"This American Life" Spotlights "Dopey," a Podcast on Addiction and Recovery

The NPR weekly radio/podcast series This American Life featured a segment on its February 1st broadcast about Dopey, a podcast about addiction and recovery heard by more than four million listeners.The podcast began as a forum for creators and hosts Dave and Chris—as well as guests ranging from Marc Maron and Dr. Drew Pinsky, to My Fair Junkie author and The Fix contributor Amy Dresner—to share "war stories" about their struggles without judgment and with a degree of humor. Dresner was a recent guest on the podcast (and will return as a rotating co-host) where she discussed how her experience trying to treat ringworm made her want to use again.  But with the overdose death of Chris in July 2018, Dave has shifted the focus of Dopey to promote recovery while continuing to address the stigma of addiction.As a result, the podcast has grown both in terms of the number of fans—also known as the "Dopey Nation," who have helped to boost downloads to more than 1.2 million to date—and as a community for listeners in all stages of recovery, as well as family and friends, to come together. As Vice noted, the roots of Dopey began in 2011, when hosts Dave and Chris—who do not give their surnames—met at Mountainside Treatment Center in Connecticut while undergoing treatment for substance use disorder.The pair became friends, and after acquiring and losing various periods of sobriety, they decided to launch a podcast about addiction that focused on what Dave called "the last bad thing"—tales from their past including "using stories, open-ended drug discussion and debate over addiction philosophy," as the pair wrote on the podcast's website. Dopey soon caught on with listeners, who submitted their own recollections. The result was a podcast where those in every stage of recovery could share their experiences and gain support.Then in 2018, Dopey Nation was rocked by the news that Chris had been found dead of an overdose. He had been sober for five years at the time of the incident, working as a manager at a sober living facility and studying to earn his doctorate in clinical psychology.In the wake of Chris's death, Dave was determined to carry on with Dopey, but as he told Vice, "It's apparent now more than ever that Dopey's main focus will be addicts living in recovery. Chris's legacy will live on through these episodes, and the lives he touched all around the world."The new approach has also brought a wealth of new guests, including Jamie Lee Curtis, Beautiful Boy author David Sheff, and musician and recovery advocate Bob Forrest.For Dave, continuing the podcast means giving individuals in the grip of addiction a place to go, to listen, and to share."[They] are not just showing up for Dopey, they're showing up to support one another," Dave said.

The Dangers of Synthetic Drugs

For law enforcement and drug counselors, keeping up with the ever-evolving world of synthetic drugs is an endless game of cat and mouse. When one substance or ingredient is detected and outlawed, backroom chemists can tinker with a formulation, changing it slightly to make an analogue that is technically not illegal. (Although legislators are trying to catch up with wider blanket bans on psychoactive substances).Despite the gray area of legality, synthetic drugs are extremely dangerous. This has been shown clearly in the United States, where fentanyl and its analogues are responsible for tens of thousands of deaths each year. However, opioids aren’t the only drugs being made synthetically. Sometimes known as “legal highs” or “new psychoactive substances,” these synthetic drugs are still every bit as dangerous—if not more so—than drugs that are explicitly banned by the law.Although there are decades of research about the health effects of drugs like heroin, cocaine and amphetamines, there is little research on synthetic drugs. Still, these so-called legal highs can present the same symptoms as those of more traditional illicit drugs, and require treatment in a rehab clinic.Here are some of the common synthetic drug formulations, and the signs and symptoms that someone might be using them to get a “legal high.”Synthetic CannabinoidsStreet Names: Spice, K2, Black Mama, Annihilation, Herbal IncenseDescription: Until relatively recently, Spice was a common sight in some corner stores and smoke shops. Spice generally features a blend of tobacco or other dried plants sprayed with chemicals that cause psychoactive effects. Synthetic cannabinoids can also be sold as liquid to be used in vapes.Symptoms: Although it is sometimes marketed as all natural or safe, Spice is very dangerous, arguably more so than marijuana. According to the National Institute on Drug Abuse, testing shows that the chemicals used in Spice are made in labs and are not safe for human consumption. Like the active ingredients in marijuana, these chemicals act on the cannabinoid receptors in the brain, but some research indicates that they bind even more strongly. This can amplify the effects of the drug, including negative effects like psychosis, paranoia and hallucinations. Synthetic cannabinoids have also been linked to suicide, violence and cardiovascular effects.Synthetic CathinonesStreet Names: Bath salts, Flakka, Bliss, Cloud 9Description: Synthetic Cathinones are a class of synthetic stimulants. Just as synthetic cannabinoids are meant to mimic the effects of the marijuana plant, synthetic cathinones are meant to mimic the effects of khat, an African shrub used as a stimulant. And, just like synthetic cannabinoids, the effects of synthetic cathinones are much stronger—and more dangerous—than the plant they are meant to simulate.Synthetic cathinones are sometimes sold in smoke shops, disguised with the categorization of "not for human consumption." Instead, they’re labeled as bath salts, plant food, jewelry cleaner or phone screen cleaner.Symptoms: When ingested, smoked or injected, synthetic cathinones act on the body in ways that are similar to cocaine, amphetamines and other stimulants. However, they’re much more potent—up to ten times as powerful as cocaine, according to one study cited by the National Institute on Drug Abuse. People who have taken synthetic cathinones can experience paranoia, hallucinations, panic attacks and delirium.Synthetic HallucinogensStreet Names: N-bomb, legal acid, smilesDescription: Synthetic Hallucinogens act on the serotonin receptors in the brain. They mimic the effects of hallucinogenic drugs like LSD but are much more powerful. They are sold in a variety of forms, including powders, liquids, on blotter paper or as edibles.Symptoms: Like most synthetic drugs, the research around synthetic hallucinogens is limited; however, it suggests that they are very dangerous. According to the National Institute on Drug Abuse, people have died from taking synthetic hallucinogens, and one scientific paper documented a suicide attempt after someone took a synthetic hallucinogen. Severe hallucinations can lead to panic in users.Some people mistake synthetic drugs for being “designer drugs” that are safer than other illicit substances. However, this couldn’t be further from the truth. As the case study of a suicide attempt shows, even one-time use of synthetic drugs can have dire consequences. It is therefore important that people who are using these drugs connect with a rehab clinic that can help them stop their use.Get more information on Serenity Health on the website or on Twitter.

