes actual. Someone who hopes well uses her imagination to consider options and scenarios and then to take deliberate actions. Hoping well is a balance of recognizing limitations, making effort, and acting in ways that are responsive and responsible.
Can’t Have One Without the Other
Imagination and hope are fundamentally connected; one must be able to imagine possibilities before he can even hope for them. Only when one can hope can imagine ways to make the hoped for possibilities actual. Imagination is a species of rational thought. When one’s imagination is compromised (able only to imagine the horrific or unable to imagine something positive), a person will have a much harder time acting and living differently.
Philosopher/Psychologist William James clearly understood the relationship between imagination, hope, and the possibility of a person’s radically changing his life. In The Varieties of Religious Experience (1902), James uses the term “conversion” to mean a radical transformation of a person’s “habitual center of personal energy.” For James, conversions happen by a variety of means; there’s no need to posit a divine being who changes a person. A person can change himself under the right sort of conditions.
Two things are in the mind of a candidate for a conversion: first, the present incompleteness or wrongness…which he is eager to escape from; and second, the positive ideal which he longs to compass.
Hope Well in the Present, Draw From the Past
A person who is eager to escape a life in which he is actively addicted still has some hope. He can see that his life has gotten off the track he had earlier set it upon; he may not recognize his own life. What’s crucial is the quality of his hope; is he wishfully hoping, willfully hoping or hoping well? What kind of actions is he willing to undertake to get himself out of that “present incompleteness or wrongness” of his life? The first move, James claims, is to say “no” to that present way of living.
As a person becomes more severely addicted, he faces more obstacles in imagining “the positive ideal.” Perhaps he’s gotten habituated into all and always imagining the worst case scenarios. He has plenty of material or experiences to draw from producing negative or horrifying imaginings. Without some positive experiences and material, imagining a positive ideal is difficult if not impossible. Where might those positive experiences and material come from?
Someone who develops an addiction later in life might be able to to generate a positive ideal by drawing from experiences before his addiction became so severe. Imagination allows us to draw from the past and chart a course for a future. A person might be able to hope well in the present by drawing from the past.
Not everyone will have positive experiences that can function this way. One of the reasons why mutual support groups can be so helpful to people trying to stop using is that they can see others who shared an addiction but have altered their use.
In hearing stories about a person’s transformation, this may be the material for another person’s imagination. Someone else’s positive ideal may function as his own in the beginning. At some point, that person may be able to imagine possibilities for/of himself, begin to hope well for them, and take concrete action to realize that ideal. Doing this, James would say, is embracing that ideal with a resounding “yes.”
Images Courtesy of iStock
Baier, Annette. 1985. Postures of the Mind. Minneapolis: University of Minnesota Press.
James, William. 2012. The Varieties of Religious Experience. Oxford: Oxford University Press.
McGeer, Victoria. 2004. “The Art of Good Hope.” Annals AAPSS, 592.
When you think of foster care, what images come to mind? For many, one of the first images is the stereotypical scene of children being wrenched from a mother’s arms and thrust into a system where they will be shuffled from home to home for the rest of their childhood.
In truth, this has happened.
Pushing More Children Into the System
The opioid epidemic has resulted in more and more children entering the foster care system. In 36 states, caseloads have risen by risen by 10% between 2012 and 2016. In Washington state alone, the number of children removed from homes due to parental drug abuse rose 26% between 2012 and 2017. Recent data reveals “there are more children in foster care this year than there have been in the last nine years.”
But it doesn’t have to be like this!
Some states are trying to change these statistics. New approaches are being taken that focus on reducing the trauma of separation and helping parents complete drug treatment. The hope is to get parents the help they need, heal families and keep them together.
New Approaches For Addicted Parents
In the past, children have been removed from parents as they complete treatment. States such as Colorado and New Jersey are rethinking this approach. Many feel this simply doubles the trauma for both parent and child. Instead, states are offering programs that allow kids to remain with parents in treatment. Other options include a combination of care by relatives and the parent. Meanwhile, the parent receives mental health services to help them achieve recovery.
The DCFS in Nebraska has launched a Mom and Me program, which provides long-term residential treatment for moms while allowing them to remain with children under the age of nine.
In some states, if a child is exposed to substances that a mother uses, this is considered a form of child abuse. In New Jersey, state services do not use this definition. As a result, the state can provide more assistance to adults and their children in these situations.
In nearby D.C., similar efforts are being made. Their kinship care program allows relatives to take in children whom the courts have deemed at risk rather than assign them to the state. Drug treatment programs funded by Medicaid have also been initiated.
With these initiatives and others, such as Colorado’s Lift the Label campaign, states are seeking to reduce the stigma associated with drug abuse. The hope is to encourage parents to get help. This, in turn, will help the children and will reduce the number of kids forced into foster care. Across the nation, more and more efforts are focused on treatment, recovery and reunification.
