People With Intellectual Disabilities May Be Denied Lifesaving Care Under These Plans as Coronavirus Spreads

ProPublica is a Pulitzer Prize-winning investigative newsroom. Sign up for The Big Story newsletter to receive stories like this one in your inbox.Advocates for people with intellectual disabilities are concerned that those with Down syndrome, cerebral palsy, autism and other such conditions will be denied access to lifesaving medical treatment as the COVID-19 outbreak spreads across the country.Several disability advocacy organizations filed complaints this week with the civil rights division of the U.S. Department of Health and Human Services, asking the federal government to clarify provisions of the disaster preparedness plans for the states of Washington and Alabama.The advocates say the plans discriminate against people with intellectual disabilities by deprioritizing this group in the event of rationing of medical care — specifically, access to ventilators, which are in high demand in treating COVID-19 cases. More than 7 million people in the U.S. have some form of cognitive disability.Some state plans make clear that people with cognitive issues are a lower priority for lifesaving treatment. For instance, Alabama’s plan says that “persons with severe mental retardation, advanced dementia or severe traumatic brain injury may be poor candidates for ventilator support.” Another part says that “persons with severe or profound mental retardation, moderate to severe dementia, or catastrophic neurological complications such as persistent vegetative state are unlikely candidates for ventilator support.”Other plans include vague provisions, which advocates fear will be interpreted to the detriment of the intellectually disabled community. For instance, Arizona’s emergency preparedness plan advises medical officials to “allocate resources to patients whose need is greater or whose prognosis is more likely to result in a positive outcome with limited resources.” Between a person with cognitive difficulties and a person without them, who decides whose needs come first?Medical triage always forces hard decisions about who lives and dies. For instance, older people with shorter life expectancy or those with severe dementia are often deemed less deserving of scarce medical resources than younger, healthier individuals. The state plans make clear that the fate of those with intellectual disabilities is part of the wrenching debate.HHS officials said they were opposed to rationing care for people with any kind of disability.“Persons with disabilities should not be put at the end of the line for health services based on stereotypes or discrimination, especially during emergencies. Our civil rights laws protect the equal dignity of every human being from ruthless utilitarianism,” said Roger Severino, the director of the agency’s civil rights office.“What we’re seeing here is a clash between disability rights law and ruthless utilitarian logic,” said Ari Ne’eman, a visiting scholar at the Lurie Institute for Disability Policy at Brandeis University. “What this is really about at the end of the day is whether our civil rights laws still apply in a pandemic. I think that’s a pretty core question as to who we are as a country.”Advocates and families of those with intellectual disabilities say their community is especially vulnerable to the disease because many of those with significant impairments live in group homes or other congregate settings.It can sometimes be difficult for people with intellectual disabilities to understand the pandemic and its demands, such as the need to wear masks and heightened protocols for social distancing and hand-washing.The death of Emily Wallace, a 67-year-old with Down syndrome in a group home in Georgia, was an early warning sign of the dangers facing the community, advocates say.Wallace was a woman of firsts. She and her husband, Richard, were the first couple with intellectual disabilities to marry in the state. They were the first to live independently in their own home in Albany, a small town in the southwestern part of the state. In mid-March, Emily was the first person with an intellectual disability in her community — and possibly one of the first in the nation — to be diagnosed with COVID-19.She was taken to a local hospital where she died alone.“Mrs. Wallace is once again the first, but this isn’t what we wanted to celebrate,” said Stacey Ramirez, state director for The Arc of Georgia, a nonprofit advocacy group that serves people with intellectual disabilities.Emily and Richard Wallace were married for 18 years. A 1992 story in the Albany Herald depicted their life as happily domestic, mentioning that Richard hated to vacuum, while Emily didn’t like to dust, and that she did most of the cooking while he raked the leaves. They made payments on their home and both held down jobs. After Richard, who also had Down syndrome, died in 2018 at 65, Emily moved to a group home operated by The Albany Arc.After a caregiver apparently brought the coronavirus into the home, Wallace fell ill. So did another resident, who was hospitalized.Emily Wallace had a do not resuscitate order, so a ventilator would not have been an issue even if care were being rationed, said DeAnna Julian, executive director of The Albany Arc.But as more people are getting sick, Julian said she worries that not enough testing for the virus is being done in Albany. She’s seeing individuals — both with and without intellectual disabilities — who appear to have mild symptoms of COVID-19.“They’re just turning them around and sending them home, they’re putting them on” antibiotics, she said. “We live here in southwest Georgia where right now, all the cars are covered in yellow pollen and everyone has some kind of seasonal allergies. … Is it just your springtime cold or is it COVID-19?”Julian doesn’t have masks, gloves or other safety equipment. She doesn’t have enough staff.“It’s a difficult and critical situation here,” she said.But no, Julian said, she didn’t see Wallace or the other group home resident receive treatment any different than anyone else. She said she wouldn’t stand for it.“I’d take it all the way to the top, to the governor! They have every right to be treated like human beings,” Julian said.With the Americans with Disabilities Act celebrating its 30th birthday this year, activists are questioning whether policymaking has come far enough in what some consider to be the final battle in the fight for civil rights.In a March 18 letter to Wisconsin Gov. Tony Evers, the Survival Coalition, a group of advocacy organizations, wrote, “‘Quality of life’ has long been a pretext for denying treatment, including life-sustaining treatment, to vulnerable populations, particularly people with intellectual disabilities.”Michael Bérubé and his wife, Janet, live in State College, Pennsylvania, with their son Jamie, who is 28 and has Down syndrome. Bérubé, a professor of literature at Pennsylvania State University and the author, most recently, of the book “Life as Jamie Knows It,” studies disability. He was not surprised to learn about state rationing plans that single out people with intellectual disabilities and other cognitive conditions.“It would be a very rare person who sees a person with Down syndrome as innately as valuable and as able to contribute to society as anybody else,” Bérubé said.Pennsylvania is among those states now scrambling to write up guidelines to determine who will have access to ventilators in case of medical rationing, according to media reports.“In two weeks, when the resources get truly stressed out, we’ll see how much of this draconian stuff goes into practice,” he said.Filed under:Health Care

