(“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.

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.

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So naturally, like a hoarder who self-soothes watching Marie Kondo videos, I was immediately drawn to Scottish physician and author Gavin Francis’s new book from the title alone: “Recovery: The Lost Art of Convalescence.” Doesn’t that just say it all? Don’t the words “recovery” and “convalescence” shimmer in your imagination like mirages? 

As Francis, whose previous books include “Adventures in Human Being” and “Shapeshifters: A Journey Through the Changing Human Body,” explains, bodies dealing with injury and illness need the one thing our culture places far too little value on — time. He traces the historical roots of convalescence, shares his own humbling healthcare experiences, and offers the reassuring, authoritative advice that truly allowing ourselves to get better helps us to stay better. It is a small jewel of a book, eloquent and humane and sensible. Weeks after finishing it, its wisdom has stuck with me like few other pieces of writing have in a long time.

Francis spoke to me recently from his office in Edinburgh about the roots of our quick-fix approach to healing, why good doctors should be gardeners instead of mechanics, and how overcoming our resistance to real recuperation is a win-win for everybody.

This conversation has been lightly edited and condensed for clarity.

There’s a phrase I’m sure you’ve heard, that people are being pushed through the healthcare system “quicker and sicker.” I wonder, did we not learn anything from the pandemic? Did we not learn anything, as medical systems, as workers, as parents, as caregivers? We went through this crisis where the consequences of illness should be pretty clear. And I feel like we learned not a damn thing.

I would beg to disagree, actually, from my perspective. I can see a lot more tolerance and a lot more kindness towards people who are suffering or struggling after following some kind of significant illness, not just from COVID. 

COVID affected everybody in some way. Everybody knows somebody who had COVID badly, or has heard of somebody who is struggling with fatigue weeks or months later. I feel like there is a greater willingness in society and among our patients generally to concede that there is a place for having respect to the process of recovery. There’s a greater respect for the process itself, because it’s so much more current.

One of the few silver linings of COVID — because it has been a catastrophe generally — has been that there’s a greater societal awareness of post viral fatigue and a greater societal awareness of the need to make time for and respect convalescence.

Let’s talk about time, because we are at the mercy of capitalism. I see many of us struggling to bounce back as quickly as possible, to just be at 100% immediately. That distances us from the concept of convalescence, which is a process. Talk to me about why we have to understand that illness and wellness are a continuum.

My impression as a family physician is that something major shifted in the mentality of humanity, certainly in the West, roundabout the ’60s, early ’70s. During the ’50s and ’60s, we had this explosion of brilliantly effective drugs. We started to have steroids, we started to have the wide availability of antibiotics, we started to have effective chemotherapies, we started to have drugs which were really effective in various mental health issues.

And so the old-fashioned notions of convalescence — of making time and space, and having somewhere clean and well-aired with a view of something green — that were time honored and self-explanatory to the Victorians, we just started to throw all that out and say, “No, all you need is the right prescription. Clearly, if you can just get the right drug, you’ll be fine.” That started to infect medicine and infect people’s expectations of medicine. 

The truth is that the drugs are wonderful. I wouldn’t like to go back to practicing medicine in a day before antibiotics, before steroids, before effective antipsychotics, for example. At the same time, there is a huge number of medical problems that we can’t properly cure definitively, that there isn’t a really effective prescription for. And these much older perspectives about giving time and respect and some self-compassion have to me being really neglected. 

Now it’s been 70 years since the early ’50s, when this drug explosion began. We can see that there are limits to the power of this scientific medicine approach. There are lots and lots of different illnesses and problems that I deal with as a doctor that don’t have a quick fix solution. And I really want us to move away from this idea of health as being some sort of golden zenith to which we all aspire to health actually being a balance between extremes, which will be different for everybody depending on their own personal circumstances.

I would like if this book could help people to reframe health as a balance, and something that’s achievable for everybody. Even if you have a condition which is ultimately incurable, there’s still health. It just means something different for you, then. Let’s let’s adopt some of those older principles and perspectives and not discard them just because we have a few really effective drugs these days.

Tell me what some of these principles are, because we do in the West think, “I’m going to take a course of antibiotics, and then I’m going to be right back out there at top of my game, better than ever.” What actually, should we be thinking about when we are recovering?

There’s various principles, and a conversation with a patient would elicit which ones are most important to emphasize. But I suppose the first really major principle is to make time and space and to respect the process of convalescence. Because if you don’t, you’ll do exactly what you just described and is far too common nowadays, people rushing back into work burning themselves out. If we don’t accept the fact that we’re operating below par, we’ll just push ourselves too hard.

What I see often in my patients that try and go back to work too quickly after a really challenging bout of COVID is that the just the end up retracting the recovery by quite a long way. If people were able to give themselves the permission to take longer to recover, I think that would help them. Respecting the process and giving yourself permission is connected to the idea of self-compassion. 

Another principle is travel. I’ve got a chapter in the book about travel, just because it’s a really time-honored approach, from the old Swiss sanatoria right all the way back through the medieval Christian tradition of pilgrimage. Many other faiths as well have a tradition of pilgrimage when you’re feeling unwell or you’re ill. Even if you don’t place a great deal of stock in the concept of faith healing itself, simply the journey to somewhere else into a new perspective, taking yourself away from the circumstances of home, from the other obligations of home which might be stressing you, can be profoundly helpful. But I’m very aware that it’s only really particularly privileged groups are able to do that. 

Another of the main principles that I try and encourage my own patients is to think about healing as a natural process, and think about nature. All our most effective drugs are derived from plants, and our bodies are part of the natural world. Healing is about a balance between extremes, rather than some sort of ultimate end in itself.

I often try and encourage my patients and my medical students to think of doctors and nurses as far more like gardeners than they are like mechanics. We don’t really replace broken parts. What we do is we try and create the environment for a natural process to flourish, which is much more of a gardening perspective than it is an engineering perspective. So that’s the third major principle, thinking about and involving yourself in the natural world in some way, even if that’s just having a window box if you can’t get out. If you can get out, think about getting fresh every day in some kind of natural space. 

Another principle is that there’s far more to treatment than just drugs and prescriptions. There are so many treatments. You know, sometimes the most effective treatment for somebody with chronic lung disease is to join a choir, for example. Some of the most transformative treatments I’ve seen people suffering all sorts of different problems for is simply getting a pet. Particularly a dog, because of the companionship and the love and the exercise that we then have to get. There’s a whole load of different kinds of engagements that you can do with your body and your life, which will help you and will be far more effective than just trying a different regime of pills. 

This idea of the recovery is not about sitting still and doing nothing. Explain to me what that difference is and what rest really means, opposed to the old-fashioned “rest cure.”

For me, rest is about learning a new language of the body and listening to it very, very carefully when your body’s telling you that you need to stop and take a bit of time. But it’s also being conscious of not letting your horizons shrink in too far. You alluded there to the famous Charlotte Perkins Gilman story whereby a woman is told basically to rest, but really it’s a way of shutting her up and silencing her. I think in the 19th and early 20th century, certainly women were pushed into this role far more often by this kind of perspective on medicine. 

Even today in the 21st century, we can see gendered approaches to convalescence. Whoever I’m trying to come up with a collaborative convalescence plan with, I would encourage to adequately rest when their body tells them to rest, but also to gently push at the edges of what’s possible and set achievable goals. The old-fashioned rest cures threatened to make your horizons completely shrink. People would get very anxious when they headed out; they would put on a lot of weight; they would lose all the social connections that sustain our lives. There were lots and lots of problems with this approach to the rest cure. When the rest cure was developed in the 19th century, they also developed at the same time this idea of the West cure, which only men were recommended, which was about going off and working on a ranch or something like that.

We do still see some evidence of that “rest cure” in how we care for the elderly, because it’s easier on the caregiving system for them to be quiet, and inactive. 

We have to find a way in our society to reframe the increasing age and frailty of our communities as a great success. People are living longer right now than they’ve ever lived in the history of humanity. If that is not a cause for celebration, then what is? How can we reframe this instead of being seen as a burden and a problem, as the corollary of some great, magnificent success? That’s really what it is. I’m delighted now that the worldwide life expectancy is now into the seventies. That’s amazing, it was down in the fifties at the start of the 20th century. We’ve got a lot to celebrate.

We’re not islands, we all exist within broken systems that do not facilitate the kind of healing that you’re talking about. We work in broken systems, where asking for time off is frowned on. And it feels like our systems are becoming less and less accommodating. What do we do about that, when we are all going to need these resources? We all are going to need time to heal.

Because it’s funded in such a radically different way, a lot of the problems with the U.K. health system can be ultimately traced back to neglect from politicians and from managers who’ve cut it and cut and cut it and cut it. Because we have one NHS which is all funded through taxpayers and contributions, for many years now they’ve been taking money out of the capital budgets just to keep the frontline services going. So we have a system now that’s really on the edge of collapse. 

In the U.S., I know you’ve got very different systems, many tiers depending on your levels of insurance cover and many different kinds of organizations involved from top to bottom. 

I love the sentiment of the founder of the U.K.’s NHS, a Welsh politician who came from a mining community. He really strongly believed that ultimately, we should judge a society by how they treat their sickest and most vulnerable people. Have we become a rich, powerful, technologically advanced civilization? I think we have. What is the point of that if we can’t use those riches, that power, that technology, in order to help the people of those communities that are most vulnerable? 

The vast vast majority of illnesses, people do not bring upon themselves. They happen to them. They are misfortune, they are bad luck. And if we can’t use all the power and the resources of these very wealthy 21st century societies in order to help people that are the victims of this kind of bad luck, then I think we’ve got our priorities wrong. 

I would really like to see much more unbiased reporting about health. I think journalism has a really amazing part to play in a functioning democracy in terms of properly laying out the facts to the electorate. I would really like to see a reframing of our aging and frail population as a success. And I would like to see some very frank, honest examinations of the costs involved and how they could be paid for in different ways. How the U.S. moves towards a system with a more compassionate approach to people who are in a low income, I don’t really know.

Some people would argue that in the U.K., one of the reasons the NHS is struggling is because ultimately, that postwar consensus where people felt very strongly that we’re all in together is starting to break up. Ultimately, if people who are wealthy are less willing to subsidize the healthcare of people who are poor, the system breaks.

Perhaps that’s, deep down, the problem. As we’ve moved further and further from the postwar decades, the wealthy are less willing to subsidize the care or the education of the poor. But I would really like to see this reframed in a way where you could say, “Look at the huge benefits for the rich of having a society in which the poor are well cared for, and anybody can end up moving both ways up and down the ladder.” You might be wealthy this year, but you might not be next year.

It is in everybody’s interests to have a healthy society that uses its power and its technology and its resources to look after most vulnerable. It’s in everybody’s interests, top and bottom of the ladder. 

One of the arguments that you’re making in this book is that this is not just about benevolence. It’s about making a good bet on ourselves and our society.

Yes, because illnesses and misfortune can happen to anyone, and how we look after that is ultimately how we’re looking after ourselves, because any of us could end up in that situation. My argument is that if you learn this new language of the body and learn how to to be kind to yourself and to convalesce properly, you will convalesce much better. The word convalescence means grow in strength, so you will emerge stronger from the experience.

A bitter pill to swallow is the fact we’re all going to get sick, we’re all going to get injured. You talk about your own sicknesses and injuries in this book and how they were managed. So what do we want for ourselves when that moment comes?

How compassionate a society do we want to ultimately build? Did you hear that your chances of staying out of a nursing home as you get older are directly proportionally related to how many daughters you have? One of the things I tried to touch on in the book is the pressures on carers, which can be extraordinary. 

The greatest thing this book does is to affirm, you have permission to be sick, and you have permission to heal. That’s challenging for a lot of us to hear and accept. For the person who is struggling today, who got those telltale lines on their COVID test or who just broke their arm, what do you want them to know about dealing with their condition right now?

Just what you said so concisely. I would like them to know that they have permission to be ill, that it’s not their fault. It’s a misfortune, and that there are time honored ways in which you can give yourself the best chance of recovering and to look into those. To try to find a clinician or carer that you can trust. To allow yourself to rest but gently push at the edges of what’s possible. To not compare yourself to others because everyone’s different. To set small, achievable goals and work towards them steadily, and not get too downhearted when you fall backwards. 

The post Permission to heal: An expert explains why we all need to rediscover “the lost art of convalescence” appeared first on Salon.com.

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.

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Two of the main components of a healthy and successful recovery program are medications that can greatly assist treatment (e.g., methadone, Suboxone, and, increasingly, psychedelics and cannabis) and peer support. Arguably, these are the two magic ingredients. Unfortunately, due to the ideological vise grip that the at-times cult-like Alcoholics Anonymous (A.A.) has had on the recovery world since it burst onto the scene in 1937, these two critical components are on a collision course with each other.

Time to enter a more modern age

It is worth noting that A.A. was established and took root in 1937, before we had modern medicine, current study designs, neuroimaging, plausible theories of addiction or any medications to help addiction. At A.A. meetings, hundreds of which I’ve been forced to attend, one has very little sense that anything from the modern world has seeped in since 1937, except for more contemporary brands of cigarettes and coffee – the “good drugs.” How is it that this old-fashioned, non-science based, and very religion-y ideology has cornered the market of our modern, medical recovery paradigm almost a century later?

The “twelve step” groups and programs are unquestioningly very helpful to a self-selecting group of people. I’ve had friends solidly recover through A.A. Yet, we need to challenge the ‘abstinence only’ model that A.A. has imposed on tens of millions of us in the recovery community. There are several issues here, such as the Puritanical idea is that if you’ve ever used one intoxicating or potentially enjoyable drug, you can’t ever use a different one for the rest of your life — “One is too many, 1000 is never enough.” If an unhappy youth was addicted to cocaine at age twenty, according to doctrine, he or she can’t safely enjoy a glass of wine with dinner in his or her 50’s. There is no evidence for to support such a draconian rule.

More concerning, according to a hardcore but hardly uncommon interpretation of the 12-step ideology:  you aren’t really in recovery if you are on Suboxone or methadone, or other potentially pleasurable or abusable drug (e.g., valium for anxiety), even if they are prescribed by a doctor and are being used solely to help with your addiction or your mental health.

Medications work

Medications such as Suboxone (buprenorphine) and methadone offer a 50 to 80 percent reduction in overdosages and deaths. These are a critical treatment that need to be made more widely accessible, without stigma or barriers. At my hospital, Massachusetts General, we view the use of these medications, for the disease of addiction, as analogous to the use of insulin for diabetes. No one says, “You aren’t really in recovery from diabetes because you are cheating by taking insulin.” Yet stories abound of people, early in recovery, hanging on by a thread, being shamed at A.A. and N.A. meetings due to their usage of these medications.

Recently, there has been an explosion of interest in, and studies demonstrating, the helpfulness of psychedelics such as psilocybin mushrooms and LSD, to treat a wide variety of addictions, including two of the deadliest: opioids and alcohol. Ironically, the founder of A.A., Bill Wilson, used LSD to facilitate his recovery from alcoholism. He believed it could help with the “spiritual awakening” so critical to recovery.  Yet he still somehow managed to come up with a rigid abstinence-only paradigm.

What about cannabis?

Most Americans have woken up to the fact that they’ve been sold a bill of goods about cannabis and stand behind legalization. Cannabis certainly has its potential harms, especially for teens and pregnant/breastfeeding women, but, for countless other patients, it can be a relatively non-toxic remedy for a wide variety of symptoms and maladies. Thousands if not millions have used cannabis to transition off of opioids, alcohol and other deadly drugs, or to minimize their dangerous usage. I have had great success with this in my practice and this is what harm reduction is all about. In my own struggle with opioid addiction, cannabis was indescribably more helpful than anything else was in alleviating the soul-crushing withdrawal effects from abrupt opioid cessation.

While cannabis can be addictive, it is less addictive than alcohol and opioids, and the quality of the addiction usually tends to be less life-destroying. No one is robbing pharmacies. We are learning more, every day, that the “gateway hypothesis”, which claims that cannabis use leads to other drug use — a foundational talking point of the War on Drugs – has no evidence to support it. For many, cannabis has proven to be a ‘gateway’ off of alcohol, opioids and other drugs, rather than a gateway onto addition. Many people are choosing to be “Cali Sober” – meaning, no drugs except cannabis, and they seem to be doing quite well, though this needs further study.

(Disclaimer: In my practice, I treat active opioid addiction with Suboxone not with cannabis, as there is a far better evidence base for this practice).

We need a bigger recovery tent

If the hardcore denizens of A.A. dismiss methadone and Suboxone – both FDA approved meds — one can only imagine how they many of them may view psychedelics and cannabis. However, times change, and we need to break with the old ideologies when they stop helping many of us. We need to provide a ‘big tent’ for people limping into recovery, so that they feel welcomed. We need to provide a tent that freely includes methadone, suboxone, cannabis and psychedelics.

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It is cruel and dangerous to stigmatize and shame people – many of whom are barely holding it together in early recovery. Further, there is no evidence for the morally stark, abstinence-based mode of recovery. The one credible study I’ve seen, published in JAMA in 2014, showed that “As compared with those who do not recover from a Substance Use Disorder (SUD), people who recover have less than half the risk of developing a new SUD. Contrary to clinical lore, achieving remission does not typically lead to drug substitution, but rather is associated with a lower risk of new SUD onset.”  The hard work of getting yourself into recovery teaches you the tools and coping mechanisms to keep you healthy and safe.

