How Harm Reduction Can Help Combat Our New Overdose Crisis

Harm reduction is essential to recovery.

Every month, I sit in on a call with county providers here in Portland, Oregon. I’m a program manager for an agency that provides peer support and recovery mentorship for people struggling with mental health conditions and substance use disorders. On these calls, part of what we do is talk about the numbers. Numbers of people we reached out to, numbers of people getting out of jail and the numbers of folks who have overdosed in that county. The last time we met when we started to talk about the overdose numbers we all knew they were higher. A lot higher. Worse still, I knew that if we were experiencing this in Oregon then the rest of the country was probably in the same place. New numbers support this fear but I also know that there are things we can do today to help slow down the recent overdose explosion. 

Brought on by the lethal combination of dwindling treatment options due to COVID-19, economic distress and global anxiety and depression, this new overdose epidemic is one those of us in the field saw coming. It’s felt like an inevitable perfect storm for months and industry-wide, we’ve been bracing for it. Recently, I have seen lots of people personally and professionally relapse. One weekend alone, brought news of three people I know who had all relapsed. According to a piece in the Wall Street Journal, “In a survey of U.S. adults released by the Centers for Disease Control and Prevention, 13% of respondents in June said they had started or increased substance use to deal with stress or emotions related to Covid-19.” The same article reports massive jumps county-by-county across the US in overdoses. In Los Angeles alone, the overdoses jumped up 48% during the first month and a half of the pandemic compared to last year. Last year’s staggering 72,000 drug deaths are expected to be even higher this year. “Suspected overdoses rose almost 18% after stay-at-home orders were implemented across the country in mid-March, compared with the early 2020 period before the pandemic struck, according to data from the Overdose Detection Mapping Application Program, which collects real-time overdose numbers nationally,” the WSJ reported. 

Social distancing and closed resources have only added fuel to the fire when people seeking treatment or trying to stop needed help the most. Earlier this month, I watched someone I love try to get into treatment, only to be met with hoops to jump through, wait lists to get on and general uncertainty.  Luckily, a series of unheard of treatment miracles lined up and they wound up going to residential treatment but it literally took magic and not reliance on dependable and plentiful treatment options. Lest we forget that COVID testing. Proof of a negative COVID status is required to get into treatment and that also slows down the process. The odds of anyone pushing through the excruciating process just to get into treatment these days are slim to none. A harrowing, recent New York Times article looked at the spike in opioid deaths since the pandemic. It points to grief, isolation and hopelessness as additional causes in of relapse, overdose and death. 

As a person who works in the field who also supervises others doing this work, what I can tell you is we need solutions right now. Sure, a magical supply of lower barrier treatment beds would definitely help as would legislation written to help people suffering from substance use disorders, instead of punishing them. But those things take time, time we don’t have. The biggest thing we can do today in hospital rooms, on the streets and online is practice harm reduction. Harm reduction, in my mind, is the only thing to possibly slow down these deaths. Encouraging people to smoke instead of shooting up, helping find clean needles and needle exchanges, reminding friends and loved ones to not use alone and always carrying Naloxone are proven to help cut down on overdoses. It doesn’t end with opioids/heroin/opiates either. Harm reduction strategies can be practiced with meth, alcohol, benzos and beyond. 

The big misconception about harm reduction is that it’s telling people that they should go ahead and recklessly use drugs. In fact, it’s the opposite. Harm reduction says your life is of value, whether you use or not. We want to help keep you alive and healthy. This is more than an idea. It’s a movement to help save lives. It’s a philosophy of compassion. The basics, according to The Harm Reduction Coalition, are, “safer use, managed use, abstinence, and meeting people who use drugs ‘where they’re at’.”  Most appealingly, harm reduction is a low to no cost idea to help out in a crisis today.  Too many times to count, my coworkers and I were forced to have quick conversations with people in the hospital who admitted they didn’t want to stop using. Having practiced abstinence in my own life, I had to get over my prejudices and remember these were humans who deserved dignity instead of my judgment. Once I did that I was able to see that these lives, these humans deserved care like everyone else. The conversation can then shift to productive questions like do have clean water to clean their needles? Do they know where to get syringes? Do they have access to Fentanyl testing strips? While a little awkward in theory, these conversations were usually incredibly powerful and they let the person know I cared about them. But you don’t have to work in a hospital to practice harm reduction and you’ve probably done it already if you’ve ever told a friend not to drink and drive or asked someone from a place of love if they’ve taken the right number of pills. 

Harm reduction is a protective measure that isn’t much different from wearing a mask: it can save lives, it can protect communities and if ignored, it can make an epidemic even worse. 

 

Unhappy Hour: When Pandemic Drinking Becomes Problematic

In my long and dramatic drinking career, I developed a talent for day drinking. Okay, it’s not really a talent as much as the ability to drink during daytime hours without shame and with stamina.

Naturally, this “talent” would lead to my drinking demise and me getting sober in 2009. Still, I would be lying if I said I don’t sometimes in the back of my mind romanticize day drinking. Particularly right now. This for drunks only or Sunday Funday justification posts on Instagram activity has become mainstream since coronavirus. I now see photos of people sipping wine outside in the sunshine or on patios and think “aww. That’s the life!” It’s easy to romanticize day drinking especially as it’s stepped into the spotlight as something cool that seemingly everyone is doing.  Until I remember that me drinking during the day usually wound up with me drinking all night long and using cocaine and probably yelling drunkenly at my boyfriend in a parking lot. Yikes. I’ll stick to ice coffee.

