Poetry. Addiction. Life.

Poetry. With just a few words it can make the most difficult feelings easily understood. Or it can transform the most mundane activity into a deeply humanistic ritual. I used to think poetry stripped things down to their basic essence but now I think it has the ability to alchemize life.

There is a belief that the creating artist suffers more than the rest of humanity. I do not believe this to be true. I had a Harvard professor (shout out to Vernon Howard!) who once said “one man’s opera is another man’s ball game.” He wasn’t merely being democratic – he was speaking the truth. Every day I am humbled by the breadth of artistic expression.

One artist I deeply admire is the Iranian born poet, Kaveh Akbar. I hesitate to explain what he means to me beyond revealing that he is in recovery and that his words seem to both inform, and include me. Miraculously he incorporates multitudes* in that his everyday language builds an opera of understanding around what it means to suffer, to dream, to survive.

 

RIMROCK – by Kaveh Akbar

Without the benefit of fantasy
I can’t promise I’ll be of any use.

Left to the real world I tend
to swell up like roots in the rain,

tend to get all lost in hymns
and astrology charts. Lately

I’ve been steaming away, thin
as cigarette paper, cleaning up

the squirrels that keep dying in my yard.
Each cascade of fur feels like a little tuft

of my own death. Am I being dramatic?
Mostly I want to be letters—not

their sounds, but their shapes
on a page. It must be exhilarating

to be a symbol for everything at once:
the bone caught in a child’s windpipe,

the venom hiding in a snake’s jaw.
I used to be so afraid of nature.

Peering up at a rush of rimrock
I imagined how unashamed it would be

to crush even me, a tiny stuttering boy
with glasses. I pictured myself

reduced to a warm globe of blood
and yearned to become sturdy in my end-

lessness, to grow heavy and terrible
as molten iron poured down a throat. Still,

I don’t know the rules. If I go looking
for grace and find it, what will grace

yield? Broken ribs, probably, flakes
of rust, an X marked in an atlas which itself

has been lost for ages. Oh, but I do
know what I am: moonstruck, stiff

as wet bamboo. I remember someone
once sang here, once strung together

a garland of near-holy moments.
It’s serious business, this living.

As long as the earth continues
its stony breathing, I will breathe.

When it stops I will shatter back
into gravity. Into quartz.

(*with another shout out to Walt Whitman’s Song of Myself.)

“ACE” made me do it.

There is a relatively new addiction model called Trauma Therapy. One of it’s chief proponents, Dr. Gabor Mate, explains that people are born perfect and adverse childhood experiences (ACEs) create trauma which leads to addiction. In an interview in The Fix Mate claims, “if children receive conditions of love and respect in their childhood, they’ll never be addicted, they’ll never get depressed and they’ll never be anxious.”

What qualifies as an ACE? Physical, sexual or verbal abuse, physical or emotional neglect, living with a parent who is abused or addicted, having an incarcerated or mentally ill caregiver, or suffering the loss of a parent through divorce, death or abandonment. The Centers for Disease Control developed these markers to identify people at high risk for obesity, depression and addiction.

According to Mate all IV drug users score positively on the ACE scale. Furthermore he insists if you do not recall childhood trauma then you are repressing it and in need of extensive “trauma therapy.” (If this is not a siren call for false memories then I don’t know what is.)

I shared my doubts with a follower of Dr. Mate. I explained that my child did not meet a single marker on the ACE scale. Stymied, they asked if her childbirth had been traumatic (which felt a bit like “mother blaming”). When I explained that she was the easiest of my childbirths I was told my daughter must be a victim of epigenetics. This was explained as “inheriting on a cellular level the trauma of previous generations.” I was then asked if something ugly could have happened to me as a child, something that I may not even recall. A subconscious molestation could be the reason I birthed an addicted child.

This does not sound like responsible science to me.

Epigenetics is the science of gene expression. It explains how the environment may turn on/off the expression of certain DNA coding. For example there is scientific evidence that extensive stress can cause permanent damage to the body’s production of cortisol. This makes sense since we are biological beings and our bodies interact with, and are affected by, our environment.

The proponents of an epigenetic basis for addiction cite work done by Rachel Yehuda Ph.D., at the Icahn School of Medicine. Dr. Yehuda hypothesized that genetic damage suffered by an individual could be passed down to future generations. She deduced this after finding an increased rate of anxiety, depression and obesity in the children of Holocaust survivors. She attributed their health problems to inherited faulty cortisol production and enzyme regulation; rather than asking if growing up with PTSD-affected parents could have produced an environment that fostered stress in the children.

