Rutgers: The Birthplace of College Recovery

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An alumnus and student during the 2012 Alumni vs. Students Recovery Softball Game.*

My last day as the Recovery Counselor at Rutgers was on July 31, 2014. Six weeks earlier, I informed my bosses, Lisa Laitman and Polly McLaughlin, that I would be leaving Rutgers at the end of July in order to pursue a few other opportunities (I will be writing about some of them in the very near future). The Rutgers Recovery House is both the prototype and the paragon of recovery programs on college campuses. Over 600 students have lived in Recovery Housing since 1988. During my five years at Rutgers, I organized (and attended) 571 activities. It is my strong belief that people in recovery need to fill their time and have fun. At Rutgers, we do that better than anyone else. 571 activities in 5 years. That’s 114.2 a year that were attended by a licensed staff member.

 

 

 

 

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Lisa Laitman, me and Polly McLaughlin while setting up for the 2014 Rutgers Recovery Graduation.*

Rutgers is known as the birthplace of college football (whatever). It really should be known as The Birthplace of College Recovery. It started with Lisa when she created the Alcohol & Other Drug Assistance Program (ADAP) in 1983 and had the uncanny vision to create the first Recovery House on (or near) a college campus in the world in 1988.

I could easily write 20,000 words about Rutgers, Lisa, the Recovery House and the amazing people that have gone through the program, stayed sober and built incredible lives (I’ll save that for the book though). Instead, I’m going to link to my five favorite articles about the Rutgers Recovery House from the last five years, share a few bits from my farewell letter to Rutgers staff and show a couple of pictures. I would like to post some pictures of my students, because they would show you the joy that can be attained when someone recovers and then turns around and helps others. Alas, I need to protect their anonymity.

Without further ado:

(1) I wrote Building a Campus Recovery Community for Addiction Professional in the spring of 2011. It details the history of the Rutgers Recovery House a little and discusses our activities and alumni a lot.

(2) The Next Big Step In Recovery was published by Rutgers Today after the 2011 Recovery Graduation. It captured the mood and spirit of the ceremony very well. If you haven’t been to a Rutgers Recovery Graduation and this is something that you care about, you should move mountains in order to attend one some day. The 2015 graduation will take place on May 19.

(3) In the fall of 2011, a New York Times reporter told me she was doing a story on addiction and recovery on college campuses and that she would like to include Rutgers in it. I urged her to visit Rutgers and meet with our students. The piece was originally supposed to describe about a dozen different schools, but after her visit to Rutgers, the author wrote basically a feature on our program and mentioned the other schools in passing. Lisa felt bad for them, but I was proud and unabashed. I know what we have. The story was published in January, 2012 and was titled A Bridge to Recovery.

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Ben’s mother presents him at the 2014 Rutgers Recovery Graduation.*

(4) Ben Chin is one of our super-duper stars and has worked publicly as an advocate for several years. He has a difficult backstory and acknowledges the mistakes of his youth. He graduated from Rutgers with a 3.9 in 2014 and won both the Truman and Luce Scholarships.

(5) In 2002, my close friend Fraser died. His death partly pushed me into this line of work. Rutgers did a wonderful piece on what it was like to lose him and weaved it into a narrative about how students in the Recovery House overcome these type of challenges. You can read about it here.

 

 

 

Below are two paragraphs from my goodbye email that I wrote to Rutgers staff. I’m happy to share them here.

I'm a kid from Rutgers. I arrived at the banks in the fall of 1997 fresh out of the Army and had 4 wonderful undergraduate years here. I met Lisa early on, and she introduced me to Gail Milgrim at the Center of Alcohol Studies. Gail gave me a scholarship for the 1998 Summer School of Alcohol Studies and thus began my career path. I graduated in 2001 and then returned for my MSW in 2004. I graduated from that program in 2006 and then returned to work at CAPS in 2009. My time at Rutgers isn't over though, as I am finishing up a Masters in Public Policy this December. I will also continue to teach at the School of Social Work and at the Center of Alcohol Studies. 

Writing about Lisa is extremely difficult. I've gotten a lot of attention and compliments over the years for my work at Rutgers, and it has led to a number of other opportunities. Taking students out for activities and hanging out at the Recovery House late at night was a tremendous amount of fun for me - I was basically paid to be me. I am fully aware of my abilities, but I could have never created ADAP or the Recovery House. Lisa was the perfect person at the right time. I am continually impressed by her work with students that are resisting treatment and recovery; again, she does things that I cannot do. The Recovery House was the first program of its kind on a college campus in the world. Since 1988, a lot of other schools have created programs, many modeled on Rutgers. No one measures up (although I do like Augsburg in Minnesota). I decided to work at Rutgers in 2009 because I wanted to be a part of something so incredible and so unique, and I knew that it would provide a number of opportunities for me at Rutgers and beyond. Without the Recovery House, I wouldn't have been named to the Governor's Council, Chaired the Opiate Task Force, been hired to train people around the country or gotten my latest trio of opportunities. In short, I owe Lisa my career. Thank you Lisa.
I wore a pink bunny suit (from A Christmas Story) while singing at the 2013 Recovery Karaoke event. I wanted to show students that one can take themselves less seriously.

