The road to Paul Little’s addiction began during a hard day at work. He took one pill to ease a headache, which turned into nine-month habit.
“I got up to 20 to 30 Percocets a day,” the former Air Force doctor said. “I was eating them like M&Ms.”
Kathy Thomas took opioids for two years until a doctor told her she was being unnecessarily medicated. She still lives with the psychological consequences.
“I still don’t think that I have cognitive functioning back where it needs to be,” the former Army program manager said.
Ted Flores, who suffered from a pinched nerve and a couple of degenerative discs from a car crash, knows how ordinary people can get hooked on pain pills. As a pharmacy technician, he saw customers who looked like him.
“I was one of the many.”
In 2018, 47,590 people died of an opioid overdose, and more than 2 million suffer from opioid addiction disorder, according to data from the Centers for Disease Control and Prevention and the National Institutes of Health. The rising death and addiction toll has followed a decade-long surge in the distribution of prescription opioids — according to federal data, more than 76 billion pills flooded the country from 2006 to 2012.
Medical experts say genetics account for about half of the risk of addiction, but mental health issues, violence in the home and access to drugs also contribute. Law enforcement officials blame illegal drug diversion by corrupt doctors and an overabundance of supply sent out by drug companies that fail to properly monitor suspicious orders. The companies blame bad doctors and individuals who abuse their products.
Earlier this year, The Washington Post asked readers to share their stories about how opioids have affected their communities. More than 700 people responded. Hundreds wrote about the devastation to their hometowns, their families and themselves. Scores of chronic-pain patients said they needed opioids to live full lives and were concerned about efforts to restrict the supply during what they believed to be a period of hysteria about opioids.
Many readers said it was easy to get hooked on the pills, whether they were taken to treat an injury or at a party. Once addiction took hold, the consequences were life-altering.
Five people described turning points in their lives — the moments that led them down a trail of dependency and addiction.
It started with a car crash
Late at night in November 2011, Ted Flores was coming home from running errands in Highland, Ind., when a car T-boned his at an intersection. He was lucky. He was diagnosed with only a pinched nerve and a couple of degenerative discs.
He tried physical therapy, but it didn’t take the pain away. Then a doctor gave him a prescription for hydrocodone. The drugs took away his pain and made him feel more energetic and sociable. Even though he was no longer in pain, he went to another doctor to get more opioids, this time oxycodone.
“I didn’t want it to stop,” said Flores, now 30. “Eventually, I started taking a little more than what I was supposed to and would tell myself, ‘I’ll take less next time.’ ”
He ran out of pills two weeks into a month-long refill. He would develop flulike symptoms whenever he finished his prescription early.
“I had to call sick into work,” he said. “I couldn’t even leave my room.”
During this time, Flores got a job as a pharmacy technician at CVS. He said he constantly saw other people like him, coming in to fill prescriptions they didn’t need. Some would wait in their cars in the parking lot before the store opened.
Six years after the crash, finally fed up with the cycle of withdrawals, Flores booked an appointment at a Suboxone clinic and got clean.
“I bear guilt or the sense I was part of the problem, giving other addicts their medication,” he said. “Seeing recent statistics about how many pills flooded my area, I’m not surprised: I was one of the many.”
It started with picking up a prescription for a friend
When Mary Young had to take pain pills after foot surgery, it felt like a chore.
A real estate agent in San Diego, she usually spent 10 hours a day on her feet. One day in 2005, a bone in the ball of her left foot split in half. She was on crutches for three months, reaching four times a day for bottles of oxycodone and Vicodin, which contains hydrocodone.
“When I took the last pill of my prescription, I didn’t think anything of it,” said Young, now 45. “If anything, I was happy to be done with it.”
Four months later, a friend asked her for a ride to the pharmacy so she could get her Vicodin prescription.
“Hearing the word ‘Vicodin,’ I don’t know why but I felt like fireworks erupted in my brain,” Young said.
“Yes, but can I have one?” she asked her friend. The friend handed her a small white tablet that Young took home. Sitting in her living room, she swallowed it and soon felt euphoria.
“It was a feeling I wanted to chase,” she said. “It only took one pill.” The friend, who wasn’t feeling any relief from her medication, willingly handed over as many as Young asked for. At the height of Young’s addiction, she was siphoning 20 a day from her friend, who suffered from stomach pain.
For six years, Young kept getting Vicodin from her friend. She says she could not have functioned without it. When she traveled, she worried about running out. When out with friends, she wouldn’t drink, fearing she could “lose the high.” At night, she would count how many she had, and if it didn’t add up to 20 for the next day, she drove to her friend’s and picked up more.
Finally, visiting family in West Des Moines, Iowa, she decided to move home and go to a recovery center. She has been in recovery for nearly a decade.
“Sometimes I look back and feel so much shame for lying to my friends and family, keeping my addiction under wraps,” she said. “I used to be so confident, but my self-esteem is now at zero. I’m still working toward building back the trust of my family — as well as my own.”
It started with a headache
Paul Little’s job as an Air Force physician at Goodfellow Air Force Base in Texas was a stressful one. It was his first job after completing his residency. He felt he had more patients and paperwork than his experience qualified him for. He was a captain, but he felt his job was one for a major.
In 1979, Little was sitting in his office on the base and plagued by a migraine. He knew that he had leftover pain pills from a hernia repair in his desk. He took one. “It was an especially difficult day,” he said.
That one day led to a year-long habit. To get more, Little would tell patients that they needed pain-pill prescriptions and then would skim some, he said, taking up to 30 five-milligram Percocets a day. He successfully hid his addiction, continued to treat patients and even won a base-wide award for his work.
He eventually realized “this insanity couldn’t go on,” and he confessed to his commanding officer. He was given an other-than-honorable discharge, his medical license was suspended and he went to prison for a year.
