alternative recovery

Heroin Addicts Are Turning to Tumblr to Tell Their Stories — And Save Lives

Originally published in Mic.

“One and done is the rule for using needles,” Nicole*, an 18-year-old from Long Island, New York, writes on her Tumblr, nicolethedopefiendqueen. “After you use it once, dispose of it (capped, in a sharps or other container); you really shouldn’t be reusing needles if you can help it. A fresh, new needle is always better than a used one, even if it’s been sterilized.”

Nicole is an active heroin user. In an email interview, she said she began using at 14 after coming across her terminally ill father’s OxyContin prescription, which eventually evolved into heroin use. On her Tumblr, she posts selfies and re-blogs moody screengrabs from drug movies like Trainspotting, as well as close-up shots of spoons, lighters and syringes.

But to hear Nicole tell it, she doesn’t just use Tumblr as a platform for blogging about her heroin use. She also teaches other users how to do heroin safely. Her blog contains information about what to do if an overdose occurs, as well as how to administer Narcan (naloxone), an emergency antidote to treat opiate overdose.

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“I decided that if I’m going to have a drug addiction blog with lots of followers, I must spread harm reduction information, because addicts deserve to be healthy and to live,” Nicole said in an email interview. “I advocate for safe intravenous drug use, especially to help prevent infection and overdoses.”

Heroin addiction is a rapidly growing epidemic in the United States. The Harm Reduction Coalition reports that overdose is the leading cause of preventable accidental death in the United States, second only to car accidents. Since 2000, opiate overdoses have increased by 200%, in large part as a result of an increase of pain medication prescription, the Centers for Disease Control and Prevention reports. Because pills and heroin are sold on the black market, opiate use can be difficult to track, but a 2014 report estimates there are 1.5 million “chronic” heroin users in the United States.

Nicole’s blog is one of many on Tumblr that track the lives of regular opiate users. Many of such blogs’ posts feature the hashtag #nodsquad, a community that curates images of drug paraphernalia as well as information and resources promoting safe drug use.

Such blogs are based on the principles of harm reduction, which aims to reduce harm associated with drug use, such as overdose and spread of diseases like hepatitis C or HIV, through counseling, opiate substitution programs like methadone and safer injection facilities, or legal, supervised injection facilities where people can use heroin under medical supervision. (There are currently no supervised injection sites in the United States, but some cities and states like New York have toyed with the idea of introducing them.)

As Nicole explains it, “harm reduction is about reducing the damage and harm done from using. It’s not about stopping use, it’s about safety, which is the realistic approach to saving addicts in this epidemic.”

It’s a strategy distinct from abstinence-only programs such as traditional 12-step recovery methods, as harm reduction psychotherapist Eddie Einbinder said in a phone interview. “Harm reduction is not anti-abstinence,” Einbinder stressed. “Harm reduction is pro-choice.”

Susan E. Collins, co-director of the Harm Reduction Research and Treatment Center, thinks Tumblr blogs like Nicole’s can help to reduce harm caused by heroin use.

“[Nicole] is a person who appears to really care about her community, and is trying to help people use safer,” Collins said in a phone interview. “She is trying to reduce harm, and is being honest about where she’s at and her recovery. Personally, I think all of that is really admirable.”

Social media has created a space that didn’t previously exist for active users to connect with others and share information about how to use drugs safely, such as how to sterilize a needleafter use.

“A core concept of harm reduction is meeting people where they are, and I feel like most people don’t spend their spare time reading up on harm reduction techniques. But people spend time on social media like Tumblr,” Caroline, who keeps her own harm reduction blog, fuckyeah-harmreduction, told Mic in an email.

“Having a resource for harm reduction information on a platform that people are already using is a great idea.”

Caroline is not a user, but she became involved in the movement through a harm reduction organization she volunteers at in Washington, D.C., most often doing needle exchange or distributing safer sex supplies.

That said, some of the information being shared on Tumblr, such as user videos on how to shoot up safely, can be shocking to watch for those unfamiliar with intravenous drug use. Such videos, as well as artily lit images of spoons and stashes, has prompted debate as to whether such blogs glamorize drug use. It’s also worth noting that some users visit the blogs as a way to find drugs, if asks from users looking to score in a new town or city are any indication.

“Could it glamorize the use? I think yes,” Einbinder said in a phone interview. “It is hard to create a completely objective vision when you’re creating different forms of reality.”

Other professionals agree that the Tumblr community has potential for both help and harm.

