Brooke M. Feldman

Personal blogging website. Opinions are my own.

I take a deep breath, tuck my chin down, open the door and slip quickly inside.

I hope nobody is in there; I hope nobody comes in.  I glance around anxiously.

The anxiety fills my already full insides.  I hate this feeling.

Maybe this was a mistake.  Maybe I should have just waited.

I feel my breathing change as my heart beats faster.

Hurry.  Hurry up.

I duck into the first available stall and quickly close the door behind me.

I hope nobody comes in.

Hurry.

I rush to relieve myself.  To conduct this necessary biological function that ought not be so nerve-wracking and fill me with fear.

I hear the door open.  The sound of shoes walking across the floor.

I hold my breath for a second, as if the very cessation of breathing will disappear this threat.

I haven’t even seen this person but I fear them.  My fear feels almost like an anger that they have entered this space.

What should I do?

I remain in the stall, barely breathing, paralyzed.

Hurry up.  Not me, I’m done.  Hurry up stranger with the blue shoes.

I wait.  I hope nobody else comes in.

The sound of a toilet flushing brings a moment of relief.

Blue shoes who I fear and therefore do not like despite knowing nothing of her beyond her intruding ankles walks past my stall and to the sink.

The sound of water.

A little more relief.

I hope nobody else comes in.  I ready my escape.

The sound of water shutting off.  Paper towels being pulled from the machine.  Shoes across the floor.  Door opening.

This is it, I have to make a run for it now.

This is it, this is what using a public restroom is like for me.

This is it, every time.

The public perception runs rampant that most individuals receiving public assistance are, as one individual who signed an online petition stated, “scumbags sucking off the system.” If this were true, then I would be a scumbag who sucked off the system 11 years ago. When I was a person struggling with a substance use disorder, I utilized public assistance to meet my basic needs and sustain my life long enough to get the help I needed to enter into recovery. Without public assistance, it’s hard to imagine that I would have made it to where I am today. Although I was a person with a substance use disorder receiving public assistance, the people who knew me would most likely not have described me as a “scumbag sucking off the system.” They more likely would have described me as an individual with a lot of potential who needed some help. Thankfully for not only myself but the people around me, I was able to receive that help, and today have close to 11 years of continuous abstinence from alcohol and other drugs. I am an engaged member of my family, an asset to my community, a taxpaying citizen and an example of what the safety net of public assistance is designed to do. It is imperative that other individuals, families and communities get the same opportunity at life that I’ve had.

Currently there is proposed legislation in the Pennsylvania House of Representatives, House Bill 1380, that is threatening to take that opportunity away from our most vulnerable residents. This legislation seeks to address the misinformed public perception that most individuals receiving public assistance are “scumbags sucking off the system” by imposing drug screening, testing and sanctions leading up to termination of benefits for individuals who may be struggling with a substance use disorder. The proposed policy is poorly thought out and does not take into account the nature of the illness it proclaims to be addressing. The policy as proposed also would hit taxpayer pockets hard, with other states having experienced costs of up to $77,000 to “catch” just one illicit substance user and 11 states having attempted and aborted similar policies (Drug Policy Alliance). Even with considering that there is some benefit to screening for substance misuse and facilitating treatment options for those who need it, House Bill 1380 is by no means the smart and sensible way to get at this. If we want a fiscally sound way to assist more Pennsylvanians with having the opportunity at life that I’ve had, we need to tell our Representatives to invite stakeholders and those affected to the table and aim to construct a policy that makes sense. If we want a better Pennsylvania, we need to address this issue with compassion, understanding and science. Those “scumbags sucking off the system” are our family members, our neighbors, our community members and some of our state’s greatest assets. I’m not a scumbag – I’m living proof of the many who have gotten a chance at life.

 

 

For a long time, our nation’s behavioral health care systems have been focused on treating people after they become unwell.  It has sort of been like waiting for the leaves to begin falling off of a plant before rushing in to provide any nourishment or care.  This approach has been problematic in many ways, most notably because there has far too often been an extraordinary amount of unnecessary suffering experienced at the individual, family and community levels when a person is not treated until acutely unwell.  We know that the longer an illness progresses, the more difficult it is to treat and the more severe the adverse impact on an individual’s life becomes.  A close second in terms of this approach being problematic is the financial cost – the United States spends more money on healthcare than any other country in the world yet ranks the lowest in terms of positive health outcomes in many categories.  It is clear that the current way of doing behavioral healthcare in our country is not working – so what do we do about it?