It took years of sobriety to earn his way back. Once he had, he wanted to do the opposite of prescribing opioids: Little, now 60, he works at a detox center in San Diego and runs a telemedicine Suboxone clinic in West Virginia to help other addicts.
It started with a chronic pain
Kathy Thomas had a senior civilian position with the Army, managing a group of nine people who reviewed complex contracts. Shortly before she retired, she was prescribed an array of pain pills in 2012 for a rare, incurable form of neuropathy.
After Thomas’s pain from her neuropathy dissipated, doctors left her on the pain pills, furthering her dependency on the drugs. When she went to the Mayo Clinic for a sleep study, a doctor noticed the drugs on her chart.
“He said: ‘Oh my God, you have been on all these drugs for two years. What is your pain management doctor’s plan to taper you?’ ” said Thomas, who is now 68 and lives in San Antonio. She said she was not given a plan.
Thomas went through group therapy to be weaned off the pills. She said everyone in the room was just like her — their addiction and dependency had crept up on them without them noticing.
Even in recovery, Thomas retains symptoms of dependency: She’s developed an eating disorder, gaining 45 pounds. Today she has difficulty remembering what day it is or showing up for doctor appointments.
Thomas also compulsively shops. At the peak of it, six boxes a week would appear at her front door. She said she had no recollection of ordering anything.
“My husband would hold up a box and ask me what it was, and I had no idea,” she said. “I wasn’t like this. I used to be unstoppable, not just mentally but physically.”
Now Thomas spend her days repeating tasks she’s already done because she forgot what she did earlier. “There’s a lot of side effects that go along with using these drugs long term that I don’t see being addressed,” Thomas said. “I don’t think a lot of people think of that.”
It started with a soccer injury
In 2001, when Kayla Leinenweber was 13, after she had wisdom-teeth surgery, her mother doled out her pain medication as prescribed. The pills did not create a problem for her.
“I was in a public high school, where most kids — including myself — were experimenting with marijuana and mushrooms, not pills,” she said.
However, after transferring to a private school in Alpharetta, Ga., Leinenweber saw her peers snorting cocaine and taking opioids. She went into her parents’ medicine cabinet to steal oxycodone pills after she tore a ligament in her leg playing soccer. The injury prevented her from playing the sport.
“I thought my life was over,” she said. “I wasn’t going to college without soccer because I was dumb.”
At 15, her school tested her for drugs and she failed. She was sent to an inpatient clinic in Washington state, but sobriety didn’t last.
“I was struggling with depression and feelings about my sexual identity,” said Leinenweber, who is now 31 and out as a lesbian. “I was my own harshest critic.”
At 22, she got a DUI, her first of two. She lost her driver’s license. She abused heroin. She went to nine treatment facilities. She overdosed three times, twice on heroin and once on Ambien. At the peak of her addiction, she would score up to $200 heroin a day.
“For the last few years, I was sick all of the time,” she said.
By 2013, Leinenweber was exhausted. She had overdosed again. With her clothes in two trash bags, she couch-surfed until she opened a sober-living home she could live in. Now she lives in Sneads Ferry, N.C., and mentors people on their treatment options.
This story was originally published by the Investigative Reporting Workshop, a nonprofit, nonpartisan newsroom at the American University School of Communication.
By: Meryl Kornfield, Investigative Reporting Workshop Title: “It Only Took One Pill” Sourced From: www.thefix.com/it-only-took-one-pill Published Date: Tue, 31 Mar 2020 07:22:19 +0000
At New Horizon Drug Rehab, we understand addiction. If you or a family member are afflicted with addiction or substance abuse we can help. We work with the top centers throughout the US to provide the best detox and addiction treatments available.
Of the many lines which have stayed with me after reading Hala Alyan’s book The 29th Year, one of my favorites is, “I have held the engine of myself against my own ear and, dear miracle, I recognized the song.” Perhaps because I’m currently twenty-nine, I found Hala’s acts of reflection so honest and piercing that the book lies on my table like a footprint in the earth. Like something has passed through here, heavy and fast.
In some ways, every poem made after (during) survival is about survival, whether this truth is spoken directly or as undercurrent. The 29th Year does a little of both while Hala traces the mosaic of her identity and how it’s shelled her experience of remaining brilliantly alive, despite the world and despite her own actions.
This book is Hala’s debut collection of poetry, following up the 2017 release of Salt Houses, a novel which narrates a middle-class Palistinian family, one generation after another, and as they migrate across countries. That novel was widely acclaimed and included in the Best of 2017 list compiled by NPR.
Her poetry debut, which came out in early 2019, similarly engages what it means to be Palistinian, but also Woman, Wife, Dreamer, Fighter, Drinker, plus so much more. This parapet of poems introspects backwards from the point of transition between emerging adulthood and the full unalloyed thing. Simultaneously, much of the collection is devoted to registering the timeline of getting sober, shaped like a metal spring, with all its behavioral switchbacks.
Another piece of language from The 29th Year that stays with me is “How a wound becomes a heart.” The collection represents a thrilling extension to the poetics of recovery, and the relationship between them and The Twelve Steps. There are many parts of this conversation I want to tattoo on the inside of my eyelids to reread every night.
I’m still thinking about intention ever since I did a workshop with Vincent Toro last summer at DreamYard in the Bronx. Can you tell me some of the important intentions of your new book?
Wait, did you say intention or tension?
IN-tention [laughs]. Although we can talk about tension if you want.
[Laughs] Oh, IN-tention. The Twenty-Ninth Year was driven by experience, and particularly a concentrated time when I started feeling a lot of essential crises about where I was in my life. I was finishing my training to be a psychologist and I was sort of entering the world in a number of ways. This all happened in my 29th year, literally.
For several months I was having a lot of vivid and intense dreams and feeling almost assaulted by memory. It felt like my mind was cycling back. On a physiological level, I had so much cortisol–that’s the unromantic explanation. I was in a state of panic. But then being a poet [laughs] I was like, what’s the story here? I did a lot of excavation and a lot of organizing and re-ordering of my understanding of who I was and how I got here.
