“They knew I was pregnant when I was being arrested because the officer threatened to throw me on the ground, and I told him, ‘Please, I’m 16 weeks pregnant — don’t,’” Leslie, who is using her first name only for privacy reasons, told Salon in a phone interview. “I told the officers … that I would be going through withdrawals, and I was already going through withdrawals when I was arrested.”

Withdrawing “cold turkey” from opioids while pregnant increases the risk of preterm birth, low birth weight, and stillbirth. Opioid withdrawal causes severe pain, nausea, vomiting and in rare cases, seizures. Withdrawing from some substances, including alcohol, can be fatal.

Medication-assisted treatment with medicines like methadone or buprenorphine is the standard of care for pregnant people with substance use disorders who are withdrawing because it can drastically reduce these health risks. Yet medicines like buprenorphine and methadone are not always available to pregnant people who are incarcerated.

Shanya, also in North Carolina, withdrew from opioids while pregnant in jail without access to medication-assisted treatment as well.

“It was not a good living situation,” Shanya, who is also using her first name only for privacy reasons, told Salon in a phone interview. “It was dirty. And I had a shower that never cut off, so the floor would be drowning and there was mold all in there.”

Anecdotes from pregnant people paint a grim picture of the state of maternal health care in the carceral system. Women have been reported living in degrading conditions and giving birth shackled to their bedposts. In 2023, a woman in Tennessee gave birth by herself on the jail floor. Dr. Hendrée E. Jones, director of the Horizons Program for pregnant women with substance use at the University of North Carolina, said she had one patient who had a miscarriage by herself on a jail floor.

“Jail is not the place that creates a context for healthy pregnancies,” Jones told Salon in a phone interview.

Still, there is not a clear picture of what maternal health care looks like in this system because there is no national database tracking the health of pregnant people who are incarcerated, said Dr. Carolyn Sufrin, an associate professor of gynecology and obstetrics at the Johns Hopkins University School of Medicine who started a research center dedicated to studying reproductive wellness and incarceration to better understand how pregnant women in prisons and jails are being treated. Sufrin estimates that roughly 8,000 pregnant people with substance use disorders are admitted to prisons and jails each year based on data collected through this project. 

Her research has demonstrated how variable the experience of a pregnant person with substance use while incarcerated can be. Some jails might not have a doctor or nurse on staff that can provide prescriptions, having to transport people with medical needs to a local hospital for care. Others may have them on staff, but with limited hours. And some have managed to find a way to administer medicines like methadone effectively, she said.

But many do not. In one study of 22 prisons and six county jails, one-third of pregnant people with opioid use disorder were not given medication-assisted treatment, and of those who were, very few initiated it in custody. In another study where Sufrin’s research team conducted interviews with opioid treatment providers with pregnant patients in custody, many reported that their local jail did not offer medication-assisted treatment to incarcerated pregnant people. 

“In many cases, there is a lot of negative stigma toward not only patients but also the medications, where people assume it’s just substituting one drug for another,” Sufrin told Salon in a phone interview. “Sometimes people who work in jails just don’t believe this is an appropriate treatment and they don’t want any opioids in their jail — even if it is methadone or buprenorphine treatment.”

Abortion access while incarcerated is also limited. One study Sufrin conducted found half of states allowed women who were incarcerated to have abortions in the first and second trimesters, but 14% did not allow them at all. Two-thirds of the prisons that did allow abortions also required the woman to pay. 

Prisons are the only place in the U.S. where people are guaranteed health care due to a 1976 decision handed down in the court case Estelle v. Gamble. For Shanya and Leslie, prenatal care and addiction treatment were provided once they were transferred from jail to prison, they said.

Some states, like California and Maryland, do specifically have legislation in place requiring screening and treatment for substance use disorder in jails and prisons. But they are the minority: According to a 2023 study, 43 states had at least one statute related to pregnant and postpartum people who were incarcerated, while seven had statutes related to substance use disorder screening and treatment.

In February, U.S. Senator Jon Ossoff introduced a bill that would require states to report information about pregnancy care and outcomes for people who are incarcerated after an investigation from his office last year found women in Georgia had given birth on their own, been shackled around their stomachs, and were forced to undergo C-sections against their will, according to a statement from his office.

The U.S. Department of Justice is also expected to release results from a survey of pregnant people who are incarcerated this year after a 2024 report from the U.S. Government Accountability Office found that "comprehensive national data on pregnant women incarcerated in state prisons and local jails do not exist.”

As it stands, the U.S. Department of Corrections and the Federal Bureau of Prisons both have dedicated medical branches to oversee health care in the carceral system, but there are no external agencies or committees to ensure standards are met, Sufrin said. 

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“That constitutional requirement never came with any required set of health care services or standards or systems of oversight, and so what you get is total variability,” Sufrin said. “Some facilities do provide a reasonable measure of comprehensive pregnancy care, including access to treatment for opioid use disorder, but many do not, and there is no systematic established oversight of prisons and jails in the United States when it comes to health care, including pregnancy care.”

In some states, like Tennessee and North Carolina, pregnant people can be sent to prison legally through “safekeeper” laws before they are convicted if it is deemed that there is not adequate medical care in their jails. Although these laws were designed to provide care to inmates who need it, they effectively take away a person’s freedom, Jones said.

“The other way to think about it is, doesn't that jail that has now taken away a person's liberty have an obligation to uphold the human right to provide adequate medical care?” Jones said. “Basically, you are in prison because of your pregnancy.”

Often, pregnant people are incarcerated because of charges related to their substance use. In a report by Pregnancy Justice released last year, nearly all of 210 cases in which a pregnant woman was prosecuted involved substance use. Ninety percent of charges were for some form of child abuse, neglect or endangerment wile 86% of cases did not require prosecutors to find evidence of harm to the fetus — meaning it was up to the judge to decide if an embryo was being put at risk due to substance use.

This particularly impacts women of color, who are prosecuted at higher rates for drug use despite using the same amount of drugs as white women. The Pregnancy Justice report showed that low-income women were particularly targeted by pregnancy criminalization as well. And in 16 cases, women were charged in connection with using medication-assisted treatment to treat addiction, said Dana Sussman, senior vice president of Pregnancy Justice. 

“There have been reports about people who are following their physician’s guidance… and still facing family policing investigations or child welfare investigations,” Sussman told Salon in a video call. “The systems are stacked against you if you need to continue on medication-assisted treatment.” 

While pregnant women can sometimes be prosecuted more strictly because of their pregnancy, the level of care they receive also seems to be tied in many cases to their pregnancy, Sussman said. For example, access to medication-assisted treatment is often removed once pregnant people give birth, even though this is a particularly vulnerable time for relapse, overdose and death.

In Sufrin’s study, two-thirds of prisons and three-quarters of jails that did provide medication-assisted treatment to pregnant people discontinued it after mothers gave birth. This was something that providers reported as well.

“They recognize that [medications for opioid use disorder] support the health of the fetus, but once there is no more fetus and the woman is no longer pregnant, their interest evaporates,” Sussman said. “They don’t actually care about the woman’s survival or the woman’s health.”

Overdose has been identified as one of the leading causes of death in the postpartum period, with mortality rates increasing by more than 80% between 2017 and 2020. Although medication-assisted treatment can reduce the risk of overdose by up to 60%, only about one-third of women with substance use disorders receive this care postpartum. This is especially important for new mothers who are being released from jail or prison, which is also a time that has been associated with an increased risk of overdose.

“[Pregnancy] is a real opportunity for intervention,” Sussman said. “But if they can't find [medication-assisted treatment] or they're cut off immediately after pregnancy, then they are set up to fail.”

It can be difficult for women to get this care postpartum due to bureaucratic barriers, said Sara Brown, director of the Pregnant and Parenting Women with Children program at the Nexus Family Recovery Center in Texas, which provides services to pregnant and postpartum women with substance use.

Brown said one of her clients, for example, doesn’t have transportation but has to travel to another city just to receive medication-assisted treatment. New mothers also have to juggle finding and paying for childcare during this time, as well as making it to probation or parole appointments and meeting requirements from Child Protective Services — all while experiencing the typical roller coaster of an experience it is to become a new mother.

“It’s hard for them because they have court dates and they're talking to their attorneys while trying to stay sober, be a mom, and focus on their pregnancy,” said Lindsay Malhotra, director of outpatient services at Nexus. 

Although CPS is a social service agency, it has a lot of overlap with the criminal justice system. Because many women fear having their children taken away due to substance use, they may not disclose their use to their providers, who are mandated to report them. This serves as another barrier separating them from treatment.

“I’ve had patients tell me they tried to hide their pregnancy so that their methadone provider didn’t know because they were worried they were going to be turned away,” Jones said. “We have certainly had patients come to our OB clinic saying they were ‘fired’ by their addiction treatment provider because they were scared that they were pregnant."

While CPS can protect children from harmful situations, children who experienced interactions with CPS have an increased risk of incarceration, substance use and having CPS involved with their own children later in life. Having a parent who is incarcerated is itself an “adverse childhood experience,” (ACE) a label used by researchers to define a traumatic experience that has lasting health consequences, including an increased risk for substance use. 

All of this together creates a system in which trauma related to substance use and incarceration perpetuates in future generations, said Dr. Mishka Terplan, an OB-GYN and addiction medicine doctor at the Friends Research Institute.

“Children are being raised, either through [the criminal justice system] or child welfare, separate from their parents, and accumulate ACEs,” Terplan told Salon in a phone interview. “These lead to addiction which leads to people being incarcerated, and it’s like a feedback loop.”

Sources say this system is likely playing a role in the maternal and infant mortality crisis, although getting a complete picture of the role that incarceration and substance use plays in this crisis is once again challenging because it relies on states, which do not always report. For example, Texas skipped reviewing the first two years of maternal mortality data after implementing its near-total abortion ban. In November, Georgia dismissed all 32 members of its committee that reviews maternal deaths after investigative reporters linked two maternal deaths to the state’s six-week abortion ban.

Jessica, a new mother that was released from jail after spending seven months of her pregnancy there waiting for a court date, is currently staying at Nexus Family Recovery Center, where she is connected to addiction treatment services including medication-assisted treatment. Yet of more than 11,000 centers across the country designed to care for pregnant and postpartum women, fewer than half administer medication-assisted treatment. Those that do are not enough to meet the demand; Nexus has a waitlist of about 10 women, Brown said.

“We are already seeing programs shut down this year,” Brown told Salon in a phone interview. “[These are programs] that helped people prepare for career opportunities, prepping them for interviews, and all of those things.”

Although Jessica will spend the next several months at Nexus, where her treatment is covered by her insurance, she worries about how she will afford and manage all of the requirements the courts and her treatment demand when she finishes her time there. She has already had to pay thousands of dollars in restitution fees.

“I felt like this was kind of setting me up for failure,” Jessica, who is using her first name only for privacy reasons, told Salon in a phone interview. “One of my concerns is how this is all going to play out, but I am just taking it one day at a time.”

Like Shanya and Leslie, in North Carolina, Jessica was connected to the pregnancy and postpartum program at Nexus that provides addiction treatment while she was incarcerated. 

“I was ready to get my life together,” Jessica said. “I needed help, and I knew Nexus had great resources, so I decided to give it a try.”

Now, all three women have had their babies and remain in treatment. Jessica’s son is doing well, and at nine-weeks old, Leslie’s daughter is hitting all of the growth milestones she should. Shanya’s son just started daycare at the center this week.

“If I hadn't come here, I don't think that I would be sober, and I would probably still be on the streets,” Shanya said. “Being in this program has done wonders for me and my son.”

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“Using Suboxone has greatly helped me not only be free of drugs and alcohol for the whole time being here, but it’s my livelihood,” Kim, who is using her first name only for privacy reasons, told Salon in a phone interview. “I can’t function without it — and I’ve tried.”

In the 20 years that Kim has been using buprenorphine, there have been several times where changes in her life, like her move, or changes in policy have abruptly cut her off from her medication. She has been able to access treatment through Medicaid, the health insurance program for low-income Americans, uninterrupted for the past couple of years. But she worries that budget cuts being debated by Republicans could take that away.

“This saved my life… and it can save a lot more,” Kim said. “I don't understand why you would try to take it from people.”

Medications like buprenorphine and methadone are considered the gold standard for treating addiction, according to decades of research, because they can reduce deaths as well as improve social functionality. Increased access to these drugs is thought to be a major factor contributing to the first significant reduction in national overdose deaths to occur since 2018. Although 87,000 Americans still died from overdoses in 2024, a decline of 24% from the previous year, many are concerned this progress could be lost, especially if the federal government makes significant cuts to Medicaid.

“It’s time to double down on all of the things that have been working, not reverse them,” said Stephanie Strong, co-founder and CEO of Boulder Care, a telehealth addiction treatment center. “That’s what I fear will happen if people lose their health benefits.”

President Donald Trump has promised to cut between $1.5 and $2 trillion from the federal budget in the next decade. Although he has said he will not cut Medicaid, Senate Republicans have been debating whether to overhaul the program. 

Some are skeptical that the administration will cut Medicaid significantly, but an analysis performed by The Congressional Budget Office earlier this month found that it would be impossible to find enough cuts elsewhere that do not affect Medicaid in some way. 

Medicaid, the largest source of insurance for addiction treatment, has demonstrably saved lives and improved access for many people seeking addiction treatment. In one 2020 study, Medicaid expansions were associated with between 1,678 and 8,132 lives saved from an overdose between 2015 and 2017. Another 2021 study found admissions for addiction treatment were 36% in states that had expanded Medicaid four years after the expansion compared to ones that had not.

“Probably the single biggest policy-level change that has benefited addiction treatment has been guaranteeing Medicaid and Medicare coverage for medical treatment of addiction with methadone and buprenorphine,” Dr. Ryan Marino, an emergency medicine physician at Case Western Reserve University School of Medicine, told Salon. “More people are certainly able to access evidence-based treatment, and lives have been saved.”

Trump’s stance on drug policy seems to largely be focused on the criminalization of drugs rather than treating the overdose crisis like a public health issue, which experts say is not as effective in stemming the overdose crisis. Trump has said that he issued high tariffs on Mexico, Canada and China because “they’ve allowed fentanyl to come into our country at levels never seen before” and has even threatened war with drug cartels. But this week, the Trump administration also extended an emergency declaration to address the national opioid crisis, first declared in 2017, which allows for some expedited decisions to be made related to substance use disorder treatments.

Still, if the Trump administration does cut Medicaid funding, regions in which its constituents live could be hardest hit by the decision. In West Virginia and Tennessee, for example, two states where Trump won the vote in the 2024 election, upwards of 20% of the population is on Medicaid. And these two states have some of the highest rates of per-capita overdose deaths in the country.

Medicaid funding not only expands access to medication-assisted treatment like buprenorphine and methadone, but also funds things like group or individual therapy as well as programs that help people find employment and other aspects of recovery in certain states, said Dr. Elizabeth Stone, who researches health services and policy at Rutgers University.

“Recovery is an ongoing process and for people who are stabilized with medication for opioid-use disorder or are seeing their therapist regularly, losing insurance coverage can be a really high-risk time for harm,” Stone told Salon in a phone interview. “Downstream, then you’re also potentially having people even less likely to access care than they already are now.”

If Medicaid access is reduced, Kim worries about the time it would take to switch over to another insurance, if she could even find one she could afford.

“That would be days or weeks from getting any kind of insurance, and if you are sick and going through withdrawals, you’re not going to wait,” Kim said. “You’re going to go and do whatever you can to get to feeling better.”

Policies that cut Medicaid might include taking away coverage from people who don’t meet certain work requirements or limiting payments given to states, pushing the states to make the cuts. 

But cutting work requirements, for example, has been tried by some states without success. In Arkansas, a temporary program with these requirements led to the loss of coverage for thousands of people but did not increase employment.

“My perspective is that they're not actually effective in reducing the number of people who are eligible for Medicaid, they just create more hoops and ultimately, more costs and administrative waste,” Strong told Salon in a phone interview. “[We need to be] making sure the resources are going to the right places, and leveraging technology and telemedicine to offer care that's lower cost and more available in rural areas, rather than investing in building more facilities and more beds.”

Nevertheless, whether potential cuts to Medicaid funding would in fact cut costs is unclear. Like with any medicine, reducing access to treatments used for addiction can make people seek care when they have more health care needs, which ends up costing more money. In one 2021 analysis, all forms of medication-assisted treatment (buprenorphine, methadone and naltrexone) were associated with up to $100,000 in lifetime cost savings per person compared to people who were not treated.

Additionally, because the Centers for Medicare and Medicaid Services covers such a large portion of the population, the center can often negotiate drug prices to be lower, which affects the market and can benefit people on other insurances, Marino said. 

“They're saying that they're saving us money by doing these cuts, but there are very few things that are as cost-effective as Medicare and Medicaid,” Marino said. “Not only because of the kind of preventable health benefit and downstream economic benefits, but also because CMS can negotiate down the prices of drugs, and even people who are on private insurance then get benefits.”

Some hospitals and treatment centers are also dependent on reimbursements from CMS, so even a small cut in Medicaid could affect their funding and lead to shutdowns, Marino said. 

“That is going to impact not only people who are in addiction treatment,” Marino said. “If the closest hospitals shut down and you now have to drive 30 minutes away when you’re having a stroke or a heart attack or someone is overdosing, that is going to lead to a lot of additional problems.”

These decisions are expected to be made in mid-2025, when Congress faces a deadline for passing Trump’s agenda. For now, the close to 4.9 million people using Medicaid for addiction treatment will have to wait and see if they are impacted.

“We’re trying to get ourselves better and we’re trying to be drug-free,” Kim said. “I would hope that the government could see that.”

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National data compiled by the Centers for Disease Control and Prevention show roughly a 20 percent drop compared to the previous year. This breakthrough is in large part because of a push by the Biden administration for greater access to harm reduction and treatment services for people who use drugs. As Robert F. Kennedy Jr. takes up his position as secretary of the Department of Health and Human Services (HHS), he has an opportunity to build on this progress toward bringing the overdose crisis under control.

Unfortunately, based on his prior comments, Kennedy has not given us reason to be optimistic. During his presidential campaign, he vowed to address the overdose crisis by creating a network of camps or “healing” farms where individuals would be sent to recover by "reconnect(ing) with America’s soil.”

In Kennedy’s view, people could either go to these camps voluntarily or be coerced through the threat of incarceration if they do not comply. (Bizarrely, he has also suggested that people who take some medicines for depression or anxiety, like SSRIs, might benefit from these farms too.)

Drug treatment farms may sound idyllic, but, in practice, they are often rife with abuse. Moreover, there is dubious evidence that they are even effective. In fact, America has tried this approach before. In 1935, the government opened the U.S. Narcotic Farm in Lexington, KY. It was closed 40 years later amid allegations of medical experimentation on patients. It also had a poor record of effectiveness: research found that 90 percent of people returned to drug use after leaving the confines of the facility.

Kennedy’s drug farm idea appears to be inspired by a decades-old program in Italy, where people who use drugs are made to work on a large farm. There have been accusations of abusive practices like shackling, beating, public shaming, and confinement in cages at these very farms. This is sadly not an anomaly.

Open Society Foundations, where I direct work on drug policy, has long documented abuses in centers that purportedly provide drug treatment, but where the mainstay of “treatment” is in fact forced labor. Survivors of these centers and other experts have chronicled torture and ill-treatment in settings as disparate as China, Russia, and the Dominican Republic. Numerous international organizations, including the International Labour Organisation have decried the abuses in these programs and called for them to be shut down.

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There is simply no evidence that performing manual labor somehow helps people quit drugs or reduce their risk of overdose. We know what does work: methadone and buprenorphine are fundamental to good opioid addiction treatment and are proven to cut the risk of overdose in half. (Kennedy at least gave lip service to these medications during his confirmation hearing.) Easy access to naloxone, a proven and highly effective medication that reverses opioid overdoses in real time, saves lives when distributed directly to people who use drugs. Drug checking is a newer approach that lets people test their drugs to see if they contain fentanyl or other risky substances, helping to keep them safer. Overdose prevention centers offer a safe space where people can use their drugs with trained staff nearby, ready to assist in case of an emergency and provide connections to treatment and support services.

Kennedy would do well to follow the science and fully fund these types of programs, rather than diverting funding toward “healing farms” or reverting to drug war approaches that have failed us for decades.

Kennedy is in long-term recovery from addiction himself, having quit heroin 42 years ago. His own story of remission from drug use involves him being arrested, put on probation, and then attending treatment and twelve-step meetings. Just because that worked for him, though, does not mean it is the right prescription for everyone. In fact, research tells us that opioid dependence treatment without medications puts people at greater risk of overdose than no treatment at all.

Our collective understanding of the science of addiction has drastically advanced since Kennedy stopped using drugs in the early 80s. As HHS secretary, Kennedy will oversee departments like the Centers for Disease Control and Prevention, the Substance Abuse and Mental Health Services Administration and the National Institute on Drug Abuse that control billions of federal dollars to address drug use and addiction.

In his new role, Kennedy must heed the science and expert advice and continue to fund programs proven to work. If he does not, the overdose gains of 2024 may turn out to be short-lived.

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A portion of the millions of people in the U.S. participating in AA find the 12-step program helpful, but others have criticized it for lacking efficacy and taking a white-knuckle approach to recovery. Moreover, many treatment models like this fail to take into account co-occurring and underlying traumatic experiences that drive a large portion of people to self-medicate with drugs in the first place, said Maia Szalavitz, a journalist who writes about trauma, addiction and her experience going through some of these programs.

“So much of our addiction treatment is actively traumatic,” Szalavitz told Salon in a phone interview. “It tells people, ‘Sit down and shut up, and your best thinking got you here,’ and there is this idea that you should take moral inventory because you have a problem you created.”

Estimates suggest roughly three-quarters of people who use drugs have experienced trauma, but many addiction treatment facilities do not incorporate the level of trauma-informed care people with co-occurring trauma and substance use require, risking further stigmatization and even retraumatization, Szalavitz said.

“If you want to actually treat addiction, we need to help people deal with trauma,” Szalavitz said. “Now this does not mean that you go to rehab and they tell you, ‘Okay, tell me about your sexual abuse,’ because this could be actually very harmful. You need to deal with this stuff sensitively and on the person's timetable.”

Research shows that treating post-traumatic stress disorder (PTSD) or other symptoms of a traumatic experience also helps people with their substance use, likely because most people use drugs as a way to self-medicate or cope with stressors or overwhelming emotions — like those accompanying trauma, said Dr. Denise Hien, the director of the Center of Alcohol & Substance Use Studies at Rutgers-New Brunswick. 

“Our messaging around it is… we have to get you to face the feelings and realize that you can live through them and you can heal,” Hien told Salon in a phone interview. “When we do that, it’s amazing what happens to people in their transformation, and they stop using substances or reduce how much they are using.”

In one randomized control trial, clinicians assigned people with these co-occurring conditions to receive one of the standard treatment models for trauma called prolonged exposure, in which physicians review the traumatic event with patients in a structured manner to help them regain autonomy over it, in addition to relapse prevention therapy and relapse prevention therapy alone. The group that received both had significantly improved mental health symptoms compared to the control group of people that received relapse prevention therapy only.

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Although substance use remained constant in this trial, other studies have shown that changes in traumatic symptoms can have downstream effects on substance use, said Dr. Teresa Lopez-Castro, an associate professor of psychology at the City College of New York and one of the trial's investigators.

“We did all of this work with people and their substance use was not exacerbated,” Lopez-Castro told Salon in a phone interview. “What we see is this mediation effect where the change in substance use disorder is taking place through PTSD symptom reduction.”

Understanding the origins of substance use 

Deep-seeded stigma surrounding substance use can ostracize people who use drugs and put them in the moral wrong, with programs like AA focusing on confronting the behavioral factors that lead a person to use drugs. In recent years, as the understanding of addiction has improved, more research has been focused on the biological underpinnings of substance use, mapping neurological differences in people who use substances and those who do not, developing questionable genetic tests that claim to predict the risk of developing substance use disorder, and even creating an addiction vaccine.

Although understanding addiction as a biological mechanism can potentially help reduce stigma and make it easier to develop better treatments for substance use disorder, some argue that this model strips people who use drugs of their autonomy and makes addiction seem like an irreversible condition from which people can’t recover — which is not the case.

“When we only focus on the brain component and you kind of disembody it and remove it from the person’s psychology, the social context, and the physical context, that’s when we get into trouble,” Lopez-Castro said.

The reasons people gravitate toward substance use are still being understood but are thought to share both biological and environmental influences. Substance use does seem to involve some sort of genetic vulnerability that can be exacerbated when paired with certain exposures or experiences in one’s environment like trauma, Hien said.

Nevertheless, once both occur, trauma and substance use can help “maintain,” each other, Lopez-Castro said. Trauma and the body’s chronic stress around it has been shown to change certain parts of the brain involved with executive functioning and the body’s reward system, which are also impacted by substance use when people use these agents to cope.

When considering the criminalization of drug use, the relationship between trauma and substance use becomes even more complicated. Dr. Kim Sue, an addiction medicine physician whose book "Getting Wrecked" concerns women with substance use disorder who were incarcerated, said the experience of being imprisoned makes existing trauma or mental health symptoms worsen for the people she works with. 

“Addressing trauma also means addressing community systems, racialized traumas caused by drug policy, and providing and being able to meet people's current and future needs in a stable environment,” Sue wrote to Salon in an email. “We should also think about what it would look like to prevent trauma and prevent substance use disorders, by early treatment and  timely intervention after traumatic events, especially for young people.”

Barriers to incorporating trauma-centered care

Some trials are being conducted to test whether certain pharmaceuticals could target the shared biological underpinnings of trauma and substance use, including MDMA-assisted therapy, which utilizes the psychedelic-adjacent drug also known as ecstasy. But many of the recovery programs tasked with the overwhelming task of treating the millions of Americans with substance use disorder do not incorporate a trauma-centered approach, Hien said. 

“A lot of places will say [they] do trauma-informed care, but what trauma-informed really means is that they understand that people have trauma, and maybe they're kinder to people,” Hien said. “But it’s not really doing the trauma-focused treatments and giving the medications that have been shown to actually work and help people.”

Many harm reduction programs do the best they can to treat people with the resources they have. Yet these programs are chronically underfunded in relation to the scale of resources needed to treat the U.S. population seeking help. 

“There are system-level barriers because specialists have to know how to treat mental health conditions or need to be in conversation with people if it demands a system that is integrated, with collaboration between psychiatrists, psychologists and counselors,” Lopez-Castro said. “That takes energy and a culture change, which we see happening, but it is quite slow.”

Some providers also fear that treating trauma in people with substance use would be opening Pandora’s box and could cause a person to relapse, although that has proven to not be the case, Lopez-Castro said. 

“It's almost like, ‘don't ask, don't tell’ in the sense that they don't even want to ask about it because if they ask about it, then they'll feel like they have to do something,” Hien said. “But they don't have anything to offer.”

Ultimately, that approach ignores the root of substance use disorder for so many. Although progress has been made in recognizing and treating co-occurring substance use disorder and trauma conditions, there is still a long way to go to ensure people using substances are getting the resources they need to heal from both.

“We have this whole false idea that most addiction is about seeking excess pleasure, and, in fact, most addiction is about trying to be okay,” Szalavitz said. “If we want to have less addiction and less harm associated with addiction, we have to improve people's lives.”

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But the price paid for childhood fame sometimes results in long-lasting emotional damage stemming from unspeakable traumatic experiences. Just look at current Netflix rom-com star Lindsay Lohan, a symbol of resilience from the child actor's plight. Lohan survived the Disney machine – ever since achieving acclaim in the "The Parent Trap" remake – and even transitioned to respectable teen stardom in films like "Freaky Friday" and "Mean Girls."

Unfortunately, she then became party girl tabloid fodder alongside starlets like Paris Hilton and Nicole Richie. A string of arrests and DUIs, in addition to public battles with her parents over control of her finances only continued this impression. In adulthood she lost a series of roles, was panned for numerous performances and eventually entered rehab.

Nevertheless, more than a decade after her very public downward spiral, Lohan has rebounded personally and professionally. She is now married and gave birth to her first child. Her comeback has made way for the actress to become a part of the Netflix rom-com universe. Her second movie "Irish Wish" currently sits at No. 1 in the Top 10 movies in the U.S.

However, not everyone has been awarded a second chance after their career came to a halt at 25. This is what the Discovery Investigation series "Quiet on Set: The Dark Side of Kids TV" explores as the damning docuseries details deeply unsettling and abusive experiences from the sets of Nickelodeon's most popular shows like "All That," "The Amanda Show," "iCarly" and "Drake & Josh." The docuseries underlines that the entertainment industry has done a poor job of protecting children on set, often leading to arrested development and/or self-destructive behavior while making the transition from adolescence to adulthood.

Amanda Bynes' story sounds somewhat similar to Lohan's at the beginning at least. The "All That" actress ascended the child star ladder starting with her sketch comedy series "The Amanda Show" produced by Nickelodeon's former head honcho Dan Schneider. At 10, the actress was electric on screen with her comedic timing, charming personality and slapstick skills.  Front and center as Schneider's muse, Bynes was a quickly emerging young talent in Hollywood, and Schneider allegedly used that to his advantage. 

Reports on "Quiet on Set" alleged that Schneider would latch on to young, pretty girls he thought were talented, and Bynes was referred to in the documentary as "his new favorite." Not only did Schneider attach himself to Bynes, but former "All That" actor Leon Frierson recalled that Bynes would be absent from the required schooling on set, reportedly spending time with her boss instead. “There would be times where Amanda would just be missing, and a lot of times we would just hear that she would be with Dan pitching ideas and writing,” he said.

