Drugging, drinking, and grasping at straw

The real power drugs hold is how they make the user accept magical thinking as real

In the 16th century, Sir Thomas More originated the idiom ‘grasping at straws’.  In actuality, the lawyer, philosopher, and Roman Catholic saint was referring to straw – cattle bedding – and that a drowning man will grasp at anything floating, even straw, to try to stay afloat (paraphrasing). It’s a perfect idiom 483 years later to illuminate how drug use is rationalized by the user and by American society.

Any drug use. Any time.

Every rational man and woman knows the risk of addiction – and death – from using opiates and opioids, for example. There is a well-documented history of addiction and death from this class of drug, dating to it’s first cultivation and use 3,400 years BCE. Why is it still around? Because people will use it. That’s why.

One of the first affects of any mind-altering drug is that it convinces the user it is somehow safe and the consequences are for the other guys. Magical thinking. Like a drowning man believing a single stalk of dried grass in an ocean will buoy him and float him to safety. Once the drug of choice takes over that human, the magical thinking gives way entirely to chemical dependence.

Even when the drug use doesn’t escalate to dependence – or I should say ‘especially’ when it doesn’t – magical thinking trumps intellect every and any time a person is under the influence.

A recovery pioneer and modern-day anti-alcohol trailblazer in the 1970’s, Father Martin, put it succinctly in his Chalk Talk. He said the human mind works best when it operates as Intellect over Emotion, or I/E. Add a mind-altering drug, any of them, and the equation flips to Emotion over Intellect, E/I. That’s a good explanation to why we say and do incredibly stupid stuff while impaired. Your grandmother was right when she said, “That’s not your Rhodes Scholar Grandpa, it’s the booze talking,” right after he declared he was going to shave the cat.

We do dumb stuff, and believe dumb stuff

A lot of recovery professionals, especially in court-ordered programs, see the aftermath of the dumb stuff followed by some more magical thinking. Every single person charged with DUI or other drug-related crime believes in magic. He or she will be sentenced lightly because of their unique situation, or get off on a technicality, or the evidence will be lost because it happened to his ‘guy’ ‘a couple years ago’ and the ‘law is muddy on this issue.’

When a drug tells the same brain it’s poisoning that the stuff isn’t so dumb, we do the dumb stuff. Including rationalizing the use of the drug. Two common examples are the well-funded oversimplifications of marijuana benefits, and the widespread acceptance of alcohol risks.

A medical user of marijuana dislikes the getting stoned part. Just like a medical user of Oxycontin doesn’t care for the high. When a recreational pot smoker wants to rationalize use, however, out comes the Emotion. Drinkers… well, there isn’t medical use and there aren’t any health benefits. It’s all about the buzz.

Send life rafts, not more straw

They’ll trot out the ‘medical benefits’ to support their continued consumption of a drug… when the medical benefits are far from their reason for smoking dope. They’ll roll out the frequently misquoted safety argument in favor of the drug. It sounds like ‘nobody ever died from smoking weed’.  True, nobody overdosed on weed, put the drug is linked to more deaths and health consequences than can be dismissed as coincidence. They’ll spout the long history of smoking herb, embraced by cultures vastly older than ours. Drowning… grasping at any fleck of straw that will keep them afloat.

The scientific evidence on alcohol as a toxin and carcinogen is even more concrete than the evidence of health damage from marijuana use. The drug can change DNA! It begins damaging otherwise healthy tissue from sip one. It’s so poisonous that if the liver had pain nerve endings, none of us would take sip two. Very scientifically sound and highly intellectual. However, even moderate use of the drug alcohol flips the I/E equation to E/I.

The grasping for straw sounds something like: ‘It’s legal’… ‘It relaxes me’… ‘Moderation is safe, the ad said so’… ‘It’s good for the heart’.  That last point has been discredited for more than a decade, by the way.  Rationalizations… buoying a drug-altered brain modified to E/I by the same drug that’s killing it. When someone is drowning, they want to believe in the straw. What if you drift to them a life raft of factsinstead? We have to deliver them back safely to the boat off which they jumped. That boat  – society and social behavior  – may not be Utopia (Sir More’s more famous work), but it beats drowning.

Scott Stevens, is the author of four alcohol books including the December 2016 release, I Can’t See The Forest With All These Damn Trees In The Way: The Health Consequences of Alcohol. Get the new BookLocker title now on Amazon (viewbook.at/prehab), alcohologist.com, and everywhere you buy books.  Click Alcopocalypse for the author’s 2017 Alcohol Awareness Month whitepaper. Image by Kevin Carden, used with permission.

Photo by Dusan Petrovic, used with permission.