Morning Roundup: Mar. 20, 2019

Wendy Williams Reveals She's Been Staying in a Sober Living House [Washington Post]TV personality Wendy Williams revealed that she has been staying at a sober living home. Williams has been candid about battling a cocaine problem and promotes recovery support through her family's foundation.Maine Lawmakers Discuss Bill to Create Substance Abuse Cabinet [Maine Public]A new "substance abuse disorder cabinet" has been proposed in the Maine Legislature. The cabinet will include officials from all state departments.Mindfulness Could Be a Key to Recovering from Substance Use Disorder, USC Experts Say [USC News]Encouraged by the positive impact that mindfulness can have on people in recovery, USC is recruiting participants for a new study that will examine whether mindfulness can help young people who are in treatment for drug use and mental health issues. Harford County to Present Free Performances of Award-Winning Play 'Addicted' [Baltimore Sun]'Addicted,' a play that spotlights heroin's impact on a community, is showing in Harford County starting this Thursday. The community is invited to attend the free performances, written and directed by a school psychologist in memory of her late brother.Kristoff St. John Cause of Death Revealed:  Was Hospitalized at Mental Health Facility Days Before Death [TMZ]Alcohol was a contributing factor to the death of actor Kristoff St. John, according to a new autopsy report. The report also revealed that the actor spent time at a mental health hospital days before his death.Aspiring Doctors Seek Advanced Training in Addiction Medicine [NPR]Schools across the U.S. are now offering fellowship programs that train doctors in addiction medicine. These programs offer training on evidence-based approaches for treating addiction.NHL Player Austin Watson Reinstated After Completing Substance Abuse Program [CBS Sports]Austin Watson of the Nashville Predators has been reinstated by the NHL after violating the league's substance abuse policy. Watson admitted that he had been living with alcoholism, anxiety and depression since he was 18 years old.'The Assassination of Gianni Versace' Sued for False Representation of Anonymous Alcoholic [NY Daily News] An anonymous lawsuit has accused the FX/Netflix drama series 'The Assassination of Gianni Versace: American Crime Story' of presenting "a false implication that (they are) a chronic abuser of alcohol who consumes alcohol throughout the day."