We need a bigger recovery tent, one that incorporates the last century or so of both lived experience and scientific discovery. Clinicians and scientists need to meet people where they are. So does the recovery community. Rather than shunning people, let us embrace them. Getting into recovery from my opioid addiction was the most difficult thing I’ve ever done. The stakes truly are life and death. Let’s welcome all of my brothers and sisters in recovery — from all backgrounds, with different philosophies and definitions of recovery — into our shared goal of a healthy way of being in the world, together, free of the death grip which our respective “drugs of choice” formerly had on us.

The post We need a bigger recovery “tent”: It’s time to think beyond 12-step programs appeared first on Salon.com.

Experts agree: Absolutely not. Indeed, a “lapse” may not even mean that you have “relapsed.”

“We tend to think about lapses and then relapses,” explained Dr. Kenneth E. Leonard, the director of the University of Buffalo’s Clinical and Research Institute on Addictions. As Leonard noted to Salon, there is a crucial difference between lapsing and relapsing. A person can engage in addictive behavior on one occasion and, if they make sure it never happens again, avoid serious long-term damage.

“If a person is abstaining from alcohol, and they’re choosing to abstain, and they have an episode where they drink some amount, that’s usually considered a ‘lapse,'” Leonard told Salon. “Then the key is preventing that from turning into a ‘relapse,’ which is where they return to their previous levels of excessive drinking. You can apply that same kind of concept to other substances as well.”

Distinguishing between “lapses” and “relapses” matters, according to Leonard, because it puts the phenomenon of breaking sobriety into a healthier context. While lapsing should never be taken lightly, it is common, and therefore a recovering addict should not feel ashamed. Most recovering addicts will lapse at one point or another. If they emotionally batter themselves over “failing” and decide to give up altogether, they will have made a terrible mistake — and will have held themselves to an unrealistically high standard.

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“My advice would be to try again!” Leonard said when asked about a hypothetical lapsing addict. “Most people who achieve stable recovery have some number of lapses. They make a number of serious attempts, and we know that some for some people that can be two or three, but it could be as many as five or six or ten. People who get back into a recovery mode can go on to achieve, valuable outcomes in their lives.”

Yet why does the lapse happen in the first place? As it turns out, there are complex neurochemical reasons underlying why addicts may return to their substance of choice. 

“One thing is clear: Addictions set up long-term changes in the brain that promote drug-seeking behavior,” explains Dr. Steve Maren, who studies how highly valence memories (whether for aversive stimuli or drugs) are suppressed, and how individuals relapse, at Texas A & M. “There are important psychological variables that interact with those brain changes. The context in which drugs are taken, and the stimuli-associated with drug taking, are key variables in the maintenance of drug use and abuse.”

When an addict decides to abstain from drug-seeking and drug-use, the changes circuits in their brain that supported the addictive behavior are reactivated. This is particularly true when a recovering addict is an environment which reminds them of why they became addicted.

“The reactivation of those circuits are essentially reminders of drug-taking and that experience,” Maren explained. “And so I think that’s one of the major factors that can drive relapse, the sort of memories that are associated with drug-taking and that caused the drug seeking behavior to kind of reappear after it’s been silent for some period of time.”

Harvard University physician and addiction specialist Dr. Peter Grinspoon writes that one should view a lapse as the final step in a larger breakdown of the recovery process. If a recovering addict has fulfilling relationships and overall is satisfied with their current life, it is far less likely that they will slip back into addictive behavior. Lapsing and relapsing addicts behave as they do because there has been a larger deterioration in their life. The decision to abuse a substance is simply the final step before they hit the bottom.

“It is often said that when a person relapses, the act of taking the drug or the drink is the final manifestation of the breakdown in their recovery process,” Grinspoon explains. “That is, people lose sight of — and stop practicing — the positive ways of being and interacting that have supplanted their drug use. The drug or the drink is left to fill the vacuum, and to erase the pain.”

While there is no quick and easy way to snap out of a spiral that might lead to lapses, there are some techniques that can be helpful. First and foremost, see if your HALT needs are being met — that is, are you hungry, angry, lonely or tired? If there are problems in those areas of your life, try to fix those immediate physical and emotional health concerns, as addressing them early can nip a potential lapse in the bud. It also helps to exercise, as physical fitness releases endorphins in the brain, which help you feel good. There is also nothing wrong with distracting yourself with sedentary and harmless escapism like watching TV, reading a book or playing a video game. Finally you should never feel like a burden for reaching out to your support network. Recovering addicts are there for each other.

The post The difference between relapsing and “lapsing,” according to addiction experts appeared first on Salon.com.

Salon spoke to Lamott recently about what’s changed since she wrote prophetically about “stockpiling for the apocalypse,” and finding grace in a big box store run.

This is an important question to be asking right now, and one you touch upon in the book. Sincerely, how are you, Annie?

I am sincerely well. I got both of my shots because I’m old. In California, they’re vaccinating 65 plus. I’ll be 67 next month. Neal’s getting his second shot today, so he’ll be less of a contaminant to all of us.

We’re all fine. Nothing interesting, which is just great. Everyone’s kind of coping. Some days are just too long and you just hate everybody and all of life. Then it passes, and it’s kind of a miracle that everyone’s doing as well as they are.

I loved the woman in the book who says, “My definition of okay is constantly changing.” That speaks very much to this moment.

Your last book opens with, “I’m stockpiling antibiotics for the apocalypse.” Annie, then an apocalypse kind of came. That book is about hope, but also very much about despair and about this dark moment that we were in two years ago. Writing this book, what was the narrative through line that you were feeling was pulling you through?

I was on tour for the last one, the hope book, which had originally been called “Doomed: Thoughts on Hope,” but then my publisher thought it wasn’t a really selling title. This book I wanted to call “The Third Third,” because I’ll be 67 in April. The publisher thought, again, not a selling title. On tour for the last one, everywhere I went, people were really in despair. They weren’t in the hope.

I mean, it was the UN climate report. It was Trump. And Australia was then on fire. It seems like a decade ago, but it wasn’t. Everywhere I went people, especially parents, felt very, very scared and doomed. Like, “If nothing changes, our kids end up in gas masks in their 30s and their children are born wearing gas masks.” I was just so struck by where you even start to revive after the catastrophe, the one-two-three punch of the last five years.

I of course wanted to write about my marriage because it’s so wonderful and so hilarious and such a mixed grill, like all of life. It was really that I couldn’t write a book ostensibly on hope because I was touring for one, and talk about beating a dead horse. That’s really all I write about, is hope and despair and second winds. This book, “Dusk, Night, Dawn,” was really about second winds.

Now it is coming out into the world when we are one year into this very strange and deeply sad time. How do you approach this book in particular now? You must be looking at it through a different lens, as I’m assuming you are looking at everything through a different lens. We all are who we are, but we are all also now collectively traumatized in a way that is in some sense unifying.

I’ve just been enraged since February of 2020, when the first cases surfaced and it was clearly not going to be addressed, even recognized, like the U.S. recognizes nations. We weren’t going to recognize it as a reality and there was going to be no real help. There was only going to be propaganda. I’ve been so angry for so long. But I’ll tell you I’m less angry this year. I am a lot less angry.

What’s that great line of Martin Luther King’s? Don’t let them get you to hate them. Even though I did hate them and kept going into that rabbit hole all through 2020, I kept remembering that line, and how it really destroys your center of gravity. It destroys yourself. I do have an inner Donald Trump, this petty, narcissistic blowhard, but to hate him took away my mostly “me” self, which is really decent and loving and caring, and mostly compassionate and mostly tenderhearted.

When I go into the hate, it’s like this cold sheet metal heart that I operate from and then I’m of no good to anyone. Probably every book I’ve written has had a great sorrow in it. My dad, and then my friend Pammy in “Operating Instructions,” I’ve just been a person who’s had a lot of death in her life and also I’m a person who doesn’t run from people when they are experiencing death. My best friend’s child just died. He was 23. She’s who said she had to keep changing the goalposts on “okay.”

All of the books have been about that mixed grill, and that it’s devastating to be here on earth and to have had children and to not be able to save them from really much of anything. That’s really my only driving desire, is to save my child and my grandchild. Sam is 31 now, and left to my own devices, I would run alongside him on his hero’s journey with juice boxes and sunscreen and ChapStick. That would be the most heinous, destructive thing I could do to him. You release, release, release. You release, release, release with your heart in your throat, you know?

How do we do that with any modicum of grace or confidence, with COVID, and with all these things that we’ve gone through as a community? There’s the Salon community, I was there forever. Then a recovery community, a community of progressives. How, in that community, do we keep our heads above water? How do we fish people out when they just couldn’t any more that week? You’re aware of all that no longer works.

In the ’50s and ’60s, people and politicians always talked about the common good. When you’ve lost faith that Americans are choosing that and it doesn’t work anymore to think that it will, you notice what still does work. Marches still work. Neal, who was much more worried about COVID than I am, because I have this nutty religious faith, put on two masks to march with Black Lives Matter, every time.

All the old people were in the back of the long marches past the Civic Center in San Francisco. That still works. Candles still work. A hot bath still works. All through 2020, the generosity and the outpouring of goodness just brought tears to your eyes. That people, when they didn’t know what to do, gave money to the food pantries. You took in either all your canned items or you went to Safeway and bought $50 bucks of canned items, or you just sent money over and over and over again.

I always come back to that amazing thing that Mr. Rogers’s mother told him when he was a little boy and scared because of a tragedy. She said, “You look to the helpers.” That’s what I did all of 2020. Who’s helping, and how can I help the helpers?

You’re reminding me of what you say in the book — how we are collectively good at going through hard things and we are good in extraordinary circumstances. I think the part where we’re not as good is what happens in the aftermath. What happens when the dust from all of this clears and how do we find our way back to each other? Because we’ve all been so isolated for so long.

I think that’s what the entire book is about. I don’t have a short answer, but the subtitle is, “On Revival and Courage.” How does my friend, who just lost her son, make a comeback? How do you come back from that kind of loss? How do you find the courage when it’s just so scary? The world has always been a very scary place. It was scary for the cave mothers.

It’s always been a scary place, and we’re a violent species. Cain is always killing Abel over and over and over again. Cain is killing Abel today. Four thousand people will die again today, or 3,200 or whatever the current number is, because of “Trump’s response” to the pandemic. What do you do in the face of it? Where do you even start?

The literary types like myself, we read a lot more poetry. You read Wendell Berry’s Mad Farmer Liberation Front, the manifesto. Read that today. It’s a complete owner’s manual. My favorite line is, “Be joyful though you have considered all the facts.” Be joyful and faithful in the goodness of humanity even though you look around.

What do you do in the face of that? Well, you send money to Doctors Without Borders. It’s not a direct lineage, but you do something like that. You take the blankets that you bought that were expensive, that you love so much, and you haven’t used in five years and will never use again, unless you move into a mansion next to the Kardashians and have a lot more guest rooms. Barring that, you give them away. That’s what they need at Goodwill and Salvation Army. You wash the blankets and you fold them up and you drive them to Goodwill because it’s very, very cold right now.

This brings up another big theme in your book, forgiveness. That feels like a button that I have to keep resetting constantly lately, Annie. How do we keep trying, when there is so much that feels almost unforgivable?

Well, for one thing, forgiveness doesn’t mean that you want to have lunch with the person, right? It means you stop hitting back. Forgiveness is not my strong suit. I’m one of those Christians who’s not heavily into forgiveness. I’m reform. You don’t get anywhere if you pretend to forgive or if you have a nice bumper sticker response when talking about it. For me, the willingness to do anything to change, to give up an old habit, or to forgive, is an old habit.

Not forgiving is a part of the comfort zone from childhood, because I was raised intellectual, and of course you don’t forgive Barry Goldwater or you don’t forgive the Ku Klux Klan. I have so many thoughts. I’ve written whole books on this, but as C.S. Lewis said, when you decide to become a person of forgiveness, maybe you don’t start with the Gestapo. 

It’s like with pickup sticks. Maybe you start with the neighbor down the street who’s just really awful to you for no good reason. I had a neighbor down the street who left doggy bags with dog poo and my name written out on the doggy bag because he hated me so much. Where do you even start with that? Well, you don’t hit back. You understand, as with Trump, that this is someone who was never loved, whose only safety came from hatred and revenge. For me, the willingness comes from the pain of not forgiving.

When I have made myself mentally ill enough in my revenge, and when I make myself just so toxic with not forgiving, then I may surrender. When I come before God, I come bitterly and with my arms crossed and I say like a teenager, “Okay. Fine. Whatever, whatev, God.” Then I think God wipes her brow and goes, “Oy gevalt.” Then something happens. There’s a tiny shift. You know what it’s like for me, Mary Elizabeth?

It’s like how good we were as little girls at untangling knotted gold bracelets. They get knots that everybody else would give up on, but not me with my OCD and my tiny fingers. You don’t tug. You jiggle. You don’t give up.

Sam, my son, has “We never give up,” tattooed on his left forearm. You don’t give up and you gently jiggle. You jiggle a little bit and there’s a tiny space where before there wasn’t. Forgiveness is so hard for me, but it’s so painful not to forgive. I am the one who is damaged and punished by not forgiving. Where do you start? You start by just telling the truth to someone, like you just did. Like I just did. Like we both do with our closest friends or with our church community or with my recovery community or with my husband or Sam or with Janine who lost her son. I’ll call her and I’ll say, “I hate everyone and I hate all of life except for you and the kitty.” She’ll say, “Well, that’s a start. We better go to Target.” We’ll go to Target, and overeating with a girlfriend helps, always. It’s 90% of the solution.

That is a pretty top-notch coping mechanism.

Right. It is.

I’m going to ask you about sobriety because it’s hard for people to be sober. This is a tough time to keep your head above water. What do you say to the people who are struggling with this right now? It’s so, so challenging for all of us, whatever it is. If it’s depression, if it’s addiction, if it’s alcoholism. These are very challenging, very isolating times. I wonder how you’re finding that community and strength every day.

I’ve been sober almost 35 years. I’ve had eating disorders too. I have 30-some years away from that, but I’ve actually thought about rekindling the eating disorder, just to have any measure of control in this world that is spinning away. One day at a time I haven’t. People are going out. People with 25 years. There’s an old Christian saying from the south that I just love, which is that the voice of the devil is sweet to hear.

The voice of the devil doesn’t say, “You are a piece of s**t and you’re going to drink anyway. Why don’t you just drink? Because anyway, no one particularly noticed that you were any less annoying sober or less of a disappointment sober.” It doesn’t talk to you like that because it couldn’t get you, it couldn’t win you over.

What the voice of addiction, the devil, toxic obsession says is, “Oh sweetie, this is really a nightmare and I want to help you stay off the bottle too. It doesn’t make any sense to me that right now is a good time to stay sober, to stay off those opiates. You know what I’m going to recommend,” it says gently, “is that we revisit this in the spring when more people are vaccinated. For now, no one will judge you, right?”

You go, “Ooh, ooh, that’s right. I’m going to go get half of a carrot cake sheet cake at Safeway.” I actually got about a quarter of one, a couple months ago when I had hit a new bottom of hating everyone in the family and all of life. I just got a very large, maybe a six-by-six piece of carrot cake at Safeway, which does not have a single ingredient found in nature, which is why it’s so great. A half-inch cream cheese frosting. This is what happened. I ate it and I did it with weird radical self-love. I said, “It is whatever it takes except for drugs and alcohol.”

Sober people with 20 years are dabbling in CBD with ever so slightly elevated amounts of the THC. People are dabbling with pain that they suddenly can’t take care of with Advil. All I can remind them is, the willingness comes from the pain. If the scary thoughts that you’re having, if the fear of losing your sobriety is big enough, then maybe just for today, you’ll pick up the 200-pound phone and call me. I am literally here all day. I am on the bed, reading with the kitty. I’m trying to teach the kitty to read during the quarantine. Call me.

That’s what works. Call one of us. If you call another sober person, it’s going to be their favorite thing that happened that day because it’s going to help us stay sober and feel great about our sobriety. You can’t get somebody not to use or drink. I saw the statistics for the very elevated numbers of overdoses and it’s heartbreaking. That is what my destiny was, you know? I will go to my grave not knowing why I’m one of the addicts and alcoholics who got fished out of that and pulled back to my feet and dusted off one day at a time all these years.

Alcoholism is a disease of isolation. It’s a disease of this extremely stark reverberating loneliness, whose solution to that is to isolate. It’s a disease that wants you dead, as all self-destruction does, but will settle for getting you drunk. The way that you don’t get drunk is that you pray. I was thinking of Christopher Robin’s little pop gun in Winnie the Pooh. You get out your little Christopher Robin pop gun and you hold it to yourself and you say, “I am going to call Caroline. I’m just going to call her. I’m going to tell her how close I am. Then if it doesn’t help, I’ll have a cool, refreshing bottle of gin.” You do the one thing. You start with one thing. I will call Caroline. I hate her too. I will call her and then also, you know what it’s like for me? Addiction, the addictive desire to change how I feel, which is awful. It’s like contractions, when you’re in labor. When you’re in the labor, the contraction says it’s never going to end and the craving for a cigarette the third day tells you it’s not going to end unless you smoke.