Addiction Recovery in the Time of Coronavirus

My roommate finally found toilet paper after weeks of searching and while he was walking home from CVS with 12 rolls in his hands, a homeless guy approached him and said, “You guys found toilet paper. Good job,” and gave him a thumbs up. My roommate, without skipping a beat, said, “Do you need some?” and the guy kind of shrugged yes. So my roommate tore open a package and handed him a roll. He is a normie, by the way. He doesn’t have a program that instructs him on how not to be a selfish asshole which makes the story all the more moving to me.Unfortunately, this isn’t the type of behavior we’re seeing in general, but it should be. Instead, people are fighting over sanitizing wipes at Sprouts. A woman walked into Erewhon coughing and somebody threw a banana at her--an overpriced organic one I’m sure--and said “Get the fuck out of here.” There is widespread panic and a scarcity mentality which is leading to hoarding, paranoia, and an “every man for himself” mindset. Personally, I find it all really depressing and in a time when I need to feel more connected, I feel less. I tweeted something about it and somebody mentioned modeling the behavior I wanted to see in others and that really struck me: Knowing people are scared and on edge, how can I cut them more slack, be more compassionate? Instead of being reactive, how can I be generous and loving toward people who are acting like dicks? As addicts and alcoholics, we know all too well how fear brings out the worst in people.Ahh, fear. We are naturally fearful people so this pandemic can really ramp up our underlying anxiety. Personally, it has totally freaked me out. I have a shitty immune system anyway and am almost famous for always being sick… without some terrifying virus taking people out all over the world. On top of that, I have 82-year-old parents. One is wheelchair bound with a horrible flu (not COVID-19) and the other is just recovering from chemo. So yeah, I’m scared.I hear program peeps being all “I choose to have faith and be positive. I’m not worried about it” while they do things that the CDC have warned us not to do. Ummm, okay, magical thinker. I’m all for being positive but let’s wash our fucking hands and not hang out in big groups. As the old Russian sailor proverb goes, “Pray to God, but row to shore.” When we get clean and sober, two different mindsets seem to emerge. One is “we’re addicts and alcoholics. We’ve survived a killer disease. Nothing can take us down.” Those people are the ones who still push for live group meetings. “Recovery first!” they chant. “Fuck fear!” I know a few places that have re-opened their homegroups, limiting the number and spreading out the participants, claiming it felt “rebellious.” Is it rebellious or is it just classic alcoholic defiance and selfishness? Let’s say you go to a meeting, catch it from an asymptomatic carrier and then go home and give it to your nana or some old woman at the market and kill her? And Jesus, is that what it’s come to? That having a meeting gets our adrenaline pumping and feels risky? Man, get a hobby.The other mindset I’ve seen when people get clean and sober is hypochondria, an OCD cleanliness, and an obsession with health. People who shot up with toilet water are now carrying Purell or drinking kale smoothies or doing ozone therapy; that ironic swing from smoking meth to becoming vegan and doing crossfit. These people are like: “I survived all that stupid shit and now I want/need to take care of my body and certainly don’t want to die from a virus.”Those people, and I count myself among them, are currently flipping out. Even before COVID-19 hit, I thought every headache was a brain tumor, every cramp was pancreatitis. I was never particularly obsessed with germs but now I try to push elevator buttons and open doors with the sleeve of my distressed vintage sweatshirt, only to find myself wiping my nose with said sleeve 30 seconds later. Old habits die hard.A key to recovery is connection. As meeting halls and churches close their doors, most 12-step meetings have moved online. Although online meetings have existed for those who couldn’t or didn’t want to go to in-person meetings, membership has really jumped since COVID-19 hit the stage. These are great stopgaps during a time when social distancing or quarantine is suggested or mandatory. And sure, it’s wonderful to see the faces of your regular meeting people, all sequestered in their individual little homes. And it’s quite incredible to be in a big online meeting with 200 people from all over the world. There’s a feeling of solidarity that’s very much needed in this time.But, let’s be honest, it’s not the same. I’m a very touchy person who likes to hug and these meetings are lacking the physical connection and face-to-face contact that I really crave. But a bigger concern than the lack of physicality for needy fuckers like me is that many older people who have been told to stay home aren’t technically savvy enough to get on Zoom or intherooms.com. So are they being left out? And how about the deaf population? Of the 2,000 brick and mortar AA meetings in LA, I believe 12 have ASL interpreters. So let’s imagine how many of the new online meetings have them. Or people who don’t have access to computers or internet connections? Granted, this is uncharted territory for all of us and we’re all learning and adjusting to this new way of life together.The isolation aspect of this pandemic is deadly for us. We are prone to isolate anyway and now we’re encouraged (or required) to do so. Isolation is the breeding ground not just for loneliness but for depression and negative thoughts to take over like some evil dictator. As I quarantine (when I’m not at the market or pharmacy), sleeping has become a big hobby, as has, I’m embarrassed to say, looking for cat sweaters for the newly shaved Colonel Puff Puff. Don’t judge. It’s easy to spiral out with too much time on your hands. And as mortifying as it is, at least I’m not getting loaded.I checked in with one of my best friends, former news anchor and certified recovery specialist Laurie Dhue. “The only thing I can really compare this to (and it’s not exactly comparable) is the eeriness of the empty streets and the feeling of desperate helplessness immediately after the 911 attacks in NYC,” she said. “There was so much fear of the unknown, fear of uncertainty, ‘is Al-Qaeda going to attack again? Will life ever get back to normal? Is this the new normal?' Those of us privileged to anchor the news during this terrifying time felt extra pressure to deliver. Of course I drank more than usual in the immediate aftermath of the terror attacks and during the war on terror for the next several years... we ALL drank more. In THIS crisis, I have 13 years of recovery so of course I can’t fall back on substances. But imagine being newly sober? I feel for the newcomers.”She brings up two great points. One is that people have a natural tendency to anesthetize during terrifying periods like this. As people get ready to hole up at home, the cannabis dispensaries have lines around the block. Liquor stores are reporting booming sales.Now that most bars are closed as well as many restaurants (apart from takeout or delivery), you can get alcohol to go as