Maia Szalavitz

There's A Better Way for American Doctors to Deal With Painkiller Misuse

When a patient recently came into the St. Paul, Minn., office of Dr. Mark Willenbring, the doctor already knew his history. Diagnosed in his 20s with a chronically painful disorder, James (not his real name) had done well on opioid painkiller Oxycontin for almost a decade.

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The New York Times Is Hooked on “Drug du Jour” Journalism

The stories we tell ourselves matter: As Joan Didion memorably put it, “We tell ourselves stories in order to live.” But journalists have a special responsibility because the way we frame our narratives doesn’t only affect us—it can influence readers and public policy. And the story we are telling about drugs isn’t working.

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Marijuana Addiction Is (Almost) All in Your Head

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Most People With Addiction Simply Grow Out of It: Why Is This Widely Denied?

When I stopped shooting coke and heroin, I was 23. I had no life outside of my addiction. I was facing serious drug charges and I weighed 85 pounds, after months of injecting, often dozens of times a day.

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Drugs Are Fun and That Should Figure Into Our Understanding of Addiction

How do you measure the pleasure that you lose when you end an addiction? To most formerly addicted people, the question makes little sense because by the time they quit, it’s often been years since the benefits of the drugs in any way outweighed their negative consequences. However, pleasure is an essential part of life: It’s not for nothing that the pursuit of happiness is highlighted in America’s founding document. Including measures of pleasure is critical to regulating addictive drugs, in fact—but only if it’s done right.

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How Much Did the Stigma of Mental Illness Harm Robin Williams?

Robin Williams has long been a hero to people in recovery. His drug humor always had the bittersweetness that comes from painful experience and his sheer brilliance and exuberance made many recovering folk proud to claim him as “one of us.” Watching him improvise, the presence of genius was visceral.

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10 Ways Addiction Is Different in America

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Teen Drug Dealers Should Not Be the Victims of Our Thirst for Revenge

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Do Special High Schools Designed for Teens With Drug Problems Actually Help?

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How Corporate Media and Journalists Perpetuate Lies and Misinformation About Drugs

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Meet the Drug Rehab Celebrity Dispensing a Dangerous Brand of Intolerance

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The Unbelievable Shift Towards Rational Drug Policy

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What Most People Think They Know About Marijuana Is Unscientific, Paranoid and Even Racist Propaganda

This article first appeared at The Fix, with coverage on addiction and recovery, straight up. 

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How the Wrong Approach to Drug Recovery Killed 'Glee' Star Cory Monteith

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A Simple Truth About Drugs That Punctures Decades of Drug War Lies

What is the most dangerous activity you can engage in? If you guessed doing illegal drugs, you would be wrong. Extreme sports like big wave surfing, heli-skiing, cave diving, white-water rafting and mountain climbing all have a higher rate of risk to life and limb. Yet the question of a ban on these behaviors beloved by "adrenaline addicts" is viewed as ludicrous, even when the risk of death, say, in climbing Mount Everest once (until recently, about 1 in 3) is greater than the annual risk of dying from heroin addiction (around 1% to 4%). 

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Zoloft Put the Pleasure in My Sobriety

Drug addicts and alcoholics are surprisingly conservative when it comes to psychiatric medications. We’re willing to try virtually anything to get high—but when it comes to taking drugs to get better, we tend to get all “Just say no.” For me, this tendency led to years of suffering before I finally had no choice other than to try antidepressants.

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New Gun Control Law Takes Aim at Addicts

t is far easier for Americans to buy a gun than to get treatment for mental health or addiction, let alone for both. Our nation's lack of these services is getting an unusual amount of attention right now in the fierce debate about gun control following December's mass shooting at a Newtown, Conn., elementary school. Yet some of the measures being proposed—and passed—are less about treating a vulnerable population and more about a heavy-handed attempt at regulating them. This poses a serious threat for almost half of all people who were or are addicts, as that's the percentage who have depression, anxiety or some other "mental illness."

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Is Dr. Drew Too Dangerous for Prime Time?

With the news last week of country star Mindy McCready’s suicide by gun, the death toll among Dr. Drew’s Celebrity Rehab patients now stands at five, giving the show an unusually high mortality rate of nearly 13%. But what’s even more disturbing is that most of those deaths—possibly even McCready’s—might have been prevented if the program had utilized treatment practices proven to be most effective.

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Will We Ever Learn to Think in Moderation?

The media seems to have three modes of action when it comes to psychoactive drugs: intense promotion of advances and benefits; general disregard; and full-on panic about negative effects, including potential for misuse and addiction. During both the benefits and the risks periods, many myths and misinformation are disseminated. But between these bouts of euphoria and panic, there is little coverage at all, especially of addiction. This up/down/off pattern does a disservice not only to people suffering from addiction, but to those with other diseases as well.

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Can a Psychedelic Drug From the Bark of an African Plant Cure Heroin Addiction?