Fitting movie clip: You’ll Never Have To Say ‘Thank You’ (for the work I did at Rutgers)

Fitting song: Time of Your Life

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* if you click on the pictures, they’ll get larger (except for the bunny suit)

** you should listen to the song while looking at the pictures

 

There is a smart person in Colorado

Gov. Hickenlooper’s office has put together a clever and in-your-face campaign to alert teenagers to the dangers of marijuana. Human size lab-rat cages are being placed at skate parks, libraries, professional sporting venues (Coors Field to start), concert locations (Red Rocks) and other public places.

I think it is a fantastic campaign. To learn more about it, click here to read today’s article in The Washington Post.

(incidentally, I’d like to see this kind of ad campaign go nation wide and also be used for prescription drugs…which would make Big Pharma absolutely crazy)

 

The Trouble with Sleep Problems (32 suggestions to improve your sleep)

Sleeping problems effect somewhere between a significant amount of the adult population. Sleeping problems include the following: insomnia, sleep apnea, movement syndromes and in rare cases, narcolepsy. This article will focus on the various types of insomnia, what causes & aggravates it, and 32 suggestions to combat it. I’ll touch upon some unique ways colleges are dealing with sleep issues.

Insomnia

Insomnia is a too-oft ignored mental health and medical issue. Dr. Dan Blazer of the Duke University Medical Center, said, “Insomnia may predispose people to anxiety and depression, just as anxiety and depression may predispose people to insomnia.”  Additionally, people with insomnia are more likely to have medical issues, and people with medical issues are more likely to suffer from insomnia. The four major types of insomnia are:

(a)   Can’t fall asleep (initiation)

(b)   Wake up in middle of the night  (maintenance)

(c)   Sleep isn’t restful or restorative  (quality)

(d)   Can’t get enough sleep (duration)

Just having one of these symptoms means that one has insomnia; if someone has two or more of these symptoms, then their insomnia is more pervasive and debilitating. Insomnia effects people in three different time categories: transient (lasts less than a week); short term (one to four weeks); and chronic (more than a month). Transient and short term insomnia are often caused by temporary sickness, stress, jet lag or a schedule change. They tend to work themselves out. The major concern here is chronic insomnia. Chronic insomnia can be caused by the following:

(1) Adjustmental insomnia  (triggered by current stress). There are many kinds of adjustmental stressors that can cause insomnia. Work, academic, familial, financial, romantic and medical concerns can all lead to difficulties in falling asleep (initiation) or staying asleep (duration).

(2) Due to substance use/withdrawal (alcohol, nicotine, caffeine, marijuana, stimulants, prescription drugs and opiates). Use of caffeine, nicotine or stimulants will cause people to stay up later and have a difficult time falling asleep. Alcohol, stimulant, opiate and other prescription drug use/abuse can cause sleep problems that last for years. People who use/abuse alcohol may have no problem falling asleep, but they may find that they wake up in the middle of the night (maintenance) or that they don’t sleep long enough (duration). One of the major signs of marijuana dependence is that people need it to fall asleep, or that they have trouble sleeping if they attempt to cut down or quit. Completely quitting caffeine or nicotine can effect sleep for up to two weeks (it will be longer if one just cuts down). Quitting any of the other substances (stimulants, prescription drugs, opiates, marijuana, alcohol) can cause or exacerbate insomnia for two months or more.

(3) Due to medical condition. They include, but are not limited to: heart problems, cancer, dementia, heartburn, diabetes, prostate problems, dental problems, gastrointestinal problems, allergies, colds and/or the flu. Medical problems and insomnia often exist together and serve to make the other worse over time. It is a vicious, downward cycle.

(4) Due to psychiatric disorder (especially anxiety, PTSD, depression and bio-polar disorder). Chronic insomnia effects at least: 25% of kids with ADHD, 50% of people with generalized anxiety disorder, 65% of adults with depression and 70% of adults with bi-polar disorder. The major findings on the Harvard Medical School’s website regarding sleep and psychiatric issues are:

    • Sleep problems are more likely to affect patients with psychiatric disorders than people in the general population.
    • Sleep problems may increase risk for developing particular mental illnesses, as well as result from such disorders.
    • Treating the sleep disorder may help alleviate symptoms of the mental health problems.

(5)  Inadequate sleep hygiene (poor habits before sleep). More on this later.

Strategies to Fight Insomnia and Improve Sleep

There are a number of changes, interventions and actions that one can take to combat insomnia. They include therapy, exercise, lifestyle changes, relaxation techniques, medical treatment and improving sleep hygiene. Here are 32 suggestions:

Therapy 

(1) Work with a therapist to improve coping skills, develop stress management techniques and consider making some minor (or major) life changes.

(2) Work with a therapist to address mental health or substance abuse disorders.

Exercise

(3) Weight training (but you should stop at least 3 hours before bed, otherwise you will be too stimulated to fall asleep). You will be more tired at night and will fall asleep quicker.

(4) Endurance training (running, biking, swimming – again, not within 3 hours before going to sleep).

Lifestyle Changes

(5) Lose weight. Changing exercise and/or eating habits can lead to weight loss. Usually, losing weight improves one’s health. Healthier people tend to have less problems falling asleep and staying asleep.

(6) Do not nap during the day. Napping breaks up one’s natural body rhythm. If one naps during the day, she is less likely to be tired at night and thus have more difficulty falling asleep.

(7) Eat healthier food.

Relaxation techniques

(8) Meditation will help reduce anxiety and/or stress.

(9) Deep breathing exercises will also help reduce anxiety and/or stress. Breathing in for a count of 3 and out for a count of 6 will clear one’s mind, lower the heart rate and lower the blood pressure.

(10) Yoga.