It is important to note that Dr. Yehuda’s work has been debunked. The Chicago Tribune (citing various sources) reported “Yehuda’s study began with too small of a study size. Only 32 survivors and 22 of their offspring were studied. That’s a very small group on which to base this theory and a major study flaw.” The article further revealed a major flaw within Yehuda’s research: “While the team studied the children of women who lived through the Holocaust, they would have to study the great-grandchildren of survivors to prove actual epigenetic inheritance from mother to offspring. Why must four generations be studied? The eggs that made you were present inside your mother when she was a fetus inside your grandmother. Because a pregnant woman already possesses the DNA of her grandchildren and these genes can be affected by things during her pregnancy, the DNA of the great-grandchildren has to be studied to show that epigenetic changes were passed on across generations.”*

I also can’t help but think that if generational trauma was a prescription for drug abuse the species would be extinct by now. The circle of damage would have increasingly widened as generations multiplied exponentially through time.

Strict reliance on ACE is problematic on another level: it rigidly shuts the door on other causes of addiction. Purdue Pharma flooded the market with highly addictive pills that have been proven to change neuro-pathways in the brain. Are we really going to insist that those who got addicted did so because of early trauma (divorced parents possibly?) and not because they were the victims of corporate greed?

Interestingly Mate acknowledges that “not all of those who have ACEs become addicts, but all addicts have ACEs.” Why isn’t Mate questioning this discrepancy? Could the difference be attributed to the fact that some people are genetically predisposed? Or that they have less emotional resiliency because of a psychological disorder that is eased by substance use such as anxiety, bipolar, or depression?

Dr. Mate insistence that psychological disorders are created by early trauma is nonsensical. Babies are not born perfect! Every day children are born deaf, blind and lame. They have congenital heart defects, they have sickle cell anemia. To think that the newborn brain is inure to imperfection is ridiculous.

Imperfection is part of nature. I often ask my art students to go outside and find the perfect tear shaped petal, the perfect circular rock. They always come back empty handed and we marvel at the impossibility of it. It is only the foolish or megalomaniacal who dream of perfection.

My daughter is flawed – but not any more than me. She is stubborn, I am prideful. She is anxious, I have self doubt. She did not have a traumatic childhood; she had a fairytale one lived out in a house near the sea with a sister, a brother and a big fluffy dog. She tells me nothing untoward occurred during her formative years and I believe her. Can she benefit from trauma therapy? Of course. But it would be for trauma experienced while using.

Mate’s proposition is maddening because it is reductionist. And because it asks people who are already suffering to seek another layer of pain where none may exist. It also demands that science take a back seat to a condition that people are finally beginning to accept as a disease.

I feel traumatized by the possibility of it.

Stats… STAT!

Our children relapse. We are warned “relapse is part of recovery.” But I don’t think most of us believe it. By the time your child has a few years under their belt you get comfortable. You see a person emerge that you haven’t seen in years. Someone who is genuinely happy. Focused. Funny. Confident. Surely this person is here to stay.

But the fact remains. A mom I know confessed to returning to the days of sending canteen money to her son after his recent relapse landed him back in jail. She ended her dark missive with “why, why, why?”

It’s a rhetorical question I suppose. We know why. Giving up anything for a lifetime is a pretty monumental task. Giving up something you once loved more than life itself must be harder. Then throw in the added bonus of having an addictive personality or a mood disorder. Those are some pretty good whys. Sometimes I am amazed at the fortitude required to obtain 2-3-4 years of complete sobriety. It feels like a miracle. But I don’t want to think this way. I don’t want my daughter’s future to be dependent on a miracle.

Last week my daughter called me from detox. It was her third attempt in ten days. Her voice was hopeless as she numbly reported “only 1% of addicts ever make it mom.” I also have heard this number quoted. And I don’t like it.

We know statistics are manipulated to present a particular point of view. Is this one in existence because historically we haven’t cared enough to get the math right? Or has it been cultivated to justify poor spending on treatment?

This number was ringing in my head when I sat on an opioid forum last week. Beside me sat the head of a Massachusetts hospital emergency room department. He confidently stated that “involuntarily committing addicts to treatment is not recommended because we are setting them up for a higher rate of overdose death.” I am presuming his reasoning was based on the premise that this population is not interested in quitting drugs and therefore would return to using. I don’t question that deaths are higher among the involuntarily incarcerated vs. the voluntarily committed when treatment ends. It makes logical sense. But the data is flawed. The data is flawed because of “patient selection bias.” The doctor failed to include those who were NOT included in the data: those not forcibly committed to treatment. I venture to say that most of them are dead – or will be dead. Look at it this way: it’s like playing Russian Roulette with people who don’t want to quit the game. If you take away the gun some may eventually go back to playing with the gun. But if you DON’T take away the gun… well everyone is going to die. It’s that simple.