So how do we know when enough is enough or if it’s too much in a world that seems to be at a non-stop happy hour?

Nevertheless, all-day drinking since quarantine is officially a thing and our former boundaries with alcohol consumption have gone the way of buffets and making out with strangers. This is all well and good if you don’t have a problematic history with alcohol or substances. But if you struggled with alcohol in the past or had tried to quit before, this new normal of endless drinking could be potentially disastrous. So how do we know when enough is enough or if it’s too much in a world that seems to be at a non-stop happy hour?

First, let’s look at the facts, alcohol consumption has actually increased in the United States considerably since the pandemic. This isn’t like shooting up bleach or sunshine to cure coronavirus. It’s a real trend happening now and the numbers support it.  A study from Jaffa reports that Americans have been drinking 14 percent more often than they used to. “The increase in drinking frequency has been higher for women (up 17 percent) and for those ages 30 to 59 (up 19 percent). The findings stem from a study by Rand Corp., a research organization, that involved a nationally representative sample of 1,540 adults ages 30 to 80 and compared their self-reported consumption of alcohol this past spring with drinking habits for the same time the previous year,” according to the Washington Post. 

This is, one can imagine, great news for big alcohol companies and little liquor stores alike. But not fantastic for people who use booze as a way to cope with stress, anxiety, and depression. Sure, health organizations are urging folks to keep their drinking down- 1 drink per day for women, and 2 for men is what is currently being recommended as healthy drinking. This is a laughable suggestion for anyone who drinks the way I used to. That wouldn’t even start to make a dent in my anxiety or an overwhelming sense of dread that I woke up with on any given day, much less during a pandemic.  Grimmer still are the recent numbers that show how alcohol-related deaths have 43% in rural areas between 2006 and 2018. Given what we know now about what coronavirus has done to those communities it wouldn’t be surprising if those numbers were even higher. As it stands, the US had about 88,000 alcohol-related deaths last year.

How can you tell if your pandemic drinking has fallen off the rails?

Next, so how can you tell if your pandemic drinking has fallen off the rails? One pattern I see almost universally working as a recovery mentor with folks who are having issues with substances is an admission that substances have disrupted their daily living. Whether it’s less serious but still concerning things like more frequent blackouts and hangovers to larger issues like losing a job or housing, everyone I’ve worked with has noticed that their drug of choice has taken its toll. In the halls of recovery, you often hear the saying that drinking started out fun, then it became fun with problems, then just problems. That’s a pretty simplistic but accurate barometer to measure if my relationship with any substance has become more problematic than fun. Other things to consider are if drinking has taken a toll on your mental health or physical health, if it’s become the focus of events instead of the event itself and if you find yourself doing it more than you used to- pandemic notwithstanding. Finally, if you’ve tried to stop and can’t that’s usually a good indicator that your festive, doing it to pass the time quarantine drinking has drifted into the lane of something more serious. The world can currently be a dark and helpless place and if drinking has become a constant activity simply to cope with daily life, it might be time to get some help.

But speaking of help, this brings me to my last thought about pandemic drinking. Sure, while the opportunities to get your drink on have certainly increased so have the opportunities to get help. Most definitely my professional world has been faced with immense challenges during this time due to places being closed, treatment beds being even more scarce, and overloaded emergency rooms. At the beginning of the pandemic, I saw dozens of people we worked with relapse partially due to intensive outpatient services and in-person meetings no longer being an option. However, I can say now, seven months into this way of life,  that the recovery communities across the globe have risen to the challenge. Whether it be online support groups in Zoom meetings, therapy is done with telehealth, or recovery groups on Facebook, seeking the help anyone needs can be done safely and from their living room. 

So much of what I always sought with drinking was the social aspect and connection and believe it or not, I can get that all with other sober people online. I know it sounds lame and crazy. But that’s okay. Because just for today it sounds better than day drinking boxed wine and watching Judge Judy and that’s progress. 

How to Cut Down on Social Media When You’re Not So Great at Moderation

You know you shouldn’t do it so much but you can’t stop. You try to manage it. You make promises to walk away from it but it falls apart in moments of weakness. It’s a never-ending cycle but this time it’s not drugs or alcohol. It’s social media. 

Seems like everyone is talking about how bad it is for you right now. It’s like the new cigarettes. From that documentary on Netflix to study after study, we keep hearing how social media is addictive and damaging. I will be honest, I’ve laughed it off for a long time. Sure, I knew my own nonstop obsessing over likes and retweets was not normal but compared to snorting drugs it wasn’t that bad, right? Well it was and had been for me for a while. If I’m honest, I’ve been on and off the social media wagon for years. Much like drugs, hitting a bottom with social media is filled with anxiety, dread, depression and an inability to stop. But how do people like me, people prone to addiction, quit or cut down on social media? Luckily, in my non-writer profession, I work with people with substance use disorders here in Portland, Oregon and I’ve picked up lots of recovery tools that can help with quitting or cutting down on social media too. 

