Rock Bottom ... and Other Lies
so this past winter i was asked to speak
uh on the top of
of addiction say a topic i i know well
i worked in it as a ceo of the local
agency for
the last 10 years and i have my own
struggle with
mental health and addiction and so the
original talk i was gonna
to give you um really focused in on that
focused uh
you know i know how these these talks go
um you hear a little bit about my
background
with those struggles i tell you some
anecdotes about
crashing a car spending a night in jail
about living in chicago in my 20s
running from pain waking up
next to women that i forgot meeting
actually in my case more more honestly
was waking up with half-eaten burritos
that i don’t remember buying
but since that time
that was five months ago and the world
has changed
and so the context of my talk changed
we’ve met a pandemic that
has completely changed the world so i
spent the last 10 years of my career
running up and down the halls of our
state capitol and even washington dc
yelling fire to anybody that would
listen to me
and not that we’ve been traveling lately
but had i been in those halls now
i don’t think i’d be yelling fire i
think i’d be politely opening the door
and saying come on in coronavirus this
is your time now we need to figure you
out
oh excuse me black lives matter didn’t
see you coming
but i should have so in a matter of a
number of months
this pandemic has halted our world
economy
devastated millions of lives
and has the world scientists working on
on cure and treatment then just a few
months later the black life
matter movement comes to fruition
and is right now the largest
social justice movement in the history
of the world
that’s all just happened folks and so
how do i talk about addiction
when this was the most important public
health
uh crisis in our country uh in the in
that context
and we see that those public crisis
are are having effect we see
what’s happening in science and we’re
going to figure this out
we also see with the black lives matter
movement things are starting to change
some some really odd things
nascar banning a confederate flag elmo
talking to our kids
about the protests
but the most significant thing that’s
happened i think in my mind relative to
this
is that we’ve named these things uh in
particular racism and systematic racism
a public health crisis
cities across the country are naming
that a public health crisis
and i think that’s significant for us as
health care professionals as we think
about
rethinking health we’ve now elevated
that
to a
to a status that that
matches hiv and aids in the 80s suicide
gun violence and yes addiction
because i think one thing that we have
seen
through both of these pandemics is that
health outcomes for folks of color are
horrific
and i think for a lot of americans for
the very first time
we’re seeing an impact of that disparity
on peoples of
people of color and it’s not just
uh covet so in the state of michigan
with 14 of the population
being black 40 of folks dying
are black and that’s not just about
covet that’s about those underlying
conditions
that are complicating uh the
mortality rates for covet so
it is a public health crisis regardless
of political
uh i know this is a hot topic and
it’s uh but it is a public health crisis
and so that brings me back to a little
bit of
where my talk was to talk about public
health crisis and what is a public
health
crisis what is a public health strategy
well the public health strategy first
really is naming a thing identifying a
thing
so that we can get our head around it
and put strategies in place
to to make sense of that thing
and that thing is something that we’ve
identified as having a
significant negative impact on a
population
so i know that i know that well for the
field that i work in
and so we also look at
if we look at these two new epidemics
the the kova 19 pandemic that’s a little
clear to understand from public health
strategy
we have scientists working on the issue
we have
uh treatment vaccines we know to wear
our masks we know about hand washing
yesterday i just read i better shut the
toilet lid um
now to uh mitigate the the spread
so we’re learning that’s a public health
strategy that’s clean we understand it
racism less so that one’s pretty messy
and again i acknowledge that that is a
messy topic
but by definition it is a public health
strategy
and that’s significant because
the way we need to think about public
health strategies is that they do not
live in isolation they are not
strategies in isolation
um they they cross
they intersect so if we take a there’s a
public health strategy in this country
around obesity where a third of
americans
are obese and uh the work that we do
there affects
other public health strategies like
diabetes which is another crisis in our
country
and and those interplay with each other
and have positive effects on other
things like
like blood pressure so it’s important to
bring it up
i think and to acknowledge
that addiction is one of those public
health strategies
and why i think it’s important is
because it’s really hard to talk about
addiction
and how we manage addiction in this
country
without acknowledging the negative
impact it’s had