long as you buy it with food. The government is urging people to stay at home and drink. But as sober people, we can’t do that. I admit that I want to vape but I haven’t been. I know some people who have relapsed on cigarettes after years of not smoking and I know people who have already relapsed on drugs. People in recovery are especially vulnerable in these unique circumstances.Dhue also points to the looming ambiguity and uncertainty that both 9/11 and the COVID-19 pandemic have created. Many alcoholics and addicts, control freaks to the max, loathe uncertainty despite it being an integral part of life. That’s one of the reasons why we drank and used. If we couldn’t control the outcome, at least we could control our feelings. Well, right now we don’t just have the uncertainty of the virus, but we have financial insecurity as well. So many people have lost their jobs as restaurants, schools, and gyms close and companies lay off employees in record numbers. So financial fear is rampant and that’s a big struggle for people in recovery even at the best of times. It’s really easy to let your mind take you to a place where you’re not only sick but homeless as well.I have a lot of friends in the treatment business and they are working double or triple shifts. Intensive outpatient clinics have closed. Clients in residential treatment aren’t allowed to go to the few outside meetings still happening or have family or friends come visit. Behavioral health care workers are exposing themselves everyday. It’s mayhem. Many treatment staff feel human contact is key to recovery, but that isn't allowed right now.Patrick Reilly, program supervisor of LSS Aspen Center and Genesis House in Waukesha, Wisconsin, who has 10 years clean and sober, told me, “I’m fearful for residents currently in treatment because most aftercare has been cancelled and there’s no community support. We have to create a new path for these individuals and it’s going to have to be social media. It’s imperative that rehabs stay connected to their alumni and help guide them into whatever the new normal of community support is.” He continued, “Personally I’m concerned that the overdose numbers will either stay where they are or increase. I’m nervous for the slow creep relapse. Are alcoholics maybe starting to smoke pot? Are junkies starting to drink? Like I won’t do my drug of choice but….As a drug addict and alcoholic when I’m scared, I know the one thing that will make it better. As people in recovery, it’s imperative we reach out to those people whose number we got once a few weeks ago. It’s on us to stay connected. We need to take care of our own. We are the most selfish people in the world and if there was ever an opportunity to challenge or change that behavior and mindset, this is it.“If you need help, financial, emotional, some dried noodles, whatever, ask for it. Stay on your meds. Do the virtual meetings. Call people. Stay connected. Be empathetic. Getting loaded will not help anything. There is no current escape from this. Do self-care, whatever that looks like. Don’t bang a lot of people. Cut yourself some slack. This is new and terrifying for all of us. Most importantly, be kind. This can either tear us apart or bring us together.

Here’s What the Science Says About CBD and Addiction Treatment

Over the past few years, CBD has been heralded as a cure for ailments from arthritis to addiction. But it can be challenging to know what’s rumor and what is scientifically verified fact. That’s why it’s essential to review what real scientific studies say about using CBD to treat certain conditions.When it comes to addiction, the research shows that CBD is promising. Here’s what you should know about using CBD to treat addiction.What is CBD?You’ve probably heard of CBD, but still not understand exactly what it is. CBD, or cannabidiol, is a chemical component found in marijuana or hemp. Unlike THC, it’s not psychoactive, and it’s not thought to be addictive either. CBD can be infused into a variety of products, from oils to bath bombs. People who use it believe it helps treat many conditions, including addiction.CBD can help people with opioid addictionOpioids are among the most powerfully addictive substances. CBD can be useful in helping people get off and stay off opioids, research indicates.For starters, having access to medical marijuana might help people from becoming hooked on opioids in the first place. A 2014 study found that states with medical marijuana programs had significantly lower rates of opioid overdoses. The study did not investigate the cause of this correlation, but it could be that people who were able to treat their pain with cannabis products were less likely to use highly addictive opioids.Another study indicates that CBD might lessen the appeal of opioids. A 2013 study done on rats founds that rats who were given CBD did not find morphine as rewarding. That suggests that CBD interferes with the way that the brain responds to opioids and could potentially impact the addictive nature of opioids. Many people who become addicted to opioids are treated using methadone. One 2013 study found that people who were using cannabis while on a methadone treatment plan reported less intense opioids withdrawals.CBD can help with methamphetamine and cocaine addictions, tooA 2019 scientific review indicated that CBD could be useful for treating cocaine and methamphetamine addiction. The research shows that CBD might help people avoid relapsing on meth or cocaine.“A limited number of preclinical studies indicate that CBD could have therapeutic properties on cocaine and METH addiction and some preliminary data suggest that CBD may be beneficial in cocaine-crack addiction in humans,” the study authors wrote. “Importantly, a brief treatment of CBD induces a long-lasting prevention of reinstatement of cocaine and METH seeking behaviours.”This use of CBD is particularly crucial because there are currently no medication-assisted treatments for methamphetamine or cocaine addiction. Opioids can be treated using methadone, buprenorphine, or naltrexone, and this medication-assisted treatment improves outcomes for people with opioid use disorder. However, there’s no similar course of treatment for people struggling with meth or cocaine addiction. Because of that, CBD could be particularly promising for those patients.CBD could be useful if you’re trying to quit smokingMany people who are in recovery from substance use disorder still smoke cigarettes. Research shows that CBD could be useful in breaking the addictive pull of nicotine. A 2018 study looked at cigarette smokers who had abstained overnight, after being given a dose of CBD. Researchers found that the CBD didn’t reduce the cravings for nicotine, but it did make the experience of smoking a cigarette the next morning less pleasurable.An earlier study, published in 2013, showed even more promise. Researchers found that cigarette smokers who took CBD as needed reduced the number of cigarettes they smoked by 40%. The study concluded, “CBD [is] a potential treatment for nicotine addiction that warrants further exploration.”Is CBD safe for people who have a history of addiction?CBD is generally considered safe, and it isn’t addictive. It’s key to make sure that you’re getting CBD from a reputable seller so that you can be sure that the CBD you’re taking doesn’t contain THC, the active ingredient in marijuana that can be addictive.Want to learn more about the science of CBD and addiction? Click here.