Amanda Bynes during Nickelodeon's 16th Annual Kids' Choice Awards 2003 – Show at Barker Hangar in Santa Monica, CA, United States. (Chris Polk/FilmMagic/Getty Images)Furthermore, the docuseries showed an uncomfortable scene with Bynes and Schneider in a hot tub for a Nickelodeon promotion. The teenage girl was wearing a bathing suit with her boss fully clothed but still sharing the tub right next to her. The clip highlighted an obvious imbalance between a male figure – disingenuously portrayed as a fellow playmate – in a position of power to  a teenage girl. At the time, however, no one dared to voice any objections lest they face Schneider's wrath. It was only recently called out because former viewers, who are also now adults, have perceived the context differently in a post-Me Too era.

Like Lohan, Bynes also transitioned into teen rom-com stardom with "Agent Cody Banks," "What a Girl Wants" and "She's the Man." However, behind the scenes, the star's home life didn't reflect her larger-than-life characters and her movie's traditional happy endings. For years Bynes struggled with a turmoil-filled relationship with her parents who were also in charge of her career. According to the docuseries, Bynes reportedly ran away from home after a contentious fight with her parents.

In a long apology YouTube video apology released March 19, Schneider addressed his close relationship with Bynes. He recalled the day she had allegedly run away, "The phone rang, I answered. It was Amanda and she was upset, she was in distress she had had some conflict with her parents — I think her father — and she called me," he said.

"I was immediately concerned about her safety. I called someone who I knew was fairly nearby. That person was able to go and pick her up, then I knew she was safe . . . she ended up being taken to the police."

Bynes' home environment was so troubling that she attempted to emancipate from her parents when she was around 16 or 17. However, the attempts were not successful and were axed by a judge. Schneider said the young actress turned to him and others for help. "We supported her, she tried to get emancipated. It ended up not working out and she didn’t."

Following years of successful big-screen comedies and the WB series "What I Like About You," Bynes hit a wall in adulthood and her career. Her last recognizable role was the hilariously quotable Christian mean girl, Marianne opposite Emma Stone in the 2010 cult classic teen movie "Easy A." Shortly after the success of "Easy A," Bynes dropped out of the 2011 movie "Hall Pass" and quit acting altogether. 

In her 2018 Paper magazine interview, Bynes revealed that she "abused Adderall" around the time of "Hall Pass" and that it left her feeling “scatterbrained.” Then it led to her inability to focus on her lines and memorize them. When Bynes left the industry altogether, she said she got “really into my drug usage, and it became a really dark and sad world for me.”

The starlet suffered through a string of public woes. Bynes was arrested multiple times for DUIs, reckless endangerment and drug possession. However, the run-ins with the law led the actress to be placed on a psychiatric hold, leading her mother to become her temporary guardian over her finances and estate, known as a conservatorship. After years of mental health treatment and a new life as a college graduate focused on fashion, Bynes requested the end of the nine-year guardianship. In 2022, a judge terminated the conservatorship. As controversial as conservatorships are, Bynes' attorney said it was "a collaborative effort with her parents. There was no fighting between her and her mother or father. Everyone was working together, including Amanda."

Similarly to Bynes, Lohan also suffered the same issues legally fighting with her parents over her finances. Her addiction and dependency issues then led to infractions with the law and eventually, she served 90 days in jail. But despite the tumultuous years spent in a toxic cycle of addiction and self-harm, Lohan not only survived her struggles but thrived. She's in what Netflix has dubbed "The Lindsay Lohan-aissance!” 

Lindsay Lohan in "Irish Wish" (Netflix)

In comparison, Bynes has taken a more quiet approach to her life after her string of arrests and battles with her family. We may never know what happened to Bynes as she was put through the child star wringer at Nickelodeon, and that's OK. Her experiences are hers to divulge or not. She has spent most of her adolescent life under the perpetual public microscope evaluating and dissecting her worth based on her looks, personality and talent.

If what was alleged in "Quiet on Set" is true, the adults, Nickelodeon and many more authority figures in Bynes' life failed her — just like they failed Drake Bell. While the docuseries helped reframe the plight of Bynes and other child stars, it's crucial to remember that she doesn't owe perpetual outsiders watching her life anything. It's a shame that her onscreen talents won't continue. A resurgence in her acting career like Lohan's might sound like a Cinderella story for us as long-time fans but that may not be true for Bynes. Not everyone's journey is the same. Most importantly, we don't get to tell Bynes who or what to be after so many years of control by others. She gets to decide. 

The post A tale of two child stars: The tragedy and triumph of Amanda Bynes and Lindsay Lohan appeared first on Salon.com.

For the past two years, there has been a buzz around the “wonderdrug” Ozempic — a medication in the class known as GLP-1 receptor agonists — from clickbait celebrity gossip websites to the front pages of leading medical journals. The ability of these medications to reduce weight, fight diabetes, even decrease the incidence of death from cardiovascular disease, has been well-studied.

But Ozempic’s effectiveness seems to be stretching beyond the realm of cardiometabolic disease and into the field of addiction medicine. Volkow’s study adds to a growing body of scientific and anecdotal evidence that GLP-1 medications can reduce cravings among people with substance use disorders, including alcohol, tobacco, opioids, cannabis and stimulants. In addition to increasing the release of insulin and slowing stomach emptying, GLP-1 analogs are thought to impact the brain’s reward circuits, leading to fewer cravings and decreased use.

As a resident physician in internal medicine and medical historian focused on addiction, I believe this data represents a tremendous breakthrough in the field of addiction treatment. It could also be the medication that brings the treatment of addiction — historically siloed from general medical practice — into mainstream medicine.

A handful of my primary care patients have made comments like what J. Paul Grayson, a patient taking Ozempic for obesity, reported to NPR last year: “Before Ozempic, I could consume a whole bottle of wine in an evening without trying real hard … But with Ozempic, even one beer didn’t feel good to me somehow.” Many patients simply don’t crave substances like they used to.

Fatal overdose, especially from fentanyl, continues to be the leading cause of death among people aged 18 to 45 in the U.S., surpassing deaths from suicide and car accidents. While much of the data on the link between Ozempic and decreased substance use warrants further investigation, health care providers should not wait for the Food and Drug Administration (FDA) to approve these medications before prescribing them. If a patient has obesity or Type 2 diabetes and a substance use disorder, providers can and should start prescribing GLP-1 agonists “off-label” as a form of addiction treatment.

If a patient has a substance use disorder and another indication for a GLP-1 analog, providers — and patients themselves — should advocate for their use. As Dr. Kenneth Morford, an addiction medicine physician and assistant professor at Yale School of Medicine, told me, “If a patient qualifies for a medication like semaglutide and happens to have a substance use disorder with no contraindication to the medication, we have nothing to lose. Why don’t we try it?”

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Attaining FDA approval for GLP-1 analogs with the specific indication of treating alcohol use disorder, for example, will take years. The ongoing extreme shortages of medications like Ozempic may compound the delay even further. While a few randomized clinical trials have been completed, dozens more are only just starting to recruit participants with substance use disorders ranging from cocaine to opioids. Leaders at NIDA like Volkow — who has called this data “very, very exciting” — and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) are allocating more funding to addiction researchers on this topic.

But in the meantime, young people are dying. Patients and health care providers are running out of time looking for potential answers.

Health care providers have been prescribing GLP-1 analogs for the treatment of Type 2 diabetes for the past decade. Due to increased demand for medications like Ozempic, providers in general practice settings have become increasingly familiar with how to prescribe these medications. Largely due to stigma and the failure to educate physicians, many primary care physicians view the treatment of addiction as outside their scope of practice.

Many medications used to treat addiction are extremely difficult to access. Methadone, one of the most effective medications for opioid addiction, can only be accessed through special clinics due to federal regulations borne out of President Richard Nixon’s War on Drugs. Buprenorphine (colloquially known by the brand name Suboxone) is more accessible than methadone and available in primary care settings. In 2023, buprenorphine became even easier to prescribe, yet primary care providers are still hesitant to begin prescribing it, likely due to fear and stigma.

That’s just opioids. Even though 29 million people in the U.S. have an alcohol use disorder, less than nine percent of patients with alcohol use disorder are prescribed any medication. Stimulants like cocaine and methamphetamine pose an even larger problem. Experts are now characterizing stimulant-related overdose deaths as a “fourth wave” of our overdose crisis. There are few if any medications that have been shown to decrease stimulant use. Ozempic could be the first medication that meaningfully treats addiction to stimulants.

Ozempic presents a tremendous opportunity to get providers on board who might not otherwise be comfortable with prescribing medications for addiction. Unlike some of the other medications used to treat addiction, GLP-1 analogs are not controlled substances, which have potential for misuse and partially explain providers’ discomfort behind prescribing.

Our overdose crisis and lack of access to addiction treatment are urgent issues that endanger thousands of young, healthy individuals. The medical community’s discrimination against people who use drugs has crippled humane access to care in general medical settings. GLP-1 analogs have the potential to bridge this historic divide and treat multiple addictions at once. Health care providers must not wait for FDA-approval to prescribe GLP-1 analogs to patients who are currently eligible due to comorbid conditions. We must respond to our overdose epidemic in innovative ways, using all the tools at our disposal. This now includes GLP-1 analogs.

The post Could Ozempic be our next tool in fighting the overdose crisis? Surprising research suggests so appeared first on Salon.com.

The 69-year-old Oscar winner and "Gladiator II" star reflected on his relationship with alcohol and substances in an interview with Esquire. The actor told the publication his addiction began with wine, specifically with a wine cellar he had built into his home where he "learned to drink my best." He said, “Wine is very tricky. It’s very slow. It ain’t like, boom, all of a sudden . . . Wine was my thing, and now I was popping $4,000 bottles just because that’s what was left."

He described that his drinking was a "15-year pattern" and it led to experimenting with other substances. Washington elaborated, “I never got strung out on heroin. Never got strung out on coke. Never got strung out on hard drugs. I shot dope just like they shot dope, but I never got strung out."

“And I never got strung out on liquor. I had this ideal idea of wine tastings and all that — which is what it was at first. And that’s a very sub­tle thing. I mean, I drank the best,” he said.

During Washington's extensive career, he never drank while working. However, he explained that there were "many months of shooting, bang, it’s time to go. Then, boom. Three months of wine, then time to go back to work.”

At almost 70, Washington said looking back, “I’ve done a lot of damage to the body. We’ll see. I’ve been clean.

“Things are opening up for me now — like being 70. It’s real. And it’s OK. This is the last chapter — if I get another 30, what do I want to do? My mother made it to 97. I’m doing the best I can,” he said.

Washington currently stars as Macrinus, an ambitious arms dealer, in "Gladiator II"

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Payne, the resident leader of the quintet, is the first of the millennial-aged group to die, in a sudden tragic incident in Argentina. The 31-year-old pop star died on Wednesday, Oct. 16 after falling from a hotel balcony in Buenos Aires. When the harrowing news broke Wednesday evening, shockwaves reverberated through the music industry and the One Direction fandom. Reports from Argentinian police said that Payne "had jumped from the balcony of his room," with no clarifying insights about the incident, The Associated Press reported.

As millions of Directioners across the world mourn Payne, his troubled persona has been peeled back, indicating that the former embattled child pop star’s international success and acclaim had weighty ramifications not only for his mental health but also his privacy — or lack thereof — even in death.

The birth of the British-Irish boyband bulldozed 2010s music with infectious pop melodies and vocal-driven performances, bringing back an international frenzy around boybands that hadn't made the American crossover since Beatlemania. The band was also named Billboard's 22nd Greatest Pop Stars of the 21st Century for their influence on pop music at the launch of the social media age. The band formed in the 2010s at the behest of the judges of the British talent show "The X Factor." The then-solo artists, who were 16 to 18, were shoved into a makeshift group. Just like that, One Direction was born. 

One Direction lasted a jam-packed six years, dropping songs like the certified quadruple platinum hit "What Makes You Beautiful" and Billboard hit "Story of Our Lives." The boys toured and performed across the world, releasing back-to-back albums at the demand of their Simon Cowell-led label and their obsessive and intrusive fans. But just like a bright impermanent star, the young, wide-eyed boys turned industry-downtrodden men burned out in 2016. They were all between 22 and 25 when the band officially went on a permanent hiatus.

As Payne's band members released critically and commercially successful solo debuts, he debuted the single "Strip That Down." It was a commercial success on the American and British charts but his first album failed to grab critical attention. His transition to a life outside of the band seemed like a difficult one. He sang in his debut single, "You know I used to be in 1D (Now I'm out, free) People want me for one thing (That's not me)."

While Payne was deemed the leader or responsible one, he was also a prolific songwriter contributing to the group alongside Tomlinson. But it often seemed like the group's fame felt like a pressure cooker for a young Payne. He told Men’s Health Australia in 2019, that he began excessively drinking while he was in the band to cope with fame and their rigorous touring schedule.

Payne described his One Direction days, saying, "When you’re doing hundreds and hundreds of [concerts] and it’s the same 22 songs at the same time every single day, even if you’re not happy, you’ve got to go out there."

He continued, "It’s almost like putting the Disney costume on before you step up on stage and underneath the Disney costume I was pissed quite a lot of the time because there was no other way to get your head around what was going on."

Ultimately, "[the band] had an absolute blast but there were certain parts of it where it just got a little bit toxic," he said.

Just a week before his death, Payne became a polarizing figure in the One Direction fanbase. He faced a series of misconduct allegations from ex-fiancée Maya Henry and several fans online. People Magazine reported Henry had issued a cease-and-desist order last week against Payne after she alleged he repeatedly contacted her. Henry previously told People that a fictional scenario in her novel, "Looking Forward" — where the main character is pressured by her partner to get an abortion — was "very similar" to an event in her own life. 

As Payne's star waned and his relationship with fame and people's perceptions of him changed in his adulthood, he spoke out about his mental health struggles. Recently, he shared that he had been diagnosed with "a couple of conditions" and decided to speak on it so people "know you’re not the only one."

Moreover, Payne has been in the spotlight since he auditioned for "The X Factor" for the first time when he was 14. All this exposure led him to deal with mental health struggles that included suicidal ideation. In 2019, he said in an interview with Sky News, "There’s times where that level of loneliness and people getting into you everyday. Just every so often, you’re like, when will this end? That’s almost nearly killed me a couple of times."

This is not uncommon for those who have dealt with fame from a young age. The public struggles of child stars like Demi Lovato, Lindsay Lohan and Amanda Bynes come to mind. The constant scrutiny, lack of privacy and attendant identity crises can lead to struggles with anxiety, paranoia and depression, Psychological Care Institute found. Not only can it exacerbate mental health conditions, but fame can ultimately change your brain because "Your neurons get used to a certain level of excitation and stimulation,” reporting by The Face explained. ​“And then, forevermore, you kind of want it to be at that level. When the fame begins to wane, it can, then, be difficult to adjust."

Operating on this tightrope appeared to be a challenge for Payne. According to reporting from the AP, Buenos Aires police said they found Payne's hotel room “in complete disarray.” They detailed that they found packs of clonazepam, a central nervous system depressant, energy supplements and over-the-counter drugs. A whiskey bottle, lighter and cellphone were also collected from the courtyard where Payne’s body was found.

During the breaking news of Payne's death, Argentinian outlets ran wild with speculation of suicide, TMZ posted horrifically violating photos of Payne's body, and photos of his hotel room showing drugs and broken items were leaked. Within hours of his death, millions of people across the world had seen his dead body and the intimate portrait of his troubled life. Even in his death, the star's body could not be laid to rest. Another piece of himself he unwillingly gave to an audience.

Hauntingly, Payne was posting Snapchat stories of his time in Argentina merely hours before his death. People have recorded and reposted these stories to memorialize his last hours. Now as I scroll TikTok, videos of Payne's girlfriend Kate Cass's travel vlogs of the couple's time in Argentina are popping up on my For You Page.

Even TikTok's algorithm isn't letting Payne rest in peace — yet another violation of his privacy. The nature of his death has attracted parasocial voyeurs treating the tragedy like an entertaining mystery. But again, as Payne described, this spectacle is just a part of the regular circus of his short-lived life.

If you are in crisis, please call the 988 Suicide and Crisis  Lifeline by dialing 988, or contact the Crisis Text Line by texting TALK to 741741.

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And in usual fashion, when pressed, very little else is discussed beyond “Oh, I don’t drink anymore” — which for the average civilian, I totally appreciate. Stigma is real and, as much as I wish it wasn’t so, there are consequences from coming out as sober.  

But Walz is not in an average place at all. He’s a person with lived experience who can help remove stigma with a few choice words. And why does the stigma around drugs matter? He can talk about it from a personal place.

Furthermore, an increasing amount of people are dying from drug overdoses in the U.S. today than at any point in modern history, and research has demonstrated that effective stigma reduction efforts normalize substance use disorder diagnosis, treatment and recovery while increasing outreach by those with substance use disorder to supportive services. 

So, the more people talk about it – especially those in power with lived experience — the more people realize it’s not so weird to get help. The more people live. 

24 million people live in recovery in the United States and we are (currently) not a organized voting block. We don’t buy music together, we don’t support movies together, etc., mainly because we lack public leadership. We have Robert Downey Jr. and he’s apparently now Dr. Doom and doing a Broadway show, so he’s busy.  

Not only are we not organized, we don’t often get mention. We didn’t get referenced in either candidates acceptance speech, even though addiction is the number one killer of people ages 18 to 45. The ultimate non-partisan issue, put on the back burner by both parties as approximately 108,000 people die a year.  

But the blame is also on us. Non-organized groups that don’t tap into their collective voting power typically don’t get what they want. Shocking, I know. Because addiction affects everyone, all genders, all races, all socio-economic levels, we are the political cause that is oddly the most American. I’ve attended AA meetings in New Orleans where I was the only one not in drag, and I’ve attended meetings in Ohio, where my flannel was actually a little boring, and I can honestly say they were both the same meeting. 

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AA would tell you that anonymity is the spiritual foundation of our sobriety, and so you should stay quiet. I would remind folks, that while you are free to believe whatever you believe, another truth is dead people don’t recover. So if we can speak up and keep them alive, I’m happy to then argue about any and all things sobriety.  

Governor Walz can change all that. He can own his recovery, tell us his full story, how he did it, how he does it on a daily basis, how he has a phenomenal family who hasn’t ever seen him drink. He has a success story, one of the best I’ve seen. He can tell us that recovery is possible. 

We all love a midwestern dad for being empathetic, helpful, present, for spreading joy. We trust them.  

If Walz openly talked about being sober, we’d love him more. More importantly, 24 million voters would feel less alone. Most importantly, with the removal of stigma, less Americans would die.  

Let’s do it Tim. Tell us. 

The post Tim Walz’s sobriety is a success story. Why doesn’t he talk about it more? appeared first on Salon.com.

On Thursday, authorities in Los Angeles announced that they had made five arrests in connection to Perry's death. The individuals arrested included two doctors — Salvador Plasencia and Mark Chavez — Perry's live-in personal assistant and a woman dubbed "The Ketamine Queen" by the LAPD. While announcing the charges on Thursday, U.S. Attorney Martin Estrada said of the arrested individuals, "They knew what they were doing was wrong,” but “took advantage of Mr. Perry’s addiction issues to enrich themselves,” by distributing ketamine to the actor in the final weeks of his life, as noted by CNN. Estrada claimed that the group “cared more about profiting off of Mr. Perry than caring for his well-being."

The indictment follows a monthlong investigation and grand jury proceedings, with prosecutors now alleging that Plasencia, Chavez, "Ketamine Queen" dealer Jasveen Sangha, and Perry's assistant, Kenneth Iwamasa, facilitated the actor's drug use that led to his death. 

Court papers revealed that a month before Perry died, Plascencia learned that he was interested in obtaining ketamine. Plascencia then contacted Chavez. In a text message dated from September 2023, Plascencia wrote to the doctor, "I wonder how much this moron will pay?”

"Let's find out," Chavez wrote in reply. 

The New York Times reported that Perry from September to October was supplied with a total of 22 vials of ketamine and ketamine lozenges secured through a bogus prescription. The drugs cost him around $55,000. Ketamine is a strong anesthetic with dissociative and psychedelic properties. It has been used as an alternative form of therapy for a variety of mental health issues. 

Prosecutors also stated that Plascencia instructed Iwamasa on how to administer the drug to Perry intravenously. “Found the sweet spot but trying different places led to running out,” Iwamasa text "Dr. P" on Oct. 4, per court documents. On Oct.12, Plasencia injected Perry with a "large dose" that led the actor to experience an "adverse medical reaction," spiking his systolic blood pressure. 

Prosecutors also stated that Perry had sought additional methods of obtaining ketamine, which he found in a person close to him, Erik Fleming. Fleming connected the actor with Sangha, who law enforcement said operated a "drug selling emporium" out of her North Hollywood home. Fleming told Iwamasa that the "Ketamine Queen" worked with "high end" clientele, and spoke highly of her supply. “If it were not great stuff she’d lose her business,” Fleming told Iwamasa, who said that Perry was “only interested in the unmarked ones not the horsey version,” according to court documents. 

During Perry's final days, Iwamasa injected him with six to eight doses of ketamine per day, as noted by The Times. On the day of Perry's death, he reportedly requested that his assistant inject him at 8:30 a.m. and again at 12:30 p.m. Less than an hour later, Perry asked Iwamasa to prepare his hot tub and "Shoot me up with a big one." Iwamasa then left to run errands. When he returned, he found Perry face down in the water, deceased. 

According to CNN, in the wake of Perry's death, Fleming and Sangha deleted text messages that indicated they had sold drugs to the actor. Fleming told Sangha, he was “90% sure everyone is protected."

"I never dealt with (Matthew Perry). Only his Assistant. So the Assistant was the enabler," Fleming wrote, also asking Sangha if ketamine lingered physically "or is it immediately flushed out."

Plasencia has pleaded not guilty to one count of conspiracy to distribute ketamine, seven counts of distribution of ketamine and two counts of altering and falsifying documents or records related to the federal investigation. “Mr. Perry was on ketamine treatment. Medically supervised, medically prescribed. And while the U.S. attorney may disagree with Dr. Plasencia’s medical judgment, there was nothing criminal at the time,” his attorney, Stefan Sacks, told CNN affiliate KCAL/KCBA. “More importantly, the ketamine that was involved in Mr. Perry’s passing was not related to Dr. Plasencia.”

Chavez for his part has pleaded guilty to one count of conspiracy to distribute ketamine, per prosecutors. Sangha has pleaded not guilty to one count of conspiracy to distribute ketamine, one count of maintaining a drug-involved premises, one count of possession with intent to distribute methamphetamine, one count of possession with intent to distribute ketamine, and five counts of distribution of ketamine.

Fleming has said he supplied the ketamine that led to Perry's death. He has pleaded guilty to one count of conspiracy to distribute ketamine and one count of distribution of ketamine.

The U.S. attorney's office stated that Iwamasa pleaded guilty to one count of conspiracy to distribute ketamine causing death.

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"When I go away, I make sure another doctor is covering for me and share their contact info on my phone message and out of office email," Manhattan psychiatrist Carlos Saavedra told me. "A patient's treatment plan may include medication, seeing a trauma specialist or getting more support from Twelve Step meetings, depending on an individual’s needs." But he prefers they discuss it with him first.

My addiction specialist, Dr. W, promoted this type of open relationship, as long as he was "the primary" (as polyamorists and detectives on "Law & Order: SVU" called it). Because I was having a hard time giving up cigarettes, alcohol and pot, he recommended a psychopharmacologist colleague of his, hoping antidepressant medication would ease my extreme withdrawal. It didn't.

Wellbutrin, touted as a stop-smoking aid, almost gave me seizures. The Adderall the doctor prescribed for my potential ADD turned me into a speed freak for 24 hours, proving I didn't have attention-deficit disorder. (If I did, the pills would have calmed me.) He then suggested group therapy and 12-step meetings, but they gave me flashbacks of feeling misplaced as a kid within my big boisterous family. I managed to get clean and sober, improve my career and marriage with the talking cure, preferring to confide in just one person who knew my whole history.

Yet my dependence on him backfired one August, when we had a falling out after I learned that Dr. W had lied to me by treating someone from my life who he'd promised not to. I felt betrayed and told him that he owed me an apology. He replied, "I'm sorry for the imaginary crime you think I committed," which made me want to commit a real crime. Instead, I stopped speaking to him, ready to quit analysis altogether. But his sudden bizarre insensitivity jarred me, causing me to lose sleep and question my sanity. My crisis management strategy became my crisis. I needed a shrink to help me deal with my shrink!

If, as Erica Jong said, "every lover is a reaction against your last," so is every therapist. Dr. W — whose diploma for Ph.D. in clinical psychology hung on the wall of his office in Greenwich Village — was a father figure who I'd seen as kind of my WASP rabbi. For a fresh perspective, I called Vatsal Thakkar, a Connecticut psychiatrist with a M.D. who was younger than me and from a Hindu family. Over a few talk sessions, I chronicled Dr. W's transgression, assuming Dr. Thakkar would take my side.

"It sounds like he made boundary mistakes," he told me. "But if you build up a man inappropriately, he has to fall."

"Do you mean that he's just human?" I asked. 

"When he helped you quit your addictions, you imbued him with supernatural power," he opined. 

"I did," I conceded. "It felt like magic."

"If he was kind and helpful to you for a long time, his recent behavior is uncharacteristic," Dr. Thakkar calmly said. "What if there's something you can't see that would solve the mystery of why he changed?" He offered the metaphor of a commuter who was angry that a woman in front of him had stopped her SUV in the middle of the street to get something in her backseat. "The furious driver couldn't see that her infant was choking."

The comparison was oddly apt. Not long later, Dr. W emailed me to apologize. His wife had been very sick in the hospital, he admitted, saying he'd lost a whole year. Afraid she wouldn't recover, he wasn't able to compartmentalize to do his job well. If I thought my husband was dying, I wouldn't be able to work either.

"I'm so sorry to hear that," I heard myself saying.

"I'm sure you'll write about this," he commented.

I did. Though I ended our weekly sessions, we later co-authored an addiction book together. Our reconciliation inspired my memoir "The Forgiveness Tour," where I quoted the wisdom Dr. Thakkar shared when he'd become my substitute guru. Ultimately, I realized that taking control of my health and well-being was my job, and looking for Dr. W's replacement saved me. If I'd known it would be so helpful, I might have shrunk around sooner. And it turned out this was a thing; some therapists even vacationed in July to fill the end of summer void.

"I encourage my patients to shop around and try other methods when I'm not available, especially if they want treatments I don't do like CBT, EMDR or grief counseling," Miami psychoanalyst Justena Kavanagh said. "Sometimes, it's helpful to get a second opinion and consider a new approach or multi-layered strategy."

She added, "You're not cheating on your therapist if you're honest about it."

"Look, I don't like when other therapists poach patients, but it's your right to explore other approaches when your regular therapist is away. You should be a smart and open-minded consumer," said Los Angeles psychotherapist and author Dennis Palumbo, who studied Buddhism and has a creative clientele. "If you're stepping out on your therapist in August, try a different modality that might offer illumination. No patient ever came back and told me, 'I liked the other guy better, goodbye.' But they have pointed out something the second therapist suggested they hadn't thought of and wanted to explore with me in September, which enhanced their treatment — and our relationship."

The post Shrinking around: Should you stay faithful to your therapist in August? appeared first on Salon.com.

Maja is my first cousin’s first cousin. In Baltimore, that means we’re close family. My dad's sister married her dad's brother, ultimately connecting us. A popular bartender, Maja created the most beautiful drinks anyone has ever seen or tasted in some of Baltimore’s fanciest restaurants.

“A MajTail,” I laughed, sipping the ginger-heavy citrus concoction she slid in my direction. “I’m in it for the long haul, cuz.”  

Fifteen years my junior, Maja, or Maj, has always been a dreamer. She has two big sleepy eyes that dominate her face and pair perfectly with her Zen-like demeanor. Many of the younger people in our family opted for traditional nine-to-fives or the streets, but she worked to make a name for herself in the art world, gaining an impeccable reputation for her drawings and paintings. The street guys and the nine-to-fivers have a lot to talk about with each other, but rarely share community with Maja’s artsy crowd. Our paths almost never collided until I joined the art world she knew so well, and began to see her at parties, and frequent places she worked, like The Charleston, Alma Cocina and Bloom's, where I would eat the most delicious food in the city and have the luxury of washing it down with her beautiful craft cocktail creations, with my wife and friends at my side. 

“You always have fun, even when y’all not drinking or before y'all’s drinks come out,” Maja said. “So just have fun — focus on that.” 

I love alcohol: the smell, the taste, the way it makes me feel. There’s something about sipping from a bottle or glass of warm confidence that just feels right. I’ve known this since I was a child — 10 years old, to be precise. 

One day, my cousin Lo begged me to go with him to see his estranged mother, who had recently won a long battle with addiction.

“I bought you something, baby,” she said, her veiny hands gripping a crumpled paper bag. “I didn’t forget you.” 

“The Colt 45 kind?” Lo guessed, his eyes watering as he snatched the bag. “Thank you, Mom!” 

Lo guzzled, then passed the can to me. I took a slow sip: like soda, but not as sweet, or even joyous at all, I thought. The aftertaste of Colt 45, a malt liquor that was as dangerous as it was popular, crumpled my face to match the bag that concealed the can. “Yuck!” 

The drink tasted so bad, but it felt so right. Imagine a cactus with milk so sweet, it’s worth the thorns. We laughed hysterically at my childish reaction, even though I was a child. I took another swig, shot another frown and passed the can back to Lo, who happily gulped. I knew my mom would have killed me if she found out, so I swore off liquor until it revisited me in 7th grade. 