Medical Treatment

(11) Use breathing strips if you have sleep apnea (one should also see a doctor for this).

(12) Get medical conditions treated and checked up on regularly. Inform medical provider of sleep problems.

(13) Engage in preventative care. Get regular medical, dental and gynecological check-ups to prevent problems from developing or to avoid letting problems get worse.

Sleep hygiene

(14)  Set a regular sleep schedule. This means going to sleep at the same time and waking up at the same time each day. If you wake up before the alarm goes off each day, you are probably getting into a good routine.

(15) Therefore, don’t sleep in on weekends or holidays.

(16) Increase exposure to natural light, especially early in the morning. You should get at least 20 minutes of sunlight each day.

(17) Turn off light when you get into bed. Light signals our bodies to wake up. Humans evolved into a rhythm of being awake in the day and asleep at night. Lights simulate the sun and cause our bodies to energize, making it hard to fall or stay asleep.

(18) Do not watch TV in bed, work on your laptop or browse through your phone. All of those technologies use lighted screens, which again, simulate sunlight.

(19) Minimize sound, or go with a fan or white noise machine.

(20) Your bedroom should only be for sleeping and sex. We are conditioned to do certain activities in different environments. You may not be hungry, but if you go into your kitchen, you might start looking at food. Working out at the gym is not the hard part; it’s getting there (because once you are there, you are used to working out). The more things you do in your bedroom, the more stimuli you have when you are in there. If you eat, read, study, work, fight or do other things in there, it is hard to send a signal to your body to just shut down and go to sleep.

(21) Do not think of yesterday, today or tomorrow while in bed.

(22) Have a comfortable environment

a. Noise can be a problem (get a white noise machine, fan)

b. If it is too hot,  you’ll wake up

c. If it is too cold, you’re sleep won’t be very restorative

d. Slightly cool is best. Studies have shown that people tend to sleep the best in rooms a temperature around 66 degrees fahrenheit. There is some variation within our species as to what constitutes a cool sleeping temperature, so you might want to experiment.

(23) Do not use sleeping pills (more on this in a separate post later this week). If you must use sleeping pills, you should be aware that they can cause a number of other problems and that many of them are addictive.

(24) Drinking warm milk actually works (without sugary syrup).

(25) Develop a bed time routine. Just as you have a morning routine, you should have a nighttime routine. Do the same things for the 5 to 25 minutes before you go to sleep every night. Your body will learn the routine and will send a signal to itself that it is time to go to sleep.

(26) Unless you want to wake up in the middle of the night to urinate, watch your fluid intake in the evening. If you are someone who is determined to drink a lot of water throughout the day, concentrate your water intake in the first half of your day.

(27) Do not take in sugar within 3 hours of sleeping. It’s a stimulant.

(28) Do not take in caffeine within 6 hours of sleeping. It’s a stronger stimulant.

(29) Do not use tobacco within 2 hours of sleeping. It’s a stimulant.

(30) Do not eat heavily within 3 hours of sleeping. Your body will begin digesting just as you are sleeping and you might wake up with energy after a short time of rest.

(31) If you can’t fall asleep within 30 minutes, get up for a bit and go to another room. Remember, you don’t want to condition yourself to be awake in your bedroom.

(32) If you sleep with someone that has medical problems, snores or has insomnia themselves, you might want to consider sleeping in separate rooms.

I don’t expect someone to initiate all 32 into their new sleep protocol, but I strongly suggest talking to a therapist or doctor who understands sleeping problems (quick quiz, ask them what sleep hygiene is) and coming up with a plan that incorporates a number of them.

Insomnia on the College Campus

Insomnia is a problem on college campuses.  A recent study reported that 63% of college students don’t get enough sleep (one aspect that contributes to that high percentage is students who work full time and go to school). I’m comfortable with the posit that students that don’t get enough sleep have a lower academic performance than students that are well rested. A number of schools have instituted a variety of different plans in order to assist students in improving their sleep. Some of them are sound and others less so:

(1) Duke University cancelled all of its 8 am classes, and most courses are scheduled between the more reasonable times of 10 am to 2 pm

(2) (from that article) “Cornell University takes a scientific approach to promoting sleep on campus, sharing a sleep-focused version of introductory psychology. In this class, students are confronted with photos, hard data, and experiments that show the effect of sleep deprivation on college students. They’ve found that it’s been their most effective way to change behavior.”

(3) The University of Cincinnati has a stress management course that teaches people about the importance of proper sleep.

(4) The University of Delaware offers a class on napping (I hope it is not a full 3 credit class, but rather a 1 hour seminar…and most sleep experts state that naps are actually a bad idea).

(5) The College of the Holy Cross teaches their students about sleep hygiene and then takes the novel approach of sending those students into the community to talk to school children about the importance of proper rest.

Colleges are addressing sleep because it leads to a healthier, better performing student body. It’s good for both academics and the business of higher education. It makes a great deal of sense to address sleeping problems on both the micro and macro level. The over-medication of the American public is something that I have talked and written about at great length, so it should not come as a surprise that I also think that we are over-medicating sleeping problems. The effects of over-medicating have the potential to be disastrous.