Hm.
So there was tension too. I can never tell these stories accurately because I’m always going to be editorializing. In the end the collection was a surrendering to that, being like, “Ok, I can’t know for sure what was accurate, so I have to tell it the way I’m experiencing it right now.” The intention was setting that record. I’m the type of person who is programmed to resist. To resist things that are difficult. To resist comfort. This was the first time I had a lot of practice at accepting.
Let’s talk about addiction. Lately, I’ve been seeing things through the lenses of social work and public health so I’m going to approach this question from those places, but I think this approach will open up more tactile conversation. What are some risk factors for addiction that are unique to Palistinians, of course, acknowledging experience various across diaspora and due to other social variables?
I speak from diasporic experience. I don’t think there is much research about this, so I’ll speak intuitively and from having conversations with people. There is a sense of dislocation and missing something that feels crucial and then filling the loss with whatever you have at your disposal. That could lead people to seek forms of self-soothing that aren’t ideal. I also believe when you belong to an identity that is marginalized and subjected to both literal and rhetorical annihilation you kind of internalize that. You learn to annihilate yourself.
There’s a line from “Call Me Prayer,” “In the exile’s suitcase, a carpet of dead grass. Seven persimmons. A dandelion stem skinny as a grenade pin.”
I can remember parts of your book where imagery of war was imprinted into descriptions of emotion. I think about that, hearing what you just said about annihilation, and wonder if there is a connection.
It’s tough to talk about collectively because it’s the least intentional and the least premeditated connection, but instead one we are most driven by experientially and needing to capture that and put it into language. But one hundred percent afterward when I was reflecting and editing my manuscript. Through more and more conflict and more and more dislocation that becomes your city, your day-to-day. And it makes sense addiction would come from that.
A similar question…in the experience of being a woman in this world, what are some of the risk factors for addiction?
The answer is similar to the previous position of being Palistinian. Womanhood is an identity that comes with trying to be controlled, trying to be made as small as possible. There’s vitriol, hatred, and violence. Again, I don’t think it’s a long walk from receiving violence from others to committing violence towards the self.
I’ve always thought of addiction as a violent act that people endure and live through. So it’s a similar thing.
What your book does well and thoroughly is chart the lines between womanhood, violence, addiction, marriage, the major points of the web, but also the small ones that fill everything in.
Thank you so much for saying that. I struggle with this writing sometimes but experientially and existentially I don’t know how to move through the world without one of those identities missing or not present.
In reading this book I thought about the people in recovery who are already poets or who want to be poets. For you, how did The Twelve Steps lend to the writing process or producing the poems. Or–and I will throw this question out there in a different way and you can navigate either however you want–how are The Twelve Steps already poetry, in terms of what they ask you to produce?
Oh, I love that. Beautiful. First, a disclaimer. I did not get sober through AA. I isolated myself and didn’t turn to anyone for support. I now look back at it as a violence I inflicted upon myself in my own way. I would do it differently now and look for community. By myself I looked up the steps and interpreted them. I’m not advocating that, but it’s just what I did. Later I thought about the Steps as I was writing the book and going through the intense period of tumultuousness, suffering, anxiety… I asked myself, “Well how did you move through the world when you were getting sober?” The taking stock of what you have. Thinking about what decisions or missteps got you here, retracing them, questioning how we can make amends.
The steps can be useful when we think about poetry and poetic device in that there is a certain surrender that comes from making art. There is a certain amends-making that comes from making art. Again you sit down with what you have, you take stock of it, you make sense of it, then you try to create some sort of meaning out of it. I think there’s definitely a simpatico there.
I personally had a similar recovery in the sense…just as in addiction, then in recovery, I did a lot of it in isolation–
Yes, I know what you mean–
So I feel that. There is a spectrum of AA practitioners, with more orthodox folks on one end who believe there is a clear right and wrong way, and then on the other end, people who say, “You can take what you want and leave the rest.”
Exactly, exactly.
For a while, I also didn’t find traction with AA and The Twelve Steps. It wasn’t for me. But the more I go now I start to feel that regardless if you subscribe to it medically, culturally it’s wicked important to recovery culture–
Agreed–
Unless you’re in a cave and you never read anything related to recovery, you’re gonna absorb a bit of it. It’s inevitably in the air.
It’s so out there. Do you remember when you were getting sober, did you rely on some of the tenets and ideas?
The first meeting I ever went to, when I was 19, I remember hearing a speaker say, “Just keep the plug in the jug,” meaning, no matter what happens in your life, no matter how bad it gets, if you remain sober at least you have that. Things would only be that much worse if you’re using. I’ve clung to this throughout sobriety.
For a while I didn’t like AA, because I didn’t know how to navigate the spiritual component. But nowadays the more I go to meetings I’m appreciating the little sayings, and appreciating The Twelve Steps as cultural objects you can find healing through, and less like medical instruments.
Like less instructional and more metaphorical. I love that.
Although, some folks believe in rigorously adhering to the Steps as they’re written in the Big Book and I want to acknowledge how this approach is valid for them. Well…with all that being said, want to look at some of your 12-Step poems?
Sure.
In your poem “Step One: Admit Powerlessnes,” it seemed like you were drawing a line between two types of powerlessness, the kind that can happen during sexual violence, and then the admission of an inability to control drinking. Again, maybe I’m just thinking like an epidemiologist, but within this poem are there multiple types of powerlessness being associated across time?
Yes, and it’s not just powerlessness in terms of sexual violence. At the end of the day, we are powerless in the face of everything we’ve experienced. That does not mean we can’t take back some power in the telling. I’ve been thinking a lot about the difference between pain and suffering lately. Pain is what happens to us that is nonnegotiable and suffering is what we do with that pain–
Wow–
So positioning the pain is what makes us suffer. It’s been on my mind a lot. Whether it’s trauma or addiction it took me a long time to get the powerlessness thing, but in both cases it was the first step towards walking through it and being liberated and being able to tell a different story. So definitely in that poem there is the tension between the two.