There are lots of blameworthy villains responsible for the prescription opioid epidemic – e.g., greedy/ruthless drug companies and distributors; careless/corrupt doctors and pharmacies; and a government overly influenced by big pharma lobbyists that was shamefully asleep at the regulatory switch.
Most of the villains have escaped meaningful accountability or righteous punishment. There are more than a thousand pending lawsuits, but so far no clawback of blood money earned and no pharmacy executives behind bars for acts that amount to massive manslaughter. The great hope is that, eventually, there will be gigantic fines (a la big tobacco) to help finance a nationwide network of free treatment for those tricked into drug dependence.
Meanwhile, the burden of the epidemic has fallen almost exclusively on the ten million victims, their families and communities, and local and state governments forced to pick up the pieces. At least three hundred thousand people have already died from prescription drug overdoses, and many more have died from street drugs obtained when legal sources ran dry or they were overtaxed by ever-increasing levels of tolerance.
The federal government’s response was far too slow in identifying there was an epidemic of careless prescribing that needed preventing. Now, adopting Trump’s typically impulsive and heavy handed approach, they have been far too fast in offering simple solutions to complex problems. Government directives have added significant injury to the already considerable suffering of those already hooked on prescription opioids.
It is striking that one third of approximately forty-four million Medicare beneficiaries received prescription opioid pills in 2016. Of these, half a million Medicare patients were taking unusually high doses of opioids, and ninety thousand were found to be on extremely dangerous doses. About four hundred of the Medicaid funded doctors were especially high fliers, prescribing heavy doses to large numbers of patients.
Medicare clearly had to do something to tame the opioid epidemic among its beneficiaries. The most urgent regulation, and certainly the easiest, was to make it much harder for new patients with acute pain to get hooked on opioid meds they didn’t really need to be taking long term. Here, the new regulations Medicare introduced make great sense – limiting prescriptions for acute pain to just seven days. Previously, lazy docs were routinely and mindlessly prescribing a month’s worth of powerful narcotics to everyone as a way of reducing the incidence of annoying calls requesting refills.
But what to do with the millions already hooked? Medicare rightly recognized the obvious – that it makes no sense to artificially restrict opioid medication to end of life patients in palliative care, hospice, or long term facilities. The benefit of their continuing need for comfort medication far outweighs the risks in such situations.
Medicare’s mistake was in imposing arbitrary limits on the maintenance dose allowed for patients who are already physiologically dependent on opioid medication. Its top allowable doses are far below what many people had previously been prescribed as a holding dose. This could be construed as Medicare practicing medicine without a license. It has clumsily interfered in the doctor-patient relationship, providing strict general rules in what inherently must be a highly individualized, specific, and flexible process of deprescribing decision making.
Understandably, we have seen great outrage among large numbers of those patients forced (by the government) to experience and endure involuntary detoxification. Numerous anecdotal reports indicate that abrupt dosage reductions can push patients to use street drugs as a way to make up the difference and/or attempt suicide. The suffering is especially acute among patients taking opioids for chronic pain – the same patients who find detoxification to be especially difficult and sometimes impossible.
There is no one size-fits-all for those currently dependent on prescription opioids. Detox should be a voluntary decision and should always be done oh-so-slowly, under close medical supervision, and accompanied by comprehensive ancillary services that promote physical, occupational, social, and psychological rehabilitation. In most parts of the country, such services are either completely unavailable or unaffordable to those who most need them.
An adequate response to the needs of opioid victims will be provided only if there is a huge influx of treatment dollars, from government or pharma fines, but preferably both. It is unfair to blame the victims while requiring no accountability from the drug companies that caused the epidemic or the federal government that permitted them to get away with murder.
At the corner of happy and healthy? Not in Kentucky.
The Bluegrass State was home to over 3,700 drug overdose deaths between 2014 and 2016, and the Attorney General plans to hold Walgreens responsible for playing a role in those tragedies.
Kentucky is suing the pharmacy chain for acting as both distributor and dispenser of the opioids that are central to the state’s current crisis. Attorney General Andy Beshear explains, “I want to make sure these billion-dollar companies take responsibility and become part of the solution.”
The company is accused of profiting from the opioid crisis while ignoring obvious signs of substance abuse. The lawsuit claims Walgreens filled orders “for such large quantities of prescription narcotic pain medication that there could be no associated legitimate medical purpose for their use.”
Turning a Blind Eye
Walgreens operates 70 locations in Kentucky, and each licensed pharmacy is equipped to monitor for suspicious activity. Pharmacies have access to real-time data that allows them to view pill dosages and amounts, as well as the specifics of customer orders.
Every pharmacy is required to report suspicious orders to the DEA and flag any orders that are out of the ordinary parameters of prescribing and filling. However, according to the lawsuit, Walgreens did not take these actions and, as a result, the people of Kentucky have suffered immensely.