on people of color
but i think the other reason to talk
about it is that for the first time in
40 years which is essentially the
time frame of our field we we believe
i’m
i’m an optimist i think we are on the
cusp of not only
now that we’ve identified a public
health strategy but that we are actually
going to
implement that public health strategy
we’re inching closer to it
in addiction
but it sure feels different now we’re
wondering whether we still have
the right even to have this conversation
and whether we have enough wind in our
sails to to to
get done uh and further the work that we
already have
my field’s an interesting thing because
we have lots of opinions
there’s leaving work the other day and
somebody you know i was a little
disheveled and said man this is tough
work right now and you know i got the
let’s fake it fake it till you make it
um it’s a popular adage
um we you know we i’ve been told that
because
i’m not involved in a 12-step program
that i’m not really in recovery
we have folks that believe that if you
take a drug to help your
a prescribed drug to to help your
addiction that you’re not really
in recovery folks have their own
pathways and they belie believe in those
and we mostly allow for that but one
thing that we’ve
really done in the last few years that i
think i’m proud of
is that we have really honed in on that
definition
of what a public health strategy is for
our field so i want to name what those
are
we understand now that the neurobiol
biology of substance use misuse in
in addiction we understand that this is
a brain disease
the science is clear the evidence is
there we know it we understand
it it’s not for debate we know that
prevention programs and policies work
we can keep people from getting addicted
we know that we have the evidence
and we’ve agreed on that as a collective
we know that early intervention and
treatment
are possible so if somebody does become
addicted we do not have to wait for them
to get really sick we can early we can
have early intervention
and that we can have better treatment
and that when they post treatment we can
help people and manage them we can we
can do that
and that the data shows us that
there’s many pathways to recovery
there isn’t just a singular way and at
the health care system
and substance abuse system have to work
in concert with each other
we realize that now for 40 years we
essentially said
as as a field we got this we’ll take
care of our own we understand this
but the fact of the matter is despite
the focus on opiates right now
in the opiate epidemic which is a
sub-epidemic of our addiction epidemic
addiction rates have not changed in this
country in those 30 years we are still
as addicted as we ever were
despite seeing some gains yes more
people are dying because the
drug of choice in this moment is opiates
and that’s devastating but we have an
addiction epidemic
so i i say that for two reasons the
first is that i don’t think that some of
that probably jives with folks our
common understanding of what addiction
is and how we treat addiction
and if folks listening to this um
might not get that but the leaders in
our field
and all the data says that is our public
strategy i didn’t make that up that is
what our strategy is that is what our
goals are and we’ve been working towards
that now for a number of years
assume i take a bite out of an apple and
i hold it to you
and ask you to describe that apple
you’re going to describe
red shiny but that’s not my reality
looking at it from this side in the bite
and that’s what this field and i’d say
our new public health the caution for
our new public health crisis is that
that are joining us
is that both realities are valid
but how do we get to see that whole
apple how do we
how do we value that both of those
perspectives are are
are true
we go to our elders we go to our
scholars
and we go to the data and the science
and so um
we have to admit that our field is
lacking the data but we’re doing some
good things
we’re starting pilot programs where we
can learn from each other we’re getting
funding from the feds
to uh to implement strategies that that
make sense based on those public health
strategies that i talked about
and that’s good stuff uh our little
organization is a
is a is an opiate health home so we’re
we’re actually doing primary care for
folks that that are struggling with
addiction and that is significant that
is something we wouldn’t have conceived
of a number of years ago
but the system we have isn’t reflective
of that and the reason for that
in other words the system that we have
in place does not reflect that public
health strategy yet
even though we’re inching towards it and
that’s because of stigma that’s because
of
of uh the biases that we have
one of them is this notion that that
folks need to hit rock bottom
right we know that everybody almost it
like it it’s
it’s hard for us to think that isn’t the
truth but it isn’t
in fact it’s inhumane it’s disgusting
and it’s wrong
it allows us to justify oppression it
allows us as healthcare professionals to
wait
and wait and watch as you get sicker
and then for some people that haven’t
died
we’ll catch you and we’ll help you
we won’t give you any aftercare because