I feel the ending lines resonate with what you said, “Through the bar window a lightbulb exploded like a white tusk and when the sun finally rose I believed in a different god.”
You’re different once you go through it. You’re different when you go through anything big and transformative. There can be a morning, but it’s not always a pleasant or easy process.
Alright, howabout “Step Two: Higher Power”? There is the line, “I guess you could say I love the city like I love prickly pears, which is to say not very much, only when I’m starving.” Perhaps I’m projecting because the higher power portion of The Twelve Steps wasn’t something that came easily to me, but the poem seems to be saying, “Alright, I’m not all in on this, but I will accept it right now out of necessity.”–
I don’t have a choice. Yeah, yeah, yeah.
There’s also the line, “This is how a year passes, with hundreds of lies, like that midnight walk in the French countryside dark, my sister giggling nervously, no streetlamp for miles. One footstep after the other, and the only way out ahead.” I’ve considered different interpretations of this. Was faith something you were lying to yourself about in order to help you survive?
It’s less about disbelief in faith…There’s a quote I really like, “Trust in god but always tie up your camel.” I have never resonated with the idea you just 100% lay down and give it all over. What I like about the quote is…you can have faith, but do your part. That idea of me walking with my sister at night, having faith the ground wasn’t going to open up and swallow us. We will reach the place we need to go. Faith is deeply important. Even if people don’t put faith in God or a higher power, that’s fine, but having faith in something, even if it’s just yourself, or having faith in other people, or having faith in time. That stuff is so crucial, because that’s what keeps people moving when there’s no indicator that there’s a way out.
I feel like I want to say “Wow” every time you answer my questions. Let’s move on to your poem “Step Four: Moral Inventory.” It made me think…all contexts aside, there’s nothing evil with wanting to be beautiful. Of course, it’s wrong to hurt people and it’s unhealthy to hurt ourselves and we shouldn’t necessarily excuse the hurtful actions which might stem from the feeling. But the feeling itself is forgivable.
Totally. Wanting things, to be beautiful, to be young, there’s shame attached to it. So being able to own that, and acknowledge that side of yourself that hungers and longs. It’s the same thing with addiction. Being able to look your hunger in the eye is an important step in terms of entering that conversation with yourself, where desire can be negotiated.
So “Step Eight: Make Amends ”…Making amends is a process in The Twelve Steps, but the poem for me also spoke outside that. It made me think of how women are pressured to apologize for things, and for taking up space.
This poem connects to your interpretation of the earlier one…about having to apologize for wanting, having to apologize for loving, to apologize for eating. Then there is the question…how much is making amends coming from a place that is genuine, versus you’re doing what you’re trained to do? At what point is amends-making another act of violence or self-hatred? This goes back to your first question, about intention. What is the intention behind a behavior? That explains a lot of why we’re doing what we’re doing. There are some amends, quote unquote “apologies” I’ve done because I felt like I was supposed to, not necessarily because I needed to.
You’re a practicing clinical psychologist. This is wholeheartedly a book of literature and I couldn’t detect much of your day job in there, at least not explicitly. I wonder how it might be showing up as an undercurrent. Does the overlap of these two lives appear in your book?
If there was overlap it wasn’t consciously put here or there like an easter egg. Psychology has taught me to ask better questions, and to be on the lookout for patterns, including false ones, like the false stories we tell ourselves and believe. The book was a work of excavation, or making sense of things, so my background in psychology might have helped in the style of inquiry.
The book spans the globe, sometimes on a line-by-line basis, a piece from one landscape stitched to another. “Highway 17 in Texas; we stop to watch buzzards / supping on roadkill porcupine. The mountains are a Persian rug of emerald and brown, wolfish clouds / gathering rain,” is a line from the poem “The Temperance (XIV) Card,”
I find your book to be double-headed to the extent it’s focused inwards while at the same time lush with observations.
I think of myself and my identity as disparate depending on where I was. I moved and traveled. I was a different person in different places. When I revisit the phases of childhood and adolescence, or college years, with that comes revisiting Beirut, and Oklahoma, revisiting all these different places. My mind drags along with it all the significant places I’ve been to.
There are many poems in the book addressed to a “you.” That “you” is constantly changing, from a husband, to an ex-lover, a friend, an enemy, or even the reader. Because it’s a poem, you’re writing it alone, sitting at a table, thinking about what the poem means to you. But it’s like the letters written to someone else are in a small way written to yourself.
Even the poem, “Dear Layal,” That’s my cousin. It’s also a letter to myself and the ways I intersect with my cousin. Or things I wish I’d said before. Even if on the surface it’s directed towards her, it’s an exercise taking place internally. Once it’s out in the world people can read it. But until that happens the process of making belongs only to the writer.
Well…we’ve reached the end. What’s going on for you in terms of writing right now?
Poetry-wise, I’m sort of lying low. I’ve been working on a series of poems based on choose your adventure books, where the reader gets to be involved in the process. That’s been fun. In terms of fiction, I have a second novel coming out with Houghton Mifflin in the next year or so.
By: Christian Arthur Title: The Engine of Myself: Interview with Poet Hala Alyan Sourced From: www.thefix.com/engine-myself-interview-poet-hala-alyan Published Date: Wed, 01 Apr 2020 06:03:07 +0000
At New Horizon Drug Rehab, we understand addiction. If you or a family member are afflicted with addiction or substance abuse we can help. We work with the top centers throughout the US to provide the best detox and addiction treatments available.
Q&A with Developmental Psychologist Hirokazu Yoshikawa
The US immigration policy that has separated more than 5,400 children from their parents had spurred psychologists and pediatricians to warn that the young people face risks ranging from psychological distress and academic problems to long-lasting emotional damage. But this represents just a tiny part of a growing global crisis of parent-child separation.