Drug Tests for Doctors

This fall, people in California will vote on Proposition 46, which, if passed, will required doctors to submit urine screens to test for alcohol and drugs. Some doctors have stated that it is an invasion of privacy, while proponents of it argue that it is past due, as the medical profession has a huge role in the safety and well-being of the public. From the article in the New York Times:

Backers of Proposition 46 have begun putting out a steady stream of news releases about cases involving doctors with a history of drug and alcohol abuse. “It’s crucial: I can’t believe we haven’t done this already,” said Arthur L. Caplan, a medical ethicist at New York University. “We can argue about how often that is, and what to do if you are positive. But the idea that we wouldn’t be screening our surgeon, our anesthesiologist or our oncologist when we are going to screen our bus drivers and our airline pilots strikes me as ethically indefensible.”

The law makes sense. It should pass.

The New York Times Digs a Deeper, Dumber Hole on Marijuana

I am a huge fan of The New York Times. After The New Yorker, it is my favorite periodical. Their pieces on Suboxone and Adderall last fall were well researched, and they recently nailed it when it comes to sleeping medications like Ambien. The Times has a great track record and probably the biggest influence of all the world’s newspapers. It is because of that track record and influence that I am so disappointed about their weeklong series on marijuana that kicked off last Sunday with a poorly thought out piece. I responded to it in a previous post.

The White House reacted with this statement, which sited several studies and argued four major points:

(1) marijuana use effects the developing brain

(2) substance use in school age children has a detrimental effect on their academic achievement

(3) marijuana is addictive

and (4) drugged driving is a threat to our roadways

All of those points are facts. On Thursday, the Times responded with this piece. They stated that they are not encouraging adults to smoke and that they agree that drugged driving should remain illegal. Ludicrously, they cited a study in marijuana medical magazine (yes, it’s a real thing) that put forth that marijuana is less addictive than caffeine. They concluded it with this statement:

We are simply asking the federal government to get out of the way so that states can decide what marijuana policies would work best for their own people.

It’s ironic that the Times has asked the Federal Government to get out of the way of states, because that is inconsistent with much of the other ideaologies that they espouse. When it comes to gun control, abortion rights, climate change, education and prison policy, the editors of the Times continually come out in favor of the Federal Government to correct the laws of states whose policies they disagree with.

Dr. Stuart Gitlow, the current president of the American Society of Addiction Medicine (ASAM), wrote this retort to The New York Times marijuana op-ed and later said in an interview that (I’m paraphrasing here), “I don’t think they talked to a medical doctor at all before they published this. I didn’t get wind of it until the morning it was published.”

The New York Times Screws up on Marijuana

Over the weekend, the New York Times called for an end to marijuana prohibition. The link to the editorial is here. I’m going to reprint the entire piece here and address it line by line. I believe that legalization has too many problems, but I support decriminalization. My comments are in red.

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It took 13 years for the United States to come to its senses and end Prohibition, 13 years in which people kept drinking, otherwise law-abiding citizens became criminals and crime syndicates arose and flourished. The lawlessness is correct, but what people fail to discuss is that there was less drinking during prohibition, fewer accidents caused by drinking, and fewer cases of cirrhosis of the liver.  It has been more than 40 years since Congress passed the current ban on marijuana, inflicting great harm on society just to prohibit a substance far less dangerous than alcohol. I agree that marijuana is less harmful than alcohol.

The federal government should repeal the ban on marijuana.

We reached that conclusion after a great deal of discussion among the members of The Times’s Editorial Board, inspired by a rapidly growing movement among the states to reform marijuana laws.

There are no perfect answers to people’s legitimate concerns about marijuana use. Agreed. There needs to be more medical research on marijuana, which requires the Federal Government to move it from a schedule I to schedule II drug. But neither are there such answers about tobacco or alcohol, and we believe that on every level — health effects, the impact on society and law-and-order issues — the balance falls squarely on the side of national legalization. Tobacco and alcohol policy can be instructive here. Both substances are taxed, and yet the money they raise pales in comparison to the medical, criminal justice and social costs that they incur.  That will put decisions on whether to allow recreational or medicinal production and use where it belongs — at the state level.

We considered whether it would be best for Washington to hold back while the states continued experimenting with legalizing medicinal uses of marijuana, reducing penalties, or even simply legalizing all use. Nearly three-quarters of the states have done one of these.

But that would leave their citizens vulnerable to the whims of whoever happens to be in the White House and chooses to enforce or not enforce the federal law. Agreed.

The social costs of the marijuana laws are vast. Agreed. There were 658,000 arrests for marijuana possession in 2012, according to F.B.I. figures, compared with 256,000 for cocaine, heroin and their derivatives. The ironic point here is that if marijuana is legalized, the number of arrests will actually go up (underage use, intoxicated driving). Even worse, the result is racist, falling disproportionately on young black men, ruining their lives and creating new generations of career criminals. Agreed. But…when someone who is under 21 gets arrested for possessing marijuana, who do you think will get off? Who will be charged? (rich white people will get off and poor black people will be charged…so legalizing marijuana won’t change this)

There is honest debate among scientists about the health effects of marijuana, but we believe that the evidence is overwhelming that addiction and dependence are relatively minor problems (this is an irresponsible claim), especially compared with alcohol and tobacco. Moderate use of marijuana does not appear to pose a risk for otherwise healthy adults. Agreed. Claims that marijuana is a gateway to more dangerous drugs are as fanciful as the “Reefer Madness” images of murder, rape and suicide. Agreed.

There are legitimate concerns about marijuana on the development of adolescent brains. Agreed. For that reason, we advocate the prohibition of sales to people under 21. Fine, but please remember my above point regarding arresting underage users.

