By Cortland Pfeffer & Irwin Ozborne
Contributing writers for Wake Up World
The drug epidemic is not an addiction problem, it is a humanity problem.
“Few medical schools or residency programs have an adequate required course in addiction. Most physicians fail to screen for alcohol or drug dependence during routine examinations. Many health professionals view such screening efforts as a waste of time. A survey of general practice physicians and nurses indicated that most believed no available medical or health care interventions would be “appropriate or effective in treating addiction.” – Drug Dependence: a Chronic Medical Disease Study
Peering into the open casket, I saw the lifeless body of my childhood friend. Although, some would argue he had been lifeless long before his death. Tommy was a drug addict for many years and had spent much time in-and-out of treatment centers and jails before his life came to a halt due to an unintentional overdose. As I stared at his now peaceful remains, I found myself highly perplexed at how this moment had transpired.
Like Tommy, I too am a drug addict. I may have been into it harder than he was at my peak and served just as much time incarcerated, homeless, and in-and-out of treatment. I treated people far worse during my active addiction, committed more serious crimes, and spent most of my days wishing for death. I couldn’t help but think that the wrong person was lying in the casket.
Through my recovery, I have met many addicts in treatment, meetings, and in my professional life. As I advanced my career, I ended up working at these same facilities – jails, treatment center, state hospitals – in which I had previously been “treated.” As I thought of all their stories it became perfectly clear.
Tommy didn’t die from a drug overdose. Tommy died as a result of a homicide by our society. He is now a statistic in the nationwide epidemic of addiction.
Epidemic, by definition, is a disease affecting many persons at the same time, and extremely prevalent and widespread.
According to a Columbia University Study in 2012, 40 million Americans age 12 and over meet the clinical criteria for addiction. Another 80 million are classified as risky substance users. That is by definition, an epidemic.
Despite these staggering numbers, somehow addiction continues to get swept under the rug when discussing deadliest diseases in this country. However, when something grows this large it becomes nearly impossible to ignore. Mostly because it starts to affect our bottom-line and nothing sparks interest in Americans as much as their money. It is estimated that addiction costs the government more than 450 billion dollars annually.
Addiction starts to affect insurance premiums for everyone due to routine ER visits, doctor visits, and accidents. Now that everyone is being affected, we are beginning to realize we have an epidemic on our hands.
Over the past decade, there have been public health scares including Bird Flu, Swine Flu, SARS, Ebola, Zika Virus, and the list continues. Almost instantly, our experts go to work and prevent the outbreak from becoming an epidemic. However, with addiction, this has been going on since the foundation of this country more than 300 years ago. In the last century alone, we have started banning substances, increasing penalties for using certain substances, and trying different strategies but to no avail. What are we doing wrong? How do we keep striking out on this one?
You will not find the answer in a peer-reviewed study, in a text book, or a classroom. I have observed over the past twenty-five years as a patient, staff, and supervisor working with addicts that we are looking to answer the wrong question. The question is not what is wrong with these addicts that they continue to use; but rather, what is wrong with us as a society that we have built this culture that has the worst drug problem in the world?
Creating the Addict:
“There are two basic motivating forces; fear and love. When we are afraid, we pull back from life. When we are in love, we open to all that life has to offer with passion, excitement, and acceptance.” – John Lennon
Is one born an addict or does one become an addict?
Here is where the choice argument regarding addiction comes into play. While it is true, you cannot be an addict if you never use a mood-altering drug; you certainly can have pre-disposition with your cards stacked against you biologically, sociologically, and psychologically.
Looking back at Tommy’s life, it is easy to see how the addict was created. He was born to two young parents who lacked parenting skills, finances, and stability of their own. Tommy’s father never worked and spent his days with the kids and was usually intoxicated. Tommy’s father had a tough upbringing of his own in which he was emotionally and physically abused and never gained any skills. His father came from a fatherless home and so this is a generational problem that Tommy had inherited.
