“Absolutely not. He cannot be discharged tonight; he’s not safe. He needs help”. I was desperately seeking that help.
“Nope. There is no medical necessity to keep him. When he gets sober, he’s being discharged. He needs to stop drinking and go to meetings.”
This was the latest exchange in an Emergency Department when my very beloved alcoholic relative needed some help. If only it was as easy as telling “Jason” to “Stop drinking! Go to meetings!” Did this nurse really think we had never heard this?
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Addiction, from drugs or alcohol, is on the rise. People often say that the addict will stop using when they “hit bottom”. For some, “bottom” may be losing a job or relationship, getting arrested or doing time. For others, the bottom is death. Over 92,000 people died from drug overdoses (illicit or prescription) in the US in 2020; in 1999, it was less than 20,000. (National Institute on Drug Abuse). According to the CDC, alcohol induced deaths are up 34%, to more than 52,000 from pre-pandemic times.
Sure enough, Jason and I walked out of the ED two hours later and once again faced the question of what to do next. It’s a lonely road to try and support someone with an addiction as serious as his. There are no answers or solutions that haven’t been tried multiple times. So, in the middle of the night, we drive to my house; I bring some liquids with electrolytes to him and encourage him to get some sleep. The next day will bring the search for a rehab bed and, hopefully, a longer-term residential “dual diagnosis” program after that.
Mental health and addiction are linked and when one is diagnosed with a mental illness and addiction, it is referred to as dual diagnosis. Current thinking is moving away from genetics or moral failure as the reasons for addiction. Increasingly, mental illness, specifically provoked by trauma, is seen to be at the root of substance abuse, and addressing the core issues is the path to becoming addiction-free. According to the American Psychological Association, trauma is defined as “an emotional response to a terrible event like an accident, rape, or natural disaster. Immediately after the event, shock and denial are typical. Longer term reactions include unpredictable emotions, flashbacks, strained relationships, and even physical symptoms like headaches or nausea”. Our world is laden with problems that lead to trauma and emotional distress. Trauma sources include poverty, racism, sexism, homophobia, sexual and physical abuse, violence, war, climate change. Others, such as emotional neglect, can be more subtle. Emotional neglect may be intergenerational; for example, the parents or grandparents went through some horrific experience like war. Their focus was survival. They are unable to provide emotional support to their offspring, thus resulting in emotional neglect and trauma. Regardless of the source, the end result is burying one’s painful feelings which can result in anxiety, depression and other mental illnesses. People deal with emotional trauma in many ways: they drink or do drugs; become addicts of shopping, sex, or any number of other behaviors; have dysfunctional relationships; commit suicide.
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Dr. Gabor Mate, a renowned addiction specialist from Vancouver BC and self-described Marxist, argues in his book, In the Realm of Hungry Ghosts, that the core objective of addictive behavior is “the self-soothing of deep-seated fears and discomforts” . He says human needs are not being met and that this is linked to the rise of capitalism. ”Now alcohol has been known in the Western world for thousands of years, and there was plenty of drunkenness, even in ancient times, but there is no alcoholism for the most part. Alcoholism came around in the 18th century with the rise of capitalism. You can make a very good case that one of the medical outcomes or one of the health outcomes of capitalism is addiction. In other words, can you understand people in isolation from the system in which they live? Well the answer is that you can’t.” (See the full article: Capitalism Makes Us Crazy: Dr. Gabor Mate on Illness and Addiction.)
Jason described to me a typical story of people in recovery. This, apparently, is the standard joke at AA. A man gets sober. He gets a job and a bicycle to get there. Gets a better job, a girlfriend and a car. Gets married, gets a house and has a family. A few years later looks around and thinks “is this it?” and starts drinking again. That, to me, is the perfect picture of Dr. Mate’s comment that people are affected by the system they live in. Our individualism, competitiveness, lack of social networks and support for families, all lead to the despair, stress and trauma that can lead to addiction.
What leads away from addiction?
“Connection is the opposite of addiction”. This, for many, is why 12 step programs work. It’s not the steps, or higher power, but rather the community that is built. A 2019 study of rats illustrates this. In the study, rats could press a lever to get drugs (meth or heroin) or have social interaction with another rat. 90% of the time, social interaction was chosen. While of course humans are vastly more complicated than rodents, the researcher says, “From a clinical perspective, our findings support wider implementation of social-based behavioral treatments, which not only include the community reinforcement approach, but also innovative social media approaches, such as those being implemented to provide social support before and during drug-seeking episodes.” (See the full article Rats Prefer Social Interaction to Heroin or Methamphetamine)
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Two days after the ED visit, we found a bed in a 28 day rehab. Jason agreed that a longer program – 90 days inpatient – was needed, but a bed wasn’t available, so the rehab is a stop-gap. As I write this, that’s where he is while we wait for a bed to open. Finding rehab resources is challenging: a bed must be available, the place must take one’s insurance, and depending on the place and condition of the person, a detox may be needed, which may be a different facility. There are some resources, such as 211, that may have a list of beds open that day, but often it’s calling around. Rehab is little more than a holding pen; it allows the person to regain some physical health, and it gives family and friends a break knowing that their loved one is safe for a few weeks. Some residents are there by court order. Many staffers at rehab are former addicts and there is a high turn-over as the pay is low. Doing any intensive psychotherapy is impossible as people are only there for a month. Who can develop a relationship knowing that they will never see that counselor again? So a lot of rehab is 12 step meetings and “skills building”. Learning stress coping mechanisms like meditation, journaling and breathing. These are all fine, but not enough for everyone and don’t address the core issues.
There are no easy answers to what some addicts need to truly conquer their addictions, address their demons and move forward to a fulfilling life. I know many people who got into recovery, maintained their sobriety, and went on to lead satisfactory lives. Jason is not there yet. It’s unclear what a truly good system would look like to help him. Certainly the parameters of our current society don’t allow for the intensive care he needs. Money, of course, plays a big part. There are private facilities that do not take insurance, that possibly have the level of care, but they cost in the hundreds of thousands of dollars for about 6 months. This is not an answer for most.
If we view the source of many traumas as our capitalist society, the answer becomes more clear-cut: abolish capitalism.
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Author’s Bio: Amy Harris is a long-time activist and former member of the LRS. She is currently working with DSA, the Working Families Party, and a local environmental group in her home state of CT.
For more information and resources on addiction, substance abuse and mental health:
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