Hawk rocked a monochromatic blue Coogi, so we wore monochromatic blue Coogis. Hawk never tied his New Balance; he purposely left the laces undone, so you’d never see a bow on our shoes either. Hawk sat drunk in the project stairwell, gripping a bottle of Absolut vodka, so when he passed it to me, I was all in. 

And I sipped, tripped and fell in love with that vodka. Booze and I became inseparable in the years that followed. It became a part of my identity: The fun guy with the drinks on deck. 

Alcohol is a depressant, scientifically speaking. But there seemed to be nothing depressing about grabbing a drink before the function, grabbing a drink at the function, and grabbing a drink after the function. There was always a reason to grab a drink with a friend. We would even grab a drink at the bar just to figure out where we should go on to grab drinks.

This lifestyle delivered so many glorious memories, nights and people I only remember in flashes. A life that I enjoyed and even bragged about, all the way up until my doctor delivered a reality check, recommending I eighty-six salty food — there goes fine dining — and go cold turkey off the booze for a while (goodbye, craft cocktails) so that we could regulate my rising blood pressure. 

Here’s what I learned during my first booze-free week after three decades of regular drinking: Liquor makes mediocre restaurant food taste like fine dining — the only ingredient better at enhancing flavors than salt. Ordering it also makes that dinner much more expensive. Everyone around me in the restaurant is also louder and sweatier, it seems, when I’m sober. And my sobriety makes other people uncomfortable, too. They poke at me, question my health, and ignore everything except what is — or isn’t — inside my glass.

* * *

“A yoooo, D Watk a weirdo! Man, oh man, aye aye, Watk lost his got dammed mind! What in the —” screamed a small woman with long braids growing out of the back of an oversized Oriole cap.  

A couple of months after the doctor told me to start eating cleaner and stop drinking for a while, an Uber dropped me off at this restaurant around 9:15, where I was greeted by thunderous applause. It kind of felt like a surprise party, except none of my close friends were there. These were casual business acquaintances, loose ties, strangers. I was being honored for my work with kids in schools. 

A young woman in a sparkly dress presented me with a framed certificate and a microphone. To my right, a DJ saluted from his booth. To my left, well-dressed educators and tastemakers eagerly awaited my words. In front of me, a packed restaurant of people ate and drank, some glancing over at me like, Who in the hell is this guy? 

I made my remarks and went over to the organizer’s table. Before I could sit, one of those tastemakers presented me with a long, luxurious brown box containing the premium tequila brand sponsor for the night’s event. 

Then four bottle girls arrived, placing four empty shot glasses in front of my face. One of the bottle girls had said, “For the man of the hour,” with a wink, filling each of the glasses in front of me with tequila until they all overflowed. The look and smell of the liquid made my head throb. 

“I have to run and wash my hands,” I told the table as they began knocking their drinks back. I cut through the crowd and entered the restroom. A walking and breathing mess stared back at me in the mirror. 

After making it through the first few weeks of my doctor-recommended sobriety, I decided to indulge a little on a family visit to Paris I had booked a few months before the physician gave me the sad news. I stuck to my guns, not touching a drop until our feet were planted on European land, and I had decided to continue my alcohol-free mission when we returned to the States. I had felt great about my choices until I was presented with that tall bottle of tequila and poured those four shots that seemed to be screaming my name. I can beat this too, I told myself. 

I splashed water on my face and exited the restroom. The educators were in full turn-up mode, iPhone filming and dancing. My shots waited patiently for me. 

I wondered what Maj would do. Maybe I should order a MajTail, I thought.

If I walked a big mocktail over to my table, I reasoned, people wouldn’t be paying attention to the fact that I was not downing those shots. 

“I’m working, on the clock, not really drinking,” I said to the bartender, a slim dude with a thinning fro. “Can you make me a mocktail?” 

“Sure, brother,” the bartender answered. “Any particular taste in mind?” 

Enter the walking Oriole cap. 

“A yoooo D Watk a weirdo! Man, oh man, Watk lost his got dammed mind! What in the—” screamed that small woman with the long braids growing out of the back of her oversized Oriole hat.

Every patron in the joint laid eyes on us at the same time, it seemed. To my surprise, others jumped in to defend me, saying things like, “Everybody can’t be an alcoholic like you, girl,” and “Don’t play with D like that!” 

Eventually, I made it back to my table, where I was greeted by another person who recently started his own wine company and wanted me to taste every flavor. Well, it’s wine, I thought, and I’m kind of sophisticated, I thought, and I just came back from Paris, I thought, so passing on this offer would be a great disservice to that young entrepreneur and the community, is what I landed on. 

I drank glass after glass, holding the bottle — bottles — making sure the women in the large cap saw me consuming enough wine to collapse an elephant. Who’s the weirdo now? 

Me, apparently, because alcohol won the battle that night. Even though I didn't take the tequila shots, I was still as drunk as a trust fund frat boy by the time I left. 

The more I reflected on that evening, the more I became bothered by things I failed to recognize or wish I would have considered in the moment. 

I don't owe these people anything, so why should their opinions force me into becoming wine-drunk? Do I lack self-control? 

I have never had the level of clarity I gained in the short sober time I had before Paris. So why would I quickly throw that away to please a bunch of strangers at a function? 

I have no idea who that little woman lost in that big-ass baseball cap was, so why would I care about her insults?

Was I drinking for me or because Maj had been found dead in her apartment a week before I left for Paris? 

And I realized that I would never be able to ask her what would she do again. I will never be able to roll into a bar and see her face, be eased by her pleasant energy and taste one of her creations ever again. Was alcohol not the fun juice I always thought it was? Thinking about Maj, it was starting to feel every bit like a depressant. 

* * *

Alcohol is one of the leading preventable causes of death in the U.S., according to the National Institute on Alcohol Abuse and Alcoholism. More than 140,000 deaths each year are estimated to be attributed to excessive drinking. It remains an urgent, life-or-death problem for many. Perhaps a growing awareness of that is why more people are being proactive about monitoring their consumption, even before it becomes a medical necessity or a chemical dependency. 

An explosion of new non-alcoholic adult drink brands shows there’s a market that still wants the feeling of going for a drink without the effects. Some people are avoiding alcohol, or just cutting back, to be more health conscious. Gen Z is drinking less than millennials and Gen Xers. And it feels much more common now — thanks in part to events like Dry January and Sober October — to take temporary breaks from drinking without the stigma attached to “falling off the wagon.” For some, mindful moderation — rather than an all-or-nothing approach — is now part of an aspirational lifestyle. 

For deeper insights into the source of my feelings about drinking and abstaining from a person who has taken the sober journey from inside — or rather, behind — the bar, I reached out to the first mixologist I ever met, Andre “Dre” Barnhill. Dre has been a star on the emerging cocktail scene in Baltimore over the past decade. He's held prominent positions at award-winning establishments like Woodberry Kitchen, and runs Clavel, one of the hottest Mezcal bars in our region. Dre was sober for two years, but recently decided to have an occasional cocktail. 

Dre is a relatively smooth fellow, always laid-back, never too visibly excited. He’s also the bartender who introduced me to what became my signature cocktail, the vodka gimlet. 

"A yo, I am traveling a little bit right now for these readings," I asked Dre one slow night at his bar. "And I'm struggling to find one go-to drink that any bartender can make, even me." 

"I noticed that you are a citrus guy,” Dre said. “So, a gimlet." 

Gin hasn’t been kind to me over the years. But Dre helped me fall in love with the smooth, clean taste of vodka gimlets. And during that time, Dre fell out of love with alcohol and the way it made him feel, so he decided to go on a hiatus. 

I reminded Dre that I did not remember him being the heaviest drinker before he took his pause––maybe a shot or two during a shift. But then I realized that he would normally be at work when I saw him, and I was coming into his bars with my own agenda, to ingurgitate as much booze and fried food as humanly possible. 

“You have to consider the lifestyle, especially 1:30 to 4 a.m.,” Dre explained. “Shutting the bar down and drinking over a period of time, it adds up.” 

I thought of how it would feel to work in a bar five days a week, and how that environment could easily transform a casual drinker into a person who consumes alcohol every day as part of their routine. 

“And then there's the social aspect that comes with being a bartender in the city,” Dre continued. “Bartenders, we love each other, so when we go out, we are always sending each other shots. And you have to take them because turning a gift down is rude.” 

Here’s an insidious thing about alcohol and stigma: It’s wrapped up in class issues. 

I imagined Dre bar hopping with his high-end craft cocktail crew: A diverse, stylish bunch wearing wool coats, high-quality loafers and cropped denims. I imagined Hawk mixing in with his bottle of vodka blue Coogi sweater, instantly changing the mood. When experimenting with vodka cocktails with Dre and his friends, I’m progressive, approachable; a good brother, not an addict. But if I were drinking the same vodka in the projects with Hawk, I’m a gangster or a bum — the world would see me as an addict. The stigma. 

The stigma around drinking is something that bartender Ashley Mac has learned to deal with on many levels. 

“I do not like the word mocktail. To mock is to make fun of, or to do a dry run, of something,” Ashley Mac, the vice president of the Baltimore Bartenders Guild known as AMAC in the hospitality world, told me. “My sobriety is not a dry run or a joke to me. It's like a personal thing. I wouldn't use the word mocktail––spirit-free, zero-proof or nonalcoholic cocktails is what I tend to lean towards.” 

AMAC — who also goes by “The Sober Tender” — is also program director for HEARD, a mental health-focused nonprofit for people in the hospitality industry. She has been sober for seven years and counting. But she didn’t leave bartending — a job she wanted since childhood — when she stopped drinking.

“I always wanted to be a bartender, ever since my parents took me to a Ruby Tuesday's back when I was a child,” AMAC said with a laugh. “The bartender ran the show, was the life of the party. And I wanted that so bad.”

AMAC got her first restaurant job at 15 and flourished professionally in the bar industry. But participating in the drinking culture that can come with working in bars took a heavy toll. She describes herself as “a late-stage alcoholic” by age 29. She even died once during withdrawal.

“I was out for 30 seconds. The next thing I remember was waking up in the back of an ambulance, and then ICU for eight days,” she said. “It was 13 days before I was discharged and off to rehab for three and a half months. I was 89 pounds when this all happened.”

AMAC returned home with major medical debt from the hospital and rehab. She had only been employed in the restaurant industry and didn’t know what she was going to do for money. So AMAC went back to bartending. 

Liquor is not my business. But so much of my business as a writer revolves around it — I call it let’s go grab a drink culture. I met my managers over a drink. Some of my first agents signed me after a drink or 10. I’ve done shots with lawyers and television executives. What would my career look like without it? Would I have been thought of a certain way if I had refused those drinks, or insisted we meet up for tea or sodas instead? 

I told AMAC about the time I tried to secretly order a mocktail at that tequila-sponsored educators’ award event. 

“That’s horrible,” she said. “I do some contract work for a bourbon company, and I don't tell people I'm sober when I'm trying to sell them bourbon.”  

“I have oftentimes been told as a bartender, I don't want you to make my drink if you're sober,” she continued. “How do you know what it tastes like? Or, I don't trust you as a bartender because you're sober.” 

Despite some of the negative experiences that both AMAC and I have had during different parts of our journey — mainly my attempt to remain sober in drunken places –– we have also both seen bar culture begin to change to incorporate sober people intentionally. 

Menus featuring specialty spirit-free, zero-proof — or the bar-industry dreaded phrase “mocktails” — are becoming more available in restaurants. Designated dry months are social trends that aren’t going away. And new nonalcoholic spirits, beer and wine companies seem to appear every day. Some are even establishing brick-and-mortar locations where tastings, events, and fellowshipping around alcohol-free living can flourish. 

The Zero Proof, a spirit-free adult beverage company, recently released the results of a survey that boldly declared the movement here to stay: “Two-thirds of American adults consciously intended to drink less alcohol in 2022, primarily fueled by health and budget concerns. This mindset, held by 64% of younger consumers (ages 21-30) and 50% of all adults who drink alcohol, will continue into 2023.” 

The survey also found that “nearly 7 in 10 of all respondents (alcohol drinkers and non-drinkers) say they wish social settings were more conducive to accommodating those who drink alcohol and those who do not. The most uncomfortable for non-drinkers are bars and house parties.” An $11 billion industry of no/low-alcohol drink brands has sprung up in response to serve that growing market. There’s even a store in Baltimore dedicated to them — Hopscotch Zero Proof Bottle Shop —  just a mile away from the restaurant where I was ridiculed for ordering a spirit-free drink. 

The explosion of nonalcoholic spirits shows the scene is changing. People want to enjoy a zero-proof cocktail — whether always, or just on occasion — with their friends, without standing out as an abstainer. After all, there are stigmas attached to sobriety, too, stemming from its associations with both addiction and moral judgment. 

“When I got sober, it was not something people were comfortable talking about,” Sarah Hepola told me. 

Hepola has been sober for 13 years, and vividly captured that journey in her critically lauded memoir, "Blackout: Remembering the Things I Drank to Forget.” Hepola’s also a former culture editor for Salon, and the one responsible for planting the seed that grew into my writing career here. Can you guess what my first essay was about? Drinking. 

The first sentence reads, “Miss Sheryl, Dontay, Bucket-Head and I compiled our loose change for a fifth of vodka. I'm the only driver, so I went to get it.”  

“There’s pressure, and I kind of went into hiding for the first year of my sobriety,” Hepola continued. “I didn't go out, because I didn't want those questions.” 

Those questions.  

Those questions made staying sober more difficult than my urge to drink did. I did not miss hangovers, and I was experiencing that nonalcoholic clarity that sober people brag about. I felt great overall — until the questions came:

“Are you dying? If so, how soon, and can have your sneakers?” 

“Do you have some kind STD? And you’re not drinking because you don’t want to throw off the antibiotic?”

“Why come to a bar and not drink? That’s like getting on a boat and not boating, right?” 

“Have a drink! Real men don’t care about no damn blood pressure until they collapse! Did you even almost collapse yet? Collapse first, then talk to me about drinking!”  

I had a great sober run after my altercation at the educator ceremony, but about a month later, it ended. It wasn’t a dark, depressing fall-off, but I did abandon sobriety. Partially because of the questions and partially because of identity — it’s still difficult for me to imagine myself as a completely alcohol-free guy. There are too many memories, celebrations and bonds forged between me and my costar booze. I can’t remember signing a deal or accomplishing a goal or grieving a loved one without it. And my doctor never said I had to stop entirely — just cut back. 

“A person's sobriety is as unique as their fingerprint,” AMAC told me. 

So maybe my version can be sipping just enough to participate without fully indulging. 

I haven’t had a taste of hard liquor since that diagnosis. I now classify as a slight social wine drinker, the guy who circles the function with one glass. But I would be lying if I acted as if I didn’t feel like I was missing out on the fun that the drunken, sweaty people are having in my sober presence. 

Drinkers and non-drinkers are going to continue to find themselves in the same spaces, though, whether for professional reasons or a refusal to stop socializing even without booze. After all, addiction isn't the only reason people have to abstain from alcohol. Not everyone quits for extreme reasons. 

“A number of my friends quit drinking,” Hepola said. “The older you get, the more it really wears on your system. I have very few friends left who are really hardcore drinkers.… They just mellowed out.” 

* * *

Having these conversations about alcohol and sobriety,  I realized that most of the people I talked to were people closer to my own age — Gen Xers and Millennials. People who, like me, came of age during a time when grabbing a drink after work felt necessary, having a cold beer during the football game felt necessary — the kind of people who looked at prayer and alcohol as the primary ways to dissolve stress. I wanted to know how the students in my writing class at the University of Baltimore — mostly Gen Z, between the ages of 18 and 21 — related to alcohol. 

“Do you guys get sloppy drunk?” I asked a small group who came to class early, when some of our best, loosest conversations happened. 

“Yuck,” a young man named Josh said. “If being drunk could get me out of a final. Wait, are you giving a final?” 

Most of the group had no real interest in drinking. They didn't consider themselves to be sober, or feel like they were part of a movement. Drinking just didn't really seem to interest them. 

“I loved to guzzle Absolut vodka back when I was your age,” I said, as proudly as if I were a liquor company rep. “We partied at the club till 2 a.m., and then we hit the after-hours that rocked til 4, and then the after-after party at my crib that went until 6 or until everybody passed out!” 

“You should be lucky you are alive,” my student Nesha said. “That whole night sounds ridiculous. How did you have any fun?” 

“I can't remember, Nesha. I was drunk!” 

My students aren’t outliers, according to AMAC, who sees similar trends in the liquor industry and around the bars she frequents from time to time. 

“There's a younger generation coming up right now that does not drink. They don't want to drink.” AMAC said. “They know the hangover comes with it. They see the stigma.” 

More young adults are abstaining from alcohol compared to college-age Americans 20 years ago, Science Daily reports. “Between 2002 and 2018, the number of adults aged 18-22 in the U.S. who abstained from alcohol increased from 20% to 28% for those in college and from about 24% to 30% for those not in school, say researchers at the University of Michigan and Texas State University.”

I was born on the cusp between Gen X and Millennials. I remember everyone drinking all of the time. There’s definitely been a shift. Hepola’s seen it, too. 

“If you're coming up underneath that, you're probably going to rebel against what your older siblings do, because it’s not cool,” she said. 

* * *

Nonalcoholic cocktails may be easier to find in liquor stores, restaurants and bars now, and young people may not be drinking as much. But let’s go grab a drink culture hasn’t retired. Maybe the conversation we should be having should be about more than navigating the world safely in sobriety — going out to a bar or a nightclub should be a safe experience for anyone, no matter what or how much they’re drinking. 

Safe Bars was founded in Washington, D.C., in 2013 by gender-based violence prevention expert Lauren Taylor. When I spoke with their executive director Amie Ward for this story, Ward — who also founded the peer-to-peer support and resource group The Healthy Tender, for sober or sober-curious folks in her industry — told me that the organization’s mission started with a focus on self-defense and bystander intervention, “because of the high link of alcohol within sexual assaults that are reported. One in two sexual assaults involve alcohol.” 

Ward’s degrees in kinesiology and cultural studies inform her insights into how power and bodies intersect in drinking spaces — an underrated skill in the hospitality world. When a patron walks into a bar, they are heading for a destination, wanting to be transported from whatever they are feeling to a place of ease. Safe Bars’ training positions bartenders as the trip’s pilot, capable of ensuring a safe trip for everyone. Ward’s first safety rule is simple: “Don't automatically give people shots.” 

“Number two: If somebody says no, that's the end of the f**king question,” Ward continued. “That’s the answer. ‘No’ is a complete sentence. Don’t ask them why — it's not your story to know!” 

I thought about my experience at the ceremony, wondering if my night would have gone differently if the bartender had stepped in. I also thought about how many people in the service industry live off tips, and wondered if it's even ethical for me to expect them to control all of the crazy conversations and interactions that happen at their bars. There are too many resources available for patrons to learn how to conduct themselves respectably. 

I landed on the idea that the answer lies in the collective; it is up to everyone — patrons, bartenders, servers, the sober and the drunk alike — to work together to create a reality where everybody is comfortable and happy. We all deserve that, sober or not. Maja taught me that.

I didn’t give Maja all the flowers she deserved when I had the opportunity. My inability to fully appreciate those times while she was here tied into the feelings that many of us — including some of the former drinkers I talked to — chased at some point in our lives: The yearning to hold onto memories, places and people that we want to see, talk to or touch again. And this is where it becomes bigger than booze — and potentially more dangerous — because there is no way to really recreate those wild nights while sober. They never would have happened the same way without the drinks.

Maja and I had so many “I was messed up last night!” conversions that I truly miss; however, I realized that I miss the art, food and life conversations we shared just as much if not more. I may not have been able to reach this understanding if she was still here, or if I had kept my drinking habit. 

The space I gained from the huge alcohol reduction from my diet has allowed me to focus on the good, the bad and the things that matter. To understand that those wild nights are gone, but better nights are coming. To appreciate what I have, and be present. To focus on the fun, just like Maja said. 

She was right the whole time. 

The post Navigating the new sober boom, where “a person’s sobriety is as unique as their fingerprint” appeared first on Salon.com.

In April, the Canadian province of British Columbia announced it was walking back its policy of decriminalizing personal quantities of narcotics (i.e. you wouldn’t be arrested for holding a gram of coke, but selling is still a crime). It follows Oregon, which decriminalized drugs in 2020 but reversed course earlier this year, meaning having a bag of white powder in your pocket is once again a jailable offense.

The idea was to avoid wasting taxpayer dollars on inflicting yet more punishment on individuals living already chaotic lifestyles, which would further damage their mental health and job prospects, and instead give them space to put their lives back together. But amid a spiraling death toll from the fentanyl crisis and homeless tents filling the sidewalks, lawmakers lost their nerve. If only we’d threatened those people with prolonged confinement and career-ending consequences, that’d show those poor folks to make pin cushions out of their veins!

On closer examination, this doesn’t add up: fentanyl fatalities have been piling up across the nation, regardless of any state policies, while Portland actually fared better in terms of its crime rate than other cities like Seattle and Sacramento, where narcotics are still penalized.

But in any case, blaming permissive policies because you’ve sidestepped someone’s street encampment misses the point: it’s never been about the drugs.

The truth is, an illegal drug is just whatever the government says it is, and that in turn is defined by a particular moment in history, culture and politics – for instance, America’s first drug laws in the late 19th Century were to shut down opium dens at a time when racist paranoia about Chinese immigrants (the so-called Yellow Peril) reached its zenith. Meanwhile, there was no particular taboo about well-to-do white women shooting up morphine.

Since then, the war on drugs has been a smokescreen for terrorizing troublesome minorities.

“The Nixon campaign in 1968, and the Nixon White House after that, had two enemies: the antiwar left and black people. You understand what I’m saying?” admitted former Nixon advisor John Ehrlichman in a now-infamous quote.

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“We knew we couldn’t make it illegal to be either against the [Vietnam] war or black, but by getting the public to associate the hippies with marijuana and blacks with heroin, and then criminalizing both heavily, we could disrupt those communities. We could arrest their leaders, raid their homes, break up their meetings, and vilify them night after night on the evening news. Did we know we were lying about the drugs? Of course we did.”

Even today, the law has little to do with the dangers posed by the drugs themselves: nearly six times as many Americans die from alcohol and cigarettes as illicit drugs, yet few are calling to execute bartenders, or round up drinkers and smokers into camps. 

“Yeah, sure,” you might say, “except everyone knows where to find their nearest bar, but not everyone knows the kind of lowlife that’ll sell you drugs. So obviously drinking is gonna have a higher body count, because it’s more available. Duh.”

Such arguments lack the nuance that death comes from illicit drugs being unregulated. Fentanyl of varying potency has turned up in everything from heroin to bogus oxycodone pills (the latter being what killed Robert De Niro’s grandson last year). But fentanyl is used safely as a painkiller in hospitals across the globe every day – it being sold to unsuspecting drug users under less-than-clinical conditions is what makes it deadly. 

It doesn’t have to be that way. After all, we don’t have this problem with booze any more. Ever since Prohibition was repealed in 1933, you can sip a brewski at your local bar without worrying if it’s been poisoned with industrial-grade methanol. Again, it’s not about the drugs – prohibition creates this situation. 

Many people have a visceral reaction to witnessing an unhoused person sparking up a meth pipe, and it’s very easy to think decriminalization has failed if you don’t see the people whose lives haven’t been upended by the justice system, precisely because they haven’t been upended. The vast majority of drug use is non-problematic. The media focuses on problematic drug use because it’s a sexy story – functioning, well-adjusted crack, meth and opioid consumers are boring. 

“Easy for you to say,” you retort, “I see these junkies with their missing teeth, sunken faces, and gross, scabby skin every day. You’re telling me these folks drank too much caffeine?”

But there’s little evidence that the ugly mugs we see on drug war propaganda, such as Faces of Meth for example, are, in fact, because of meth. It’s far more likely that certain drug users’ haggard appearance is from a combination of poor diet, hygiene and living on the street – you sleep rough, you look rough. If the cops are after you and you’ve nowhere to live, booking a spa day is unlikely to be a top priority.

But either drugs themselves or their “evil” pushers are blamed for all manner of social ills, which are actually the product of upbringing, circumstances or the breakdown of personal relationships, as if they’re the cause, and not merely a symptom, of social decay. 

Take the 1980s crack cocaine crisis, for instance. While crack can indeed be terribly habit-forming, addiction is more complex than just taking a drug and developing dependency. Crack didn’t create the hood, it didn’t drastically cut back public services or limit access to health care, and it didn’t artificially inflate its own value through prohibition, making it valuable enough to steal and kill for. 

When Black people migrated to the big cities in the north, they were redlined into ghettos. Then Reagan drained funding from public housing, schools and services in inner-city areas, while blue-collar jobs moved offshore.

“[Black] neighborhoods always had high unemployment, high homicide rates long before crack,” Dr. Carl Hart, a professor at Columbia University and author of Drug Use For Grown-Ups, once told me. “But it was a convenient story for Ronald Reagan’s America and subsequently George Bush’s America. It was a story everyone loved, even some Black people. You had to explain why things were so horrible.”

But crack did however provide an excuse for law and order politics, presenting the war on drugs as a simple solution to complex problems, and caging untold numbers of young (often minoritized) men and women. 

“So now you have this story everyone bought into of crack being the enemy: that’s the reason our country’s falling apart,” Hart continued. “Just like with terrorism or the Cold War with the Soviet Union, you always need an enemy to society. We exported it to our allies so now there’s a worldwide war on drugs — which is really a war on the poor because rich people are still gonna do drugs. You think the war on drugs affected the Rolling Stones? Hell no.”

Meanwhile, the murder rate for young Black males doubled between 1984 and 1994, but not because of crack-crazed loons on the rampage. An analysis of drug-related homicides in New York City found only 14% were “psychopharmacological” – under the influence of the drug itself. However, over two-thirds of these intoxicated crimes were committed in a drunken rage, and only 16% high on crack. 

Some crack users did turn to crime, but crack ingestion by itself doesn’t induce kleptomania. Rather, smoking crack could prove an expensive pastime, as the price was wildly inflated to compensate for the threats to life and liberty faced by all parties down the supply chain. But in any case, merely 3% of homicides were robberies gone wrong. By far the largest category – nearly three-quarters – were related to the crack business i.e. turf wars and rip-offs over a precious commodity, not because of crack itself, just like the St Valentine’s Day massacre wasn’t because Al Capone sipped a few too many at the speakeasy.

Likewise, today’s overdose crisis should be seen in the context of the dying American Dream. Industries have either shuttered, moved abroad or become automated, decimating tens of thousands of jobs. Adjusted for inflation, the 2020s minimum wage is worth less than it was in the 1960s. Social circles have shrunk to the point that by 2021, over half of young Americans reported feeling lonely all the time, and opioids (and other drugs) help fill that void.

Yet certain voices would have you believe that cities like Portland and San Francisco are literal Hellmouths infested with crime and smelly homeless people because they handle their druggies with velvet mittens, while the real culprits — soaring rents and gentrification — are kicking local residents to the curb in the first place. Conservative writer Michael Shellenberger claims SF’s homelessness crisis started in 2009, when California stopped making housing assistance contingent on sobriety, but this was the same year as the financial crash when many in the middle class lost their homes. The unstable homeless lifestyle is in turn likely to worsen addiction and mental illnesses: losing your job and your home are stressful events for which you may seek chemicals to cope. 

West Virginia, meanwhile, leads the nation in drug deaths, but its affordable housing means the problem stays out of sight and not splayed out over the sidewalk.

Just like the Chinese were blamed in the past, these days it’s another set of immigrants accused of corrupting wholesome, all-American boys and girls with their fiendish ways. The idea of dirty foreigners spreading some sort of disease or contagion is a trope as old as time, and now it’s drugs standing in for the plague: Republicans have demanded Biden shut the southern border, the alleged floodgates of fentanyl. 

But of the 1.8 million migrants that the Border Force caught crossing over from Mexico in 2021, just 279, or 0.02%, were found to be carrying fentanyl. The overwhelming majority of smugglers busted transporting fentanyl are U.S. citizens, who’d naturally arouse less suspicion, but that doesn’t fit with the white nationalist talk of an “invasion.”

Portugal, which decriminalized all narcotics over two decades ago, hasn't abandoned its depenalization project, pouring money into treatment services and harm reduction. The coastal country now enjoys among the lowest overdose rates in Europe. Is it really easier to punish people than to help them instead?

The post Abandoning drug decriminalization is a mistake — the drugs were never the point appeared first on Salon.com.

But alongside her growing command of the music that she has loved all her life, she is proudly a Black Appalachian native. While living in the birthplace of early roots music, Kiah found her love of country and bluegrass. The singer's life story and personal journey to becoming a successful folk musician is documented in PBS' "The Express Way with Dulé Hill."

The series invites viewers into the perspective of everyday people and how music can be a universal language and healer to all. In the second episode titled "Appalachia," the former "Psych" actor and professional tap dancer Hill travels to parts of Appalachia, namely Tennessee, to talk to people about their relationships with music and the deeper and more personal ways that it has affected their personal lives. What Hill sees in Appalachia is a community so determined to come together and uplift one another even during the most challenging moments of their lives. Alongside talking to a founder of Appalachian Stringed Instrument Co. – who helps bring in people who have struggled with addiction, as the opioid crisis hit blue-collar workers – Hill spotlights Kiah to share her experiences with addiction, loss and grief and how music helped heal her mind.

In an interview with Salon, Kiah told me that for her it was crucial to learn "the role that Black people played" in roots music but "it also just revealed another layer of 'OK, so this music has always had these cross-cultural connections.'" She described her love and motivation for music as connected. She said, "That's beautiful. I think music is a representation of how we can treat each other in real life." While sharing intimate parts of her life for the docuseries was "a bit nerve-wracking" it was a very humbling experience, Kiah felt "grateful that people are gaining something from the story." 

