I am happy to present the first article on my site by someone other than me. For a long time, I’ve thought about the importance of offering up other voices and perspectives. I have known Regina Diamond-Rodriguez for several  years and am extremely impressed and proud of her. I reached out to her a few months ago and asked her to write her story.

Regina abused drugs and went to prison. She eventually got clean, attended Rutgers and transformed her life. Her story appears below. It’s timely, as President Obama came to Newark, NJ this past Monday and celebrated the drug treatment that is offered at Integrity House and the criminal justice reforms that have been pushed by professionals at Rutgers Newark (I am a proud former employee of both). Here are a few questions that I want you to think about as you read her story:

(1) What kind of support was available at critical times? Is this institutional support or purely personal (family & friends)? Are both necessary?  (2) Could that support/opportunities/encouragement have made a difference if it had been there earlier? or in a different form? (3) Are there flaws or impediments in the available social services that impede the success?

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Regina Diamond-Rodriguez, LSW, MSW

I had a typical happy New Jersey childhood. As a child, I played softball and basketball. I loved going camping and spending my summers at the beach. I have loving parents, who did the best they could. Despite my happy childhood and loving parents, I began to feel like an outsider in my early teens. I developed a smart mouth and a rebellious attitude. I felt insecure and angry most of the time. I tried alcohol at the age of 14 and attempted suicide at 15. I was regularly smoking marijuana at 17, and I eventually tried a number of drugs soon after that. I was arrested for possession and being under the influence of LSD at 18; instead of jail, I was hospitalized. I received pre-trial intervention (PTI) and the charges were eventually dismissed. For the next six years I was in and out of therapy and outpatient rehabs, but somehow managed to get decent jobs. I even became a licensed broker’s assistant (obtaining the Series 7 license); however, my life was unstable and I couldn’t hold a job for more than nine months.

In 2003, at the age of 25, I was in the grips of a near-fatal drug and alcohol addiction. I was unable to maintain employment, healthy relationships, or housing — any semblance of a functioning life. I became unemployed, homeless, and had few friends. I felt so lost and alone. Drugs were the only thing that made me feel ok, and it was always just temporary. As my life spiraled downward, my substance use increased. I was arrested for possession of drugs and credit card theft. I spent a few weeks in the county jail and was homeless upon my release. In a moment of drug-induced desperation, I robbed a small store. I went armed with a water gun, demanded money, and ran out with cash in hand. The police were called and I was arrested within an hour of committing the crime. I spent five months in the county jail before I received my first offer for a plea deal: 15 years in state prison. I eventually agreed to a five to ten year sentence with a mandatory 85% and five years parole upon completing the sentence. The final deal would be determined by the judge on sentencing day.

I knew I had to get sober. During the time I was out on bail, I successfully completed detox, a 28-day inpatient program, and ten months in a halfway house. I attended hundreds of Alcoholics Anonymous meetings, got a sponsor and worked the 12 steps. I was inspired by the laughter in those rooms and the stories of redemption. It was difficult though, especially because no matter how well I did I would still be going to prison. I never wanted to live the way I was living when I committed those crimes – desperate and alone, a slave to my addiction. I hurt so many people while I was active in my addiction, including my family, my friends, myself and the victims of my crimes. I cringed with shame whenever I thought about it.

Sentencing day was August 5, 2005. The courtroom was packed with family and friends. I was sentenced to five years in prison. Tears filled the courtroom, and my mother had to be escorted out because she couldn’t stand up. I ached to see her like that. And then the five year sentence hit me, and I could not imagine how I would survive the next four and a half years.

After the shock and grief passed, I decided that I must stay focused, continue working a 12 step program, and obtain a college education. I was moved from county jail to Edna Mahan Correctional Facility for women. After a few months of settling in and searching for productive things to do, I came across a sign-up sheet for a college math class. I enthusiastically signed up. I relished the idea of taking some college courses while I was incarcerated. I could begin to turn my life around while I was locked up. I was devastated to learn that college level courses were only offered to women under the age of 26, and I had just turned 27. I was angry and hurt and confused. The time seemed to stretch on forever. I spent two years in the maximum security and found very few ways to improve my life. I played handball and cards, learned how to cross-stich and cook. The AA and NA meetings were inmate-led and were nothing like the meetings I was accustomed to on the outside. I was on the brink of despair. But I didn’t use.

In 2007 I was moved to minimum security and to a behavior modification program within the prison. I struggled in this program; the model was confrontational and punitive. I was already sober for nearly three years and had the experience of getting sober in a supportive and nurturing environment. I managed to get through the program and was moved to a halfway house in 2008.

While in the halfway house, I took some basic computer skills training. The class was run by a woman who also worked at the local community college. She and Mr. Fletcher, the Director of Education at the halfway house, suggested that I register for classes through the Next Step Program at Essex County College (ECC). I was excited at the thought of this new opportunity. Mr. Fletcher introduced me to Dr. Roden, a history professor at Rutgers. Dr. Roden came to meet with me at the halfway house and told me about the Mountainview Program, which consisted of a small group of formerly incarcerated students who were registered on the Rutgers New Brunswick campus. He suggested that I get a few semesters under my belt at community college, and then apply to Rutgers University. I was thrilled! This was what I had been hoping and searching for during my incarceration.