For example, the tool of detox. A far cry from the horrific weaning off drugs and alcohol, a digital detox has helped me reset and realign. The last time I did it back in January, I deleted apps off my phone but not all at once. Think of it as a taper. First Facebook, then Instagram and so on. Once a couple of days of edginess wore off, I felt less distracted and more present. An integral part of any social media detox (of which I have done several because again TOTAL ADDICT) for me is limiting screen time for at least 30 days. For the first thirty minutes of the day and the last thirty minutes, I don’t look at my phone. This helps me wake and go to bed in a calmer, less “OH MY GOD THE WORLD IS ENDING!!!” space. It’s hard initially but the effects are almost immediate. Once the sites are off my phone, my brain starts to breathe a little easier and I start to sleep better. My last detox, I substituted my social media apps for meditation apps and that helped. I also left my personal phone turned off for several hours of the day when I was at work. This helped me resist the pull to check it constantly. My detox ran smoothly without any slips. Granted, I’m a human, and an addicted done at that, so I went back when my target time was over but I do feel like it helped. 

The next thing is total abstinence. While not for everybody, sometimes a complete break from social media is unavoidable. In June, my anxiety was at an all-time high. Living in downtown Portland and a mile away from the very necessary civil unrest meant nonstop helicopters and sirens. Couple this with the endless death scroll of Twitter, I was a wreck. For my sanity, I left Twitter. I deleted it off my phone, didn’t check it on my laptop and didn’t even click on news stories with tweets. While my all-time favorite social media obsession, Twitter had become toxic for me and was actually causing me discomfort. Cutting it out completely was necessary. This differed from a detox because I quit cold turkey with no goal in mind other than one day at a time I wouldn’t be on Twitter. I had lost perspective with it. I unable to bring any humor or light to the platform so a total break felt needed. Twitter-free life was good and it also corresponded with me quitting all gay dating apps thus the peace of mind and decrease in anxiety was palatable. I walked anywhere between 7 and 10 miles a day over the summer which became a healthy replacement. I have since gone back to Twitter but with boundaries and with the confidence that I get do without it if I need to.

As you might have picked up on, I’ve never fully quit Facebook, Twitter or Instagram 100 percent. In addition to using them for work I kind of like the dumb things and this brings me to my last tip from my work world: harm reduction. The harm reduction philosophy with social media, for me, looks like using it in ways that are healthier. Turning off social media notifications, for example, is something I’ve long done since I noticed that my relationship with it could be all-consuming. What this does it cut down my urge to look at my phone as well the endless binging and flashing which does nothing but inflame the aforementioned anxiety. My battery lasts longer too when it’s not burdened with notifications every two minutes. Not posting every day or limiting how much I post, like one would limiting the amount they drink, has been helpful for me as well. This gives me more time away from my phone and lets me be present even if just for a few additional minutes. Somedays I won’t even go on Twitter at all which is progress for a tweet junkie like myself. Lastly, I’ll delete apps with no time limit or expectation but just because not having them on my phone will bring me a little peace even if that’s only for a few hours. 

When I got sober in 2009, the best thing anyone told me was “Just do right now.” This concept gives me permission to focus on the moment at hand and if said moment is better without social media, fantastic. Will it be like this forever? I don’t know nor do I need to. I can worry about my often shocking amount of screen time tomorrow. I also heard, “progress not perfection” back then. This is helpful too. I can fall of the wagon or stay abstinent from social media but thanks to recovery from drugs and alcohol, I know that it’s possible. 

Staying in The Moment Even When The Moment Sucks

Somewhere along day fortysomething of quarantine, I’d had it.

I’d had it with baking bread, I’d had with making funny videos, I’d had it with hanging out with myself for 12 hours a day. I’d had it with hearing crap like ‘we’re all in this together” because we are not and especially stuff like “think positively!” because that’s dismissive and inauthentic. But what I had really had it with was not having a way to check out and not feel any of the real-time trauma and global loss we are all going through.  Sure, every streaming service under the sun provided some relief but it wasn’t like drinking and using. Sorry back to back episodes of The Great British Baking Show isn’t an 8 ball of cocaine. Never will be.  But I don’t drink and use any more nor have I for over 11 years. That escape hatch was no longer an option. So how does somebody like me who isn’t a huge fan of reality stay present when drugs or alcohol are off the table?

People always say “just do today” or “stay in the moment” when you first get sober. It’s good advice but good god is it hard. Like sure “stay in the moment” but what if the moment, like the current scary-ass pandemic one, is a terrible moment?  I’ll stay in the moment but can I exchange this one for a different moment? Staying in the moment would be easier if this moment was a little less depressing and more glamorous, to be honest. This kind of thinking is what made such a good drug addict. Having a bad day? Hate your current reality? Simply take three hits of ecstasy, drink some vodka, and who cares if it’s a Tuesday. Regardless, it is true. Staying present and breathing through whatever difficult things are happening gives me a chance to stay sober. If I try a little to wait for some of my discomforts to pass, maybe it will. Or maybe it won’t right away but at least I will still be sober. Therefore, the first thing I have to do is just not drink or use it. I recognize saying “just don’t use” to an addict is kind of like telling koalas to just not be adorable. It feels and sounds impossible. But I swear it’s worked for me. My early recovery was jam-packed with rough moments I REALLY wanted to get wasted over but I listened to sober people who said “don’t use and it’ll pass.” I didn’t always feel great right away but later I felt proud of myself for moving through something hard without my old toxic ways of coping, or not coping as the case may be.