In contractions, you realize you don’t like children or want children and that you’ll do anything to get out of like eight more hours of this. But it will end. It’ll end in several minutes, a contraction and a craving. You remind yourself of what worked before and that’s a lot of “Dusk, Night, Dawn.” If that’s what worked before, it may, and I’m underlining and italicizing “may,” just work again. You try it. You take the action. “Figure it out” is not a good slogan. You take the action. You get yourself a lovely cup of tea and you call horrible Caroline, and you leave the rest in God’s good hands.

The post Anne Lamott on coping with “existential exhaustion,” from the healing power of Target to forgiveness appeared first on Salon.com.

This is without doubt a good news story, reflecting an impressive 27 per cent drop in the number of people dying from cancer over the past 25 years. However, it is important to recognize that cancer care does not stop after treatment ends.

Although many cancer survivors are able to recover and get back to normal functioning, many others suffer toxic side-effects of treatment. These include fatigue, neurocognitive impairments and psycho-social challenges such as anxiety, depression and changes in relationships.

These side-effects can leave survivors disabled. They can interfere with their ability to work, engage socially and carry out simple daily tasks such as preparing meals, shopping, bathing and dressing. Indeed, research has shown that having a medical history of cancer at least doubles an individual’s likelihood of poor health and disability.

This poses significant and pressing challenges to our health systems. The limited resources for cancer care have traditionally been directed to the treatment of new cancers and reducing mortality.

It is time for cancer care to expand the focus and include improving functioning, well-being and recovery.

Swelling, fatigue, social isolation

A recent national study conducted by the Canadian Partnership Against Cancer polled more than 13,000 people who had completed cancer treatment. It found 80 per cent of patients reported physical challenges, 70 per cent reported psychosocial challenges and 40 per cent reported practical challenges such as returning to work after treatment ended.

Lisa, a busy 56-year-old mother of two college-aged children who worked full-time as an administrator in an office, is one example someone who has experienced these challenges. Lisa was diagnosed with stage II breast cancer after it was detected on a mammogram and confirmed by a biopsy. She had a mastectomy, followed by chemotherapy and radiation therapy. When Lisa finished treatment she was told to come back for a follow-up appointment in three months.

Lisa developed fatigue during her treatment and started to have a heavy feeling and some swelling in her arm. She hoped that this would go away once her treatment ended, but two months later she still felt tired and had no energy and the swelling in her arm had increased. She felt pressure to get back to work and she was increasingly feeling socially isolated because she had no energy to get out and see her friends.

She started feeling anxious and not sleeping well. But Lisa didn’t tell anyone she was suffering. She felt she should be happy she survived. She wondered if this was just normal and to be expected.

Survivors left on their own

For people like Lisa who are affected by persistent side-effects of cancer and treatments, rehabilitation can play an important role. Rehabilitation for cancer survivors is similar to rehabilitation from other conditions (for example after a heart attack or stroke) and there is good evidence demonstrating the benefits of cancer-specific rehabilitation interventions for quality of life and physical functioning.

Based on this growing evidence base, there are now consensus‐based guidance statements on rehabilitation. Despite this, there is little to no funding for outpatient rehabilitation for patients after cancer treatment. Integrated comprehensive cancer rehabilitation programs are still the exception rather than the rule across North America.

As a result, cancer survivors often feel left on their own to manage the long-term consequences of cancer. As cancer rehabilitation researchers Julie Silver and Laura Gilchrist describe it:

“The medical system creates a situation where high-functioning individuals are given life-prolonging treatments and then left to struggle with how to recover from the toxic adverse effects of these therapies.”

In Lisa’s case, at her three month follow-up appointment her oncologist referred her to a lymphedema specialist to help manage the swelling in her arm (on a fee- for-service basis) and recommended that she start exercising to help with the fatigue.

This was good advice given the current evidence, but Lisa had no idea how to start and was so tired and distressed that she felt overwhelmed. She also didn’t know what exercise to do and if it was safe given her lymphedema.

Multidisciplinary teams leading the way

Lisa is not an isolated case. She would have greatly benefited from a multidisciplinary rehabilitation team that could have helped her begin a safe and progressive exercise program, address her mood and sleep issues and make a successful return to work plan.

Some emerging rehabilitation programs are leading the way and offering examples of what could be standard of care for cancer survivors. At the Princess Margaret Cancer Centre in Toronto, patients who have identified impairments are referred to the Cancer Rehabilitation and Survivorship Program which offers a lymphedema service along with one-on-one consults with the rehab team to address issues such as return to work, physical function and neurocognitive changes.

The program also offers an eight-week group rehabilitation program which combines exercise and education and is soon to launch an online program for patients to access from home. The demand for this program has grown by close to 30 per cent each year, yet the funding for this program comes from the Princess Margaret Cancer Foundation rather than health-care funding. Patients from outside of Princess Margaret do not have access to these services and often pay out of pocket for access to rehabilitation specialist who may not have specific cancer training.

Cancer rehabilitation should not be viewed as a frill add-on but rather an essential part of cancer care. The increasing number of cancer survivors, along with the growing evidence documenting the lasting effects of treatments, serves as an urgent call to action — to invest in the recovery and well-being of cancer survivors and help them get back to life after cancer.

# # #

Jennifer Michelle Jones, Director of the Cancer Rehabilitation and Survivorship Program and Butterfield Drew Chair in Cancer Survivorship Research at Princess Margaret Cancer Centre. Associate Professor, Department of Psychiatry., University of Toronto

This article is republished from The Conversation under a Creative Commons license. Read the original article.

The post Cancer survivors urgently need funded rehabilitation care appeared first on Salon.com.

As soon as Whitefish was awarded a controversial $300 million contract by the Puerto Rico Electric Power Authority to restore the island’s power grid that was destroyed by Hurricane Maria, the Trump administration was heavily criticized for using such a tiny company.

After further scrutiny, it was reported that Zinke has strong ties to Whitefish Energy Chief Executive Andy Techmanski. It was also reported that HBC Investments, which finances Whitefish, was founded by Joe Colonnetta, a Trump donor, who also serves as the firm’s general partner.

When all of that was combined with the news that the utility company, because it only has two-full time employees, hired roughly 280 workers as subcontractors — which Whitefish receives a gratuity for — San Juan Mayor Carmen Yulín Cruz raised her concerns.

“You would think I am the only one in the world that has commented on this. What is it about women having an opinion that irritates some?” Cruz tweeted about Whitefish’s response to her concerns, which it said were “misplaced.”

You would think I am the only one in the world that has commented on this. What is it about women having an opinion that irritates some? pic.twitter.com/XxGNLomjQy

— Carmen Yulín Cruz (@CarmenYulinCruz) October 25, 2017

In a tweet that followed, she wrote, “If @WhitefishEngergy feels that asking for transparency is ”misplaced”, what are they afraid we will find.”  

If @WhitefishEnergy feels that asking for transparency is ”misplaced”, what are they afraid we will find. — Carmen Yulín Cruz (@CarmenYulinCruz) October 25, 2017

The utility company then responded and said, “We’ve got 44 linemen rebuilding power lines in your city & 40 more men just arrived. Do you want us to send them back or keep working?”

We’ve got 44 linemen rebuilding power lines in your city & 40 more men just arrived. Do you want us to send them back or keep working?

— Whitefish Energy (@WhitefishEnergy) October 25, 2017

On Thursday, the company apologized to the mayor and to the people of Puerto Rico.

“Mayor Cruz and everyone in Puerto Rico — on behalf of our employees, we would like to apologize for our comments earlier today, which did not represent who we are and how important this work is to help Puerto Rico’s recovery,” the company said in a statement on Twitter.

The statement continued, “We have a strong team on the ground, we are working hard and making good progress. Our goal is to continue to do all we can to help everyone in Puerto Rico in this time of need.”

But the controversy isn’t quite over. The House Oversight Committee, in a bipartisan request, “asked Department of Homeland Security and FEMA to provide all documents or communications ‘relating to any steps taken to prepare Puerto Rico and the U.S. Virgin Islands for Hurricanes Irma and Maria, as well as logistical challenges, distribution of commodities, or power restoration following the storm,'” as Salon previously reported.

The rates of Whitefish’s subcontractors have also been called into question. It costs $462 per hour for a supervisor and $319 for a linemen.  

.@WhitefishEnergy relies on subcontractors. Their rates are also raising questions: $462 per hour for a supervisor, $319 for a lineman pic.twitter.com/zH1360PAV8

— CBS Evening News (@CBSEveningNews) October 25, 2017

The post The company rebuilding Puerto Rico is in hot water over one tweet appeared first on Salon.com.

These dramatic photos show Hurricane Irma’s devastating impact on Florida https://t.co/fV4A9zmqgr pic.twitter.com/NeMBSRsA6n

— BuzzFeed News (@BuzzFeedNews) September 10, 2017

Though the struggle with Irma’s aftermath continues on mainland Florida, the Florida Keys had it even worse, having been completely decimated by the storm. Roughly 90 percent of homes in the Keys were damaged, ABC reported, while 25 percent were totally destroyed.

Mike Theiss, a photographer and storm chaser for National Geographic, posted the below footage of Irma’s floods and devastation in the Keys to Twitter.

Sections of US-1 (Overseas Hwy) washed away from storm surge in the lower #FloridaKeys from #HurricaneIrma pic.twitter.com/uEccflWzon

— Mike Theiss (@MikeTheiss) September 11, 2017

 

Many uprooted large trees in #KeyWest This tree completed crushed this house. #Irma pic.twitter.com/rOVvYXpljl

— Mike Theiss (@MikeTheiss) September 11, 2017

 

Surge coming in #KeyWest as #HurricaneIrma made landfall. pic.twitter.com/4ToLvAhxOU

— Mike Theiss (@MikeTheiss) September 11, 2017

Experts told NBC News that full recovery in the Keys could take years, and even short-term recovery measures, like regaining power, are not expected to happen for at least another week.

“It could be about as long as a month before we have full electricity in the Lower Keys,” Monroe County Commissioner Heather Carruthers told MSNBC. She added that although residents were permitted to return to survey the hurricane’s damage: “We don’t really encourage people to come back and stay.”

Six people died at a Hollywood, Florida, nursing home, CBS reported, after the facility lost power and air conditioning. The patients at the Rehabilitation Center at Hollywood Hills were among the 4 million Floridians without electricity. The facility evacuated 115 patients, and was evacuating another 18 from a neighboring mental health facility.

“Most of the patients have been treated for respiratory distress, dehydration, & heat- related issues.” Dr. gives update on nursing home. pic.twitter.com/oLIzgVrbe2

— CBS Evening News (@CBSEveningNews) September 13, 2017

The post After Hurricane Irma: It could be months to get back to normal, Florida officials say appeared first on Salon.com.

Some people bring out the best in you, while others can bring out the worst. And then there are those rare human forces like Kristin O’Leary, who quietly demand the most from you. As vice president of the only North Carolina state licensed recovery facility for women diagnosed with substance use disorder, O’Leary has made Hawley House a sanctuary in more ways than one, for the women who enter and leave the center. Leading the women in daily worship and bold reverence of their sacred lives, O’Leary’s own journey through addiction and substance abuse serves as the daily offering of comfort and hope.

O’Leary was just six-years-old when her maternal uncle began to repeatedly molest her. “He got me in trouble with my grandfather, told him I had done something that I didn’t do, something he did. My grandfather believed him, and then spanked me with a plastic shoe horn,” O’Leary recounts. “It scared me for life.”

It was only a decade later that O’Leary found herself playing for a Triple A softball team when the coach’s brother-in-law, a Colombian drug dealer, kidnapped and raped her. Eventually, she found an opportunity to escape. After developing a severe case of PTSD and law enforcement suggesting she be placed into the witness protection program, O’Leary found security in enlisting in the United States Army.

“There’s not a woman that walks through the doors of Hawley House that has not experienced something that I can’t give them experience, strength and hope on,” she says.

Hawley House, a modest yellow fixture with white shutters and a front porch made for housing soul-touching conversations, is unique in its approach to recovery. “We leave nothing to question,” O’Leary explains. “We have a 14-day jump-start plan when our clients first arrive. We accomplish several tasks in those first 14 days, and then we start working on the treatment/rehabilitation plan that it is uniquely written for each individual client.” The six-occupant home is facilitated through the Winston-Salem’s YWCA chapter and goes beyond the traditional treatment and medical care. “We have collaborated with numerous agencies so that all the services that our clients receive are brought to them at our facility so that they aren’t exposed to less than desirable areas that they would have to go to otherwise,” O’Leary says. “If we do not have funding for a certain, task then our staff transports the clients to where they must go, to receive services and are there to help in any way.” 

Drug abuse can be an alluring escape from reality, and for the women who enter the doors of Hawley House, their hope is to leave having created a better and new one. With an 80 to 85 percent success rate in recovery this last year and having been instrumental in the reunification of 16 families, Hawley House, much like the women who enter, is a unyielding reminder that the work put in on the inside is what matters most. 

“My hope for every single woman that enters the Hawley House is that they accept the love that they are given from the moment they enter, that they receive it and learn to hold on to it until they learn to love themselves,” says O’Leary. Addiction is not a one-woman fight, and Hawley House is here to remind us all that it takes an army. 

The post A sanctuary for women in recovery: “There’s not a woman that walks through the doors that hasn’t experienced something” appeared first on Salon.com.

The door suddenly creaked open. Clipboard in hand, her physician entered with a smile. “Hi Alexa,” she said. “Let’s get you weighed and measured.”

Read more Narratively: “Polyamorous People #4: “When I Show Up at These All-White Events and I Feel Uncomfortable, I’m Not Quiet.””

Giardino leapt down from the table and padded over to the scale. Her weight was the current focal point of her entire existence. She knew she was exactly 129 pounds. She knew she was thirty pounds lighter than at her last appointment the previous year. But most importantly, she knew that she owed her weight loss to countless post-meal purges.

She held her breath and sucked in her stomach, waiting to see if her physician’s face would fall into a frown. She anxiously envisioned a scenario in which her doctor would be forced to confront her about the possibility of having an eating disorder. Instead, after what seemed like a solid minute of fidgeting with the scale, a pearly-white smile spread across her doctor’s face.

Read more Narratively: “I Went to the Hospital to Give Birth…And Tested Positive for Meth”

“Wow, you lost a lot of weight! Congrats! Now let’s check your blood pressure.”

For the rest of the appointment, Giardino found herself in a hazy stupor. She went through the motions, inhaling and exhaling when her doctor placed the cold stethoscope to her chest. She bent over and touched her toes as her doctor ran her hands over her spine, checking for scoliosis.

“Looks like you’re all ready to head off to college,” her doctor said. “You can put your clothes back on now.”

As she pulled on her pants, the button on her size-six jeans seemed menacing. All Giardino could think about was that she still wasn’t thin enough. If a medical professional couldn’t tell that she had an eating disorder, then surely she must have not been trying hard enough to shed pounds.

Read more Narratively: “The Day My Therapist Dared Me to Have Sex With Her”

“This was so disheartening for me, because this same doctor has known me since I was eight years old, has seen me cry every time I had to get on a scale because I was always an overweight kid and ashamed of it, but now eighteen years later all of a sudden I’m an average weight?” Giardino said in an interview four years later.

“We praise these people who are losing weight so fast and intensely, that if they were a smaller size we would be trying to get them treatment, not praising them. Where is that line, and why does it exist?” Giardino asked.

Now a 22-year-old graduate student of social work at SUNY Albany, Giardino is one of an estimated thirty million Americans who have struggled with an eating disorder. But there is something unique about her struggle that made the path to recovery more complicated than usual.

A lot of people don’t think a chubby girl can have an eating disorder. The pervasive stereotype in our culture of someone suffering from an eating disorder is that of a tiny, emaciated girl who thinks she is fat but is really withering away. But it’s so much more complicated. As Giardino’s case shows, it’s possible for a person to suffer from disordered eating and to have an unhealthy obsession with their weight, while still technically being what’s considered a “normal” weight.

“My first therapist straight-up told me, ‘I don’t think you have an eating disorder, you just have anxiety,’” Giardino said. “I had tried telling her about how I was making myself purge, but she completely brushed it off, and it was such an invalidating experience.”

Giardino’s case is one specific example of the problematic ways in which mental health professionals traditionally identified eating disorders.

Before the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was published in 2013, sixty percent of eating disorder patients were diagnosed with “Eating Disorder Not Otherwise Specified” (EDNOS), a label for those who had only some anorexic or bulimic traits. For example, someone who had symptoms of anorexia but continued to menstruate would be diagnosed with EDNOS.

The fact that EDNOS accounted for the majority of eating disorders in the United States suggested that existing diagnostic criteria were inadequate. So, the DSM-5 revised the rigidity of eating disorder categories, and replaced EDNOS with Otherwise Specified Feeding and Eating Disorders (OSFED).

OSFED is very similar to EDNOS in the sense that both are just “other” categories where patients who do not meet all of the criteria for a bulimia or anorexia diagnoses fall. The biggest difference is that OSFED is a much smaller category because of the newly-expanded definitions of anorexia and bulimia. Those who were previously labeled as EDNOS could now justifiably migrate into being diagnosed as straight-up bulimic or anorexic.

Currently, about thirty percent of Americans with eating disorders fall under the OSFED label. While this is half the percentage of EDNOS diagnoses, eating disorder advocates believe there is much more work to be done.

Jenni Schaefer, National Recovery Advocate of Eating Recovery Center’s Family Institute, wants to put forth a method of treatment that cares for patients as the unique individuals they are, rather than treating them according to still-rigid diagnostic categories.

