Tag Archives: addiction

June 25, 2016 · 8:44 pm

The Trauma Currency, Part Two

(Continued from part one)

Cermak’s intent was to present codependency as a legitimate focus of clinical attention, applicable to a variety of contexts. And so we have the Co-Addict Model, which draws attention to problematic behavior as a function of an underlying, pervasive disorder. While RT adherents may agree with aspects the co-addict corollary, their clinical focus downplays the pathologizing accent. Coping strategies, such as keeping busy with tasks, are instead normalized, cast as affect regulating under exceptional circumstances. Certain behaviors such as indiscriminate sharing of a sex addict’s behavior with friends or family, including children, are discouraged; however, these behaviors are framed as products of social isolation and episodic trauma brought on by an addict’s behavior, not an underlying or even associated pathology. The notable literature that represents this position includes Your Sexually Addicted Spouse (Steffens, Means, 2009), and Facing Heartbreak: Steps to Recovery for Partners of Sex Addicts (Carnes, et al., 2012): the latter, in keeping with recovery tradition, outlines a healing process in stages: a pre-discovery stage, followed by phases of crisis/decision, and repair. In the crisis/decision stage the partner asks, “how did I get here?”, and comes to realizations like, “nothing in this marriage has been real”. Note the emphasis upon present or recent past events, not family of origin, early developmental or even adult developmental material.

The framework of RT appears to contraindicate a neutral therapeutic stance, becoming partner-centric, especially upon discovery of sexual betrayals, because the proposed de-pathologizing shift only applies to partners. There’s nothing in the RT paradigm that contests the assessment of sexual addiction. Indeed, the scope of questions for the revised version of the Sex Addiction Screening Test (or SAST) has widened in recent years, to address not only changes in technology—the broader means of acting out available to sex addicts—but also the impact upon partners of sexual betrayals. Notice, for example, a question on the 1989 version of SAST, “Does your spouse ever worry or complain about your sexual behavior?” (Carnes, 1989), versus a question on the revised 2008 version: “Has your sexual behavior ever created problems for you and your family?” Notice the slant has shifted to query problems identified by the would-be addict, instead of that which is externally identified by a partner whose perspective might be denied by the would-be sex addict, or distorted by a co-addict disorder.

The RT model calls for sex addicts or acting out partners to be identified as perpetrators of trauma, and this term—“perpetrator”—seems close enough to the connotations of “offender” that observers may be surprised that APSATS hasn’t called for the inclusion of more sex addicts on public sex offender registries. In the RT model, partners are validated as victims of a relationship-specific betrayal, and thereafter supported to integrate this experience in a way facilitates a healthy re-emergence in life, comprised of self-care, fellowship with a strong support system, realistic observation of sex addict behavior, but also renewed trust in humankind. The approach suggests that observation of predisposing pathology and validation of traumatic experience are mutually exclusive goals, which may lead to facile, short-term interventions, tailor made for practitioners presenting brief, intensive programs of care. While this may be an appropriate shift in the paradigm with respect to many partners or with all partners of sex addicts in the immediate aftermath of discovery, I wonder about the pathology that will be overlooked in the service of trauma validation, especially amid follow-up treatment episodes wherein identified-patient premises collapse over time.

In cases of sexual betrayal, a therapist working with acting out and non-acting out partners functions as a container for memories and emotions that cry out for expression, or disavowal in the case of those struggling to cope with the past. This Winnicottian task dovetails with reparation efforts—a Kleinian concept before a sex addiction treatment strategy—which hinges upon individuals’ capacity for mourning. Klein (1975) wrote that grievances we harbor towards parents for the wrongs they have committed, and for having denied those wrongs, elicit feelings of hate and desire for revenge. Durham (2000) has argued that the capacity for making reparations in the internal world is the basis on which empathy for others is established. When individuals defensively split, they attach to a narrowly defined narrative: therefore (borrowing the RT Model identifiers) a victim’s anger and hatred is rigidified in the face of a perpetrator’s denial, which represents an evil system built upon a primitive intrapsychic structure. A working through of splitting, into mourning, requires the perpetrator to own his destructiveness so as to experience mourning; then, if the victim is sufficiently open to an awareness of “good enough” qualities in the perpetrator, a re-internalization of that individual as a good object might occur, which in turn enables the victim’s own work of mourning.

Whether or not labels of victim, perpetrator, addict, or codependent are necessary, harmful, or inhibitive of this process seems ambiguous. Assessment and diagnostic nomenclature informs psychiatric intervention; enables the placement of individuals in appropriate levels of care, including hospitals when necessary; generates short and long-term treatment planning goals. Informing patients of their diagnoses gives informed consent to treatment based upon an understanding of conditions that are the focus of clinical attention. At the same time therapists know the stigmatizing risk associated with assessment and diagnostic labels, particularly those whose prescriptive measures are not clearly defined, or subject to a range of treatment alternatives, despite the attempts of some who promote protocols in response to diagnoses. The advisability of informing a patient or client that he or she has a substance dependence, for example, seems predicated on particular factors well understood across professional disciplines, and by the general public: that the problem can be accurately assessed in a short time frame; that prescriptive measures can be readily understood by those potentially receiving services (such as recommendations of abstinence, or attendance at 12-step meetings); that a person may be at grave risk of illness, injury, or even death if immediate intervention does not occur.

Are these factors true with respect to sex addiction, or codependency, or personality disorders? Maybe in some cases, but of the forty five questions on the revised SAST, for example, only one pertains to behaviors that place afflicted individuals in dangerous situations. In my training I learned to refrain from using diagnostic or assessment labels when addressing clients about their problems, unless the applicable term or terms seem critical for intervention, or unless prescriptive measures based upon the nomenclature can be articulated succinctly and concretely. Otherwise, confusion and/or resistance typically follows, with clients left thinly understanding conditions, floundering to make sense of new identities imposed by expert opinion. I often experience this when clients meet with me for the first time, having been diagnosed by a previous practitioner with, say, Narcissist Personality Disorder. They’ve been given an article to read, or a DSM criteria sheet to examine. Afterwards, they exhibit disorientation, manifest with awkward attempts to describe their freshly assigned disorder. When devising a plan, they offer that they need to learn to empathize with others more. Woodenly, they report feeling instructed, and branded, but not understood.

