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