Johnson & Johnson Called Opioid "Kingpin" In Oklahoma Lawsuit

Johnson & Johnson is being named as a “kingpin” of the opioid epidemic in the first big trial targeting opioid manufacturers, which is set to take place in May 2019.The lawsuit, brought by the state of Oklahoma, is naming the multinational company as a “top supplier, seller and lobbyist” for prescription opioids, according to a report by Axios.Although Purdue Pharma is the most commonly cited company associated with the opioid crisis, there are several other pharmaceutical companies being targeted by the many hundreds of lawsuits being brought to court by local governments as well as individuals.Johnson & Johnson, most often associated with baby powder and lotion products, is classified as a pharmaceutical company. Prior to the Axios report, Johnson & Johnson came under fire when it was discovered that the brand’s baby powder contained asbestos. The company was ordered by a California judge on Wednesday to pay $29 million to a woman who sued based on the claim that the powder was a “substantial contributing factor” in the development of her terminal cancer.In addition to everyday home products, Johnson & Johnson “produced raw narcotics in Tasmanian poppy fields, created other active opioid ingredients, and then supplied the products to other opioid makers—including Purdue Pharma,” according to the report.The company also allegedly boasted about the high morphine content of its poppies, targeted children and the elderly in its marketing, and funded multiple “pro-opioid groups.” A brochure made by one of the company’s subsidiaries even claimed that “opioids are rarely addictive.”The lawyers representing Oklahoma in the upcoming case have asked a court to release millions of pages of Johnson & Johnson’s confidential documents to the public, based on the fact that the company has divested from the opioid business and therefore shouldn’t have to worry about losing trade secrets.“The public interest in this information is urgent, enduring and overwhelming,” wrote Oklahoma Attorney General Mike Hunter.Johnson & Johnson provided Axios with a statement in the company’s defense, claiming that it “appropriately and responsibly met all laws and regulations on the manufacturing, sale and distribution of APIs (active pharmaceutical ingredients) and the raw materials that go into them” and that its “actions in the marketing and promotion of these important prescription pain medications were appropriate and responsible.”The company claims that it accounted for “less than one percent” of the total market share for opioid medications.However, the Axios report points out that Johnson & Johnson made $1 billion in 2015 by selling the opioid Nucynta and $2 billion from the fentanyl patch Duragesic, which it still sells to this day.

Sega Pulls "Judgment" Video Game After Voice Actor's Cocaine Arrest

Japanese actor Pierre Taki could be erased from his role in the video game Judgment after he tested positive for cocaine use. Somewhat ironically, his voice and likeness were used for the role of a yakuza crime boss.Sega is taking steps to distance itself from Taki, deleting all tweets promoting Judgment (titled Judge Eyes in Japan) and indefinitely halting further sales of the game, released in Japan in December 2018.The hold will continue until they decide what they should ultimately do about the big budget game that is already slated for international release later this year.“We believe that the arrest of Mr. Pierre, who is a performer of our product JUDGE EYES: The Testament of the Grim Reaper, is highly regrettable,” read a statement from Sega. “We have received arrest reports and are currently confirming the facts, but for the time being we have decided to refrain from shipping and DL sales of the product and posting of product HP etc. We apologize for any inconvenience caused to our customers and related parties.”Taki admitted to using a small amount of cocaine, which carries a penalty of seven years in prison in Japan. It is also likely to be a death sentence for his career.Disney Japan is replacing the actor as the voice of the snowman Olaf in the Japanese release of both the upcoming movie Frozen 2 and the already-released game Kingdom Hearts 3. His voice will be replaced in the latter with a pending software update.Seeing an actor or performer’s career come to an end from a single allegation of drug use is unheard of in the West, but it’s commonplace in Japanese media. In 2014, Aska, a member of the pop duo Chage & Aska, was arrested for possession of MDMA. Universal Japan stopped all sales of his (and his bandmate’s) music, and Disney Japan removed the group’s song and animated music video from all subsequent releases of a Studio Ghibli animated collection.All this has some speculating that Sega is gearing up to recast and replace Taki in Judgment as well. If so, it wouldn’t be the first time Sega replaced an actor in its games, having previously swapped out the voice and likeness of another actor in the re-release of the game Yakuza 4 following his own cocaine allegations.As of yet, there has been no official announcement of what they plan to do with Taki and Judgment.Fans of the game outside of Japan, who have anticipated Judgment’s international release later this year, await news of a probable delay.

Can Binge Drinking Alter DNA?