“I wish we didn’t have to diagnose people altogether,” Schaefer said. “A diagnosis cannot measure someone’s pain and suffering.”

Schaefer knows this first-hand. She recounted her own experience recovering from an eating disorder in the bestselling self-help book she co-authored with psychologist Jennifer J. Thomas, “Almost Anorexic: Is My (or My Loved One’s) Relationship with Food a Problem?”

The book asserts that while one in two hundred adults will be diagnosed with anorexia nervosa in their lifetimes, a whopping one in twenty adults will experience key symptoms for a clinical eating disorder but will not receive any treatment for it. This phenomenon, which Schaefer and Thomas coin “almost anorexia,” is just as legitimate as a full-blown eating disorder in their eyes.

When Schaefer was first diagnosed with an eating disorder after graduating from college, she fell under what was then the EDNOS category. As her eating disorder progressed, she eventually lost enough weight to be diagnosed with anorexia nervosa. She entered inpatient treatment, and as she started to approach a “normal” weight was shuffled back into the EDNOS category for the rest of her treatment, even though she was far from cured. She realized that while her anorexia diagnosis was seen as more severe, she was still struggling while categorized as EDNOS.

Schaefer insists that eating disorders exist on a spectrum that is impossible to capture with current diagnostic techniques. She adds that those who are diagnosed with an acronym, whether EDNOS or OSFED, typically feel invalidated. That’s why in her discussion groups, specific labels are rarely used in order to describe someone. Instead, all participants just use the label of “eating disorder” to establish a common ground.

This concept of individualized care is something that Giardino didn’t see as an option.

“Going to inpatient treatment was something that I never wanted to do because I didn’t fit into the body standard of someone with an eating disorder,” Giardino said. “I thought that being around girls that were thinner than me was just going to exacerbate how I felt and things I was going through. The reality is that even when I was at my thinnest, 129 pounds, I still don’t think I would have qualified for inpatient treatment.”

This is because Body Mass Index (BMI) is frequently used by physicians in order to assess whether someone has an eating disorder, particularly when diagnosing anorexia nervosa. In order to be clinically anorexic, a patient must have a body weight less than 85 percent of what is expected in the individual’s age, gender and height class.

With the DSM-5, this 85 percent mark is not set in stone. These new guidelines leave body weight up to the interpretation of the health care professional, so a patient does not need to lose a certain amount of weight in order to be considered eligible for diagnosis. But stereotypes tend to die hard.

* * *

As the hazy summer before entering college drew to an end, Giardino still had not been diagnosed with an eating disorder. She didn’t feel deserving of help. She wasn’t one of those wasting-away girls, even though she felt weak and was consumed by thoughts of dieting and food.

Lauren Smolar has encountered many individuals with OSFED since becoming the Director of Helpline Services at the National Eating Disorders Association, and said that the issue of whether one has a “legitimate” eating disorder is pervasive and can hinder people from seeking treatment.

“If the reason they have received [an OSFED] diagnosis is because they do not meet BMI criteria, it can be misleading, confusing and feel like they don’t have a serious enough issue,” Smolar said. “This can be very tough to deal with when just beginning recovery.” Some patients, Smloar added, “fear that they will be rejected when seeking out help.”

As Giardino entered college, the severity of her eating disorder intensified. She subjected herself to hour-long workout sessions at least six days a week and purged everything she ate. She memorized the times of day when the dorm bathrooms were emptiest to ensure that no one would hear her retching. She trained herself to feign the act of eating when she would not be able to purge afterwards, masterfully fidgeting with the food on her plate to make it look as if it was reducing in size.

Her peers noticed her weight loss, and they were ecstatic about it, even envious. As she recounts those days, Giardino pulls up a picture from her Instagram that shows her at her thinnest, with a long chain of positive comments from friends and family about her appearance.

“Look at these comments,” Giardino said as she scrolls nearly three years back on her Instagram account. She smiles as she reads some of them out loud. Most are friends raving about how thin she looked, with emojis scattered for emphasis. At the time, the social currency the weight loss gave her raised the question: Why would she stop?

Suddenly, a somberness settles over her. She locks her phone and set it face-down on her lap.

“I still wasn’t thin enough for people to realize I was struggling,” Giardino said. “And you know what? I look at that picture, and I know I was just too thin. BMI is bullshit.”

The stress of college life was also intensifying Giardino’s anxiety and depression. Her mother persuaded her to find another therapist. Giardino passively agreed.

She expected it to be just like any other therapy session. She thought she would sit down and talk about how she throws up after every meal. She thought her new therapist would respond to that statement with doubt, projecting his own preconceptions of what a girl with bulimia looks like onto Giardino. But she was pleasantly surprised.

“It was really validating when I got to my new therapist, to have this big, two-hundred-pound man sitting down with me and saying ‘I’m going to diagnose you with bulimia,’” Giardino said. “That was the first time I felt validated. I thought I would never fit that criteria.”

Sitting across from her new therapist, Giardino was completely taken aback. She became slightly defensive, and immediately countered: “How? I’m not underweight.”

He explained that from what he could tell, food-related thoughts were taking up about ninety percent of her day. It was an obvious warning sign that could not be overlooked, even if her weight was within what was considered a normal range.

Giardino was restless, finally feeling affirmation for an illness that had been seemingly invisible to everyone around her. She was determined to be productive in her recovery, and she reached out to others she found out were also being treated for eating disorders. Her brother’s ex-girlfriend was one of those she contacted, and as their friendship developed, she encouraged Giardino to look into the organization Project HEAL.

Project HEAL is a non-profit that raises money for those who cannot afford adequate insurance coverage for eating disorder treatment. The average cost for eating disorder treatment is approximately $30,000, which covers about a month of inpatient treatment. Although eating disorders affect a large portion of the American population, insurance often doesn’t cover treatment because of narrow, weight-related diagnostic criteria.

During the time Giardino was seeing her new therapist, her father got laid off. Eventually, she got a phone call from him about their financial constraints. She felt a pang of anxiety when her father warned, “Unless insurance starts helping us out, you can’t see your therapist anymore.”

But this fear was short-lived, and she has a hunch that her mother is to thank for her continued psychiatric support. “It was a very panicky feeling, but I have a feeling my mom had a screaming match with someone, because all of a sudden I was getting covered,” Giardino said with a chuckle.

After learning about Project HEAL, Giardino was inspired. She decided to apply to start a chapter during her senior year of undergrad at SUNY New Paltz. The only hitch was that the organization states that one must be fully recovered in order to be a community leader and conduct meetings. This was an issue, as Giardino still occasionally found herself kneeling in front of the toilet if she felt particularly guilty about something she had eaten. But as her application was pending, she used the potential to be a positive force among those who also struggle with eating disorders as her main drive for recovery.

She would ask herself every time she thought about purging, “How am I supposed to stand in front of people and be there for them if I’m not there for myself?”

The summer before entering her senior year of college was slipping away, and every day that passed without news about her application, dampened her spirits. But one day, the phone rang and brought her to tears. She was approved to start the SUNY New Paltz chapter of Project HEAL.

The group, while small, was diverse. It was composed of about ten people who experienced all different types of eating disorders. Giardino would look around during group meetings and no longer feel alone in her struggle.

“There were so many varying weights in Project HEAL,” Giardino said. “We all still look very different. We all have been heavy, or thin, or maybe not. Some of us have stayed the same weight our entire lives. There is no one narrative for an eating disorder.”

Community is not something to be taken for granted when so many who live with eating disorders feel like their struggle is completely their own. According to the National Eating Disorder Association, the mortality rates for eating disorders are higher than that of any other mental illness: four percent for anorexia, 3.9 percent for bulimia, and 5.2 percent for OSFED.

Giardino recently completed her first year of recovery. How will she celebrate? With food, of course.

“I’m going to sit down with all of my friends and plates of what I would have considered ‘bad food,’ and I’m just going to let myself eat,” Giardino said. “And maybe have a few glasses of wine,” she added with a laugh.

The post Stereotypes die hard: What happens when you’re bulimic, but not thin enough for anyone to notice? appeared first on Salon.com.

Kalanithi, who earlier this week appeared at the San Francisco Zen Center in a conversation on “Sickness, Old Age, and Death,” spoke to Salon via phone recently on love and loss.

I think we’re in a very small club of people who know what it’s like to write a book while you’re running out of time. I had Stage 4 cancer and got in a clinical trial and was pronounced disease free in three months. But then I got my book deal almost simultaneously with one of my best friends finding out that there was nothing more the doctors could do for her. I know that feeling of wanting to get it all down and get it right and honor the memory and tell someone’s story.

So I was speaking at an event this weekend and the first question someone asked was “What good experiences and happy memories do you have from that time of your life?” I thought it was an awesome thing to ask because it starts from a place of understanding that there are happy memories.

It’s everything at once. And suffering is not a special experience. It’s very very personal and very very universal, and that has been comforting to me.

When you can be present for it, there are so many beautiful payoffs. It’s not a place you ever want to go, but if you can go, go into it with your eyes open.

It makes you better able to tolerate the actual suffering part, too.

So what has happened for you over this past year of talking about gratitude and acceptance and pain?

There’s the personal version and connecting to people over those experiences and conversations. That’s a really unexpected piece of it. I never thought I would be part of sharing something really personal. Especially as a physician, we’re supposed to be perfect and present this sort of unblemished self, within the profession and publicly.

That’s changing a little bit. Physicians are starting to talk in a real way about our own experiences. There’s not as much this idea of detached concern or paternalism. I think the culture of medicine and health care is changing in really good ways. I almost feel part of that as part of what I’m doing. The same taboos that are outside the hospital are inside the hospital, too. Doctors are just as uncomfortable as anybody with death, if not more. Surprising but true.

And we as patients have been very well trained in avoiding our own pain and suffering. We go the doctors hoping they’ll say good things. Doctors don’t want to give us bad news, and we don’t want to hear it.

I’m giving a talk on TEDMed next month and that’s part of it. I think that’s so important. I get a lot of calls and emails from people with lung cancer. They call me when they first get diagnosed asking, “Who is the best doctor and what should I be doing and thinking about?” I’ve found they also call me when they know they’re dying. They’re like, “How do I navigate this?” There’s no obvious blueprint. It’s not part of our lexicon.

It makes you realize how much it’s needed. What has changed for you in your perspective since you crossed over to this side of the experience?

Some of it has changed and some of it is exactly the same. Being physicians prepared us really well for Paul’s illness because we didn’t feel angry. He had just seen it so many times, especially when you’re a neurosurgeon. The reason you have a job is because people have brain tumors and hemorrhagic strokes and giant car accidents. He was seeing young people dying all the time.

For me, I’m a general internist, so I was practicing primary care for a lot of that time and then doing a fellowship at Stanford thinking about health care value. So I had multiple patients who were terminally ill, whether it was neurologic disability or cancer or whatever. I had had a lot of those conversations.

I worked on a project about stroke, but thought a lot about health care costs. How we think end of life is one of the places in health care in which there’s a need to lower costs. But I think there’s also a moral case for doing it. Because if it’s built to match people’s care to their values, theres a really wonderful overlap between the way in which increased communication in health care improves value at every point.

Not to be prescriptive, but I think a lot of times people don’t know their options or know how to think about quality over quantity.

I was comfortable witnessing suffering and trying to help people understand tradeoffs and help them understand sometimes you only have bad choices. How do you retain who you are during that period of hard choices? But it was of course reasonably abstract.

Sometimes Paul and I would swap stories or help each other try to manage our own emotions around it, but it was an unbelievably different experience to actually have to tolerate facing your own mortality and facing that grief and loss, that ever-present sadness. And then also the uncertainty is so painful, too.

Even if you know you’re dying, there’s the fact of not knowing. All the uncertainty is so hard to tolerate. It’s a great time to be a cancer patient; the range of possibilities is so wide; and meanwhile, you’re trying to figure out, Should we work? Should we have a baby?

It’s like saying someone is going to stab you in the heart. How much can you really brace for that? The foreknowledge does not mitigate the pain when it happens. And then afterward, you have a new identity.

My own ability to tolerate discomfort was so deepened. You just have to, right? There’s not anything you can do. Paul had to. I have this really great therapist who I had before Paul’s illness. Thank God some of these earlier, much less difficult experiences prepared me somewhat for this time.

I remember during an earlier time, she wrote on her white board, this really Buddhist idea that “Pain plus nonacceptance of pain equals suffering.” At the time I was like, I don’t even understand, but I don’t want to feel this! I don’t accept it! Now it’s like, oh yeah, of course I understand exactly what that means. I think softening to it made all the difference.

I feel sorry for the people in my life who couldn’t do it — who backed away or were so insistent that “Everything’s going to be OK!” It’s so much harder to get to another place in the experience when you’re denying what the experience is. I wonder what we can do to gently tell people that there’s a better way to do it?

I think about this all the time. I also think about the ways in which that refusal has major implications on your health care. If it winds up being the “battle” metaphor and “fight, fight, fight,” it can lead to increased physical suffering or even post-traumatic stress for family members and the patient. It can be quite extreme.

It’s hard to help somebody navigate those decisions. I think a lot about how the ability to tolerate misfortune or push back against misfortune can really affect the practical decisions that you make in your life and either increase or soothe the suffering underneath it, particularly the amount of care. I don’t know the answer. I watched Paul model it through writing, and just having the conversation. You’re doing that, and I’m doing that.

It’s easy to talk about it in the abstract. But I think actual people’s stories are more powerful. To have somebody modeling it, so they’re watching you and saying, “Why is she not more angry? Or why is she angry and accepting at the same time? Where does that acceptance come from?” I think sharing it seems to be really important.

I’m trying to normalize pain and grief and trauma in all its forms. My daughter went into septic shock and spent five days in the ICU earlier this year, and I was grateful that we had practice in our family in dealing with traumatic events. I don’t have to rush to get my child back to feeling normal about life. I don’t have to push her to feel something she doesn’t feel yet.

The secret of being a grown-up is people die and marriage is hard and suffering is coming. It’s helpful. I think if you approach it extremely authentically and fully, you get to be your full self.

Despite all of this, it was so disorientingly difficult, especially after Paul died. That was by far the worst part, which maybe seems obvious. I had this unbelievable tingling in my hands. My hands were on fire for months. Of course, I thought I had some terrible neurologic disease and I wouldn’t be able to take care of [our daughter] Cady. You know, catastrophic thinking.

Then about a year after Paul died, it just cleared up, just stopped. That tingling didn’t fit a particular nerve distribution. So objectively speaking from a medical perspective, everything was normal. It didn’t add up. There were all these things it wasn’t.

But at the same time, I couldn’t believe it could just be grief. It was so surprising; it couldn’t be just grief. Just grief, so to speak. In retrospect, I really, truly think it was. It’s gone now. It’s so interesting because at the same time I was thinking, I’m coping really well; I’m not doing anything destructive; my daughter is thriving; I feel like I’m able to tolerate this despite how painful it is. And meanwhile, my hands are falling off. It was still so, so unbelievable.

These things do a number on your body, a number on your brain.

I remember thinking, I cannot believe this is something that all humans go through. I cannot believe it.

It reminds me of how I felt when I had my first child, like I couldn’t believe every person on Earth got here because a woman had gone through what I just had done. It blew my mind.

You go through grief or suffering, and then in a weird way you do feel that deep, profound connection to the human story. I feel like I’m really part of the family.

And now, raising a child. You think, Oh, I want my child to be happy and sheltered from pain. No, I actually think you want your child to be resilient and feel that she has meaning in her life. But that’s different from being happy. Or that’s, I think, what happiness really is.

The post Lucy Kalanithi: “Suffering is not a special experience, and that’s comforting” appeared first on Salon.com.

The London-based facility will consist of 12 apartments, four of which contain double bunks and can comfortably house 16 women each. Dominic Ruffy, the foundation’s special project director, told The Guardian’s Nadia Khomami that there’s “a paucity of women-specific recovery housing beds” in the city, and that the only other “women-only recovery house in London [is] only a four-bed with a six-month waiting list.”

Ruffy added that, in his experience, “if you give people an extended period of time post-traditional rehabilitation treatment, you will improve the percentage of people who stay clean [in the] long term. We have a saying in recovery that the drink and drugs aren’t our problem, it’s living life clean and sober.”

This difficulty arises, in part, from the fact that many of the women who enter the program have also undergone physical, as well as psychological, abuse. Amy’s House wants “to ensure they were either safe and away from ex-partners, or safe from their issues around co-dependency, around men.”

“It was evident,” he noted, that “there was a clear need and the women would feel more secure in an environment [where] they knew they weren’t going to be troubled by aspects from their past.

The post “Amy’s Place”: Amy Winehouse Foundation to open London-based drug and alcohol rehab center for women appeared first on Salon.com.

The weeks leading up to my brother’s wedding were hectic—frenzied even. I was 21, and had just returned from a year studying abroad. After months of not seeing my family, I’d come home with a partner in hand, whom no one had met or known much about. To introduce a serious boyfriend to your very conservative, Colombian mother is no easy feat, and everyone’s anxiety before the “big day” made for a general mood of distress and foreboding.

In those first weeks back in New Jersey, my mind was lost in relationship worries and perpetual mother/daughter/boyfriend quarrels—things that seem preventable in retrospect. Maybe if everything had gone more smoothly with my partner and my mother, I would have made more of an effort to see my sister. Amidst my blended family of step-this and half-that, divorce, marriage and drama, my kind, beautiful sister, Christin (on my father’s side), had always remained a constant.