This is often true with individuals who are told they have a sex addiction, or a codependency problem, and while many can wrap their minds around the concept of sex addiction, the assessment still bears much explanation and holding of emotion. As for codependency: from an object relations point of view, that umbrella term represents a whole multitude of dynamic relational configurations, replete with intersecting projections and introjections. So no wonder partners of sex addicts are flummoxed and invalidated by the term, regardless of what betrayals they have felt. Aren’t many or even most shocked to hear that they may have enabled another’s addiction? Won’t many be confused to hear they may have contributed to another’s disorder by an overly close, or conversely, a distant involvement? Doesn’t it jolt the senses, the unconscious, one’s entire being, to hear that one might have a sex addiction, and that an important aspect of that concept is its impact upon intimate partners? Ultimately, what seems important is to hold the idea of a complex problem, brought to light by acting out behaviors, but not reducible to those habits, necessarily. Might it not render the divide between rival models of treatment moot to consider that our clients deserve to not be hamstrung by labels, or denied what is useful in our nomenclature? Rather, they should feel held by our open minds and fuller understanding.

 

 REFERENCES

 American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA. American Psychiatric Publishing.

 Bergner, R. & Bridges, A. (2002). The significance of heavy pornography involvement for romantic partners: research and clinical implications. Journal of Sex & Marital Therapy, 28, 193-206.

Black, Claudia (2009). Deceived. Hazelden. Center City, Minnesota.

Carnes, P. (1989) Contrary to Love. Hazelden.

Carnes, S., Lee, M. A., Rodriguez, A. D. (2012) Facing Heartbreak: Steps to Recovery for Partners of Sex Addicts. Gentle Path Press.

Cermak, T. (1986). Diagnosing and treating codependence. Minneapolis, MN: Johnson institute

David J Ley (2012, September) “Abusing the Term Trauma”. Retrieved from https://www.psychologytoday.com/abusing-the-term-trauma/

Durham, M.S. (2000) The Therapist’s Encounters with Revenge and Forgiveness. In “Psychological Repair: the intersubjective dialogue of remorse and forgiveness in the aftermath of gross human rights violations”. Journal of the American Psychoanalytic Association. Volume 63. Number 6. December 2015

Glass, S. (2003) Not just friends: Protect you relationship from infidelity and heal the trauma of betrayal. New York, NY. The Free Press.

Klein, M. (1975) Love, Guilt and Reparation and Other Works, 1921-1945. London: The Free Press, 2002.

Steffens, B. A., & Rennie, R. L. (2006) The traumatic nature of disclosure for the wives of sexual addicts. Sexual Addiction & Compulsivity, 13, 247-267.

Steffens, B. A., & Means, M. (2009) Your Sexually Addicted Spouse: How Partners Can Cope and Heal. New Horizon Press.

 

 

 

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April 22, 2016 · 6:54 am

About reviews, popularity

Ever get the feeling someone’s trying to tell you something by not telling you something? Psychotherapists (that identifier feels awkward for some reason) have to learn to interpret the unsaid, by thinking about non-verbal information: everything from muted sighs to averted glances at a hidden clock, to I’m-running-late text messages, belated vacation or business trip announcements; e-mail terminations. Relationships in some people’s lives end with tumbling regularity. Exchanges are transient. Promises are easily given, and more easily withdrawn or better yet, forgotten. If you wrote it down, good for you. Kudos for the documentation, signifying that something meaningful happened.

I don’t spend a lot of time documenting psychotherapy, largely because it makes for dull reading, the type of notes one is meant to write for nosy overseers. It makes for good stories however, not that I can lift them directly from my clients’ shares. Instead, it’s an exercise in grabbing at pieces, tossing them at a blank page, worrying later about the links. For my first four novels I’d picked sketchily from my clients’ backstories, preferring to represent moments, unidentifiable fragments of individuals’ lives, maintaining everyone’s confidentiality. Except mine, of course. It’s several years since my first effort, the much somethinged Living Without Blood, about somebody named Eric Metcalf and his friend Richard something else, coming together after years of gradual estrangement in order to…actually, I’ve forgotten what they did together. I loved LWB at its time of publication—2009. It was my first-born: a sloppy, muddled beginner trying to find its legs after a nine-month labor, but occasionally standing tall, inspired by a self-consciously prosy flow. Skip to 2012: the release of Crystal From The Hills, a picaresque adventure that I’d conceived as a 600-page novel, only to split the story in half, releasing its follow-up, The Situation, two years later. Crystal took three years to write, in sporadic bursts in between semesters of my post-graduate training program at the Masterson Institute. Written three times, suffered over like a still-birthed thesis, it was my best effort thus far I thought, and I was confident enough of its value to submit a manuscript for review, with Kirkus magazine, a reputed den of literary cognoscenti.

Kirkus didn’t like Crystal From The Hills, calling it “sprawling”, “meandering” (a reference to its many flashbacks, childhood background material to make John Bowlbyesque sense of my protagonist’s disturbance). I got my first real taste of a reviewer’s, and presumably an average reader’s distaste for disrupted narrative, impatience with detail. I learned that some might find my prose difficult to read, for it was “ponderous”, “stacking of clauses and syllables”; containing way too much minutia. Gee, had they ever read David Foster Wallace? There wasn’t much complaint (from Kirkus) about the plot as such, or about character development—rather a suggestion that readers prefer heroes to be heroes, or at least charming, as opposed to being self-absorbed underdogs, or as one reader put it, losers. Ironic, for the novel’s underlying theme was empathy, so I did indeed fail in my task. I absorbed the criticism graciously, I think, noting that for my modest investment I’d received more honest feedback in two paragraphs—indeed more feedback, period—than I’d received from most non-paid (friendly or not) readers over the previous three years. Seriously, outside of the odd sympathetic review posted on Amazon, my readers, which include one loving family member, plus a rough crossection of my friendship circle, have given me little interest over the years. Some of them don’t care for psychodrama, preferring sci-fi, fantasy, non-fiction, or pleasant yarns about dogs or foreign travelogues. I think some struggle with the opening pages of my books, are left sucking oxygen within minutes having regarded my prose as if it were like the text of vacuum cleaner manuals. Most think that theme is subordinate to plot, which I agree with to some extent, except that some just don’t register ideas, only action. And some just don’t read. Period.