Throughout the world, wars, natural disasters, institutionalization, child-trafficking, and historic rates of domestic and international migration are splitting up millions of families. For the children involved, the harm of separation is well-documented.
Hirokazu Yoshikawa, a developmental psychologist at New York University who codirects NYU’s Global TIES for Children, recently looked into research on the impacts of parent-child separation and the efficacy of programs meant to help heal the damage. Writing in the debut issue of the Annual Review of Developmental Psychology, he and colleagues Anne Bentley Waddoups and Kendra Strouf call for an increase in mental health training for teachers, medical doctors or other frontline service providers who can help fill the gap left by the lack of mental health providers available to cope with the many millions of children affected.
Knowable Magazine recently spoke with Yoshikawa about the crisis and what can be done about it. This conversation has been edited for length and clarity.
Are there any good estimates of the number of children throughout the world who’ve been separated from their parents?
Exact numbers are hard to pin down, especially because several of the categories involved — like child soldiers and child-trafficking — aren’t well reported. What we know for sure is that the number of people around the world being displaced from their homes is at a historically high level. In 2018, some 70.8 million individuals were forcibly displaced due to armed conflicts, wars and disasters. That’s a record, and given that these phenomena often result in family separations and that more than half of these individuals were children under the age of 18, it suggests that historic numbers of children have been separated from their parents.
Why have such family separations become more common?
Many factors are driving it, but climate change is playing an increasing role in displacement and armed conflict all over the world. Climate change reduces access to dwindling resources and contributes to natural disasters, like floods, droughts, crop failures and famine. All of this increases conflicts, drives migration and breaks up families. This is not a blip in history; it’s a trend we will have to live with for generations to come.
What’s most important to know about the damage that comes from children being separated from their parents?
There are thousands of studies on the power of disruptions of children’s early attachments to their parents to cause longstanding problems. We’re talking about cognitive, social-emotional and other mental health impacts.
The developmental study of the mechanisms that may explain why these separations are so harmful goes back to before World War II, with the work of psychoanalysts and scholars such as Anna Freud, John Bowlby and Mary Ainsworth. In 1943, Anna Freud and Dorothy Burlingame studied children who’d been evacuated from London and learned that in many cases being separated from their mothers was more traumatic for them than having been exposed to air raids. When families left London but stayed together, the children behaved more or less normally. But when children were separated from their mothers, they showed signs of severe trauma, such as wetting the bed and crying for long periods of time.
Later on, Bowlby and Ainsworth published their more well-known studies of how infants form attachments with their mothers, and how sensitive and responsive parenting is key to forming secure attachments both with parents and later on with others. Researchers have found that this process can be disrupted in prolonged separations — say of more than a week — before the age of 5.
More recently — for example, in the ongoing and high-profile studies of Romanian children who were raised in abysmally low-quality orphanages — researchers have shown how children in institutional care have suffered from poorer learning and social and emotional behavior due to the lack of intellectual and emotional stimulation and the opportunity to engage in relationships with caregivers.
How seriously children are affected can depend on factors such as whether the separation was voluntary or not, how long it lasts and what kind of care exists in its wake. Permanent loss of parents can create some of the most severe consequences, while long periods of parent-child separation, even if followed by reunification, can seriously disrupt a child’s emotional health. Children are generally more vulnerable to long-term harm to their social-emotional development in early childhood, up to five or six years, but no period of development is immune.
One major problem we see is that most children who are separated from their parents have already experienced some other trauma along the way, which then makes the separation even harder. When parents are present, they can often help buffer the impact of extreme adversity from bad experiences.
What did you learn that most surprised you as you reviewed the scientific literature?
The sheer range of outcomes was surprising to me — beyond learning and achievement and mental health outcomes, they include very basic human functions like impaired memory, auditory processing and planning. They also include a range of physiological outcomes related to stress that are themselves related to long-term disease and mortality. So parent-child separation as it is currently experienced can shorten lives and increase the chances of physical disease.
Meanwhile, something that didn’t surprise me because I’m immersed in this literature all the time, but will probably surprise your readers, is that there are now about 8 million children in the world living in institutional care. This is a problem that reflects the lack of robust foster care and capacity of governments to facilitate placement with relatives, who will generally give more stable care than strangers. As we state in our review, even in otherwise good-quality institutional care, children suffer due to the high turnover of caregivers.
What relevance does your work have for US policies that have led to many parents and children being separated at the border?
US officials should know that there’s a global consensus, expressed in the UN Convention on the Rights of Children, on how to respond to children’s needs in this context. Primarily that means avoiding separating children from parents whenever possible and, when it must happen, keeping it as short as possible. An overwhelming amount of research, going back to Bowlby, supports these guidelines.
Unfortunately, we don’t have a lot of research findings on children separated from their parents while awaiting detention. And it doesn’t make it any easier that the Department of Homeland Security has had so much trouble keeping track of the kids involved.
Yet there are hints of the kind of negative effects you might expect to see if you look at the research on children whose parents have been detained without warning, for example in large workplace raids to arrest undocumented workers. In these cases, researchers have found that children have missed school and suffered behavior problems and depressive symptoms.
This brings up the fact that, in the United States, we’re talking about many more than 5,000 children being separated from parents. While the separations at the Mexican border have gotten a lot of media attention, millions of other children across our country are affected by the relatively recent harsher, sweeping policies resulting in more detentions and deportations of immigrants already living in the US. This has created a climate in which the threat of family separation is omnipresent.
We’re particularly concerned that many children separated from their parents stop going to school, perhaps from lack of supervision or from the need to support themselves or family members. The humanitarian sector tends to focus on basic needs and that’s understandable — they want to save lives. But from a developmental perspective, we have to focus on whether children thrive, not just survive.