According to Erik Erickson’s stages of development the first stage is birth to 18 months. This is when the child goes through what Erickson called trust versus mistrust. The child decides if the world is safe or unsafe. This is a critical stage in everyone’s development that is out of our control completely. If we have an unsafe environment in which we are neglected, abused, or not cared for, it not only makes us feel the world is unsafe but it actually alters the chemistry in our brain.
There was a study done by Harvard that showed specific changes in the hippocampus in the brains of young adults who were mistreated, this makes the victims more prone to depression, addiction, and PTSD. When a child is under stress often, it makes the brain less resilient to stress later in life. This can make the person at risk for more trauma as they now are less resilient to stress. When we are under stress, our brain goes into “fight or flight” mode and always on high alert. If someone is always on high alert, they are going to develop intense anxiety. Anxiety is the anticipation of danger which creates ongoing fear of the world around us.
Tommy’s mother worked long hours to provide for the children. When she came home, she wanted to sleep and did not care for Tommy. He spent his early years being neglected by his mother and in the care of his alcoholic father who would often abuse and neglect him as well. His brain chemistry has now been altered and he is living in constant “fight-or-flight” and fearful of his surroundings.
This is the biopsychosocial model of addiction. It shows how we are influenced biologically (genetic predisposition), psychologically (the chemistry in our brain and how we react to the world), and sociologically (our external environment and how we were raised).
The next phase of creating the addict is the invalidation which creates the mask. As a child, Tommy loved the world. He loved animals, loved to sing and dance, and act goofy – like most children. His father passed on his generational pain by punishing Tommy for these acts; hence, he punished Tommy for being himself. Tommy was trained “how to be a man” meant to use anger and violence.
At age 13, Tommy uses alcohol for the first time. It is the most magical feeling that words cannot describe. All the fear, stress, anxiety, sadness, and pain vanish in an instant. He feels peace and freedom – the way he should have felt all along. The drug releases a huge surge in dopamine – which is a neurotransmitter responsible for pleasure and reward – which opens Tommy’s mind to a world that he never knew existed. This is highly reinforcing because of the mood-altering ability, which makes Tommy want to use more often and more regularly because for the first time in his life, Tommy felt OK.
Thus, we have created a fool-proof formula for Tommy to be prepared to become a drug addict. But this is only the beginning. We certainly cannot prevent 100-percent of cases like Tommy from happening, but the creation of the epidemic has allowed this to continue for so many years.
Creating the Addiction Epidemic:
While Tommy has learned that using drugs and alcohol alleviates his pain; once the drug wears off, the fear and anxiety return. In fact, it returns and is even a little bit more intense than before due to what is known as the “rebound effect.” This leads to him using in greater amounts and more regularly which increases his tolerance.
At school, Tommy is struggling staying focused and he uses marijuana before class. It allows for him to stay focused and calms his nerves. Again, because he gets a desired outcome it is reinforced in his brain. Of course, like alcohol, there is a rebound effect and he starts needing more just to function.
Tommy starts missing class and his grades start declining. He starts to get labeled as a problem child at school due to his grades, truancy, and behavior issues. He also starts picking up labels from his peers as he is teased for being a “druggy”, “burnout”, or “loser.” These, too, work as reinforcements as he has already believed he was not a good person based on his childhood and these just affirm his already negative self-esteem.
However, these are also some of the first missed opportunities to help someone like Tommy. Where were the social workers, teachers, and counselors when they see Tommy failing classes, wearing the same clothes every day, and being picked on? What did they do? They added to his pain and problems by labeling him as a “bad kid.”
“Five percent of the student’s cause ninety-five percent of the problems,” said a school administrator to me one day. My initial reaction was that if it is only five percent of the school, why aren’t we doing more to figure out what is going on rather than punish them for coming from a broken home?
As a teenager, Tommy is given a probation officer to follow him around and check on him. If he fails a drug test, he gets in more trouble. If he is not in school, he gets in more trouble. But when has he ever been offered help? Instead, it has been shame-based tactics of trying to scare him into being a “good kid.” At this point, the drug is the only means of coping with the world and he is unable to give it up. When he is not using, he is emotionless, and now needs to drug just to get by on a daily basis. He starts to use harder drugs to re-establish that euphoria he has been chasing.
