The Silences of Our Work, Part II: Trauma

Editor’s Note: Today, Points brings you the second in a series of posts on silencing and substance use by Heather Sophia Lee, PhD, LCSW, an Assistant Professor of Family Medicine and Community Health at Rutgers’ Robert Wood Johnson Medical School. You can read the first installment here.

I chose to focus my time as a guest blogger on Points focusing on the Silences of Our Work because, in the academic spaces in which I exist, I am most frustrated by what goes unsaid. The gold standard of “science” calls for ignoring certain variables, so that other variables may be tightly controlled. Our work is silenced by design.

Trauma figures prominently in the lives of many of our clients and their relationship to substances, but is often silenced in our work. I don’t mean that everyone who struggles with alcohol and other drug use has experienced trauma– but many people I’ve worked with have, yet the existence of trauma is largely unacknowledged in mainstream discourse about substance abuse in the United States. In my qualitative interviews and clinical work with participants of harm reduction programs, trauma frequently plays a role in participants’ narratives about their relationship to alcohol and other drugs. Yet in the discourse about these clients, trauma rarely enters the conversation. The “why behind the what” is absent.

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The Silences of Our Work, Part I: A Preface

Editor’s Note: Points is delighted to welcome Heather Sophia Lee, PhD, LCSW, an Assistant Professor of Family Medicine and Community Health at Rutgers’ Robert Wood Johnson Medical School. Lee is a practicing clinician and qualitative researcher who studies how stigma influences access to health and social services. Today, Lee opens her series on silencing and substance abuse with a reflection on her relationship to this work.

Some months ago, Points co-founder Trysh Travis read an article I published about integrating harm reduction and twelve step approaches to treatment, and asked how I became interested in addiction research. My answer: I began observing addiction and recovery long before I learned to study these processes systematically. I was born into the witnessing of addiction; it began with my father’s struggles and untimely death when I was nine years old.

This experience exposed me to the scripted language of recovery at an early age. But I’d argue that, even for people without this early formative experience, the scripts of addiction treatment and drug policy manage to shape the psyche. I’ve witnessed many contrasting cases in which the dominant response model to drug and alcohol issues (i.e., punitive, abstinence-based, and informed by an explicit set of assumptions) failed to meaningfully reach those in need of help.

Later, as a clinician-scholar, I believed there must be a better way to engage those in need of help and began exploring alternatives. I acknowledged that the dominant model does reach some people– but it fails to reach most people, and that was the population I wanted to engage. As I reflect on my personal and professional experiences, I think my work has been driven by something deeper and less tangible than clinical efficacy: the greatest injustice in treatment practice and scholarship is the silenced voices of those who struggle with addiction. I also believe that by facilitating space to desilence those voices, we will learn about our failings and be better able to help those who struggle with substance use and misuse in this country.

Image via Harm Reduction Coalition (harmreduction.org)

Image via Harm Reduction Coalition (harmreduction.org)

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Has LSD Matured? The Return of Psychedelic R&D

Editor’s Note: This post was written by Lucas Richert and Erika Dyck, and was originally published on The 2×2 Project, an online journal from Columbia University’s Department of Epidemiology.

In February 2014, Scientific American surprised readers with an editorial that called for an end to the ban on psychedelic drug research and criticized drug regulators for limiting access to such psychedelic drugs as LSD (Lysergic acid-diethylamide), ecstasy (MDMA), and psilocybin.

A few months later, Science further described how scientists are rediscovering these drugs as legitimate treatments as well as tools of investigation. “More and more researchers are turning back to psychedelics” to treat depression, obsessive-compulsive disorder, various addictions, and other categories of mental illness.

Historians of medicine and drugs have long held a view that psychoactive substances conform to cyclical patterns involving intense periods of enthusiasm, therapeutic optimism, critical appraisals, and finally limited use. The duration of this cycle has varied, but this historical model suggests psychedelics are due for a comeback tour. It was just a matter of time.

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The Islands of New York City: How a Real Estate Boom is Turning Former Homes of Crime and Contagion Into Boho-Chic Living—Except for One Tiny Island Off the Bronx (Guest Post)

Editor’s Note: Today’s guest post is a is a modified excerpt from Jessica Diller Kovler’s upcoming book, The Boys of the Bronx, to be published in 2015. Kovler is part of the History of Science program at Harvard University and currently teaches at John Jay College of Criminal Justice, the City University of New York. Her work has appeared in The New York Times, Forbes, and Discover magazines. 

In my city—which, as you may have heard, doesn’t sleep—some nonetheless lethargic neighborhoods have had an awakening of sorts. Many New Yorkers are forgoing the bustling city centers for the far-flung shores of Manhattan as well as some of the city’s 41 adjacent islands, neighborhoods previously considered “The Devil’s Stepping Stones.” (Legend has it that indigenous New Yorkers chased the Devil across the waters of New York, and every time the Devil stepped down on the water, an island was born.) These areas were so removed from the grid that they were used to house the city’s derelict, destitute, profligate, and banished—drug addicts, criminals and those deemed too mentally or physically ill, or even too dangerous to live in “mainland” New York City.

Take Roosevelt Island, where Nellie Bly penned her work on the infamous Woman’s Lunatic Asylum; that island is now home to luxury rentals, with Cornell University planning an extension campus for 2017. Randall’s Island and Wards Island, home to cemeteries, asylums, and contagion hospitals, are now home to Little League games and the Electric Zoo festival.

Amidst this transformation, one island has been forgotten, though thousands of New Yorkers have (reluctantly) called it home. The last inhabitants of North Brother Island comprise a lost chapter in the story of urban institutionalization, a faded memory of a city grappling with a perceived epidemic of both juvenile delinquency and adolescent narcotics addiction. Now abandoned, its buildings fading behind overgrowth, the island nonetheless reveals why New York institutionalized drug-addicted teenagers, even as a nationwide movement towards deinstitutionalization was beginning to gain momentum.