On June 2, 2009, I was released from the halfway house and returned to the community. I decided not to move in with my family, but instead moved to the county where I went to rehab and got sober before going to prison. I lived with my sponsor, who had sponsored me throughout my entire prison term. I attended AA meetings nearly every night, got a full time job in a local deli, and attended Bergen Community College as a part time student. I loved being back in the classroom, but I definitely felt different from the other students. I was 30 years old and in classes with people who were mostly in their teens that probably would shutter if they knew I had been in prison. I had difficulty with social situations during the first year after being released. I was extremely anxious and insecure. I could not wait to get out of prison, and now that I was out I felt awkward and self-conscious. It was frightening and frustrating.

The first year was a huge transition for me. I lived with my sponsor for the first six months, and then I stayed with my parents for six weeks, and finally moved in with my partner whom I met in prison two years earlier. She had already completed the Next Step program, and was enrolled as a full-time student in the Rutgers Mountainview Program. I completed my second semester at community college, and applied to Rutgers University through the Mountainview Program. I began as a full-time Rutgers student in September of 2010. The Mountainview students were linked with various resources on campus for support. Our main point person was Chris Agans; at the time he was the Director of Student Support Services (SSS). During orientation we were introduced to the staff at the counseling center (CAPS) and also the advisors in Equal Opportunity Fund (EOF). I believe that the support I received through those three programs – SSS, CAPS and EOF – was what helped me to maintain my sanity and sobriety, successfully navigate college life, and eventually graduate with a 3.9 GPA three years later. Through EOF and SSS I received one-on-one academic advising, tutoring and workshops. I also received a work-study job. At CAPS I met with a counselor regularly for emotional support and guidance. Transitioning to Rutgers was not nearly as difficult and overwhelming as the transition home from prison due to all the support and encouragement I received from non-judgmental staff who were genuinely interested in seeing me succeed. A critically important component of the Mountainview Program is the sense of community and encouraged interaction amongst students in the program. Being around other people who went through similar situations and were on the same path as me tremendously increased my sense of belonging. One of my fellow Mountainview students put me in contact with some sober women in AA and I began attending local meetings, some of which are held on campus and some in the surrounding areas off campus. I attended meetings regularly and gained a network of support.

During my second year at Rutgers, I declared my major as social work. I took summer classes each year with the goal of graduating in May of 2013. During my third and final year at Rutgers, I completed my internship at the Rutgers for Social Justice & LGBT Communities, which is where I met Jenny Kurtz, the Director at the time, and now one of my mentors. During my internship I facilitated a support group for LGBT students and served as a liaison for the New Jersey SPEAK (Students Promoting Equality, Action, and Knowledge) Summit. I volunteered as a mentor to first year Mountainview students and also worked as a tutor for EOF.

In January of 2013, I applied to Columbia University, Fordham University, New York University, Rutgers University and University of Pennsylvania to pursue a Masters in Social Work. I was accepted to all five schools and I chose Fordham. I completed my internship at a care management organization working with children who have mental, emotional and behavioral issues. I was referred to the agency by my field liaison from Rutgers; she knew my story yet was still willing to vouch for me. I was hired as a full time care manager, and graduated with my Masters in May of 2014.

In June 2014, I completed parole. I had been involved in the criminal justice system for over a decade, and now I was done. It was surreal.

I continued to work as a care manager for another year. I stayed involved with the Mountainview Program, which had flourished on the New Brunswick campus. Many students were graduating and several had won prestigious academic awards, scholarships and fellowships. I learned about NJ-STEP (NJ Scholarship and Transformative Education in Prison) which is a consortium of higher education institutions that partners with New Jersey Department of Corrections to provide college classes for students (now for people of any age) while they are still incarcerated and assists in the transition to college upon their release. Rutgers Mountainview Program is part of this consortium. Several Rutgers Mountainview alumni are currently employed with NJ-STEP. I learned that the Mountainview Program planned to expand to the Rutgers Newark campus, so I applied for the role of Program Coordinator. I was hired. Amazing! I now work to serve others, act as a role model, give them hope, and help them navigate to becoming sober, educated, upstanding citizens. I have been so lucky and I owe so many people a great deal of thanks.

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I’m not sure if Regina’s substance abuse problem could have been avoided or stopped in her early teenage years. That said, I think it is imperative that we have more (and better) prevention education at the middle school and high school levels. She would have been a good candidate for drug court, and I hope to see NJ and the USA continue to expand those programs. Drug courts cost a fraction of incarceration and have better results – participants are less likely to recidivate. She reported that the 12-step meetings she attended in prison were weak – that is appalling. The State of NJ’s corrections department is in dire need of volunteers to bring in meetings to the prisons (if you are in recovery, please consider doing this).