Researchers have determined that binge drinking may alter a person's genetic makeup and result in an even greater desire to consume alcohol.A recent study suggested that two genes that help to control drinking behavior become altered, and as a result, have different responses in individuals who classify as binge or heavy drinkers.The study appears to underscore the notion that genetics play a more significant role in alcohol and drug dependency, as well as the possibility for scientists to determine a predisposition for addiction.The study, conducted by researchers from Rutgers University and Yale University and published in the journal Alcoholism: Clinical and Experimental Research, focused specifically on genetic responses produced in binge or heavy drinkers—which according to the Centers for Disease Control and Prevention (CDC) are defined as men who consume five or more alcoholic beverages in a two-hour period, and women who consume four or more in the same period, resulting in a blood alcohol concentration of 0.08% or above, at least four times per month. The two genes at the center of the study are PER2 and POMC, both of which are involved in the regulation of drinking behavior. PER2 plays a role in the body's biological clock, while POMC regulates the stress response system, according to a press release from Rutgers.In binge drinkers, both genes were found to exhibit a change caused by alcohol called methylation, which employs a chemical tag that retains the DNA sequence of the gene but also retains the ability to turn those genes on or off.As the Philadelphia Inquirer noted, environmental stressors like drugs or alcohol, but also emotional stress, can cause methylation in different genes.To support the notion of genetic change due to alcohol, groups of test subjects—differentiated by their level of drinking (moderate, heavy and binge)—were shown stress-related, neutral or alcohol-related images, as well as containers of beer, and were allowed to taste beer while their motivation to drink was evaluated.The researchers found that binge and heavy drinkers who exhibited signs of genetic change also showed an increased desire to consume alcohol.Though the exact impact of the DNA change will require additional research, the study authors believe that focusing on genetic alteration will lead to the discovery of a biomarker, or genetic indicator, that can determine if a person is more likely to develop an alcohol or drug dependency."That's always been the hope of all mental illness," said Bill Jangro, medical director for the division of substance abuse programs at Thomas Jefferson Hospital, to the Inquirer. "That we would find a medical cause that is somehow reversible."

How to Deal with Dental Anxiety in Recovery: An Interview with Dr. Tasha Bollermann