When Purell is Contraband, How Do You Contain Coronavirus?

This article was originally published on March 6th by The Marshall Project, a nonprofit news organization covering the U.S. criminal justice system. Sign up for their newsletter, or follow The Marshall Project on Facebook or Twitter.When Lauren Johnson reached for a squirt of hand sanitizer on her way out of the doctor’s office, she regretted it immediately.In the Central Texas prison where she was housed, alcohol-based hand sanitizer was against the rules—and the on-duty officer was quick to let her know it.“He screamed at me,” she said.Then, she said, he wrote her up and she lost her recreation and phone privileges for 10 days.The incident was a minor blip in Johnson’s last prison stay a decade ago, but the rules hold true today and underscore a potential problem for combating coronavirus: Behind bars, some of the most basic disease prevention measures are against the rules or simply impossible.“Jails and prisons are often dirty and have really very little in the way of infection control,” said Homer Venters, former chief medical officer at New York City’s notorious Rikers Island jail complex. “There are lots of people using a small number of bathrooms. Many of the sinks are broken or not in use. You may have access to water, but nothing to wipe your hands off with, or no access to soap.”So far, the respiratory virus has sickened more than 97,000 people worldwide and at least 200 in the U.S. More than 3,300 people have died. As of late Thursday there were no reported cases in American prisons, though experts say it’s just a matter of time. (Ed Note: These were the numbers as of March 6th, 2020. At time of this publication, they have increased. See current stats here.)To minimize further spread, the Centers for Disease Control and Prevention suggests things like avoiding close contact with people who are sick, covering your mouth with a tissue when you cough or sneeze, disinfecting frequently-used surfaces and washing your hands or using alcohol-based hand sanitizer.But these recommendations run up against the reality of life in jails and prisons. Behind bars, access to toilet paper or tissues is often limited and covering your mouth can be impossible if you’re handcuffed, either because of security status or during transport to another facility.Typically, facilities provide some access to cleaning products for common areas and individual cells, but sometimes those products aren’t effective, and Johnson recalled women stealing bleach and supplies so they could clean adequately.Hand sanitizer is often contraband because of the high alcohol content and the possibility for abuse (the alcohol can be separated out from the gel). A spokesman clarified Thursday that the Texas prison system now sells sanitizer on commissary, though it is a non-alcohol-based alternative, which is not what the CDC recommends.Even something as basic as hand-washing can be difficult in facilities with spotty water access or ongoing concerns about contamination, such as in the recent Legionnaires’ outbreak at one federal prison complex in Florida. (Legionnaires is caused by contaminated water, though the source of that water is not clear in Florida).Aside from all that, prisons and jails are large communities where a sicker-than-average population is crammed into close quarters where healthcare is often shoddy, and medical providers are often understaffed. In an infectious disease outbreak, health experts recommend separating sick people from well people to prevent the disease from spreading, but in prison that can be nearly impossible, since prisoners are already grouped according to security and other logistical considerations.Given all that, correctional facilities often respond to outbreaks with the same set of tools: lockdowns, solitary confinement and visitation restrictions. That’s what some prisons and jails did during the 2009 swine flu pandemic, and it’s what happened more recently in the Florida federal prison complex struck by Legionnaires'. In Texas and other states, prison officials regularly shut down visitation or institute partial lockdowns during mumps and flu outbreaks.This time, though, some public health officials—including former Rikers health official Venters—are proposing a different solution: large-scale releases, like those already underway in Iran. There, officials approved the temporary release of more than 54,000 prisoners in an effort to combat the spread of the new virus.“That’s a gauntlet for the U.S.,” said Jody Rich, a professor of Medicine and Epidemiology at Brown University. “ Really? Iran's going to do it better than we are?”Advocates in Indiana on Thursday called on the governor to consider releasing large numbers of elderly and sick prisoners, who are at highest risk of complications from coronavirus. People with chronic illnesses are vastly overrepresented in U.S. prisons and jails, and elderly inmates are the fastest-growing share of prisoners.Some in law enforcement immediately criticized the proposal."I don’t think a viable solution for the safety of our community is to have mass releases from jails,” said Joe Gamaldi, president of the Houston police union. “As much as we have to balance the dangers that coronavirus poses to the community, we also have to balance that against the danger of letting violent criminals back out on the streets."It’s not yet clear whether any prisons or jails are seriously considering widespread releases. A spokeswoman for the federal prison system did not respond to questions about the idea, instead saying that the isolating nature of prisons could be an asset in handling any potential outbreak.“The controlled environment of a prison allows the Bureau of Prisons to isolate, contain and address any potential medical concern quickly and appropriately,” said Nancy Ayers, the spokeswoman. “Every facility has contingency plans in place to address a large range of concerns.”