We have a midbrain and a prefrontal cortex. The prefrontal cortex helps us plan our day, organize our activities, analyze and assess. This part of the brain does not fully develop until our mid-20s. Meaning that when an adolescent starts to use drugs that they are at much higher risk to develop a dependency. This is because the brain is still developing and we start to create neurological pathways with strong reinforcements that shape how we manage mood and emotions. However, the midbrain is for survival and always will supersede the prefrontal cortex. If a lion walks in a room, we run for survival regardless of our plans.
As an addict, the drug starts to affect the midbrain and you begin to feel that you need to drug to survive or live. It is the same as if you are starving or not having food. This is where cravings arise as our brain is sending us signals telling us we need to drug and it takes precedent over the analytical and rationale part of our brain – especially for an adolescent with an underdeveloped brain. Then when he is unable to quit, he gets shamed some more.
Here is another missed opportunity. We lack quality counselors in the school system that understand chemical dependency. In the city of St. Paul (Tommy’s hometown), there is only one licensed alcohol and drug (LADC) counselor in the eight high schools. They claim to have a lack of resources, yet in 2014, they passed a bill that approved $3.1 million for all the students to have iPads.
Eventually it becomes too much and Tommy drops out of high school to add more labels to his resume. He can’t keep a job due to using while on the job and the pain and torture accumulates. He has been told since he was a child that he was selfish, not smart, not good enough, and a bad kid. Now it is playing out in front of him. This is when we met; two addicts outcast by society.
Tommy met a girl from a similar background and they moved in together. Within a few months, they had a child of their own at a young age. Unable to afford to pay for bills to keep the child healthy, Tommy had to find ways to make money. He did the only thing he knew, which was to sell drugs to his friends. Eventually, he is caught, arrested, and incarcerated.
Adding to his labels he is now a criminal and unable to care for his family.
The Legal System:
The legal system plays a major part in the creating of the epidemic. We have all seen many stories on the massive failure of the “War on Drugs” which has resulted in an influx of drug problems at the expense of the taxpayers to profit those in power.
The idea was to create stricter punishments for people who abuse drugs and that will decrease the drug-related problems. But you need to remember that people who are addicted are working from their midbrain. A prison sentence is not going to stop someone from using a drug. You could have threatened to shoot me if I got high again at the peak of my addiction and I would have tried to find a way around it or hope that you were out of bullets. Punishing someone for a disease is outdated and ineffective.
Eighty-percent of offenders in jail abuse drugs or alcohol. Approximately 60-percent of individuals arrested test positive for drugs at the time of arrest. Approximately 95-percent return to using drugs when released. Sixty to 80-percent of those arrested will be arrested again. The evidence is overwhelming that locking up addicts doesn’t work.
What if we had a cancer drug that made people sicker? We would throw it away. However, we continually lock up and criminalize people who have been traumatized as children, likely abused and shamed, so they turn to a substance that eases their pain. In turn, we lock them up and re-traumatize them for using a drug (marijuana) which we now are finding medicinal benefits and even legalizing for recreational use.
Furthermore, due to the mass incarcerations during the Drug War, the prisons became over-populated. This led to the privatization of prisons. That’s right, the private for-profit sector got involved in operating prisons. To operate for-profit prisons means that these prisons need to be full. The prisons sign contracts with the government guaranteeing 80-95 percent occupancy for the next twenty years! In order to fulfill those contracts, the police then need to arrest more people and the judges need to hand out lengthier sentences to ensure they are full.
The prisons then spend millions of dollars lobbying to congress for stricter drug laws to ensure they make large profits. In turn, congress (the ones that make the laws) start to invest in these private prisons.
In a nut shell, the prisons give money to the law makers to make tougher laws and then after accepting this money and passing laws, these members of congress invest money in these businesses knowing that they cannot fail since they just wrote the laws. Everyone gets rich besides those struggling with addiction.
Instead of paying attention to this corrupt system, we blame the victim – the addict. If you have ever been inside a jail, you know that there is no rehabilitation going on inside those walls. It is a place in which one group of people has absolute power over another which is a recipe for corruption. We take our most abused traumatized people and we continue the abuse.
