Tag Archives: adolescent drug treatment

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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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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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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Full Metal Self

Had a few ideas recently, after watching the film Whiplash; made a few links, reignited certain determinations, sighed and resigned to my fate on a few other matters. The film stirred hope and–dare I say, inspiration–on many levels: firstly, I learned that the film had been out for nearly a year already, though it was only recently making a splash in theaters. I am reminded that promoting a film, like promoting a book, takes time, hard work, and no little amount of salesmanship. This parallels the story of Whiplash somewhat. Miles Teller plays Andrew Neyman, a young would-be jazz prodige, a drummer in a prestigious music conservatory band. Scouted and then selected by the school’s jazz maestro, Terence Fletcher, he joins a band that is further elite, and is initiated into rehearsals in a manner that is at once predictably brutal, yet also fascinating and entirely gripping. Actually, more so than any thriller or action flick I can think of, this film had me gripping my seat for almost its entire length, such was the tension created between the quietly narcissistic hero and his near sociopathic mentor. In scene after scene, I watched with mounting angst as Fletcher alternately seduces and then terrorizes the naive yet ambitious Neyman. He flatters him, telling the class he’s found his Buddy Rich; then, minutes later, he is tossing cymbals at Neyman’s head, mocking him for not keeping tempo, threatening to “rape him like a pig” if he fucks up his band. For my part, as non-musician, I had no idea drummers were this important.  Meanwhile, the Fletcher character brought to mind a few teachers from my past, sort of morphed with that terrifying drill sergeant character from Kubrick’s Full Metal Jacket.

About two thirds into the story, we get Fletcher’s rationale for being the way he is: modern jazz, like modern society, is in a sorry state, he says. The words “Good job” constitute the most harmful phrase in the English language (I’m paraphrasing). He’s an advocate of tough love, obviously; of the belief that teachers must push people beyond expectations in order to get the best out of them. The ends, as in the preservation (or growth) of standards, justifies the brutal means. The film’s counterpoint is to indicate casualties: a former prodige whom Fletcher had allegedly driven to suicide; the girlfriend whom Neyman dumps so as to focus on his drumming. Neyman’s father, a loving but feckless man, voices opposing values, decrying Fletcher’s abuse, challenging his son’s obsession, imploring him to slow down lest he (literally) die on the drumstool. Ultimately, the story seems a celebration of going for it; of not compromising standards. It’s just that it doesn’t ignore the costs.

Again, the film brought up a lot for me. I wonder how much of Neyman and Fletcher’s drama is transferrable to the world I inhabit. If you’re a would-be client of mine reading this, don’t worry. I have no plans to emulate Fletcher or the drill sergeant from Full Metal Jacket. However, I reflect on the opinions I expressed in Working Through Rehab, my book about adolescent drug treatment; sympathetic views about the dinosaur-like, similarly tough-love ethos of the much maligned Therapeutic Community Model. This week, I shall be teaching a short-term class on the Masterson Model at a community service agency in Marin, and espousing the value of, among other things, therapeutic confrontation, the importance of having boundaries, a therapeutic frame in which consistency, self focus–striving beyond expectations–are at least analogously observed. The dialectic I anticipate will mirror the drama of Whiplash, and maybe FMJ: principled agreement about driving people to their best, tempered with compassion for those who, for a variety of reasons, fall short.

As for myself, I go for it in my own way. Inspired by Andrew Neyman and the indelible image of his blood-stained drumkit, I might stay up late tonight, working on my latest manuscript: tightening the prose, adding pieces of subtext, changing a character or a plot point, correcting sundry mistakes in punctuation and spelling. I am well read with respect to my own books. I read them over and over again. It’s like combing the text, looking for tiny bugs. Sometimes I am satisfied; more often, I am not. Figuratively, I bleed. I have expectations.

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Where there is hierarchy there is violence (part two)

 

…Which means there are casualties. They are victims, if you’re feeling sympathetic and outraged. They are losers, if you’re not. Chris Leavitt, my protagonist from Crystal From The Hills, is not much of a victim, but he is much of a loser. And I write that with love. In a way, I prefer losers to victims, though they are in some respects the same. Losers lack the hubris of victims, mostly because they haven’t the fortitude to call themselves victims. So Chris Leavitt is a traumatized individual; a casualty and a loser, not a victim: he is privileged, free for the most part but wary of his onlookers–his shadows, both real and not. Ironically, he pays more attention to the less than real shadows, which render him paranoid yet oblivious to what’s right beneath his nose. He is innocent in so far as he is uncalculated, uncensored and anarchic. Whether too impulsive enough or just lacking in political savvy, he is unequipped for any tight, hierarchically-driven order.

There are hierarchies all around: some are tacit structures, governed by race, class, gender, philosophy, religion–prejudices of various kinds. This is not original, but then neither is the hand-wringing that surrounds public controversies. It’s not nice to judge people for being different, people say on camera. But they do. Of course they do. It’s the correct thing to aim for the center (“the center holds” our President tells us), but all around us (and him), splitting, the thoughtless, triage-like division of life into “good” and “bad”, right and wrong, is occurring, and meanwhile, we are all shepherded into cliques, nurturing our prejudices and providing succor within echo chambers. I was once clique-bound at Thunder Road, the workplace that employed me for fifteen years, and which I depict in another book, Working Through Rehab: An Inside Look at Adolescent Drug Treatment. Contrary to my younger observations, Thunder Road is just another typical hierarchical system governed by shadows who determine who fits and who doesn’t; whose turn it is to be in charge, and whose turn it is to go…what works and what doesn’t. Leaders use corporate tools for the most part: manuals, handouts, HR policies, lawyers and spreadsheets, to create order. Meanwhile, the world they govern is an inchoate mass driven by an oral tradition, and the unconscious.

My turn on the rollercoaster lasted longer than most, though it was never my goal to merely have my turn. It was my pretension to do more, and now I have, only from the outside looking in. The point of my book is that taking a turn is not enough. Being politic, fitting in and censoring dissent may suit a hierarchical system, but it is psychological death to the conscious individual, the growing professional. I could avoid hierarchies, mess with hierarchies, dissent and maneuver only so much until shadows converged and told me that if I was to continue avoiding the trappings of leadership and compliance, then it was my time to leave. Cohesion: it means togetherness, which is good, sort of. But coherence, which is like music, is superior. I remember being told once by someone in charge that if I was to really take a turn being in charge, then I’d have to assert just that, regardless of what is right. The decisions were mine, I was told: ultimately, what I said prevailed, not because I was right, but rather because I was in charge. Reluctant leadership. I nodded compliantly but remained slippery, thinking this a dangerous, undemocratic idea, this thing about being right because it was necessary to be so. The problem with equating rightness with being in charge is that being in charge doesn’t last.   

One of my favorite passages of literature reminds me that the exiled exist in numbers, are neither contained nor containable, even if they’re not in charge. Even if they’re not right. This is John Self from Martin Amis’ Money:

“I hate people with degrees, O-levels, eleven-pluses, Iowa tests, shorthand diplomas…and you hate me, don’t you. Yes you do. Because I’m the new kind, the kind who has money but can never use it for anything but ugliness, to which I say: you never let us in, not really. You might have thought you let us in, but you never did. You just gave us some money.”

 

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