Unaccompanied children who are trying to migrate are an increasing part of this global problem. What kind of special risks do they face?
It’s true that there has been a significant increase in recent years in unaccompanied minors trying to migrate internationally. At the US border, this increase has been happening since the 1990s, due to both economic crises and increases in urban violence in Mexico and in Central American countries. But the trend is now accelerating. From 2015 to 2016, there were five times as many children estimated to be migrating alone than from 2010 to 2011. In 2017, more than 90 percent of undocumented children arriving in Italy were unaccompanied.
Compared with refugee children who flee with their families, unaccompanied children are at greater risk for trauma and mental illness. One study of refugee children attending a clinic in the Netherlands found that the unaccompanied children were significantly more likely than those traveling with their families to have been victim to four or more traumatic events in their lives, including during their travels. They also had a higher rate of depressive symptoms and even of psychosis than refugee children living with their families.
What are some of the best ways that governments and nonprofit organizations can help these children?
Whatever can be done to avoid the separation from parents in the first place and to avoid detention and institutionalization of children whenever possible is in the children’s best interests. (That’s the guidance from the Global Compact for Refugees, Article 9 of the Convention on the Rights of the Child, and other global rights documents.) After that, it’s a matter of limiting the time away from parents or other caring adults as much as possible. The earlier and younger that children leave institutional care for stable foster care or adoption, the better it is for them.
You can see this in some of the follow-ups of the study of children in Romanian orphanages. Children who left the orphanages for foster care by 15 months of age had trouble speaking and understanding in early childhood, but not later. Children placed before 30 months showed growth in learning and memory so as to be indistinguishable from other children by age 16. So recovery from early institutionalization is possible, but it may take longer if a child spent more time in the orphanage.
What kinds of programs for children, if any, can help lessen the impacts of being separated from their parents?
In general, programs that help equip children for their daily lives can be useful. That includes education in decision-making, problem-solving, communication and stress management.
Teachers and doctors can play a major role, at minimum by identifying children who need mental health services and directing them to programs. The fact is we’ll never have enough mental health providers, so it makes sense to train members of the education and basic health systems that are already in place.
In the review, we describe a few of these efforts. One that stood out for us took place in two schools in London where children on average aged 12 to 13 had been separated from one or both parents due to war or migration. They came from Kosovo, Sierra Leone, Turkey, Afghanistan and Somalia. Teachers identified children who needed services, and who then spent one hour a week for six weeks with a clinical psychology trainee doing cognitive behavioral therapy. The treatment helped reduce PTSD symptoms, and the children’s teachers later reported that the children were behaving better in the classroom.
Granted, this was a very small study with no longer-term follow-up, so you can’t draw very strong conclusions, but it hints that even such a short-term intervention can be helpful in addressing children’s traumas. Studies have shown that even as few as 12 sessions of counseling from people trained in cognitive behavioral principles can help many people.
Do we have any idea of how many kids are being helped by these sorts of interventions? Are we still mostly talking about small experiments?
We’re not anywhere close to meeting the need for services. Unfortunately, health systems worldwide continue to overlook all kinds of mental health needs, particularly in low-income countries, even as depression and other mental illnesses take an economic toll, leading to reduced lifespans and reduced economic activity. The economic costs of mental health problems are huge, yet this may be one of the most underinvested areas in terms of health care.
The largest program you describe is in China, which isn’t that surprising, given how many internal immigrants China has.
Yes, there are potentially tens of millions of Chinese children and youth whose parents travel to cities to work and leave them behind, in the care of grandparents or other relatives. Between one-third and 40 percent of children in rural areas of China are in this situation. And there’s a lot of research documenting that these children are doing less well than children who are being raised by parents.
We describe one community-based program involving 213 rural villages with nearly 1,200 left-behind children. For three years, each village designated a space for after-school activities for the youth and hired a full-time employee to provide welfare services. The findings suggest the approach helped reduce disparities between the left-behind and non-left-behind groups.
What if anything gives you hope that this situation may improve?
The outcry over the US policies has increased awareness about a very vulnerable population of children. That could be a silver lining of the crisis. These parent-child separations are going on not only at the border, but also all over the country. The hope is that the attention will increase support for organizations, such as the national Protecting Immigrant Families Coalition, that are working to make a difference.
When it comes to children throughout the world who’ve been separated from their parents, we need a lot more people to be aware and concerned so as to provide the attention, stimulation and care that can help them recover.
Editor’s note: This article was updated on January 24, 2020, to clarify that in addition to teachers and medical doctors, Dr. Yoshikawa and his colleagues also recommend mental health training for all frontline service providers.
This article originally appeared in Knowable Magazine, an independent journalistic endeavor from Annual Reviews. Sign up for the newsletter.
By: Katherine Ellison Title: Treating the Growing Trauma of Family Separation Sourced From: www.thefix.com/treating-growing-trauma-family-separation-hirokazu-yoshikawa Published Date: Tue, 04 Feb 2020 06:30:31 +0000
At New Horizon Drug Rehab, we understand addiction. If you or a family member are afflicted with addiction or substance abuse we can help. We work with the top centers throughout the US to provide the best detox and addiction treatments available.
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On the afternoon of Dec. 3, workers at the Oceanview Manor Home for Adults found resident Ann McGrory, 58, lying on the floor, lifeless, with her pants down around her ankles. She had cuts and bruises on her hands, head and face. By her side, seated atop his bed in Room 512, was resident Frank Thompson, 64, her sometimes-boyfriend who had a reputation at the home as a heavy drinker with a short temper. The aides called police. Thompson was brought into custody for questioning later that day and placed under arrest on Wednesday.