Regina had a difficult transition to the outside world after her release from prison; this illustrates the need for aftercare/transition services for people that have left both jail and prison. Former Gov. Jim McGreevey runs a transition program in Jersey City that helps get ex-offenders education, treatment, housing and job training. We need more programs like this (regardless of what you think of ex-offenders, these programs save money by reducing recidivism). She attended classes at Rutgers and enjoyed a number of social and academic supports that are provided by that university. If more schools and states replicate these programs, we’ll have far more stories of recovery, redemption and productivity like Regina’s. Right now, Regina is a rare success story. If we implement the correct policy changes, we can have hundreds of thousands like her.

Last week, I received a phone call from a childhood friend who is a Marine Corps Officer. He told me that another man whom he was deployed with a few years earlier recently took his life. My friend expressed anger, sadness, frustration and regret. He proceeded to tell me that a number of fellow Marines that he has served with have taken their own lives in the last few  years. The first question I asked him was if his friend was divorced. “He was in the process of it,” he responded.

When I talk to law enforcement professionals*, members of the military and veterans about PTSD, depression and suicide, I always ask about alcohol/drug use and divorce because both of them are positively correlated with suicide (you should keep these two questions in the back of your mind, whenever you read or hear about a suicide attempt).

In the last several years, the military has been doing a better job about spreading the awareness of PTSD, depression and suicide among service members and veterans. However, they are not addressing alcohol abuse (misuse, dependence…you can pick your own clinical wording) and relationship problems nearly enough. During a month-long training for Army medical professionals this summer, my class was repeatedly told “if you are married, stay married.” This was particularly in reference to weekend activities. At no point were relationships and marriage discussed in depth. No attention was given to time spent together, communication, fair fighting, family planning or overcoming adversity together.

Marriage is difficult – it takes a lot of continual work. A lot of people take their partner for granted or say things like, “I don’t want to have to work at my relationship.” The stark reality though is that it takes constant work; some are far better at it than others (there are those that say they correct their mistakes in a second marriage, but the statistics are pretty clear that the divorce rate for second marriages is higher than for first ones). People have different needs and expectations, and they grow and change at different rates. Add in job stress, health problems, deployment, financial issues, kids, or perhaps a substance abuse problem, and the chances of marital difficulties, separation and/or divorce increase. Service members lives are often rife with the aforementioned problems.

Addressing relationships in the military requires a change in policy. It means early and ongoing instruction/support. There are existing family programs and support groups, but they are clearly not working. We need more therapists that are working with the military (both as embedded military members and as civilians) that help them learn how to select partners, have quality relationships, fight fairly and work through difficulties. I believe that this will reduce suicide attempts by service members and veterans.

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* I recently had lunch with a number of law enforcement officials. We got to talking about PTSD, depression and suicide in their profession. I asked them what was the percentage of divorce in their field. While they couldn’t give me a global figure, they told me that their organization had a 70-75% 1st marriage divorce rate. Those that are divorced, they said, have higher rates of alcohol problems and suicide.

This past Saturday, I spoke at the Vigil in Camden County, NJ. There were over 200 people in attendance, and many were there to remember one of the 274 individuals who died from an overdose whose names were read at the event. A number of people have asked for a copy of my speech; that’s quite a compliment, but alas, I only speak from an outline rather than a full script. I’ll cover some of the key points here, as well as list a few more resources that may be useful to the parent who has lost a child to an overdose (I’m not going to cover all of the current policy problems listed in my speech or review the positives from the last year or list my own policy goals, because I write about those issues here on a regular basis and it would also quadruple the length of this article).

I was going to be a Shakespeare professor, but then my friend died in late-2002 and I decided to work in an in-patient treatment program in Northern NJ. I engaged clients in individual counseling, group work, psychoeducation, family therapy and multi-family groups. I took them to 12-step meetings and on activities in order to teach them new ways to have fun. My work as a drug counselor led me to pay more attention to drug policy. One can’t look at drug policy without also looking at criminal justice policy. I am often exasperated with our state and country’s drug and criminal justice policies. I am angry with a number of different individuals, forces, companies and institutions.

I am angry at Big Pharma for pushing providers to expand diagnoses so they can increase their market share.

I am angry at Insurance Companies that refuse to pay for the appropriate level of care, or stop paying in the middle of treatment or decline to pay for any kind of treatment all together.

I am angry at those who tell me that it is “God’s will” that someone died.

I am angry about advertisements for drugs on TV and in print media.

I am angry at politicians who say they support forward thinking policies but then refuse to supply funding for said programs.

I am angry at people who write horrible things about those that have died from addiction and hide behind the anonymity of the internet.