Oh well.

The effort to engage strangers moved on. The Situation received a warmer review from Kirkus, as in lukewarm, with concessions that it contained less of its predecessor’s flaws, as in less background material, less “meandering” plot. This was a somewhat hollow non-criticism, as the novel was a sequel and therefore did not require much backstory. However, other elements, like theme, the relatively fast pace or crisp prose, plus what I thought were clever plot devices (For example, Crystal’s opening, “He’s dead”, regarding a referenced character named Weed, is mirrored by Weed’s opening line of Situation: “I’m alive”. Reaction from Kirkus: nothing). Clarion/Foreword reviews didn’t notice this and other plot tidbits either, but otherwise offered a glowing review of The Situation, giving me four stars out of five, and remarking that my text was “captivating”, my writing assured; the story humorous, adventurous and fast-paced: gratifying, if not quite redemptive of the story as a whole. Kirkus’ reticence continued to irk me. I held the impression that their reviewer was holding something back, thinking my novel worthwhile but not wanting to say so.

This idea was reinforced earlier this year by their latest (and likely the last I’ll solicit) review, for my new novel, Venus Looks Down On A Prairie Vole. I was cautiously optimistic this time, half thinking my third submission would be the charm, otherwise simply believing my latest novel is pretty damn good. Alas, it was not to be. Upon providing a typically competent synopsis of the plot and a begrudging recognition that I was “drawing attention to an important issue”, Kirkus then complained that my protagonist, the sarcastic, at times pathetic Daniel Pierce, is not likeable. No kidding. According to them, he is pompous, contrarian (like that word, actually), and anti-feminist—a problem, apparently. Actually, as a therapist he’s resolutely neutral: a Bionion depository, as he puts it, “lacking memory or desire” (a famous Wilfred Bion quote). Outside his office he’s not so much anti-feminist as anti that which co-opts platitudes for self-serving aims, which is why he might be unlikeable. I suppose that negativity is not likeable, which I further suppose depends upon point of view. Anyway, it should tell me something, this reaction: something I’ve known at least since high school: in this world, in nearly all endeavors, it’s not enough to be good. BTW: my novel is damn good! But here’s the thing: you have to be liked.

 

 

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April 10, 2016 · 5:19 am

Introducing Venus

 

Time to fulfill a promise. Last year, about nine months ago now, I previewed a novel I had then nearly completed and which now has been available for about three months online. At the time it was called Blocked, not that names matter, and I wrote that I’d comment on the novel, its various themes and other elements, leading up to and beyond its publication. Alas, that didn’t happen. Sorry. I know you were waiting with baited breath. Anyway, I got distracted, like my protagonist Daniel Pierce often does; became sarcastic, as I still am, though he is less so. Among other things, my object relations explicating Tommy article got accepted for publication in an academic journal (I’m quite proud of that, in case you can’t tell), and random events occurred, concerning dogs, graphic novels, the politics of evidence-based psychotherapy: all happening with Bionic (as in Wilfred) meaning.

So the novel’s called Venus Looks Down On A Prairie Vole, which is a meaningful title, but you’d have to read the novel to learn fully its point. I know. What a typical, asshole-self-important author thing to write. Well, I’ll give a heads up on a couple of things, hopefully make this labor of my last two years interesting for you. Venus is a reference to women, which shouldn’t surprise. A prairie vole is a monogamous rodent. There. Figured it out yet? Oh well, let’s take it one step at a time, one day at a time, which should clue you into one theme of the story, at least. So, the first chapter (about five pages, I think), will introduce you to Daniel Pierce, a lonesome psychologist (actually, the reader doesn’t really learn his name and vocation until chapter two) who is talking to an insurance representative, seeking payment for a claim that’s gone awry, but also flirting somewhat. There’s some foreshadowing in this comic opening, but mostly I’m introducing a voice—one that’s flippant, like this blog entry—and a theme of subjugation to a system or machine. Daniel suffers and doesn’t “forgive” systems, but he latches onto individuals, like his clients, and also like the angelic-seeming, barely English speaking helper on the line. She’ll listen to him, he hopes. She might really listen. No one else does, he explains sourly.

There isn’t much to help a reader feel sorry for the self-pitying Daniel Pierce, but a troubled, flaky son, and a deceased wife give some cause early on. Later, as he becomes dogmatic, contrary, awkwardly humored, if self-deprecating, liking him might get even harder. But try, won’t you…he needs help. As to his crises, the reader first learns about Ryan, his early twenty something son: absconded from Daniel’s home after completing a stint in rehab and winning from him the reward of an inherited car—a bad move, Daniel concedes. You’ll learn that it’s one of many mistakes he is making in his life, though hereafter they will relate mostly to his working life: his poor boundaries, and at least questionable ethics. In the early pages, Daniel’s wife, Lisa, is introduced as “sleeping”—a figurative trick, for she is really gone. She and Ryan are spectral figures in this tale: oblique motivators, sources of regret, or in Lisa’s case, an overseer of sorts.