Ah, ibogaine. It just so happens that ibogaine and I have a long history: though I never took it, I knew Howard Lotsof, the former heroin addict whose own recovery began in 1962, when he accidentally discovered that ibogaine can relieve heroin withdrawal. I wrote about ibogaine as a potential “alternative treatment” detox drug, in fact, in my first book, Recovery Options. As a fan of psychedelics who finds their therapeutic potential intriguing—and as someone who likes to see people in recovery advance the field—I’ve followed its highs and lows with great interest.

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The Case for Performance-Enhancing Drugs

Anyone familiar with addiction is likely to be wary of brain-boosting drugs: we all know how chemicals that once seemed the answer to all our woes can become instead our biggest problem. But those of us who have also benefited from antidepressants and other mood-altering prescription drugs know, too, that the right drug in the right situation can be positively transformative—and that simply deciding that “all drugs are bad” can be counterproductive. 

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Is Scientology's Narconon Killing Patients?

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The Dangerous Panic Over Painkillers

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Sex Abuse in Rehab? How Predators Can Take Advantage of Addicts Seeking Help

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The Great Antidepressant Hypocrisy

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Is Babysitting the Ultimate Source of Our Ability to Understand Each Other?

The following is an adapted excerpt from Born for Love: Why Empathy Is Essential—and Endangered (Morrow, 2010) by Maia Szalavitz and Bruce D. Perry, MD, PhD.

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Must-See Indy Film Exposes Cruel Teen Correction Programs

Until now, there has never been a feature film that takes us inside "tough love" teen programs like those headed by Romney financiers Mel Sembler and Robert Lichfield. The New York Times calls Nick Gaglia's indy production, Over the GW a "lean yet harrowing ... look at reprogramming that masquerades as rehabilitation." It is playing for just a short time here in New York City (details)-- and I urge everyone to see it, especially those whose lives have been touched by these monstrous "therapies."

The movie was based on Gaglia's own story. From 1997-1999, he attended the KIDS program in New Jersey, which was run by Miller Newton. Those who follow these issues will probably recall that Newton previously served as national clinical director for Sembler's Straight Inc. Despite having had to pay out over $10 million in settlements related to abuse he participated in and directed and admitting abusive practices to regulators, Newton still sits on an advisory board for Sembler's Drug Free America Foundation.

Gaglia discussed his experience with me recently. Just 25, the writer/director is beginning to hear from Hollywood -- the NY Post, NY Sun and Variety also took note of his debut film. Before being sent to KIDS, Gaglia had auditioned for and was accepted to New York's prestigious Professional Performing Arts School, whose notable alumnae include Clare Danes, Alicia Keys and Britney Spears.

But Gaglia had problems at home. Although he's still not quite sure why, he didn't want to go to school and simply couldn't communicate with his parents, who had divorced when he was nine. "I wanted to do what I wanted to do," he says. "I wanted my independence and they were getting in my way." Soon he was drinking and smoking pot daily-- and coming home late, smashing furniture and punching doors. Until after KIDS, he'd never even tried any other drugs.

When taken to the program, located near a major shopping mall just over the George Washington Bridge from his home, he was told by his parents that he'd be going shopping. "I tried to run away, but a group of five people grabbed me. I was a really skinny kid and I wasn't going to fight, I wasn't violent."

He was strip-searched by teenagers who were already inmates-- made to "chicken squat" naked in front of them. In the film, the violence and potential for abuse in having unsupervised adolescents do such searches is represented with the terrifying snap of a rubber glove and images of a naked boy, surrounded by bigger, tougher kids who are clothed.

What he doesn't show is the urine stains visible on the "clean" underwear he was given to replace the "druggy" clothes he was made to leave behind when admitted. When restrained on the floor, teens were not given access to the bathroom. "At my first group, there was a kid being restrained on the floor and his hands were soiled," he says.

"I was restrained over 100 times," he continues, detailing how fellow participants would throw him to the floor for "offenses" such as responding to being poked because he wasn't paying attention by trying to fend off the attack. These restraints could last hours-- with one person sitting atop the victim while others held down each limb. The most frightening part was fear of suffocation: sometimes the victim's mouth would be covered and his nose pinched close.

Writhing was interpreted as defiance. "One time I felt like I was five seconds away from dying," he says, "I have scars in my mouth which was bleeding. I was panicked and trying to communicate but they think you are resisting. What are you supposed to do?"

Grim as this material is, Gaglia represents only the barest outlines of it in the film: limited both by budget and by recognizing that if he did show the whole truth, he might make a movie that was unbearable to watch. He also avoided the trap of didacticism, which often mars attempts to tell these stories.

"I wanted the viewer to feel like he was sitting in that room," he says. "You don't know why your sister was there, you don't know what day it is, you don't know why they were doing certain things. And that's the way I directed the actors."

In fact, the actor who played the character based on Newton didn't even know that there was a real-life model for the story until later. "I told him to act as though he believed he was doing everything 'to help these kids,'" says Gaglia. The self-righteous rage and "ends justify the means" thinking that characterize the operators of tough-love programs comes through vividly.