I would like to yell and curse and mock and belittle and put-down and threaten and perhaps beat those that I am angry with. But not only are those behaviors ineffective, they are actually counter-productive. We must follow the example of Dr. King and win over those that stand against us with love, patience and the sharing of our personal experiences. In 2013, I spoke at the the NASW-NJ conference in Atlantic City. I talked about how Narcan can save lives by reversing overdoses, and how another social worker said something to the effect that we “should not encourage people to take drugs by having the safety net of Narcan.” Rather than yell and curse and belittle her, I showed her the picture of a mother and her son who died from an overdose and said, “I’d like to give her 3 more days with her son or even 4 more hours.” We need family members to show up at public events, speak at schools, talk before legislative committees and go to treatment programs and tell their stories. I encourage you to wear shirts with the pictures of your loved ones who passed from an overdose. Those shirts are devastating to look at and impossible to deny. You may find that people will say you were a poor parent, that your kid was a bad apple, that addiction is a choice, or that we need to clean up the gene pool. You will get angry. And I need you to respond with patience and tolerance. If I can do it, you can do it.

I have worked with people for a dozen years, and helped them through major life events like the death of a loved one, the end of a romantic relationship, job changes, money problems, moving, and health problems. I have suffered losses in my life as well: the deaths of family members, the aforementioned overdose of my friend Fraser, a divorce, and my sister’s battle with breast cancer (she is alive and well, but it was a doozy of a year for our family). During those stressful events, time slowed down and I would walk aimlessly around my house and stare at nothing in particular. I know other people do that too. At last year’s vigil, I met a woman who buried her daughter that morning. I wanted to comfort her and make everything better, but that is beyond my powers and abilities. But I do have some unsolicited advice for the parents who have lost a child:

1) Attend a meeting of GRASP or Parent-to-parent

2) See a professional grief counselor

3) Spend time with other family members

4) Engage in your hobbies, even if you take no joy in them

5) Get out of your house each day

6) Find a purpose. Last year, I wrote an article about what people can do to help (it’s a good starting point). Paul Ressler decided his purpose was to expand the use of Narcan. Others might want to talk to the parents of a young adult who is in the midst of her addiction. A few of you might want to become a therapist. The point is that there are many options, including work outside of the addiction and mental health fields.

This work often leaves me saddened, angry, cynical, skeptical and frustrated. But I continue to look for hope, help others, and work towards meaningful policy changes. Things are better than they were a year ago. They can get better still. Please join me.

While Governor Christie continues to flirt with his no-shot bid at the GOP presidential nomination, dithers on meaningful policy, and blusters on about meager funding for treatment, local leaders in NJ are the ones making an actual difference in the Garden State.

Patty DiRenzo and the Camden County Addiction Awareness Task Force continue to lead the way on implementing innovative drug policies at the municipal and county levels. Ms. DiRenzo was one of the many vocal forces behind the passage of the 2013 Overdose Protection Act and then fought for Narcan expansion last year. Narcan is an anti-overdose drug that is “nonaddictive, nontoxic and easy to administer through nasal, intramuscular or intravenous application. It reverses the effects of an opioid overdose by essentially blocking the opioid receptors that are targeted by heroin and many prescription painkillers.”*  People that would otherwise die can be saved. Since its expansion in June of 2014, the application of Narcan has saved over 300 lives in Camden County alone. It is now available without a prescription at CVS in 12 states, including NJ.

I spoke about the advantages of Narcan at the 2013 NASW-NJ conference, and one audience member asked me if it was “a good idea to encourage people that we can bring them back from an overdose?” A few friends of mine were in attendance, and they half expected me to flip out. I wanted to (a brief aside here…I deal with idiocy, selfishness and figurative blindness at most public events that I attend or speak at, but I am wise enough to know that yelling, cursing, belittling or mocking are not the correct response).

I paused, looked at the woman and said, “I assure you the alternative is grim. I have met with hundreds of parents whose kids have died. If we could give them 1 more day, heck, 3 more hours with their kid, they would take that time and treasure it. The only time that it is too late to change the course of your life is when you are dead. We are social workers. We know this.”

Over the last two years, others have asked me more nuanced questions. The best ones sound something like, “So we save them with Narcan but then don’t help them get more services. That doesn’t make sense. Can’t we send them to treatment so that we aren’t just giving them Narcan and then releasing them back to the street?”  That is an excellent point, but it requires policy change, willing partners, treatment beds and funding.

On October 7th, Camden County announced Operation Sal, a local initiative that has $150,000 in funding to help people revived on Narcan go to detox and then attend treatment. All four hospitals in Camden County are participating, law enforcement has been alerted and is on board, and patients will be sent to Delaware Valley Medical. This is the ideal next step after Narcan. Kudos, Camden County, and thank you.

This piece was written under emotional duress. The subject matter caused (and still causes) a mix of stunned disbelief and anger. Before we get to the subject matter at hand though, permit me to share a semi-vulgar anecdote that explains the process of normalization.

My friend Andrew had a dog named Steve. Steve was a very friendly, but untrained, yellow lab. Andrew had a lot of problems with Steve. He ate his socks, chewed on his shoes, ate three garden hoses, sniffed crotches, jumped on guests and even once ate a steak that Andrew was seasoning on the kitchen counter (Andrew turned away for a moment, turned back and it was gone). One winter night Andrew heard banshee-like howling coming from his yard. He had never heard that tone and level of shrieking out of anything and (he would later tell me) “it made my hair stand on edge.” He proceeded outside, where he saw Steve limping around, then hopping, then limping again, all while shrieking terribly. This was around 10 pm. Andrew tried to make out the cause of the problem. While he was scanning for a bear or a trap attached to a leg, he noticed that Steve appeared to have a second tail. He did a double take. As he got closer, he realized that Steve had half a tube sock sticking out of his butt.