The next thing that helps me is owning the suckiness of the moment. A big part of my drinking using was the dishonesty and delusion that it really wasn’t all that bad. I was the king of singing “I’m fine!’ as I was on the verge of eviction or moments after a cocaine-induced panic attack. What sobriety has gifted me with is honesty. By first honestly admitting I needed help, I blew the doors open to speaking more truthfully about where I was at and what I was feeling. Staying sober required me to continue to do that so I wouldn’t drink or use the parts of life that hurt. Over the years, I have gone through the death of loved ones, divorce, major health dramas, and done it all sober. That’s been able to happen because I’ve talked openly about it to other people. It’s vital and lifesaving to my recovery. As someone who also works in the addiction field, I can honestly say I have never seen people who act like everything is okay to be able to stay sober. The folks who make it are the ones who share about what’s going on. They share like their lives depend on it because they do. 

It helps to have people who I can call when I’m trying to stay in a not so good moment. Not long ago, my sister and I were on the phone. We were lamenting about how everything kind of sucks. We laughed and sort of just owned the horrible moment together. She’s sober too so she gets it. What we didn’t do was try to give each other a silver lining or fix one another with bad advice. We just shrugged and sort of said “yeah everything is the worst right now.” By doing that, things felt a little better. I talked with someone about how I felt so I didn’t have to carry all of this heaviness alone. Let’s be real all of this is incredibly heavy. We’re frail, little humans, not strong, mighty elephants. There’s only so much we can carry. Talking openly with sober people helps me feel lighter, less broken, and not alone. 

The last thing that helps me is undoubtedly the hardest when it comes to difficult moments: acceptance. When I first heard that word in recovery I thought it meant if I accepted something I had to like it. It was later explained to me that acceptance wasn’t about loving your circumstances or the actions of others. It was about accepting the truth of those people and things. With so much sadness, racism, and death in the world currently, acceptance is a tall order. But it’s vital if I want to stay sober. I can change myself and my reactions and I’ve discovered that’s about it. Changing people’s actions, changing the weather, changing global crises? Child. Not so much. Once I accept these things, there’s a ton of freedom that comes. I feel like less of a victim of circumstance, less self-centered. What’s more, is acceptance means I’m not tortured in the moment by things I really have no control over.

 As I wrote the first draft of this, protests raged blocks away from my house. The moment felt scary. It felt heartbreaking. It felt inevitable. But it would have felt worse if I was drinking or using. By accepting what was happening outside my door and not hide in a bottle. Also, this acceptance lets me focus on what I can change: I can help other people struggling, I can listen and I can stay sober no matter what the moment is.

Alcohol Companies Sponsoring Pride Month is Still the Worst

You would think with what we know about the LGBTQ+ community and its toxic relationship with alcohol that we still wouldn’t be talking about liquor companies sponsoring pride. 

After all, tents filled beer and float sponsored by Stoli vodka feel a little outdated in this day and age. Widely considered an at-risk community to develop substance use disorders, a booze brand sponsoring Pride feels like a high school dance being sponsored by gun manufacture. Likewise, you would think that in this COVID-19 era with Pride celebrations canceled around the globe, Big Alcohol might sit this year out. You would think that and you would be wrong. The doomed marriage between alcohol and Pride rages on, the pandemic is damned. 

Wine, beer, and liquor brands early on hopped on the already super questionable marketing push for consumers to “party at home” in quarantine. This, apparently, was a smart strategy. Alcohol sales hit all-time highs early in the pandemic and have held steady. With in-quarantine holidays like Cinco De Mayo (a racist, problematic alcohol marketing bonanza which deserves its own essay, if not documentary) and Memorial Day proving to be big hits for drinkers, Pride was the next one on the list. Myself and the other queer people I knew folks happily threw ourselves behind the pressing issues of Black Lives Matters and police brutality among the black community. Nevertheless, alcohol makers already had bottles of rainbow liquor and cases of Gay Beer ready for the shelves. Check out your grocery store’s wine aisle this month and I guarantee you will spot at least one bottle ready for Pride.  The party was going to carry on even for booze brands, even if the parade was canceled. 

Absolut, a longtime pusher to the gay community once again packaged its rainbow bottles under the guise and pomp that they are allies to the community. According to GLAAD’s chief program officer Zeke Stokes, “Absolut’s commitment to celebrating the LGBTQ community all year long, and not only during Pride month, is a shining example of how brands can bring inclusivity, diversity, and acceptance to the forefront of their mission.” These are all nice words but when said product is literally killing a group of people, they’re meaningless. If Absolut was so in love with serving the LGBTQ+ community, profits donated towards culturally specific treatment centers would mean a hell of a lot more than cheap rainbow-colored bottles. Just saying. 