Gaglia eventually managed to escape from KIDS by jumping out of a car stuck in traffic at the toll plaza of the GW Bridge. The program parents who were driving the car had childproof locks to prevent escape via the back doors-- but the front seat was empty, and Gaglia went for it. Fortunately, after getting the attention of the police, he was able to convince his own parents not to return him.

But, like many who left, he was at first terrified that the program's predictions of a future of "jails, institution or death" would come true rapidly because he'd left without completing it. And, again like many others, when that wore off, he began drinking more heavily and using harder drugs. "When the drunkest guys you know are saying 'Hey dude, you're drinking too much,' you start to think it's a problem," he says. Ultimately, he studied film at Hunter College and got back on course.

"I don't see how anyone who was in that kind of a situation for as long as I was could come out without post-traumatic stress disorder," he says. "I had nightmares all the time that I was back in."

I attended a screening recently for those who had been through KIDS and similar programs. I was struck by the age range: there were people from their mid-20's to their 40's who had suffered through years at KIDS. Though many were nervous that the film would trigger distressing memories, those I spoke with found that the film validated their experience. "More than anything, I made the movie as an homage to these people," says Gaglia, "We're all speaking with this film."

Let's hope that people who can prevent the abuse from continuing are finally listening.

Multiple Sclerosis Sufferer Serving 25-Year Sentence for Taking Pain Killers

Florida's Supreme Court has rejected an appeal from Richard Paey, a wheelchair-using father of three who is currently serving a 25-year mandatory prison sentence for taking his own pain medication. In doing so, the court let stand a decision which essentially claims that the courts have no role in checking the powers of the executive and legislative branches of government when an individual outcome is patently unjust.

Richard Paey -- who suffers both multiple sclerosis and from the aftermath of a disastrous and barbaric back surgery that resulted in multiple major malpractice judgments -- now receives virtually twice as much morphine in prison than the equivalent in opioid medications for which he was convicted of forging prescriptions.

He had previously been given legitimate prescriptions for the same doses of pain medicine -- but made the mistake of moving to Florida from New Jersey, where he could not find a physician to treat his pain adequately. Each of his medical conditions alone can produce agony. Paey has described his pain as constantly feeling like his legs had been "dipped into a furnace."

The Ivy-league educated attorney has no prior criminal convictions, and weeks of surveillance by narcotics agents did not find him selling the medications.

The Florida Court of Appeals had upheld his conviction -- despite the lack of evidence of trafficking and despite the fact that most of weight of the substances he was convicted of possessing (higher weights lead to longer sentences) was made up of Tylenol, not narcotics. The majority suggested that Paey seek clemency from the governor, claiming that his plea for mercy "does not fall on deaf ears, but it falls on the wrong ears."

In a jeremiad of a dissent, Judge James Seals called the sentence "illogical, absurd, unjust and unconstitutional," noting that Paey "could conceivably go to prison for a longer stretch for peacefully but unlawfully purchasing 100 oxycodone pills from a pharmacist than had he robbed the pharmacist at knife point, stolen 50 oxycodone pills, which he intended to sell to children waiting outside, and then stabbed the pharmacist."

But the Florida Supreme Court disagreed, letting the sentence stand, without comment. It released its cowardly decision in the media quiet of a Friday night. As Siobhan Reynolds, founder of the Pain Relief Network points out, "Where Florida stands now is that individuals have no recourse to the courts when the executive and legislative branches behave tyranically." Under the Constitution, the role of the judiciary is supposed to be to check the powers of the other branches -- not simply to defer to them.

Paey's only other alternatives now are an appeal to the U.S. Supreme Court or clemency from Governor Charlie Crist.

Writing in support of clemency, leading academic pain specialist Russell Portenoy, MD, said, "the information available indicates that any questionable actions [Paey] took, actions which led ultimately to his arrest, were driven by desperation related to uncontrolled pain."

He noted that such cases "may increase the reluctance of professionals to treat pain aggressively."

Portenoy wrote that despite the fact that Paey required high doses of opioids, those doses were "clearly in the range used by pain specialists in this country." He stressed that, "The number of pills or milligrams of an opioid required for analgesia says nothing about any of the negative outcomes associated with these drugs-including abuse, addiction and diversion-and reference to the amount of drug as evidence of these outcomes by regulators or law enforcement should not be condoned."

Unfortunately, across the country, pain patients are being undermedicated and doctors are going to prison because the Justice Department refuses to believe this.

People profess to be experts about addiction because they have personal experience with drugs or addicts; they think they know about opioid drugs because they've watched a few episodes of E.R. or been through DARE classes at school. The truth is that opioids are amongst the safest drugs known to humanity -- when given appropriately, they do not kill.

Unlike aspirin, Tylenol, Vioxx, Celebrex, Advil, Alleve and every other known class of pain medications, opioids do not harm any organs and there is no maximum dose once a person has become tolerant to them. People need to educate themselves about the complexities of how drugs, brains and settings interact before making policies about them that send people like Richard Paey to prison.

Governor Crist, please, do the right thing and send Richard Paey home.

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