If we continue to use the analogy of a sick plant, our current paradigm is situated perfectly to wait for a plant to become unwell, remove that plant from its soil and then place it into an expensive incubating environment for treatment.  Unfortunately, this incubating environment is not designed to treat all of the different kinds of plants that exist in the world and additionally, many plants are unable to gain access to these incubating environments.  For the plants that are privileged enough to gain access to and receive individually relevant treatment in an incubating environment, sometimes there is growth and signs of getting better.  The plants become a little healthier and then are removed from the incubating environment to be placed right back into the soil from which they came.  Also unfortunately however, the very soil from which the plant initially came was never treated – it is still the same soil which failed to nourish and sustain the plant to begin with.  As a result, even those plants that gained access to and experienced improved health from treatment received while incubated will often go on to become unwell again a short time after being placed back into the same untreated soil.  Our current paradigm treats the plant, not the soil.  We must shift to begin to treat the soil at the same time as the unwell plant.

Treating the soil to sustain returning plants that have become unwell is not enough though.  We need to go a step further.  We need to nourish the soil and pump it full of the nutrients needed to prevent plants from becoming unwell to begin with.  In this regard, our current behavioral health systems need to shift to serve as greenhouses of sorts.  With the knowledge that lifestyle and environmental factors are responsible for 70% of good health outcomes, there is no reason why behavioral health systems should not move toward fostering improved access to these positive social determinants of health.   Additionally, with the knowledge that many behavioral health challenges have known risk factors and early warning signs which make prevention and early intervention a very real possibility, there is no reason why behavioral health systems cannot move toward fostering environments equipped to respond early.  If we are truly to see any significant changes in positive behavioral health, our systems need to serve as greenhouses in which good health is promoted and sustained, early warning signs of becoming unwell are detected and addressed, and the environment is made rich with the nutrients of resources and supports needed for all inhabitants to maintain good behavioral health overall.

I am a huge fan of the Office of National Drug Control Policy’s (ONDCP) Director Michael Botticelli and hold both him and the transforming ONDCP agency he leads in the highest regard.  I could write endlessly on what an amazing recovery advocate and ally we have found in Director Botticelli and the ONDCP’s recovery-oriented approach to addressing the nation’s substance misuse challenges.  To that end, what follows is in no way an attack on Director Botticelli and the ONDCP but more so a challenge to the substance use disorder prevention, treatment and recovery field – this is directed at the practitioners, advocates, individuals and family members in recovery, researchers and educators who all share the common goal of making prevention, early intervention and recovery from a substance use disorder more accessible and available to all.

Currently we see a debate raging on regarding the legalization of marijuana.  This debate has been supercharged in recent weeks by Director Botticelli’s reiteration of the federal government’s stance on opposing the legalization of marijuana as some states have moved toward legalization.  Director Botticelli cited the ideas of marijuana as a “gateway drug”, young people having a low perception of risk regarding the use of marijuana and research that supports the dangers of marijuana use on the developing brain as some of the core reasons for opposing legalization.  Many experts and advocates are in agreement and see the legalization of marijuana as potentially increasing use among youth.  Many other experts and advocates disagree and see this as a step backwards in what has been forward momentum around decriminalizing substance use and substance use disorders.

While I do not pretend to know the best direction to go in, I do believe there are some aspects of this debate that are important for all of us to consider.  As a person in long-term recovery from a substance use disorder who has utilized an abstinence-based pathway to recovery for close to 11 years, I recognize that for me personally, using marijuana – whether it is illegal or legal – is not something that is in the best interest of my recovery and therefore not something I can engage in.  Just like the act of indulging in the currently legal substances of alcohol, tobacco and McDonalds cheeseburgers is not in alignment with the practices I need to maintain my health and wellness, marijuana is in the same boat.  Moreover, I can recognize that my abstinence from alcohol, tobacco and McDonalds cheeseburgers is what remains the best practice for me personally while not imposing my personal needs and choices on other people.  Millions of individuals can use these substances and eat a cheeseburger afterwards without it moving into problem use or a substance use disorder.  I just happen to not be one of them.  I do not need to oppose other people’s use of these substances just because it would not be a good idea for me and many of my friends.  I recognize that many of my friends and I, despite sometimes living in still siloed recovery systems that do not allow for us to see it, are actually in the minority when it comes to this need for abstinence only.