that doesn’t exist so agencies like mine
can’t get
assistance in in really helping folks
throughout that disease process
another bias that we have is that
relapse
is is devastating we’ve seen the slo-mo
videos or the movies right is he going
to take that final drink after the hard
day he’s been in recovery for six months
and we judge when that happens i just
watched a movie the other night where
that was that was it
most folks relapse this is a chronic
relapsing disease but our system is
built around
not having those systems in place if we
had more uh
early intervention we had more
prevention we had held people in a path
of recovery
we would have less death we know that
again the data is there
the criminalization of addiction is
another
just devastating reality
there’s nothing in our strategy that
says addiction is a crime
we understand where this narrative came
from in the war on drugs but it that has
been the
one of the largest public health
failures in the history of this country
and unfortunately now the result is that
the largest system
that manages our mentally ill and
addicted folks in this country
are our prison systems by far
which brings us to the to my last point
that that this is a moral
failure of some sort this is a character
deficit that folks struggling with
addiction
are somehow defective we know that’s not
true the science tells us
that’s not true the data tells us it’s
not true but our systems don’t allow for
that
so i’m interest i mentioned the
intersection between diabetes and
obesity as a simple clean intersect
there’s also an intersect between what’s
happening in the world right now
and addiction work so as a question
what’s our role in this
i challenge our profession that this is
the moment
the world is upside down and it’s not
gonna if you listen to this talk five
years from now this is gonna have
relevance because this is not a
a a quick moving train
when we look for those intersects just
think about what we could do in our
field that would have an impact
on what we’re seeing what if instead of
calling the police on an intoxicated
person instead somebody that looks like
me as a social worker shows up there
and a first responder and we with mental
heal
mental health first aid and we get some
folks some help
what if we didn’t have local judges that
would put people in jail for taking a
prescribed medication by their doctor
to manage their addiction that’s
disgusting
but we allow it to happen what if our
local hospitals
didn’t defund behavioral health programs
but understood the public health
impact that a robust
behavioral health program that treats
mental health and treats addiction will
have on
on public health but we’re seeing just
the opposite happening
what if we tended to the trauma
of people and understood that poverty
understood that abuse understood that
unstable homes
are trauma and we build systems to help
folks manage those
as as desmond tutu talked about let’s
stop picking people up downstream and
figure out why they’re falling in the
first place
what if we embrace harm reduction
strategies that build systems to reduce
people’s harm
or even better yet that we build systems
that don’t cause that harm in the first
place
what if we agreed that life has value
and that we need to treat people when
they’re struggling we need to
identify that
what if we didn’t automatically keep
drug users from voting
what if organizations like mine were
empowered to do early intervention
and to do after treatment so that we
could keep people out of the system
my system instead of incentivizing that
they embrace my system and come back to
my system and we wait for you to come
back
what if we educated the public about the
things i talked about what addiction is
and isn’t
it would change our whole narrative
because what we believe about a thing
what we believe about a thing is is the
start of how we policize it
and how we build interventions around it
so that belief system has to change
we are at a moment in time where we’re
defining that
we have a path we have a plan in our
field
the public health crisis of of
systematic racism there’s no plan yet
but we understand that the things that
we do
in our field this is a call to action
this is a once in a generation once in a
lifetime opportunity as the world is
upside down
for us to step in and make a positive
difference
and that’s not an understatement i
believe that strongly
we have an opportunity to have a public
health impact
that is like nothing we’ve ever seen
before
and i’m not trying to to give you an
exhaustive list
um those are just examples and those are
examples of things that are already
happening that we’re learning from
so they’re real if you don’t believe the
intersect
of addiction and what’s happening
right now in our world let’s go back to
the murder of george floyd and what the
other officer
said during that time to the crowd of
onlookers
don’t do drugs kids this is a moment in
time where we get to
redefine what health care looks like
what addiction care looks like in our
field
and for the first time i believe ever
we can say that the disproportionate
impact that this has on the people of
color
is a good thing
so i hope we can seize this moment thank
you