Andrew walked over, whispered and petted Steve and then tried to pull the sock out. It was wet, a little frozen and quite stuck. Steve yelled. Andrew said, “Sorry about this Steve,” and gave a very strong pull. The sock came out. Steve howled worse than before. Then he quieted down, went in the house and lied down to sleep. Andrew said to himself, “That’ll teach him to eat my socks.” A few weeks later, Andrew was watching a football game and Steve walked in front of him. He had a second tail again. Andrew did a double take, and then he realized Steve was not howling. The sock coming halfway out of his butt had become somewhat normal. That is a pristine example of normalization.

There are others. I’ve had dozens of clients tell me that their first experience in jail would be their last, because it was so incredibly horrible (the food, the 24 hour light, the hard metal bed, the boredom, the fear). A number of them returned to jail or even prison, and the second time wasn’t nearly bad as the first. They had become accustomed to it. Normalization. We can do this exercise for getting bad grades, domestic violence, horrific hangovers (how many of you reading this swore off booze because of a tremendous headache), brutal romantic relationships or a host of other behaviors that cause us pain that we later just accept as normal. Normalization.

I’ve been treating people with heroin problems since 2004. I’ve been talking about the spread of prescription opiate painkillers since 2005. I started conducting trainings on the heroin epidemic in 2010, chaired a Task Force on opiates in 2012 and we released a report in 2014. I’ve written about opiates and opiate policies a number of times on this site. I am horrified to write this next paragraph.

I was watching a football game the other day and this ad appeared on TV. I did not pay attention to it at first, and then halfway through I thought it was a Saturday Night Live skit. When it came on again, I gave it my full attention. Movantik is advertised as a drug that helps people who take opioids deal with the side effect of constipation. The ad shows the woman talking to her doctor, sitting in the park (pictured below) and of course, walking into the pharmacy with her opioid pill. Everywhere she goes, her opioid is with her. There are advertisements on television that show a person with their opioid 24/7 and taking other drugs to deal with the side effects. This is normal now. Constipation is just an irritating side effect of chronic opioid use, and now it can be dealt with through more medication. At no point is a question raised like, “Should she be on opiates?” (I wrote this four times before I took the adverb-curse out of here). Opiate use has been normalized in this country. So much so that it has a cartoon-pill figure on television ads for mass audiences. I expect we’ll see more of these. Andrew’s dog got used to having a half eaten sock stick out of his ass. We will get used to seeing opiates in our lives all the time. I am aghast.

Over the last few years, I’ve written about the marijuana situation in Colorado and the problems of edibles, the first marijuana vending machine, and public health campaigns about the dangers of marijuana. I took the New York Times to task for their pro-legalization stance, spread the news when NYC decriminalized marijuana, and reacted when Nathan Edelman (the head of the Drug Policy Alliance and staunch pro-legalization advocate) spoke about his newfound concern regarding the mass marketing dangers posed by the new marijuana industry.  I give about a half dozen presentations on “The History of Marijuana Policy” each year. A free webinar version of it is available from the National Association of Addiction Professionals (NAADAC) here.

A close friend of mine told me recently that he thought that my work on reforming the criminal justice system in America does not align well with my position on marijuana. I asked him what he thought my position on marijuana was, and he told me that I was for keeping it criminalized. I’m writing this post to inform people about the difference between legalization, criminalization, medicalization, and decriminalization. I am firmly ensconced in the decriminalization camp.

Criminalization – It is illegal to buy, sell, possess or use marijuana. This is the current policy in a majority of states. One can be arrested and charged. One can be sent to jail or prison for using or possessing marijuana. These laws disproportionately effect minorities and people from lower-income households. Having a criminal record makes it very difficult to get a job, a loan, or an apartment. It can also make pursuing higher education problematic as well. For many people, an arrest for marijuana use at 19 can be an albatross for the rest of their lives. Of all the policies here, this is, by far, the worst option.

Legalization – The possession and consumption of marijuana is legal for people 21 years and older. It usually allows for the personal possession of up to 1 ounce. It is regulated by the state government, requires a license to sell it, and is a source of tax revenue. Colorado, Washington, Colorado, Alaska and the D.C. have all legalized marijuana for recreational use. My chief concern about the legalization of marijuana is that it will encourage more people to use it (think about the rampant use of prescription drugs and how the legality of them helped lead to a surge in their use – it is important that I go on record that I believe that the abuse of RX stimulants, depressants and opiates is worse than marijuana abuse). The tax revenue is a major selling point for states with severe budget problems (almost every state). Another worry of mine is: will the widespread use of marijuana lead to more costs (will it lead to more health problems, thus offsetting the revenues brought in by selling it)? That will be difficult to measure (there is a precedent here though – it is widely agreed that for every dollar that tobacco taxes bring it, it leads to $10 in social and healthcare costs). All that said, if the tax revenues are large, this discussion will be a moot point and more and more states will chase those new dollars.