In addition to the idea that abstinence from marijuana is not the goal of nor necessary for more individuals than not, another point to consider is the following.  Alcohol, a legal drug and the most deadly, has seen a steady decline among youth and was actually used less than marijuana among 8th graders in 2014 according to the National Institute on Drug Abuse.  The use of tobacco, another legal and the second most deadly drug, has also steadily declined among young people. The idea that legalization increases use falls flat when we look at steady decreases in the use of these two substances.  Perhaps we ought to explore more how education and prevention efforts may have aided in this decline and how these efforts can be enhanced and more effective when substances are in fact legal.  At the very least, the data shows that marijuana use among youth is already happening at a rate higher than that of legal substances, so keeping marijuana illegal doesn’t seem to be working out too well for our nation’s young people.

To reiterate, I do not pretend to know the answer as to whether the legalization of marijuana would increase or decrease use among youth.  I believe more unbiased research is needed and there is much to consider.  What I do know however is that we have a lot of evidence showing continued decreased use among youth when it comes to legal substance use with increases in illegal substance use.  I also know that we have a lot of old thinking still pervading how we approach this issue and that some of us who subscribe to and apply the abstinence-based pathway in our own lives have difficulty seeing other possibilities outside of only abstinence. Ultimately, for those of us who practice, advocate, educate, shape policy around and aim for change in the area of substance misuse, I only propose that we step back for a moment and think more openly, critically and broadly about the idea of legalizing marijuana use.  We owe it to our young people to be doing just that.

The act of openly sharing one’s recovery status with the world around them allows for some of the most extraordinary of things. When those of us in recovery talk or write about our journey through and past the difficulties associated with mental health and substance use challenges, we are then able to serve as beacons of hope and visible guideposts for others who seek to do the same. It is most certainly one of the highest acts of selfless service; to be willing to disclose that we have experienced illnesses and challenges that are still so highly stigmatized and discriminated against takes courage, guts and a willingness to be vulnerable. In sharing ourselves so candidly, we help to shatter stigma, strip away shame and stomp on the sordid idea that recovery is not possible.

There are many times that I’ve been called an inspiration as a result of my own candor regarding my recovery journey. For me, this is the most humbling of adjectives and one that I have always felt privileged to show up as in the world for others. The idea that some of the most painful experiences of my life are now used to serve as a light for the world is one that brings personal fulfillment and a deep level of gratitude. I am tremendously appreciative of the opportunity to serve as an inspiration, however I also recognize that there are certain responsibilities that come with carrying that adjective. One of the responsibilities, for instance, is to always remember for myself and to inform others of the reality that my recovery is largely as a result of many factors for which I cannot take credit. Some of these factors include access to resources and supports that I had while so many others are literally dying to have. Another responsibility when being called an inspiration is to share the whole story – not just the neatly packaged pretty parts but the entire barrel of all that comes with it. If I tell you that you can accomplish something because I have, but do not tell you all of the obstacles and barriers I have experienced while attempting to accomplish it, am I really doing you a fair service in the end? It is therefore important to authentically share the challenges along with the successes if we truly wish to serve as guideposts for others seeking to do the same.

To that end, it is important to share that recovery is messy, just like being human is messy. With nearly 11 years in sustained recovery, I can tell you that for me, there are still some days when the idea of continuing on in life can be overwhelming and scary. There are still many instances in which I struggle with depression, insecurities, feelings of unworthiness, bad decision making, fear, loneliness and a multitude of other challenges. There have been many times when not using alcohol or other drugs has been replaced by an astoundingly creative wide variety of other self-destructive things. There have been many occasions when a Taco Bell drive-thru served as the cop-man or self-pity surfaced regarding all of the things in this world that I cannot indulge in. For every monumental milestone, awesome achievement and inspirational impression, there are equal amounts of hard work, mistakes, struggle, falling down and getting back up, lessons learned and opportunities for improvement.