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June 22, 2015 · 8:28 am

The Reading

I was ready for my reading. The first of its kind was to take place before a private little gathering in a semi-lit room, with an overhead projector not working because my friend, a confirmed techno-specialist, didn’t have the right cord to fit my computer, my less-than-a-year old computer. We could head down to the Radio Shack to get the VRG-DHR cord (I don’t know—I can’t remember its actual name) cord that we needed, he offered with enthusiasm.

“Forget it,” I said with mine draining from me.

Whenever I invite friends or family to show up for me, whether it’s for a public event or not, I find that I have to fight impulses towards the negative: a sour, ill-humored cloud that creeps over me, threatening to douse energy and kill joy at the first sign of a setback. It wasn’t so much that I needed the damn laptop presentation anyway. It was leftover from the workshop I’d given six months ago, and was a supplement to a reading of about half a dozen passages from my non-fiction, Working Through Rehab, which I am occasionally hawking to would-be readers through…anyway, I didn’t need the laptop. That was the point. So I had to coach myself to breathe, or more specifically, to issue forth a gust of breath that would dislodge the wad of resistance that would soon form a mass and block my voice. I had to, as they say, get over it. “Whatever,” I said aloud to no one, dismissing early interpretations: that this was a harbinger; a symbolic alert, signaling me to stop what I was doing, sneak out the back door, leaving a note with apologies for everyone’s inconvenience. For the next few minutes, the lull prior to my beginning, I fought gravity’s tug upon my lips, that smile that was turning upside down. People started to arrive, greeting me with pleasure, eager to support this writing thing I did on the side.

“How’re you doin’?” asked my best friend, seeing a cloud over my face.

“Nervous,” I said.

“Drink water,” he advised.

I did. Throughout the talk, whenever I paused to field a question or a comment, I stole a sip from my bottle, and felt buoyant, if nearly drowned after an hour. There weren’t many there—maybe a dozen people, total. But it wasn’t so much how many were there, or even the fact that I was speaking before an audience, sharing passages from my book, and breaking to make comments in between. It was the who that mattered. Speaking to family, friends, plus a crossover of collegial knowing, I imagined deeper judgments, more fraught investment, and a more rigorous, concerned critique: speak louder, someone whispered ironically after five minutes. “You should look at your audience more”, someone else remarked afterwards. I nodded politely and took it in. How do I do that and read? I thought churlishly. The positives made it through the blockade, however. Gathered around me in a circle, the assembled uttered their “good job” pronouncements, their gentle congratulations and other good wishes. One person left early, without comment, which nagged at me for the rest of the evening. “Sorry I had to go,” he texted later. “Had to pick up my kid. Good job.”

You’d think the event was about me, and it was. The book is about drugs, adolescents, their parents, and the people who work with those suffering from drug abuse and addiction. If you check out the image which is the cover of the book, take note of its artful rendition of drug treatment, milieu therapy, and community mental health. Up front there’s me, the author, sat on a time-out device, having left the field, but now raising a thumb in accordance with an old protocol of rehab expression, indicating that I have something to say. To my left is a doctor, or psychiatrist, holding a clipboard, observing from an aloof position the goings on, wondering what prescription(s) may be best. Over my right shoulder, there’s an officious-looking floor counselor, a fledgling member of the mental health army, not yet working with kids in the manner of his/her choosing, monitoring an affectless, acting out, poorly attached and difficult young person who will nonetheless touch hearts. With his back to all of this is a man busy at a console, producing a report, maybe of numbers. But he’s not an accountant. He’s a therapist, or a case manager, as they are euphemistically called in such places. Tellingly, his back is to the scene, thought it’s not by choice. It’s by necessity. This is the business of mental health that I’m talking about, and writing about, and reading aloud. In public.

Meanwhile, that review came, the one I moaned about in my last entry: it arrived finally, and it was pretty good, sort of. The reviewer read between the lines, observed the melancholy, and something of the humor. He or she (it’s not clear) wrote that I was cynical and bitter, though the comment was not a complaint necessarily. This reminds me of something I heard recently and have recycled for patients: if you don’t complain how do you know there’s pain? I don’t mean it to sound like a rap, but there is pain. That’s the melancholy truth of Working Through Rehab. From my point of view and that of other veterans of drug treatment, there isn’t a happy plan in place for the consumer; no all-conquering model for the professional to embrace. Once, there was a working idea: treat the adolescent more or less as an adult, and certainly as an addict. Operate as if a compulsive pattern has gained a foothold, and that strategies for using other human beings in a human way were profoundly offline. Those who thought this weren’t wrong, and most agree the attachment disorders of those in treatment seem pervasive. But disagreements abound as to solutions. Containing the drug user’s behavior is one thing; aiming for motivation, and assessing capacities are the other great tasks, and this is where drug treatment with adolescents–with everyone, frankly–has gotten tricky.

Why? Because increasingly, kids, old and young, think that using drugs, sex, video games, and cell phones are acceptable tools for soothing the attachment disorders which they may agree are present and ongoing. Don’t see this? At least as far as drugs are concerned, read the latest statistics released by The National Institute of Drug Abuse (NIDA) about the opinions of high school seniors. Only 16% consider that use of drugs constitutes an unhealthy risk, compared to 27% who thought this just five years ago. Wake up: self medication is being normalized. This is why treatment centers like Thunder Road are at risk of being closed down; it’s why places like it have already closed down, and why public officials are reaching out to the media, bemoaning the impending lack of options for at risk youth. It’s why drug treatment as it once was may be a thing of the past, except for the wealthy. It’s one of the reasons my book is a little melancholy, and just one of the reasons my reading of it might stir the nerves.

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June 15, 2015 · 6:37 am

The Submission

When I first submitted Working Through for review at the The Therapist, I waited. I waited patiently. Over the previous year, I’d been writing prolifically, completing two books, one a novel whose basic plot I strain to describe in less than a paragraph, but whose themes cover the bases of a therapist’s sphere of influence: addiction, depression, psychosis, and most crucially, the good news: empathy. My other book, my expose of drug treatment and adolescents, fully entitled Working Through Rehab: An Inside Look at Adolescent Drug Treatment, is an ambitious, sprawling memoir cum essay that has been variously thrust at agents, publishers, and indulgent peers, though getting people to read it feels a bit like peeling wet leaves off a driveway in the dead of winter. I take my readers one at a time.