Moreover, Kiah also clarifies that Black Appalachians exist, and even though "the depiction of Black people has usually been disparaging," "The Express Way," highlights how they are the backbone of roots music. She felt like the show's depiction of the rich history and Black Appalachians "was done with dignity and respect."

Read more of our conversation below:

The following conversation has been lightly edited for clarity and length.

What do Appalachian instruments like the banjo mean to you?

For me, learning about Appalachian music was a way for me to establish a sense of place and identity. For a really long time, specifically like in my late teen years, I developed a certain amount of social anxiety. It came from that awkwardness of grappling with my sexuality and grappling with body dysmorphia, and being around a lot of people that didn't necessarily look like me and feeling overlooked a lot of the time, just as I got older. I would say this is even more egregious than the other two faiths but we didn't go to church which is a big no-no in the predominantly, conservative Christian, suburban area that we lived in. There was just a lot of confusion as far as understanding where I fit in. A huge part of my later teen years involves just getting on the family computer and just really digging into music 

American musician Amythyst Kiah plays banjo on the Rooftop Stage at the 16th annual GlobalFest at the Copacabana, New York, New York, January 6, 2019. (Jack Vartoogian/Getty Images)Things like the banjo and seeing that connection even though no one should have a birthright to enjoy the music or be interested in any kind of music. I mean, we had it at the college and we had Japanese exchange students who loved bluegrass and played in the bluegrass band. No one should have a birthright to play it. But I think learning about the role that Black people played, it also just revealed another layer of "OK, so this music has always had these cross-cultural connections." And that's beautiful. I think music is a representation of how we can treat each other in real life and not to say that everybody around the world, we all need to hold hands and sing "Kumbaya." That's unrealistic, right, but the idea of being able to find your tribe, find your path, find the people that love and support what you do, and not like just stay in your lane and just fighting and arguing with each other about all these different things going on.

Like whether or not a Black person should be able to play an excellent kind of music or a white person should do this or have an Asian person do that. We get caught up in this discourse of who's right and who's wrong and then we forget that we're fundamentally human. And while yes, and it's inevitable, that we're going to have the kind of diversity that we have so far as people's cultural upbringing, the way that they speak, the foods that they eat, all of these things.

A lot of Black Appalachian history is being brought to the light by pop culture figures like Beyoncé in "Texas Hold 'Em" which features banjo player Rhiannon Giddens. What does this feel like for you to see like playing out in real time?

It's really been fascinating to see this all to see this all unfold. I couldn't see any other Black woman being able to do this on this level. When I first heard about, "Cowboy Carter" and "Texas Hold' Em" and she was the first Black woman to have a No. 1 country hit on the Billboard 200 I was like this is the only Black woman on this planet that would have been able to do that. The fact that she reached out, that her people and herself reached out to Rhiannon, and recognized her role in helping and being a huge role in reshaping the narrative about Black country music history, which is American history as well. It's all connected, and for her to reach out to her – what it got me thinking about was that Beyoncé is obviously fully aware of her power and what she's able to bring to the table. So for her to reach out to Rhiannon, who has been literally busting her a** – she's been working herself, just through and through, to get her art out and to get the message out, which is something I've always admired about her.

To see the two of them coming together and her getting a platform to speak further on the issue that she's been campaigning now for the past 10 or 15 years, to be able to see that I think this is just a huge, very symbolic moment in just a moment in music history because it's now finally on a national, international scale.

This is now being seen. The truth is being told, and it's being seen on such a massive scale. I know that there has been some discourse around whether or not Beyoncé did enough. She's a pop artist. She is a pop veteran, one of the most acclaimed artists, in our generation. So she is doing what she wants to do, and she wants to incorporate country music, but she also wants to continue to be fluid in her genre expression. And it's what I that's what I do with my music. That's what a lot of us do with our music. A lot of us that are in Americana, do that exact thing. Every song doesn't have to sound exactly the same, have the exact same chords. It's not cookie-cutter. Regardless of whether someone is really rich or really popular, or whether they're not. If we're really going to talk about gatekeeping and how toxic it can be, which of course it can be, it has been. There are different ways to help shed light on things, and I think if we start to then police, who should be doing what, I just don't see where that's helpful.

Your song "Black Myself” garnered a Grammy nomination in 2020 for Best American Roots song. The song lyrics, “I pick up a banjo and they sneer at me/Cause I’m Black myself,” really stick out to me. Is this the constant push and pull that is at the center of what it's like to be Black in country music?

I will say that one in particular was more directly pointed at the gatekeeping in country music specifically. And the remnants of that segregation of the commercial music industry inevitably led to the remnants of that in my own personal experience. Obviously, I've been able to make a living doing this so obviously there are have been people that I've met along my journey that appreciated what I did, knew the history and never once saw me as out of my league to be interested. I would run into people that never directly challenged [that] in any way.

Usually, the way it would come about would be if I'd be at a show and, or I'd be coming to play somewhere for the first time. The most common question that was asked to me would be, how'd you get into this music? That's what you could consider a microaggression. Whether intended or not, but when I decided to respond by talking about history and nine times out of 10 people would be like, "Oh, I had no idea." Fortunately, in a lot of my situations, I've been able to really disarm people and put them in a position where they're actually rethinking some things. I'm sure there have been people that have had a problem with it. I'm sure I know those people exist, but out there. At this point in my life, they've not stood in my way. As long as they're not my way, I'm good. You can do whatever you want to do, but just stay out of my way because I live my life regardless.

Addiction is heavily present in a lot of the backstories of Appalachian people, including yours. How did sharing this intimate part of your mother and father feel? 

To be honest, it was a bit nerve-wracking. Because during my album campaign, the album is full of songs that I've written over the course of five or six years, and they were all about me dealing with the unhealthy ways in which I was trying to cope with my own grief. What I wasn't anticipating was how I would feel talking about some of these things repeatedly in interviews. While I think it's important to talk about mental health and talk about addiction and how it can affect people – how it can affect literally anybody, anywhere at anytime, no matter how great your life looks that people can fall victim to it – it really took a mental toll on me.

And so I hadn't had to do that in quite some time. I've been focusing on the record and really getting into this new chapter in my life with these new songs. And being able to really enjoy writing as opposed to just always being this catharsis or trauma. It was becoming something that I realized could have so much more dimension and adds so much more to my life and to be able to write about things that I enjoy and that I think are interesting. While also still always write songs about how I'm feeling, I mean that that'll always be present, but just to be in a new chapter run in a healthier mindset. So going back to the documentary, having to talk about all that stuff again. It was very nerve-wracking to do that. From the feedback I've gotten, I'm very humbled and grateful that people are gaining something from the story and or maybe gaining a better understanding about not just even just my story, but the other two guys, their stories as well.

Music can be this universal healer. What did it heal for you?

The best way I can describe it, is it healed my mind. It helped me heal my entire relationship with myself. It played a role in that. There was a lot of other things that had to play a role too: eating well, taking my physical, mental health obviously more seriously, having a therapist for the past eight years. Actively looking to improve my quality of life. But also, trying not to get too obsessed with it and then making that the stressor, which I've unfortunately done a few times in my life. We all do it to some capacity. My relationship with myself and my sense of self-loathing, and anger anxiety. I think by really actively just being able to reshift the way that I approach my art, the way that I listen to music, it's allowed me to be the most creative that I think I've been.

Amythyst Kiah speaks on her music outside her home (Larkin Donley/ Joe Bressler; CALICO)“The Express Way” highlights how music is also a sense of community for people who are struggling and just people who want to be seen. How do you see the importance of music to Appalachian people?

I think music is a part of — it's just a part of life. I don't think it's necessarily so much different than any other any other places per se. I live in East Tennessee. A lot of times people talk about Tennessee, they'll talk about the talk about Nashville, it's all about Memphis. And obviously some, some amazing things have happened musically about those places. But when you talk about East Tennessee, it's a little off the beaten path. But I think that, musically, the music history here is just as rich as any other place. Two of the first big country stars for commercial music were the Carter family and Jimmie Rogers, and they both came to Bristol to the recording sessions that Ralph Peer record executive was hosting. Those were known as the Big Bang of country music in that area. There's a whole history museum there that I was part of the curation team called The Birthplace of Country Music Museum.

There's so many different other really fascinating cultural aspects here that are celebrated. Unfortunately, in a lot of media, back to the days of travel writers in 1800s and 1700s, the depiction of Black people has usually been disparaging and it's been showing the worst of the worst. I think if you take a camera into any rural area or area that's poverty-stricken, it's not gonna look pretty, but somehow we were special. I just think there's been a lot of underestimation so that's why I truly think it's awesome to be part of something that is really going to show the breadth of a good sampling of what Appalachia is for people and can be for people. So I feel like it was done with dignity and respect I think that all we want is just dignity and respect and to be able to share what we have to offer.

In your experience, how have Black Appalachians been forgotten, ignored population or just misrepresented?

Yeah, I think I just I think generally speaking, There are still people that think there are only white people who live in Appalachia. You know, I was talking with someone there a few months back that came that told their friends that they were coming to the festival to write about the festival. And the person was like, "Oh, no, they still lynch people down there?? What? Like that doesn't happen. So there are people that truly think that it's "Deliverance" over here, that it's the "Beverly Hillbillies" or something. 

Amythyst Kiah headshot (Todd Roeth)Alongside the downsides or maybe the negative experiences, what are the joys of being in this space as a Black Appalachian musician?

Things are things feel really good. I feel like I'm in a really, really good place in my life. I've got my fiancée, bought a house, got a house out in the county. There's a really lovely community here. Johnson City is a college town. So there's camaraderie between artists and just all different kinds of people. It's a really awesome art and music community. I mean, we've got bluegrass and country, and then we've also got punk rock and metal. There's all people and all kinds of music. There's also all these different visual artists as well. A lot of different coffee shops settled and host local art. So it's a very, very active art community.

We don't move to bigger cities because we all love where we live. I think the reason why we wanted to stick around, one of them being that we'd love to be part of continuing to grow what we have as opposed to leaving. Because when people leave, then things don't change. Not to say anything is people that do leave because everybody's got to decide what they need to do. If your life is going to be treated negatively— if you are a trans person, and you're heavily concerned about being able to get the care you need, I understand why you need to leave. You have to do what you need to do. But I think because I'm privileged and able to be in the space that I'm in and to see the diversity of community where I am, I want I'm in a position where I can take part in that

What are you listening to these days, and who do you want to recommend people to listen to?

I was just turned on to this band; apparently it's been around since 2014. There's this band called Jungle. I think maybe they're from the U.K. or something. But the music is just this incredible blend of of hip-hop and contemporary R&B and some electronic elements. It's just really, really good. Really good dance music. It's so awesome.

What's next after "The Express Way"? Do you have new music coming or? What do you want to share with people about what you've got going on?

Right now we're working on an album. I've been recording it. All the recordings are finished and now we're working on the packaging. I just did a photo shoot a couple of days ago with some really sick photos — super excited to have out in the world. So we did a bunch of basic –  just been working on the promo stuff for it and the packaging for the album, and that will be coming out later in the fall. We'll announce the dates. Hopefully soon, but it will be in the fall. So that'll be coming out.

And then I started tour opening for Molly Tuttle for some shows this week. I'm going to start driving towards Texas. Then opening for Iron & Wine in the summer out west, which I'm also really excited about. So yeah, working on getting the new album out and just start releasing singles. And then on the road with two amazing artists. Things are looking pretty good.

"The Express Way with Dulé Hill" is now available to stream on PBS.com

The post “The truth is being told”: Amythyst Kiah on Beyoncé, Black country music roots and Appalachia appeared first on Salon.com.

Prior to this novel, which was released in 1976, what we knew of vampires came from Bram Stoker's "Dracula" (1897), and later adaptations of that source material brought about by F. W. Murnau's German silent film, "Nosferatu," (1922) and Tod Browning's "Dracula," (1931), starring Bela Lugosi. These vampires, although lovesick, charming and seductive in their own right, lacked the humanity of Rice's — and their depictions would be much harder to tie thematically to addiction because in order for a character to be painted as an addict they have to try to quit whatever it is they're addicted to and find that they cannot. The thought of going "vegetarian," as Louis calls it, substituting animal blood for human blood, would have never crossed Dracula's mind.

Whereas Dracula prowled his eternal nights in search of blood with little reluctance, and only a glimmer of mourning for the living being he once was; Louis is as addicted to his attempt to pass as his once living self as he is to the living blood he subsists on. Speeding through his immortal existence as generations come and go around him, Louis yearns for whatever beautiful and trivial distraction will make his nights feel a little less long, but has only one true need, the need to drink. And while writing this book, that's something that Rice herself could very much relate to.

Anne Rice, whose full maiden name was Howard Allen Frances O'Brien, learned at a very young age what an unquenchable thirst looks like when, at the age of 15, her mother Katherine died from alcoholism. Sadly, Rice grew to develop a thirst of her own and struggled with alcohol from the age of 20 up until a year after the birth of her son Christopher in 1978. In a video titled "Don't Drink," which Rice posted to her YouTube account in 2008 in celebration of 28 years of sobriety, she describes her experience and what eventually made her quit.

"From the very beginning, alcohol was very bad for me," Rice says in her video. "For years I was an episodic drunk, then, after a considerable length of time, I became what I would call a steady drunk. I still managed to be very successful at life. I wrote 'Interview with the Vampire' and got drunk at night . . . I wrote 'Feast of All Saints' and managed to get drunk in the evenings afterwards. I don't know that I'd be alive today if I'd kept up the way I was going back in 1978. But something saved me. It was a miracle. And the name of that miracle was Christopher Rice."

Jacob Anderson as Louis de Pointe du Lac – Interview with the Vampire _ Season 1, Episode 1 (Alfonso Bresciani/AMC)In "Interview with the Vampire," the first of the 13 books in her Vampire Chronicles series, Louis spends a good portion of his early vampire years struggling with his relationship to drinking and how to go about filling his body with the blood it needs without having to kill people in the process. Louis' maker, the co-dependent Lestat de Lioncourt, shames him for this, encouraging him to give in to what he is, which is a killer, but Louis refuses. Along the way there are slips, which every addict must reasonably anticipate and weather the after-effects of, but he makes do with animal blood and blood donated from lovers and servants whom he drinks from without draining to the point of death. Knowing what we know of Anne's own struggles, it's easy to see how she may have written herself into this character.

"I wasn't even thinking about Lestat when I wrote 'Interview with the Vampire,' I was thinking about Louis," Rice writes in a post shared by a fan page. "Louis was the hero, everything revolved around Louis."

While both Anne and her character Louis grappled with their romantic notions of morality and restraint, Lestat was the polar opposite. Based on Rice's own husband, poet Stan Rice, Lestat was the character born from Rice's own sorrowful imagination, coaxing her to not only drink, but drink until she was to the point of bursting.

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Sam Reid as Lestat De Lioncourt – Interview with the Vampire _ Season 1, Episode 1 (Alfonso Bresciani/AMC)

"Lestat just sprang to life in the corner of my eye," Rice writes. "This character took on all this ferocity . . . I had an idea of Lestat as the man of action, the man who could do things that I couldn't do, that man who could make the decision that I never had the nerve to make; and the person who could go through life joyfully in spite of the questions that torment me — the doubts that torment me, the horror of death that torments me."

Rice, who passed away in 2021 having lost her husband in 2002, was no stranger to death. In her books, she describes death, and the act of dispatching it, as something poetic, giving it deeper meaning beyond just the end of a life. Like with the themes of drinking and addiction, she used writing as a therapy to cope with some of the darker aspects of her real life.

In 1972, Rice experienced the tragic loss of her 5-year-old daughter Michele from leukemia and, after going on a bender to drown her sorrows, funneled that unspeakable loss into the creation of one of her most famous characters, Claudia, a doll-like child vampire unburdened by the pains of mortality. A daughter who could live forever.

"It was a nightmare," Rice said about her loss in a 2016 interview with Horror Feminista. "I was nothing and nobody. I had no prestige. I wasn't a mother. I was a bad wife — I never cleaned house. I was no good at anything."

After the worst of her grieving, Rice dusted off an old short story she'd written that would eventually become "Interview with the Vampire," and used her sadness and addiction to turn it into so much more than a book about bloodsuckers, but a legacy of work that, at the heart of it, is a love letter to life and recovery.

Rice passed away in California, where she relocated in 2005, after the death of her husband, but she will always be tied to the city of New Orleans, where she lived for most of her life, and which she chose as the setting for her Vampire Chronicles. If you've spent any amount of time in New Orleans at all, then you know how hard it would be to try to kick a drinking habit in a place that literally has drive-through daiquiri shops and bars that advertise "big ass beers." She put her own struggles into these books, and her characters guzzled in ways she could no longer allow herself, or, in the case of Louis, acted as sponsor in her own recovery.

"Suddenly, when I was in the skin of Louis . . . I slipped into this seemingly unreal thing and looked through his eyes, I could make my whole world real," Rice said to Horror Feminista. "He was able to say, 'Let me tell you about New Orleans; this was our world,' and I could write about all the beauty. Even the most fictional stuff in there was somehow out of my real world. It fell into place and was coherent . . . I didn't know it at the time, but it was all about my daughter, the loss of her and the need to go on living when faith is shattered. The lights do come back on, no matter how dark it seems."

Rice died during the early stages of filming AMC's TV adaptation of "Interview with the Vampire," a project that she toiled for many years to get into the right hands. In interviews, show creator Rolin Jones, Jacob Anderson, who plays Louis and Sam Reid, who plays Lestat, have all expressed that as huge fans of Rice, they'd wished she'd been able to see what they've done with her characters. As someone who read first editions of her Vampire Chronicles as they came out, and who also struggles with alcohol, I would bet a thousand nights that she would have appreciated the many ways in which the show pushes the themes of her book to the forefront.

In AMC's "Interview with the Vampire," Louis becomes a vampire shortly after the death of his brother. In the show's first episode, "In Throes of Increasing Wonder. . . " he describes what it felt like to be drunk on Lestat's blood for the first time.

Reconnecting with journalist Daniel Molloy (Eric Bogosian) to continue a discussion that began in Rice's debut novel, Louis asks him to think back to his own days as an addict and recall the best he'd ever had.

"Imagine that flowing inside your veins again, now multiply it by miles to the rings of Saturn and back," Louis says.

In Episode 2, ". . . After the Phantoms of Your Former Self," he goes into further detail, describing his first moments as a newly made vampire, walking the streets with Lestat as he points out passing humans and compares them to different types of alcohol.

"Lestat's blood was giggling inside me; teasing my senses, illuminating the District with overwhelming detail, as if I'd walked my entire life as a dead man," Louis says.

"You were f**king loaded," Daniel replies.

Jacob Anderson as Louis de Pointe du Lac – Interview with the Vampire _ Season 1, Episode 2 (Alfonso Bresciani/AMC)

As an introvert who first read Rice's "Interview with the Vampire" in high school, I would think of her written descriptions of these experiences as I chugged whole bottles of Boone's Farm at parties, waiting for that moment where my true self cracked out of its shell, allowing me to navigate the room in ways I felt I couldn't have otherwise. As a sober person I was stoic, trapped inside myself. But once drunk, I could step outside of the prison my own mind kept me in and be free. This has always been the allure of drinking for me. It has the ability to calm me, comfort me, help me really "live." But as any addict or vampire knows, such apparent gifts come with consequences. For both alcoholics and vampires, those consequences are often death.

Rice saw her mother die at the bottom of a bottle. "As a matter of fact, I think she swallowed her tongue," the writer told Horror Feminista, describing the severity of the addiction that stole her own maker away from her. For Louis, the consequence of his addiction was his own witnessing of the loss of life, by his own hand, which caused him to break away from the norms of his own vampire companions in a way that others were not strong enough to do, or had no interest in considering.

In Episode 4 of AMC's "Interview with the Vampire," ". . . The Ruthless Pursuit of Blood with All a Child's Demanding," we see what the full-fledged party years of addiction look like for a vampire when Claudia (Bailey Bass) drinks her way through the population of New Orleans.

Saved from a burning building as a young girl by Louis, and turned into a vampire by Lestat, Claudia's eternal youthful enthusiasm turns her need for blood into an unbridled and unquenchable frenzy. If you were a drinker in college, think back to those nights when you could slam upwards of 10 red cups of beer, wake up for brunch the next afternoon, and then do it all over again that night without giving it a second thought. Now "multiply it by miles to the rings of Saturn and back," to steal a phrase from Louis, and that's what life as a fledgling vampire is like for Claudia.

Bailey Bass as Claudia – Interview with the Vampire _ Season 1, Episode 4 (Alfonso Bresciani/AMC)Having been made a vampire at such a young age, Claudia will never be able to grow out of her youthful hunger. While she eventually does mourn the fact that she'll never blossom into a woman, never have children, and never marry a man who isn't the sort who would be OK with sleeping with the body of a child, she's absolutely fine with her drinking habits, which she doesn't see as a problem at all.

"I tasted it, and right away I felt as strong as a streetcar," Claudia says, describing the first moment she tasted Lestat's blood. "I realized what I thought was heaven was just some nice room. And what I thought were angels were really Hell demons . . . I decided to make the best of it."

Addiction, much like a vampiric craving for blood, waxes and wanes in terms of its influence. There are days and nights when it may seem easy to pull back, or abstain all together, and there are others when it feels like there's not enough in the world to satiate your thirst. For Rice, and for her vampires, the main differential is in how that unending thirst is dealt with. For Rice and Louis, they hold themselves to a certain standard. For Lestat and Claudia, they give into it completely, drinking like fat ticks.

At the end of Rice's "Interview with the Vampire," Claudia is killed and, in this moment, she essentially loses her daughter Michele for a second time.

In describing to Horror Feminista how she grappled with that ending, Rice said "that Claudia had really been meant to die at the end of 'Interview' the way Michelle had died . . . I almost died myself and went kind of crazy. I saw germs on everything and washed my hands 50 times and really cracked up."

Sacrificing Claudia, mourning the death of her daughter, and wrestling with her own thirst for booze sent Rice spinning all over again, only to emerge from the depths of her despair years later, born anew with the birth of her son. A mother and child, gazing upon the world with new eyes.

"Don't make the mistakes I made," Rice says in her 'Don't Drink' video. "Don't give your young years to drinking. Don't give your young adulthood to being drunk."

Lestat would likely roll his eyes at that. But Louis, Rice's hero, who was created by her and will live on in her memory, would happily toast a warmed glass of donated AB negative in her honor.

The post Lust for life: How Anne Rice’s alcoholism influenced “Interview with the Vampire” appeared first on Salon.com.

However, research suggests that police officer views about people who use drugs are generally negative, and studies show that prior experience administering naloxone to an overdose victim is not associated with more positive views about this aspect of their jobs. Expecting a police officer to respond to an overdose may present a conflict for him within the broader context of the war on drugs. Law enforcement officers have been taught to see an overdose victim as a criminal who illegally acquired and used drugs from the underground market for half a century. Rather than viewing an overdose as a medical emergency, many have been trained to see it as evidence of criminal activity.

Yet we now instruct officers to look at the overdose victim as needing medical assistance and intervene with naloxone. And at the same time, we expect people who use illegal drugs to be willing to call 911 for help with the full knowledge that officers with the power to arrest them may be the first to respond. 911 Good Samaritan Laws were passed to protect overdose victims and bystanders from arrest when police officers respond to overdose calls. However, these laws have not significantly reduced overdose deaths because many people still fear arrest due to the limitations of state-specific protections in the Good Samaritan Laws and because many people still fear arrest.

The disconnect between the criminalization of drug use and our desire to promote a public health approach to the overdose crisis plays out in these situations every day. While it is important to ensure that any potential first responder, including a police officer, is prepared to help save a life and armed with naloxone, we must question whether police officers should be dispatched to overdose 911 calls at all. Why are police officers the first to the scene of a medical emergency rather than an EMT or another first responder with training in crisis response? What else could an emergency response look like?

Many harm reductionists support alternative crisis response hotlines which dispatch people trained in mental health and crisis response, like social workers and paramedics, to overdoses rather than police. More of these alternative hotlines are popping up in communities across the country, since it is clear how these trained responders would be better equipped to save lives, and vulnerable people may feel safer when calling for help. Harm reductionists also want public funds to prioritize buying and distributing naloxone for community distribution in higher quantities because families and friends respond to far more overdoses in our neighborhoods than law enforcement. Beyond this, harm reductionists continue to advocate for Overdose Prevention Centers so people can avoid calling 911 and get the help they need on site.

Another example that comes to mind is the provision of sterile syringes outside Syringe Service Programs (SSPs). Some states have passed laws so that you can legally buy syringes at the pharmacy without a prescription to increase access to sterile syringes for people who may not have an SSP nearby. In New York State – where most counties do not have an operational SSP – you can buy ten syringes without a prescription at any pharmacy through the Expanded Syringe Exchange Program (ESAP). By offering these services, pharmacies can fill this harm reduction gap in more parts of the state.

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However, there are limits to how much these programs can increase access to sterile syringes for the most marginalized people who use drugs. There’s often a large difference between what is legal and what happens in practice. Just because someone can legally sell syringes does not make their program a harm reduction program. And just because you can sell syringes to people who use drugs does not mean you will. Studies with pharmacists in several US states suggest that only a small percentage of them are willing to sell syringes without prescriptions and that many pharmacists hold negative and stigmatizing views of people who inject drugs.

I once guest lectured on harm reduction to a class of pharmacy students enrolled in the university’s PharmD program when I was an Assistant Professor of Social Work. Almost all of the students had current internships for school credit at community pharmacies across New York City and Long Island, so I asked them if they knew about the state’s ESAP law. Most of the students did not.

One student raised his hand and told me he recently had a customer come up to the counter to purchase syringes without a prescription but the managing pharmacist told him to lie and say they had no syringes in stock. Another student then raised her hand and said she had a similar experience; however, the managing pharmacist told her to tell the customer they only had large gauge syringes (intended for intramuscular injections) in stock, not the smaller hypodermic syringes the person had requested. In both cases, the customers left without the syringes they wanted.

I asked the class why they thought their classmates were discouraged from selling syringes. Some described a phenomenon known in the research as the “honeypot effect.” They believed that the managing pharmacists worried that selling syringes to people who used drugs would attract more of them to their pharmacies, particularly from other communities.

The students hypothesized that the pharmacists wanted to avoid serving these so-called undesirable customers and did not want to gain a reputation as a pharmacy that sold syringes to drug users because they wrongly believed it would invite more criminal activity to their neighborhood. Other students talked about how perhaps the pharmacists were worried about “enabling” or “encouraging” injection drug use by selling syringes.

I used these anecdotes as an opportunity for further discussion. First, I dispelled the honeypot theory by discussing existing research both in the United States and internationally that found that harm reduction programs of all types typically draw in only existing members of the neighborhood and do not increase crime in the vicinity of the program. I also encouraged them to think about how hard it must have been for these customers to walk through the door in the first place, given the stigma toward injection drug use and the fact that they “outed” themselves by making such a request.

I asked them how these customers must have felt when they were treated this way – did the students think the customers believed the staff when they said they had no syringes or only had certain ones, or did they know the pharmacy staff simply did not want to serve them? I asked them to imagine what happened when the customers left the pharmacy after being unable to buy those syringes. Would they try another pharmacy? Would they wake up the next day and simply stop injecting drugs because they had no new syringes? Would they reuse or share a syringe with someone else the next time, since they did not have sterile syringes of their own?

I also reminded the students that these customers came to the pharmacy fully intending to pay for these syringes. After all, SSPs give them out for free. So, if someone is coming to a pharmacy, they either have no nearby program or prefer the setting. By refusing to serve them, the pharmacists made it hard for these customers to engage in health-promoting behavior.

And they may have just discouraged these people from seeking syringes at a pharmacy ever again. I encouraged the students to think about what they would do if they were in this situation in the future. Would they behave differently? Many raised their hands when I asked whether they would consider selling syringes to customers.

I left that presentation thinking about the pervasiveness of drug-related stigma in our society and how much work it will take to get people to challenge their deep-seated thoughts and beliefs about people who use drugs. But it also reminded me that we cannot simply expect systems and institutions to be effective substitutes for harm reduction programs without adequate training and monitoring for compliance.

Of course, ESAP programs are reducing the spread of blood-borne infections, and police officers are reversing overdoses every day, and there are well-intentioned people who want to do it. But reviewing the research and reflecting on conversations like the one in my classroom also highlight exactly why harm reduction programs are still so essential and can never truly be replaced (at best, they could be supplemented by such approaches.)

Harm reduction programs clearly fill a gap in our communities because, unlike many parts of our healthcare system and criminal legal system, they not only welcome the highest-risk and most marginalized people in the door but also want them to be there. 

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(“Hi, Rae.”) 

It’s not the seasonal depression or Christmas blues that get to me. It’s the holiday parties full of people you can barely tolerate, even when lit. It’s getting hockey-checked by frenzied consumers in packed shopping outlets while trying to log into your banking app. It’s the migraine-inducing cheery jingles ringing from on high while you cram more work into fewer shifts, just so you can race out the door and drive for hours toward your miserable little hometown, all to be with the collection of personality disorders that’s been posing as your family for 40 years. 

The holidays are a relapse gauntlet for someone who struggles with alcohol, even for us California sober types. And lately that’s especially the case for women. Compounding the problem, the recently sober run this bottled-in-bond obstacle course while facing increased isolation as support networks and therapists head out of town themselves. Like every dry drunk, I’ve been told the key to getting through the minefield with your chip intact is to have a plan and stick to it. Plenty of mental health and addiction experts have offered their tip sheets. 