The beautiful thing is, recovery still happens. In all of our humanity and with all of our imperfections and flaws, when we share our recovery journeys honestly, openly and transparently with the world around us, we truly do serve as inspirations. Not as pie-in-the-sky, unachievable, perfectly packaged inspirations but as very human, very real examples of recovery being possible from mental health and substance use challenges, and really, for humanity as a whole. At the end of the day, perhaps the greatest act of service when it comes to being an inspiration is in sharing this: I am human, I am flawed and I still recover…so can you.

We know that any gains made in treatment often plummet and fall apart when communities aren’t equipped with the nutrients of resources necessary to serve as fertile soil for continued recovery.

Whenever a public health crisis cascades upon us, it is natural that we grasp at the quick fixes and shiny objects that capture our attention. As history has shown us however, these sort of responses rarely yield long-term success and can instead result in a slew of unanticipated consequences that further compound the concern. With increased attention and a much welcomed sense of urgency emerging when it comes to addressing substance use challenges in this country, it is important that we continue to think globally on the issue and not settle for narrow and insufficient resolutions.

One area in which we can direct our focus is in the public perception that treatment is the be-all and end-all solution to addressing substance use challenges. While access to evidence-based, clinically sound, culturally appropriate and readily available mental health and substance use treatment is of extraordinary importance, access to initiating and sustaining recovery is something that extends far beyond merely access to treatment. We must take care to remember, as well as to educate others, that increasing access to treatment in and of itself is far from a comprehensive response to facing addiction and facilitating recovery.

Treatment is but one pane on the larger recovery umbrella that encompasses all of the resources and supports an individual and their family may need to initiate and sustain recovery.

Although it is true that for many folks, having immediate access to quality treatment is an instrumental ingredient in their wellness and recovery journeys, we must not forget that long-term community-based recovery support services are just as influential and necessary when it comes to sufficiently addressing substance use challenges in this country. As a matter of fact, long-term community-based recovery support services that offer peer support in the areas of employment, education, housing, life skills and more are a vital and critical resource if we are ever to see true, lasting opportunities for individual, family and community recovery.

As we continue to advocate for a large-scale response to our country’s large-scale substance misuse and associated costs problem, it is imperative that we do not settle for anything less than what is truly necessary for individual, family and community recovery. While we certainly ought to continue assertively advocating for much needed improved access to quality treatment, we must also speak just as loudly to the need for increased and improved community-based recovery support services.  We must not settle for narrow and insufficient resolutions.  We must not forget about the soil.

The irony is never lost on me when I am engaged in a conversation with a person in recovery who, between deep puffs of a cigarette or long sips of their sugar-filled cup of coffee, believes that the use of medications such as Methadone, Suboxone or Vivitrol excludes a person from being able to identify as being in recovery. If you’re smoking a pack of cigarettes a day or consuming caffeine like it’s your day job but claiming that a person using prescribed medication as part of their treatment for substance use disorder “isn’t clean”, your stance is problematic at best, hypocritical at worst.

Caffeine and nicotine are both stimulants.   They are both addictive, mind and mood-altering substances. In fact, smoking is the number one cause of preventable death in this country. So to be using these drugs while stigmatizing, ostracizing and alienating individuals who are utilizing prescribed, evidence-based medication as part of their recovery journey is both foolish and harmful.

There are many pathways to recovery and many definitions of what that means for a given individual. While for some, certain medications may have been misused in the past or the use of them is not a strategy we would choose for ourselves, that does not mean we should impose our beliefs on others. And while for some, choosing to use the most harmful drug in the United States is not something we believe excludes us from identifying as “clean” or in recovery, we all ought to allow each and every individual to identify for themselves what recovery means for them.  With drug overdoses being the number one accidental cause of death in this country, the time is now to be more inclusive and welcoming than ever.