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Selling care: Patient brokering in addiction treatment

Ambulance-chasing. Society generally looks on with disgust at the attorney who markets directly to the accident victim in the hours after the ink on the police blotter dries. The practice isn't illegal, but it brings up the subject of ethics. A similar practice has smoldered silently in the addiction care business for the last decade and will be leading to more scrutiny – and crackdown – over the second half of 2016.

Treatment centers provide a service (detox, intensive outpatient, inpatient, partial hospitalization, or some combination of elements) for a fee, which is charged to the client or the client's insurer. It's America. Lawyers charge a fee in a time of need. Mutual fund companies charge a fee to manage the retirement money upon which you'll develop a need. Lawyers are regulated. Fund companies and their sales reps are regulated and supervised. The practice is largely unregulated in the treatment industry.

The ambulance chaser in the addiction care business solicits business in 12-step meetings and detox facilities and even emergency rooms. There are reputable recovery coaches and other addiction paraprofessionals in the service of those struggling with substance abuse who also attend to those venues and offer suggestions. When they are paid by a treatment entity to deliver those struggling heads to the facility's beds is the point in which the practice becomes predatory.

Take for example, Alcoholic Joe. Joe turns up in the emergency department, unconscious due to acute intoxication. (e.g., he's beyond drunk) A responsive ER staff will inquire about what he's had, how much, and how frequently. Maybe even a social worker or staff associate will address the possibility that Joe has a substance use disorder and suggest courses of action beyond the hospital's capability. Other resources may be given to Joe, if he inquires. He takes it to heart (or his wife does) and Joe goes to a 12-step meeting.

So far, so good. When Joe bumps into a counselor, a self-styled recovery guru or a fellow at the meeting, the conversation sometimes turns to treatment. If the person steering the conversation toward a facility is getting paid $1,000 or $5,000 a head to steer Joe toward that facility – and never discloses he or she is on the dole – is where the industry is getting its latest black eye.

It's not unfamiliar territory for the healthcare biz. Rewind the tape back to the early 90's when physicians were accepting elaborate junkets from pharmaceutical companies and medical device makers. The public bristled when the kickback exposed that the patient might not be getting the best medication or device for his condition, just possibly the medication or device offered by the company with the sweetest “conference” destination. In the early 2000's a similar practice in the mutual fund business was discontinued when fund companies were found to have influence over brokers who might not be offering the most suitable investment for the client, just the funds that landed on the “preferred list” because of the extras offered the broker or brokerage firm.

As the opioid epidemic continues to grow within the shadow of the alcohol pandemic, more treatment centers are opening. Which can only be considered a good thing if they are treating the patient and not the one who provided the patient. As start-up facilities – and some established ones – struggle to keep cashflow manageable, a pay-per-client (heads-in-beds) can be an attractive alternative to shelling out for a marketer's salary and benefits. A captive marketer is going to work for one facility or group of facilities. He or she may not have a component of their compensation based on the census of the facility (e.g. percentage of beds filled at a given time). But they are, in theory, still driven by getting the right fit between the client and the facility. Many even network with other centers' marketing staff and refer business to the right fit based on the cost, insurance and most importantly the client's needs. When a consultant makes a referral without accountability to the facility or for the outcome of the treatment for that client, but for what it appears to be the financial gain of a $5,000 payday over a $1,000 payday, the treatment industry's self-policing has a weakness.

There is no inference that every per-client marketer or treatment facility that employs the tactic is sketchy. As with any enterprise, there are scrupulous and unscrupulous sales people. This industry is no exception even though it is commonly referred to as a helping profession which comes in contact with families and clients during a real and human and emotionally charged crisis.

In the early part of this decade, healthcare officials as well as federal agencies have had the practice show up on their radars. In some cases, the fit between the client and facility or program was so poor, litigation ensued. In extreme cases, people have relapsed and/or died while in the care of a program. Not that the relapse is uncommon with the disease of addiction to alcohol or other drugs… it's not a welcome outcome in or shortly after treatment.

For now, the status quo is under greatest scrutiny in California and Florida, two treatment industry hotbeds. However the status quo remains as a practice that is not illegal – like ambulance chasing – just potentially unethical until greater oversight and guidance is provided. For the time being, it pays to ask a question if and how a person is being compensated for making a recommendation of one facility over another.

The entire 26 episode HD The A-Files: Alcohol A-Z series is available on disc, along with fact sheets, for helping professions. Visit alcohologist.com for a replay of CBS Sports' Power Up Your Health featuring Scott Stevens.  Another interview is on Alcohol Awareness.  Syndicated radio program Savvy Central Radio did this interview, too. Lucy Pireel's "All That's Written" included a feature called "When alcohol doesn't work for you anymore."  Details on the third literary award for Every Silver Lining Has a Cloud and the first for Adding Fire to the Fuel also can be found on www.alcohologist.com. Download the FREE Alcohology app in the Google PlayStore today. Stevens also is the public relations officer with AddictedMinds.com