But is marketing alcohol to LGBTQ+ really all that bad? In a word, yes. Personally, I came out in the era where you came out in bars which were also safe spaces but definitely places people like me who loved to party could find any and everything they wanted with relative ease. The gay culture in the ’90s was everybody met while drinking or using drugs. It’s who we were. We didn’t have the language then to identify that many of us, self-included, were drawn to drugs and alcohol to help self-soothe our various traumas, many of which were caused by being queer. Sure, dozens of statistics show that queer individuals are twice as likely as their straight counterparts to develop substance use disorders. But I know in my own life that the societal weight I carried as a gay man, the discrimination, the internal hatred because of my sexual orientation mixed with a family tree filled with addicts and alcoholics, made me the perfect target for this kind of marketing. In my early twenties in the 1990’s I had moved to Los Angeles. Brands like Budweiser, Coors, and Absolute were already marching in Pride parades and setting up booths at gay festivals. At the time, it felt like these brands were being bold. After all, Ellen had just come out and Will & Grace were on TV. Being gay was now cool and more acceptable. It seemed like it was finally time for all of America to get on board with the LGBT community. 

As a young bar and nightclub regular, to me, it was cool and progressive that brands would laugh in the face of heteronormativity. They were selling their products directly to me and my friends.  These brands weren’t like my parent’s brands. They were down with the cause and supported us. But as it turns out, it wasn’t cool at all. 

 These huge companies launched campaigns targeted to me and my friends for the same reasons they put billboards for malt liquor in black communities or marketed cigarettes in Spanish in Latino neighborhoods: because they knew their customers. Companies like Coors and Smirnoff spend millions on demographics and research to figure who’s buying what so they can push even harder to those folks. Once they figured out that my people were spending lots of money on booze, they heavily invested in ways to find out how to make us spend even more. What’s beyond messed up about this is that we now know better in 2020. We have the receipts of years of data that shows it isn’t solidarity or support. We know the rate of addiction with queer people is out of control. We know that LGBTQ+ face more mental health conditions than their straight counterparts.  It’s simply about money and money made from people struggling the most. Yet they continue to do it anyway. 

Pushing aside the bottles and shot glasses decked out in rainbow colors, it’s important to remember that Pride celebrates the Stonewall Riots which were the first move toward gay rights in this country and started by queer and trans people of color. This wasn’t about being a product. It was about being treated fairly like everyone else. As our rights are constantly threatened even today, we don’t need your stuff. We need your help. If we really want to show our support to gay, lesbian, bisexual, asexual, trans and queer people, it will take more than buying merchandise. What my community deserves is access to a culturally specific treatment, free mental healthcare, and comprehensive campaigns that don’t sell vodka but sell the idea of recovery while smashing the stigma. Now, that would be something to really be proud of. 

The Crisis Inside the Crisis

For the last nearly three months, I’ve scrolled the Instagram and Facebook pages of friends and family members who while on unemployment have spent their time baking banana bread, playing Animal Crossing, and coming up with an at-home workout.

I’ve maybe been a little jealous…

Okay, a lot jealous. Because while I know the uncertainty of life as we know it is stressful for everyone particularly those who no longer have jobs, there’s part of it that seems carefree and like an opportunity to recharge. Yet when I’ve talked to sober friends stuck at home suddenly without jobs, the fears are real. They’re afraid they won’t have work when life returns to whatever the hell normal is. They’re afraid of relapsing. They’re afraid of losing connections with their recovery communities. So the grass isn’t so green on the other side. From working in the very real and very intense current worlds of mental health and addiction this entire time, I know their worlds are not all baking and Tiger King. See while we’re watching the current COVID-19 crisis calm down, the ripple and fallout it’s caused in the recovery world is only beginning. 

For me, a person in long term recovery with a condo, Wi-Fi, and food in his refrigerator, not to mention access to any recovery ZOOM meeting in the world, this whole thing hasn’t been so bad. But for the people, we support at my job and the majority of folks struggling with substance use disorders all over, this virus is deadly on several levels. The first crack we saw in the system as places closed down and services became more and more limited was vulnerable populations immediately at higher risk for relapse. By the very nature of shutting down spaces where people had 12 step meetings, received MAT, group therapy, or spiritual support, a population that struggles under the best case scenarios had their lifelines cut off or at least harder to access. Also, we’ve always told people in recovery to reach out, to ask for help and that connection is the opposite of addiction but all of a sudden we were saying staying home and stay away from people. Sure, there’s online and digital support but that sort of support and social distancing, in general, is soaked in privilege. Around 75% of the people I supported at a busy hospital here in Portland, Oregon were homeless. They didn’t have phones or iPads, they didn’t even have somewhere to sleep.  So these meeting spaces and clinics weren’t just vital to their recovery but to their survival for things like snacks, warmth, and human interaction. The fallout from all of this from what I’ve seen begins with people falling off the radar. Now as a program manager, the mentors I supervise have lamented that people who they once saw weekly and who they could support at appointments, were now left to go at it alone. People struggling with mental health and addiction need the connection and haven’t always been able to get it over the last few months. 