“If we truly believe that addiction is a serious health problem, then why do we continue to have departments and centers of substance abuse?” – William L. White

Language is extraordinarily powerful. As our understanding of substance use disorder has continued to grow with research and a greater recognition of the need for better policies to address substance use disorder has continued to emerge, there is no time like the present to revisit the critical and long overdue act of adjusting our language. Not only does our language need to be adjusted within the discourse of our individual conversations; it needs to be modified in the names of the very institutions charged with leading the way.

As renowned addiction recovery author William L. White has written, “Of all the words that have entered the addiction/treatment vocabulary, “abuse” is one of the most ill-chosen.” The term abuse “has long implied the willful commission of an abhorrent (wrong and sinful) act involving forbidden pleasure” and “has also come to characterize those of violent and contemptible character–those who abuse their partners, their children or animals.” To include such a stigmatizing and shaming word in our conversations about substance use disorder is to continue to frame addiction as a moral failing on the part of an individual rather than a preventable and treatable health condition with multiple biological, sociological, psychological, cultural and environmental factors. To include such a stigmatizing word in the very names of our nation’s leading organizations charged with addressing substance use disorder is perhaps even more harmful as it continues to perpetuate this misconception at the highest levels.

When I look at some organizations funded by my tax dollars such as the federal Substance Abuse and Mental Health Services Administration (SAMHSA), Pennsylvania’s Office of Mental Health and Substance Abuse Services (OMHSAS) and the National Institute on Drug Abuse (NIDA) – the last of which actually uses the web domain of “drugabuse.gov” – I can’t help but feel compelled to demand better. If our nation’s leading organizations that are tasked with addressing the health condition of substance use disorder continue to use the word “abuse” in their agency names and website addresses, how can we truly expect the general public to move its language and perception of substance use disorder away from the idea of abuse?

Change is possible.

In my city of Philadelphia, our publicly funded behavioral health system used to be called the Philadelphia Department of Behavioral Health and Mental Retardation Services (DBHMRS) prior to advocates at the national level demanding the removal of the stigmatizing word “retardation.” These advocates in the intellectual disability arena successfully asserted “that the term “mental retardation” has negative connotations, has become offensive to many people, and often results in misunderstandings about the nature of the disorder and those who have it.” Shortly following the implementation of a 2013 federal rule requiring that the word “retardation” be replaced with “intellectual disabilities”, Philadelphia, under the leadership of Commissioner Dr. Arthur C. Evans, changed the name of its publicly funded behavioral health system to the Philadelphia Department of Behavioral Health and Intellectual disAbility Services (DBHIDS). Not only was there a swift change to abolish the word “retardation” but a special emphasis was placed on celebrating the strengths of individuals living with an intellectual disability by making the “d” a lowercase “d” and capitalizing the “A” for the word “disAbility.” Witnessing this extraordinary act of leading by example take place in my city served as proof that with a little advocacy and some public will alongside strong leadership, a small but powerful name change is possible for any organization or bureaucracy.

The time is now to see this symbolic act of leadership take place at the national level when it comes to language surrounding substance use disorder. The time is now that we, those of us who pay for these agencies, demand to see this change. The time is now for our nation’s leading organizations on substance use disorder to alleviate the very word that continues to perpetuate the idea that substance use disorder is anything less than the health condition they are charged with addressing. The time is now to get rid of the word “abuse” for good.

For many of us in recovery from a substance use disorder, we often cite our devastating experience with substance misuse as the catalyst for self-discovery and the facilitator of our own personal awakening.  We frequently refer to our experience with substance use disorder as a beautiful blessing borne from a horrific curse.  Even those of us who would not identify as spiritual or religious can be found regularly expressing this concept in terms of simply stating that we were catapulted into becoming better human beings.  Somehow, being touched by substance use disorder turned out to be an experience that led us to seek out who we really are and how we can continuously improve the ways in which we show up in the world.  Consequently, not only do we experience an enhanced way of living ourselves but the world around us is exposed to all of the benefits that this enhanced way of living brings.  We become better partners, siblings, parents and children.  We become more engaged and productive members of our workplaces, communities, cities and towns.  We show up as change agents in the world as we take our own personal transformative experience and use it to transform the world around us.