Missed Amends

(This article is excerpted from Crimson Letters: Voices from Death Row by Tessie Castillo, Michael J. Braxton, Lyle May, Terry Robinson and George Wilkerson, Black Rose Writing, 2020.)During the summer of 1996, when I was fifteen, my three brothers and I were split between our parents. I was in court for various charges, including a probation violation for habitual larceny and assault charges I’d acquired at age twelve. The judge told me I could either leave Asheboro, North Carolina, to live with my mom in Fayetteville until I turned eighteen, or go to a juvenile detention facility for eighteen months. I chose to live with my mom and so did my older brother Mike. By then my mother had married a third time and owned a Korean restaurant where I was put to work washing dishes. My younger brothers, Daniel and Albert, followed right before school started in the fall.For my sixteenth birthday, I asked my mother to help buy me a car, since I’d been working in her restaurant without pay. In January of 1997, two months before I turned sixteen, she made me a deal. If I found a job and worked all year, saving my money, she’d help me buy a car in time for Christmas. I happily agreed and found a job at Taco Bell.All year I envisioned how my new car would look packed to capacity, my friends’ arms akimbo out the window. The music system would pound as I rolled around corners, announcing my arrival as if a red carpet had been laid out. My popularity would explode as I graciously granted rides to whoever kissed my…ring.Two weeks before Christmas, my mom took me to a car lot and helped me pick out a car. But when it came time to pay, she refused to co-sign although I could not get credit to finance a car at sixteen years old, nor did I have ten thousand dollars cash to buy the car outright. I threw a fit, demanding she explain how she was “helping” me buy a car if she’d neither co-sign nor pay the difference (I’d saved up only fifteen hundred dollars). She never answered except to say, “I no co-sign.” I raged at the humiliation I’d face in front of my friends, to whom I’d bragged all year about getting a car.In retaliation, I withdrew all my savings from the bank and blew it on revenge.Christmas morning, everyone gathered in the family room. The gifts had been distributed and we were about to open them—but everyone stared at me: I sat amid a mountain of fancy packaging, while they had smaller mounds around their knees.“Okay I’ll go first,” I chirped, carefully selecting a present. I shook it by my ear, wondering aloud what it was. I unwrapped an expensive Nautica jacket and feigned surprise. “Oh thank you Santa—I’ve been wanting one of these all year!” I said sarcastically, before tossing it aside and snatching up another present.I looked my mother dead in the eyes the whole time. Her lips were a tight line. When her face twitched, I felt I’d glimpsed a shark fin. I ignored it, along with the looks on my siblings’ faces. They didn’t know yet that I’d bought fifteen hundred dollars worth of gifts, mostly for myself, and padded the base of the tree with them. They thought our mom was showing favoritism.After that, my mother went into attack mode. I wasn’t invited when she took the family out to eat, to the golf course, or on shopping sprees. I might go up to my room for a few minutes, come out, and everyone would be gone. I felt alienated and invisible. I was sorry, but clueless about how to make amends.In 1998, Mike and I moved back in with our dad. One afternoon, Mike and I were finishing up an exercise routine on our weight equipment in the spare bedroom, when our dad barreled into the room and dove right into a verbal assault. Mike groaned, “Dad please, not now.” At that, Dad came at Mike swinging. Mike caught his arm. Dad punched him in the stomach with his free fist and it was on.I jumped out of the way to evade wayward elbows and more than 500 pounds of thrashing flesh. The bench toppled, bars and plates clattered. All of us screamed obscenities. I was mushed into drywall.I tried to break it up but got swatted aside. I seemed to be the only one taking hits, while they grappled with each other.For four or five minutes they roared and cursed. Steel objects clanged around the floor, kicked this way and that. I got side-swiped into walls and knocked to my knees. They would not stop.Mike pinned our dad against a wall, trying to control his arms and screaming for him to calm down. Dad frothed, his face reddened with exertion. Mike looked back at me, pleading.I cried with frustration, shaking, keening. My ears buzzed as blood flooded my brain. Like many things in life, I didn’t know when I’d had enough until I snapped. Something like a war cry, wordless and guttural, erupted from my throat. It was a sound I’d never heard before. Without thinking, I snatched up a five-pound chrome bar, grabbed our dad’s right arm from Mike and shoved it to the side. Mike did the same with the other arm. Dad looked crucified.“STOOOOOOOOP! STOP! STOP!” I howled. Aside from our ragged breath, all was quiet. Mike and Dad eyed the shiny bar I held high overhead.“Dad, this stops today! Right fucking now! Do you understand me?” I screamed so hard, white flecks of foam speckled his cheek.“Dad, we are your sons, not your fucking punching bags,” roared Mike, joining in. “Your sons. You had a bad day? So what? It ain’t our fault, so don’t take it out on us. We are your sons and we love you—“—but we will kill you,” I interrupted. “We will beat you to death and get away with it and you know it. If you don’t swear right now to stop trying to hurt us…”Dad quit struggling and looked back and forth between us. Tears brimmed in his eyes.“Finally…my boys have become men,” he said, with pride.Speechless, Mike and I looked askance at each other, then back at our dad.“Alright goddamit! I promise! Now let me go you crazy sons of bitches!” said Dad.And that was that. He never attacked us again.