Unsurprisingly, relapse is also on the rise. The people my team support who were struggling before the pandemic were suddenly at a higher risk. Add to this a huge amount of stress, loss, grief, and financial uncertainty and you’ve got the perfect recipe for relapse. For example one of our mentors who work in a hospital is usually given access to hospital rooms to build connections with folks with substance use disorders. This work is vital and it works to help get them connected to recovery resources outside of the hospital walls. She’s now forced to do this work over the phone and as you can imagine, it ain’t the same. The opportunity for a face-to-face to perhaps disrupt a pattern of use is now nonexistent. It’s a leap of faith that some connection can be made over the phone. Despite the limitations, she’s been able to get people into treatment and deliver much needed basic needs items like food boxes and phones. But the undertaking is monumental and the deck is stacked against recovery mentors with limited access and forever dwindling resources. She’s seen twice as many patients return to using as she has got into treatment. Again, this is difficult work even when a pandemic isn’t happening but now it’s blossomed into a crisis of its own.

I work for an agency that provides peer support and one of the things I love about the field is that we meet people where they’re at. If they want to get sober, terrific we help with that. If they’re interested in MAT, we help connect them to various clinics around town, and if they want to keep suing we talk about keeping them safe and harm reduction. Yet now actually meeting where they’re at is a challenge. We can’t pick them up and take them to the DHS office. We can’t take them to a recovery group. We can’t even meet them for a much-needed cup of coffee. Our magic trick of meeting people where they’re at is now made harder as we don’t know where many of our homeless people are and we couldn’t be near them even if we did know.

The final fallout from all of this is the worst and most final of all: suicide. I happen to live by one of those historic bridges you always see in photos of Portland, Oregon. About two weeks ago, a neighbor of mine ran through our courtyard frantic and told me to call 911. Someone had jumped off the bridge near my house and into the Willamette River. It shook me to the core obviously because it was right in my backyard but also because it illustrated what must be happening right now in communities around the country. The Washington Post recently ran an article outlining how America’s treatment centers and mental health facilities were ill-equipped for what was about to happen. Writer Brene Brown described it as “the crisis inside of the crisis” which is completely accurate. But for those of us working inside of that crisis, it feels more like a tidal wave after an earthquake. You see it coming but there’s very little you can do to get out of the way. 

Recovery Isn’t Just For Straight People

If you were only to look online and never meet real sober folks you might think that we’re all nice, straight white people. Yet despite what we know about LGBTQ and substances, my people recover too.

Two modern tropes, the boozy gay man’s best friend and the sober enlightened straight cisgender white woman, became tropes for a reason. The first, and I speak from personal experience here exists because most of us came out of the closet and walked right into a bar. Alcohol and the places they serve is an integral part of the gay experience, whether we like it or not. Was I a drinker who then became gay or was I gay and then started drinking or was I, in fact, born both, a hard drinker and a flaming homosexual (ding ding ding!) who the hell knows. But what I do know is that my drinking (and drug use-duh) and my gayness are so entwined that when I went to get sober in 2009 I couldn’t imagine being one without the other. The other trope (which I clearly am not) seems to be the loudest voice in the online sober-sphere as of late. And why the hell not? The real world has been mainly male-dominated since the advent of 12 Step groups so it’s about time for women to share their stories of recovery.  The countless fearless, female voices to hit the digital world in the past decade is overwhelming and inspiring. Yet if you take a look at these voices, it feels like that’s all there is: straight women who get sober. Granted, women account for the largest percentage of folks who buy books and read online but there’s a disparity is queer voices in the recovery space overall. 

What we do know about my community and its relationship with drugs and alcohol isn’t pretty. The very real numbers are grim to say the least. A recent survey reports that some 18 million LGBT live with substance use disorders. Also people who identify as gay or lesbian are more than twice as likely as heterosexuals to a severe alcohol or tobacco use disorder while people who identify as bisexual are three times as likely to develop a substance use disorder. Not to mention the surge in meth related deaths among gay men and the losses of gay icons like George Michael. Couple all of this with the still devastatingly high numbers of LGBTQ youth suicides and overdoses, the outlook for my people isn’t exactly the inspiring stuff that the gals from the suburbs want to read about in their book clubs. Many studies point to higher instances of trauma, discrimination and internalized homophobia as some of the possible reasons why our addiction rates are so much higher. 

Yet talk to anybody who has been to an intensive outpatient program, a 12 Step meeting or an inpatient treatment facility has probably shared space with gay, lesbian, queer or trans folks. Since we struggled more than our average heterosexual friends, we also wind up seeking treatment more too. Barely visible online or not, the truth is we exist in large numbers in recovery and many of us have long term recovery. To bounce back to the celebrity example, for every five George Michaels there’s at least two or three Elton Johns. Plus, gay communities across the country have long responded to the high risks of addiction by providing support and are currently stepping up to address everything from drinking to the dangerous “chemsex” trend. Yet for examples of queer folks conquering addiction, I need not look further than my own inbox.