Medicalization – In 1996, the first medical marijuana law passed in Oakland, CA. It created a co-op that allowed members to grow and use marijuana if they suffered from HIV, cancer, glaucoma and a few other severe conditions. After a few years, that law was overturned for a short time but the rubicon had been crossed and California eventually allowed for the use of medical marijuana with a doctor’s note (not prescription). Currently, 20 states have medical marijuana programs, including most of the Northeast and California. Originally pushed for helping people with a half dozen of severe and/or chronic conditions, you can now get medical marijuana for over 200 conditions in a number of states. Medical marijuana is taxed lower than recreational marijuana, so there is an incentive for consumers to try to get medical marijuana. Most research on the medical benefits of marijuana are shoddy, but that is partly the result of the government’s listing marijuana as a schedule I drug. I believe that marijuana should be downgraded to schedule II so that research can be conducted and we can be sure of whether or not there are actual medical benefits.

Decriminalization – (I’ve taken the following definition from NORML)  “Typically, decriminalization means no arrest, prison time, or criminal record for the first-time possession of a small amount of marijuana for personal consumption. In most decriminalized states, these offenses are treated like a minor traffic violation.” Nine states have effectively decriminalized marijuana and two more have laws that will soon be enacted (Delaware in late 2015 and Missouri (!) in 2017). I believe in this path because I think legalization encourages more people to use and I think that marijuana, like tobacco and alcohol, may be revenue negative (the taxes brought in won’t cover the healthcare, social, workplace and legal (underage arrests, high driving) costs).

I have argued for keeping the status quo for the next few years to see the differences in addiction rates, arrests, tax revenues, crashes, and health benefits in the states that have different policies. In three to five years, we will have some excellent data so that we can determine what is the best policy path. If the data shows that I am wrong, I will admit it (rather than do like many who double down on their beliefs despite the presence of solid data).

From the 9/17/15 New York Times:

Fourteen years ago, a leading drug maker published a study showing that the antidepressant Paxil was safe and effective for teenagers. On Wednesday, a major medical journal posted a new analysis of the same data concluding that the opposite is true.

This is the shit that that makes me wild. Back in 2001, a study was released that Paxil was safe for teenagers and young adults. Now a study comes out saying that it’s not safe. Let’s think about this for a moment.

It’s 2002, and your 15 year old daughter’s behavior has been a big concern for several months. She doesn’t talk much and she responds to questions with one or two words. She rarely makes eye contact, eats sparingly and isolates in her room. She sleeps over 10 hours per day. Her friends have changed and her grades are not what they used to be. You’ve talked to your friends and parents about it and taken her to a number of different therapists. Nothing seems to work, and you are getting terribly worried about your daughter and feeling like a failure as a parent. You think about your daughter at work, and it saps your production and energy. You and your spouse sometimes argue about what to do (and whose genes are responsible for it). You feel desperate. You hear about a new drug called Paxil, but you are nervous about its effects. You see this ad on TV. A doctor tells you that a recent study says that it is safe and often effective for treating teenage depression. The choice between a depressed, isolating daughter whom you don’t recognize and a chance to see your sweet girl’s pleasant disposition return, you convince your daughter to take Paxil, because you trust the government and your doctor.

And now we learn that they were wrong. What kind of damage did Paxil do to your daughter in the meantime?

The drug companies don’t always have the consumers best interests in mind (I’m being diplomatic here). This article from MotherJones entited “Disorders Made to Order” is harrowing in how it breaks down how Big Pharma creates a market in order to push their chemicals on a trusting public:

GlaxoSmithKline’s modus operandi-marketing a disease rather than selling a drug is typical of the post-Prozac era. “The strategy [companies] use – it’s almost mechanized by now,” says Dr. Loren Mosher, a San Diego psychiatrist and former official at the National Institute of Mental Health. Typically, a corporate-sponsored “disease awareness” campaign focuses on a mild psychiatric condition with a large pool of potential sufferers. Companies fund studies that prove the drug’s efficacy in treating the affliction, a necessary step in obtaining FDA approval for a new use, or “indication.” Prominent doctors are enlisted to publicly affirm the malady’s ubiquity. Public-relations firms launch campaigns to promote the new disease, using dramatic statistics from corporate-sponsored studies. Finally, patient groups are recruited to serve as the “public face” for the condition, supplying quotes and compelling human stories for the media; many of the groups are heavily subsidized by drugmakers, and some operate directly out of the offices of drug companies’ P.R. firms.

The FDA and the federal government seem to be constantly fighting rearguard battles. In August of 2002, a federal judge ordered GlaxoKlineSmith (the makers of Paxil) to stop running ads that say it isn’t habit forming. This USA Today article states that 35 patients experienced severe withdrawals when they stopped taking Paxil. It’s very hard to know who and what to trust.