On the day of my brother’s wedding—June 23, 2012—I received a phone call that Christin had committed suicide the previous night.

I often wonder whether, had I made more of an effort to see her in the weeks leading up to the wedding, I would still have received that call.

It was in 2010—my sophomore year at college—that Christin and I became truly close. After serving in the Coast Guard for over five years, she had finally stepped away, 26 years old and ready to pursue fashion design in New York City. She’d visit for sleepovers at my dorm, where we’d cram our tall selves—me 5’10” and her 6’1”—into my student twin bed. We caught up on the years spent apart after my mother and our father divorced. We shopped. We watched bad Robert Pattinson movies. We ate PinkBerry and drank Cosmos. We’d joke and sometimes cry about being lost souls—yearning for new worlds and new ways of life, but in each other’s presence we were at ease.

It was Christin who gave me my first joint. She said it was better for me to smoke for the first time with someone I knew and trusted, in case I got paranoid. But it was me who gave Christin her first Oxy. She’d suffered a back injury in the Coast Guard, but never bothered to take anything other than Tylenol for it. I had some left over from getting my wisdom teeth removed, and had occasionally taken them when my angst was getting the better of me and I needed to mellow out.

The relief she soon felt would ensure a lasting relationship with oxycodone, and later on a few of its friends: Valium, Vicodin and Xanax.

For most of my life, I’d shied away from drugs. Our elder sister had spent over 10 years addicted to the hardcore stuff, everything from meth to heroin. Christin and I saw what it did to her, and vowed at young ages never to get into anything so cruel to the body and mind.

But pills never seemed like “drugs”–especially not back then. My school gave me pills for anxiety and depression. Christin got them from the military in bulk. They were readily accessible in mom and dad’s medicine cabinets. They were legal.

“The line between recreational use and medical use has, for many kids, become a hoax, an anachronism, a lie,” writes David Amsden in his New York Magazine essay “Pop. Snort. Parachute,” in which he interviews dozens of New York City teenagers using uppers, downers and everything in between. The insidious nature of prescription drug addiction and its widespread impact has been well-documented in recent years.

This year, the National Institute of Drug Abuse revealed that the US is responsible for 75% of the world’s prescription drug misuse, causing over 100 deaths daily. And around 52 million people over the age of 12 have used prescription pills recreationally.

I don’t hate drugs, even after everything. I know certain drugs—legal and otherwise—are fine when taken responsibly, or as prescribed. I do hate the misinformation, ignorance and stigma that surround drugs. In my sister’s case, she had a prescription, so she—and I—thought it would be ok. But it wasn’t, because the legality of a substance isn’t always representative of the magnitude of the high, let alone the detrimental side effects it can cause.

When Christin and I would get together, we’d share each other’s pills. We didn’t discuss this, or the highs that would follow—the softness of Oxy, the vacantness of Valium. But whenever one of us seemed distressed, sad, or anxious, the other was there with a bottle at hand—under the pretense of necessity rather than pleasure or desire.

I’m lucky. I never got addicted. I only ever popped pills when Christin and I were together. Pharmaceuticals were never my “thing.” I preferred a Captain Morgan and Coca Cola, or a nice spliff, to anything that came in an orange tube with a doctor’s note.

But Christin couldn’t stop. “Hooked” seems like an understatement. She would tell me that she loved the oblivion. She loved being able to forget about the shitty life she’d led. Everything from her mother’s death, to our elder sister’s physical and psychological abuse of her, to the death of her secret love after his motorcycle accident, to her issues with my mom, to her struggles with body image and eating disorders—they all faded into the background, even her strained relationship with our dad that she always hoped to remedy. On pills, she was free. And freedom was worth any physical or psychological side effect.

I left for study abroad knowing it was the right choice for me—I had some of my own demons to face. When I was home for a week at Christmas in 2011, Christin asked me to stay. By this point, I knew something wasn’t right. She’d lost 30 pounds and barely ate. She was dating a man who was rumored to be a misogynist and coke addict. Maybe I should have stayed, for her. But I had found love, and Europe, and a sense of self-worth. I wasn’t prepared to give that up.

So when I returned for my brother’s wedding, six months later, I made plans to see her right away. But things went badly between my mother and partner, and preparing for the wedding consumed my time and energy. On more than one occasion, I didn’t answer Christin’s calls and ignored her text messages. We made a plan to get together but it fell through, and the wedding rehearsal took its place. Being there for my partner, my mother, and my brother took precedent over seeing my sister. There had been a grim monotone to her voice the few times we’d spoken, but I put it to the back of my mind.

I was getting my hair done, on the morning of the wedding, when my dad called to give me the news.

The world seemed to stop.

But the wedding had to go on; that was the decision my mother and father made. My brother—unrelated to Christin by blood—wasn’t told until after his honeymoon. My father told me to be there, otherwise it would be obvious to guests that something had happened.

The night of my brother’s wedding, with every ounce of strength in me, I was plastering on fake smiles and being forced to dance the YMCA; the next morning, I was staring at my sister’s casket, not believing it was really her—this frail, pale, sickly-looking girl. Not Christin. An empty shell.

I don’t doubt that the cocktail of pills Christin was taking from 2010 to 2012 were predominantly responsible for her unraveling state of mind, the drastic highs and lows, the heart attack she suffered that spring while I was away, tailed by a series of random respiratory halts in the months to come, her rising depression and suicidal thoughts. On June 22, 2012, she swallowed over 60 pills and finished them off with some aerosol inhalation.

I don’t know whether Christin would still be alive had I not given her that first Oxy (though I tell myself she probably would’ve started eventually, as soon as her back pain got to be too much). I wonder whether she would be alive if her doctors had not overprescribed her. Or if I had met up with her in those days before the wedding.

When someone you love commits suicide, people around you are quick to say, “It wasn’t your fault.” But I don’t know. In many ways, it was my fault—just as it was my father’s fault and my elder sister’s fault and everyone who should have been there when she needed us.

Maybe we all could have saved her, had we cared and loved and given as much as she cared and loved and gave to us all.

The post I still blame myself for my sister’s addiction and suicide appeared first on Salon.com.

1. $1,000,000,000,000,000 in Sales. Not One Cent for Sales Tax

The trading volume on the Chicago Mercantile Exchange (CME) reached an incomprehensible $1 quadrillion in notional value in 2012. That’s a thousand trillion dollars. In comparison, the entire U.S. GDP is $17 trillion.

On that quadrillion dollars of sales CME imposes transfer fees, contract fees, brokerage fees, Globex fees, clearing fees, and contract surcharges, many of them on both the buyer’s and seller’s side. As a result, the company had a profit margin higher than any of the top 100 companies in the nation from 2008 to 2010, and it’s gotten even higher since then.

But not a penny in sales tax for the taxpayers who provide publicly-funded infrastructure, technology, systems of law, and security to help them process billions of financial transactions.

Instead — incredibly — CME complained that its taxes were too high, and they demanded and received an $85 million tax break from the State of Illinois.

2. A Single Tax-Avoider Made More Money in 2013 Than ALL the Emergency Responders in the U.S.

Warren Buffett watched his net worth grow by $12 billion in one year, much more than the $8.3 billion our country spends on almost a quarter-million Emergency Medical Technicians and Paramedics.

Meanwhile, his company, Berkshire Hathaway, hasn’t been paying its taxes. According to the New York Post, “the company openly admits that it owes back taxes since as long ago as 2002.” A review of Berkshire Hathaway’s annual report confirms that despite profits of almost $29 billion in 2013, a $395 million refund was claimed, while $57 billion in federal taxes remain deferred on the company’s balance sheet.

Berkshire Hathaway does report an income tax expense. But all of it, in the company’s own words, is hypothetical.

3. Walmart: $13,000 per U.S. Employee Taken in Profits, $4,000 per U.S. Employee Taken from Taxpayers

It gets worse. In addition to Walmart’s $19 billion in U.S. profits last year, the four Walton siblings together made about $29 billion from their personal investments. That’s over $33,000 per U.S. employee in profits and family stock gains. Yet they pay their 1.4 million American employees so little that the average Walmart worker depends on about $4,000 per year in taxpayer assistance, for food stamps and other safety net programs.

How does Walmart spend its profits? Instead of providing a living wage for its workers, company management spent $7.6 billion, or about $5,000 per U.S. employee, on stock buybacks, in order to further boost the value of their stock holdings.

4. U.S. Wealth Grew by $25 Trillion in the Recovery, but 90 Percent of Us Got NONE of It

U.S. wealth grew from $47 trillion to $72 trillion in the four years after the recession, largely as a reflection of continued American productivity. In other words, a full one-third of the total wealth in the U.S. in 2013 was generated since 2009. But the richest 10% took all of it.

That’s $6 trillion per year in new wealth for the rich. In contrast, the total annual cost of ‘entitlements’ and the safety net is less than $2 trillion.

One consequence of this redistribution of wealth is that more money has been transferred from minorities to prosperous white Americans. The richest 1% took 95 percent of the gain. Less than two out of every hundred individuals in the richest 1% are black.

5. Extreme Fees: Nickeled and Dimed until the Retirement Fund is Almost Gone

The one- to two-percent fees don’t seem like much, but savvy financial minds know better. It has been estimated that the average underserved household spends $2,412 each year just on interest and fees for alternative financial services. Food stamp recipients have to pay companies like JP Morgan to process their benefits. The unemployed are getting their benefits through banks who issue fee-laden debit cards instead of cash. And it’s not just low-income households paying the fees. A two-earner household with median incomes will pay an average of over $150,000 in 401(k) fees over their lifetimes.

The fees are not only draining us individually, but also at the levels of local and state government. Los Angeles last year spent more on Wall Street fees than it did on its streets. In Detroit, financial expenses might approach a half billion dollars, in a city where homeowners can barely afford the water services. Chicago may end up paying Morgan Stanley $9.58 billion for a $1.15 billion parking meter deal. And in Rhode Island, it has been projected that the state will pay $2.1 billion in fees to hedge funds, private-equity funds and venture-capital funds over twenty years, the same amount the state will be taking from workers by freezing their cost of living adjustments.

Solutions?

All these issues have solutions: a wealth tax for (1) and (4) above; a minimum wage increase for (2); a speculation tax for (3); public banksand Post Office banks for (5).

The post 5 extreme acts of greed that screw the American people appeared first on Salon.com.

I was also a little boy-crazy. This was nothing new; I’d been like that, in part, since my first kindergarten crush. The only time in my life when I hadn’t really been like that were the few years before I got sober: My life had gotten so small that the most regular guy in my life at that point was my coke dealer Alex and trust me when I tell you that I didn’t have a single sexual thought about him.

But suddenly, I was among the living again. I was in groups and meetings with a bounty of straight men and though my counselors and sponsor were telling me that I should avoid dating for the first year of my sobriety, it was advice that I nodded at and then promptly ignored. I’d been holed up in my apartment with only cocaine and cats for company for years and now that I wasn’t isolated anymore, they were asking me to turn off the part of myself I’d been somewhat ruled by since before I ever discovered drugs and alcohol? Uh, try again.

How well did the dating go? Suffice it to say that I ended up learning why this yearlong avoidance had been recommended. The best way I can summarize what happened is that my addiction had done something to my “picker” and as a result, the men I was drawn to weren’t the healthiest specimens. But I was one of the lucky ones—even though I dated various men and suffered rejection and remorse and all those things that can accompany less-than-healthy dating, I was able to stay the course. I don’t really know why that was true for me and isn’t always true for others; maybe my disease wasn’t as far advanced as it could have been or the men I got involved with weren’t appealing enough for me to have bottomed out after things went awry. All I know is that I have seen many women leave the program and sobriety because the pain they were experiencing as the result of romantic entanglements left them feeling like they had no other choice.

Strangely, despite the fact that it’s been established for quite some time that there are differences when it comes to treating men and women for addiction and that women from all-female recovery treatment groups relapse less often than women in mixed groups, rehabs have been slow to implement gender-specific treatment. Hazelden (in Florida, Illinois, Minnesota, New York and Oregon), Caron (in Pennsylvania, Texas and Florida) and Solid Landings Behavioral Group (in Costa Mesa, California) are the only major rehabs I’m aware of which separate the genders for treatment. And as far as I’m concerned, there’s nothing that could make more of a difference in terms of helping women find recovery.

Dr. Jerry Brown, one of the country’s leading advocates for gender-separated treatment and the clinical director at Sure Haven, the female treatment center under the Solid Landings umbrella, agrees with me. “What’s emerged is that treating women for addiction is often about treating trauma,” he says. While trauma isn’t, of course, limited to women, the fact that addicts tend to start using much earlier now than they used to—Brown estimates the average age to be 13 or 14—girls are, he says, “more likely now to get themselves in situations where they’re abused if they are impaired by alcohol and other drugs.”

But it’s not just the reasons that women become addicted which is the distinction; the way women respond to alcohol is fundamentally different than the way men do. “Women metabolize alcohol differently than men,” says Dirk Hanson, who wrote about the need for gender-specific treatment programs for Scientific American. “With less water and more fatty tissue in their bodies, blood alcohol levels are higher for women than for men. Women get drunk faster and have heavier hangovers.”

And yet it’s harder for women to pursue treatment than it is for men. Hanson cites a National Center on Addiction and Substance Abuse (CASA) book which says that for women with small children, “lack of childcare is a serious obstacle to seeking treatment…For some women, fear of losing their children to the child custody system upon admission that they have a problem makes them apprehensive about entering treatment.” And that’s not the only obstacle. “Women are stigmatized,” says Dr. Paul Hokemeyer, a marriage and family therapist in New York. “Because they breathe in the dominant cultural message that tells them they need to be ‘pretty and perfect,’ women often internalize enormous guilt and shame about their condition.”

Thankfully, some are doing everything they can to even out the playing field a bit. The work that Brown and Sure Haven are doing isn’t solely focused on dividing the genders so that they can stay better focused but also on providing as much information as possible to their female clients about how, exactly, their bodies work. One of Brown’s main objectives is to spread awareness about just how much hormones can impact addiction. “I noticed in my practice women telling me they’d wake up in jails and detoxes wondering what happened,” he says about coming to realize the significance of monthly cycles on relapse. “I’d ask, ‘Did you start your period in detox or jail?’ And they’d always say the same thing: ‘How did you know?’”

I told Brown what my very first sponsor told me: to mark in my calendar when my period was due. I’d told her at the time that things like that didn’t impact me very much and she’d said, “Oh, you just think that because you’ve been messed up for so long. Once you start paying attention to what’s going on and not poisoning yourself anymore, you won’t believe how much your hormones impact your moods.” (Let’s just say that this wasn’t the only thing she got 100% right.)

Brown is surprised that more clinicians who work in recovery don’t consider these factors more—“Even women in the field seem to not pay attention to this”—and he’s determined to stress the information to Sure Haven’s female clientele. “Information is power,” he says, explaining that the women there receive lectures not only on Premenstrual Disorder but also on eating disorders since so many females in recovery are also in recovery from anorexia.

But none of this means that recovering men are left out in the cold when it comes to receiving education about the particular challenges women in recovery face. “I also give the lectures on PMDD [Premenstrual Dysphoric Disorder] to the guys,” Brown says of the talks he gives at Rock Solid Recovery, the Solid Landings treatment center for men. “Sometimes they look at me as if to say, ‘Why are you telling me this?’ And I’ll say to them, ‘Do you have a wife, a girlfriend or a mother? Is she possibly an addict? This impacts you too.’”

The post Is rehab harder for women? appeared first on Salon.com.

You can frame this conventionally: supporting regulators, punishing rules violators, mopping up 2008-style disasters to limit the damage and attempting to prevent such chaos from happening again. But by “tougher rules,” maybe Americans are really signaling a vague but persistent dissatisfaction with an economy that has become dominated by the financial sector. And you can see within that how transforming banking back to its traditional purpose — as a conduit for putting capital in the hands of worthwhile business ventures and driving shared prosperity — would be one antidote to an unequal society full of financial titan gatekeepers, who confiscate a giant share of the money flowing through the system.

Sen. Elizabeth Warren — in many ways the avatar of a new populist insurgency within the Democratic Party that seeks to combine financial reform and economic restoration — will speak later today in Washington at the launch of a new report that marks a key new phase in this movement. Released by Americans for Financial Reform and the Roosevelt Institute — and called “An Unfinished Mission: Making Wall Street Work for Us” — the report is a revelation, because it finally invites fundamental discussions about these issues. Its 11 chapters from some of the leading thinkers on financial reform do look back at the successes and failures of the signal financial reform law of this generation, the Dodd-Frank Act. But the report also weaves in a story about how we can reorient finance as a complement to the real economy, rather than its overriding force. Mike Konczal, a fellow at the Roosevelt Institute and the co-editor of the report, tells Salon, “The financial sector is still eating up a lot of GDP [gross domestic product], and it’s not clear what we’re getting out of it. We want to get the conversation at that level.”

This report fills in the details, creating definable action items and goals that could serve as a marker for legislative and regulatory action, as well as primaries in the next several election cycles.

The roots of this conversation go back decades, if not hundreds of years. One of the report’s authors, John Parsons of MIT, notes that the debate over whether to force derivative trades — the bets on top of bets that helped accelerate and magnify the financial crisis — into central and transparent clearinghouses dates back to the Minneapolis Grain Exchange of 1896. The concept of a fiduciary standard, which states that anyone offering advice on investment strategies should act in the interests of their individual clients rather than trying to enrich themselves, was initially settled in the Investment Advisors Act of 1940.  Even Ben Bernanke last week drew parallels between the 2008 crisis and the Panic of 1907, which led to the creation of the Federal Reserve.