I suffer with near-debilitating dental anxiety. Every time I visit the dentist it affects my whole body: I struggle to articulate how I feel and the issues I’m experiencing, I become so tense that I have to be reminded to breathe, and I typically lose the whole next day due to exhaustion and an emotional hangover. And I’m not alone. Almost everyone I speak to in recovery has some kind of dental anxiety — so much so that many avoid the dentist altogether, neglecting care they desperately need. Thankfully, I have a great therapist. She suggested that I mindfully explore the process of receiving dental care, advocating for my needs, and recovering my ability to self-regulate my fight or flight response. I have complex PTSD, which makes this whole process more challenging.Since moving to America I’ve spent thousands of dollars on dental care. I had no choice but to deal with months of dental pain by having a whole host of procedures, including root canals and crowns — all of which were unpleasant, to say the least. During one procedure I even had a panic attack, and I left many doctors’ offices feeling like I was too sensitive, an inconvenience.In my heart I knew that there had to be a dentist out there for me. I was so tired of feeling dismissed by doctors who roll patients in and out like they’re on a conveyor belt, only treating the symptom and never looking deeper.I had to find a doctor who understood the complexity of my situation and medical history and was thoughtful and patient enough to look at my experience holistically. After four dentists, I finally found one who demonstrated listening and compassion on a scale I’d never experienced. She had me when she told me that it was an honor to do her job.Curious to find out more about why people in recovery neglect their oral health, and the impact that drugs have on our teeth, I interviewed Dr. Tasha Bollermann for The Fix.The Fix: Thank you for taking the time to participate in this interview.Dr. Bollermann: I would like to thank you for giving me the opportunity to participate in this dialogue. The work you are doing to help people in recovery is important and powerful. My goal is to help people who are suffering live healthier and happier lives. I would also like to thank the reader for showing up and being ready to take the next step in their journey. Whether you know it or not, some part of you brought you to this article. Some part of you wants to break the cycle and pattern of where you have been and move into wholeness. You are ready for the next level of growth and healing. Otherwise you would not be reading this right now. Some of what I say might make you uncomfortable. This could be a signal that it is an area you are ready to begin to heal. So, congratulations on being here. I hope my words help you make progress in your journey.In your opinion, why do you think there is a tendency to neglect oral health even when the person is in recovery? What do you think are the main barriers preventing necessary treatment?Substance use may stem from a lack of self-love and self-respect. The basic needs for survival were not met, and therefore self-respect was not able to develop from a very early age. Often people show signs of self-loathing. This can lead to a desire to numb the shame with substances.I have witnessed the transformation from self-loathing to self-love. The habits of self-neglect need to be replaced with habits of self-care and nurturing. Teeth are vital for our survival. A person with a nice smile will get a job that a person with obvious dental diseases will not. Statistics show that the first thing we notice about a stranger is their eyes, and the second is their smile. So, breaking the habit of self-neglect and replacing it with a habit of self-care is essential to success. In my experience, the biggest barrier to oral health care in recovery is the lack of desire to care for yourself, and the lack of good habits. Neglect can lead to severe damage to the teeth and other organs. Often the damage to teeth is obvious without the expert opinion of a dentist. It is blatantly obvious to everyone you meet, as well as yourself when you look in a mirror. In comparison, the damage to the internal organs is less obvious. A return to overall health can be costly in time and money. There are financial obstacles in some cases and location obstacles in others, but a lot can be done with a toothbrush, some floss, a healthy diet, and a desire to get better.What are some of the effects that certain drugs have on the teeth, like meth for example? Are these effects from the drugs themselves, or rather from neglect?First of all, most drugs are harmful to teeth, so I don’t want you to think that this is a complete list of problems. However, some drugs deserve a mention here. Meth, for example, is one of the most destructive drugs I have encountered. It destroys the teeth rapidly. To my understanding, the drug itself is corrosive, which means it dissolves the teeth. Second, it creates extreme sugar cravings, which accelerates the process of tooth destruction. Ecstasy causes permanent neurologic changes in the brain. These changes create severe clenching and/or grinding of the teeth during sleep.Another substance use-related challenge is not being able to get adequately numb for comfortable dental treatment. This is most commonly seen with heroin and cocaine, but I also see it with alcohol consumption.Alcohol, marijuana, and tobacco are probably the most common drugs I encounter in my practice. The risk of losing the teeth to gum disease is significant, not to mention the risk of oral cancer. The more you drink and smoke, the higher your risk.Dental phobia is prevalent within the recovery community. How can people deal with that?Severe dental anxiety is best addressed before the dental appointment with a skilled practitioner of hypnosis, EMDR, neuro-linguistic programming, or other anxiety and recovery therapy. Once the patient can step into a dental office, it’s important for them to understand that they are not alone in their fear. The majority of people have fear around dental treatment. The stories my patients tell me are often heart-wrenching. Lying in a dental chair and having someone work on something so vital to your survival is a very vulnerable position to be in. Finding a dentist you can trust will help you build habits of success to manage your anxiety.Some patients are so terrified of communicating with their dentist that they often experience a frozen sensation, unable to articulate their fears or level of discomfort. What would you recommend to a patient that is even terrified to raise their hand to ask you to stop?This is tricky. As dentists, we rely on our patients to give us feedback on how they are doing. If the patient knows that this kind of freezing up has happened in the past and they share it with the dentist, then together they can work out a plan of action. A touch on the shoulder to reassure and check in can break the spell, so to speak. However, some patients don’t want to be touched. Again, I would say that needs to be discussed, and some kind of signal has to be arranged. Everyone has to be involved in the conversation. The dental assistant is, more often than not, the person who sees and acknowledges the signal, so the patient needs to include the assistant in the conversation as an important part of the team. If the patient is intimidated by the dentist, they should talk to the assistant about ways they can signal a concern that needs to be addressed.Many people in recovery will refuse pain medication stronger than Tylenol and local anesthetic. What do you recommend as a way to ease dental anxiety, and how would they compare to say traditional anxiety medications like benzodiazepines?The patients who refuse strong pain or anxiety medications are very wise. Benzodiazepines and opioids are highly addictive and can interfere with the recovery process. There are alternative ways to achieve relaxation and pain relief. Double-blind studies show time and again that ibuprofen and Tylenol are better pain control medications than prescription narcotics. Some of my patients visualize a safe and happy place that they escape to in their mind. Others take a combination of over-the-counter relaxation aids. Another approach is the use of acupuncture, aromatherapy, or naturopathic treatments before or after a dental appointment. Anyone in recovery should be careful about what they take for relaxation and pain control.L-theanine reduces anxiety. It promotes relaxation and stress reduction without sedating. L-theanine can help foster a state of calm, attentive wakefulness. It has positive effects on both the mental and physical symptoms of stress, including lowering heart rate and blood pressure. It is available in most health food stores.GABA (Gamma-Aminobutyric acid) is an amino acid produced naturally in the brain. It reduces the activity of neurons in the brain and central nervous system, which in turn has a broad range of effects on the body and mind, including increased relaxation, reduced stress, a more calm, balanced mood, alleviation of pain, and a boost to sleep. It’s available in most health food stores. It should not be used by patients already taking gabapentin.Brainwave entrainment works for almost everyone. It is a great way to lead your mind into states that you might usually have difficulty reaching, allowing you to experience a sense of calm relaxation without medication. Instructions are available on YouTube.If you plan on using any of these alternatives, I recommend you try them out in the comfort of your home first to see how it affects you. (Editor’s note: Consult your physician before taking any supplements. Even benign substances may interact with other medications or have unintended side effects.)What are some dental advancements that people may not be aware of since their last visit, but which would make the experience a whole lot less stressful?While most of the advances in dentistry are technical in nature, many shorten the time you have to spend in the chair. These include digital X-rays. You used to have to wait 15 or 20 minutes for the dentist, hygienist or assistant to process the films and bring them back, leaving you waiting and worrying. Now they are instantly available. The biggest advancement I would recommend is exercising your personal choice in dentists. Many dental offices today are very patient focused, virtually gone are the days of little to no concern for patient comfort. Choose your next dental office carefully, with the assumption that you will find a compassionate office.Tell me what similarities you see between dental disease and substance use disorders. Both dental disease and substance use disorder are lifestyle diseases. You can overcome both by creating small lifestyle changes that build on themselves. Achievement in oral health, or in substance use recovery, is a practice in the art of daily living. People who grow up in an environment of brushing and flossing daily are more likely to continue doing those things into adulthood. Those who grow up in an environment where the basic needs of survival are either not met or are minimally met are likely to continue those patterns into adulthood. Sponsors help keep the substance use at bay, and in a way the dental team is a sponsor for oral health. Regular checkups allow connection and repetition, which build habits of success. Habits of success build self-respect and self-love.Many of us neglect our teeth while in active addiction and sometimes this continues into recovery. How are you taking care of your teeth today? Let us know in the comments.