If the new study is correct and Paxil is harmful to young people, than I hope that a class action lawsuit will bring GlaxoKlineSmith to its knees. To read the full New York Times article, click here.

Rutgers Football Captain Leonte Carroo was arrested on Sunday morning for  assaulting “a woman he was romantically involved with by picking her up and slamming her down on a concrete surface.”  This came on the heels of the news from 10 days earlier that 5 Rutgers players (eventually more would be charged) were arrested for a series of home invasions, armed robbery and assault. A few of these football players must be experienced in those crimes, as it’s hard to imagine all of them breaking the law for the first time together (it’s not often that someone is caught the initial time they engage in criminal behavior). A couple of days before those arrests became public, it was announced that Rutgers Football coach Kyle Flood was under investigation for breaking university rules by contacting a professor on behalf of one of his players who failed a course (and to make matters even worse, that player was one of those charged with the aforementioned campus terror crimes). Let’s not forget that Rutgers also produced a player who engaged in one of the most notorious acts of domestic violence in modern American history.

One can sardonically state that Rutgers Football has finally made the big time, because a lot of top football schools also are chock full of perps who terrorize the campuses that houses, feeds and educates them for free. This is nothing new: Sports Illustrated published a story in 2011 about the out-of-control crime committed by college football and basketball players. Back in 1989, national media outlets published stories about the Oklahoma Sooners Football Team’s reign of terror on their campus, but it actually pales to what has happened at Rutgers during 2015.

Not only does the Rutgers Football team consist of numerous violent individuals with a disregard (disdain?) for paying students, but it is a program that requires subsidies by the very students that they are assaulting in order to operate. During the 2012-13 school year, the Rutgers Athletic department took $47 million dollars from other parts of Rutgers. It’s the most revenue negative athletic program in the nation. For people that argue that joining the Big-Ten will help with the revenue stream, they are only partially correct. Because in order to play in the Big-Ten, a school also has to spend more. Dr. Thomas Prusa summed it up in Daily Targum last spring:

“When compared to other universities in the United States, Rutgers’ academic program bears the highest cost to the rest of the University for an intercollegiate athletic program”, said Thomas Prusa, chair of the Department of Economics. “To try to do any sugarcoating of the magnitude of (this) financial loss is just not being honest,” he said. “We’re No. 1 in financial losses … by a mile, we lose more money than any other university on athletics”.

“Rutgers Athletics is engaging in a financial arms race against other Big Ten schools, making important decisions with the assumption that spending more money translates to winning more games”, Prusa said. To say the University is operating at a net loss would be an understatement. “The only spillover benefit from the University’s athletic spending would be a perceived sense of pride in going to Rutgers because of the wins made by revenue-generating teams,” Prusa said.

“There’s a direct cost imposed on students, that students don’t understand is (there),” he said. “We’re now in this better conference, and the reality is, we’re in a set of schools that have so much of a giant financial advantage (over Rutgers). It’s just a financial spending race.”

In 2007, Rutgers English Professor William Dowling’s Confessions of a Spoilsport was published, and it detailed the history of Rutgers athletics up to that point. Dowling described a number of scandals that rocked colleges and universities over the previous 30 years. He explained that there is a common pattern in the way they are usually handled:

1) college officials express shock
2) an investigative committee is established
3) a version of the following statement is issued: “the scandal does not truly represent this esteemed university”
4) there is an announcement that “nothing like this will ever happen again”

I expect Rutgers will follow this playbook this fall. And in a few years from now, we’ll probably go through this again. Rinse. Wash. Repeat.

I hike in the Adirondacks a few times a year. The region is huge, as it has over 6.1 million acres. There are 46 peaks, with the highest one being Mt. Marcy (5,343). Over 132,000 people live in the region year round, scattered through over 100 towns and villages. Over the years, the major sources of industry have included farming, mining, milling, and in more recent times, tourism and recreation. The Winter Olympics have been held there twice – in 1932 and in 1980 (the arena where the USA Hockey Team’s “Miracle on Ice” victory over the USSR is still in use in the center of Lake Placid).

Last February, a friend and I took a winter mountaineering class in Lake Placid, NY. I remarked to our instructor how far from a major city center the region is, and I asked her if tourism was the number one source of income for people that lived there. “No,” she replied, “it’s the prison industry.”

I’ve spent a little bit of time researching this, and I’ve determined that it’s extremely hard to determine what is the top industry in the Adirondacks. The list of prisons in New York State is so long that it is shocking. This map shows that a vast majority of them are located in rural areas. One researcher has been writing about the increase in the number of rural prisons for over two decades: a chilling 2002 paper can be read here. Whether it is the number one, three or five industry, it is obvious that the department of corrections is of vital importance to the economy of Northern New York.

Over a decade ago, the then-commissioner of the Connecticut Corrections System engaged in some major prison reform initiatives because it was too prohibitively costly not to. Her major push was for the early release of prisoners – in doing so, she saved her state tens of millions of dollars. With the economic collapse of 2007-08 and the subsequent further collapse of state revenues throughout the nation, both Republicans and Democrats are acknowledging the need for criminal justice and prison reform (here is an excellent article about it from the New Yorker this summer). You can read about the different stances that the various 2016 Presidential Candidates have taken here – regardless of their views, it is clear that criminal justice reform has become too expensive not to address.