In the past few decades, Wall Street has devised financial “innovations” with the primary purpose of outpacing regulatory reach, surmounting decades-old reforms. This frees non-bank financial firms from oversight by the watchdogs, and allows them to accumulate risk in search of greater profits. For example, Marcus Stanley of Americans for Financial Reform looks at shadow banking, the lending markets that “convert illiquid, risky, long-term assets into ‘safe,’ liquid short-term securities.” This creates an illusion of safety and puts massive amounts of money outside the New Deal-era regulatory apparatus, where the firms involved don’t have requirements to carry capital to guard against inevitable losses, for example. In 2008, the breakdown of parts of the shadow banking system made it impossible for large financial actors to access short-term funding, turning a downturn into a crisis.

While shadow banking does not have access to the public safety net (things like bank deposit insurance, or access to Federal Reserve liquidity programs), in reality it is hooked into mega-banks inside the safety net. AIG was bailed out because its counterparties were corporations like Goldman Sachs and JPMorgan Chase, determined to be too big to fail. So you have the worst of all possible worlds; a giant alternative banking system not subject to any of the rules that limit risk, vulnerable to old-style bank runs, but able to get government relief if their gambles turn sour. You get privatized profits and socialized losses. You also create more fragility in the system, because shadow banking involves multiple links from borrower to lender, and as Stanley told Salon, “Each link in the chain is another opportunity to lie about what’s inside the loan.”

There are two ways to look at this problem. One is seen in the way Dodd-Frank tried, with varying success, to bring New Deal-era structures to the broader financial sector, pulling systemically important activities like insurance and hedge funds under a regulatory regime. Unfortunately, the maddening complexity of financial innovations generates uncertainty over what really falls under the rules, giving Wall Street and compliant regulators the opportunity to take advantage of loopholes. Orderly liquidation authority, the new measures for regulators to wind down large financial institutions, is so full of holes, argues Stephen Lubben of Seton Hall University, that it could quickly devolve into “a bailout in all but name.” Regulators have not even begun to reckon with large elements of the system, like money market funds or the overnight “repo” markets, which made significant contributions to the financial crisis. “Many of the conditions that helped cause the 2008 crisis persist,” writes Jennifer Taub of Vermont Law School in one of the report’s chapters.

The other way to deal with financial innovations is to simply eliminate those activities that only serve to pool risk without productive social purpose. For example, Wallace Turbeville of the think tank Demos, in a section on derivatives purchased by state and local governments, concludes that these municipalities would be better off hedging their risks by building a cash reserve, instead of paying the financial sector exorbitant fees for a product they don’t understand. “Inefficiencies that transfer earnings to the financial sector are like a tax that redistributes wealth upward,” Turbeville concludes.

Similarly, we can ban mega-banks from, as Saule Omarova of the University of North Carolina School of Law puts it, becoming “financial-industrial conglomerates,” pushing into commercial business like energy, transportation and physical commodities and distorting those industries for profit. We can give shareholders a greater say in executive compensation, tying it to actual performance. We can significantly boost capital requirements so financial institutions cover their own risk rather than allow taxpayer dollars to serve that purpose. We can restrict shadow banking, and reestablish the link between borrower and lender so that the lender has a stake in the borrower’s success. We can empower regulators with easy-to-implement, clear rules that place limits on banking activities and bank size. We can demand that law enforcement creates deterrents to fraud by legitimately punishing wrongdoing on Wall Street. All of these recommendations and more are in the comprehensive report.

There’s a real-world consequence to keeping unnecessary financial innovation in place, argues Brad Miller, former congressman now a senior fellow at the Center for American Progress. “The yawning inequality of income and wealth is not because the middle class isn’t working hard enough or because the richest fraction of a percent is making an enormous contribution,” he told Salon. “Much of the reason is what economists call ‘rent seeking,’ or extracting money without doing anything useful, mostly in the financial sector. It’s a wonder the economy has the strength to get out of bed in the morning.”

This core debate – whether to build a new regulatory regime for 21st-century financial products, or to just bar “innovations” that merely allow financial interests to capture money that should cycle through the economy – has not been part of the Obama administration’s approach to Wall Street reform, Mike Konczal says. “Paul Volcker said there wasn’t a financial innovation with a useful purpose in the last 30 years except the ATM. But the administration didn’t engage in this debate.”

The administration has seemingly taken the position that any effort to build on financial reform would reflect a tacit admission that Dodd-Frank didn’t solve the problem, and therefore nothing else can be done.

But in three years, President Obama will leave office, and these core issues will not. The age of “boring” banking, without these innovations, coincides directly with the creation of the broad middle class and a time of unparalleled economic expansion. Kleptocracies aren’t known for their economic vitality, but that’s what we have with a Wall Street-dominated economy.

The issue of Wall Street reform isn’t just about which regulations are sufficient to the task. It’s about what kind of economy we want for all our citizens.

The post Elizabeth Warren’s populist insurgency enters next phase appeared first on Salon.com.

We simply do not have the federal resources needed to spur the kinds of investments it will take to rebuild communities and put people back to work. So we need more money. And there’s money to be found. Not in grandma’s pension or grandpa’s Medicare, not in our children’s classrooms, and not in programs that protect the poorest among us. The money is on Wall Street.

Legislation introduced in Congress would institute a 0.5 percent tax on stocks, a 0.1 percent tax on bonds and a 0.005 percent levy on derivatives and currency. That’s literally fractions of costs to Wall Street, but these small taxes would raise approximately $350 billion annually. And 40 nations — including Singapore, Hong Kong and the U.K. — already have such a tax. Instituting this basic tax in the United States wouldn’t hurt Wall Street but would simply bring our policies into line with the rest of the global economy.

America has been through economic crises and recessions before, but what we’ve never done is recover through cuts and austerity. Rebuilding our economy means literally rebuilding, investing public money to strengthen our infrastructure, invest in our education system and create jobs that help get our nation back on its feet. It’s time for the next generation of big, bold investments to launch the next great wave of American innovation and prosperity — the kinds of investments that brought us Social Security, a railroad system, cures to disease, and provided jobs and security to generations of Americans and will get us on our feet yet again.

The question, then, is: Who should pay? Are seniors, students, the poor and working class expected to continue to make all the sacrifices? Or will those who benefit the most from the laws — and in many cases lack of laws — of our nation pay their fair share and fully contribute to the rebuilding of this country.

Modest taxes on Wall Street transfers is a chance for America to make game-changing investments in our people and our infrastructure. It is also a means of making sure bankers on Wall Street pay their fair share.

This isn’t another “Grand Bargain” where everybody loses — it’s a Grand Vision for a better tomorrow, built by American investment and ingenuity, and funded by the part of our economy that is already humming along.

The fact is that I pay a sales tax when I buy clothes for my daughter, but there is no tax on Wall Street trades. All a transaction tax would do is close this loophole exception for Wall Street, which would generate $350 billion that we can invest in projects and programs that help all Americans.

According to a 2013 poll by Hart Research Associates, 62 percent of Americans support a small tax on stock, bond and market trades. The same poll found that nearly two-thirds of Americans want corporations to pay more in taxes.

And yet in Washington, conservatives continue to push for massive cuts, and refuse to have new revenues on the table in any budget negotiations. Meanwhile a number of Democrats show signs of buying into an austerity agenda, negotiating with themselves before the negotiations have actually begun. Not only is this bad policy, it’s bad politics. The American people support raising revenues — politicians, especially Democrats, just have to put their finger in the wind on this one and do the right thing.

We need public investment to jump-start our still-too-sluggish economy. That money should come not from slashing investments on our grandparents and our children but from a tiny little pinprick of a tax on Wall Street — a tiny tax that will raise a ton of revenue. And then we can get America working again and back in line with the world economy — and not a moment too soon.

The post Wall Street’s nightmare: Here’s how to really expedite the recovery appeared first on Salon.com.

It’s absolutely astounding to me how negotiations among politicians regarding the funding issue for the U.S. only pick up when the deadline is nearing—or is already here. The funding issue isn’t like that college paper you crammed into a couple sleepless days to meet the deadline; we’re talking about the future of a country here.

I mean, why did the House wait until the last minute to debate the funding issue when it was aware of this a long time ago? Heck, the funding issue could have been resolved by now and we could be onto the debt ceiling limit debate; we still have that to discuss before the October 17 debt ceiling deadline.

What do politicians do all day? If they ran a company, the business would likely go broke due to the infighting and failure to come to an agreement. It seems like a game of who’s going to cave in first.

Of course, we have the 800,000 Americans at home without any pay. It’s not a great time for them, and clearly not a big confidence booster for the economy and the country.

But while the two parties continue to blame each other, America is heading down the wrong path. But then there’s the old saying, “You have to go through hell to get to heaven.” So as we approach the debt ceiling deadline, I guess we’ll have to deal with the default, clean the mess up, and then it’s off to a more viable situation.

Let’s say the shutdown continues into next week, with Columbus Day next Monday, followed quickly by the debt ceiling deadline on Thursday. What then? Well, the government will no longer have funds to pay its bills and debts, as it cannot breach its debt ceiling. The financial system would be sent into disarray, which would impact government debt.

America would be broke and would need food stamps of its own. Maybe the International Monetary Fund or all of the countries the United States has given money to in the past will come forth and help us with mountains of gold. Sounds great, but I don’t see this happening. China has three trillion U.S. dollars in foreign reserves. Maybe it wants to buy more American debt? They probably would, but at much higher yields to compensate for the risk.

The Department of the Treasury says the failure to raise the debt ceiling would drive a default that could have a horrendous impact on the economy, which could possibly cause another recession. This is when you would want to exit stocks and quickly pile into gold, if not before.

And can you imagine the upheaval in the global markets if the debt ceiling was not resolved?

Emerging markets could collapse and countries with heavy trading with the United States could also be greatly affected and forced into another economic downturn.

So, the next few days will be critical for not only the United States but the global economy as well. As the U.S. debt ceiling deadline nears, you may want to consider taking some profits off the table and waiting for a deal to be put in place. In the case that the debt ceiling deadline passes without a resolution, I advise you make sure you have some put options already in place to protect against major market selling. You may also want to look at also exiting some positions in government debt, as the value will most likely fall if the country defaults.

This article U.S. Default to Derail the Global Economic Recovery? was originally published at Investment Contrarians

The post Would a U.S. default derail the global economic recovery? appeared first on Salon.com.

I smoked pot daily from 1999 to 2011. I chose to stay home alone and smoke rather than meet up with friends, go out on dates or see family. For one year, mid-2007 to mid-2008, my only social contact was with my next-door neighbor, a pot dealer. I always dropped by his place to smoke and never offered anything in return. I was devastated when I came home one day and he’d moved out in the middle of the night without saying anything to me, but then it hit me how pathetic and parasitic he’d probably viewed me.

Pot came first in my life, and I hated what my addiction did to my sociability, creativity and work ethic, but I got high anyway and always thought about getting high when I was sober. I knew how horribly my addiction affected my life, but I developed a very defeatist attitude toward it. While high, I lamented all of the things that I could be doing if only I were sober, but when I was sober, all I wanted to do was get high.

Finally, my mom checked into rehab for alcohol addiction, which caused me to quit smoking and drinking. In the nearly two years that followed, I only smoked once, at a Halloween party last year. I’ve developed great habits — work, exercise, cleaning, cooking, writing, socializing — and have painfully cut pot-smoking friends from my life, some of whom I’ve known since childhood. I love my life right now, and I love not smoking pot.

So now the relationship part. “Helen” and I have been friends for 12 years. We’re both in our mid-30s. We met through mutual friends, and when we met she was dating a former classmate of mine. We both had crushes on each other but were never single at the same time. This went on until three months ago, when I broke up with my girlfriend and Helen wasn’t dating anyone.

Helen wanted to start dating, but I told her I needed a little time, as I didn’t want to jump into another relationship immediately. We finally got together a month ago and have enjoyed each other’s company as we’d both always hoped we would. On our second date, though, she told me casually that she wanted to become a pothead. She’d always liked pot but had always preferred drinking, so she drank way more often than she smoked. However, she was getting tired of hangovers and she just really wanted to come home after work and smoke a joint.

When Helen told me she wanted to become a pothead, this worried me. We kept seeing each other, though, because we get along so incredibly well. However, a couple of weeks ago she took me to a party where everyone was smoking pot, and for the first time in a year, I gave in and smoked. Last week, we went to a bar, and people were smoking joints, inside and out on the patio. This past weekend, she took a friend home from work in exchange for a pipe, then cooked dinner for some friends in exchange for some pot. She told me this when I went to her place last night. When she told me she had pot, I got that adrenaline rush I’d always get when someone pulled out their stash. She didn’t offer me any, but for a minute I wanted her to.

Because she’s so enamored with me, I expect that she’d offer to give up pot if that was my condition for dating her. However, she’s taken steps within the past few days to achieve her goal of becoming a pothead, and most of her friends smoke, and the parties/bars she goes to are filled with pot. I’ve run through a hypothetical in which a friend who had a drinking problem for years asks for my advice when he starts dating a girl who wants to become an alcoholic, and the answer, very clearly, is “don’t date her.” “But she says she won’t drink if we’re dating.” “Yes, but she said repeatedly that she wants to be an alcoholic and she’s acquired a bunch of liquor. Don’t date her.”

I’ve never dated a girl who I get along with as well as I get along with her. Do you think I should end this before it gets serious? Should I see if she’s willing to give up pot in order to date me? Part of me thinks this can work if I make serious efforts to abstain when in the presence of pot and to avoid those situations as much as possible, but I don’t know if I can do that. I only have so much will-power. I absolutely dread becoming a pothead again.

Nip It In The Bud?

Dear Nip It In The Bud?

This relationship is dangerous to your well-being. You need to get away from this woman.

You don’t seem to see the danger. Or maybe you do but you’re not responding appropriately.

Here’s what I think is going on. As the child of an alcoholic, you learned to pretend that the person closest to you is not actually destroying herself. You learned to play along with her lies. It is natural for a child of an alcoholic to pretend. It’s unbearable to see your mother ruining her life. So you pretend. It saves you from what is emotionally unbearable. But the pretending becomes an emotional habit. And now this habit of pretending threatens to destroy your own precarious success in quitting pot.

I feel for you, man. I think you can be fine if you can get out of this alluring, seductive trap. But you’re going to have to be clear and firm and not negotiate. I’d just walk away.

Seriously: You get along so well, you say. Why? Because you have learned to get along with self-destructive women. You probably associate self-destructive behavior with a mother’s love.

So get away from this woman until you can begin to feel an appropriate outrage at her behavior. Get away from her and get into Al-Anon. There you can learn the effect your mother’s alcoholism has had on your judgment, and why you find it hard to distinguish between people who love you and care about you and people who think it would be amusing to plunge you back into your addiction.

You’ve had some success quitting on your own, but there will be times when there’s nothing between you and that joint except another person who’s also working to stay clean. When you find yourself blindly flirting with a seductive and self-destructive partner, it’s useful to have others about you who can see what is happening and help you change course. Plus, being in a program can help you see the role addiction has played in your relationship with your mother.

Personally, this infuriates me. Part of that is because I have some history with this sort of thing, I’ll admit that. It pushes my buttons.

I’m not amused. I’ve seen too much misfortune to be amused.

And it isn’t just about you and her. It’s about the ripple effect of addiction throughout families and societies. If she becomes an addict and then decides it would be amusing to have children, then here come more children raised by a spaced-out, inconsistent, unreliable mom.

But the ruin does not have to spread. A pattern that may stretch back many generations can be stopped.

So have some backbone. Put your survival ahead of your infatuation. Back away.

The post She aspires to be a pothead! appeared first on Salon.com.

I am powerless to control my addiction to this kind of talky, theatrical, pseudo-therapeutic picture, which doesn’t mean – as with other kinds of addictions – that I’m entirely happy about it. Anybody who’s done time in or around a 12-step movement will immediately understand that the title of Blumberg’s film is highly specific: It’s what you might say, with or without some degree of irony, after someone in your circle has told their self-aggrandizing and/or self-hating story about all the wretched things they used to do (and are likely still doing) and how they’re handling the whole “one day at a time” business. I have the uncomfortable but compelling feeling, in fact, that “Thanks for Sharing” is drawn from life, and that one or more of the characters are based on the writer-director. (Blumberg is best known for co-writing the Oscar-nominated screenplay to Lisa Cholodenko’s “The Kids Are All Right,” and wrote this one with Matt Winston.)

In “Thanks for Sharing,” Mark Ruffalo and Tim Robbins play two longtime members of a 12-step group for sex addicts who will – big spoiler ahead! – face numerous crises and emergencies despite their years of alleged sobriety. I can’t claim I didn’t learn something from the fascinating portrayal of this particular recovery movement. I didn’t know, for instance, that “sobriety” for sex addicts doesn’t just mean abstaining from non-monogamous interpersonal action, but may also include no TV, no Internet, no cellphones, no riding on subways or buses and no masturbation. As Robbins’ character, a Brooklynite named Mike with working-class roots who appears to own an entire brownstone (yes, definitely possible, but not explained), explains, this particular addiction comes with unique challenges: “It’s like trying to quit smoking crack when the pipe is attached to your body.”