Ever since I got sober, I have been fortunate to have a life filled with gay men doing what I previously thought was impossible: getting and staying sober. We text one another all day long, we check in and make sure we’re all okay. Mainly we laugh a lot, far more than you’d expect from people who nearly died at the hands of drugs and alcohol.  In my first gay meeting in Santa Monica in 2009, I couldn’t believe that people, particularly gay people had stopped drinking and using drugs. Dozens of them had 60 days, 6 months and 6 years sober. It blew my mind but it showed me it was possible. I might have come out in a bar but I didn’t have to stay there. In early recovery, I had to find real self-esteem where I finally learned how to accept my sexuality and learn to love my big gay self without drinking and using. It was no picnic. After decades of self-hate, shame, internalized homophobia, untreated mental illness and lost and lots of drugs, I was forced to the real Sean for the first time.  Turns out I was enough: gay, sober, living with depression, PTSD and HIV- I was enough. What’s more is the longer I stayed sober, the more I authentically really love myself. Who knew that would ever be possible? 

 11 years later, I get to help other gay men new to recovery too. All these things about myself that caused me shame or embarrassment, like being HIV positive and being gay, are now professional assets in my work as a peer support specialist and recovery mentor. When I get to work with people who have the same experiences as me, something magical happens. Sure, I’m there to support them but I always feel better too. We’re both suddenly less alone. We show one another that we can survive, pull through and stay sober. The feeling of belonging that I wanted in gay bars is now found in people bravely beating the odds and walking the same path as me. Sure, that path forged by my LGBTQ sober brothers and sisters might not be a much talked about blog or hip best seller which fits snuggly into our current marketable version of what sobriety looks like. But it’s one that exists and for that I’m forever thankful.  Remember recovery isn’t just for straight people. 

 

When Your Family Wants You to Get Sober

“We’re Really Worried About You”: When Loved Ones have THE TALK About Your Drinking and Using. 

There are certain conversations burned into your mind that stay fresh, no matter how long ago they happened. My sister and I had one of those about 27 years ago. It was a hot Denver summer and we were walking down a tree-lined street near the house she and her friends were renting. With tears in her eyes, she confronted me. She had heard from a hard-partying but in this case totally accurate, a friend of ours that I had been using meth. This was the kind of friend who was always wasted and totally unreliable so I laughed it off to that. I then went on to attack my sister for even believing such a thing. Defensive and mean spirited, I accused my sister of being dramatic and believing gossip instead of asking her own brother. It was an ugly conversation and my reaction was uncalled for. She was someone I loved just asking if I was okay. But I was about 16 years away from being ready to have that conversation.  I stayed unready to talk about my relationship to substances that were always worse than any bit of gossip anyone could ever imagine. Yet it begs to question if there is ever a good time to hear that you need help and that the people in your life are worried about you?

Look nobody, addict or not wants to hear stuff like “Wow! You were really wasted last night!’ or “Maybe you should slow down on the wine?” These kinds of observations, although perhaps dripping with judgment, immediately turn the mirror on ourselves and we have to look, if even for a moment, at our relationships to substances. So when a family member or friend takes it to a more serious place and tells you they think you need help, no wonder people like myself explode. Quite honestly, I don’t know if there’s a “good way” to react to these conversations. Trying to reassure people I had it under control was always my default response. “It was bad but now it’s better” or “I like to have fun! I’m not hurting anyone” seemed to roll off the tongue for me when questioned. Likewise so did minimize how much I was using, talking about how someone we all knew had a worse problem then me and blaming my increased partying on stress. I guess my advice would be to try to hear when people tell you they’re worried about you. Maybe try to leave aside feelings of being attacked and know that whatever is coming out of a friend or family member’s mouth, it’s out of love. But honestly, even when we’re ignoring concerned people, we hear them. I had an old boss told me at age 21 that she thought my drinking and using was getting in the way of my job- and this was at a restaurant/bar where the bartender was our cocaine dealer! I was obviously a mess for her to even notice among the other drunken disasters who worked there. I shrugged it off but I never forgot it. She told me I should slow down and take care of myself. And then she fired me. 

Long gone from my restaurant days, I now work in the world of substance use disorders at a hospital. Daily, I see upset moms, dads, and siblings struggling with these conversations. There’s a belief on their end if they could just get through to their loved one with how much they care and how scared they are then the person would stop using. From bringing in friends and therapists to inviting medical staff in, I’ve seen families make attempts to have “the talk” that will hopefully save their loved one’s life and get them to choose recovery. Things like interventions are popular and make for good television but the reality is if the person isn’t ready to quit, there’s no conversation in the world that can make it all better. 

As I write this at age 47 with over a decade sober, I’m currently wondering if there is the best way to give or receive these kinds of conversations. The shoe is on the other foot for me, as I now find myself worried about two people in my life and their respective relationships with substances. Our basic human instinct is to shake people and say “WHAT THE ACTUAL HELL ARE YOU DOIN?!” but I know that never worked for me in my addiction. I also have to remember that I wouldn’t scream at someone with cancer or diabetes and likewise it wouldn’t help them at all. When pushed and threatened and given ultimatums, no one is going to hear that you’re concerned. My poor sister wasn’t even being accusatory and I exploded so I can’t even imagine what my reaction would’ve been if she was even remotely punitive. Therefore, I know the same applies for me and the people who I love that I’m concerned about. What I’ve been able to come up with is this: I love you. That’s it. That’s where I have to start the conversation. I love you and I hope you know I’m here for you if you need help or if you want to talk about anything. Working in the world of peer support, I’ve learned the art of meeting people where they’re at. If someone I’m concerned about wants to get sober help, I’ll ask them if they want me to help them with that goal. If they want to keep using, I have to respect that too. That tough conversation also starts with I love you while maybe introducing ideas of harm reduction and letting them know I want them alive and healthy, regardless.