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Recent News Roundup: The Sobriety Coach Edition

Twelve-step sponsorship is so twentieth century—or so The New York Times would have us believe. In an article published last month in the newspaper’s Fashion and Style section, author Marisa Fox made the case that “recovery coaches,” “once consigned to Hollywood entourages to keep celebrities on the straight and narrow,” are currently trending among upper-class women “from the Upper East Side to the beachfront homes of Boca Raton.”

Last weekend, NPR’s All Things Considered followed the trend, offering a more inclusive description of recovery coaches’ clientele (the stock image that accompanied the report was still a view from the beach).

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Diane Diederich/iStockphoto featured on NPR.com

The historical angle adopted by both news outlets was obvious. The old-fashioned practice of sponsorship—defined by Alcoholics Anonymous as the process by which a person “who has made some progress in the recovery program shares that experience on a continuous, individual basis with another alcoholic who is attempting to attain or maintain sobriety”— presents shortcomings in today’s treatment marketplace. The women featured in the Times have the ability to buy their way out of the social awkwardness and fear of exposure that twelve-step meeting attendance invites. The NPR piece notes that people in early recovery don’t always gravitate toward the most adept supporters— coaches, who are trained to provide practical as well as spiritual guidance, can help solve this long-standing problem.

Clipping from Hazelden's MORE program pamphlet. The program offers coaching for clients in early recovery.

Clipping from Hazelden’s MORE program pamphlet. The program offers coaching for clients in early recovery.

As historian and clinician Bill White explained, coaches are not sponsors (they don’t do voluntary twelve-step work on “paid time”) and they’re not quite counselors (they don’t diagnose or probe underlying psychological issues). They occupy a new niche in the service economy that employs more than 75 percent of today’s American workers. They are “the new Pilates instructors,” one coach told the Times. They are compensated to be both “cheerleaders” and “beacons of hope,” another told NPR.

Like NPR reporter Martha Bebinger, I think coaches can produce tremendous benefits, both for people in recovery and for the treatment system as a whole. But the proper role of recovery coaches in today’s health service sector also deserves a systemic critique—and not the trolling, “New York Times Style Suction” sort.

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Presenting Terada Shin: The Life History of a Female Drug User in Prewar Japan

Editor’s Note: Today, Points features a guest post by Miriam Kingsberg, an assistant professor of history at the University of Colorado at Boulder and author of Moral Nation: Modern Japan and Narcotics in Global History. (University of California Press, 2013). You can read the Points interview about the book here).

For historians of drugs, user perspectives are often frustratingly difficult to capture. Narcotics consumers generally leave behind few records in their own voice, forcing scholars to rely on the (frequently biased) perceptions of those who come into contact with them: law enforcement, doctors, social scientists, policymakers, etc. In the course of my research on narcotics in Japan and its empire from the 1850s through the 1950s, each of these groups provided critical information. My search for user-authored narratives, however, proved fruitless until virtually the last moment. In 2011, as I was preparing the penultimate draft of my book manuscript, I learned that a collection of documents, formerly inaccessible to scholars due to their poor condition, had been digitized and made available by the National Diet Library in Tokyo. To my delight, I found materials on the Drug Addiction Relief Association [Mayaku Kyūgokai], founded in 1933 as Japan’s first domestic facility for treating narcotics dependence. These sources not only enhanced my understanding of the history of addiction medicine, but also included about twenty life stories by patients, as recorded by doctors at the clinic in the mid-1930s.

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Terada Shin (right) with Y. Masa (a fellow patient at the Narcotic Addiction Relief Association)

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Texas Veterans for Medical Marijuana: Backstory on a “War Without End”

Last week, I attended a panel discussion co-hosted by Texas Monthly and the Baker Institute for Public Policy at Rice University. The subject for debate was a recent article by Bill Martin, the director of the Institute’s Drug Policy Program. “War Without End,” published in the June edition of Texas Monthly, describes how Texas veterans of the wars in Iraq and Afghanistan are successfully self-medicating for post-traumatic stress disorder (PTSD) with marijuana. (Trigger warning: their stories are not easy reading). The decision to opt for cannabis over the antidepressants, sleeping pills, or psychotropic medications commonly prescribed by Veterans Administration (VA) doctors makes these veterans criminals in the state of Texas. Although Governor Rick Perry recently said he plans to “implement policies that start us toward decriminalization,” the Texas Legislature hasn’t budged in recent years. Unlike Colorado or Washington, Texas does not have a ballot initiative or referendum process, so the Legislature is the state’s main route to reform. Majority support from the public and the best efforts of groups like the Marijuana Policy Project and local chapters of the National Organization for the Reform of Marijuana Laws (NORML) have, so far, come to naught.

Enter the veterans. Reformers believe Texas legislators will listen to war heroes, and state Senator Joan Huffman (R-Houston), a panelist at the Baker Institute event, seems to agree. Huffman told audience members that, in her opinion, a focused campaign for medical marijuana legislation for veterans diagnosed with PTSD would stand a better chance of success than broader initiatives aimed at population-wide medicalization, decriminalization, or legalization.

Photo illustration by Darren Braun for Texas Monthly

Photo illustration by Darren Braun for Texas Monthly

 

“When a guy has done four tours in Iraq, like some of our people, and been wounded in action, it’s hard to look him in the eye and call him a slacker pothead,” one veteran and activist told Texas Monthly. This new depiction of the traumatized veteran as uniquely deserving of marijuana does more than challenge the stoner stereotype. It recalls many of the psychological, symbolic, and treatment policy developments associated with the Iraq War’s most frequently cited historical analogue: the war in Vietnam.

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