It’s traditional in this kind of movie for supporting characters to outshine the alleged dramatic center, and such is the case here with Robbins’ white-haired, blue-collar, cliché-spouting character, who comes on strong as Mr. Zen Meditation Recovery Guru, but also has unacknowledged anger issues and a conflict with his adult son (Patrick Fugit) he hasn’t even begun to deal with. Even Joely Richardson, in what’s almost a wallpaper role as Mike’s wife, Katie, is a more compelling character than the tortured, earnest Adam (Ruffalo), who after five years of zero sexy-time is ready to start dating and picks a cancer survivor and fitness freak played by Gwyneth Paltrow. I love watching Ruffalo in almost anything – he always makes interesting choices and (as they say) he’s always present – and I’m not a Gwyneth-hater at all. But slapping the two of them together and asking us to care about cancer and recovery and eating disorders and their incipient but troubled romance all in one go is like a quadruple dose of sugar-frosted sincerity. I couldn’t wait for Adam to go off the rails and start texting Estonian prostitutes (and I cannot print the term he uses to describe them in a late-night phone call to Mike).

Then there’s the third-wheel character who’s not so secretly the real hero of the movie, the nebbishy, overweight E.R. doctor named Neil (Josh Gad, aka “the other Jonah Hill”), who starts out attending the sex-addict meetings only to fulfill a court order, and then gets fired from his job for shooting upskirt videos of his attractive boss. Neil lies about his sobriety, refuses to destroy his immense porn collection, gropes women on the subway, hits bottom with a resounding crash and then finds salvation in an unlikely friendship with Pink. No, I’m entirely serious – the singer Pink, also known as Alecia Moore, here plays Dede, one of the group’s only female members, and the connection between Dede and Neil, which at first stretches credibility to the breaking point, may be the best thing about “Thanks for Sharing.”

Dede’s not initially attracted to Neil, which is why she picks him as a confidant, and then she realizes that he possesses the raw material for a totally awesome guy, but by that point they’re both making strides, against all odds, with their sobriety. It’s a strong-coffee jolt of wonderful, lived and irresistible real-people drama, in the middle of a movie that’s immensely muddled overall but that I couldn’t stop watching. I bet I wasn’t supposed to find it hot, for instance, when Adam ditches the rabbit-diet fitness chick and hooks up with a clearly disturbed ex-girlfriend (Emily Meade) who wants to play out an alarming fantasy. But it’s those fragments of darkness and danger, around the edges, that give this brave, well-meaning and self-indulgent dramedy its gravitational pull.

The post “Thanks for Sharing”: Sex addicts of the world, unite! appeared first on Salon.com.

Today my brother has 10 months sober. I woke up to this email from him, addressed to my parents and me:

“I would not change 1 thing in my life today. So crazy to actually mean that. I luv all y’all so much & y’all have each helped me beyond ur understanding in different ways. Today I am really fuckin grateful.”

A year ago today, he was dying from a cocktail of opiates, benzos and alcohol. Having spent the latter part of my teens and early 20s shooting heroin into every vein in my body, I knew his pain. Yet I was still powerless to help because, as we know, someone has to first want that help.

So one day I woke up and decided to do the only thing I could—put it all down on paper in the following letter to him. I share it in the hope of making someone feel less alone today.

Dear Jonny—

In 1998, I knew I needed to change. I knew there was a better life somewhere out there for me. I believed in freedom and creativity and love, and had somehow given all of that up in the service of my addiction. I had become completely dependent on outside sources to give me any kind self-worth—mostly this was in the form of external accomplishments or the bravado and reassuring self-delusion that came along with getting high.

Only to say that I had nothing left to tap into in my own heart to let me know that I was going to be okay.

Or that the universe was a safe place.

Or that love, in its unending series of messes and compromises, was in fact perfect and holy just the way it was. And moreso, that what made it truly god-like was the very fact that it was beyond my control. It did not come in the form that I wanted it to…and it took me years to discover that this was because it was so much bigger than me, or anything I could fathom. I realized that I was not in control!

And that was the moment when I became more than the sum of my parts. That was the moment that I finally felt like I belonged to something greater. That was when I truly began to grow… and at the same time realized that there was no destination.

I spent years (well into my early recovery) painting elaborate stories in my brain about why “I was right.” I would have hours of conversations with people inside my own head and make up their side of the story/conversation, too. Then I would rebut their story with lawyer-like precision until I came to a place where I won.

The more that I actually lost in my life, the better my internal lawyer would have to be to win the case. But my brain is fierce and my will is strong, so I could do it. To the bitter end I could do it.

And then, one day, after the haze started to clear, and I had been following direction (that I hated!) for a while, I had one simple thought. “What am I getting out of being right?” Then another question followed: “Why do I need to be right?” And for that split second, I had an epiphany that I have spent the last 14 years trying to remind myself of (to varying degrees of success): BECAUSE MY DISEASE WANTS ME TO BE ALONE.

Several months ago, mom and dad told you that we would not be getting together as a family anymore because it was just too hard and too toxic. Last week, I told you that I did not want to carry the relationship that we had (without some kind of professional help or guidance) because it hurt too much and never seemed to get better. By your own admission, your disease has alienated you from friendships.

It must take a lot of mental work to explain away all of these (seemingly similar) changes in your life and lawyer your way out of them. But I know this disease. I have this disease. And I know your own fiercely intelligent brain. So I’m sure that you can do it if you decide to continue to do so.

I guess what I’m saying is that if you’re anything like I was (and still am at times, when I’m in my deepest fear), you’ve read this letter and your brain is telling you, “He doesn’t understand.” It will sum up the years that I’ve spent in pain wishing to have a better connection with you, the days (since I found out about the extent of your habit) that I’ve spent praying and crying, and the hours that I’ve spent writing and rewriting this letter into some form of a write-off.

“He loves me but he doesn’t get my life.”

“He’s too caught up in his own bullshit to see what’s actually going on with me.”

“He means well, but I got this thing. I know how to do this.”

If this is the case, I just ask you to take one single moment to quiet those thoughts. Quiet your brain and try to find God in your heart (your higher self that has no fear or anger) and then ask this one question:

What are you getting out of being right?

And if your heart can hear this question. Consider one more thing:

What if you’re wrong?

And if, by chance, there is now any inkling of doubt deep inside you, then maybe you can hear this:

There is a truth and beauty in this universe that we cannot even begin to know until we put the gloves down. Surrender is where we find the strength that we never knew existed. Surrender is always in action, never in thoughts.

Your brain is your enemy.

You are safe.

You are loved.

You are sick.

You cannot do this alone. No one can.

Your plans don’t work.

You are me and I am you. Your pain is not just your own. Because I love you, because you are my brother, it is my pain too.

And lastly, that there is a life out there that is beyond your wildest dreams. And it’s nothing like you imagine it will be. It is so much better.

And it’s yours for the taking.

I can see it right in front of you! But I cannot give it to you. That is a journey for you and you alone.

But all you have to do to get from here to there is let go…

—Joshua

The post A letter to my sober brother appeared first on Salon.com.

No substantial evidence links marijuana to traffic accidents, domestic violence or cancer, yet pot is illegal and listed as a Schedule I controlled substance by the U.S. Drug Enforcement Administration. Meanwhile, alcohol remains legal despite the fact that it has been proven to contribute to many societal ills, including domestic violence and auto accidents.

In 2011 alone, an individual in the U.S. was arrested for marijuana use, sale or possession every 42 seconds, according to the FBI’s Uniform Crime Reporting (UCR) program. Those numbers have been climbing.

Some of the obvious hypocrisy inherent to marijuana prohibition is highlighted in a commercial (see below) that ran a brief stint before NASCAR audiences last month, until it was removed to preserve the “family atmosphere” of the event, according to race organizers. The ad space for the commercial was purchased by the Marijuana Policy Project (MPP), the largest marijuana legalization advocacy group in the states, and the creators of the commercial.

The Huffington Post reported that MPP celebrated the commercial as:

“… the first time a pro-pot campaign would be seen at a major sporting event. Organizers for the Brickyard 400 race at the Indianapolis Motor Speedway disputed that claim, noting that the boards set to display the commercial were not technically on stadium grounds. When officials with the company that had allowed MPP to purchase air time caught wind of its pro-marijuana message, they scrambled to take it down.”

In 31 seconds, the ad points to a series of clear-cut ways pot is statistically less harmful than alcohol. The commercial has received more than 944,500 YouTube hits and made the rounds on Facebook.

It begins with the line: “If you’re an adult who enjoys a good beer, there’s a similar product you might want to know about—one without all the calories or serious health problems, less toxic so it doesn’t cause hangovers or overdose deaths, and it’s not linked to violence or reckless behavior.”

That product, of course, is marijuana. MPP created the commercial in an effort to clarify some of the myths and misconceptions that taint marijuana’s reputation—misconceptions MPP says are perpetuated by the U.S. government.

On its site, MPP states,

“If you’re like most Americans, you have been led to believe that marijuana is a dangerous and addictive drug that has destroyed the lives of millions of teens and adults. You have been encouraged to believe that marijuana causes lung cancer and is a ‘gateway’ to harder drugs. The government has even tried to convince you that most people who use marijuana are losers who sit around on couches all day doing nothing.”

MPP says its goal is to “wipe the slate clean” and replace fiction with facts about marijuana use. “We simply hope you will come to understand that it is far, far less harmful than what your government has told you,” the text states. The MPP website goes on to describes the common recreational uses of marijuana, which are similar to alcohol consumption patterns:

“None of this is ‘bad’ or ‘wrong’ or ‘immoral.’ It is simply something that these responsible adults choose to do. And frequently, it is something they choose to do specifically instead of alcohol. And for good reason! Alcohol is more toxic, more addictive, more harmful to the body, more likely to result in injuries, and more likely to lead to interpersonal violence than marijuana.”

The page also includes the following bulleted list comparing alcohol to marijuana:

1. Many people die from alcohol use. Nobody dies from marijuana use. The U.S. Centers for Disease Control and Prevention (CDC) reports that more than 37,000 annual U.S. deaths are attributed to alcohol use alone (this figure does not include accidental deaths). On the other hand, the CDC does not even have a category for deaths caused by the use of marijuana.

2. People die from alcohol overdoses. There has never been a fatal marijuana overdose. The official publication of the Scientific Research Society, American Scientist, reported that alcohol is one of the most toxic drugs and using just 10 times what one would use to get the desired effect could lead to death. Marijuana is one of – if not the – least toxic drugs, requiring thousands of times the dose one would use to get the desired effect to lead to death. This “thousands of times” is actually theoretical, since there has never been a case of an individual dying from a marijuana overdose. Meanwhile, according to the CDC, hundreds of alcohol overdose deaths occur in the United States each year.

3. The health-related costs associated with alcohol use far exceed those for marijuana use. Health-related costs for alcohol consumers are eight times greater than those for marijuana consumers, according to an assessment recently published in the British Columbia Mental Health and Addictions Journal. More specifically, the annual health-related cost of alcohol consumption is $165 per user, compared to just $20 per user for marijuana. This should not come as a surprise given the vast amount of research that shows alcohol poses far more – and more significant – health problems than marijuana.

4. Alcohol use damages the brain. Marijuana use does not. Despite the myths we’ve heard throughout our lives about marijuana killing brain cells, it turns out that a growing number of studies seem to indicate that marijuana actually has neuroprotective properties. This means that it works to protect brain cells from harm. For example, one recent study found that teens who used marijuana as well as alcohol suffered significantly less damage to the white matter in their brains. Of course, what is beyond question is that alcohol damages brain cells.

5. Alcohol use is linked to cancer. Marijuana use is not. Alcohol use is associated with a wide variety of cancers, including cancers of the esophagus, stomach, colon, lungs, pancreas, liver, and prostate. Marijuana use has not been conclusively associated with any form of cancer. In fact, one study recently contradicted the long-time government claim that marijuana use is associated with head and neck cancers. It found that marijuana use actually reduced the likelihood of head and neck cancers. If you are concerned about marijuana being associated with lung cancer, you may be interested in the results of the largest case-controlled study ever conducted to investigate the respiratory effects of marijuana smoking and cigarette smoking. Released in 2006, the study, conducted by Dr. Donald Tashkin at the University of California at Los Angeles, found that marijuana smoking was not associated with an increased risk of developing lung cancer. Surprisingly, the researchers found that people who smoked marijuana actually had lower incidences of cancer compared to non-users of the drug.

6. Alcohol is more addictive than marijuana. Addiction researchers have consistently reported that marijuana is far less addictive than alcohol based on a number of factors. In particular, alcohol use can result in significant and potentially fatal physical withdrawal, whereas marijuana has not been found to produce any symptoms of physical withdrawal. Those who use alcohol are also much more likely to develop dependence and build tolerance.

7. Alcohol use increases the risk of injury to the consumer. Marijuana use does not. Many people who have consumed alcohol, or know others who have consumed alcohol, would not be surprised to hear that it greatly increases the risk of serious injury. Research published in 2011 in the journal Alcoholism: Clinical & Experimental Research found that 36% of hospitalized assaults and 21% of all injuries are attributable to alcohol use by the injured person. Meanwhile, the American Journal of Emergency Medicine reported that lifetime use of marijuana is rarely associated with emergency room visits. According to the British Advisory Council on the Misuse of Drugs, this is because: “Cannabis differs from alcohol … in one major respect. It does not seem to increase risk-taking behavior. This means that cannabis rarely contributes to violence either to others or to oneself, whereas alcohol use is a major factor in deliberate self-harm, domestic accidents and violence.” Interestingly enough, some research has even shown that marijuana use has been associated with a decreased risk of injury.

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We grew up on neighbouring cul-de-sacs in Guelph, Ontario, and our elementary school was nearby. During recess, Dan sat by himself near the school doors, flicking pebbles at nothing. I was stick thin and bookish. Without a father, I had never learned to move like the other boys, didn’t know how to throw a football or swing a bat. So Dan and I found each other. In junior high, as cliques hardened, we drew closer, sitting for hours in his wood-panelled basement, where we talked about bands—Radiohead, Tool, Pink Floyd—in the rockist shorthand of teenage boys.

Dan played the saxophone then, and he looked as if he were fighting the thing, his cheeks red and puffed, his pudgy fingers manipulating the keys. He was, more than anyone I’ve ever known, an embodied person, moving like a tank and altering the gravity of any room he entered. He highlighted his curly brown hair with blond, and often wore two shirts at a time, as if trying to constrain his bulging proportions.

The rest of this article appears on the The Walrus’s site here.

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To find this column every day: Bookmark http://www.salon.com/topic/since_you_asked/.

Cary,

I saw a similar letter written to you by a woman in a relationship with a heroin addict. I’m also writing for some insight and advice because of my own experience. I don’t understand drug addiction or how to heal and move past the damage it can do. I thought you could offer some advice and wisdom from your own experience.

I was in a relationship with a man for over four years. He was several years sober at the time I met him, in a 12 step program, and did not drink or use drugs. According to him drinking never had been an issue, but he struggled with drug use earlier in his life. At the time we met, he abstained from both. He was extremely charming, always there for me. I thought I had met “the one”! We enjoyed so many things together and grew quite close, although I was hesitant to get too serious too fast due to his past. He always had the right answer, though: “I won’t let you down,” “I love you,” “I only want to be with you.” So before I knew it, we were in an exclusive relationship and he quickly became a big part of my life.

We eventually had some struggles related to finances. It was usually me who paid for things, or lent him money, and he was having a difficult time securing employment as he had a record and the economy was not great. When I tried to talk to him about it, he was very defensive and I didn’t want to be a “mean mommy” so I would let it go. When he decided to start a business I signed a loan for him to purchase a new truck. We had an agreement between us regarding the payments and other obligations, and I felt secure he would hold up his end of the bargain. We also got a new puppy and began making arrangements to move in together. Soon after, I saw the beginning of a real downhill direction for us. Before long I found out about missed truck payments, parking tickets in collections, and insurance and registration problems and a host of other financial issues that I hadn’t known about. If I confronted him, it was a huge fight. And my anger and frustration seemed to push him further away. I felt lied to and used and betrayed, so I know I was acting critical and angry much of the time.

Eventually he became more distant. He became unreliable and was always late or barely awake if we spent time together in the evening. And he never wanted anything to do with me physically. I thought he was tired due to the new puppy. I also found messages he sent to other women although he swore he wasn’t cheating. I decided not to move in together until we worked out some of our issues. I started finding balls of tin foil in his trash and eventually put two and two together and realized he was smoking heroin. First he denied it, then he kept saying he would stop, yet the behavior continued. We tried therapy, but the things they would ask us to work on — better communication, no more disappearing acts on his part, honesty, no more drug use — he couldn’t follow through on so we ended up not continuing with counseling. I was so confused. He blamed me for so much because I would get angry and frustrated and fight with him. I kept trying to be better, and fix things, but nothing seemed to work.