* * *After that incident with my dad, I moved out. I was seventeen. I started making a living as a full-time drug and fence (buying and selling stolen goods) dealer. By 2004, when I was twenty-three, I had become the production manager for a furniture manufacturer in Asheboro. I yearned for peace with my family, especially my mom. She had moved into a new house and allowed me to visit for a few hours at a time. She didn’t know about my illegal side ventures.That year, around Christmas, I decided to win back my family. At the furniture manufacturer, I hand-made a plush red recliner for my mom. It looked like a throne. Remembering my selfish Christmas years before, I stuffed my pickup truck with gifts for everyone before driving to Mom’s home. My truck was a blur of wrapping paper streaming down the highway towards my family. I couldn’t wait to tell them about my new plans. I wanted to go to college. They’d be pleased and proud.On Christmas morning, with most of us still crusty-eyed and slightly hung-over, we slumped around on couches. My sister Sara, from my mother’s second marriage, distributed the presents. My mom’s throne sat in the center of the TV room downstairs. She had been stunned and thrilled by my generous gift, which she took as a sign that I had changed.Soon everyone had a pyramid of presents in front of them.Except me. I had a shirt box. And a card.From their looks, this was not a conspiracy. They were as surprised as I. They tried to downplay it.“…it’s no big deal, Bruh…”“…really didn’t know what you liked…”“…had a ton of people to shop for…”“George honey, it’s not about how much you get. It’s the thought that counts,” my mom offered.“I know. You’re right, Mom. It’s the thought that counts,” I replied. “And it’s pretty clear what everyone thinks about me.” I could sense their collective cringe.I felt ashamed and defeated, wondering if I’d ever fit back into my family. I wanted to laugh at the inside jokes too. I wanted to be safe and dependable. I wanted them to smile when they saw me, not greet me with the look of caution one gives to a rickety ladder.Fuck this, I thought. Somehow I would break the cycle. I put on a plastic smile and said, “Hey, I get it. It’s no big deal. Look, I’ve got to work in the morning, so I’d better be heading out. Got a long drive ahead.” I went around the room hugging and kissing everyone. I didn’t know then it would be the last time I’d ever touch them.Their sympathetic looks were almost too much. I couldn’t take it. I had to get the hell out of there. In my haste, I forgot to tell them about my college plans.Two weeks later, I was arrested for a double-homicide.Crimson Letters: Voices from Death Row is a collection of essays written by residents of North Carolina’s Death Row. Each carefully crafted personal essay illuminates the complex stew of choice and circumstance that brought four men to Death Row and the small acts of humanity that keep hope alive for men living in the shadow of death. Now available on Amazon.Sign up for Tessie Castillo’s newsletter for a chance to win a FREE book copy!

Recovery and Sobriety During the Pandemic

12-Step Fellowship in the middle of a pandemic. This seems like an oxymoron. Aren’t we all supposed to be following an “as-rigid-as-possible” social distancing plan for the next few weeks? Many 12-step meetings have been temporarily suspended and the list of “No’s” and “Suggested No’s” can seem overwhelming, even to those who are not in recovery:Stay home Only essential trips for groceries and medicationsNo visitors in our homesNo theater/concerts/athletic eventsNo gymsNo restaurants or cafesNo librariesNo playdatesNo church servicesNo group gatheringsSo many of these “NOs” feel like essential “YESes” for those of us in recovery: group meetings, church services, post-meeting breakfasts or coffees with 12-step friends, libraries, or other public refuges free of booze or drugs. And how do we practice Step 12--”Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs”--if we are staying home, if we can’t attend meeting or hold hands at the end of our meetings in our hopeful circle of prayer? If we can’t create that in-person linked chain that relies on common purpose and support? And if we are in early recovery or if we struggle with depression, anxiety, or any mental illness? Or if we are on the front lines, working service jobs that are incredibly stressful and exhausting, particularly in these times?One of the first refrains clinicians recite over and over: Don’t isolate. Seek out community.Yet, the advice now given by clinicians to keep us all healthy and to help us be responsible to our communities is exactly (or seemingly) the opposite: Isolate. Keep your distance from each other.And what of the "Hey! Let's drink and drunk away the virus while we're at home!” memes and posts? The online pics and tweets showing shopping carts full of booze? The jokes that “alcohol kills germs”? No, 12-Steppers aren’t humorless, but if we’re sober, struggling to stay sober, or trying to get sober without our 12-step meetings, it can be hard to shrug off the lighthearted banter. These jokes, too, can trigger fleeting or ruminative catastrophic thoughts: i.e., “F*ck it. Why not get drunk or use? No one will know. And if we’re all going to die…” Yes, we can and should call our sponsors and we can and should call our sponsees. Revision: No can, no should. We will call each other. Basic 12-step outreach. A few texts across the day to let each other know we are here and still working our program. A quick phone call or video chat to hear one anothers’ voices and to see one another in real time. If you and your sponsor/sponsee have smart phones, download one of the free video chat services and have a virtual one-on-one meeting together.If you have access to a computer and internet, there are online Recovery/12-Step meetings that you can “virtually” attend. If you worry about privacy, create an anonymous user name and find a meeting that is text/message based (so no video). A computer and basic computing skills are all that is generally required to enter a meeting: click, link, join, and type (or voice text). These online meetings, like those held out in the world, have a regular schedule, and most online options offer daily meetings. Some resources for online meetings are:https://www.addictionrecoveryguide.org/resources/online_communications/online_meetingshttps://www.onlinegroupaa.org/https://www.intherooms.com/home/live-meetings/Also if you are healthy and able, try to get outside for a walk (keep 6 feet distance from others) or take a (true) breather from your front steps as often as you can (as long as you are not symptomatic). Open skies, sunshine, clouds, rain, wind, trees, bird song--that is, the noise of the world--can help remind us that the world is here and we are still of the world.If you are reading this in order to find out how you might support friends or loved ones in recovery who can’t attend meetings or follow their out-in-the-world recovery protocols: Please reach out to those who are self-quarantining or social distancing. They might be newly sober. Or in the middle of their 90 Meetings in 90 days. Or