But the point is we keep saying something, we keep saying I love you. Because even 27 years later, I can still hear the people who said it to me. 

 

Why Is Meth Left Out of Medication-Assisted Treatment?

When it comes to meth, there’s no MAT, no funding and little hope

For being in the middle of an opioid epidemic, we sure did talk a lot about meth when I worked on the addiction medicine team at a local hospital as a recovery mentor. In fact, we talked about it all of the time and depending on our patient list, we talked about it all day long. The collective brilliant brains of social workers, doctors and mentors like myself couldn’t fix the meth problem for our dozens of suffering patients. Yet for something we all talked about endlessly, for an American tragedy we desperately were trying to help solve, it certainly felt like no one beyond the hospital walls was talking about it. After all, medications like buprenorphine and methadone were lifesaving medical interventions helping combat opioids and heroin addictions. But why aren’t there the same types of medications for meth and why don’t we talk about meth and the thousands of lives destroyed by it? 

From what my creative and certainly not medical brain has learned, MAT (medicated assisted treatment) for meth is a very tricky thing. I’ve heard many doctors say something like stimulant replacement therapy (for example replacing meth with a prescribed stimulant like Wellbutrin) is too inconclusive in results and too controversial in concept to ever be taken seriously. Plus, patients going for the extreme highs for meth probably wouldn’t respond to a more subdued and controlled medication. Conversely, there are gateway medications to meth like Adderall. Adderall is high in amphetamines and considered by some to be as addictive and dangerous as meth itself. Lastly, there are the real results from years of tests that really aren’t that encouraging. Inconsistent and mostly negative findings mixed with a heavy stigma have landed MAT for grounded before liftoff. But it shouldn’t be especially since deaths from meth rose at a frightening rate in 2019. 

Then there’s the additional problem of the crippling stigma that goes along with meth. Mildly put, meth has a bit of an image problem. The reality is we aren’t hearing about nice white ladies from upper middle-class families dying from meth like we were when the opioid crisis exploded. When we hear meth we think of a long canceled tv show featuring desperate criminals, poor, uneducated folks or the LGBT community. Meth, or so we would like to believe, doesn’t affect our friends or neighbors and isn’t as lethal as heroin. It’s out of sight and out of mind with meth. A homeless man I supported in the hospital once remarked, “Nobody cares about people who use meth because we are all poor, homeless or have mental illness.”  It was hard to argue with him. We somehow forget the psychosis, the deadly heart problems and the endless burden of meth use on our criminal justice and healthcare systems. As someone who struggled with meth in the past, I can say that as an addiction it is absolute hell and anyone suffering from it deserves out help, stigma or not.

So what’s the answer? The key when it comes to meth, it probably won’t be one answer but lots of answers. For example, cities like Portland, Oregon, and San Francisco are having clinical trials featuring micro-dosing of prescription stimulants and other drug combinations to see if they can crack the code. Also, some doctors are circling back around to a study from 2009 that reported ADHD medication dexamphetamine helped decrease meth use in study participants. Likewise, Naltrexone is currently being hailed as a possible MAT solution for meth users. In a report last fall, NPR talked to doctors, psychologists, and patients who all had success using Naltrexone to help with symptoms of meth withdrawal. The report found that the combination of the drug with other medications like the antidepressant bupropion proved to be helped for treating meth use disorder. While the use of Naltrexone to treat meth use disorder has yet to be approved by the FDA, it’s at least now being seriously considered as a medication that might provide hope. 

 Next, there are a number of non-medication options that provide a little hope. The one I’ve seen work incredibly well for people struggling to quit meth is contingency management. For the uninitiated in recovery world lingo, contingency management is a simple system of rewards for goals met. For example, giving out coffee shop gift cards for each month a patient stays sober or things like snacks and candy for negative drug tests. Sounds silly and a little like bribery but studies show that the rewards coupled with therapeutic positive reinforcement really work on methamphetamine users. At the hospital, much of my job as a peer recovery mentor was encouraging the people I worked with to stay and complete a long course of antibiotics to treat infections caused by IV drug use. Promising and delivering little rewards for each week they stayed in the hospital gave them something to work towards and be proud of. 

But the biggest answer for America’s meth problem is better access to treatment. Working with folks battling meth addiction on the streets and in hospitals, I’ve seen the devastation this epidemic is causing firsthand. There aren’t enough treatment beds, too many insurance barriers and a broken criminal justice system that all stand in the way of people wanting help. This means thousands of people who want help are unable to get it. This a mind-blowing and baffling truth for a rich country with endless resources. Consider how fast Washington acted to address the dangers of vaping. Yet it’s taken decades to get more treatment for people dying of substance use disorders.  Much like other health epidemics such as the AIDS epidemic, our addiction crisis might have to be solved and pushed for by the people dying from it. Policy changes and political activism to increase treatment and reduce stigma will have to work side by side with medication interventions to bring about a solution for a meth nightmare currently spinning out of control.