When I was finally on the edge and knew something had to change, I found a counselor that specialized in addiction and relationships. We began to see her and I saw some hope. She addressed the addiction head-on and and emphasized that he could not have a real relationship while on drugs. He was shooting up heroin and he said he wanted to change. He worked on getting clean. I thought things were going in the right direction. We were looking forward to a summer trip to Europe, and enjoying more time together, and finally I was feeling confident we might repair some things. Then a couple weeks before our trip we had an argument. I think it was about his smoking (another lovely habit he had picked up along the way) and he was angry and telling me I didn’t really care for him or accept him for who he was. After a few days of not hearing from him, I went to his apartment to try and talk and resolve our disagreement. I found him with another woman. He was sleeping with her and she was married to someone else! I was devastated. He never contacted me again. He stood me up for the trip, and never paid me for the several thousand dollars that was on my credit card for airfare and non-refundable lodging. He would not return my calls or pay me for any of the cost, he kept our puppy who I never saw again, and this married woman moved in with him. I’m devastated. I’ve only seen my ex once or twice over the last few months and he had track marks and was clearly shooting heroin again. He’s still with that other woman (who I believe also does drugs but I can’t say for sure).

I feel so hurt and rejected and alone. I am an educated, successful woman who is fit and financially secure. I can’t understand why he chose this trashy woman over me. I feel a sense of guilt for all the times I was angry or hurtful instead of trying to be a friend or help or understand him. I don’t know where one starts to heal from something like this. Sometimes the pain is so intense I don’t even want to get out of bed and face the day. I often wonder if he’ll ever get clean, or miss me, or at the very least stop blaming me for so much. I don’t know what to do.

Sincerely,

Lost in San Diego

Dear Lost in San Diego,

A relationship with a heroin addict can be a life-scarring experience. What you need to do is what you would do if this had been a physical wound: learn what happened and aggressively seek treatment.

The quickest route to learning what happened would be to get into an Al-Anon group. Such groups are repositories of specialized knowledge about just this very thing: relationships with addicts.

The other thing I suggest is that you get yourself a psychotherapist who has experience working with addicts and their loved ones.

If you do these things you can recover more quickly and more fully than if you just try to get over it on your own.

Seriously. I wouldn’t leave this to chance. Too often after an experience like this, the victim assumes she’ll just get over it. That’s like assuming you’ll just get over a stabbing, or a broken leg, or being run down by a truck. Even if you do heal, you’ll heal crooked. Better to set the bone right and heal straight.

Now, you may feel tortured wanting to know why. The short answer is, this is how heroin affects people. People who are addicted to heroin are going to be unreliable and untruthful; they are going to be irresponsible and unpredictable; they are going to have poor judgment about risks; they are going to have trouble making decisions based on long-term considerations; they will have trouble delaying gratification and will be disorganized; they will lack energy and will have erratic sleep habits. They will shack up with a trashy married woman and take your puppy.

So get some help. Learn what happened to you and why you fell for it. Undertake a program of recovery from it. Make that your primary focus for the next year.

And, if at all possible, get that puppy back. Puppies deserve better.

The post My boyfriend stole my puppy appeared first on Salon.com.

There’s a new normal in the American economy for vast slices of society and it’s discouragingly tough, despite all the cheerleading from the White House and economists that the country is in a slow but steady recovery. If anything, the new American economy has undergone a structural shift where far too many jobs are not paying enough to cover basic living expenses and money worries are simmering and never-ending.

“It’s difficult to point fingers at people and say, ‘You screwed up in some way’ or ‘You aren’t working hard enough,’” said Erica Seifert, a senior associate at Greenberg Quinlan Rosner Research, which recently conducted a series of focus groups in Florida and Ohio among young college women, Latino voters and white working-class voters. “This economy isn’t functional. The jobs don’t pay.”

Siefert’s firm convened groups of likely voters to hear detailed remarks about how they and their familes were faring economically. What they found was that previously given explanations for economic hard times, such as saying, “It’s the recession,” were replaced by comments that suggested that America is now beset with “institutional inequality.”

“In the past, we would talk to people and the recession was the obstacle,” she said. “Now we have people with educational degrees who can’t make enough money to pay their loans back and meet their expenses. It’s not that those people make poor choices.”

What follows are eight tenets of the new economy, according to her firm’s research. The quotes are from participants—some were teachers, bank clerks, truck drivers, massage therapists, social workers, working mothers, etc. Some had higher education degrees, while others were only high school graduates.

1. It’s not my economic recovery.

News about the rising stock market, increase in home values or tech sector boom—all staples of mainsteam media content—does not describe their world. The women aged 30 and younger and Latino voters in the Orlando area, and working-class men and women of all ages near Columbus, Ohio, said in many different ways that their personal finances were rocky and frail.

One was “afraid of losing my house.” Another said, “Back six years ago, I was making double the income I’m making now.” One said, “I think the best way to describe my finances is precarious.” Another said, “Me personally, not so good; my household is getting by.” One said, “I own my own home and don’t see the home values going up. I see the neighborhood selling quickly, but what are they selling for?” Another said, “Two steps forward, four steps back.”

2. The mood is fear, not hope.

Many people are living on an economic “edge where fear, worry and caution are pervasive,” the researchers found. “I can’t afford to lose right now,” one person said. “I’m being conservative… It’s starting to balance out a bit, but we never know. It’s a rollercoaster,” another said. “It’s pretty scary,” one said. “Afraid,” said another. “Most of my family and friends are, they’re making ends meet but they’re struggling… They’ve got financial, you know, worry in the back of their minds. You know, if something happens, what am I going to do?”

3. Self-sacrifice is now routine.

The personal strategies for getting by include routinely cutting corners, pooling resources and not just having underemployed young people move in with their parents, but people taking in their parents after their jobs disappeared.

“Cutting back on unnecessary items and home and just [living] paycheck to paycheck” was how one participant put it. “Looking for sales, pinching pennies,” another said. “I moved my mom in with me last month. I am currently supporting my mom; her factory shut down and she was on unemployment,” a young woman said. “After we pay our bills we make sure that our children eat, but there’s times my husband and I can’t afford it,” another said, saying, “We eat peanut butter, potatoes or rice. We make sure our children are eating four food groups a day.”

4. Lower and lower expectations.

Tellingly, when asked what a good economy would look like, the responses were a litany of humble aspirations. Paying bills on time, having “a few extra dollars after payday,” getting annual raises, having a full-time job, being able to see people and “go out and have fun,” and being “able to save more” were all cited by participants.

Notably, these comments were in stark contrast to the regular news reports about steadily falling national unemployment rates and other economic indices. The participants asked: where were the jobs that were being created; who was hiring; what was the work; and what pay scale was offered? “How many of those [175,000 newly created jobs in May] have actual living wages?” one participant asked. “The lower income jobs, those grew exponentially,” another said, adding, “I’m actually looking for a job right now. There are lots of jobs on there in housekeeping, things like that.”

5. Necessities keep going up.  

The cost of living was “very depressing,” one participant said, echoing comments by others that cited rising food and gas prices, and increased childcare and healthcare costs. “Raises aren’t happening, the cost of living continues to rise, bills continue to go up,” another said. “I don’t really know how people do it, I really don’t,” one said.

6. No escape from debt and loans.

Consumer debt, especially paying off student loans, was also cited as a tremendous source of stress and even prompted some participants to question whether education was worth it. A young woman with a social work degree said, “I have plenty of student loans that I’m paying. I have a degree. I’m working as a bartender not by choice… I make more money doing that than any position I could get from my degree, so I pay my student loans as a bartender.” Another said, “I can’t go to school because my credit is bad because of my previous school loans, but I can’t afford to pay them. There’s not really anything that I can do to better my education.”

Older people said that new college and university graduates faced untenable pressures. “When you come out of school you’re $50,000 or $100,000 in debt,” one said. “You’re lucky if you’re making, you know, $30,000 or $40,000 a year. That’s paying your bills. That’s paying your rent. You’re not paying off your debt, so you’re never getting ahead.” Said another, “There’s lots of students that just graduated and can’t get a job.”

And some parents added that they didn’t know how they could afford to pay for higher education, even though they thought that it was a necessity for a good job. “School right now is $30,000 a year,” said one parent of a grade schooler. “In 10 or 15 years, it’ll probably be $80,000 a year, and you’re saving up for that but you’ll never be able to catch up.”

7. Economic inequality is a fact of life.

Those interviewed by the focus group leaders said that they were more aware of economic inequality, not just by their own struggles, but by seeing how the richest Americans and managerial class was operating.

“There’s people making $30,000 a year paying a higher tax rate, and people making $30,000 a year have a lot less money to live on obviously than somebody making millions,” one said. Another said, ideally “you’d let these corporations run their businesses without government interference but the problem is you have people who are giving themselves multi-million-dollar annual bonuses and they’re cutting wages or they’re cutting jobs.” Another concluded, “It’s getting better for the rich and it’s not getting better for the poor.”

8. The political system is unresponsive.

The research firm that convened the focus groups generally works with Democrats. It found, tellingly, that people who feel these economic pressures were responsive to the GOP’s rhetoric of cutting government spending—because they personally had to cut their expenses. At the same time, they said that the government needed to do more to pay for education and had to make college more affordable, starting with lowering student debt.

The top two percent are “holding us hostage and they’ve got the money to buy the politicians to get what they want,” one participant said. Others were frustrated that the two major political parties were constantly at each others’ throats. “It is frightening to me to even consider that the Republicans block any bill or proposal just because they don’t like the president,” one said.

The New American Economy

The focus groups convened by Greenberg Quinlan Rosner Research were part of an ongoing series to trace “emerging perceptions and understandings about how the economy now operates,” its July 11 report said. Erica Siefert, who sat in the room as participants talked and then analyzed the comments, said the takeaway was that America’s economy was failing on a massive level to produce living-wage jobs.

“When you sit in the room and you listen to these people, it’s important to understand whatever they are saying as individuals and in aggregate,” she said. “I think people often think that they are to blame, but the game is really rigged against them.”

Steven Rosenfeld covers democracy issues for AlterNet and is the author of “Count My Vote: A Citizen’s Guide to Voting” (AlterNet Books, 2008).

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–home prices/sales/starts, the stock market, consumer confidence are all trending up, supporting the recovery;

–GDP and jobs are not breaking records, but they’re solidly positive;

–the sequester isn’t hurting growth as much as some folks thought it would.

Though I’d be cautious on that last point — the fiscal drag is backloaded and some of this stuff, like kids losing Head Start slots, doesn’t show up in this quarter’s GDP — the macro-economy has been consistently expanding since the second half of 2009, “corrections” to once overleveraged household and business balance sheets are largely completed, and the ever-essential housing market is reliably crawling off the mat.

But these kinds of stats are all a bit removed from what matters most to middle-income working families — what’s happening with those trends?

They’re a lot less favorable. The figure below shows four measures, all adjusted for inflation: the S&P stock market index, GDP growth, the earnings of middle-wage workers, and median household income. In each case, I’ve plotted the growth over the expansion that began in June 2009 through the most recent month of data availability, April 2013 (for GDP, it’s 2009q2-2013q1).

Now, I’m always careful to point out that stock market gains don’t just benefit the wealthy. There are pension funds and 401(k) accounts in that mix as well. But as shown here, the bulk of the market’s gains accrue to the rich: the top 1 percent holds over a third of equity market wealth, the top 10 percent holds about 80 percent; the bottom half holds well under 10 percent.

Also, those unsettlingly small bars on the graph that represent the wage and income trends of middle-income folks leave out any wealth effect from rising home values — the fact that when your house appreciates in value, you’re wealthier and research shows that tends to boost your spending by something like four cents on the dollar.

But those details are sideshows to the fact that trends in real paychecks and household incomes reveal a quite different story than all the good vibes from home starts, market indexes, GDP and so on. Sure, there’s a lag between macro and micro, and if the recovery accelerates, unemployment should come down more quickly and the tighter labor market will enforce a more equitable distribution of growth. But that’s not in the near-term cards, and those who want to understand how people are doing in the current economy must take account of all three of those bars in the figure, not just the first one.

Sources: S&P, Standard and Poor’s; GDP, BEA (2009q2-2013q1); Weekly earnings are for blue collar workers in manufacturing and non-managers in services, from BLS; Median household income is from Sentier Research, Figure 1 (since I was too cheap to spend the $25 bucks for the underlying data, the -4% in the figure is from eyeballing their HH index values in the relevant months).

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A few days ago, I learned that my husband had been lying to me. It was about something small. Actually, it was a series of lies — a few to cover up an original omission of the truth. I had watched our children under the pretense that he would be somewhere, which he wasn’t. He stated that his reason for lying was fear, and he was trying to avoid a conversation and criticism. As a result, I feel hurt. I feel used. I feel angry. I also feel that he may have a point.

We’ve been together 10 years. We have two children, and as long as I can remember, he’s been lying. Most were small, but some were very big.

He’s a recovering addict working a 12-step program, and he’s been sober for just over a year. I’ve been patient. I stayed through the demon days when I didn’t know what the hell was going on during his bottom-out. I stood by when he went to rehab after he told me what he was involved in. I’ve been far from perfect myself. There are times that I’ve been loving and kind. There are times when I’ve expressed anger and frustration in a tone I’m not proud of, recounting to him all of his wrongs. I’ve been seeing a therapist, and attending Al-Anon. There were years in which I felt truly victimized before he got sober. He took money I made, used my credit without my permission, got emails from women that he forgot to tell me about, sent texts to women that were unacceptable, and played while I paid the bills. This past year of his sobriety has been far from perfect, but these damaging behaviors were largely absent. I felt grateful, like the program was really working.

After all that we’ve been through, this latest series of small lies feels devastating. I don’t know if it’s a matter of him having a lot of growing up to do and I just can’t suffer alongside anymore, or if a breakthrough is just around the corner to reward  perseverance. He’s got amazing, sensitive, redeemable qualities like changing people’s tire when they are stranded on the side of the road and making my coffee each morning. He’s smart and attractive, and there have been countless nights when he was up with sick children while I slept. But, I’m tired of feeling hurt, manipulated, and as if a basic need of mine is just maybe beyond his capability at the moment. It just is not acceptable to treat me this way. I have told him this. And yet, I’m doing nothing about that.

I believe that our children would be irreparably damaged in the event of divorce or separation. They love him fiercely, and for good reason. Also, because I love him, I have wanted to work through things. In some twisted way, I feel protected. I experienced horrors as a child, and somewhere in my conscious mind, I know that these damages will not happen to our children as long as he is present. He’s got just the right amount of crazy in him to ward off predators. I truly believe that he is greater than the sum of his parts. I’m also terrified of him relapsing if we were to become separated. I have fearful images of him with a needle stuck in his arm in some gas station bathroom. Some might think that’s overly dramatic, but unfortunately I have come to learn that was the reality he lived.

I’m terrified. I don’t want to make a mistake and hurt my children in the process. I also don’t want to continue accepting this. I have absolutely no interest in dating. My therapist says that I’m a smart, beautiful, athletic woman who struggles with self-confidence. I am finishing up a second bachelors degree and moving into a lucrative, high-demand career. I came from a chaotic upbringing permeated with abuse, abandonment, alcoholism and drug use. I was the first person in my family to earn a degree, and I did so on an athletic scholarship. So, why … after all that I have accomplished, is it so hard for me to honor my boundaries and refuse to be manipulated?

I want my marriage to work. I want to be treated with respect, honesty and fidelity. I want my husband to be financially secure, and to pay for the debts he incurred in my name. I want to be able to trust. I don’t feel like I’m asking for too much, but I also feel like he’s either incapable or unwilling to give me these things. I would have hoped that at this stage of his 12-step program, he would have had the ability to tell me the truth. He was given the name and number of a marriage therapist three months ago, and only last week he finally set up the appointment. I had asked him several times if he was going to set up the appointment. I felt that he finally did so to reduce my nagging.

When is it enough? I feel like the vow I took would say, “never,” but I’m now not so sure. I want insight that isn’t my therapist. If you would be willing to share your thoughts, I would be thankful. Just reading this over, I feel so whiney. I feel like I’ve got a lot to be thankful for, and yet I’m still hurting, afraid and confused.

Still Hurting

Dear Still Hurting,

One of the things that will probably come up in your meetings with the marriage therapist is how you feel about the pace of your husband’s change, and how hard it is for you to accept his continuing habit of dishonesty.

Your husband’s habit of withholding information and hiding things can change. But it will take time. Perhaps the therapist can help the two of you with that. Perhaps there are ways you can get on a timetable where at least you see progress.

After all, I detect progress. He indulged in an old habit but then he came to you and admitted it. Before, he used to hide things and never tell you. Now he hides them but eventually tells you. That’s progress. It’s not perfection, but it’s progress.

One achievable goal would be to shorten the lag time between when he tells a little lie or hides something from you and when he tells you about it. Ideally, he will practice the 10th step daily, which says, “Continued to take personal inventory, and when we were wrong, promptly admitted it.” Perhaps you could agree upon this as a goal in your marriage. He might eventually find that he can stop himself before he lies. He might start to tell you a lie, as his old habit indicates, but then stop and say, No, I’m going to tell you the absolute truth.

Of course, there will be times when you do not want the absolute truth. It will take time to find a happy medium, and to begin to observe decorum while also being honest.

By the way, it’s great that you are going to Al-Anon. When an addict recovers, it affects the whole family.

Speaking of family, you say, “So, why … after all that I have accomplished, is it so hard for me to honor my boundaries and refuse to be manipulated?” If it helps any, I would like to suggest that one’s life accomplishments do not change one’s fundamental orientation toward the world. If we grow up in households that condition us in certain ways, that conditioning persists. It can be changed, through conscious work in therapy and in groups. But it takes time to change. It is embedded deeply in us. And no matter how well we do in other spheres of life, we retain our conditioning.

Like they say, “sometimes quickly, sometimes slowly.” That’s how it works.

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