might rely on daily meetings. Or weekly meetings. Or meetings only when they need them. For some, their home group meeting might be what has been keeping them sober and alive.The isolation that can set in as a result of not being able to attend those meetings is real, and while there are online 12-step meetings (as noted above), many in our fellowship might be homeless, may lack access to internet, may not be computer-savvy. And many might struggle with staying sober when contending with the anxiety, potential or real loss of income, and fear I imagine we all share.Those of us in recovery often dedicate ourselves and sobriety to one spiritual tenet: One day at a time. But this tenet can be a practical and necessary spiritual guide for all of us navigating this pandemic and these perilous times. We do what we can do from home (if we are lucky to be able to stay at home), while also being mindful of our health and well-being. Stay connected to each other as we can. Most of us aren’t prepared for living or working in isolation in our homes and may feel adrift without our usual sustaining routines (12-step meetings, church services, gym workouts, meetups with friends and family). And if we’re being honest? 24/7 close quarters is hard with the people we love, and hard if we're single--stress, anxiety, boredom, frustration, depression, and ants in the pants.So yes, one day at a time. Lower expectations if needed. Have compassion for each other and ourselves. If we emerge having learned that we are survivor-thrivers, that we are able to sustain our sobriety and our connections across phone calls, video chats, online check-ins, that we are beings and not just doings? That might be our greatest recovery success yet.

As The Coronavirus Spreads, Americans Lose Ground Against Other Health Threats

For much of the 20th century, medical progress seemed limitless.Antibiotics revolutionized the care of infections. Vaccines turned deadly childhood diseases into distant memories. Americans lived longer, healthier lives than their parents.Yet today, some of the greatest success stories in public health are unraveling.Even as the world struggles to control a mysterious new viral illness known as COVID-19, U.S. health officials are refighting battles they thought they had won, such as halting measles outbreaks, reducing deaths from heart disease and protecting young people from tobacco. These hard-fought victories are at risk as parents avoid vaccinating children, obesity rates climb, and vaping spreads like wildfire among teens.Things looked promising for American health in 2014, when life expectancy hit 78.9 years. Then, life expectancy declined for three straight years — the longest sustained drop since the Spanish flu of 1918, which killed about 675,000 Americans and 50 million people worldwide, said Dr. Steven Woolf, a professor of family medicine and population health at Virginia Commonwealth University.Although life expectancy inched up slightly in 2018, it hasn’t yet regained the lost ground, according to the Centers for Disease Control and Prevention.“These trends show we’re going backwards,” said Dr. Sadiya Khan, an assistant professor of cardiology and epidemiology at Northwestern University Feinberg School of Medicine.While the reasons for the backsliding are complex, many public health problems could have been avoided, experts say, through stronger action by federal regulators and more attention to prevention.“We’ve had an overwhelming investment in doctors and medicine,” said Dr. Sandro Galea, dean of the Boston University School of Public Health. “We need to invest in prevention — safe housing, good schools, living wages, clean air and water.”The country has split into two states of health, often living side by side, but with vastly different life expectancies. Americans in the fittest neighborhoods are living longer and better — hoping to live to 100 and beyond — while residents of the sickest communities are dying from preventable causes decades earlier, which pulls down life expectancy overall.Superbugs — resistant to even the strongest antibiotics — threaten to turn back the clock on the treatment of infectious diseases. Resistance occurs when bacteria and fungi evolve in ways that let them survive and flourish, in spite of treatment with the best available drugs. Each year, resistant organisms cause more than 2.8 million infections and kill more than 35,000 people in the U.S.With deadly new types of bacteria and fungi ever emerging, Dr. Robert Redfield, the CDC director, said the world has entered a “post-antibiotic era.” Half of all new gonorrhea infections, for example, are resistant to at least one type of antibiotic, and the CDC warns that “little now stands between us and untreatable gonorrhea.”That news comes as the CDC also reports a record number of combined cases of gonorrhea, syphilis and chlamydia, which were once so easily treated that they seemed like minor threats compared with HIV.The United States has seen a resurgence of congenital syphilis, a scourge of the 19th century, which increases the risk of miscarriage, permanent disabilities and infant death. Although women and babies can be protected with early prenatal care, 1,306 newborns were born with congenital syphilis in 2018 and 94 of them died, according to the CDC.Those numbers illustrate the “failure of American public health,” said Dr. Cornelius “Neil” Clancy, a spokesperson for the Infectious Diseases Society of America. “It should be a global embarrassment.”The proliferation of resistant microbes has been fueled by overuse, by doctors who write unnecessary prescriptions as well as farmers who give the drugs to livestock, said Dr. William Schaffner, a professor of preventive medicine at Vanderbilt University Medical Center in Nashville, Tennessee.Although new medications are urgently needed, drug companies are reluctant to develop antibiotics because of the financial risk, said Clancy, noting that two developers of antibiotics recently went out of business. The federal government needs to do more to make sure patients have access to effective treatments, he said. “The antibiotic market is on life support,” Clancy said. “That shows the real perversion in how the health care system is set up.”A Slow DeclineA closer look at the data shows that American health was beginning to suffer 30 years ago. Increases in life expectancy slowed as manufacturing jobs moved overseas and factory towns deteriorated, Woolf said.By the 1990s, life expectancy in the United States was falling behind that of other developed countries.The obesity epidemic, which began in the 1980s, is taking a toll on Americans in midlife, leading to diabetes and other chronic illnesses that deprive them of decades of life. Although novel drugs for cancer and other serious diseases give some patients additional months or even years, Khan said, “the gains we’re making at the tail end of life cannot make up for what’s happening in midlife.”Progress against overall heart disease has stalled since 2010. Deaths from heart failure — which can be caused by high blood pressure and blocked arteries around the heart — are rising among middle-aged people. Deaths from high blood pressure, which can lead to kidney failure, also have increased since 1999.