Mine includes everyone getting out of my face while I pound sugar like I live in a timeline where size-zero clothes and diabetes never existed. Then I’m leaving town for the closest weed-legal state, with the singular goal of chiefing so hard the local budtender nicknames me “ISS” — because nerds with a death-wish have been trying to get inside and fix me since 1998, but I’m so complicated and high it’ll take two alphabets and a billion-dollar international consortium to make me come down safely. 

Not all of us are abandoning ship, though. And there are still a few parties to attend before I bounce. Mind you, I’m not an expert in anything except getting paid and being 100% that b****, so this list isn’t reflective of advice from the broader recovery community. Nonetheless, here’s a few helpful hints from Hell-oise on making your holiday party more recovery friendly for the Cali-sober people you love.

Why am I even here?

Is this a party or just a really slow and uncomfortable drinking game? Give me something to do. Where are your dice? Why don’t you have poker chips? Is this a bong? Hey, did you know the counterweight on your record player’s tonearm was set to four freaking grams? I don’t know where you found a cartridge that heavy but you’re gonna shred your wax that way, man. Yeah, no worries, I zeroed it out for you but the anti-skate knob is loose. Where do you keep your screwdrivers? 

The Irish exit

Your freshly dried-out friend actually showed up? Like… not by accident, but intentionally left the house to come here?? Holy hell. Congrats. Even 30 seconds of attendance hits the social-acceptability quota, and a lot of us will probably dip that fast. Don’t make a big deal about it, especially if the food sucks and boozing is the only thing to do. We’ve got a fine-tuned radar for when things are about to get too fun, and you’ve got other guests to worry about — like Ted. He just hasn’t been the same since Annette took his carpet-cleaning business in the divorce, and now he seems to be mistaking your monstera for a urinal.

Mocktails and non-alcoholic booze

If the coffee game is on point, we will love you in ways your parents never did. It’s marvelous of you to have NA-booze options around. Don’t be offended if some of us steer clear; depending on the person and the moment, near-beer can either be a perfect delight or trigger blood-lust level cravings for the real deal. Friend hack: If you keep a bottle of club soda with bar fruit and mixers nearby, we can keep our hands busy making PlaySkool mocktails (what a stupid word) instead of taking apart your spouse’s expensive turntable. 

Mind your business

I’m looking forward to people asking why I’m not drinking so I can see how uncomfortable I can make them. My biggest hope is that they’ll ask if I’m pregnant, and I’ll get to teach them a lesson about asking women That Question. I’ve been practicing my sadly wistful smile in the mirror, along with a softly spoken “not anymore” and just the exact right heel-turn. Werk.

Stop making it weird

So you’re doing Dry January and this is your last hoorah. Or you’re cutting back these days. Or your uncle just got sober. Or you quit smoking and just want me to know you understand how hard addiction is. Good for you — I wish I could launch myself out of this conversation and straight into the sun. Stop trying to relate when you don’t. Stop soliciting validation kudos for your pet false equivalencies. Stop veiling your own discomfort with self-deprecating remarks that tacitly seek permission to drink in front of me. I’m not here to collect sympathy, convert you to the church of AA, nor frown disapprovingly over proceedings from some moral high ground. Stop making it weird already and help me find the damn screwdrivers. 

Solo rolling sucks

Always assume I’m bringing a plus one-ish. Is it going to be a romantic interest? A sponsor? Two be-sequined nuns named Sister Petty Davis and and Sister Velveeta VonTease, who ziplined into your kitchen from our helicopter Uber while lip-syncing “Twerk Your Turkey”? Who knows. But if you’ve got another sober friend or three, invite them. Misery loves company and, if things go well, maybe one of them will start a badass girl gang with me. Maybe she’ll be cold and say she likes my leather jacket. Maybe she’ll tell me she always hated Parcheesi, and that the carpet-cleaning business is boring but it’s good money if you don’t mind the blood stains, and then ask if that’s my chopper and if I want to meet her cats — after all, I’m OK to drive.

An earlier version of this article originally appeared in Salon's Lab Notes, a weekly newsletter from our Science & Health team.

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“You’re too intense now,” said my mother in Michigan.

“I liked you better before,” admitted my cousin, who’d complained whenever I’d lit up but was now annoyed I couldn’t go bar hopping with her. Did she only want me to ax the bad habits we didn’t share?

“You’re no fun anymore,” carped a college buddy I’d once partied with. Did he prefer me stoned and half-conscious? 

Even a mentor said, “You’ve lost your spark.” Did he miss the deep, crazy conversations we had while chain-smoking and guzzling cocktails? I was hurt he found me more fascinating when I was using.

The muscular personal trainer I’d splurged on for a few sessions saw me sweating from nicotine withdrawal and said, “You look horrible. If it’s so painful, why don’t you just smoke?”

“I hired you to help get me over my two-pack-a-day fix,” I replied, startled. “It’s an impulse disorder. I need to learn to ‘suffer well.”

Those were the words of Dr. Woolverton, the substance specialist I saw weekly. Though I’d paid for two more sessions, the doctor suggested I cut my losses. So I quit the trainer too.

“Why all the negative reactions?” I asked in therapy, stunned and confused by the backlash.

“Your sobriety holds up a mirror to everyone’s excesses. It could be seen as threatening,” he explained. “Especially for those who don’t want to — or can’t — stop.”

But maybe there was another reason. What if I sounded like a moralizing, self-righteous prig? Was it time to give up people-pleasing, too? 

Anxious, overweight and friendless at 13, tobacco and pot relieved my social awkwardness and miraculously suppressed my appetite. I was nervous to start college early, so I became popular as the fun girl who threw wild soirees. (Well, wild for Michigan.) We shared smokes, booze (my drink was vodka and Tab), a water bong, magic mushrooms and the occasional Xanax. I relished the role of bohemian poet, sure I needed to be wacked out to write. I clung to those crutches for decades.

It wasn’t so cute at 41 — more like pathetic and depressing. While I was too prissy to try LSD, heroin or Oxy, I loved blow since it kept me from eating for three days. Before I put my entire bank account up my nose, I committed to a year of one-on-one talk therapy with Dr. Woolverton. But each time I cut out a substance, a new fetish surfaced. A psycho-pharmacologist thought I had Attention Deficit Disorder with Hyperactivity and prescribed Adderall. It made me feel like a speed freak, so I threw those pills away. One dose of Wellbutrin almost gave me a seizure.

With no one-size-fits-all balm, we tried an idiosyncratic, all-out behavioral strategy to avoid the “substance shuffle” common with addicts. Eating the icing off a dozen cupcakes caused a sleepless sugar rush, and my jeans refused to zip. A stick of Juicy Fruit gum to quell my nicotine cravings turned into ten packs a day until a nutritionist pushed me toward sugarless — and then the sorbitol made me sick. After losing two fillings, my dentist insisted I quit gum altogether. In a state of chaotic agitation, I ricocheted from the caffeine in endless daily cans of Diet Coke to hundreds of cinnamon sticks to being unable to sleep without Tylenol cough syrup.

“You have such a compulsive personality, you could get hooked on carrot sticks,” Dr. Woolverton said. He delineated the difference between an innocuous ritual versus an obsessive dependency: Stop doing it for two weeks, and if it hurts, you’re getting addicted.

As the nicotine patch stemmed my cigarette cravings, my recovery required retraining my brain to stop reaching for anything to obliterate difficult emotions. To do that, I journaled, recording the complicated feelings I could no longer inhale, imbibe or eat away. I repeated mantras incessantly, like “Lead the least secretive life you can” and “The only way to change is to change. Understanding follows.”

When a colleague called me “a walking Oprah episode,” I thought of toning it down. But then I learned the buff former personal trainer who’d asked, “Why don’t you just smoke?” died of a heart attack in his 40s. Another client of his revealed he’d been on steroids. I was shocked. I’d been so myopically involved in my own recovery, I’d missed signs he was doping. Was my temperance triggering? His death reminded me how dangerous substances could be, with deadly opioid overdoses increasing catastrophically over the last few years.

Without intervention, addictions don’t get smaller; they grow more out of control until they explode, Dr. Woolverton insisted. He advised me to put as many obstacles between myself and my substances as possible. But how?

To stay clean, I had to be boring — and vigilant. As everyone was either part of the problem or part of the solution, it was easier for me to remove people, rituals or entire food groups than be moderate. To avoid gaining weight, ruining my throat and teeth, I nixed gum, diet soda, bars and late meals at restaurants. My friend Karen called to ask me, “Want to go out and get some water?” (We wound up taking a long walk.)

I was now hooked on unhooking.

Catching a glimpse of Marlboros in the purse of a new housekeeper I was trying out made me want to bum one. How could I ask her to leave them home?

“Tell her you need to have a cigarette-free apartment, so you’d appreciate it if she left the pack downstairs with your doorman,” my doctor said. 

“That would make me sound like a control freak,” I lamented.

“You are a control freak,” he said. “Would you rather risk your sobriety than politely ask someone you might hire to help you out with a minor request?”

When I did, she replied, “Sure, no problem. I’m trying to kick it too.”

At least some acquaintances understood my need to be self-protective. Others were miffed by my rudeness. I left pals behind at readings and quickly crossed streets if I smelled a hint of weed to avoid a contact buzz, confusing companions and walking buddies. I offended an acolyte who caught me pawning off the dessert basket she brought me to a neighbor, and insulted a coworker who’d gifted me holiday champagne by saying, “Don’t you know I don’t drink?”

Without my old self-soothing methods, my nerves frayed and my patience was nonexistent. But I allowed my discomfort to surface and to play itself out, telling its own story. Nights and weekends I let myself cry, scrawling purple poetry into my journal, playing Bob Dylan bootlegs lamenting that everybody must not get stoned.

Since addicts depend on substances, not people, I attempted to rely on more humans. Yet I couldn’t handle AA groups where everyone smoked butts outside, guzzled soda and coffee and ate donuts. Instead, I avoided crowds, leaning on a few “core pillars” I trusted, like my therapist, my cousin Molly (also in recovery) and my long-suffering husband. For the first 12 months of my addiction therapy, he’d travel with me, petting my head to calm me, calling himself my “support animal.” Watching a TV show every night, he'd hold me for an hour without speaking, soothing my angst, though one evening he whispered, “The pillars are tired.”

I felt guilty for being so draining, difficult, twitchy, sweaty and claustrophobic in small spaces. At my teaching job, I fought for classrooms with windows and heating and cooling I could regulate, which alienated my bosses. In theaters, airplanes and performance spaces, I needled my companions by demanding specific aisle seats for legroom and faster escape. Everything simple was now a struggle. I’d become the Diva of Deprivation. “Life is easier when you’re anesthetizing yourself,” Dr. Woolverton opined.

My desire to please everyone was becoming toxic, so I quit that too. I skipped superficial New Year fests and literary galas filled with semi-strangers, lest I be tempted by quaffs, canapés or cannabis. I channeled those hours at home into writing and teaching instead. My frenzy and brain fog lifted and I found I could concentrate with a laser-focused intensity. I’d never be non-addictive, but as compulsions go, workaholism seemed comparatively benign, especially with regulation. I’d be at my desk at 9 a.m., then come up for air in time for class or dinner with my husband. Within nine months, something miraculous happened: My marriage, career and a few close friendships flourished.

Turned out the chemicals hadn’t liberated my creativity; they’d held it hostage. After decades of rejections, I sold several books in a row — a few chronicling my recovery — and tripled my income and energy level. Feeling intense empathy toward my students, I increased my class load and felt honored to win teaching awards. I added hours of volunteering and upped charity donations. I was so sure I’d aced clean living. And I let my guard down.

Seventeen years later, the pandemic hit. As I binge-watched TV, I munched nightly on bowls of popcorn, convincing myself it was a good, natural, snack: gluten free, whole grain, high fiber. One day when the grocery ran out of my brand (Bob’s Red Mill Whole Kernel White Popping Corn) I ran to 12 stores, unable to find it anywhere. I sweated out the 24 hours it took to arrive from Amazon. The popcorn had morphed into another obsession I couldn’t live without. A harmless one, I’d thought, before I saw I’d gained 25 pounds. I was unwittingly shuffling substances again. I knew what to do: Give up my favorite snack. It was hard for a few days, then I felt better and dropped the weight.

“You’re never recovered; you’ll always be in recovery,” Dr. Woolverton warned.

I might have to keep quitting things forever. It won’t win me any popularity contests, but having a smaller circle of VIPs who understand me is a deeper and warmer experience than placating a crowd. Dylan sang that just when you’ve lost everything you find there’s a little more to lose. After 20 years without smoking, toking or drinking, I’d add: And to be gained. By giving up toxic habits, I’ve made room for something more beautiful to take their place.

The post Secrets of a serial addict: How I got hooked on quitting, over and over again appeared first on Salon.com.

This fall, the Centers for Disease Control and Prevention released new data showing a marked increase in overdose fatalities nationally. Nora Volkow, director of the National Institute on Drug Abuse, told CNN that she had expected overdose deaths to decline after a sharp spike during the pandemic. Instead, such fatalities have only gone up.

Meanwhile, by the end of November, Donald Trump was riding high with nearly 60% support in Republican primary polling. In the past 43 years, according to the Washington Post, no candidate has had such a commanding lead and failed to win his party’s nomination.

On the face of it, his astonishing poll numbers would appear to have nothing whatsoever to do with the continued rise in overdose deaths. As it happens, though, the two phenomena are horribly intertwined, connected to a fundamental question so many Americans are grappling with: In a world that feels increasingly lonely and often hopeless, how can we feel better?

Being honest about our loneliness

One of us, Mattea, is a writer who currently uses drugs, and the other, Sean, is a doctor living in long-term recovery from a substance use disorder. Both of us were raised to believe that our accomplishments were the measure of our worth and that something out there — status, money, accolades — would make us whole. Both of us bagged various degrees and have admirable résumés, but neither of us found that such achievements brought any sense of wholeness. In fact, it’s often seemed as if the more impressive we appeared, the emptier we felt.

It took us about 40 years to realize that our quest to be accomplished and better than other people was, in fact, causing us despair. And today we’re writing because we remain in pain and want to be honest about it. We have come to understand that even those people who appear to be on top often feel an emptiness they try to fill with work, antidepressants, cannabis, wine, benzodiazepines, you name it.

Meanwhile, there is a nascent but growing awareness in the medical and recovery communities that loneliness is at the root of so much addiction — and that loneliness is on the rise. According to Surgeon General Vivek Murthy, loneliness in America has indeed grown into a public health crisis. Earlier this year, Murthy released a report entitled “Our Epidemic of Loneliness and Isolation,” in which he described taking a cross-country tour and hearing countless Americans of all backgrounds disclose that they feel invisible, insignificant and isolated. That experience of loneliness coupled with trauma and a wide spectrum of mental health challenges is now tearing at the fabric of American life, driving new levels of despair and death, much of it drug-related, that are ripping through families and communities and lowering life expectancy.

In such a bleak landscape, one way to feel better is to put your hopes into a magnetic leader who makes you feel like you’re a part of something meaningful. Another way is to have a martini and any mood- or mind-altering substance — anything to numb the pain.

This is not an individual problem. This is not a moral failing or a flaw in our brain chemistry (or yours). This is a vast social problem, one that benefits The Donald immeasurably.

Disconnection nation world

Bruce Alexander is a professor emeritus of psychology at Simon Fraser University in British Columbia and the author of "The Globalization of Addiction." He struggled with alcohol as a young man and then left the U.S. for Canada, where he devoted his professional life to the study of addiction. He focused on the significance of “psychosocial integration,” the healthy interdependence with society an individual experiences when he or she feels both a sense of self-worth and of belonging to a larger whole. According to Alexander, psychosocial integration is what makes human life bearable and its lack is called “dislocation” or, in common parlance, disconnection.

In a sense, disconnection goes hand-in-hand with our modern free-market society. Many potential sources of psychosocial integration like the sharing of food among all members of a community are today seen as incompatible with free markets or otherwise logistically implausible. Instead, each individual is meant to act in his or her own self-interest. According to Alexander, this makes a sense of disconnection not the state of a relatively few members of society, but the condition of the majority.

Such disconnection generally proves to be a psychologically painful experience that all too often leads to confusion, shame and despair. As individuals, we tend to try to manage such feelings by numbing ourselves or reaching for a substitute for genuine connection, or both. This leads masses of people to compulsively pursue and become addicted to work, social media, material possessions, sex, alcohol, drugs and more. Of course, simply to pursue any of these things doesn’t mean a person is addicted. It’s possible to have a healthy relationship with work or an unhealthy one — and that’s true of just about anything.

In this view of modern existence, addiction is a very human answer to the conditions in which we find ourselves. According to physician and childhood trauma and addiction expert Gabor Maté, addiction is so commonplace in our world that most people don’t even recognize its presence.

Yet to label people “drug addicts” is to strip them of their humanity and assign them to the lowest echelons of our society. It’s a term that implicitly undermines the validity of a person’s experience and negates their very worth. Even though different types of addictions — to drugs or money, for instance — are inherently similar, the former is stigmatized, while the latter is acceptable or even revered.

“To ostracize the drug addict as somehow different from the rest of us is arrogant and arbitrary,” writes Maté, who has been candid about his own addictions — to work and shopping — to the point of sharing his experiences with patients who were addicted to drugs. His patients, he reports, were astonished that he was “just like the rest of us.”

“The point,” Maté said in an interview with the Guardian earlier this year, “is we are all just like the rest of us.”

After more than half a century of studying addiction, Bruce Alexander no longer separates compulsive drug use from other dependencies. He categorizes addictions to alcohol, drugs, food, gambling, power, a sense of superiority and a litany of other things as responses to the same underlying pain.

Yet he does regard one flavor of addiction as distinct from all others.

“What’s the most dangerous addiction of all in the 21st century?” he asked in a conversation with one of us over Zoom last year. And then he answered his own question. According to the octogenarian professor who has devoted his life to addiction psychology, the most dangerous addiction today is the rising obsession globally with cult political leaders like Donald Trump.

What drugs and autocracy have in common

Today, there is an emerging awareness among medical professionals that loneliness lies behind our addiction crisis. But political scientists have long known that loneliness can drive social decay, eroding political stability in unnerving ways.

Historian and philosopher Hannah Arendt understood isolation and loneliness as the essential conditions for the rise of an autocratic ruler. For a politician to seize absolute power, she wrote in 1951 in "The Origins of Totalitarianism," people must be isolated from one another. She referred to widespread isolation as a “pre-totalitarian” state, suggesting that totalitarian domination “bases itself on loneliness, on the experience of not belonging to the world at all, which is among the most radical and desperate experiences of man.”

In her moment, Arendt also saw political propaganda as both an art and a science that Adolf Hitler and Joseph Stalin had developed to near perfection. She labeled it the “art of moving the masses.” Had she lived into our time, she would undoubtedly have been struck by the ways in which the science of drug chemistry and the art of political propaganda have soared to novel heights. After all, we carry in our pockets, day and night, tiny computers that all too often deliver disinformation, while the drug supply has become so potent that fatal overdoses regularly occur from both legally obtained prescription pills and a continuously shifting assortment of illicit drugs.

This should be terrifying, but we’ve also learned something significant from our own experiences and those of other people who use drugs. Every person’s drug of choice — whatever it is — deserves to be understood and respected as a strategic coping mechanism. Follow the drug to the pain underneath. Gabor Maté’s mantra is: “Don’t ask why the addiction, ask why the pain.”

No matter whether people ease or numb their suffering with drugs, alcohol, television or by following a leader determined to be the one and only in their world, that strategy serves an important purpose in their life. And that’s true even if today’s widespread addiction to a would-be all-American dictator were to lead to the awarding of incontestable power and control over the world’s largest nuclear stockpile to a vengeful demagogue. It’s important to understand that a romance with a drug or with Donald Trump (or both) helps people tolerate their pain — very often, the pain of feeling that they don’t have a place in the world.

This molecule understands me, it doesn’t judge me. This guy understands me, he doesn’t judge me.

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Arendt grasped early on that the lies of political propaganda offer an alternate reality, and when masses of people support an autocratic leader, they’re casting a vote against the world as they know it — a world marked by loneliness. It’s just such loneliness that fuels support for the iron-fisted politician, while creating a hunger for mind-numbing molecules, both impulses born of a frustrated need for connection. As a New York Times headline put it, opioids feel like love (and that’s why they’re so deadly in tough times). That one can experience love through drugs might seem fantastical to many — but such love is all too real and feels better than no love at all.

Amid endemic loneliness, drugs and autocracy each provides an escape from a reality that otherwise seems unbearable.

We decided to witness each other’s pain

Our cultural modus operandi is to judge people who use drugs or are in the throes of addiction — to consider substance use an essential character flaw, a deep moral problem. In 2022, one of us led a national public health survey that found 69% of respondents across the U.S. believe society views people who use drugs problematically as “somewhat, very, or completely inferior.” In other words, the vast majority of us believe that people who use drugs are outcasts. Meanwhile, our legal system criminalizes certain substances (while similar or even identical molecules are legal and widely prescribed) and regards the people who use them as bad actors who must be punished and supervised in jails and prisons or through parole or probation.

But once you grasp the underlying problem — that people are lonely, traumatized and in pain — it becomes all too clear that incarceration or other similar punishments are not the answer. They represent, in fact, just about the worst policy you could possibly bring to bear against people who are hurting and self-medicating in an attempt to feel better. The U.N. Office of the High Commissioner for Human Rights recently called on all nations to regard drug use as a public health issue and curb punitive measures to deal with it. In the U.S., even as there is a dawning awareness that the war on drugs has been a miserable failure, many elected officials (and presidential candidates) only want to double down on harsh policies.

One of us has personally experienced criminal punishment for substance use, and the shame of being judged and punished is so physically palpable that it’s the equivalent of being stabbed and then having the knife twisted in you again and again. On top of devastating repercussions that touch every dimension of your professional and civil life, it’s common to be judged badly for your substance use by friends, family and neighbors — nearly everyone you know. That, in turn, makes recovery from a substance use disorder seem all but impossible because drugs are what numb the shame.

So we personally decided to try something different. We’re two people who have experienced loneliness and, rather than judge each other, we’ve chosen to witness one another’s pain. That means listening to our experiences without diminishing, deflecting or trying to fix the problem. And what we’ve found is that this makes us less lonely and provides a strong measure of healing.

Notably, research indicates that nonjudgmental peer support is a genuinely effective strategy for addressing substance use disorder. Whereas being jailed or otherwise punished or dismissed as weak or dirty is a barrier to emotional health (and all too often proves deadly), having the support of trusted peers and loved ones is associated with a reduction in the psychic pain that drives people to use drugs in the first place.

This squares with what Arendt thought, too. In "The Origins of Totalitarianism," she wrote that loneliness is “the loss of one’s own self” because we are social creatures, and we confirm our very identity through “the trusting and trustworthy company of [our] equals.” That is, we need one another to be our fullest selves.

To put that another way, when it comes to addictions, whether to drugs or to a dangerous leader, the true medicine is connection to each other.

The post The most dangerous drug of 2023: Loneliness, Donald Trump and you appeared first on Salon.com.

The answer is the average person doesn't think a peanut allergy is a moral failing. The average person doesn't think “Can't Uncle Sean just pull it together and not have a peanut allergy this Christmas?”

We won't be able to truly have deep conversations about what is killing our children, our loved ones and ourselves, until we change the national narrative about what addiction and substance use disorder actually is at its core. In my opinion, the only way to do that is through the arts.

When Barack Obama ran for president, he was opposed to gay marriage. Nowadays you can't repeat what he said and run for City Council as a Democrat. Was Barack Obama really against gay marriage or did polling tell him it wouldn't be popular? The national narrative was that people weren't ready for it. What changed?

I'd say the arts. It all comes down to the TV that we watched, the movies that came out, the books that we read. Ellen came out as queer and we all thought maybe her career was over. It wasn’t. “Queer Eye For The Straight Guy” aired on TV and we thought it was amazing that perhaps men might actually look in the mirror before leaving the house. The conversation changed to acknowledging that the gay community is and has always been a part of who we are.

The narrative has changed. More people are out. There is less shame in our lifetime. We need the arts to do that for the 40 million Americans struggling with substance use disorder. The crisis that costs the U.S. economy 1.5 trillion a year. Yep, with a T.

In the 1980s Reagan didn't want to talk about AIDS. So, Larry Kramer and the Public Theater staged “The Normal Heart.” At the end of each performance, Larry stood out front and handed out pamphlets with information about HIV. The conversation was unstoppable. Reagan eventually acknowledged it. Larry Kramer and the arts led the way and saved lives.

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The way national narratives on AIDS have changed can be a guidepost for what we could be approaching addiction. Thirty years ago, the guys in my high school thought if you got AIDS, it was your fault and it was a death sentence. I have very clear memories of my friends mourning the death of basketball player Magic Johnson on the night we learned he was HIV positive. He’s still alive (and hopefully reading this.)

Addiction is very similar. Yes, if you don’t talk about it, and don’t get help, you will almost inevitably die. But just like AIDS, it’s not anyone’s fault, and you can live a full life. We’d all rather have Stage 1 Cancer than Stage 4 so the goal should be the same: early conversation, early detection, changing the national perception about what it means to be ill — so that if you're one of the people that struggles with pills, or booze, you do exactly what every person does when they get diagnosed with cancer. You walk into work the next day, tell your boss, select family friends, get multiple doctors’ opinions and collectively, as a community, start figuring out a way to fight.

If you had cancer, friends would support you, people would bake for you, your in-shape friends would run marathons for you. Bless their hearts. Why? Because even if you are a smoker or even if you eat cheeseburgers all the time, like me, people don't currently think of cancer as a moral failing. It’s hereditary, it gets a lot of people, whatcha gonna do? Interestingly, at one point we did paint cancer as the victim’s fault. Another narrative that has changed in our lifetime. It’s possible.

So, what should the arts be doing? They can break the national narratives around addiction by portraying the multiple and vast ways of recovery. When I was trying to get sober, TV had told me that if you wanted to get sober you had to go to a sad church basement where seven people would sit in a circle and chant your name.

I can't imagine why the average person doesn't want to do that.

Anyone that's actually been to a series of AA meetings knows that despair is far from the truth. Yes, there is the occasional chant that still catches me off guard, but there’s also some of the funniest stories I’ve ever heard. There are people ready to help you. Smart, hilarious, great people.

Let's also be clear: you can get sober, you can spend years in recovery, help save others and have nothing to do with AA at all. Not a lick.

But until there’s a conversation about addiction not as a moral failing, there won’t be a conversation about the many ways it can be fought.

Honestly, I can't think of a single show I've ever seen where a person in recovery shows up and their relapsing isn't a plot point. Admittedly, it's a great way to end season one – or they take a drink right before intermission? Who saw that coming? Everyone. Because it’s the only narrative the arts provide. So, it’s what we expect.

We need plays, movies, books, operas, TV shows that show the many ways that people can make positive change in their life. People in recovery walk amongst you, California sober people (which means they don't drink but they smoke pot) walk amongst you,  people who have actively decided to ‘deal with the issues in their life in the order with which they may kill you’ walk amongst you. They need to be represented in the art the public consumes.

The arts can show the world the full breadth of recovery, the full breadth of humanity, and like gay marriage, change the narrative in our lifetime.

At the end of Tony Kushner's "Angels In America," a character says, “We won't die silent deaths anymore.” The arts said that once, meant it, and lives were saved. People are alive because of that play. The next crisis is upon us, and it’s time for the arts to step up once again.

The post The arts are the first step towards conquering the addiction crisis appeared first on Salon.com.

Amanda, who asked to be referred to by her first name, has been on Suboxone since 2010 after two decades of using methamphetamine, cocaine and other drugs, including a few years of consistent heroin use. Once she decided to get treatment and stop using drugs, she continued to have to jump through hoops to get not only her Suboxone but also her Adderall prescription.

She said she was required to have monthly visits with her provider to get her prescription refilled and perform monthly urine screens, which both came with additional co-pays. There were other shortages, too, during which she had to go in person to multiple pharmacies and was sometimes turned away. Ultimately, she cycled through more than 10 different providers before finding one that was able to consistently fill both of them through Medicare, she said. But she's had friends who have been diagnosed with ADHD and haven't been able to connect to treatment.

“The whole system of just being able to acquire your ADHD medication is a huge problem and ordeal,” Amanda told Salon in a phone interview. “It's easier for a lot of people to just get it from the street.”

Amanda’s experience highlights a host of factors that have contributed to the rise in U.S. stimulant use in recent years: Many people who use drugs do so as a means to cope with undiagnosed mental, behavioral or neurological health conditions. Untreated ADHD is more common in people with stimulant use disorder than in the general population, and many patients get into using methamphetamine as a way to self-treat their condition, said Dr. Mark Willenbring, an addiction psychiatrist at the Expanse clinic in St. Paul, Minnesota. 

“I have patients who used it in a controlled way for 30 years, as if they were self-treating ADHD,” Willenbring told Salon in a phone interview. “Their doctors wouldn't prescribe anything for them, so they were kind of stuck between a rock and a hard place.”

Last year, the Drug Enforcement Agency’s (DEA) quota for the amount of drugs like Adderall used to treat ADHD fell short of increasing demand, which contributed to the shortage. Just like the withdrawal of prescription opioids on the market is thought to have pushed people with addiction toward illicit opioids like heroin, restricting prescriptions for stimulants like Adderall could push people toward an illicit supply instead.

“I've had people say to me, ‘Why don't you just do a bump of meth and it’ll set you straight all day?’” Amanda said. “I don't want to have to do that. I have a prescription and I just want to be able to get my medication.”