Creating systems for regulating manufacture, sale and marketing will be complex. But those problems are solvable, and would have long been dealt with had we as a nation not clung to the decision to make marijuana production and use a federal crime.

In coming days, we will publish articles by members of the Editorial Board and supplementary material that will examine these questions. We invite readers to offer their ideas, and we will report back on their responses, pro and con.

We recognize that this Congress is as unlikely to take action on marijuana as it has been on other big issues. But it is long past time to repeal this version of Prohibition.

John Oliver’s Brilliant, Succint and Funny Take on Prisons and Criminal Justice Policy

On Sunday night, John Oliver devoted 17 minutes of his show to discussing prisons and criminal justice policy. He touches upon:

(1) how Sesame Street is now teaching kids how to cope with a parent that is incarcerated

(2) mandatory minimums for drug offenders

(3) the disproportionate number of minorities in prison

(4) the lack of services for prisoners, including inadequate food

(5) the privatization of prisons

(6) how privately owned prisons look for investors by arguing that they are good investments because of “high recidivism rates”

It’s incredibly well done. To see it, click here.

The Legalized Drug Market for Opiates

Over the weekend, an article appeared in the New York Times about a doctor who knowingly overprescribed oxycotin (and other drugs) to known drug dealers:

Dr. Li, an anesthesiologist from Hamilton, N.J., ran a pain management clinic one day each weekend in Flushing, Queens, where he saw dozens of patients a day, posted a price list on the wall for drugs that included oxycodone and Xanax and accepted payment primarily in cash. During closing arguments, prosecutors said Dr. Li was driven by greed and ignored warnings from emergency room workers and his patients’ relatives that he was placing lives at risk. His lawyer, Raymond Belair, countered that he was dealing with difficult patients, some of whom misled him about their substance abuse problems.

The case against Dr. Li was unusual because the office of New York City’s special narcotics prosecutor typically charges doctors accused of knowingly prescribing painkillers to drug abusers with criminal sale of a prescription for a controlled substance. Dr. Li was instead charged with manslaughter after Joseph Haeg and Nicholas Rappold, who were under his care, died. Though the tactic has been used in cases in several other states, it is rare in New York.

The story of doctors like the aforementioned Dr. Li are why there are prescription drug monitoring programs (PMP) in 49 of the 50 states. Missouri is the one state that does not have a PMP. Unsurprisingly, Missouri has a huge problem with the illegal acquisition and sales of prescription drugs. Today’s New York Times has a story about Missouri: America’s Drug Store. Foolishly, a few state lawmakers have refused to implement a PMP there:

But while proponents say the vast majority of the Legislature supports the measure, it has been blocked by a small group of lawmakers led by State Senator Rob Schaaf, a family physician who argues that allowing the government to keep prescription records violates personal privacy. After successfully sinking a 2012 version of the bill, Mr. Schaaf said of drug abusers, “If they overdose and kill themselves, it just removes them from the gene pool. There’s some people who say you are causing people to die — but I’m not causing people to die. I’m protecting other people’s liberty,” Mr. Schaaf said in a recent interview in his Senate office. “Missouri needs to be the first state to resist, and the other states need to follow suit and protect the liberty of their own citizens.”

Mr. Schaaf’s steadfast opposition has come under sharp criticism from fellow Republicans, including a United States representative, Harold Rogers, Republican of Kentucky, one of eight states on Missouri’s 1400-mile perimeter. “It’s very selfish on Missouri’s part to hang their hat on this privacy matter,” Mr. Rogers said. “The rest of us suffer.”

History informs us that Senator Schaaf can only impede progress for a time and that Missouri will eventually get her PMP up and running. In the meantime, the state suffers. But there are some interesting characters that have sprung up to fight the lack of a PMP. One of them is Richard Logan (pictured below), a dual-classed pharmacist and sheriff’s deputy.

On his office phone at L & S Pharmacy, Richard Logan listened as a doctor’s office detailed how a patient had just left with her third prescription for painkillers in only nine days — and was quite possibly getting more, illegally, elsewhere.Mr. Logan, 61, holstered two guns, slipped on a bulletproof vest and jumped into his truck. Because in his small corner of America’s epidemic of prescription drug abuse, Mr. Logan is no ordinary pharmacist. He is also a sheriff’s deputy who, when alerted to someone acquiring fraudulent drug prescriptions, goes out to catch that person himself.

“I’m only one guy, and for every person we get to, there are probably 100 who we can’t,” Mr. Logan said. “How many people have to get addicted and die for us to do what everyone else is doing about it?

What do Recovery Coaches and Sober Companions do? (and why should you be wary of them)

Recovery Coaches and Sober Companions* are in the news lately because of a recent article in the New York Times and the fact that Toronto Mayor Rob Ford has a sober companion. One of the key concerns regarding recovery coaches is that they are not required to have any education, training or licensing (it is harder to cut hair or do nails than it is to be a recovery coach). The article from the July 11, 2014 NY Times described how wealthy New York women that struggled with addiction were employing recovery coaches:

“You get over one thing and you get slammed with something else,” said Ms. Mellon, 47, looking slinky in a crisp white blazer, a high-slit skirt and gladiator sandals. She recalled some of the ordeals: her father’s death, two hostile takeover attempts, taking her mother to court. “It’s a miracle I’m still here,” she said. Her secret to staying sober through it all? Ms. Mellon enlisted the aid of a recovery coach, Martin Freeman, a London-based psychotherapist.