He is charged with second-degree attempted murder rather than murder because the medical examiner has not yet determined the cause of death to be a homicide, according to a law enforcement source. McGrory also had serious preexisting medical issues, including brain cancer. The criminal complaint, however, lays out evidence that McGrory was severely beaten. She was found with a bruised, swollen eye, blood on the back of her head, broken fingernails and what appeared to be blood beneath them. Thompson has not yet entered a plea. Brooklyn Defender Services, which is representing him, declined to comment because the case is in such an early phase.
The incident is the latest in a decades-long string of controversy at Oceanview Manor and other adult homes throughout New York City, which are occupied primarily by impoverished adults with mental illness but are gradually taking on seniors in need of assisted living.
In the spring of 2017, a ProPublica reporter spent parts of several weeks at Oceanview, where ill and unkempt residents could be seen eating from garbage cans and using outdoor dumpsters as toilets. They complained among themselves of thievery and predation, as well as failed intervention from state regulators. There were two deaths in a matter of weeks and police responded to several emergency calls there, including one related to a resident who had slashed another. At the time, an attorney for the home denied any stabbing, attributed the deaths to natural causes and said that comparing the current state of the homes to their scandalous history was unfair.
In 2002, a New York Times investigation found that adult home residents had been exploited for profit and received subpar health care. Disability rights advocates sued the state, arguing that mentally ill people had been warehoused in Oceanview and other adult homes in New York City, violating their rights under the Americans with Disabilities Act. After more than a decade of litigation, a federal judge ordered the state to assess and move out residents capable of living independently.
In 2017, lawyers representing the adult home industry sued the state on behalf of a single former resident at Oceanview, who allegedly decided to move into his own apartment under the new state program and then changed his mind, wishing to move back into Oceanview because he missed life there. Rather than allow the man alone to move back, the state agreed to temporarily suspend a rule limiting the number of mentally ill adults who can live in the homes. The state has reinstated that rule.
In spite of its problems, the home, like at least a dozen others, is moving into a state-sanctioned business model to care for the elderly and infirm. ProPublica reported this year that hundreds of mentally ill residents have been certified as assisted living recipients, which allows home operators to bill more for their care.
According to the complaint against Thompson, video surveillance footage at the home shows him and McGrory entering his room together at 2:35 p.m. At 2:50 p.m., McGrory opened and then closed the door to his room, but no one else entered the room. At 3:48 p.m., workers entered the room and later told police that they saw Thompson trying to remove McGrory’s pants. It is unclear whether McGrory was asking for help when she opened the door or what prompted the workers to ultimately enter the room.
McGrory was pronounced dead by Emergency Medical Services at 4:57 p.m.
“We are shocked and saddened by these horrifying allegations and are investigating,” said Jonah Bruno, a spokesman for the New York Department of Health, which oversees the home. He would not say whether the home’s administration had properly reported the incident, which would be part of the department’s investigation.
Asked what McGrory’s fate says about the home’s ability to care for people with such extensive medical and psychiatric needs, Bruno said, “Adult homes are capable of providing varying levels of care based on levels of need and are required under state law and regulation to only accept residents for whom they can provide appropriate care.”
Lisa Vider, the home’s administrator, did not return a phone call for comment on this story. But Jeffrey Sherrin, an attorney who represents Oceanview, said, “The incident is under investigation, and so far as we know, no cause of death has been determined. We are unable to comment, and we must also respect resident privacy.”
Fellow residents say both Thompson and McGrory had recently struggled at the facility.
Patricia Rosetti, 68, said she had shared a room with McGrory in the group home since 2014. “She was so lonely all the time,” Rosetti said. “She was divorced and had a son and it drove her nuts that she couldn’t see her family.” ProPublica made efforts to reach her next of kin but was unsuccessful.
Rosetti said McGrory had been repeatedly hospitalized for a variety of psychiatric and physical issues. Over the summer, Rosetti said McGrory had gone to the ocean wearing nothing but her underwear and came back scratched and bruised by the rocks. She spent the next couple of months in a mental hospital and was scheduled for an operation on her brain in January.
Rosetti said that McGrory had struck up a kind of relationship with Thompson, which worried the roommate because of his drinking. “I told her not to hang around with him,” she said.
Thompson’s roommate, Rufus Lane, 74, and his friend Johnny Lide, 69, sat across from Rosetti on a bench in a smoking section outside the home. They nodded as a fellow resident described Thompson’s temper but then came to his defense. “He would talk shit to me all the time,” Lide said, “but I never paid him no mind.”
Lane and Lide said that Thompson liked to drink but was not a violent person. They were surprised that he had been accused of hurting McGrory.
“That girl was his heart and soul,” Lide said. “I can’t see him doing no shit like that. That shocked the shit out of me.”
After about 30 minutes last Wednesday, workers at the adult home asked a reporter to leave the premises, saying it was private property.
By: Joaquin Sapien, ProPublica Title: These Homes for Mentally Ill Adults Have Been Notoriously Mismanaged. Now, One Is a Gruesome Crime Scene Sourced From: www.thefix.com/these-homes-mentally-ill-adults-have-been-notoriously-mismanaged-now-one-gruesome-crime-scene Published Date: Mon, 03 Feb 2020 08:05:13 +0000
At New Horizon Drug Rehab, we understand addiction. If you or a family member are afflicted with addiction or substance abuse we can help. We work with the top centers throughout the US to provide the best detox and addiction treatments available.
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Advocates for people with intellectual disabilities are concerned that those with Down syndrome, cerebral palsy, autism and other such conditions will be denied access to lifesaving medical treatment as the COVID-19 outbreak spreads across the country.
Several disability advocacy organizations filed complaints this week with the civil rights division of the U.S. Department of Health and Human Services, asking the federal government to clarify provisions of the disaster preparedness plans for the states of Washington and Alabama.
The advocates say the plans discriminate against people with intellectual disabilities by deprioritizing this group in the event of rationing of medical care — specifically, access to ventilators, which are in high demand in treating COVID-19 cases. More than 7 million people in the U.S. have some form of cognitive disability.