A colleague, a good friend whom I do not shame into reading my material, suggested I take advantage of membership in the statewide association of Marriage and Family Therapists, and submit my non-fiction to its flagship journal, The Therapist. The magazine, which is published quarterly, or thereabouts, features a section in which members can volunteer to read submissions and then provide a review. It seemed like a good idea to take advantage of a service that is a privilege of membership. My friend is good at having ideas that obscure his lack of effort. Anyway, what could I lose? I thought, especially after I’d just waiting six months waiting fruitlessly upon a publisher to study WTR, express enthusiasm for its content, but ultimately reject its content. They don’t publish memoirs of non-famous people, said an executive editor, gratuitously pointing out that I wasn’t famous. Fair enough, I thought. However, he could have told me this earlier, rather than having me wait with bubbling hope that a fantasy writing contract was forthcoming. In the end it was a flat e-mail that delivered the publisher’s verdict—an afterthought, really—by a deputy editor who had forgotten to reply to my last message. A flattering response, “well-written and compelling”, was quickly followed by the word, “unfortunately…” rendering the compliment a consolation.

So I submitted WTR to The Therapist in January 2014, thinking it might be advertised in the next issue, and possibly reviewed in the issue following that (as suggested by the editor). March was the next issue, and my fresh-looking book was there in print, alongside several other titles, looking eager like playful children, but also like bags on an airport carousel waiting to be collected. I was pleasantly anticipating, thinking my book an important work. As far as I could tell, no one else was writing about what really happens in drug treatment, and I feel in my gut that there’s a readership for subject that’s slightly off-center: it’s comprised partly of parents concerned with the impact of drugs upon kids, which is what publishers might presume the book is about. There’s a faction of society that is more broadly concerned with mental health, and with the problems of poorly attached individuals, the famous and non-famous, who are collapsing around us, killing themselves with addictions, violently attacking others in schoolyards and movie theaters, or just plain killing themselves. And there’s a faction of workers in this field, who aren’t necessarily readers, who are slated to work with all these people and somehow help figure out all of their problems: they are therapists, social workers, drug and alcohol counselors, for the most part, and they—not the adolescents or their families, actually—are the heroes of my story.

At least some of them are, and that’s what’s potentially controversial about my book, because it’s not exactly a tribute. You see, I write about some of the things people expect to learn about drug treatment: like what leads kids and their families into drugs and addiction, and how treatment and therapy can help claw them out. But I’m not writing a how-to guide for parents, or any other consumer of the industry. I’m more of a critic of the process; the only kind of critic this business could really have: that of an insider, versus, say, a peripheral insider, such as a policy maker, or even most physicians. I’ve worked several positions within a hospital-based treatment setting, as a counselor and later as a supervisor of therapists. I was a manager of a six-bed group home for teens for three years; a leader of an intensive outpatient program for another three, and have seen patients across several divides in private practice for about twenty years. I’ve tracked the dialogues between the addicted and their families. I’ve been a part of and witnessed the back and forth arguments between patients and helpers, administrators and clinical professionals, and I understand the context of treatment’s limited resources, the conflicts many do not understand. I know the Gordian Knot that is drug addiction and the continuum of drug treatment, and the strained efforts to untie it.

As for the feedback process: I’d written the book, had it appear in black and white, and learned that it was selected by a volunteer to read. Again, I waited. When it didn’t appear in the next issue I sighed and reasoned that the book was long (350 pages) and dense, and was perhaps demanding more time and effort from a committed reader than I’d accounted for. But when a review didn’t appear in the issue after that (another two and half months on), I wondered what was happening. I e-mailed the magazine’s editor, a man who had cheerfully written that WTR had been selected six months earlier, and asked the question. Seeming like the deputy editor of that unnamed publisher, he wrote back that he hadn’t yet received a review from the volunteer, and didn’t know why. With curious incuriosity, he added that I might re-submit a copy such that the book could be advertised again as available for review, and that I might implicitly begin the cycle of waiting all over again. It was: oh yeah, I forgot, followed by an attempt to sweep the matter aside. Waiting and writing: years ago, when I started practicing this pleasing craft, I had no idea there would be this much waiting. What was I submitting myself to? Coolly, I replied to the editor, modeling the curiosity the situation compelled: Was there a problem? Is the volunteer no longer willing or able to provide a review? Did they get bored after reading a chapter and burn the copy? Or were they so engrossed that they couldn’t take their eyes off the material, even when driving, and thus died in a fiery crash. The sheepish editor, to whom I did not share these fantasies, wrote back that he’d pursue my inquiries. A week later, after I again solicited information, he replied that he still had none to give. He vaguely apologized on someone’s behalf, perhaps his own, for being inattentive. He excused the magazine by pointing out that this event—this phenomenon of neglect—seldom happens, and once again invited me to re-submit a copy.

Which I have done, and I am waiting. It is June of 2015: enough time for topical subjects to come and go; happily, or not, addiction isn’t one of them. And as I wait, I will continue to ruminate on my work, and perhaps inflate its importance, thinking that someone is out there waiting to snatch up another copy for review, but then blocking its exposure by abandoning the task. Or maybe I’ll be rewarded for my patience, and my raw message on this subject will be read, perhaps even in numbers, and a fair critique will come back at me finally. In the meantime, I will remind myself that while the culture continues to seek and develop tools for immediate gratification, the writer must endure the slowest, most excruciatingly elusive feedback system ever known.

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April 16, 2015 · 6:51 pm

Saving Thunder Road

In a recent article in the Contra Costa Times, journalist Malaika Fraley writes that Thunder Road Adolescent Treatment Center in Oakland is scrambling to stay open. She reports that TR’s longtime operator, Summit Medical Center, has been planning to sever ties with the program for two years, due to annual running costs of the residential drug rehab and plus facility in excess of $6 million, yearly deficits of $800,000, and declining admissions. Well, I think that conversation’s been happening for much longer, actually.