Although stimulants are becoming increasingly involved in overdose deaths in what some are calling the “fourth wave” of the overdose crisis, treatments for this form of drug use are few and far between. Earlier this month, the Food and Drug Administration (FDA) called upon drug makers to develop new treatments that could be used to treat meth, cocaine or prescription stimulant addiction. 

In a statement, Marta Sokolowska, the deputy director of the substance use unit within the FDA’s Center for Drug Evaluation and Research said: “Currently there is no FDA-approved medication for stimulant use disorder. When finalized, we hope that the guidance will support the development of novel therapies that are critically needed to address treatment gaps.” 

One of the main challenges to finding treatment for stimulant use is that it can vary significantly depending on the person, the drug of choice and the route of administration. Cocaine, prescription stimulants and meth all work differently in the brain, have different effects on the body and are used in different ways, including being snorted, smoked or injected.

In its draft guidance for stimulant use treatment, the American Society of Addiction Medicine (ASAM) cites a handful of pharmacological medications that can be prescribed off-label to treat stimulant use disorder. Some studies show bupropion, an antidepressant used to treat tobacco addiction, can be effective for cocaine use disorder as well as amphetamine use disorder, particularly when paired with a drug used to treat opioid use disorder called naltrexone in the latter. 

In addition to a few other off-label drugs that show some benefit in treating stimulant use disorder, one 2020 study published in Psychopharmacology showed stimulants used to treat ADHD can reduce cocaine use, including methylphenidate (also know as Ritalin) or mixtures of amphetamine salts like Adderall. Similarly, methylphenidate, which is FDA-approved to treat narcolepsy, can also reduce amphetamine use.

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The idea to use meth or amphetamines to treat these conditions resembles the idea behind using opioid agonist treatments like buprenorphine and methadone to treat opioid use disorder. These two medications have been shown to be very effective in treating opioid use disorder because, being opioids themselves, they target the opioid receptors that cause cravings and withdrawal. 

However, stimulant use activates not just one but many different receptors, and giving patients drugs like dextroamphetamine would not produce the same reductions in cravings or withdrawal for someone who used methamphetamine, said Dr. Brian Hurley, the medical director for the Bureau of Substance Abuse Prevention and Control for the Los Angeles County Department of Public Health. The why for using these drugs is also different: While people who use opioids tend to do so on a daily or more frequent basis to prevent withdrawal, people who use stimulants also differ in that they more frequently use in binges, Hurley said. 

“Though the analogy [comparing] opioid agonists with opioid use disorder and psychostimulants for stimulant use disorder is logical, the combination of the mechanism of action of stimulants and the variability in the reasons people use stimulants outside of just kind of pure pharmacologic craving make the stimulant agonists less effective,” Hurley told Salon in a phone interview.

The ASAM recommends using psychostimulants to treat underlying ADHD in people who have both ADHD and stimulant use disorder, although their use remains “controversial” due to the potential for "misuse." However, there are some prodrugs of dextroamphetamine used to treat ADHD, such as Vyvanse, that have a slow onset and could be used for these patients, Willenbring said. Yet providers may be hesitant to prescribe any controlled substances that have shown promise in treating stimulant use off-label due to all of the additional regulations they are under through the DEA.

In lieu of not having any FDA-approved medications to treat stimulant use disorder, the ASAM also recommends turning to behavioral interventions instead, including contingency management, an evidence-based program in which people using stimulants are awarded small monetary rewards for not using. 

California’s state health system has deployed contingency management across 24 counties. Essentially, when patients test negative on urine-drug screens, they receive gift cards, with a maximum reward capped at $599 over a six-month period. However, so far this is merely a pilot program and access is limited, said Chelsea Shover, Ph.D., an assistant professor-in-residence at the University of California, Los Angeles. Plus, contingency management in general tends to stop working for people once they stop attending, Willenbring said.

“It’s out there but in a pretty limited and scattered way,” Shover told Salon in a phone interview.

Why it hasn’t been more widely accepted traces back to the stigma that continues to constrain harm reduction efforts. Federal anti-kickback regulations that prohibit medical providers from rewarding patients to generate business may make healthcare providers nervous to offer services like contingency management, Hurley said. Although the Office of the Inspector General for the U.S. Health and Human Services Department released an advisory opinion that said such programs presented a "minimal risk" of being punished via anti-kickback statutes, a Montana clinic providing contingency management was investigated for fraud last year, illustrating the complexity of the issue.

Just like opioid agonist treatments are being used in addition to safe injection sites and needle exchange programs to mitigate the impacts of opioid use, any medications for stimulant use will need to be paired with behavioral and social interventions that meet people using these drugs where they are as well. Yet both pharmacologic and behavioral interventions are up against stigma that could prevent them from getting to patients even once they do prove to be effective.

"There are no molecules that I've seen in literature that have had a really robust response, but that doesn't mean that some can't help," Hurley said. "I'm glad [the FDA] is calling for additional research because we certainly need additional options."

For Amanda, the combination of Suboxone and Adderall to treat her substance use and ADHD has been "life-saving," she said. Not only does it help reduce cravings and attention problems, but also helps treat her fibromyalgia and depression that all once contributed to her substance use. 

"That combination has allowed me to get my life stable again, control my pain and help with depression," she said. "It helps with so much, but people are reluctant to believe that. There's so much stigma around it."

The post Treatments for stimulant use disorder are scarce or nonexistent. The FDA hopes to change that appeared first on Salon.com.

In the 1950s, sociologist Howard Becker conducted a series of interviews with marijuana users, seeking to unpack the panic around the drug and those who used it. Becker’s work in this space has become an important way of understanding a basic, but still perplexing, question among substance use researchers like us: Why do people use drugs, particularly when the potential negative consequences can be so deep and well-known?

As Becker explained it, drug use was something of an acquired taste that one had to grow into. Specifically, first, one had to learn how to properly use the drug. Second, they had to perceive the drug as being responsible for producing some kind of effect, like relaxation or joy. Third, the person had to then come to enjoy that effect.

While this is a really mechanical way of considering how we “experience” drug use, Becker’s classic model provokes a larger series of existential questions that touch on dense, philosophical topics like free will. It doesn’t fully address them, but it does stimulate a fairly intuitive observation: Any answer to the question of whether we have the free will to do (or not do) drugs depends on who stands in the way — or who’s there to facilitate it.

In recent years, forced drug use has become a growing risk factor for the development and worsening of substance use disorders and social stress. Forced substance use is a transactional dynamic where an individual compels someone into using a substance, such as alcohol or heroin, to induce a particular outcome — like getting sex, money, domestic favors or other acts of subservience from the victim. Domestic violence forums on platforms like Reddit are teeming with tales of these harrowing, unpredictable experiences, with many of the victims just learning that this is a “thing” and one experienced by many others. 

Most of us go through multiple forms of quid pro quo like this at some point in our lives. As kids, our parents probably told us to eat all of our dinner or risk not being able to go outside and play, or maybe a high school teacher temporarily let us off the hook for skipping class if we agreed to do an extra make-up assignment. These are generally innocuous and well-intentioned efforts meant to get us to do something that’s objectively good for us. However, when forced drug use occurs, it’s neither innocuous nor well-intentioned. And it often occurs parallel to what’s referred to as substance use coercion.

Like forced drug use or sexual assault, substance use coercion is less about the act and more about the gratification that comes from domination, which is a tool for manipulation, not a “tough love” approach to imparting life lessons. Substance use coercion is a pattern of tactics used by an abusive partner to weaponize their partner’s substance use — or the stigma or illicit nature of many substances — against them to maintain power and control.

In 2014, pop artist Kesha alleged that her superstar producer, Dr. Luke, had sexually assaulted and bullied her into taking drugs for nearly a decade, a claim which many at the time scoffed at, framing her as an artist who couldn’t handle the rigors of the music industry and was ultimately clout-chasing. It wasn’t until just this past summer that Kesha and Luke’s rape and defamation cases were settled.

Kesha’s alleged experience illustrates a common tactic of substance use coercion: forcing or pressuring a partner to use substances, to use more than they had wanted or to use new and more addictive substances. A substance use counselor in southern Illinois, Diana, who we interviewed for one of our studies, explained the following: “Each and every one of them if you really sit with them, they have a story. And why they started, it’s either a girlfriend that was forced into using by her boyfriend, or it would be basically because of peer pressure and depression. So, I feel sorry for a lot of those people; but it’s very rare when you find someone that wants to use just because they want to use.”

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Substance use coercion can also be counter-intuitive: In some cases, a person may threaten to disclose their partner’s drug use if that partner stops using the drug, as a means of keeping the victim under their thrall. One survivor we spoke with described how this happened to her: “I had got 10 years clean. So in the midst of that, I was trying to do things right.” This is when he partner’s subversion came. “‘I’ll call [Child Protective Services] and get these kids taken away from you’” she says, mirroring the language of her ex. “Just because I was trying to walk the straight-and-narrow.”

There are also cases of abusers withholding means of accessing drug use treatment and other resources. In his kinetic defamation trial in the U.K. with his ex-wife, actress Amber Heard, actor Johnny Depp, who Heard alleged had psychologically and emotionally abused her, alleged that Heard withheld his withdrawal medications as he detoxed, describing it as the lowest point in his life.

A 2012 survey conducted by The National Domestic Violence Hotline and The National Center on Domestic Violence, Trauma, and Mental Health found that 37.5% of a general sample of callers reported that their abusive partner threatened to report their substance use to the authorities to keep them from getting something that they want or need, including custody of children, a job, benefits or a protective order, and virtually anything else of emotional or material value that you can imagine. Abusive partners are hip to the thin margin of error that their drug-using partners have.

Once a survivor has a criminal record due to substance use coercion, it creates seismic barriers to stabilization. This includes barriers to getting a job, finding stable housing, accessing public benefits, and if the child welfare system has been involved, being unified with their children.

These realities become even more complex when we think about the effects of substance use coercion on families, including the ways that substance use is treated by Child Protective Services. At least 1 out of 8 children live with at least one parent who has a substance use disorder. And roughly 40% of child removals from homes, for example by Child Protective Services, are due to a parent in the home having a substance use disorder. America’s child welfare and criminal legal systems are notoriously hard on women who get caught up in drug-related cases, particularly when they’re Black. These survivors not only have to negotiate and navigate their abusive partner’s threats and abuse, but also the weaponization of systems against them and laws that punish their very survival.

At the heart of substance use coercion is a desire for control and power whereby the abusive partner hijacks their partner’s autonomy to enforce dependency. It’s vindictive, humiliating, and also highly effective, representing a vortex of power that draws a person in, leaving them few options. In this respect, substance use coercion is a mutation of the odious "pickup artist" movement, the point at which the target has been fully undermined and psychologically manipulated into submission. These adjoining ideologies are heavily validated by a public that blames survivors for the violence that abusive partners inflict on them and that stigmatizes and supports the criminalization of drug use.

It's also reinforced by a culture of forced substance use that permeates our world in ways that haven’t been previously understood and appreciated by public health experts. Greek life, for example, is rife with cases of forced drug use — used by fraternity and sorority leaders as a litmus test for the dedication and loyalty of pledges. Similar practices have been seen throughout collegiate sports, too, as the recent Northwestern University football program scandal showed.

This can also be seen in instances of “sextortion,” wherein an abusive person weaponizes sensitive details or intimate images against someone to threaten and control them. Abusive people leverage the threat of disclosure — for example, to the victims’ family members and friends — to shame and control the victim. However, taken together, these cases have historically been written off as the errant acts of immature youth rather than predators, particularly when the perpetrator is white.

During Becker’s time, substance use was something of a cultural oddity, but like today, it was policed and criminalized in wide-ranging ways, and people frequently conceived it as being, first and foremost, a result of peer pressure. The mostly ineffective Reagan-era D.A.R.E. and "Just Say No" campaigns of the 1980s heavily deployed the theory of peer pressure to rally kids away from the seductive power of drugs. To this end, forced substance use is an extension of how we have conventionally thought of peer pressure. But substance use coercion is not restricted to substance use: it has all-encompassing, radiating impacts that invariably affect everyone in the victim’s immediate radius.

From this vantage point, it’s also possible to see substance use coercion as a microcosm of a highly complex history of manipulative geopolitics. In 1839, in response to what it dubiously labeled as unfair trade practices in relation to China’s vast opium cache, the British Empire initiated a four-year war with the Qing dynasty, which had recently banned sales of the drug over concerns about increasing cases of addiction in the ascendant country, an act the British sought to undermine using India-based smugglers. British subversion and battlefield mastery not only effectively ended China’s opium prohibition, but it facilitated the British acquisition of Hong Kong. A second so-called “opium war” between the British and Chinese, again won by the British, followed roughly two decades later as a result of British dissatisfaction with Qing’s concessions, with spoils including greater British influence in the country and region that persists to this day.

To this day, the effort to disrupt substance use coercion remains stymied by both a conceptual and legalistic roadblock, both of which is amplified by economic interests and moral ambiguities tied to the War on Drugs. To this end, there are numerous policies in place, from “failure to report” policies to those that criminalize pregnant women who use substances, that are especially harmful to people experiencing substance use coercion. 

What can we do to disrupt the practice of substance use coercion? The first step is to advocate for policies that would contribute to the development of systems that decriminalize substance use and end the War on Drugs, while recognizing that this alone won’t fully dampen the stigma that abusers leverage to coerce their victims. However, one of the things that makes substance use coercion so dangerously effective is the constant threat of entanglement with the criminal legal and carceral systems, and divorcing the legal aspect of drug use from the moral aspect will push the public writ large to reconceptualize their views.

Second, access to healthcare, including supports for those who have substance use disorders, is challenging even in the best of situations. Increased funding, training and support for healthcare systems that serve people who use substances is critical.

Third, we can all be more alert to the experiences of people in our lives with substance use disorders, being mindful of those in their lives who may leverage drugs to suppress them, and supporting and linking these individuals to resources like the National Domestic Violence Hotline when coercive incidents arise. Measures to prevent or mitigate most modern public health crises don’t typically arise until we begin to see cases of it in the local news over and over again. This is a rare emergent epidemic that we can still nip in the bud.

The post More than peer pressure, coercing people through drug use is on the rise. Here’s how we can fight it appeared first on Salon.com.

One told him his ID wasn’t clear enough for them to confirm his identity, another wanted to put him on a pain management contract and a third pharmacy didn’t accept the discount card he needed to use in order to afford the medication, Garrett said. The pharmacy he finally found to fill the prescription was a 100-mile round trip from his home in Martin, Tennessee. Once Garrett and his partner separated the next year and he lost access to a car, getting to the clinic became even more challenging.

That’s when Garrett went to his first detox program, through which he was able to get the cost of his medication covered. In Garrett’s first round of medication-assisted treatment or MAT in 2019, he was so stressed by the process of obtaining the medication that he wasn’t really seeing its effects. Once the financial and physical barriers were removed in his treatment program, things got a lot better, he said.

“The main issue surrounding MAT access is not the drug itself,” Garrett told Salon in a phone interview. “It’s the systems in which they are prescribed, dispensed and provided.”

Patients with substance use disorder and their providers have to jump through various hoops to access MAT, which includes buprenorphine, methadone and naltrexone. All of these drugs are opioids, but are markedly different in how they function compared to heroin and morphine. In December 2022, President Biden signed the Mainstreaming MAT Act of 2023, removing one barrier to treatment by no longer requiring so-called “X-waivers,” which doctors were previously required to fill out to authorize the outpatient use of buprenorphine.

But the bill was quietly passed at the end of the year, many doctors are still hesitant to prescribe these medicines and access hasn’t improved as much as some had hoped.

“I am happy that it’s gone,” said Dr. Ryan Marino, an emergency medicine physician at Case Western Reserve University School of Medicine, referring to the X-waiver. “I am still skeptical that this will expand accessibility and access.”

More than 46 million people in the U.S. met the criteria for substance use disorder in 2021, but 94% of them went untreated. Nationwide, over half of rural counties do not have a buprenorphine provider and roughly one-third of Americans living in rural counties do not have access to buprenorphine. Meanwhile, overdose deaths are an all-time high, reaching over 111,000 deaths in the 12 months ending in April 2022. These deaths are driven in large part by opioids like illicit fentanyl, but often combinations of drugs like stimulants, which are driving a “fourth wave” of the crisis.

The FDA approved buprenorphine to treat opioid use disorder in 2002 along with a boxed warning, stating its potential for misuse and abuse, as well as extra requirements for prescribing. Buprenorphine and methadone work to reduce cravings associated with substance use. Studies consistently show MAT is effective in reducing overdose deaths and relapses — decreasing death by as much as 50 percent or more — and it is the standard of care for patients with substance use disorder. (Buprenorphine and methadone are also used to treat pain because they activate opioid receptors, partially and fully, respectively.)

As overdose deaths continued to climb year after year, doctors and legislators called on the federal government to remove the extra hoops embedded in buprenorphine prescribing to save lives. Some championed the removal of the X-waiver and saw it as a necessary step in clearing the way for providers, especially in rural areas, to be able to prescribe MAT, while also eliminating a layer of stigma that additional restrictions created for patients.

“The fact that there was this whole system, this separate license requirement and training, created this false idea for prescribers and for everyone in general that it was somehow dangerous, more difficult to start and a more complicated drug that had a lot more risk,” Marino told Salon in a phone interview. “It’s actually safer than a lot of things people feel maybe too comfortable prescribing every day.”

In the past couple of decades, buprenorphine prescribing has increased, with the number of psychiatrists and addiction medicine doctors able to prescribe buprenorphine increasing from about 9 to 12 per 10,000 specialists between 2010 and 2018. Some argue it is essential to widen the prescriber base to include family medicine doctors and general practitioners, and the number of registered primary care doctors did increase from about 13 to 27 doctors per 10,000 across the same time period. Between 2006 and 2019, the number of buprenorphine doses in national supply also increased from 42 million to 577 million, according to a Washington Post analysis published last week. 

However, just because providers have a waiver and the nation has a greater supply doesn’t mean clinicians are actually prescribing more buprenorphine. One 2020 study found only half of clinicians with waivers were writing buprenorphine prescriptions. In a survey published in July of this year, a majority of providers who had newly gotten access to prescribing buprenorphine said they hadn’t made the effort to prescribe it before because of the waiver and educational requirements. Yet the same group also reported a lack of patient demand as the most common reason that they hadn’t prescribed the drug since obtaining prescribing privileges. 

That suggests additional barriers remain. Ten states have their own regulations for prescribing MAT, including urine screening for providers that prescribe buprenorphine, or counseling to be used with treatment. A 2019 survey of family medicine providers found only one in five were interested in treating opioid use disorder, suggesting stigma still largely influences whether patients are getting treatment.

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There are still regulations on the amount of buprenorphine that can be prescribed and the number of patients for which doctors with prescribing authority can write scripts. For the treatment of substance use, the recommended dose of buprenorphine is usually 16 milligrams, but recent data suggests that a higher dose of 24 milligrams may be more effective, especially as fentanyl has entered the drug supply and increased drug tolerances with its high potency. Nevertheless, even if providers prescribe buprenorphine, pharmacies do not always dispense it.

For this reason, some doctors have argued that buprenorphine should be allowed for sale without prescription, making the drug behind-the-counter, but far easier to obtain. “The incidence of any risks related to buprenorphine is likely low for individuals and the population; however, the magnitude of risk is high (overdose death) when it does occur,” Drs. Payel Jhoom Roy and Michael Stein wrote in JAMA in 2019. “On balance, this risk-benefit calculation favors making buprenorphine available under select regulation without a prescription.”

Meanwhile, methadone arguably has even stricter stipulations, making it one of the most heavily restricted drugs on the market, requiring patients to take treatment at federally-accredited facilities nationwide.

“There’s a weird double standard where you can use methadone for the treatment of pain and there’s no restrictions on it at all,” Marino said. “But when it comes to withdrawal and addiction treatment, it is not allowed to be prescribed by anyone at all as an outpatient and you have to instead go to a federally-accredited opioid treatment facility.”

Efforts are being made to reduce barriers that remain in prescribing MAT, with some medical schools embedding buprenorphine training into their curriculum. The Mainstreaming MAT Act was passed with the additional requirement that the Secretary of Health & Human Services will “conduct a national campaign to educate practitioners about the change in law and encouraging providers to integrate substance use treatment into their practices.”

Dr. Daniel Ciccarone, a substance use researcher at the University of California, San Francisco who worked to get the X-waiver removed, said he is hopeful the next generation of practitioners will be more willing to incorporate addiction treatment into their practice regardless of specialty, but that these changes might be slow-moving.

“It’s going to take time,” Ciccarone told Salon in a phone interview. “Just because the policy changed doesn’t mean that there isn’t some cultural resistance to it.”

In recent years, many efforts have been made to abate the opioid overdose crisis, including changes in policy like the removal of the X-waiver, lawsuit payouts from pharmaceutical companies sued for their role in the overdose crisis and increased access to naloxone and other harm reduction policies. But these strategies are still ramping up to meet the massive need, Ciccarone said.

“We haven’t gotten there yet,” Ciccarone said. “Meanwhile, people are dying.”

In Tennessee, Garrett, who is uninsured, said he wishes there was more information about which if any, family medicine providers in his area prescribe MAT so he doesn’t have to shop around through multiple providers as he did with the pharmacies.

“I was excited that whenever I get out, I wouldn’t have to go to a Suboxone doctor, specifically, the costs would be lower and maybe I would only have to go once every month to see the doctor right off the jump,” Garrett said. “I figured I’d see some advertisements or see this in the news or hear about this from somebody … I haven’t seen any of that.”

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As a survivor of sexual abuse who’s just written a book about my various brushes with cults, I find the performance reason enough to convict him of, at the very least, trivializing sexual assault. 

Recorded in the style of the anti-establishment guru he’s shoehorned his way into being — a dead-eyed stare delivered direct-to-camera, plus excessive hand-gesturing — Brand refers to his past as a problem of promiscuity. It’s not the first time he’s used patriarchal norms to excuse his behavior and promote his agenda. 

When convenient, Brand has worn his “Shagger of the Year” title (first awarded by The Sun in the U.K. in 2006) as a badge of honor. He told GQ UK in 2006 he could bed three women a day. By 2017, his past helped shore up his creds as a spiritual influencer. “Because I’ve experienced, forgive me, sort of a promiscuous lifestyle . . . that I thought might resolve the way I feel, I now know that they won’t,” he told BBC Newsnight at that time.

Over the years, I’ve had a (one-sided) love/hate relationship with Brand. I had no idea he’d been a drug-fueled comic when I saw him in the comedy “Forgetting Sarah Marshall,” where I enjoyed what I thought was his performance as an oblivious cad. He didn’t come back on my radar until his marriage to Katy Perry, when I learned both were sober. Then I forgot about him until he wrote a book updating the classic text of “Alcoholics Anonymous,” which — as someone who’s been continuously clean and sober for 27 years — I applauded for demanding more inclusive definitions of the problems faced by people in recovery.

More recently, however, I’ve watched in growing dismay as he’s slid down the conspiracy theory rabbit hole, much like his recent guest/pal Tucker Carlson. “Thanks for joining us on our voyage for truth and freedom,” Brand exhorts viewers of his YouTube channel, which covers everything from COVID to spirituality to racism. His video denying these sexual allegations is a mortifying culmination of his work to date.

First, there’s Brand’s dismissal of his past. He claims the relationships were consensual, and though he doesn’t address the allegations directly, he doesn’t deny having relations with these particular women. This implies he’s including the 16-year-old he was with for three months when he was 30. Lumped together, the women are simply part of his “promiscuous past.” But promiscuity and sexual assault are unrelated. Having multiple partners is a choice, one I’ve made in the past. Sexual assault is a crime, something that was forced on me against my will.

While it’s worth noting that these assertions haven’t been proven in any court of law, claiming that his promiscuity is being mistaken for something it’s not is injurious to survivors of sexual assault everywhere in the here and now. Worse, suggesting that the past must be buried — in that same BBC Newsnight interview, Brand waved off the promiscuous label saying he’d “made amends for all that” — is also insulting to people recovering from their addictions. 

Having spent years in recovery, I know that putting down substances doesn’t equal immediate reform. Many of us barely can acknowledge that our using has anything to do with our problems, let alone see how we’re responsible for causing them. This, I eventually discovered, is true of all acting-out behavior. Owning up to our mistakes can take much longer than any reasonable, non-addicted person might suspect. But there’s no spiritual bypass. We must change in order to stay sober, not to be excused from past misdeeds. Nobody gets out of a drunk driving charge because they quit drinking.

Perhaps this comes easily to Brand for the same reason it did for one of the founders of 12 Step recovery, Bill Wilson, a notorious womanizer. One of my issues with the seminal text, “Alcoholics Anonymous,” is over its dismissal of extramarital affairs. Written in 1939, the book says, “unless some good and useful purpose is to be served, past occurrences should not be discussed.”

With Brand, it’s worse. He’s pretending these allegations are part of a conspiracy against him, and that he and his fans must stand together to speak truth to power. “It feels to me like there’s a concerted effort to control these spaces . . . and I mean my voice and your voice.” He’s saying this in front of a backdrop of wood and greenery that also includes not one but two statues of young Krishna, which symbolize the Hindu gods’ power to command attention and attract young women.

www.youtube.com/watch?v=ZGr_PVUHn2I

His words decry the fact that a media outlet broke this story, instead suggesting this makes the claims suspect. But massive attention is what it takes to get any movement on a sexual assault case. That, and more than a single source. Imagine what he’d say if the accusation came from just one person, and with no media attention. But wait, you don’t have to imagine. This did happen, in 2020, when one of these women approached his publisher about her allegations. Brand had his lawyer issue a denial and a claim that she was looking for money.

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Now, in yet another move that will sound familiar to American audiences, Brand is calling on his supporters to move to Rumble, a separate media platform that is to YouTube what Truth Social is to Twitter. Except Rumble hosts Truth Social, and Brand already has 1.49 million (and growing) followers there. This second video doesn’t reference the sexual assault allegations — he’s also ditched the Hindu gods in the backdrop  — but instead stays squarely in the lane of how he’s being persecuted. And it’s not just him, but “us” who are in trouble. He runs through all the top hits — the “deep state,” “a military industrial complex” and, of course, “Big Pharma.”

This is what nefarious cult leaders do, rely on cultural tropes that have become normalized to drum up support among followers they’ve groomed. I began the week hoping these allegations would mean a #MeToo-style reckoning for influencers across the board, now I can only imagine how far he’s willing to go to save his own skin, with a growing group of followers

The post Russell Brand is evolving his next gig: Cult leader appeared first on Salon.com.

“It got to the point where I was like, ‘Okay, I have to call now because I can’t verify this is sustainable with life,'” Murray told Salon in a phone interview.

Murray, the Harm Reduction Program Manager at Boston Medical Center, has survived an overdose himself and is also a paramedic. He created the hotline in 2020 as a form of harm reduction. In 2023, it has fielded over 500 calls in the state and beyond, and Murray and his team have seen a growing number of people who identify as primarily or exclusively stimulant users, he said.

More than one million people have died from a drug overdose since 1999, with the number of deaths steadily increasing over the years. In the 12 month period ending in April 2022, more than 111,000 people experienced a fatal overdose, according to the latest provisional data from the Centers for Disease Control and Prevention. The crisis has become so pervasive that about the same number of Americans died from drug overdoses last year as they did from diabetes.

To describe this phenomenon, some drug policy experts have used a model of “waves.” In the early 2000s, overdose deaths were driven primarily by prescription opioid use in the first “wave” of the crisis. As the drug supply was restricted over time, people who were already using opioids turned to other drugs instead. In 2010, the second wave saw more people using heroin, which was quickly followed by a third wave in 2013 driven by synthetic opioids like fentanyl, which were involved in two-thirds of overdose deaths in 2022. 

A new study confirms what many have suspected: We are now in the throes of the fourth wave of the overdose crisis, driven by multi-substance use — not just opioids, but stimulants as well. Writing in the journal Addiction, researchers found the portion of overdose deaths attributed to fentanyl and stimulants used together rose from 0.6% in 2010 to 32% in 2021, with that increase sharply rising in 2015.

While some studies have emphasized “signals of polysubstance overdose death can be traced back for decades,” that signal seems to be getting much stronger. And although overdose deaths caused by prescription opioids and heroin in the first and second waves have decreased over time, these initial waves have not gone away either, emphasized study author Chelsea L. Shover, Ph.D., an assistant professor-in-residence at the University of California, Los Angeles.

“They are all still happening,” Shover told Salon in a phone interview. “It’s just that this is adding to an already pretty dire situation.”

The reasons behind the rise in overdose deaths due to concurrent fentanyl and stimulant use are complex and not fully understood. In a Washington Post analysis published this week, the number of prescription hydrocodone and oxycodone pills decreased by 45% from 2011 to 2019, in part due to major litigation against opioid manufacturers and reduced prescribing patterns in the medical community. However, the number of overdose deaths due to prescription pills has stayed about the same.

“Ironically, the move to pull opioids from the shelves has made us less safe,” Murray said. “Overdose rates have gone up from 20,000 a year to 100,000 a year and opioid prescribing is not a driver of this anymore.”

Instead, the driver may be a rise in counterfeit or contaminated pills circulating in the drug supply, said Dr. Daniel Ciccarone, a substance use researcher at the University of California, San Francisco, who coined the term “fourth wave” in relation to the crisis. People who intend to take stimulants, for example, may unknowingly overdose on drugs laced with fentanyl or other synthetic drugs. 

There may also be intentional multi-drug use at play. Some who use stimulants take opioids or benzodiazepines to come down from a high, Murray said. Or vice versa: people who use fentanyl or opioids may use stimulants to combat some of their depressant effects, Shover added.