Some have said this is starting to get better. We now are doing more drug courts and forced treatments and getting people the help they need. However, we still have this epidemic. If we are trying to recognize this as a disease and get people into treatment, why is it not working?
Insurance Companies and Treatment:
We also have for-profit health insurance companies in this country. That means that in order to make profit, they need to minimize costs. The best way to do that is to deny benefits.
Insurance companies do not want to pay for inpatient treatment because of the cost. They will listen to the person’s story and they will decide that it is not medically necessary for them to do inpatient treatment and will only outpatient. I have seen this happen far too often. Then the person ends up relapsing, which leads to further problems – legal, health, assaults, rape, overdose, and death. If the person does live through it, they are then offered inpatient treatment – but only for four weeks. How are you going to treat a disease a person has had engrained in their head from the time they were a child in 28 days?
Meanwhile, the CEOs of these insurance companies are making between 10 and 15 million dollars per year. They are making enormous amounts of money by denying you care! This isn’t just addiction; they are denying all forms of health care because that is a loss for their for-profit business model. This is the true meaning of mental illness – taking up more than you need while others are suffering.
Tommy attempted outpatient many times but would always relapse because he never had a supportive place to stay. They then judged his effort and that he was doing this to himself. He would get reported to his probation officers and return to jail. Eventually, after an overdose and placed in detox, he was offered inpatient treatment. But only because he lived in a state in which the government will pay for inpatient treatment. If he lived twenty miles to the east, in Wisconsin, they would not offer inpatient treatment. Instead, they pay for countless outpatient treatment which ends up costing everyone far more money.
But in Minnesota, there is a stipulation to that. They will only pay $183 per day to the facility. This leads to the treatment centers needing to significantly cut down on expenses just so they can operate. They hire low-quality staff, in poor recovery settings, and cram people into houses – not to get rich, but to pay the bills.
There might not be a worse-trained medical profession than drug and alcohol counselors. They are being paid to treat an illness that involves more than just drugs and alcohol but someone’s lifetime of pain and trauma. You only need a four-year degree and a few months of internship. The counselors are then paid less than $40,000 out of school – and you get what you pay for. How are you supposed to get quality professionals when they are poorly trained and offer them an outrageously low salary for the work you are asking them to perform? In Wisconsin, you only need a two-year degree! This leads to many 23-25 year olds entering the field, albeit with good intentions, trying to “save the world” but are in over their heads. Then they fall into a corrupt system which judges the patients, calls them names, belittles them, and questions their behavior without really knowing anything about the disease other than what they learned in a textbook.
Ninety-five percent of Drug Rehab programs are unsuccessful. A 10-percent success rate is considered good. What other business would continue to exist with those numbers? However, they can always fall back on blaming the patient and show their phony progress notes that show “we did all we could” and they were just noncompliant.
I travel to see patients in treatment centers all over and the biggest detriment to the patient is the attitude of the staff. These are the people that need the most compassion and encouragement, yet they continued to get shunned and belittled. The industry is about filling beds, cutting corners, and saving money. If it is about helping people, we are failing miserably.
Then there is the all-powerful Big Pharma that plays into the equation. America consumes 80-percent of the world’s pharmaceutical drugs and has by far the biggest problem with abuse and addiction in the world.
The United States is one of two countries in the world that allow the pharmaceutical companies to advertise on television. This leads to an influx of patients asking for drugs by name at their doctor’s office. There is big money involved in doctors and psychiatrists prescribing certain drugs which highly affects their prescribing practices.
There was information made public under a provision of the 2010 Affordable Care Act that mandated disclosure of payments to Doctors by pharmaceutical companies. Surveys conducted in 2004 and 2009 showed that more than three quarters of doctors had at least one type of financial relationship with a drug or medical device company. I have been in doctors’ offices in which the patient is doing well on a medication, however the doctor changes to a prescribed med. When I worked at the county hospital, one doctor had 75% of his patients on Abilify. What was interesting about that is that the average for Abilify is less than seven-percent of the market. However, this Doctors wife was a sales rep for Abilify. She made commission on his prescriptions, and he also did speeches for the company. You won’t see this in a study, this is what happens in real life, and I had access to this as I did the audits. This was a Doctor making his patients sicker so he could increase his portfolio. Then when the patients get sicker and go to the hospital, we can simply blame the patient, or the victim. Who is going to believe the sick patient over the respected Doctor if the patient brings this up?