I worked at Thunder Road for fifteen years, between 1996 and 2011. I chronicled my time, what I observed, what I think treatment for substance abuse and teens entails, both from a research and personal perspective, in a book I published in 2013, entitled Working Through Rehab. Among other things, I remember that threats to the program’s viability started around 2004, and continued periodically thereafter. When I left TR in 2011, I’d worked most clinical positions in the program, seen various changes to program structure, tweaks of philosophy and methods, etcetera, and held the view that TR had been “scrambling” for some time. I am sympathetic to its latest bid for survival, and for the prospect of retaining “the only program of its kind” for Bay Area, and especially East Bay, Alameda residents.

But what is the meaning of this latest, perhaps most threatening of crises? If the community wants drug treatment for youth; if it believes that drug abuse, gang violence, physical and sexual abuse, child abandonment, are ills damaging the community, where is the ongoing support for programs like Thunder Road? Why were admissions declining? Where is the city leadership, the rally of business sponsorship that would spare a thirty year old institution from this desperate position? At the risk of disparaging efforts that may yet come to fruition, I wonder if there is enough conviction to save Thunder Road; if there exists a muted rejection of drug treatment in the community as a whole.

An overview survey from 2014 by the National Institute on Drug Abuse (NIDA) reveals some interesting trends. Use of illicit drugs has generally declined over the past two decades: decreasing use of alcohol, cigarettes, the misuse of prescription pain relievers; stable rates of marijuana use among teens, but perhaps more importantly, changing attitudes about the perceived risk of harm associated with marijuana use. 36% of adolescents say that regular use puts users at great risk compared to 52% just five years ago. In other words, a majority of teens no longer think marijuana use is significantly harmful, which begs the question: what becomes the pretext for treatment, especially a residential admission, if this attitude prevails? Aundrea Brown, who runs Alameda County’s public defender’s juvenile division, states that Thunder Road is an essential placement alternative to juvenile hall (according to the Times article). The Save Thunder Road petition site says something similar. But I suspect many citizens of Alameda, the county that TR now dominantly serves, might reject the implied dichotomy. They’d surely rebut that neither alternative should exist; that a society moving towards legalization of currently illicit drugs, and that deems K2/spice, painkillers, e-cigarettes (according to NIDA, the only major substance whose use is on the rise) as effective, acceptable mood-altering substances, should leave well enough alone.

I hope the county is able to broker financing for a provider (or coalition of providers) to take over care of Thunder Road from Sutter. On balance, I believe what the program brings is a valuable service to the community, though it undoubtedly needs reform. But a broader question needs to be aimed at the community, in schools, churches, within board meetings and without: what do you really want to do about drug use?

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October 5, 2014 · 11:06 pm

Coup De Grace

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Having some difficulty with the novel, The Situation. Some of you are reading it, for which I am grateful, but some of you are not getting it, about which I am…hmm…chagrinned, to put it politely. I know. I’m a whining, narcissistic author, starved of understanding. I should accept the partial appreciations I am receiving, the enjoyment some are having, taking what they like, as they say in 12-step programs, and–and the corollary is huge–leaving the rest.

To hell with that.

I wrote both CFTH and The Situation, for various reasons: 1.) to express myself creatively, 2.) to entertain, and 3.) to teach something important as an adjunct to my psychotherapy practice, which happens privately, behind closed doors, thus generating a need to venture outwards. There are in my novels several themes of note, and as my own process is sometimes unconscious, I can’t account for them all. Not that I don’t try, so here’s a rough list of succinctly-termed ideas present in the text and subtext: addiction, trauma, the tyranny of workplaces, of secrets within closed systems, like workplaces and families; about the ubiquity of dissociation, of impotence, and indifference; about the distance of friends, the lingering power of the absent, and the tense battles between lovers, for each self to fit in.

I guess that should be enough, but especially for The Situation–the follow-up and coup de grace–there needed to be something special (not to mention positive), something to make sense of, tie together the story as a whole. Empathy. That was the quality–the redemptive, sobriety-supporting (as one reader puts it) quality–that came to mind, as the point. And so, the novel delivers a climax with empathy as its thematic core, and everyone, author, characters and readers alike, should get the point and transport said point, somehow, back to our (or their) daily lives. And they seem to, those supportive few. But there are clues along the way–words unfortunately skipped, I suspect–that are getting missed; and it’s important. Why? Because you might notice something in relationships as in art: you shouldn’t miss the details.

Anyway, much misunderstanding centers around a contentious section of Situation, entitled “Nightmare”. Bryan “Weed” Tecco, my cardboard villain from CFTH, referenced only in his absence in that novel, is thereafter my protagonist, and he’s alive, contrary to the suppositions of my other characters, and in all likelihood, readers of CFTH. Emerging not-quite drowned from a lagoon in West Marin, he holes up at an old friend’s house in villagy Bolinas, then hitchhikes back to suburbia, only to be picked up and later drugged by a man, Dan Pritchard, with a sadistic streak and an apparent diaper fetish. Apart from recalling Chris Leavitt’s wayward new diaper invention from the first novel, the notion here is to have my character make a psychic return to helplessness: to a time when all needs are taken care of (and Dan Pritchard does take care); to a time when the body is uninhibited; to a time when the mind is bewildered, and possibly terrified. Weed is humiliated by Dan Pritchard, and though he appears to escape uninjured, there lingers the suggestion that Weed has been violated, while asleep no less.