Ms. Mellon’s recovery coach is a psychotherapist (the article does not mention if he is licensed in New York state though). Most recovery coaches are unlicensed and either shoddily or completely untrained. One doesn’t need a license to be a recovery coach; they don’t even need a certification. A person can get a certification in New York state quite easily. To get the certification, one doesn’t have to have a license, or a college degree, or any work experience. A person needs only take 60 hours of training (a week and a half of classes) and to pass a test. The more serious professions require significant levels of education, intense trainings, difficult tests and then lengthy licensure requirements (medicine, law, accounting, counseling, teaching, engineering, plumbing). These barriers to entry keep the fly-by-night charlatans out of those fields as much as possible and also serve to protect the public. The lack of a barrier means that almost anyone can be a recovery coach and that it is difficult for consumers to find viable help. There are websites and organizations springing up to offer credentials in recovery coaching in order to give them the appearance of legitimacy. Here is one of them; it’s clearly not Mensa.

Let’s return to the NY Times article and Ms. Mellon:

“He’s the most enduring relationship I’ve had,” said Ms. Mellon, who keeps her sobriety coach on a retainer to ensure he will be there for morning chat sessions and late-night calls and to accompany her to stressful events. “I’m his one and only.”

There are a few causes of concern here:

(1) how often are these morning chat sessions and late-night calls and how much do they cost?

(2) “the most enduring relationship I’ve had” is an worrisome statement – people in recovery often have poor boundaries and struggle with relationships

(3) “I’m his one and only.” What happens if that recovery coach moved? Or if the coach took on another client? Would Ms. Mellon get angry? Feel hurt? Relapse? Because recovery coaching is unlicensed and unregulated, they are not held to the same standards that psychologists, social workers, licensed drug & alcohol counselors or licensed professional counselors are.

More grist for the mill from the Times:

“Addiction is a disease of isolation,” added Ms. Karr, 59, who has a 28-year-old son (she starts “Lit” with an open letter to him). “I would have loved to have someone come over and help me not get drunk.” It’s not just the extra glasses of pinot or rosé. Cosmopolitan mothers these days are also reaching for Adderall (the multitasker’s best friend), Percocet (the antidote to the taxing trifecta of marriage, children and career) and Ambien (that bedtime staple), not to mention a cocktail of other drugs that high-strung mothers also have at their disposal. And by the time these mothers realize they need help, they don’t exactly have the time or wherewithal to check into rehab or attend 12-step meetings. In addition, they want more privacy, the better to avoid the judgment and stigma that mothers with addiction face.

In addition to alcohol, people are addicted to stimulants, painkillers, sedatives and tranquilizers. They need professional help, not para- or quasi-professional help. Another concern is the line “they don’t exactly have the time or wherewithal to check into rehab or attend 12-step meetings.” It is that kind of self-absorption and denial that makes them a high risk to relapse. If you are addicted, you should go get professional help and probably should enroll in an in-patient or out-patient treatment program. “Who has time for treatment?” is akin to the following ridiculous questions: who has time to sleep, eat, exercise, save money, or engage in other behaviors that increase our health and longevity.

Back to the Times article and Ms. Powers, an untrained, unlicensed recovery coach:

Ms. Powers, 53, a former heroin addict, was an art director at Area, a prominent nightclub in New York during the 1980s, before moving to Los Angeles to get clean. She joined Narcotics Anonymous, where she became a sponsor to help fellow addicts through the program. These days, when she’s not on a tour bus with a rock-star client or on a film set with an actor, Ms. Powers rides her bike from Wall Street to Carnegie Hill, where she weans mothers from Vicodin or Klonopin.

“They’re starved for companionship,” Ms. Powers said. “Today’s pill-popping moms are a far cry from the bored, suburban housewives of ‘The Valley of the Dolls.’ They’re taking opioids, which are dangerously addictive. If you’re trying to withdraw from OxyContin, a doctor might prescribe Suboxone, which is even harder to kick than heroin.”

So we have unlicensed, untrained professionals helping people get off of dangerous drugs and charging money for it. Ms. Powers heart is probably in the right place, and she appears to have had a few success stories. But her dismissal of Suboxone, which is a legitimate medication assisted therapy (MAT), is unfortunately fairly typical of a number of people in 12-step programs. Claiming to be a recovery coach and charging money for her work gives Ms. Power’s medieval views an ill-earned sense of legitimacy. This is a problem.

Rob Ford made international headlines last year as the crack smoking mayor of Toronto. After a series of escalating episodes, Mayor Ford recently went away to rehab for two months. Upon his return to work, he announced that he had a recovery coach, Robert Marier. Mr. Marier is a self-identified former crack addict with a lengthy legal history who claims to be sober for the last 10 years. This is from the July 14, 2014 Toronto Globe and Mail:

Mr. Marier has no formal clinical training, instead using his own experience – a “been there, done that” attitude – when working with clients. Working through a company that hires him out, he said he’s helped hundreds of clients in the five years he’s been coaching.

I hope people are picking up on the theme here: unlicensed and untrained individuals that work with people with addictions and claim to have helped hundreds of people. How do they measure success? Do they keep data? Do they engage in supervision, where they discuss their clients’ issues with other recovery coaches? Are there quality of care reviews? I expect the answer to all of these questions are either “not applicable” or “no” or “no comment.” More on Mr. Marier:

Donny M., a recovering cocaine addict who asked that his last name be withheld, credits Mr. Marier for saving his life. The 24-year-old had seen Mr. Marier around in AA meetings, but in 2010 he was surprised (and irritated) when the grey-haired man approached him in a McDonald’s restaurant.