It also becomes easier to write a prescription to a drug than to treat a patient with an illness. Tommy was offered anabuse to stop his drinking. This is a drug that makes you violently ill when you drink on it. Easy enough, he stopped the pill when he wanted to drink. They tried giving him methadone in which he continued to use other opiates. He was given Adderall because his behavior was viewed as signs of mental illness, which is s drug that resembles methamphetamine and this was quickly abused. They were treating a drug addict with drugs; he was getting sicker while they were profiting.
Tommy was eventually placed on what is called a Civil Commitment, meaning he is a danger to his self or to others. He was court ordered to go to treatment – that is how he got into treatment. Think back to his story for a minute – it is actually an easier route to get into treatment once you become a danger to yourself or society than to just offer treatment when the person is in need. How much more damage do we do to the individual and their environment by waiting this long?
In a commitment a social worker will follow the patient to make sure he follows through or else he can be sent to detox facilities or state hospitals. The social workers will typically have caseloads of 20 to 30 people, with ridiculous amounts of paperwork. So they do not see the patients as much as they should, and most of them again come from a background of suburbs where they wanted to “help the world.” While their intentions are good, they are unqualified to handle this type of work. When a patient does not follow orders, instead of going out and meeting with them and working it out, they revoke their commitment resulting in more punishments.
Now this may be as close to a solution as I have ever seen, and the state of Minnesota is far ahead of the pack in doing this. However it is a great vision with poor training and execution; so it is turning into more of punishment-based, ineffective, and damaging solution.
Tommy was kicked out of treatment for missing his third group. He was depressed, having nightmares, and had never been sober. His family would not talk to him and he had no one. He was feeling feelings that had been bottled up his whole life on top of the physical symptoms. His doctor continued to prescribe him a med that made him have side effects, he told the doctor. However the doctor told him he had to take it or he was non-compliant and would report him to his probation officer and his case manager and he would go back to jail, or a state run facility.
A state run facility is basically a warehouse where no real treatment takes place. What they do there is hold people and claim they run groups – they certainly bill the insurance for the groups, but they do not actually run them. Taxpayers are being defrauded by these places. I have no study, but I have seen it. Why do you think they have no cameras in the facilities? While they hide behind the HIPPA laws and say they are protecting the patients, but they are protecting themselves from their fraudulent practices and mistreatment of patients. If the public knew this, they would be forced to change.
They do not do any real treatment; they all beg not to have to do the groups with the patients. The staff at these state facilities is some of the worst that I have ever seen in my 21 years. They get paid less money and again you get what you pay for. They have absolute power and more corruption and abuse. Patients more often than not leave these places worse off than when they are committed.
So for Tommy, back at treatment, he was then taking a med that made him sick, which led to him missing groups and was called non-compliant which justified him being kicked out. His chart would likely read “He is not ready for treatment.” It will also include his criminal record, lack of education or work history, failed treatment episodes, etc. This is the exact reason I refuse to read a patients chart until I meet them. I do not want someone else’s opinion as it gives us preconceived notions and then we start looking for these things. However, most folks in the field will read the chart and their mind is made up before ever meeting the patient.
Tommy was now kicked out of treatment. However he was still on commitment and probation.
Tommy had gone to state hospitals and they let him go. He went to shelters and they let him stay one night. He called old friends, knocked on doors, reached out to family and no one helped. Many people saw this man, but no one did anything to help. He was just a number to so many industries and no one took time to hear his story.
Then he had his overdose.
When I walked into the room where the casket was, no one was in the room. It was silent.
Maybe because deep down inside, we know that we killed Tommy. All of us. But we won’t admit that. Or maybe people just do not care, and trust the authorities and the “experts” to solve the issue.