Attentive readers, those who stuck with the various backstories of CFTH, may think this just desserts, this victimization. After all, according to Chris Leavitt, Weed introduced friends like Chris to not only a drug using lifestyle, but also a milieu in which prostitutes, sex, and consent for sex, moves freely (from one POV), or inchoately, dissociatively (from another). Regardless, I had plans for Bryan “Weed” Tecco–plans to make him an unlikely hero, back from the dead, but more importantly, back from infamy and indifference. In the chapters that follow “Nightmare”, Weed resolves not to talk about his ordeal with Dan Pritchard, but as many in my practice have discovered, not talking about something far from means that one is un-impacted. However, time is short in drama, and therefore serendipity: Weed meets Jill Evans, a shared “friend” of Chris Leavitt, and as she accompanies Weed on his road-trip search for his friend, she lets slip the clumsy near-rape Chris had attempted in CFTH. For the determined separatist, Weed, this presents an opportunity for his own suffering to quickly metabolize so that he might support another.

And later, as he finally connects with Jules Grotius, the creator of the subversive online game, ‘The Situation’–the self-styled guru of a new medium through which conscientious activism can be achieved–he listens, half-percolating the needs of his re-emerging self, half-reconciling current events with past traumas, while absorbing the heroic purpose he has unwittingly lived over the previous several days. Weed the drug dealer may live on. Weed the woman-distrusting bully may even persist with old habits. But Weed the game-fixated, insular enigma has been dealt a death blow.

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September 17, 2014 · 6:36 am

No Place To Go

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There is no place to go, nothing to do, participate in, or witness, that will achieve the elusive state that exists in Bryan “Weed” Tecco’s head. Not that he doesn’t imagine: its glory and the path backwards through memory to the thing he really wants, the euphoric recall. But it’s in the subtext now, this longing. Even at the premature age of twenty seven he’s been coasting along, living with subdued disappointment and thwarted experience; a specimen of ennui and muted self-loathing. In the post-script of this missive, I’ll give him a break and call him by his real name.

Bryan’s day job is that of a game-tester for a telecommunications giant called Sahi communications. Ten years ago the average reader of a book like The Situation might have asked if being a tester of video games was a real job, but these days, with e-sports an actuality, role-play video games more popular than film or music, the job in question might now be the ultimate career choice for the average teenage or tweenie male. Girls wouldn’t want this gift, except maybe those desperate to squeeze into the male world; one-time little sisters playing out the drama of not being left out. However, Bryan works his day job by taking it for granted, paying it little heed while using the languidly passing hours as a springboard for the evening’s moonlighting, his wax dealing side-gig. Though seemingly bright, creative, and possibly ingenious, he nurses an old wound that obstructs ambitions, his prospectively society-contributing lifestyle. In his world, whether that is Richmond, California, or the affluent, hippy back roads of West Marin, Bryan is a misfit: born without guidance or guidelines, though he is subject to hasty yet capable nurturing later on. He is destined to plunder his own path, revisit his original script of rejection more effortlessly than Chris “Crystal” Leavitt ever will. He will keep others at arm’s length, generating intrigue in some, contempt in most, but still assessing his limitations all along.

As a serendipitous adventurer, Bryan fits the bill for me, but not for Sahi, a corporate beast that doesn’t notice the special talents of its worker bees. A wildcard in their system, Bryan recognizes special elements in a game he’s been given to test; elements uncannily similar to the hallucinogenic visions (called ‘Shadows’) that he shares with his also wayward friend, Chris. Galvanized by an impulse not fully expressed to the reader, Bryan steals the files for the game, called ‘The Situation’, half-believing that he’s found a cause that will stoke a dormant heroism. In the novel’s predecessor, Crystal From The Hills, the notion of a situation is given some comic mileage as an inside joke between friends: a situation is a personified event with an attitude, and given a cosmic edge. A situation, as introduced in the first novel, is an umbrella term for an event with some manner of sentience at its core. A situation: it has opinions and feelings; it wants things, and like God, will fuck with people if it has to. It’s a signal that all things, happenings and beings that wander aimlessly, congeal in order to find meaning, reflecting the existence of an overseeing power.

The presumptions of a psychotherapist, which are perhaps similar to those of a dramatist, are that people care: they care about themselves, about their friends, their parents or siblings, their lovers. They care about their communities even, and given half the chance, lifelong frustrations or limitations notwithstanding, they’d seize the opportunity to make a difference, disrupt the presumed versus natural order of things and bring forth something like goodness. Bryan’s adversaries generally see him as an opportunist and a sociopath, and so they miss him. His doppelganger, Eric “fierce” Pierce, chases Weed across the landscape of California, pursuing him with all the righteous fervor of Javert, but also the collapsing delusion of a failing system. Pierce haplessly represents his employer, which thinks it can easily squash the individual, the fly in the ointment, “between the pincers of a superior being”, I write. But of course it isn’t superior, this corporate behemoth that is Sahi Telecommunications. It’s made up of individuals, after all: all lost in the mix. Like Bryan, it only acts as if it knows what it’s doing. Underneath the pretense, my protagonist acts as if he doesn’t stand a chance. That’s why he separates, as in separates from everything and everyone as often as he can. The backstory? Sorry (or not), this story’s not like CFTH; it’s locked into the present and future, not the past. It’s in the subtext also, Bryan’s quiet lack of self-worth.

Who he is lies somewhere in between the texts of the two novels, or else before either, out of sight of his author even, and hiding defiantly. It’s late now, a good several months since I finished The Situation, plus a year or two since I birthed Bryan “Weed” Tecco. I know he’s better than he thinks he is. I knew from the start that he’d be much more than the cardboard nasty I expose in CFTH. I thought he might be a good anti-hero, a curmudgeon with a tender heart, a bit like the John Milner character from American Graffiti: greased, beefy and sour, yet sweet enough to give a kid a break; kissing the thirteen year old girl on the cheek at the end of the night. If you read the dense yet worthwhile gem that is CFTH then you might have thought you’d seen the last of Weed, and thought good riddance (to Weed, and maybe the book, I guess). You didn’t know I had plans, ideas that were only half-thought through as I got started. I was playing it by ear, looking for redemption in a sequel, hope in ordinary guys—not even men—and believing in few things less than I do heroism, which is a problem for me, I admit. Really: the way heroism is sold in this life is a deadly lie. I prefer redemption as a concept. There’s more personal history, less of a script for others to steal, transform into something banal, there just for common consumption, or exploitation. Instead, there’s something musical, un-captured and pure. There’s even more syncopation in the sound of the word.