Some state plans make clear that people with cognitive issues are a lower priority for lifesaving treatment. For instance, Alabama’s plan says that “persons with severe mental retardation, advanced dementia or severe traumatic brain injury may be poor candidates for ventilator support.” Another part says that “persons with severe or profound mental retardation, moderate to severe dementia, or catastrophic neurological complications such as persistent vegetative state are unlikely candidates for ventilator support.”
Other plans include vague provisions, which advocates fear will be interpreted to the detriment of the intellectually disabled community. For instance, Arizona’s emergency preparedness plan advises medical officials to “allocate resources to patients whose need is greater or whose prognosis is more likely to result in a positive outcome with limited resources.” Between a person with cognitive difficulties and a person without them, who decides whose needs come first?
Medical triage always forces hard decisions about who lives and dies. For instance, older people with shorter life expectancy or those with severe dementia are often deemed less deserving of scarce medical resources than younger, healthier individuals. The state plans make clear that the fate of those with intellectual disabilities is part of the wrenching debate.
HHS officials said they were opposed to rationing care for people with any kind of disability.
“Persons with disabilities should not be put at the end of the line for health services based on stereotypes or discrimination, especially during emergencies. Our civil rights laws protect the equal dignity of every human being from ruthless utilitarianism,” said Roger Severino, the director of the agency’s civil rights office.
“What we’re seeing here is a clash between disability rights law and ruthless utilitarian logic,” said Ari Ne’eman, a visiting scholar at the Lurie Institute for Disability Policy at Brandeis University. “What this is really about at the end of the day is whether our civil rights laws still apply in a pandemic. I think that’s a pretty core question as to who we are as a country.”
Advocates and families of those with intellectual disabilities say their community is especially vulnerable to the disease because many of those with significant impairments live in group homes or other congregate settings.
It can sometimes be difficult for people with intellectual disabilities to understand the pandemic and its demands, such as the need to wear masks and heightened protocols for social distancing and hand-washing.
The death of Emily Wallace, a 67-year-old with Down syndrome in a group home in Georgia, was an early warning sign of the dangers facing the community, advocates say.
Wallace was a woman of firsts. She and her husband, Richard, were the first couple with intellectual disabilities to marry in the state. They were the first to live independently in their own home in Albany, a small town in the southwestern part of the state. In mid-March, Emily was the first person with an intellectual disability in her community — and possibly one of the first in the nation — to be diagnosed with COVID-19.
She was taken to a local hospital where she died alone.
“Mrs. Wallace is once again the first, but this isn’t what we wanted to celebrate,” said Stacey Ramirez, state director for The Arc of Georgia, a nonprofit advocacy group that serves people with intellectual disabilities.
Emily and Richard Wallace were married for 18 years. A 1992 story in the Albany Herald depicted their life as happily domestic, mentioning that Richard hated to vacuum, while Emily didn’t like to dust, and that she did most of the cooking while he raked the leaves. They made payments on their home and both held down jobs. After Richard, who also had Down syndrome, died in 2018 at 65, Emily moved to a group home operated by The Albany Arc.
After a caregiver apparently brought the coronavirus into the home, Wallace fell ill. So did another resident, who was hospitalized.
Emily Wallace had a do not resuscitate order, so a ventilator would not have been an issue even if care were being rationed, said DeAnna Julian, executive director of The Albany Arc.
But as more people are getting sick, Julian said she worries that not enough testing for the virus is being done in Albany. She’s seeing individuals — both with and without intellectual disabilities — who appear to have mild symptoms of COVID-19.
“They’re just turning them around and sending them home, they’re putting them on” antibiotics, she said. “We live here in southwest Georgia where right now, all the cars are covered in yellow pollen and everyone has some kind of seasonal allergies. … Is it just your springtime cold or is it COVID-19?”
Julian doesn’t have masks, gloves or other safety equipment. She doesn’t have enough staff.
“It’s a difficult and critical situation here,” she said.
But no, Julian said, she didn’t see Wallace or the other group home resident receive treatment any different than anyone else. She said she wouldn’t stand for it.
“I’d take it all the way to the top, to the governor! They have every right to be treated like human beings,” Julian said.
With the Americans with Disabilities Act celebrating its 30th birthday this year, activists are questioning whether policymaking has come far enough in what some consider to be the final battle in the fight for civil rights.
In a March 18 letter to Wisconsin Gov. Tony Evers, the Survival Coalition, a group of advocacy organizations, wrote, “‘Quality of life’ has long been a pretext for denying treatment, including life-sustaining treatment, to vulnerable populations, particularly people with intellectual disabilities.”
Michael Bérubé and his wife, Janet, live in State College, Pennsylvania, with their son Jamie, who is 28 and has Down syndrome. Bérubé, a professor of literature at Pennsylvania State University and the author, most recently, of the book “Life as Jamie Knows It,” studies disability. He was not surprised to learn about state rationing plans that single out people with intellectual disabilities and other cognitive conditions.
“It would be a very rare person who sees a person with Down syndrome as innately as valuable and as able to contribute to society as anybody else,” Bérubé said.
Pennsylvania is among those states now scrambling to write up guidelines to determine who will have access to ventilators in case of medical rationing, according to media reports.
“In two weeks, when the resources get truly stressed out, we’ll see how much of this draconian stuff goes into practice,” he said.
By: Amy Silverman, Arizona Daily Star Title: People With Intellectual Disabilities May Be Denied Lifesaving Care Under These Plans as Coronavirus Spreads Sourced From: www.thefix.com/people-intellectual-disabilities-may-be-denied-lifesaving-care-under-these-plans-coronavirus-spreads Published Date: Mon, 30 Mar 2020 07:45:56 +0000
At New Horizon Drug Rehab, we understand addiction. If you or a family member are afflicted with addiction or substance abuse we can help. We work with the top centers throughout the US to provide the best detox and addiction treatments available.
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