“He just came up to me and asked me about cleaning my apartment and stuff like that – ‘did you make your bed this morning?’” Donny said. “It’s a Bob thing … addicts, we think we’re too good to do the things that normal people do. We think we’re above it,” he said. Over the next four years, Mr. Marier became Donny’s AA sponsor, showing up at 8 a.m. every Saturday morning to drive him to meetings.

Mr. Marier is both a sponsor and recovery coach; the lines are blurred. I have no doubt that Donny has found Mr. Marrier to be helpful and supportive and that Donny’s life is better for it. But it seems that his life is better because he went to AA and got Mr. Marier as a sponsor…unless Mr. Marier charged Donny money for his efforts. Legitimate professionals do not approach people at McDonald’s looking for work or to haggle them (car salesman and Jehovah’s Witnesses do, but let’s give some respect to the word legitimate). Mayor Ford’s sobriety coach is alleged to have kicked a protester while the mayor was holding a press conference last week. Mr. Marier denies this: “It didn’t happen. We touched each other. It was a grazing, and there was no kicking motion. Absolutely none.”

Why Sober Coaches Earn $1000 A Day was published on thefix.com a few years ago. A couple of different high paid recovery coaches talked about the problems with recovery coaching. One of them is Ms. Powers, who apparently is one of the stars of the field and a media darling.

Unfortunately sober coaches can become as much of a crutch for some clients as the drinking and drugging once was. The onus is on the  companion to maintain healthy boundaries and an appropriate degree of professionalism—a dangerous position, given how many hustlers there are in the game. Schrank notes that the business isn’t regulated in any way: “There are no professional associations or standards of practice,” he says. “So you have a lot of charlatans in this game.”

Powers admits that some sober companions have dubious qualifications for the job. “You are a sober coach if you say you are, so what does that mean?” she asks. “It means there will be people with a good sales pitch and a gift for hustlers using therapeutic jargon—people who may not really be in recovery—selling themselves as sober coaches. If someone is looking for a sober coach,  I’d tell them to really take time to interview several candidates, or better yet, have their therapist speak to them before arriving at a decision.”

There is a company called Sober Champion which has a nice website and attempts to explain what sober coaches and sober companions are and are not, but they still have pretty lax requirements. They advertise that they will “accommodate your lifestyle” and help you “Stay out of jail!”

There was a great article on thefix.com titled I was a paid celebrity sober companion. The author talks about how he was flown out to LA to help out a celebrity for $600 a day. He felt out of place and ran into all kinds of problems because of the celebrity’s status and money. He discovered that he could help the celebrity by coercing him to go to 12-step meetings and getting him to open up during long talks. Eventually, the author returned to NYC and drank again. He didn’t blame his work as a recovery coach as the cause of the relapse, but he acknowledges that it “didn’t help.”

There certainly must be some good recovery coaches out there, but they are few and far between and hard to identify. As a group, they aren’t as bad as the predators who put addicts on television, but it is close.

The concept of the recovery coach is not new. Major League Baseball has had stars with drinking problems since the game was invented, and clubs looking to keep their stars on the field employed recovery coaches/handlers/babysitters over a hundred years ago. They were called “keepers” then, and of course, average or below average players weren’t given keepers. It was only for really good players. Steven Goldman, a NJ based writer who used to be the Editor-In-Chief at Baseball Prospectus, wrote one of my all-time favorite articles in February of 2011 after (future 2-time MVP and triple crown winner) Miguel Cabrera was arrested and charged with driving under the influence in Florida.

Let’s try a real antecedent, Jimmie Foxx. There’s a funny scene in A League of Their Own, the 1992 film about women’s professional baseball during World War II where “Walter Harvey,” a stand-in for Phil Wrigley, lectures ex-player “Jimmy Dugan,” a character inspired by Foxx:

Walter Harvey: You kind of let me down on that San Antonio job.
Jimmy Dugan: I freely admit, sir, I had no right to sell off the team’s equipment like that; that won’t happen again.
Walter Harvey: Let me be blunt. Are you still a fall-down drunk?
Jimmy Dugan: Well, that is blunt. Ahem. No sir, I’ve, uh, quit drinking.
Walter Harvey: You’ve seen the error of your ways.
Jimmy Dugan: No, I just can’t afford it.
Walter Harvey: It’s funny to you. Your drinking is funny. You’re a young man, Jimmy: you still could be playing, if you just would’ve laid off the booze.
Jimmy Dugan: Well, it’s not exactly like that… I hurt my knee.
Walter Harvey: You fell out of a hotel. That’s how you hurt it.
Jimmy Dugan: Well, there was a fire.
Walter Harvey: Which you started, which I had to pay for.
Jimmy Dugan: Well, now, I was going to send you a thank-you card, Mr. Harvey, but I wasn’t allowed anything sharp to write with.

All of which is hilarious until you consider that the great Double X was through as a big-league regular at 33, and would have been through period if not for a wartime encore. Yes, he hit .325 with 534 home runs career, but he also lost a third of his value after his age-31 season and all of it shortly thereafter. He died, miserable, at 59. In John Bennett’s excellent short biography for SABR, the question of when and why Foxx starting drinking is kicked around quite a bit—was it the chronic pain from a devastating 1934 beaning that drove him to it? His daughter dismissed that explanation: “Daughter Nanci believes his drinking problems had a lot to do with the emptiness he felt in adjusting to normalcy once his playing days had ended.”