For e-book link for The Situation, click on the following:

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July 10, 2014 · 8:55 pm

Accidents

 

My twin novels, good friends Crystal From The Hills and The Situation (published 6/29) both begin with accidents—the same accident, but with different conclusions, different, uh, opinions as to what really happened on a last Wednesday in March. Someone died, says book number one, CFTH. Someone’s still alive, says the spoiling follow-up, bringing hope, or denial. Distortions. It’s a problem when two people experience the same event but come away with different ideas, different memories. What really happened? What really happens in drug treatment? In yet another book I claim to know the answer to that question. Who’s in charge? Who gets to decide the truth, the way things ought to be?

Accidents. They’re all accidents, the things that happen in life. They have to be, for to insist otherwise is to say that things are consciously determined: mapped out, overseen, foreseen, and taken care of. Are we being taken care of? When accidents happen, someone is meant to step in and mollify bad feelings, guilt and inadequacy—things we download somewhere between 2 and 5. Someone’s meant to step in and say everything’s okay when we break things or fall down. But what if they don’t? What if those grown ups are gone, or just preoccupied; depressed? We forget the early stuff, the wrongdoings of our bodies, the pre-sexual mistakes of bad touch, upsets in the crib; inexplicable, cosmic aloneness. Do we really want to grow up? Some, like my characters, don’t so they keep having accidents—violent, sexual, toilet-centered, water-based accidents—things that keep us young, hoping to be picked up and rubbed until feeling better. One protagonist’s parents gave him up early, passed him off to another couple, one that tried and still tries to love. The other one’s parents stuck around, but clearly had other things to do, and perhaps should have given him up, broken up with him like women tend to; let bossy yet formidable aunts take over; just disappear, maybe.

Give the kids a break. When they’re men, let them grow down and not up, just a little. “Gimme time,” says Chris Leavitt in hapless climax. It happens too fast, this life of responsibility and mission: like this opportunity that fell upon the lap of Bryan “Weed” Tecco at some point before the text of either novel. The flash drives, plural of drive, drove him to steal, and then head out on a doom-laden drive. Weed had a vision, just like Chris Leavitt, his friend, has visions, and the vision informed Weed that the video game he was expertly testing, “The Situation”, contained elements he recognized: these “Shadows” that the likes of he and Chris see on a regular basis, pointing out truths that no one is willing or able to speak of: about wrongdoings, what’s happening in the world; what ought to happen. Weed has a problem, a God-like problem. He foresees that fallout, the events that will unfold, subverting all that should happen. The problems start when Weed starts to plan: to steal the plans for “The Situation”; to lead his corporate security followers on a chase; to take his friend Chris with him for back up, as if that were something he needed. Maybe human beings should never try to plan things. You see, we don’t it well: planning. All things are just accidents…horrible, wonderful accidents.

 

 

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July 7, 2014 · 7:28 am

A Day in Symposium, Part Two

As I listened to several speakers champion the apparently threatened cause of drug treatment at the 2nd Annual Addiction Symposium in San Francisco, I wondered to what degree I was hearing cutting edge opinion. Conventional wisdom is that drug treatment should be thriving, with Parity Laws, Affordable Care Acts, and so on paving the way for expanded services: more spaces in outpatient programs; increased number of beds in hospitals. Third party payers must now think of addiction, or substance use disorders (as they are termed in the APA’s DSM V), as a disease, and therefore pay accordingly for its treatment. But programs aimed at specific professionals, such as doctors and nurses, are under threat, apparently. At least so-called “diversion” programs are threatened, though speakers thought the term “diversion” ought to be threatened (for reasons I didn’t really understand, I should add). Meanwhile, I wondered about the implications for a particular corner of the drug treatment industry, one in which I worked for fifteen years: namely, adolescent residential treatment.

When speaking of access to treatment for doctors, airline pilots, nurses, as well as adults in the general public, advocates tend to speak against discrimination issues: the problem of individuals being discharged from treatment programs because they relapse on drugs, or because they otherwise break program rules, fail to comply with medication regimens; because they exhibit the symptoms of their disease. The mocking that is directed at such intolerant discharges—the would you turn away a heart disease patient who has a heartattack? arguments—remind me of the similar yet more detached observations of journalist/physician Lonny Shavelson in his book Hooked. He likewise decried the strict rules of Therapeutic Communities, and lauded drug courts for working more flexibly with society’s most difficult cases, its most inveterate users. However, it’s strange to me that given the ubiquity of sanguine opinion at the level of medical leadership, that principals of adolescent programs, especially residential programs, don’t weigh in with some counterarguments: most notably, that relapsing substance users don’t just disaffect themselves as they continue to use drugs or refuse to take pills or go to therapy. Sometimes they spread drugs in a program, or threaten people, physically hurt people; harass people, verbally abuse people, staff and peers. Problem? Of course it’s a problem—a problem of safety. And it’s not a problem that can be resolved with a brief course of motivational interviewing, and so discharging—that “discriminating” act against the incorrigible—is not only appropriate for some, it’s necessary.

This issue of how to make treatment safe for everyone (especially kids) is one of the most important topics in my book, <em>Working Through Rehab: An Inside Look at Adolescent Drug Treatment</em>. Who am I to offer opinions? Who do I need to be? I am not a physician. I’m not a recovering drug addict, nor am I a long-suffering parent of a troubled teen. But I am a psychotherapist, and I worked for fifteen years in this complex rehab business that defies soundbites, pat summaries of phenomena. I compiled memories and opinion, and now offer for a concerned readership a nuanced view of what really happens in an average drug rehab.

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