The teachers who knew, the social workers who did not want to do the extra paperwork or take the extra time, the neighbors, those working at the clinic, the doctors just feeding drugs, the schools that train the counselors, the insurance companies, and the legal system all missed their cues. Everyone is so concerned about themselves and keeping their jobs, that we look the other way. This is our doing.
In the end, Tommy left the world the same way he came in, alone.
This is the addiction epidemic. It continues, because we want it to. We created it and many industries and individuals profit handsomely off of it. We take the most sensitive traumatized, shamed individuals of our society, and we lock them up, re-shame them, label them, and watch them die slow deaths while we make money off their misery.
The one glimmer of hope I had watching Tommy’s story was towards the end, in a meeting. He was being yelled at by staff, family members, probation, and all those assigned to help him. He left the room. Everyone said see he does not care. There was a staff member there who was about 30 years old. She got up and left the room; she went up to Tommy and gave him a hug. He cried. They talked, he came back in the room and they had built a relationship eventually and he did have some sober time before the relapse.
She was reprimanded and written up for this incident. It is more about following your boss’s orders and mirroring their values than doing what was right. But one out of 10 people will do what is right anyways. However most of humanity has been programmed to do what they are told by authority – research Millgram Experiment for evidence.
But that hug kept Tommy alive for about a year. For that one moment, he got what he always needed, what we all do, but he never got. She was reprimanded for it but it extended his life. She gave him peace without drugs. She gave him hope. It is people like her that could change this epidemic. However she has since left the field. It is people like her that should be leading this field, not leaving it.
In that last year of his life, he had a son. He would not have been born if not for that hug. That’s how you change the world. Let’s hope our society treats Tommy Jr. better than we did his father.
It is not an addiction problem we have, it is a humanity problem.
“You may choose to look the other way but you can never say again that you did not know.” – William Wilberforce
Taking the Mask Off: Destroying the Stigmatic Barriers of Mental Health and Addiction Using a Spiritual Solution
“Taking the Mask Off” is the new book by Cortland Pfeffer and Irwin Ozborne. Cortland Pfeffer spent years as a patient in psychiatric hospitals, treatment centers, and jails before becoming a registered nurse and working in the same facilities. Based on his experience, this story is told from both sides of the desk. It offers a unique and valuable perspective into mental health and addiction, revealing the problems with the psychiatric industry while also providing the solution – one that brings together science, spirituality, philosophy, and personal experience.
Recommended articles by Cortland and Irwin:
- Over The Rainbow: The (Yellow Brick) Road to Enlightenment
- Licensed to Kill: Psychiatry, Big Pharma and the State-Sanctioned Drug Cartel
- Celebrating Genocide – Christopher Columbus’ Invasion of America
- The Craving Behind the Craving: Addiction as a Spiritual Disease
- Bipolar? Or Gifted? The Modern Day Epidemic of Medicated “Madness”
- Suicide: Falling Through the Cracks of Stigma
- The Fictions Surrounding ADHD and the “Chemical Imbalance” Theory of Mental Illness
- Schizophrenia – Psychosis or Something More Profound?
- The War On Drugs: How the “Land of the Free” Became the “Home of the Slaves” for 2.3 Million Americans
- What If We Are The “Bad Guys”?
About the authors:
Cortland Pfeffer founded Taking The Mask Off in 2014 to help shine a light on the mental health industry (as well as other areas of our society that are shrouded in deceit and misinformation). Sharing insider perspectives and real life stories that have been gathered over 20 years in the field, Cortland (a pen-name) is a psychiatric Registered Nurse who was himself once a patient in psychiatric hospitals, jails, and treatment centers. He now wishes to share his experiences with others, and has recently made several public speaking appearances. Cortland can be contacted for speaking engagements via email: [email protected].
This article was co-written by Cortland’s partner Irwin Ozborne (also a pen-name). An avid historian, Irwin Ozborne is a survivor of childhood abuse and torture over a period of 13 years, and a recovered alcoholic. As a mental health practitioner, today Irwin practices holistic care and incorporates eastern philosophy into his work with clients. He is available for speaking engagements as well, and can be contacted via email: [email protected].