Are there better stats regarding relapse? Unfortunately there is a dearth of long term data. One of the few long term NIH funded studies followed 1,162 addicts for eight straight years. Published in the Journal of Alcohol and Drug Abuse it revealed that as the length of time in sobriety increases, so do the odds of continued sobriety. Those with less than a year have a 33% success rate. Those with over a year increase their odds to 50%. And those who achieve five years can expect an 85% future sobriety success rate. Data just doesn’t exist for those with 20 or 30 years of recovery time; but those who work in residential centers find their reappearance rare.

So we know clean time breeds more clean time. I remember joking a few years back with a local officer.  I asked him to handcuff my daughter to her bedroom radiator to prevent her from scoring. He smiled, but then seriously replied “yeah, I can’t do that…and neither can you.”

Since that day I have been searching for a legal means to success.  That searching even led to attendance at a spiritually based reading group (disclaimer: it is an act of desperation for me to turn toward faith for any sort of answer.)  What I found was that many of those in attendance were living a life of successful sobriety.  History, science, and society have not been kind to those suffering from the disease of addiction so we can not blame them for remaining in the shadows.  AA and NA use “anonymous” for a reason.  But by sharing their status this group become a living example of hope and, even better, a room full of positive odds!

It is still going to take a lot of unbiased research to get us solid numbers to stand upon.  Faulty statistical analysis, unfunded federal research, a lack of evidence-based treatment, and social stigma have led us to this unsettling place. To live within the world of addiction is to stand on shaky ground.

For now I will tell you what I can do. I can share a whole new set of facts with my daughter when I visit her at the hospital. I can tell her with confidence that the 1% success rate is inaccurate. And I will tell her with even more confidence that she matters 100% to me.

These are the only true numbers at my disposal and, for today, we are relying upon them.

I Am Never Tired.

I am never tired.
I am consumed by the what-ifs.
A 100 pound mother in boxing gloves with starry eyeteeth.

You can not tell me to let it die.
I will not let it die.

My furnace is stoked with yesterdays newsprint
dirty fingers licked by white sleeves,
silver smoke smothering all rational thought.

But rational thought is a white flag,
and I am a-boil in shaky embers and the bluest of ash.
I am aware that we are both a-simmer
vein deep in illogical warfare.

But I will not accept the prophetic precision
with which you stick your self made kewpie doll.
Make no mistake this is a race
Desperately filled with
red poppies, red poppies
ground into artificial blood.

But I will not be detracted from my stoking,
gathering tiny fairy twigs and discarded birthday ribbon.
I am a swollen bonfire
belching a message to the sky:
There will be no scorched earth today.
No more clotted dirt and darkened eye.

I am so very, very busy.
You see this fire, your fire,
I will not let it die.

Rainy Beach Day.

Exactly two years ago I wrote these words in my journal:

Sarah is still clean.
It is a miracle.
Others are dying though. Dying everywhere at an unprecedented rate.
But we all die. I think about this at the beach and I cry with relief.

I think about these words. I don’t remember writing them.
Was I crying because my daughter was safe?
Or was I crying because death is our shared destiny
– and how can you fear something so natural?

I don’t know.

Today my daughter is safe after her relapse.
But today I do not feel relief.
Maybe it is the rain. Or the wind signaling the end of summer.
Or maybe it is something internal that I just can’t access.

It could be fear for the future,
or stress over the uncertainty.
It could be sadness for her struggle,
or anger at my being unable to fix it.

It is probably all of these things.  And more.  I know there is more.

One thing is certain though – today I will visit the beach.

The Art of Telling Stories.

I recently joined a storytelling troupe. This is a weird one for me since I don’t like being on stage. No one would ever describe me as theatrical. But this particular group shares recovery stories. Wishing to ‘end the stigma” I felt a moral obligation to sign up.  Plus, let’s face it, I have a lot of ugly stories in need of a facelift. Quite possibly this group could help with that. And there was a selfish reason; I was searching for people whom I could talk to. I’m not a recluse; I have some pretty awesome, long-term friends. But the whole friendship thing gets complicated when your child suffers from addiction. Most of the time, your friends just don’t ask. I had been forewarned ‘when your child suffers from a disease like cancer you get cards and casseroles, but when your child suffers from addiction you get silence.’ I found this to be true. Five years brought me one card, and no casseroles. Occasionally I did get to share my experience… but the exchange became too lurid even by my standards:

Mom #1: “X can’t seem to pass his driving test and he is so depressed. I worry about his self esteem.”

Me: “Y is sleeping in a filthy motel forty miles away using type A narcotics. I can’t sleep at night worried that she may be dying as I lay here in my beautiful bed.”

You can see the problem.

So you end up alone with your thoughts, either by choice or because people don’t want to engage in this kind of exchange (how are they supposed to respond?) But if not careful your sense of isolation can fester into a wound of resentment. You can’t help but wonder what friendship is really for. You start to feel buried alive: your once perfect family is now dysfunctional and your friends are psychologically absent. It can be a dark place to find yourself in.