“It’s not that we don’t have good blood pressure drugs,” Khan said. “But those drugs don’t do any good if people don’t have access to them.”Addicting A New GenerationWhile the United States never declared victory over alcohol or drug addiction, the country has made enormous progress against tobacco. Just a few years ago, anti-smoking activists were optimistic enough to talk about the “tobacco endgame.”Today, vaping has largely replaced smoking among teens, said Matthew Myers, president of the Campaign for Tobacco-Free Kids. Although cigarette use among high school students fell from 36% in 1997 to 5.8% today, studies show 31% of seniors used electronic cigarettes in the previous month.FDA officials say they’ve taken “vigorous enforcement actions aimed at ensuring e-cigarettes and other tobacco products aren’t being marketed or sold to kids.” But Myers said FDA officials were slow to recognize the threat to children.With more than 5 million teens using e-cigarettes, Myers said, “more kids are addicted to nicotine today than at any time in the past 20 years. If that trend isn’t reversed rapidly and dynamically, it threatens to undermine 40 years of progress.”Ignoring ScienceWhere children live has long determined their risk of infectious disease. Around the world, children in the poorest countries often lack access to lifesaving vaccines.Yet in the United States — where a federal program provides free vaccines — some of the lowest vaccination rates are in affluent communities, where some parents disregard the medical evidence that vaccinating kids is safe.Studies show that vaccination rates are drastically lower in some private schools and “holistic kindergartens” than in public schools.It could be argued that vaccines have been a victim of their own success.Before the development of a vaccine in the 1960s, measles infected an estimated 4 million Americans a year, hospitalizing 48,000, causing brain inflammation in about 1,000 and killing 500, according to the CDC.By 2000, measles cases had fallen to 86, and the United States declared that year that it had eliminated the routine spread of measles.“Now, mothers say, ‘I don’t see any measles. Why do we have to keep vaccinating?’” Schaffner said. “When you don’t fear the disease, it becomes very hard to value the vaccine.”Last year, a measles outbreak in New York communities with low vaccination rates spread to almost 1,300 people — the most in 25 years — and nearly cost the country its measles elimination status. “Measles is still out there,” Schaffner said. “It is our obligation to understand how fragile our victory is.”Health-Wealth DisparitiesTo be sure, some aspects of American health are getting better.Cancer death rates have fallen 27% in the past 25 years, according to the American Cancer Society. The teen birth rate is at an all-time low; teen pregnancy rates have dropped by half since 1991, according to the Department of Health and Human Services. And HIV, which was once a death sentence, can now be controlled with a single daily pill. With treatment, people with HIV can live into old age.“It’s important to highlight the enormous successes,” Redfield said. “We’re on the verge of ending the HIV epidemic in the U.S. in the next 10 years.”Yet the health gap has grown wider in recent years. Life expectancy in some regions of the country grew by four years from 2001 to 2014, while it shrank by two years in others, according to a 2016 study in JAMA.The gap in life expectancy is strongly linked to income: The richest 1% of American men live 15 years longer than the poorest 1%; the richest women live 10 years longer than the poorest, according to the JAMA study.“We’re not going to erase that difference by telling people to eat right and exercise,” said Dr. Richard Besser, CEO of the Robert Wood Johnson Foundation and former acting director of the CDC. “Personal choices are part of it. But the choices people make depend on the choices they’re given. For far too many people, their choices are extremely limited.”The infant mortality rate of black babies is twice as high as that of white newborns, according to the Department of Health and Human Services. Babies born to well-educated, middle-class black mothers are more likely to die before their 1st birthday than babies born to poor white mothers with less than a high school education, according to a report from the Brookings Institution.In trying to improve American health, policymakers in recent years have focused largely on expanding access to medical care and encouraging healthy lifestyles. Today, many advocate taking a broader approach, calling for systemic change to lift families out of the poverty that erodes mental and physical health.“So many of the changes in life expectancy are related to changes in opportunity,” Besser said. “Economic opportunity and health go hand in hand.”Several policies have been shown to improve health.Children who receive early childhood education, for example, have lower rates of obesity, child abuse and neglect, youth violence and emergency department visits, according to the CDC.And earned income tax credits — which provide refunds to lower-income people — have been credited with keeping more families and children above the poverty line than any other federal, state or local program, according to the CDC. Among families who receive these tax credits, mothers have better mental health and babies have lower rates of infant mortality and weigh more at birth, a sign of health.Improving a person’s environment has the potential to help them far more than writing a prescription, said John Auerbach, president and CEO of the nonprofit Trust for America’s Health.“If we think we can treat our way out of this, we will never solve the problem,” Auerbach said. “We need to look upstream at the underlying causes of poor health.”