People have historically used drugs together with opioids for similar purposes, but fentanyl and other synthetic opioids are different. Because fentanyl can be both extremely potent and unpredictable in its potency, it may be causing overdose deaths in people who identify as primarily stimulant users, have a relatively low opioid tolerance and unknowingly take fentanyl, Murray said. That also influences harm reduction because people using primarily stimulants might not be prepared with naloxone or other life-saving materials when they are using drugs.

“If you have no opiate tolerance and you’ve been using stimulants for four or five days and then you sniff a little bit of a fentanyl to come down, your autopsy is going to show both the stimulants in your system and the fentanyl in your system,” Murray said. “It’s probably the fentanyl that killed you, but that person would not have been identified as someone who was at risk for [opioid] overdose because they were not someone who regularly used opioids, nor would they have said that in an interview.”

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Shover’s study also showed that cocaine was predominantly used with fentanyl in the Northeast, while methamphetamine was more commonly concurrently used in the rest of the country.  

That’s probably due to “the combination of very low-cost, high-purity methamphetamine outcompeting cocaine and other stimulants at the national level, in addition to an enduring, well-entrenched illicit cocaine market in the Northeast and other pockets of the country,” according to the study.

Shover’s research analyzes data up to 2021, but some addiction specialists are already anticipating the fifth wave of the overdose crisis based on what they’ve seen since then. Murray, in Massachusetts, is particularly concerned about the concurrent use of xylazine with opioids. Xylazine, a veterinary tranquilizer, is used to prolong the effects of the high produced by opioids and is of growing concern to harm reduction groups across the country because it’s thought that its effects cannot be reversed with naloxone, though a preprint study released this week hints it could.

Ciccarone said he might classify concurrent xylazine use under the fourth wave of multi-substance use, along with stimulants. He is also concerned that counterfeit pills will or are already contributing to the next big wave of overdose deaths.

“The next couple years it’s going to be a lot about xylazine and a lot about counterfeit pills, I think,” Ciccarone said. “Whether we call that a fifth wave or we give up the notion of waves, I’m not quite sure.”

There are things that can be done to reduce overdose deaths. Contingency management has been shown to be effective in treating stimulant use disorder, and buprenorphine can successfully treat opioid use disorder. Naloxone can reverse an overdose and reduce the number of fatal overdoses. And test strips can alert people using drugs to the presence of any potentially fatal contaminants. 

But Murray said many of these solutions are just Band-Aids that, while vitally important to save individual lives, will not work on the scale necessary to abate the crisis. Yet large-scale policies that have been designed to reduce overdose deaths haven’t been successful, either. Instead, with every new wave of the overdose crisis, avoiding additional deaths becomes increasingly complex. 

“I feel really good about the lives that we’ve saved,” Murray said. “But I am also very frustrated on a larger scale by our lack of ability to have meaningful solutions.”

The post Stimulants may be driving a “fourth wave” of the overdose crisis, with deaths at an all-time high appeared first on Salon.com.

“Secured through the suffering of people who use drugs and their loved ones, these funds should be used to help individuals directly impacted by the failed ‘War on Drugs,'” according to a brief from 133 public health organizations, including the Drug Policy Alliance and AIDS United. “Sadly, in many places, people are not seeing opioid settlement dollars put toward things that would actually improve their lives.” 

The settlements, which some estimate will amount to at least $50 billion distributed over the next 18 years, require recipients to dedicate at least 85% of funds to “abate the opioid epidemic.” Some communities in Rhode Island and Michigan, for example, are using the money to fund an overdose prevention center and a program designed to keep families together. But one program in Louisiana is allocating 20% of funds to sheriffs, while a county in Wyoming will use $750,000 for a new police cruiser and another in New York is using some of their funds to pay for overtime expenses for law enforcement personnel conducting narcotics investigations.

Public health groups say these funds should instead be prioritized for harm reduction, housing and local community organizations that address the “collateral consequences of drug war policies.” Coalitions of addiction medicine specialists and other research organizations have also published guidance on how to spend the funds, recommending prioritization of harm reduction. Christine Minhee, a lawyer who runs the Opioid Settlement Tracker, told The New York Times it is clear that “between the lines” of the settlements local politics will be in charge of enforcing the settlement agreements rather than the court.

“This means that the task of enforcing the spirit of the agreement — making sure that settlements are spent in ways that maximize lives saved — is left to the rest of us,” she said.

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In truth, although each of the above was a contributing factor, by January 1969 a much darker force had made its presence known in their world. During that fateful year, the Beatles suffered, as so many families do today, from the daily pain and bewilderment of an opioid addiction.

Although we have slowly come to recognize the opioid epidemic as the Western world’s most perilous health crisis, we have yet to turn the corner in terms of stemming its tide. In fact, things are getting worse. The National Safety Council recently reported that opioid addiction has become so pervasive that Americans are now more likely to die from an opioid overdose than an automobile accident.

In early 1969, the faces of heroin addiction for McCartney, Harrison and Starr — three quarters of rock music’s Fab Four — were Lennon and his wife Ono. With The White Album lording over the global record charts, the Beatles were the biggest act in the world by a wide margin. By this time, they had challenged themselves to “get back” to their roots, strip away the high-gloss production of LPs like “Revolver” and “Sgt. Pepper’s Lonely Hearts Club Band,” and find new levels of greatness.

And for the most part, they would succeed. The “Get Back” project would come in for a rough landing with the band’s triumphant Rooftop Concert on January 30th, and they would record a spate of new classics that summer. That fall, they would release “Abbey Road,” their magisterial swan song. While heroin had infiltrated their midst, they managed — for a time, at least — to overcome the drug’s insidious nature. The Beatles, after all, were that good.

As history has demonstrated resoundingly, the band members were no strangers to drug experimentation. They had become veteran pill-poppers during their days in Hamburg’s seedy postwar clubs, seeking out amphetamines to increase their stamina during those long nights on the Reeperbahn. Later, marijuana would come into their lives by way of Bob Dylan in August 1964. In the coming years, they would make international headlines for tripping out on LSD, and in the summer of 1968, as the Beatles had toiled in the studio to record The White Album, McCartney would engage in an extended dalliance with cocaine.

However, Lennon’s addiction left his bandmates in a state of alarm. By the advent of the “Get Back” sessions, Ono openly joked about taking heroin being the couple’s form of exercise. “The two of them were on heroin,” said McCartney, “and this was a fairly big shocker for us because we all thought we were far-out boys, but we kind of understood that we’d never get quite that far out.”

Lennon later claimed that the couple’s addiction developed in the wake of a hashish raid on his Montagu Square flat by Detective-Sergeant Norman Pilcher’s notorious drugs squad. Lennon attributed Ono’s mid-November 1968 miscarriage to the raid’s aftermath, later remarking that “we were in real pain” after the loss of their baby. Yet at other times, he would attribute his flirtation with heroin to his bandmates’ refusal to accept Ono as their equal, claiming that they began to snort heroin “because of what the Beatles and their pals did to us.”

Love the Beatles? Listen to Ken’s podcast “Everything Fab Four.”

But in truth, Lennon’s experimentation with the drug had begun much earlier—most likely, during Ono’s summer 1968 exhibition at the Robert Fraser Gallery. “I never injected,” he liked to say. “Just sniffing, you know.” But as journalist and Lennon confidant Ray Connolly observed, Lennon “rarely did anything he liked by halves. Before long, heroin would become a problem for him.”

As anyone with a friend or relative who suffers from substance abuse knows all too well, the addict’s reasons for imbibing their drug of choice are often multitudinous and frequently hurtful. The brutal truth is that they simply must have it. Whether it be alcohol or heroin—the user is powerless in the face of the drug’s delectable, unerring pull.

When the Beatles finally got to the business of recording “Abbey Road,” Lennon’s participation was delayed by a harrowing automobile accident in Scotland that left him and Ono briefly hospitalized and riddled with stitches. When he finally joined the other Beatles towards mid-July, he had a bed from Harrods installed in the studio to allow Ono to convalesce within easy reach.

Not surprisingly, the accident’s aftermath resulted in heroin being the couple’s go-to salve. Indeed, by this juncture, Lennon’s mood swings and absenteeism—the ups and downs of his erratic, unpredictable behavior—were likely the result of their protracted heroin use. As music historian Barry Miles later wrote, “The other Beatles had to walk on eggshells just to avoid one of his explosive rages. Whereas in the old days they could have tackled him about the strain that Yoko’s presence put on recording and had an old-fashioned set-to about it, now it was impossible because John was in such an unpredictable state and so obviously in pain.”

Years later, American actor Dan Richter, a friend of Ono’s, recalled making his way inside EMI Studios to provide Ono with the Lennons’ latest fix. “It felt weird to be sitting on the bed talking to Yoko while the Beatles were working across the studio,” said Richter. “I couldn’t help thinking that those guys were making rock ‘n’ roll history, while I was sitting on this bed in the middle of the Abbey Road studio, handing Yoko a small white packet.”

After the Beatles’ last photo session at Tittenhurst Park on August 22nd, 1969 — in fact, the final occasion in which all four Beatles would be together in person — the couple resolved to kick the habit once and for all. Ono sought out the help of Richter, her supplier, to assist them in breaking free of the opioid. “We were very square people in a way,” said Ono. “We wouldn’t kick it in a hospital because we wouldn’t let anybody know. We just went straight cold turkey. The thing is, because we never injected, I don’t think we were sort of — well, we were hooked, but I don’t think it was a great amount. Still, it was hard. Cold turkey is always hard.”

Today, the UK’s National Health Service has much to offer in terms of maintenance therapy and detox programs. But in August 1969, opioids were scarcely on the NHS’s radar. To Lennon’s mind, the only means at their disposal was going “cold turkey,” which denotes heroin’s abrupt cessation. Desperate to wrest himself free, Lennon reportedly ordered Ono to tie him up to a chair. For some 36 hours, he roiled in pain as he attempted to rid the drug from his system.

In an effort to memorialize his recent experience trying to shake his heroin addiction, Lennon composed “Cold Turkey,” a song that illustrated the excruciating throes of heroin withdrawal in brutal detail: “My feet are so heavy / So is my head / I wish I was a baby / I wish I was dead.” But the composer’s triumph over the drug would be dishearteningly short-lived. By the time he debuted the song for Dylan a few days later, he was snorting heroin yet again. Lennon later recalled that he and Dylan “were both in shades and both on fucking junk.” He knew that it would take much more than a chair and a rope, admitting that “I was nervous as shit.”

It would take several more attempts for Lennon to beat the drug. To his great credit, the musician lived his life transparently, sharing his trials and tribulations across numerous interviews. In September 1980, he lamented that back in 1969 the BBC banned “Cold Turkey” from the radio airwaves “even though it’s antidrug.” Even then — long before our contemporary opioid crisis took flight — Lennon intuited society’s inability to understand, much less combat addiction. “They’re so stupid about drugs,” he exclaimed. “They’re not looking at the cause of the drug problem: Why do people take drugs? To escape from what? Is life so terrible? Are we living in such a terrible situation that we can’t do anything without reinforcement of alcohol, tobacco? Aspirins, sleeping pills, uppers, downers, never mind the heroin and cocaine—they’re just the outer fringes of Librium and speed.”

While we understand far more about the nature of addiction and drug treatment than Lennon could possibly have dreamt in the autumn of 1980, we are lost nevertheless in a health crisis that continues to surge. The striking similarities between the Fab Four’s predicament and today’s devastating health crisis remain indubitably clear. As we stumble forward as a culture nearly five decades after the Beatles’ disbandment, it is genuinely staggering to recognize how far we still have to go.

The post In 1969 the fifth Beatle was heroin: John Lennon’s addiction took its toll on the band appeared first on Salon.com.

When the woman I’ll call Ann married her husband in 2002, he was “someone who couldn’t care less about anything political at all.” Over the years, he drifted into being a Republican, but it wasn’t until 2017, after the election of Donald Trump, when she says “his radicalization and intro to conspiracy theory happened.” Within the last few months, Ann told me, her husband began telling their children “how the people behind Monster Energy drink are obviously Satanists because they hid symbols on their can.”

I met Ann on the Reddit forum QAnon Casualties, where family members and friends of QAnon believers and other far-right conspiracy theorists come to commiserate. Like several other members of the forum I contacted, she requested that Salon not publish her real name.

Ann hung in there for years, sticking with her husband through the far-right conspiracy theories and the flat-out weird ones. “He tried to convince me that the NFL was run exactly like the WWE in that it was entirely scripted,” she told me. Eventually, with the help of a therapist, she came to the conclusion that “there is literally nothing I can say to bring him back.”

That realization “has made things easier to handle,” Ann says. Before that, “all I could think about was how badly I wanted to die,” she continued. “I was scaring myself with how badly I just wanted out.” With her therapist’s aid, she says she is now  planning an exit strategy from her marriage. 

Ann’s journey is one that untold numbers of people have endured in recent years: watching a loved one become radicalized through online disinformation. Once such people have disappeared down the proverbial “rabbit hole,” it can sometimes be impossible to get them back. Preventing people from falling into the disinformation abyss in the first place is obviously crucial — and the good news is that prevention is possible. Experts already know a lot about both why and how people get radicalized, but the difficult part is interrupting the process by which vulnerable people are exposed to ever more vicious propaganda that lures them into the darkest caverns of social media. 

One of the most promising avenues for prevention has emerged from a surprising place: Parents and schools who have made it a mission to battle social media addiction. They’re using the same tools that proved so effective at curtailing a different and even deadlier public health menace: cigarette smoking. Only this time around, instead of suing Philip Morris and other big tobacco companies, they’re going after Meta, Twitter, TikTok, YouTube and Snapchat. 

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Another QAnon Casualties poster who goes by Tristan Penifel (also not his real name) told me that Ann’s story is highly typical of visitors to the forum. People show up initially, he said, wondering how they can debunk the wild stories and outrageous claims they’re hearing from a formerly normal loved one. Tristan says he and the other forum regulars gently try to steer the newbies away from that path. The old hands know that it’s nearly impossible to argue people out of false beliefs they’ve picked up online, once those have become ingrained in their identity. 

Tristan told me his father fell deep into the realm of right-wing conspiracy theory years ago, and became obsessed with the claim that Barack Obama had been born in Kenya. “I spent hours one evening debunking every single thing that he could find about the birth certificate being fake,” Tristan explained in a Zoom interview. “By the end of all of that, he was like, OK, maybe the birth certificate is real.”

But Tristan’s victory was short-lived. His father immediately pivoted to another conspiracy theory that claimed Obama “was handpicked by the banks to protect them after the 2008 financial crisis.” Tristan’s father had once been involved in Occupy Wall Street, but the allure of online conspiracy theories had pulled him far to the right.

Tristan went on to write about his experiences at Medium, arguing that “all of this is ultimately on the conspiracy theorist. They are the one who has some kind of emotional sickness driving them into these beliefs, and they are the one who can cure themselves. If they refuse to engage, no one else can save them.”

None of this comes as a surprise to experts who research far-right groups and conspiracy theorists. What the members of QAnon Casualties see happening to their loved ones is much bigger and more systematic than a small subset of the population adopting some kooky notions. Instead, they have become radicalized, and recent history tells us that while most people who believe outlandish conspiracy theories will not commit violent acts, the danger is very real. 

Even when they don’t commit violence, “people who get involved in these movements destroy their lives,” David Neiwert, author of “The Age of Insurrection: The Radical Right’s Assault on American Democracy,” told me in a recent interview. “It draws people into the abyss. It ruins their family relationships, ruins their relationships in the community.”

Early in the Trump administration, activists like Christian Picciolini, who has worked to help deradicalize white nationalists, attracted a flurry of media attention. Most experts believe, however, that convincing someone who has dug themselves deep down the rabbit hole is a difficult and unpredictable process. 

“Deradicalization is even more personal and idiosyncratic than radicalization,” Brian Hughes, an American University professor who co-founded the Polarization and Extremism Research and Innovation Lab (PERIL), told me. “Deradicalization is something that you do after the worst has already happened,” he continued, meaning “after a person has really made a grave social and even moral mistake, or sometimes committed an act of violence.”

Even at that point, it frequently doesn’t stick. Even as defendants from the Jan. 6 Capitol attack face prison sentences, there’s a common thread to many of their stories: They’re totally not sorry. Jacob Chansley, the infamous “QAnon shaman,” got some relatively sympathetic media coverage after his arrest, when his defense attorney portrayed him as a regretful dupe. Now that he’s out of jail, however, Chansley has made clear that he’s still a member of the QAnon faithful.

Chansley told the Arizona Mirror he was “not a big fan” of his now-former lawyer, “after I found out all the things he was saying in the media without my consent. He said that I felt duped by Trump. I never said that. I never asked him to say that. He said that I denounced Q and the QAnon community. I never said that.”

Lisa Sugiura of the University of Portsmouth encountered a similar phenomenon, she said, while researching her book “The Incel Rebellion: The Rise of the Manosphere and the Virtual War Against Women.” While some men she interviewed identified as former rather than present-tense incels, Sugiura reports that many still share the same misogynistic views found on the “involuntary celibate” forums they have supposedly left behind.

“They will still say, ‘Oh, well, you know, women still get away with a ‘pussy pass,'” or that “women shouldn’t be so picky,” she said. “It’s very depressing. You think, well, is there a way out?”

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“There is no getting him back. He is very much dead to me,” said George Fincher, who lives in Birmingham, England, and agreed to use his real name. He was talking about his stepfather, a former Royal Marine who has gone deep down the online QAnon rabbit hole. Fincher said he suspects that his stepfather is battling unresolved trauma, and in the process has alienated his family.

“He doesn’t speak to his kids. He’s met his grandchild once,” Fincher explained. “Probably, in his mind, the only thing that he has going for him is this [QAnon] idolatry. Because he certainly doesn’t have a family anymore.”

This comports with what researchers know about people who become radicalized. PERIL uses a “supply and demand” model to explain the process. Hughes laid out this theory in a legal brief filed in a lawsuit after Steven Carrillo, an Air Force sergeant affiliated with the extremely online Boogaloo movement, shot three law enforcement officers in California, killing one of them. 

“On one hand, extremist recruiters and propagandists offer a supply of ideological material, imagery, entertainment, and opportunities to organize with like-minded extremists,” Hughes wrote. “On the other hand, individuals pursue radicalization because it meets certain social and psychological needs — this is the demand side of radicalization.” 

As Hughes told Salon in an interview, “In the days before the internet, a person would have to be very lucky — or very unlucky, depending on how you want to look at it — to encounter extremist propaganda or an extremist recruiter.” Neo-Nazis used to trawl hardcore punk clubs looking for vulnerable kids; white nationalists would look for prospects target at gun shows. “What’s changed nowadays with the internet,” he said, “is that you can’t avoid radicalizing material. Propaganda is everywhere.”

Evidence that the internet has accelerated radicalization is also everywhere, as anyone who has watched Facebook friends melt down in real time can attest. Researchers at the Public Religion Research Institute (PRRI) found in 2022 that “nearly one in five Americans (16%) are QAnon believers.” Among Republicans, that proportion rose to 25%.

Beyond the damage done to individuals, families and the body politic, there is compelling evidence that online radicalization has fueled a rapid rise in extremist violence. The Government Accountability Office reported a nearly fourfold rise in domestic terrorism cases from 2013 to 2021. In many of the most dramatic examples, a common factor is online radicalization. Consider “incel killer” Elliot Rodger in California, white supremacist mass murderer Dylann Roof in South Carolina and the mass shootings in a Pittsburgh synagogue, an El Paso Walmart and a Buffalo supermarket. These dreadful cases are alarmingly similar: A young man radicalized by online propaganda decided to act on his bigoted delusions with real-world violence.

A Facebook whistleblower opens the door

In the fall of 2021, former Facebook employee Frances Haugen began to release reams of internal company documents exposing all manner of embarrassing secrets: Facebook had knowingly let disinformation flourish on its platform, had turned a blind eye to hate speech and overt incitements to violence, and deliberately targeted underage users, despite internal research showing that social media overuse could be dangerous to minors. 

“There were conflicts of interest between what was good for the public and what was good for Facebook,” Haugen told “60 Minutes.” “Facebook, over and over again, chose to optimize for its own interests, like making more money.”

The Facebook document dump was a big scandal, at least at first. But media attention faded rapidly, especially as Elon Musk flirted with buying Twitter and then finally did so, shifting the locus of concern over social media disinformation away from Facebook and toward the “bird site.” But Haugen’s whistleblowing clearly had an impact on government and the legal system in terms of one crucial issue: The mental health impacts of social media algorithms on teenagers and children.

 Facebook whistleblower Frances Haugen appears before the Senate Commerce, Science, and Transportation Subcommittee on October 05, 2021 in Washington. (Matt McClain/The Washington Post via Getty Images)

Over the past year and a half, there have been multiple congressional hearings about the health risks of social media for underage users. A Centers for Disease Control report on the teen mental health crisis included concerns about the impacts of social media. In May, Surgeon General Dr. Vivek Murthy released an advisory noting “growing evidence that social media use is associated with harm to young people’s mental health.” While admitting that the phenomenon is complex and that social media access can be beneficial for some kids in some circumstances, he argued that unregulated, excessive use was a likely contributing factor to the “national youth mental health crisis.”

What mental health risks are we talking about here? This remains a fraught topic, where research is continuing. What’s discussed most often are issues like low self-esteem, suicidal ideation, eating disorders, insomnia and attention disorders. But there is also evidence that the potentially addictive qualities of social media — although the term “addictive” remains controversial — contribute to right-wing radicalization. So one way of framing the problem, and a potential solution, is to argue that if social media companies can be forced to curtail the business strategies that lead users down right-wing rabbit holes and negatively affect mental health, it would be much more difficult for far-right movements to recruit online. 

Legislative approaches to regulating social media are still in their infancy, and are likely to encounter strong resistance. But there’s one promising channel that could move a lot faster: Litigation. A growing number of lawsuits filed by school districts, parents and young people themselves are claiming that social media companies deliberately design their products to be addictive — or at least to draw in users for longer periods of time and maximize “engagement” — which is contributing to the youth mental health crisis. 

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“The end goal is to make young people engage with and stay on the platforms as long as possible, because that means they can sell more advertising,” lawyers for the Cabrillo Unified School District in Northern California argue in a district court lawsuit filed in May. “The YouTube, TikTok, Snap and Meta companies have learned that this is best accomplished by catering an endless flow of the lowest common denominator of content that is most provocative and toxic that they can get away with.”

Anne Murphy, one of the plaintiff’s lead attorneys, told Salon: “There’s been good research done that shows that social media’s effect on the brain is very similar to the effects that you have with gambling or even taking recreational drugs.”

“What we are looking at is the ‘public nuisance’ legal theory, which allows government entities to hold companies liable for unique damages caused as a result of a company’s conduct,” said Ron Repak, a lawyer who is representing Pittsburgh-area schools in a similar lawsuit.

The lawyers who spoke to Salon pointed to precedent-setting lawsuits of years past, based on claims that companies had deliberately addicted their customers to harmful products in search of greater profitability. The most famous of these were the consumer protection cases against tobacco companies that began in the 1990s, which were so successful the federal government joined in. In 1999, the Department of Justice won a racketeering suit against Philip Morris and other tobacco companies, successfully claiming those huge corporations had systematically defrauded the public by lying about the health risks of smoking. Now the school districts suing social media companies are making similar claims, also from a position of governmental authority. Similar lawsuits are being filed by parents who allege direct damages to their children. 

The lawyers who spoke to Salon emphasized that their goal is not strictly financial, although their claims are partly based on the taxpayer money lost because schools must spend more on mental health and security. They also hope that a measure of real accountability can force social media companies to rethink how they do business. Ira Weiss, who represents a different Pittsburgh-area school district, said he believes that these kinds of lawsuits — against the tobacco giants, Big Pharma and vape manufacturers, for instance — can also help educate the public and political leaders. 

During the discovery process, Weiss explained, internal company documents will likely be obtained, and “there will be depositions taken where all this marketing and technology strategy will become known.” (One recent model that made headlines was the defamation suit against Fox News by Dominion Voting Systems, which exposed a great deal of embarrassing material about the right-wing cable network’s internal operations.)

Theories about exactly how social media addicts people or lures them in deeper, especially younger people, are still being developed. It’s fair to say the mechanism is not exactly understood, as was also true of nicotine addiction for many years. But there can be little doubt that social media companies program their algorithms to make scrolling seem almost irresistible. As Haugen put it, Facebook’s internal research made clear that its products were “designed to be engaging,” and also that “that can lead to very high rates of what we call ‘problematic use.'” As an article for NBC’s “Today” site explains it, “That’s how an innocent search for ‘healthy recipes’ on Instagram might lead a teenager to eating disorder content instead.” 

That’s what is meant by the ubiquitous term “rabbit hole”: Users may begin with relatively innocuous content, but to keep them “engaged,” social media algorithms keep serving up ever more extreme — and, yes, more engaging — content that can plant dark thoughts and provoke deep insecurities. One lawsuit filed by California parents cites Pew research showing that, for some users, “the more they use social media, the more they are drawn down the rabbit hole into further use, making it increasingly difficult for them to stop.”

“Addicted” to QAnon, misogyny and the Boogaloo

The same rabbit-hole phenomenon that can draw social media users deeper into the world of eating disorders or suicidal ideation also appears to be a factor in online radicalization. Lisa Sugiura notes that many of the men she interviewed while researching the “incel” community were first drawn into that world through unrelated or apolitical online material, before the algorithm turned their heads toward darker stuff. One interviewee, she said, had done a “simple Google search” about male pattern baldness and eventually ended up on “incel forums, which were heavily dissecting and debating whether being bald is an incel trait.”

That man became an incel “very much through the algorithm,” Sugiura said, and through online conversations with people who “showed him a different way to view the world.”

“Pathologies like eating disorders and suicidality exist on a continuum with radicalization,” said Brian Hughes, the American University scholar. “In a lot of cases, they’re co-morbid. Depression and radicalization are commonly seen together.” Just as online merchants hawking dangerous diet products exploit young women’s insecurities, he added, the world of far-right influencers displays “an obsession with an idealized masculine physique, which often leads to steroid abuse.”

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The most famous example of that phenomenon is Andrew Tate, a British influencer currently being held by Romanian authorities on charges of rape and human trafficking. Tate’s alleged victims say he choked them until they passed out, beat them with a belt and threatened them with a gun. A former kickboxer, Tate has made a fortune by showing off his muscular physique and expensive toys, gizmos and gear to attract a massive online following of young men, promising that he can turn them into “alpha males.” Tate has become so popular with boys and young men in the English-speaking world that educators are organizing and sharing resources in an effort to combat his influence. 

“There’s been a huge increase in rape jokes that the boys are making,” a seventh-grade teacher in Hawaii told Education Week. 

Conspiracy theories and right-wing propaganda often hook people, as Tate does, by appealing to anxiety and insecurity, especially regarding hot-button issues like race, gender and status. In his legal brief in the case of Steven Carrillo, Hughes explained that the murderer “was gratified by the feelings of anger and indignation” from far-right videos he saw on Facebook and “was rewarded with more extreme, more angering content.” (Carrillo pleaded guilty to murder and eight other felony charges last year, and is serving a life sentence without parole.)

“Facebook algorithms would encourage Carrillo to join a Facebook group called ‘/K/alifornia Kommando,'” Hughes wrote. Once there, “his deterioration increased at a terrific speed. He fully embraced the new identity of Boogaloo revolutionary.”

Jason Van Tatenhove understands how that process works. A former member of the Oath Keepers, he offered dramatic testimony before the House Jan. 6 committee last year, explaining how leaders convinced their followers to join the insurrection on Trump’s behalf. In his book “The Perils of Extremism: How I Left the Oath Keepers and Why We Should Be Concerned about a Future Civil War,” Van Tatenhove details how he first got sucked into the group, and what it took for him to get out.

 Jason Van Tatenhove, who served as national spokesman for the Oath Keepers testifies on July 12, 2022, in Washington. (Kevin Dietsch/Getty Images)

“There’s kind of a formula to what we were doing,” said Van Tatenhove, who was hired to do communications work by Oath Keepers leader Stewart Rhodes, who was recently convicted of seditious conspiracy and various other charges, and sentenced to 18 years in prison. “We were always watching the news aggregates. We would set up Google alerts on certain keywords,” in order to tailor recruitment content to what potential prospects were seeking out, especially on social media.

“What were the issues that really got people outraged and angry? Because that’s the low hanging fruit,” Van Tatenhove added. “We were looking for that outrage and that anger, because it seems to short-circuit our critical thinking centers.”

That’s exactly the kind of content that Facebook’s algorithms have favored, according to Frances Haugen. “When you give more distribution to content that can get reactions,” she said in a recent MSNBC interview, “you end up rewarding more extreme content. Because the shortest path to ‘like’ is anger.” 

Van Tatenhove says he is personally in recovery from drug addiction and, during our conversation, compared the allure of conspiracy theories to that of heroin. “While heroin feels great, it ruins your life,” he said. “While conspiracy theories feel great and we get all those chemical releases — much like shooting heroin — it’s damaging to our country and it’s damaging to our democracy.” He suggested that the U.S. needs an analogue to “methadone” for our conspiracy-theory addiction.

What is to be done?

There’s clearly no magic-bullet solution to this problem, but the growing number of lawsuits by parents and schools could be the beginning of one. None of these plaintiffs seek a cold-turkey approach to social media, which would neither be possible nor desirable. As Murthy told the “Offline” podcast, it’s clear that many people “find community” on social media they might not find elsewhere, and that was doubly true during the pandemic. Social media, he added, can be especially beneficial for those “from a historically marginalized group where it’s difficult to find people who may be going through similar experiences,” such as LGBTQ youth. 

