United for Compassion Instead of Stigma

By Eddie Einbinder 10/22/15

Parents and clinicians want to change the way we understand and respond to substance misuse.

United for Compassion Instead of Stigma
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A growing movement among parents, policymakers and clinicians is working to change a system that it views as having historically stigmatized substance misuse and responded to it with punishment. Led by the grassroots organization Families for Sensible Drug Policy, a diverse group of stakeholders driven by “pain, compassion, love and family” recently gathered at The New School in New York. Their aim was to build momentum for their common goals: viewing substance misuse compassionately, eliminating its stigma and treating addiction as a complex clinical phenomenon as opposed to a behavior to be punished. Harm reduction therapist Eddie Einbinder was in attendance; here he weighs in on the event and connects the themes addressed to his own form of practice…Dr. Richard Juman

On the evening of September 24, 2015, a diverse audience was packed into an intimate lecture hall at The New School for Social Research in Manhattan. They were there to listen to experts from a variety of fields—from mothers to retired police majors to harm reduction psychologists—call for a new paradigm in the way that substance misuse is approached in the United States. The presentations were linked by a common theme—that the War on Drugs that has conditioned American society to view drug use as a crime, and punishment as the appropriate response had run its course. The focus was on improving the education, supervision and treatment of young adults dealing with issues of drug abuse and addiction and stopping the inadvertent, unfortunate traumas that are often incurred in our current system as a result of a problem with drugs. Dr. Jenifer Talley of The New School and assistant director at The Center for Optimal Living  was at the podium to cheerfully greet the audience and introduce the moderator for the evening, Dr. Scott Kellogg, president of the Division of Addictions of the New York State Psychological Association.  

The event was called "Bringing Communities Together: A New Vision for Helping Individuals and Families Impacted by Substance Use and Mental Health Issues," and the driving force behind the evening was Families for Sensible Drug Policy, and that’s what made the event special for me: the event wasn’t just a panel discussion based in academia and policy but one also borne from pain, compassion, love and family.  

Families for Sensible Drug Policy was recently founded as a non-profit organization by Carol Katz Beyer and addiction psychologist Barry Lessin, but it has already developed an incredible following and involvement that has grown beyond its community in Philadelphia to become international in scope. 

Lessin discussed his gradual change in approach to addiction, eventually realizing the need for a change in his practice towards a harm reduction mentality after exposure to too many overdoses partially resulting from abstinence-only based treatment and a failing public health system. Carol Beyer spoke passionately of the counterproductive effect of punishing kids using drugs in high school—removing them from healthy school environments and extracurricular activities and instead coercing them into treatment where they had to label themselves as “addicts,” falling victim to further shame and stigmatization. She related the time when she was told by a drug treatment center that she should call the police to discipline her child. Beyer stated, “If we’re told that relapse is part of the process, then why do our children get in trouble for that part of the process?” Beyer ended by talking about the “school to prison pipeline,” claiming that “privatized prisons are making money off of our children, as a commodity.” 

I found Beyer’s talk particularly impactful, because my work involves doing harm reduction psychotherapy with teens and young adults who have problematic relationships with drugs. Parents of my patients also sometimes get involved in the work. I mention this because outside of the office, at events like this in which one hears heart-wrenching testimonials from parents, I am more susceptible than I desire to be to experience the deep sadness and frustration expressed by so many. It is always harder for me when there are dozens of mothers in the room. I know too well the burning conflict within parents who have to watch their children hurt themselves, and who often feel the need to analyze their own actions—deciding if they themselves are hurting or helping their child.

Daniel Raymond, the policy director at the Harm Reduction Coalition, which has been around since 1994, spoke of the myriad recent improvements and progress with respect to public health reform and the many benefits for people who use drugs. He noted the fact that the chainstore CVS recently announced that it would offer naloxone, an opioid overdose-reversing drug, without a prescription in 11 more states. He invited attendees to a meeting the following week regarding the potential benefits of supervised injection facilities in the U.S. and how realistic the opening of similar facilities in the United States might be. In July, I had been on a tour of Insite, the supervised injection facility in Vancouver, Canada. There are people injecting heroin onsite every single day, and yet nobody has ever died at the facility. They have an understanding with the police in the neighborhood, and the police will bring people to them if they are obviously having an issue with drugs. There are examples of these kinds of progressive trends in this country as well.

In Seattle, for example, if a cop finds a person in possession of an illegal substance, he gives that person the option to go straight to drug treatment instead of getting arrested. I find this approach ideal, in that it allows the individual to receive help while avoiding the legal problems that so often make the person’s situation much worse. We are gradually seeing a transition from punishment to treatment in more progressive states and police forces across the U.S. In 2011, New York’s Good Samaritan Policy finally came to fruition, so that one person on drugs could take another person on drugs to the hospital, and neither would get into legal trouble. This was an enormous breakthrough, so as to no longer inhibit people from seeking medical treatment for real-time problems with drugs. Again, we’re talking about encouraging people to come in for different kinds of treatment, no matter what their situation. 