John Mayer Talks Sobriety On "Ellen"

Grammy-award winning singer-songwriter John Mayer recently marked two years alcohol-free, and he opened up about it on The Ellen Degeneres Show. “I just finished,” Mayer explained to host Ellen DeGeneres. “I completed my course in drinking. Thankfully, for me—I’m very lucky—I didn’t go all that deep. I just went, ‘You know, I think I’m done.’ It’s like Forrest Gump running and he just stops running at some point. ‘I think I’m out.’ So I punched out.”Mayer added that he stopped drinking after he had “a good, long talk” with himself.Mayer told Complex last year that the turning point was when he attended Drake’s 30th birthday party, “and I made a fool of myself… I was in my sixth day of the hangover… I went, ‘Okay John, what percentage of your potential would you like to have. The voice in my head said, ‘OK. Do you know what that means?’ I went, ‘We don’t have to talk anymore. I get it.’”Once Mayer stopped drinking, his productivity went through the roof. “The next year, I did four tours, I was in two bands, I was happy on airplanes.” In 2017, Mayer publicly announced on social media, “I want people to know that ‘that’s enough for now’ is on the menu, so to speak.”Last year in Rolling Stone, Mayer revealed that he entered the “cannabis life,” and has also been pushing for the legalization of marijuana on Jimmy Kimmel Live! “I put [weed] where drinking used to go, and the quality of life has gone up considerably. Drinking is a f—ing con.”Mayer is also launching a foundation that will help military veterans living with PTSD. The Heart and Armor Foundation has been in the works since 2012.“We’re going to the public with things like published research papers and having raised enough money to really build some pilot programs," Mayer said. "We have some really great data and we want it to be working first so that a lot of the questions were answered before we brought things to people by way of awareness.”