As the complaint in the California parents lawsuit argues, the issue is not the existence of social media but the companies’ reliance on an “algorithmically-generated, endless feed to keep users scrolling in an induced ‘flow state’; ‘intermittent variable rewards’ that manipulate dopamine delivery to intensify use; ‘trophies’ to reward extreme usage” and other features that keep people overstimulated and unable or unwilling to log off.  

The desired outcome here is simple: Perhaps the financial threats from these lawsuits will induce social media companies to make their products less addictive. Haugen has repeatedly argued that the path forward will require some form of government regulation. But the two approaches aren’t separate but intertwined, the lawyers who spoke to Salon emphasized. They believe their lawsuits can generate public attention and information that will help shape both future regulation and the public will to enact it. 

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The most promising legislative effort is a bipartisan bill introduced by Sen. Brian Schatz, D-Hawaii, and co-sponsored by another liberal Democrat, Chris Murphy of Connecticut, and two conservative Republicans, Katie Britt of Alabama and Tom Cotton of Arkansas. The Protecting Kids on Social Media Act, like a similar state law in Utah, would bar kids under 13 from starting social media accounts and require parental consent for older teenagers. That is almost certainly unenforceable but, more intriguingly, the bill also takes aim at online algorithms, barring companies from using them to drive content to minors, although it would remain legal to use them on adults.

“While kids are suffering, social media companies are profiting,” Schatz said in a statement. “Our bill will help us stop the growing social media health crisis among kids by setting a minimum age and preventing companies from using algorithms to automatically feed them addictive content based on their personal information.” Of course, as the families of QAnon believers and the victims of right-wing extremist violence can attest, it’s not just kids who are going down dangerous online rabbit holes. Schatz conceded as much in a Wired interview, saying that “it’s bad enough that it’s happening to all of us adults,” but that “the least we can do is protect our kids.”

The fate of that bill is uncertain, and there’s considerable resistance in both parties to pursue direct federal regulation of social media, which would surely be cast by the social media industry and some civil liberties advocates as an attack on First Amendment rights. Schatz has argued, however, that there is “no free speech right to be jammed with an algorithm.” Restricting the use of algorithms wouldn’t impact anyone’s constitutional right to express their opinions on social media. It would simply prevent the companies from shoving the most incendiary content at the most vulnerable users.

These questions of free speech and social media algorithms are tricky, and the legal and legislative arguments are in their early stages. When the Supreme Court was confronted earlier this year with a case arguing that social media companies should be liable for algorithmic promotion of pro-terrorist content, the justices seemed grateful to punt the entire issue.

Legal experts hope that the consumer protection argument driving this new wave of social media lawsuits will create a framework for addressing this issue that sidesteps First Amendment concerns. The recent Supreme Court case looked at “whether a company can be held accountable for specific content,” attorney Anne Murphy said. “We’re looking at it much more holistically,” by considering whether the algorithm should exist in its current form at all, considering the demonstrable harm it does to children.

The core idea here is to shift the focus from individual speech, which everyone agrees is protected by the Constitution, to the larger question of regulating the social media business model to mitigate its effects on public health. If the legal groundwork can be laid in these cases on the principle that children and teenagers should be protected from predatory business practices and deliberately harmful products, that could open the door to a larger regulatory structure that makes the internet safer for everyone. 

This entire discussion is still in its infancy, and more needs to be learned about the way social media affects mental health. As mentioned above, there’s considerable debate over whether the “addiction” model is a fair or accurate way to describe what happens when people get sucked deep into online rabbit-hole communities that encourage destructive behavior or ideologies. As the lawyers who spoke to Salon almost universally expressed, they hope this litigation can help illuminate some of these issues and drive more resources toward the necessary research.  

Still, the family members of right-wing conspiracy believers have little doubt that social media had a profoundly debilitating effect on their loved ones, in many cases people who were vulnerable to the algorithm-driven pressure to stay online. Some people who dive down the rabbit hole may be struggling with long-term trauma or undiagnosed mental illness. Many are extremely lonely. In some cases, they have pre-existing prejudices and are eager to have their bigoted views validated by disinformation. Whatever the root causes may be, social media platforms are profiting handsomely off people who are slowly losing their minds to the reality-distortion field of their feeds. No one suggests these lawsuits can solve the problem by themselves, but they could mark the beginning of a major public reckoning with the harms of social media that leads, eventually, to real answers. 

The post Shutting down the right-wing rabbit hole is possible: First, follow the money appeared first on Salon.com.

In fact, taking on this project felt like fate during a dark time in his own life, Royo shared with me. “I felt a sense of loneliness. I was really into drinking at that point and I just wasn’t happy. I’m thinking to myself, ‘I’m going to get f**ked up and I’m on a one way ticket,’ like ‘Leaving Las Vegas.'”

When Royo called up Bogosian, an old friend, his outlook began to change. “He was like, ‘I’ve got this play, “Drinking in America.”‘ I was like, ‘I’m drinking right now. I don’t know if I can do a one-man show. It’s been 15 years since I’ve been on stage.’ He was like, ‘Well, I did it back in the day, and I wrote it when I was a year and six months sober.’ If I said yes to this project, I’d be doing the rehearsal when I’m a year and six months. I felt like it was kismet.”

According to the U.S. Dept. of Health and Human Services, 46.3 million people aged 12 or older (or 16.5% of the population) met the applicable DSM-5 criteria for having a substance use disorder in the past year, including 29.5 million people who were classified as having an alcohol use disorder and 24 million people who were classified as having a drug use disorder. But addiction stretches far beyond narcotics, which “Drinking in America” proves out in the 12 to 13 characters Royo portrays — from how we ride our ambition toward that good ole American need for success, womanizing, overeating and spending. With the legalization of sports betting and casinos popping up across the country, more and more Americans are finding themselves chained to things and activities that they don’t need.

Royo is best known for a pivotal television role that taught him and America so much about addiction — playing recovering heroin addict and police informant Reginald “Bubbles” Cousins on HBO’s “The Wire.” Recently, he has appeared in the film “To Leslie” and the series “With Love,” “Truth Be Told,” “Empire” and “Hand of God.”

Watch Andre Royo’s “Salon Talks” episode here or read a Q&A of our conversation below to learn more about why Royo is sober today, his journey with fatherhood and how he found his way back to the stage. 

The following conversation has been lightly edited for length and clarity.

How does it feel to be back home in New York City?

I’m feeling great, man. It feels good to be back home. I’ve been in LA for a while now, and I forgot a little bit about that New York energy. It’s fantastic. The minute you land at the airport, you just feel yourself getting revved up. “I’ve got to get my luggage, I’ve got to get that cab, I’ve got to get to my Airbnb.” You just feel alive again. That’s what New York does, it hits you with a jolt of electricity. It’s good to be home.

People know you as a talented actor. People know Eric Bogosian as a talented playwright and actor as well. You two linking up on this project, I feel like it’s something special. Take us back to the beginning when you decided to do this.

Well, it’s a long beginning. It comes in sections. I was with a dear friend of mine by the name of muMs. I don’t know if you know him, muMs, the poet. That’s my high school buddy. We were doing a play at The Lab called “The View From 151st Street.” Every night after the show, muMs would go to Eric Bogosian’s house to play poker. He invited me one day, and I went to Eric Bogosian’s house, and he was a fan of “The Wire.” He was telling me about his dealings with heroin and stuff like that. He was telling me how much Bubbles meant to him. We just hit it off, and we started playing poker. I’m not a good poker player, so I would lose my money. 

I love his writing, and I wanted to do “Talk Radio” one day. He wrote this play called “Talk Radio” that Oliver Stone did a movie about where he played the lead character. I fell in love with that play and that movie, so I told him, “I want to do ‘Talk Radio’ one day.” Cut to, you know the game, I’m in LA doing shows, living my life, and then COVID hit. Once COVID hit, it just seemed to me, at that time, that things were over. Broadway was closed. I’d never heard of that. New York City was shut. New York City, we take pauses, but shut down? I just was like, “It’s over.” 

All of a sudden, we started coming back, and I got back into doing some TV, and it didn’t feel the same. I felt a sense of loneliness. I was really into drinking at that point and I just wasn’t happy. I’m thinking to myself, “I’m going to get f**ked up and I’m on a one way ticket,” like “Leaving Las Vegas.” I’m dealing with deaths in my life. I’ve lost some friends, and COVID hit, and I went through a divorce. I’m unhappy, and I said, “I’ve got to find my joy because I love the craft too much. I need to go back to New York and get on stage.” 

I called Eric Bogosian up and said, “Yo, I want to get on stage.” He was like, “I’ve got this play, ‘Drinking in America.'” I was like, “I’m drinking right now. I don’t know if I can do a one-man show. It’s been 15 years since I’ve been on stage.” He was like, “Well, I did it back in the day, and I wrote it when I was a year and six months sober.” When we were talking, if I said yes to this project, I’d be doing the rehearsal when I’m a year and six months. I felt like it was kismet.

I said, “Eric, I’m going to take you up on that. Let’s do ‘Drinking in America.'” Once I said that, it just seemed like the universe was speaking for me. It just lined up. Audible called up. I don’t even know how they heard about it. We were in Indiana, me and my director, Mark Armstrong, and met Jesse Eisenberg, who was working with Audible at the time. Again, we were thinking about “Talk Radio,” and when we got to New York, “Talk Radio” couldn’t happen because of some rights, or some legality. “Drinking in America” was all full steam ahead, and they said the same thing you said. They were like, “Eric Bogosian is writing, and you’re acting. We want to do it.”

I was like, “OK,” and two, three months later, we’re here. It’s been a life-changing experience for me to be on stage back in New York, in front of my family, in front of my friends. My daughter never saw me act on stage before, so it was the first time for her. You’ve got to show her the reasons why dad’s been away for moments in her life because of the craft. It’s just been a monumental moment. I would put it right up there with my experiences with “The Wire.”

The key in “Drinking in America” is stamina. You were on 1,000% from minute one, all the way to the end. The one thing that came to mind, I was like, “How’s this guy not tired? He must have a Bowflex and a Peloton and a shake weight.”

It’s called a two-liter Coca-Cola and a lot of green tea. When we said yes and we were really getting into the complexities and the preparation, Eric Bogosian said, “You put your foot on the gas, and you don’t let go.” I’m a New Yorker; we move fast. Everything about us is just, go, go, go, get it done. Food to go, breakfast to go, get to work, get on the train. I would say it’s in my DNA. You go as hard as you can until the buzzer buzzes. When the curtain closes, then you pass out. Believe me, when the show’s over, I go out, I sign a couple of playbills, I say hi to a couple of people, and I’m running to bed.

I’m running to bed just to hit the bed and recharge. It’s just energy that I think I’m born with, or grew up in. When you get on stage and you see that audience, there’s an obligation, there’s a relationship, and they’re feeding you. When I walk out, and I see the audience, I see you in the audience for a second, I’m going, “Y’all came here for a show. Let me give you a show.” That’s my responsibility. If I feel myself getting low, I just close my eyes, or I just concentrate in the moment of my character, and I could feel you guys in the audience feeding me, “Do it, Dre. Do it.” It’s a give and take, and if you give me the energy, I’ll give you the show.

There are some funny parts, too. Does the funny come easily to you? 

For me, the funny has come easy because I’m not trying to be funny. I’m a student of the craft. There was a moment when I was in school and my acting teacher at the time was telling me about Jack Lemmon. He said, “Any actor trying to be funny is the kiss of death.” It’s not something you should try to do. You should try not to be funny and that’s funny. When you have an emotional scene and you’re trying to get to a point where in certain roles or certain scenes, you’re expected to cry, for me, it always worked where, when you try not to cry, when you’re trying to stop yourself from crying, that’s when you cry.

I think it’s the same with comedy. I’m not a comedian and I think that’s the hardest job in the business. I think those guys deserve more than they get as far as accolades, as far as awards, because to walk into a room where people are expecting you to be funny, “Make me laugh right now,” that’s a pressure I don’t like to mess with, I don’t f**k with. When I’m doing my roles, I would say I’m a comedic actor, where I know that there are moments that are funny, because we as an audience have a f**ked up idea of what’s funny. When somebody busts their a** in front of us, we laugh.

I’m like, “S**t, I wish I was recording, so I can show it to my family at dinner.”

Listen, Worldstar became famous, the phone became famous with that camera, from cats and people getting f**ked up. We have a horrible sense of humor. We laugh at anything, even when we are uncomfortable, it’s an uncomfortable laugh. I don’t know why it comes easy. Like I said, I just think, because I try not to be funny, I just try to be honest, and I think I leave it up to the audience. Most of the time, the audience is just as f**ked up as I am.

There’s a collection of characters in your one-man show. Can you walk us through them?

It was interesting. There’s about 12 or 13 characters in the show. When I was trying to memorize this goddamn 70 pages of lines, it was hard for me. I would memorize one monologue and forget the next one. What helped me digest the words was, I looked at all these characters as one. I felt like, in my relationship with alcohol, I’m a year and eight months sober now, but in my relationship with alcohol, I felt like I’ve been each one of these characters at one point in my life.

That’s what weaves them together.

That’s right. It is an addiction to something. They have different substances, but the addiction is the same. When you really want something, and you lose control of your desire for it, you’re addicted. Some of these characters are addicted to the American dream, like the melting pot. It’s about the immigrant from Havana who came in America and he really believes that if he works hard, all his dreams will come true. He gets caught up into that American dream, and he’s just working, working, working, working, not having time for anything else, losing family, losing sleep, but he believes, if he works that hard, the dream will come true. Unfortunately, for five out of 10, it doesn’t.

You just be caught in that hamster wheel, just working, and you forget how to live. Then, you’ve got the agent, Wired, who’s f**king doing coke and drinking and he’s into the Hollywood fame. He wants to be number one. Jay-Z said it best, fame is one of the worst addictions in the world. It makes you do s**t that you don’t want to do just to be noticed, just to be seen.

Then, you’ve got the dude, the ceramic tile salesman, and he’s addicted to despair. One thing that we know as artists, and you’re a writer, a fabulous writer, sometimes you’re in different hotels in different states, it’s lonely. You sit around, bored out of your mind. I don’t want to lose any sponsors, I would love to get on hotels.com, but any hotel, from one star to five star, week after week, it’s a nightmare.

You’re just sitting there, just lonely. You go down to the bar, you sit around, you’re trying to make friends and cordial conversation with people that you don’t know and you’re not going to keep in touch with. You’re just trying to make a connection for now. He’s addicted to that, so he finds himself caught up in celebrating, hookers and champagne. These guys are all addicted and all lost in a certain bottle. It describes the alienation of men in post-modern time, where we as men built this idea of what masculinity is. We go, “We must protect, we must provide, we must stay strong.” 

When I was growing up, and I look at my dad and my uncle, you had men that just were so hell-bent on being strong, not showing weakness. If you were too smart, you were a geek or a nerd. If you show vulnerability, you were a sucker or a marshmallow. Good guys finish last. This idea where men have to be strong and couldn’t show emotions, work is hard. It wears you down, and all of a sudden, you can’t go to anybody and go, “I’m f**king tired. I need a break,” or else you’re considered soft.

At what point in your life did you understand the flaw in that thinking? It took me a long time.

When I had my daughter. A daughter changes everything.

I just had a daughter three years ago.

It changes everything. And I knew it. I was in a club when I found out my wife at the time was pregnant. I’m celebrating, I’m in the club just getting drunk, hollering, hoping for a boy. “I’m going to get a boy, it’s going to be hip-hop, it’s going to be this, this and this.” I remember going to the bathroom, and I took a piss, and I’m looking in the mirror, and I’m drunk as hell. I looked at myself, and I was like, “If I have a boy, I’m not going to change. Nothing is going to change about my lifestyle right now. It’s going to be partying and bulls**t, and teaching my kid how to get laid and how to be a man. If I have a girl, I don’t want her to be with a guy like me. I’m going to have to change. I’m going to have to be vulnerable. I’m going to have to open up, and really try to be a different idea of what a man is.”

Once that opened up, I started looking at my dad, I started understanding my uncles, and seeing how they never showed me emotions. They busted their asses and worked hard for me, but I never saw them ask for help. I never saw them show any emotion but strength. I also saw them go to the bottle.

A lot of men have daughters, and they don’t go through that change. I wonder, why did you have that change? Why did I have that change? Maybe we are good people.

You know what? I’m a mama’s boy. I’m a mama’s boy all the way, and she told me, she didn’t care what I became, she didn’t care what I did. She knew the hustle out in the streets was going to be . . . one way or another, she wanted me to just be a good person. Whatever job you had, even if you’ve got that illegal job, whatever job you’ve got, just try to be a good person. For me, that stuck. For me, understanding what a good person meant was breaking outside of barriers, thinking for yourself, and trying not to get caught in a cycle that you know is wrong. I always had this idea in my mind. 

When I hung out with my crew, we did some bad s**t. Everybody was doing bad s**t, but there were certain people within the crew that didn’t know that they were doing bad s**t. They convinced themselves, “If I’m stealing, I need it. I’ve got to have it.” It’s about, only strongest survive. There were certain guys who knew they were doing bad, and when they did it, they got worse karma, because they knew they were acting outside of who they were. For me, I knew everything about myself. At one point or another, I had to at least gauge it to, are you being a good person? Maybe that’s what opened up that moment of me looking into the mirror, drunk as f**k, about to have a kid, I was like, “I’ve got to be a good dad.”

I wasn’t acting at the time. I was doing a little theater here and there, but I was doing construction. My mind was telling me, “I’m about to tell this little kid, you could be anything you want to be,” and I’m saying that with true belief. I didn’t want my kid to look at me and go, “You wanted to be a construction worker? Is that what you wanted?” I was like, “I can’t have that. I’ve got to have my kid look at me and believe what I’m about to tell them by action.” I want my kid to look at me and say, “You’re an actor. You always wanted to be that. You’re speaking truth.” I had to open up a vulnerability and just change my game.

Especially for you, “Drinking in America” is such an important piece of art because you played Bubbles on “The Wire,” who was one of the most memorable, lovable addicts in television history. Do those worlds connect for you? Was there any inspiration in that?

I had a long stint with alcohol. In my preparation for Bubbles, I saw and met a lot of people in different variables of an addiction. Again, as a New Yorker, growing up, I saw guys and women coming out of offices in the middle of zero-degree weather having to have a cigarette, you had to have a smoke. I just looked at everything and realized: we’re all addicted to something. Sugar is number one.

Even with the hard stuff, too. When I was on the corner, dudes in suits would pull up to buy crack, because it’s Friday. A little Friday crack.

It’s the accessibility to just get away, to escape. I’ve had many aspects of understanding that addiction is not the problem, it’s the problem of self resilience. When you quit drinking, it’s not like your life gets better. You still have the same problems. What happens is, you’re just saying to yourself, “I don’t need the liquor to handle my problems.” Then, you’ve got to build a certain strength. I think we all have that strength. We just get worn down. 

Once you get a little taste of something that makes you feel better, you are going to do it, and you don’t know you have a problem until it becomes a problem. Alcohol is something in our society that’s just used and commercialized as a celebratory thing. We pop bottles when you want to celebrate. It’s, “Happy New Year,” drink all day. When you have a bad day, “Go get a drink; it’ll make you feel better.” 

It’s medicine, and we do it all the time. We have beers and watch sports. Alcohol is connected to everything, and the person drinking doesn’t know he has a problem until it becomes a problem. I think that’s with anything, with sugar, obesity, with nicotine, with caffeine, we all have it. Once you, the individual, recognizes it, and understands that it’s gotten away from him, he’s doing it now when he doesn’t want to do it, then he can start deciding on whether to make a change, and it’s not easy. For me, I don’t even know if I would be sober right now if I didn’t make a decision, or things didn’t start happening to me that made me have to make a real, rock-bottom choice. I lost some friends, I went through a divorce, my daughter graduated. I’m an empty-nester and I’m feeling like s**t, and I’m just drinking.

Trader Joe’s was selling Japanese whiskey at $30 bucks a bottle. That’s easy, I’m just going in. I get a phone call, and I don’t mind sharing this with you, because we’re family, and if it can help people out there, so be it. I got a call, and like I said, I’m a mama’s boy, and my mom was diagnosed with Alzheimer’s.

Sorry to hear that.

At first, I was boo-hooing. I’m talking to my friends, and most of my friends are like, “I lost my mom three years ago,” or, “My mom is going through that now.” I realized, I’m 50-something years old. It’s just my turn to deal with grown-up s**t. If your mom is calling you and you’re finding out that she has Alzheimer’s, I have no time to be drunk. I have to always be ready. If that phone rings, and you need me, I’m ready. I can’t be like, “I’ve got a hangover. I can’t do it right now.” Or, forget that you even called in the first place. 

Playtime is over. For me, that was my, for lack of a better word, bottom. I don’t think there is a bottom. I think you make a choice after you get a couple of hits, and whatever your hit is that you can’t take no more, you’re going to make a choice to go one way or the other. My way was to put the bottle down, and make sure I could always pick up the phone. That was it, cold turkey, enough said. 

I realized once I put the bottle down and started going through my sobriety, it wasn’t the liquor that I was addicted to. I was addicted to the lifestyle. I like being in the bar, I like talking s**t. I like going whoo-ha for the team, and knocking back a beer. I realized, I can do all that woo-hollering with a cup of coffee, or another vice, Coca-Cola. 

“Drinking in America” came in at the right time, we were saying how the universe speaks, where I was like, “Wow, I can take all my issues, and all my experiences with alcohol, and put it in my craft instead of my liver.” This is my way of being able to go on stage, and saying, “Thank you liquor for all the good times.” There were good times. Sometimes liquor gave you the courage to talk to the right girl. Sometimes liquor calms you down, so you can go into that audition and book a job. I had great times with liquor, and “F**k you for all the bad times.” I’m on stage going, “Good day. Bravo, and I’ll see you later.”

Is there a formula for Audible? Do they record every play, or is it just one?

I don’t know, bro.

The one I went to, you didn’t miss a beat. You didn’t skip a word. 

Thank you, I hope they recorded that. Knowing how the universe works, they probably missed that one. I know, from what I understand, they bought the Minetta Lane Theater, a wonderful theater that I used to go to back in the day. I think it’s set up to be able to record, I just don’t know what they choose to record, or what day. I think they were going to tell me, but I told them not to tell me, because I don’t need extra pressure. I know that it’s set up that they can record when they want to, and I know that there’s a couple of shows throughout the run that they probably did record. Hopefully, they recorded the good ones, and if not, they’ll just do a whole bunch of splicing, and get it right.

Audible has been fantastic, man. Audible has really set up a certain standard in theater, where they really respect and treat the artists the way they should be treated. We go out there, and we try to give our blood, sweat and tears to perform, or entertain, and when you go backstage, they make it real nice, and really set you up with a lot of caregiving. They got me a a personal trainer to stretch me out. They make sure that I’ve got the right type of dietary needs to keep my stamina up.

Six two-liters of Coca-Cola?

When I need it, that’s right, and a two-liter of water, just to make sure I mix it up a little bit. It’s been a great experience. Like I said, I hadn’t done theater in about 15 years, so to come back and take this on, and have this type of lift, it just makes me really appreciate the love of acting, and the love of the audience, and that relationship that we always share. The theater is the actor’s medium. It’s the most spiritually satisfying experience that any actor can have. Television, it’s the writer’s medium. You guys [the writers], pen the paper, it’s where y’all can tell eight episodes, y’all can tell a real gripping story, and it pays very well for the actor. Movies are the director’s medium. The director is the boss, the God. 

Any actor out there, if you get a chance to step on the stage, I always say, go for it. It’s a jolt of creative juices that I never experienced. Once I got a taste of it back in the day, I knew I was going to find my way back there. Your first question, “How does it feel to be home?” It feels like love. I’m glad to be back.

What’s next for you?

What’s next for me is a nice, long nap. Then, I go back to the hustle. I go back to LA. I live in Ojai now, but I go back to LA. I tell the people, “OK,” because when you tell your agents and managers you want to do theater, they get pissed off. They go, “Aww, s**t.” Now, they’ve got to make up for lost time, and hopefully, I’ll end up on another show somewhere, or do some movies. I love independent films. The last film, “To Leslie,” did well. There’s talks of this going other places, talks of maybe taking “Drinking in America” to London or to LA. “Talk Radio” is still something I want to tackle. I think this experience on stage has just opened up another avenue, where I can now travel with my creative aspirations, and do it all.

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The 60-bed safety-net residential treatment center in Santa Fe Springs, run by Los Angeles Centers for Alcohol and Drug Abuse, has a dedicated detox room, on-site physicians and nurses, substance abuse counselors, licensed therapists, and other practitioners. It offers group counseling as well as individual and family therapy, and it endorses the use of medications for addiction treatment, such as buprenorphine and naltrexone, which are increasingly considered the gold standard.

Willard Sexton, a staff member and former Allen House patient, says the most important part of his job is speaking with each resident daily. Most of them, like him, came to treatment straight from jail or prison, and he knows as well as anybody how stressful it is to stop using.

“It’s similar to grief and loss,” says Sexton, 35. “The drug was their best friend for a long time.” Interacting with them, he says, helps him in his own ongoing recovery.

At a time when drug use is among the nation’s gravest public health crises, a visit to the Allen House offers key lessons: Addiction is a chronic illness requiring constant vigilance, there’s no one-and-done solution, and relapses are part of the journey to recovery. Peer mentoring is an invaluable element of drug counseling, since people who have plodded the difficult path from dependence to sobriety understand the mindset of patients on a visceral level.

And most importantly for those who feel despair in the grip of addiction, there is hope. “Recovery happens,” says Michelle Doty Cabrera, executive director of the County Behavioral Health Directors Association of California. “Every single day people come into treatment and succeed in addressing their substance use disorders.”

Drug-related overdoses kill almost as many Californians as lung cancer, more than diabetes, and two to three times as many as car accidents, according to a report by California Health Policy Strategies, a Sacramento consulting group. The report showed there were about 11 times as many fentanyl-related deaths in 2021 as in 2017, accounting for more than half of overdose fatalities. And addiction can ruin lives even if it doesn’t end them.

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But proper care for substance use disorders can still be hard to find. Experts in the field say residential treatment beds are in short supply. A pandemic-driven shortage of health care workers has hit the drug treatment world. Unscrupulous operators, with an eye on their bottom lines, may take advantage of people desperate for any answer. Commercial insurers often deny treatment requests or propose cheaper alternatives.

Some treatment programs shun anti-addiction medications that have proven effective. Physicians, nurse practitioners, and other providers with the requisite training can prescribe these drugs in California, but too few seem willing or able to do so — though that could change now that federal law no longer requires them to get a special waiver.

A page on the website of the Substance Abuse and Mental Health Services Administration (www.samhsa.gov) allows you to find practitioners in your area who treat patients with buprenorphine.

There’s no one-size-fits-all solution for addiction. Treatment can differ depending on the substance — opioids, alcohol, or methamphetamine, for example. And people with substance use problems come from all walks of life: Some are straight off the streets or out of jail or may have serious mental or medical conditions that require additional care. Others may be otherwise healthy with good jobs and insurance. If a clinic tries to sell you on a standardized treatment program, cross the place off your list.

And if someone tells you that after one stint in their program you or a loved one will be drug-free for life, run the other way. For many people, addiction is a chronic condition that ebbs and flows over many years. Too often, patients in the throes of an overdose are revived and then discharged with no follow-up.

“If we talked about treating other chronic illnesses like diabetes or asthma in the same way we often approach treating substance use, people would think we were crazy or would sue the doctor for malpractice,” says Bradley Stein, a psychiatrist and senior physician policy researcher at the Rand Corp.

Finding the treatment that is right for you or a loved one will take legwork.

Whether it should be a residential or outpatient program depends on multiple factors. People who need to be shielded from exposure to a dealer or a toxic domestic situation, require detox, or have mental health or medical conditions on top of their drug use generally are better off in a residential setting, says Randolph Holmes, medical director of the Los Angeles Centers for Alcohol and Drug Abuse. Outpatient settings are more suitable for people with stable lives and better health or those transitioning from residential treatment, he says.

The cost of treatment can vary widely depending on duration and the patient’s circumstances. In some cases, it can reach tens or hundreds of thousands of dollars.

Various websites allow you to search for nearby addiction treatment. The Substance Abuse and Mental Health Services Administration has a treatment locator at www.findtreatment.gov, or you can call its help line at 800-662-HELP (4347). Shatterproof (www.shatterproof.org) is another source for finding treatment. In California, the Department of Health Care Services publishes a list of substance use help lines by county.

If you’re on Medi-Cal, California’s version of the federal Medicaid program for low-income residents, your county is a good place to start. It can point you to several options, at least in more populous areas. Almost all patients with the Los Angeles Centers for Alcohol and Drug Abuse, for example, are Medi-Cal enrollees.

If you have commercial insurance, call your health plan first. Parity laws require insurers to cover substance use treatment, though they often find reasons not to provide the treatment your provider recommends. If your plan denies you treatment you think you need, you can file an appeal. The Department of Managed Health Care (www.dmhc.ca.gov), the state’s primary health plan regulator, has a help line (888-466-2219) that can assist in appealing your case. Or you can do it online. If the department does not regulate your plan, it can steer you in the right direction.

And remember that recovery is a long-term commitment.

When Sexton first started using in his early 20s, his drug of choice was meth. He later started smoking it with heroin and fentanyl mixed in, he says.

Several years ago, Sexton spent 45 days in residential rehab and got sober. Then he started seeing a woman who was addicted to heroin. He thought he’d help her get sober but ended up doing drugs with her instead. He landed in jail for two months, and a judge ordered him back into residential drug treatment.

Sexton says he continues to actively pursue his recovery even as he helps others do the same. “There are bumps in the road, but I feel like I’m in a Range Rover,” he says. “I’m not going to spill my coffee.”

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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