Some say that the human tendency to attach meaning to life events is more of a primitive brain response developed for our species survival than a spiritually significant signpost in our search for who we really are.  Others say that the inclination to find meaning in life is by no means a mere biological function of humanity and that it instead may be the most important act we undertake as human beings.

As I’ve grown over the years, I’ve concluded that both schools of thought can co-exist as correct.  I’ve married the two concepts by considering that perhaps my very survival is hinged on my ability to seek out who I really am and where I am meant to be in this world.  I’ve decided that the profound sense of purpose and fulfillment resulting from finding meaning in life events is in fact a positive thing and a magnificent motivator.  I’ve recognized that finding meaning in life events greatly enhances my experience of life and therefore makes the search for meaning a philosophy for living that is worthwhile to employ.  My life is far richer when I pay attention to the signposts and follow the path to which they point, regardless of the origin of my ability to recognize them and the source of my drive to follow them.  Interestingly enough, I have also found that how I show up in the world for others is significantly enhanced when I follow the road laid out by attaching meaning to life events.  It is fair to conclude that not only is my own experience of life enriched by finding meaning but that how others experience me in their lives is enriched as well.

My experience with substance use disorder, and my ability to have access to what I needed to initiate and sustain my recovery, is a life event from which I find much meaning.  There are countless ways that I have been transformed as a result of this experience, and there are just as many ways that the world around me has been transformed as well.  The ripple impact of one person being able to find recovery and go on to live an enhanced life is immeasurable.  The wave of positive change that one transformed human being can bring into the world is endless.

Whether it is a silly biological tick of the brain that leads me to find meaning or a deeply spiritual alignment with something greater than myself, all I know is this: my ability to find recovery from a substance use disorder has transformed me into a better human being that has in turned transformed the world around me.  When I think of the endless wave of positive change that one individual finding recovery can cause to swell up, I can’t help but think of what the world would look like if we had more of these waves unleashed to cascade through our homes, communities, cities, states, countries and the world.  I can’t help but search for the signposts that point toward the floodgates.

The world needs the transformation that recovery brings.

Although history has shown us many examples of the oppressed becoming the oppressor, the emergence of this human habit in the addiction recovery communities is one that raises great concern.  Infighting within any social change movement is a common, perhaps even necessary stage, but when people’s lives and well-being are at stake, it seems to me that we ought to shorten this period by taking a step back to regroup and unite.  In addition to there being a clear urgent need to break down all silos and any either/or approaches to recovery, the strengths and skills of people in recovery make us ripe to tackle this human habit with a grace that could be a model for the world.  It is time that we lead the way.

The bottom line is this: there is no one recovery pathway, resource or strategy that works or doesn’t work for everybody.  No resource ought to be excluded if it works for even just one individual and their family, as should none be forced upon those for whom they do not work.  Whether it is Alcoholics Anonymous, SMART Recovery, Women for Sobriety, Lifering, Overcomers Outreach, Millati Islami, Narcotics Anonymous or any other mutual aid group, there is a place for them all. Whether it is Cognitive Behavioral Therapy, Motivational Enhancement Therapy or Family Behavioral Therapy, there is a place for all evidence-based treatment interventions and promising practices. Whether it is abstinence-based, moderation management, medication assisted or reduction of use, there is a place for all approaches to recovery. Whether an individual initiates and sustains recovery naturally, with no treatment or mutual aid support, or an individual initiates and sustains recovery with a high level of treatment and mutual aid supports, a path ought to paved and room made for any possible course of action an individual selects as best for them.  In order for more people to have access to recovery, we need all of our existing options and alternatives to be equally accessible and supported as we continue to seek out even more.

For those of us who find ourselves fanatical about one particular pathway or overly zealous in our slandering of another, it is time that we do some personal soul-searching about the origins of our attitudes, ideas and beliefs.  For those of us who demonize a particular resource or deny its validity for those whom may have benefited from it, the time is now that we take stock of the possible harm we may be causing.  One recovery pathway will work for one person while another pathway will work for somebody else, and there is place in this world for both paths – for all paths – to coexist peacefully with a little bit of the open-mindedness, ego-management, acceptance, tolerance and love that many of us in recovery have learned to practice.  It is time that we lead the way.

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