Accountable to Recovery

People who are active in their addictions lie. They cheat. They steal. And often they wiggle their way out of accountability for their actions, dodging and weaving to avoid the consequences that would leave them face-to-face with the destruction that their substance abuse has caused.That’s why at Recovery Ranch accountability is a critical part of learning to live a productive, sober life. The men’s sober living program, which provides structured sober support for men in early recovery, helps by surrounding recovering addicts with peers who will hold them accountable, even when that process is painful, says Dave Martz, intake manager at Recovery Ranch.“Accountability is the core of our recovery at the Ranch,” Martz says. “It is the means by which we help each other take responsibility and ownership for our actions and make the necessary changes to our behavior that lead to quality recovery.”Often, this is a drastic change for the young men who come to the ranch. Most of them arrive at the ranch with deep character flaws that can be addressed only with brutal honesty.“Our character defects are what lead us to using drugs,” Martz says. “We are dishonest, disrespectful, lazy, selfish, and ungrateful people; getting sober doesn’t change that.” Usually these men have never been held responsible, by themselves or their loved ones. “Accountability is an important part of recovery because we addicts rarely have any decent standard that we live by,” Martz says. “Any standard that we wish to adhere to, we are unable or unwilling to hold ourselves accountable to.”That’s part of the reality of being powerless over substances. At the ranch, taking a direct approach to accountability is part of working the 12 steps and learning to function sober. Men learn to be accountable to the others they are living with and working with at the businesses that the ranch runs. This helps them transform from addicts into gentlemen at the ranch and learn to be productive members of society.“What changes that is having people around us who care enough to say something to us whenever we behave in those ways, and that is what we have at the Ranch,” Martz says. “We hold each other accountable by adhering to a standard of living and speaking to each other with brutal honesty. This is how we care for each other. We do not sugar coat our situations, we don’t feel sorry for each other, and we don’t let each other fail.”Men at the ranch have made the decision to get sober, but most still don’t know how to hold themselves accountable for their actions. Instead, the group is able to step in and help guide them.“Before we build a solid foundation in recovery, most of us cannot hold ourselves accountable,” Martz says. “If we knew how to do that, we wouldn’t need to hit rock bottom before we decide to do something different with our lives. We need help. We need someone else to hold us accountable before we can take on that responsibility ourselves.”Initially, men at the ranch might push back against being held accountable for the first time ever.“When we are in our addiction, we live without accountability for our actions,” Martz says. “Anyone who tries to hold us accountable, usually the ones who care about us the most, we resent and blame. When we feel there are no consequences for our actions and we have no standard to live by, we have no meaning in our life; when we have no meaning in our life, we get loaded.”However, over time men at the ranch realize that their peers hold them accountable because they love them and want to see them succeed in sobriety. This can help them stay sober for the long-term.“Recovery is only strong when it is shared,” Martz says. “The strength of my recovery is in the relationships I have built with the people around me who have walked through the same struggles that I have. These relationships are strong because of accountability.”The Recovery Ranch provides structured sober living for men in Santa Ynez, California. Get more information by visiting the website or calling 805-705-0766.

Pregnant and Scared to Get Treatment: When Conception Meets Addiction

With one in three individuals with opioid use disorder passing through the criminal justice system annually, court dockets across the country are overflowing with cases of illegal behavior fueled by addiction. Though such cases wrangle with the complexities of punishing individuals afflicted with what is increasingly seen as a disease that erodes free will, they are the bread and butter of the legal system. However, the recent Pennsylvania Supreme Court case known as In the Interest of L.J.B. adds another level of intricacy to the court's decision-making process. The question asked in the case—Does drug use during pregnancy constitute child abuse? —is unpleasant to contemplate, but it is one of absolute importance.The defendant in the case, a woman referred to as A.A.R., tested positive for illicit opioids, benzodiazepines, and marijuana when she gave birth to her infant, L.J.B., in January 2017. L.J.B. then required 19 days of inpatient treatment for drug withdrawal and was placed in the custody of Children and Youth Services, which alleged that her mother’s drug use during pregnancy was child abuse. On December 28, in a 5-2 decision, Pennsylvania’s Supreme Court ruled in favor of L.J.B.’s mother, stating that Pennsylvania’s child abuse law clearly excludes fetuses in its definition of a child. While the issue may be settled in Pennsylvania, there is little doubt that similar cases will be heard across the country amidst the opioid epidemic.Pregnant Women with Opioid Addiction — Overlooked and UndertreatedThe case of L.J.B. and her mother has drawn national attention to women who simultaneously carry a child and the burden of an addiction—a group that has often been overlooked or ignored in the national discussions about the opioid epidemic. Few individuals in our society bear such a stigma as these women. As an addiction psychiatrist, I’ve heard harsher judgment passed on these patients—even from fellow healthcare workers—than on any others. This stigma permeates our medical and legal systems, creating dire consequences not only for these women, but also for their unborn children.Pregnancy is unparalleled in its ability to motivate women towards healthier behavior, but approximately four percent of pregnant women still use addictive drugs. When I’m asked to evaluate a woman who is pregnant, I know her disease is severe before I’ve even laid eyes on her. If one needs proof that addiction is a disease and not a moral failing, look into the eyes of a woman who knows her behavior is harming her baby but still can’t stop. There is no better example of the ability of a chemical to overpower the deepest-rooted human instincts.A recent report released by the CDC revealed that opioid addiction among women in labor quadrupled from 1999 to 2014, signifying the need for immediate action. Opioid addiction during pregnancy can create many problems for mother and child, including preterm labor, neonatal abstinence syndrome, and even fetal death. Tragically, pregnant women with addictions are less likely to receive prenatal care. Aware of society’s disdain, many don’t want to be stigmatized at the doctor’s office. Some mothers-to-be can’t even find a physician willing to treat them, and others are afraid of being reported to authorities due to laws that have arisen out of prejudice and misinformation.Harsh Laws Harm Mother and ChildTwenty-three states already consider drug use during pregnancy child abuse. In three states, it’s grounds for involuntary civil commitment. Though some people think such laws deter women from using drugs during pregnancy, they don’t. If a woman’s addiction is so severe that it is active during pregnancy, laws that threaten arrest or loss of custody will not bring about remission. They also rarely bring about legal punishment, since the charges are dismissed or the convictions are overturned 85 percent of the time.All that these laws do is cause pregnant women with addictions to avoid prenatal care visits or forego them all together. Tennessee discovered this the hard way, when it passed a law in 2014 making drug use during pregnancy punishable by up to a year in prison. The number of pregnant women seeking treatment for addictions fell drastically because they were too afraid of the legal ramifications. Thankfully, the law expired in 2016, but Tennessee's legislature is now considering passage of a similar bill.How to Help Pregnant Women with Addictions and Their ChildrenIf our actual desire is to help pregnant women with addictions and their children, there are effective actions we can take. We can start with repealing counterproductive laws, and, as funding is being allocated to counter the opioid epidemic, we can earmark portions of it for these patients and create more treatment options for them. Only 19 states have programs specifically targeting the unique needs of pregnant women, and only 17 provide them with priority access to state-funded addiction treatment programs.Healthcare providers can help by addressing their own stigma and stepping up to provide treatment to this vulnerable group. These women already face significant barriers to care, so finding a willing and caring healthcare provider shouldn’t be another challenge to overcome. There are also ways to avoid tragic situations like this in the first place. Out of all pregnancies in women with opioid addictions, eighty-six percent are unintended, so ensuring access to affordable and effective family planning services is essential.For addicted women with unborn children, an invitation into care is far more effective than any legal threat we can muster. Let’s dispense with negative attitudes and legal barriers that keep these patients from seeking treatment. Ensuring that help is available when needed is the way forward, because the only way to aid an unborn child is to help its mother, regardless of how her actions might make us feel. 