The theme of treatment and understanding replacing punishment and stigma was highlighted by many other speakers. The Drug Policy Alliance was formed in 2000, and the important role of Youth Policy Manager was created in 2014. Jerry Otero, M.A., who holds that position, began by noting that ”any good drug policy is built on four pillars: prevention, treatment, harm reduction and public safety. The crucial question is, what are we trying to prevent? Any drug use? The harms of drug use? The harms of prohibition?” He went on to discuss various approaches to youth education and the legal system, noting the connection between smart policy and kids’ ability to thrive in the school environment. 

Law Enforcement Against Prohibition (LEAP) was founded in 2002, and its executive director, Major Neill Franklin (Ret.), gave a moving talk. He conveyed the failure of current drug policy by sharing that elevated crime rates are more often related to drug prohibition than to drug misuse. He was passionate about restoring a healthier, respectful relationship between the public and law enforcement. “Social influence is how you reduce drug problems. You do not do it through prohibition!” he declared. 

Dr. Andrew Tatarsky spoke of the many adverse effects of the prevailing system: “We see terrible drug policies and the criminalization of drug use driving people into terrible treatment that sets people up to overdose.” He noted that “the way that we understand problematic substance use suggests how we treat it,” and argued that a real understanding of the complexities of substance misuse should cause an integrated, multifaceted approach to its treatment.

Tamara Oyola-Santiago, a health educator at The New School, shed light on the unique perspective of dealing directly with college students in the on-campus setting, and the complicated variables involved in that context. She shared academic and student affairs' collaborative projects that work towards safer alcohol use on campus. It is rare to find an on-campus health educator with such a progressive outlook, although not surprising that we’d find her at The New School. 

My experience as a clinician connected deeply with the evening’s themes. I have worked with both privileged private school students and with teenagers on parole who’d spent time in prison and dropped out of school by the eighth grade. One common challenge for most people with whom I have worked, regardless of their background, is that they need to find motivation within themselves before they will change their thinking and behaviors. Everyone has a different perspective, but they need to want to change for themselves. If a person is not ready, it often won’t matter who is pressuring them or what they are being threatened with—whether it’s being taken out of college by your parents who are paying your tuition or being put back in prison.

Patients often need to work with therapists to figure out their own goals, what they can achieve, how they can minimize the risks of their relationship with drugs. Once given the opportunities to figure this out for themselves, I find that most people eventually come to a goal or lifestyle that is comparable to what their parent, counselor or parole officer wanted for them in the first place. Of course, precautions should be taken if the patient’s drug use is putting the patient at a high risk of overdose, disease or death.  But the fact is that after a maybe a few days, we can’t stop most people from accessing drugs. Most patients I have worked with who have spent time in prison say that it’s easier to obtain and use drugs inside of prison than outside. The realistic precaution to take is to educate patients about the drugs they are using: Provide them with harm reduction tactics, both logistically, to avoid overdose in the near future, and for their long-term general health.

I would agree with Neill Franklin of LEAP, who now openly states that the most moral, efficient way to fix our current situation is to legalize all substances, along with the regulation, taxation, education, and supervision of their use. If all of this happened, the individual user would be far less likely to die from drug use. And, of course, less likely to risk his life in obtaining the drugs or ruin his life by dealing with the consequences of getting caught with the drug. 

Harm reductionistic, open-minded treatment will get more people into treatment where they will be afforded the opportunity to receive the supervision, guidance and support they need. From there we can help patients assess their situation and figure out how they’d like to improve it, assuming that they are looking to change something about their situation. I believe it is an individual’s right to decide whether or not they want to improve their situation—it’s not for others to decide what is better or worse for someone else so long as the patient is not harming others. 

When we take a harsher approach by immediately demanding that they start by achieving a goal, and then struggle from the start to maintain this new, foreign lifestyle, we are often creating a far more dangerous situation. It is dangerous to force people to change before they are ready, and often a forced change, when achieved in the short term, leads to a lack of preparation and a lack of education. Will your tolerance decrease over time? Will you be able to trust the stranger you’re buying from since your old dealer was arrested? Will you be too ashamed to go get clean supplies from your local syringe exchange program? Will you have a safe space in which to use, free of physical danger and judgment? Will you even have one friend to ask to monitor your breathing while you plan to go unconscious, so as to decrease the chance that you die alone on the floor? Will you have a place to debrief and share about your relapse? A place to talk it out, learn from this part of the process, how it made you feel, how you can develop coping skills and strategies to use lower doses and less frequently or not at all?  

Harm reduction includes everything from helping people achieve abstinence to simply decreasing the risks involved in their continued drug use. Harm reduction is about options. It is about letting people decide where to start, meeting them there, and having the opportunity to help them to get where they want to go. This is how we’ll reach and be able to help the most people. And, in my experience, if they start where they want to, they are much more likely to get to, and maintain, a healthier level of functioning, and in a quicker amount of time.  

None of this is simple. And what I propose will not be an easy transition, not for individuals and certainly not for society. But the participants at the Bringing Communities Together event, have started an open, honest conversation among people from all walks of life. Only through honest conversation about the issues, with genuine concern for the welfare of our children, and ourselves, will we move forward in a moral, rational manner. And that is what we plan to do. We will keep having meetings. And all are welcome to join.

Eddie Einbinder, LMSW, is a Harm Reduction Therapist at The Center for Optimal Living in New York City. 

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Eddie Einbinder, LMSW, is a Harm Reduction Therapist at The Center for Optimal Living in New York City. Follow him on Linkedin and Twitter.