To pay for this neglect, the state is demanding the pharmacy giant cover the litany of related costs that have mounted across the state. The lawsuit lists a host of expenses including:
Kentucky isn’t the first to take such legal action (and the state likely won’t be the last). In a growing trend, Delaware also filed a similar suit against CVS and Walgreens. Florida has also filed an action against drug manufacturers. Similarly, the Cherokee Nation in Oklahoma made accusations against Walgreens, CVS and Walmart, who allegedly “flooded tribal lands with opioids.”
These legal ramifications seem to have gotten the attention of leading drug retailers. New restrictions, such as Walmart’s seven-day cap on acute painkiller prescriptions, are being added to pharmacy policies.
How Walgreens responds to this latest suit remains to be seen. The hope is that better restrictions and protocols at all of the major retailers will prevent future overdoses, reduce over-prescribing and ultimately help change the course of the nation’s opioid epidemic.
Blue states. Red states. Left-wing. Right-wing. The November elections emphasized how diverse political stances can be in our nation. Yet, one issue has brought leaders together. Leaving party lines behind, politicians are working to battle the opioid crisis in America.
This unity is evident in the legislation signed by President Trump on October 24th. In an otherwise divided Congress, this legislation gained enough support from both sides to make it to the President’s pen.
Addiction is a Neutral Party
Ohio Senator Rob Portman, who was a leading supporter of the legislation, explained, “Because of the severity of the crisis, and particularly in states like mine, people are willing to work together and join hands and figure out how to solve it and forget the politics.”
Opioids don’t care if you’re a Democrat or a Republican. Addiction is present in both camps.
Individuals and families in every state and every socioeconomic class have been impacted by the opioid epidemic. In fact, drug addiction is one of a select number of issues that Republicans and Democrats agree is a “very big problem.”
Addiction Prevention and Treatment
The new legislation is designed to deal with this very big problem at both ends. NPR reports that it is aimed at “helping people overcome addiction and preventing addictions before they start.”
How? Like any legislation, it is multifaceted. The extensive package includes:
Preventing foreign shipments of illegal drugs to the U.S.
Will This Be Enough?
Is this new legislation enough to turn the tide on the opioid crisis? Critics shout a resounding no. Even with the additional $6 billion Congress approved earlier this year, the funds allocated for fighting this battle fall short, critics say. The war is far from won, and we need continued efforts in this arena.
As Senator Maggie Hassan pointed out, “We have to treat this as a starting point. We have a lot more work to do.” Still, this work has to start somewhere, and hopefully this legislation is a step in the right direction.
The pantry was nearly empty. Two solitary cans of soup accounted for its remaining contents.Thefridge was barren and icy.The kindergartener and toddler sitting on the filthy living room floor had dirty clothes and rumbling stomachs. The five-year-old hadn’t been to school in two days, but that was preferable to last week, when her mom forgot to pick her up. This quiet afternoon was also better than the yelling that happened most nights. With their mom passed out on the couch, at least all was calm for the moment.
This scenario, and others like it, have become all too common in American households. Currently, over 30 million adults in the US struggle with substance abuse. For the families affected, drugs and alcohol direct their days. Childcare drops dangerously low on the priority list as addiction takes over the home. Kids are neglected, abandoned, or abused.
In Harm’s Way
Parents who are in a battle with addiction no longer think clearly. Their realities are altered; their perceptions skewed. Their responsibilities as a parent often take a back seat to getting their next fix.
As they suffer from addiction, their kids suffer, too. Children in these situations often experience abuse or neglect in several forms, whether through lack of attention or supervision to verbal, physical or sexual abuse.
Bearing the Scars
Understandably, it is extremely difficult for children who are raised in these circumstances to overcome them. Many prison cells are filled with inmates who suffered some type of abuse or neglect in their youth.
The examples set by their moms and dads, and the trauma the kids suffered, led them down a path all too similar to their parents’. The statistics are undeniable: children who grow up exposed to parental drug abuse tend to become drug users themselves.
Breaking the Cycle
Of course, this outcome is not inevitable. Parents, children, family members, and the community can take steps to break this cycle of addiction and abuse.
Perhaps one of the most obvious methods to help family beat substance abuse would be by seeking support in a community. Many areas offer children and family centers that provide a safe environment for kids and assistance for parents. It is important to establish and support these efforts.
Appealing to adults and children alike with drug education courses could also be effective. Schools and community programs often offer drug education for youth. This is essential. Kids of all ages must be made aware of the proper use of substances and the danger of abuse. Many are not hearing healthy messages at home, so it’s up to community leaders to deliver the message that could save their lives.
In some cases, it might be necessary to take more drastic measures – interventions. Removing the children from the home might be a necessary – if not temporary – step. Should you intervene if your loved one is addicted? If someone struggling with addiction is no longer able to properly parent, this could be the best thing for the child. Find out more about this process in part two.