New York Counties Skeptical Of Marijuana Legalization

As New York state moves forward with plans to legalize the recreational use of cannabis, some counties in the state are expressing skepticism and considering whether to “opt out” of recreational cannabis. If marijuana is legalized in New York, counties may be able to stop marijuana businesses from operating within their boundaries, according to WKBW Buffalo. Chautauqua County in Northwest NY is one of the counties that is wary of marijuana legalization, according to Chautauqua County Executive George Borrello. "It's irresponsible to legalize recreational marijuana," he said, adding that the bill being considered by the state does not make the rules around recreational cannabis use clear. Niagara County Legislator Jesse Gooch said that he does not have a strong opinion on marijuana legalization, but he would like to hear from his constituents about their concerns. Because of that, he plans to host community forums to discuss whether Niagara County should opt out of legalization by not allowing marijuana to be bought, grown or sold in the county. "I would like to set up a couple of open forums where we invite the public residents to come in and really just talk it out,” Gooch said. NY Governor Andrew Cuomo expressed opposition to legalization as little as two years ago, but now supports a bill to legalize recreational use for people over 21. He has essentially said that the move is inevitable. "It's a false choice legalize marijuana or not, because we are there already,” Cuomo said, according to WIVB. Despite that, law enforcement in New York has been against legalization. In the more rural counties upstate, sheriffs and others are concerned about the effect that marijuana legalization will have on road safety, according to Thomas Dougherty, Livingston County Sheriff.Dougherty said officers will need to be specially trained to detect whether a driver is operating under the influence of marijuana. "I don't know many agencies that can afford to have a full force of [drug recognition experts], some of the largest counties have 3 or 4. Again we have major concerns on what will be the fiscal impact," he said. Dr. Gale Burstein, Erie County Health Commissioner, said that since she has no say in whether marijuana use is legalized, she’s just doing her best to prepare for how that may impact public health in the county. "We know that you can get addicted to marijuana. That's a known fact, even though people don't believe that,” she said. “In states where marijuana has been legalized, they've seen a much higher incidence of impaired driving and very serious motor vehicle accidents compared to states where marijuana has not been legalized for recreational use.”