Who, so gifted an athlete—and Miguel Cabrera is certainly that—would do things that would hasten forth the inevitable end, sending themselves hurtling pell-mell towards the fate that awaited Mantle? “Well, hold on,” you might say. “Alcoholism is a disease. Addiction has both a psychological and biological component.” This is true. Yet, unlike most other diseases, this one can be responsive to therapy and the exertion of human willpower. No 12-step program will cure congestive heart failure or lung cancer, but it just might allow a fellow to lick a drinking problem.

Of course, a problem drinker has to want to get on the wagon. Listening to sports radio last week, I heard several callers question why the Tigers had not assigned Cabrera a handler or babysitter—“keepers” is what they called them in baseball’s rowdy early days—a sober hand who could steer the player safely from ballpark to hotel with nary a saloon stop in between. The problem is, it’s not a new idea and it generally didn’t work.

The Giants tried it with the aforementioned Phil Douglas, a quality pitcher on two pennant-winning teams they would have very much liked to keep dry and focused. His last keeper was a future Hall of Famer, the former left fielder Jesse Burkett. Burkett, nicknamed “The Crab” for his less-than-cheerful disposition, and Douglas made quite the odd couple. “They probably drunk more ice-cream sodas together than any two grown men in history, before Doug got away on his last binge,” a former teammate recalled to John Lardner.

Yet, get away he did, and he drank himself out of the game, albeit faster than did, say, Rube Waddell or Hack Wilson. Wilson, like Cabrera and Foxx a right-handed power-hitter, is another example of a player who invested more in the bottle than in the maintenance of his baseball career, and spent the rest of his short life regretting it. He also had his share of keepers, concerned friends, solicitous managers, and helpful teammates. It didn’t matter. He stopped being interesting at 32,  was out of the league at 34, and died at 48. Or consider Foxx’s post-career fate, pink-slipped from his last job in baseball, as Gene Mauch’s hitting coach for the Triple-A Minneapolis Millers. As Mauch later recalled (again, see Bennett’s SABR bio), Foxx “was seldom at the park on time to be of help. I idolized the man, and kept him away from scrutiny. At the end of the season, [Red Sox GM Joe] Cronin gave him his money and sent him home—it was so sad.” Baseball is a very forgiving game, but not if you can’t handle yourself.

I think there may be some instances where recovery coaches can help, but they need to be educated, trained and licensed professionals. There is too much room to cause harm. As addiction and recovery work there way more and more into the public spotlight (partly because of the 21st century opiate epidemic), more and more people will look to make money off of this problem. I don’t begrudge anyone for trying to make a living, but not at the expense of someone’s sobriety or life. Be wary of the predators. Be wary of recovery coaches, sober companions, sober escorts and sober coaches.

* Recovery coaches, sobriety coaches, sober escorts and sober companions are different words for the same quasi-profession. I will use the term recovery coach for the rest of this article for literary consistency

Frederick Douglass was a Recovering Alcoholic

Frederick Douglass is one of my great heroes. He was born a slave in 1818. He taught himself how to read and write and at the age of 20, he ran away to freedom. He spoke about his experiences as a slave, and how slavery debases both the slave and the slave owner. He would tell how slave owners would act pious in church and in their communities and then come home and yell and beat their slaves. Douglass was such an eloquent speaker that many people raised the question of whether or not he had ever been in bondage. In 1845, he wrote the Narrative of the Life of Frederick Douglass in order to prove to people that he had been a slave. He was very specific with exact names and locations so that people could fact check. He did not want there to be any doubt about his story (the book is 70 pages long and can be bought in paperback for $2 or on kindle for $1…every American should read it).

In Chapter X of his book, he writes about:

(1) How slaves were given the time off between Christmas and New Year’s, and that their masters encouraged them to drink. “It was deemed a disgrace not to get drunk at Christmas.”

(2) Some slave owners would make bets on their slaves to see who could drink the most without getting drunk.

(3) “We felt, and very properly too, that we had almost as well be slaves to man as to rum.”

(4) “So, when the holidays ended, we staggered up from the filth of our wallowing, took a long breath, and marched to the field, — feeling, upon the whole, rather glad to go…back to the arms of slavery.”

One of his great joys in life was teaching other slaves and ex-slaves how to read. It wasn’t enough to be free, but one had to be educated in order to protect one’s freedom and to be a productive member of society.

After his book was published, Mr. Douglass went on a tour of Britain and Ireland for two years. While he was over there, he described himself over and over again as a “sot” in his speeches. Sot is an English word that originated sometime in the 1590’s and means “one who is stupefied by drink.” He would talk about the evils of slavery, the religious hypocrisy of slaveholders, how slaves are encouraged to drink and discouraged from reading. He said,

“There is no freedom from the bondage of slavery without freedom from the bondage of alcohol.”

Frederick Douglass was a recoverying alcoholic* before we had the term. He experienced physical and mental slavery and eventually overcame both. He got educated, traveled, helped others and he talked about his experiences. He was a role model and he helped implement changes on a national level. His story has a number of themes that resonate with people in recovery today (clearly, his journey was harder).

I am not going to be so arrogant and foolish as to say what Mr. Douglass’s positions would be on current issues, other than to say that he probably would have encouraged people with substance abuse problems to not use and all people to get educated.

He’s one of my great role models, and I want to share him with you.

* or use whatever term you are comfortable with: reformed drinker, former drinker, person in long-term recovery, abstainer