Throughout the United States, state prisons cost over $50 billion dollars a year to run. This does not include capital costs (construction), nor does it include employee benefits and pensions (this falls under a different department); therefore, the yearly costs for maintaining state prisons is much higher than the advertised $50 billion.

It’s a big industry that employs a lot of people. A lot of these prisons are located in rural areas, and are major employers in those regions. Any discussion about cutting the size of prisons or closing some down are surely to be met with a rabid response from the people that work there. Prison employees are so numerous in some areas that they have real political power, as is illustrated in this 2013 article about the closing of two prisons in Pennsylvania:

But closing prisons is no easy feat. As a Texas legislator pointedly explained, prisons – often large employers in sparcely populated rural areas – develop their own political constituencies. Sen. John Whitmire, the longest-serving senator in the Texas Legislature, told the Patriot-News, “There are so damned many prisons in so many legislators’ districts, they’ve got a built-in lobby.”

Democratic Sen. John Wozniak, who represents Cambria County, told the Johnstown Tribune-Democrat he was concerned about the employees and contractors who rely on the prison at Cresson for their livelihood.

The Tribune-Democrat noted the prison is important to the economy of the region, quoting Linda Thomson, president of Johnstown Area Regional Industries, who said “First of all, they’re recession-proof, or likely to be there, and these jobs are highly sought after. They’re family-sustaining jobs, so good for the economy.”

Reforming drug policy, eliminating mandatory minimum sentences and three-strike laws, and providing counseling and job training to prisoners and ex-offenders are all difficult goals to accomplish. They are that much harder when opposed by people who are fighting to keep prisons open and full in order to save their jobs (and provide for their families). Part of the discussion of prison reform must also include a plan to address what will happen to the people that work in prisons. Without it, meaningful reform will be even harder to attain.

Over the last few months, I’ve received a number of calls, texts and emails asking me about Medication Assisted Treatments (MAT’s). Putting someone on MAT’s should not be part of an initial treatment plan during a patient’s first time in treatment. MAT’s should be considered after previous attempts at treatment have failed. I often refer people to an article I wrote about MAT’s last summer:

Vivitrol is injectable naltrexone. Because there isn’t any opiate or synthetic opiate in it, it is not a controlled substance. Any doctor can prescribe it. Patients get a shot 1x a month. Vivitrol helps reduce cravings and it mostly blocks the euphoric effects of opiates.

It is effective for both opiates (heroin, oxycotin, hydrocodone, etc…) and alcohol. Vivitrol is not a controlled substance, so it doesn’t take a special prescriber’s license or training to issue it. It is neither addictive nor abusable in any way. All that said, there is an American line of thought that says “take a pill, get better.” That tactic angers me for almost any illness. When it comes to getting clean and staying off of opiates or alcohol, Vivitrol (or other MAT’s such as suboxone) is not particularly effective without regular therapy and urine drug testing. The law does not require therapy or drug testing, but clearly the best practice is to do so. I tend to recommend Vivitrol for a period of 6 to 12 months. This allows the client enough time to stabilize, reduce cravings, get proper therapy, develop a support network and plan for the next phase of their life (education, work, service).

One of the key concerns about Vivitrol is that it is very expensive. Even with insurance, it can cost a few hundred to upwards of a thousand dollars a month. This means that it is really only accessible to the upper middle class and above. I’m hoping that will change. This summer, Senator Joe Vitale, introduced legislation that was ultimately passed by the NJ legislature and signed into law by Governor Christie that would allow people on Drug Court* to graduate from that program while still on MAT’s. It seems a bit wild that we need to have a bill that allows for this, but then criminal justice reform and the improvement of treatment & aftercare are often tough, uphill slogs (but there is improvement all the time…it is not a sisyphean task).

I have never taken money from any pharmaceutical company in any way, shape or form. I never intend to. I think that once one takes money from a pharmaceutical company, it compromises both your viewpoint and the appearance of your viewpoint. I prefer to remain a neutral, well-informed outsider that others can trust.

Finally, I’m a bit appalled by the comments on articles that I’ve read over the years about MAT’s and how they can help people get and stay clean. The comments usually follow one of three themes:

(1) I got sober through God and AA. That’s the only way. Everything else is BS.

(2) I hope this author dies a fiery, painful death.

(3) Another shill for Big Pharma. I hope you die.

All this really proves is that one probably shouldn’t read the comments at the end of articles, but for the fact that it shows us where a percentage of the interested population are currently at. Educate, educate, educate. The data is there (though usually people with ideas that entrenched will double down on their beliefs, even in the face of data).

* Drug Courts cost about 20% of jail, while offering a better return on the public dollar. Less of them relapse and return to crime compared with their brethren that are stuck in jail or prison without treatment, education or job training.