This time when my daughter relapsed I decided things were going to be different. I considered asking for what I needed. But I just couldn’t do it. It felt like asking someone to love you… pathetic and powerless.

Instead I opened myself up to new avenues of expression. The arts take Courage and Power (uppercase letters intended). I am going out on a limb here… but I would venture to say that the definition of good art is that it is emotionally complex, it inspires conversation, and that it accesses the buried but universal elements of human nature.

As suspected it wasn’t easy to stand up in a room full of strangers and entertain, inspire and heal with a broken hearted story. One teller spoke of a day when she had sat at a table littered with jittery tinfoil scraps and the small rocks of crack she had been hoarding. She describes her apprehension when a strange man decides to sit opposite her. When he offers her a little blue pill to help her come down from her teeth clenching high, it is not the free pill that takes her by surprise. It is the impossible blue of his eyes. Suddenly the drugs became secondary to basic human connection. I could feel my head nodding. Connections can be made in the most difficult of environments. And the truth is that those who say you can “do it alone” are either misguided or lucky enough to not have been in too dark of a place.

One of the last storytellers spoke sadly of the loss of her marriage and self control to drug use. And of her dad’s steady effort to take her on long daily walks. On stage she mimic’d how her father, on these walks, would steal long wordless glances her way. It was all she needed; to be fully seen and quietly loved. To be fully seen and quietly loved – it is the only thing any of us truly need.  Life had taught me this.  And the arts gave me the means to express it.

 

 

Angry about (t)HAT.

I can’t help being angry about “HAT.”  HAT is the acronym for ‘heroin assisted treatment.’ A vocal minority is currently pushing for the legal prescription of heroin. Yes, you read that correctly. Before your head spins on it’s axis, consider that the aim is a noble one: ending death by overdose. Lives should be saved because the prescribed heroin would be pharmaceutical grade; not tainted by fentanyl, carfentanil, or any of the dozens of additives and poisons that can make up a street purchase.

HAT isn’t the brainchild of businesses trying to cash in on a future market (like WeedMaps, a California based online marijuana dispensary which is funding pro-marijuana lobbying groups in Massachusetts). Nor is it coming from those seeking lost tax revenues or the end of illegal street dealing and the crime that accompanies it. Instead it is voiced by those whose opinion should be highly valued: former addicts.  And by addiction counselors whose only motivation is saving the lives of their clients.

Disagreeing with such individuals gives me great discomfort.
But I feel strongly that HAT would be a mistake.

Prescribing heroin to an addict feels like giving up on them. (Would we prescribe bottles of vodka to an alcoholic so they wouldn’t drink antifreeze?)  These substances are KILLING them.  The ugly fact is that those who suffer from addiction are not going to quit until their life becomes unmanageable. Unmanageable may never come if we hand them their poison. The counterargument would be that HAT is successful in the Netherlands, Germany, Canada and Portugal. But they measure success by the decrease in deaths by overdose. You may have less death, but you may also have less recovery.  Isn’t recovery the goal?

Besides the ethical implications, there are practical ones, What sane physician would prescribe heroin? I can hear the counterargument: doctors have been happily prescribing oxycontin for decades so why stop now? While it is true that some willfully ignorant doctors bear partial responsibility for the opioid epidemic, most were deliberately duped by Big Pharma’s false claim that oxycontin was non-habit forming. Then, as an added blow to responsible prescribing, insurance companies tied doctor compensation to patient pain management (thanks again to Big Pharma’s funding of fake focus groups). But the past is the past and I can’t imagine finding a nation of doctors willing to prescribe what they should not have been prescribing in the first place.

HAT will have its supporters if the movement gets off the ground. One of them is certain to be the insurance industry. Did you know that heroin costs $5 a bag? On the other hand Vivitrol, a medication which blocks the effectiveness of heroin, costs $1000 a month. Which do you think your insurance company would rather cover?

I bet Big Pharma will also sign on for HAT. Why not get the green light to repackage oxycontin as heroin and continue to profit from the misery of others? I feel like smashing my t.v. on a daily basis when I see Purdue Pharmaceutical marketing their new pill Symproic to help opioid constipation. The joke is most certainly on us.

Possibly the biggest obstacle to prescribing heroin may be the addict themselves. As my daughter confessed “enough is never enough.” Will we have to continually increase the amount of heroin we prescribe as their tolerance increases? And if we do not will they trade their prescription for fentanyl laced street dope? My child told me that many addicts seek out fentanyl for the higher high. Let that sink in.

There is a saying that “if we could ‘love’ our addicts to health there would be no addicts.” There are so many of us out here, right now, seeking a quicker, better, safer solution. I know of a parent who drove their child to purchase heroin, waited in their car fitfully until they returned, and then watched them inject it because they needed to test positive for detox admission. Can you imagine being that parent? No one, no one, wants to be that parent.

Legally prescribing heroin….it feels like being that parent.