“On the one hand, users are often the experts of their experiences and their own needs. If a user is generating content which is informed, safe, promotes hygiene, and teaches people how to reduce risks, then it can be powerful and helpful in a way that resonates with other users,” Sheila Vakharia, a coordinator of a substance abuse counseling concentration for students at Long Island University, Brooklyn, said via email interview.

“However, if user-generated content is full of people doing things in risky, unhygienic ways or if they are sharing false, mixed, or un-researched information, it can be just as harmful as any other problematic content on the web.”

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The blogs also raise the question as to whether Tumblr has any obligation to monitor content that promotes drug use on the platform.  (Mic has reached out to Tumblr for comment, and have not received a response at the time of publication.)

“I don’t necessarily think that platforms have a responsibility to monitor drug use content because it seems like a slippery slope,” Vakharia said. “I also understand that sales or advertisements of illicit drugs are in violation of laws. However, instructional videos from the health professions show doctors/nurses injecting patients all the time. Should a video of a person doing it to themselves be censored because the vial is filled with a substance that we think is illegal?”

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My Shrink Broke Up With Me

Going back to the dark days in my latest for Broadly.

According to therapist-cum-speaker Dr. Julie Gurner, “A responsible psychologist will always make a referral if the client continues to need treatment elsewhere, but it is ultimately the client’s responsibility to follow through with that referral. An exception to the client taking responsibility for follow through might be if they are feeling unsafe (suicidal) or are compromised in some other way.”

Two years ago, on a hot New York Summer’s day, still drunk from the night before, I walked into my shrink’s office and told him I needed to quit drinking and wanted to kill myself. I’m not sure if it was as cohesively articulated as that, but rather a rambling about how high a sixth floor walk-up apartment is, various uses of a cleaver, and that Lenny Kravitz had jumped out of the audience to play drums at the show I attended the prior evening. Regardless of my exact words, my psychiatrist’s response was clear: “I am no longer qualified to treat you, and I must terminate this relationship.” My ex-shrink told me he would be in touch with names of doctors who would be a better fit, and I wandered into Washington Square Park, shielding the sun from my eyes.

The Summer of 2013 was brutal for me: a sexual assault, followed by an alcoholic bottom, a breakup, and my parent’s divorce–I was a suicidal nutcase. As it was August, my ex-shrink was going on vacation, so by the time he got around to calling me with those recommendations he promised, I was already in treatment with someone else, primarily because I was taking antidepressants and benzodiazepines, which were going to run out. Benzodiazepine withdrawal can involve seizures, so it’s something you don’t want to fuck with. “If the patient is taking medication, sometimes they will simply continue the medication under the supervision of the same psychiatrist, but their visits will be less frequent. This would all be an ongoing discussion with the patient,” says Amanda Itzkoff, MD.

I’m too crazy for a boyfriend right now, but am I too crazy for a psychiatrist?

Being broken up with by your shrink can be a brutal blow to the ego–it has you thinking “I’m too crazy for a boyfriend right now, but am I too crazy for a psychiatrist?” Flipping through old diaries from that period feels like stepping into a horrific rape scene that I’ve seen in a movie–there’s a fearful recognition, but I can’t believe I ever actually lived it. Back then; even I didn’t want to be around myself, so I don’t blame the guy for ending the client/patient relationship. But I was curious: why do shrinks break up with patients? Are they even allowed to do that? 

“There are guiding principles you should follow, rather than an official set of protocol,” explains Dr. Gurner. “In graduate school, the act of separating with a client is referred to as “termination.” A fair amount of attention is paid to how you separate from a client…because how we say goodbye and end our relationships is so important.

Often, a psychologist or psychiatrist will terminate a relationship because the patient is exhibiting symptoms they don’t feel qualified to treat, as doctors typically have specialties. A common occurrence of this lies among patients diagnosed with Borderline Personality Disorder, as 10 percent of individuals with BPD successfully complete a suicide attempt. “Some disorders are certainly more difficult to treat, but I have not known of someone ending a patient relationship because of liability. The only reason I would see someone ending a patient relationship based on a diagnosis, is if they did not feel they could provide the specialty treatment required,” says Dr. Gurner. “Almost everyone I know has unfortunately had a client end their life, but none of them have ever faced legal action or fear that element of their practice.”

If the client is not committed to treatment, I would terminate our time together.

It may not happen often, but shrinks can be sued, which is maybe why my very handsome doctor felt I was out of his control. “Yes, therapists can get sued,” says Dr. Barbara Greenberg. “If the survivors feel that it was inadequate care. That’s why with all of your patients you have to access carefully for suicidality, or any predictors of violence, and you are responsible, and yes, you can be held liable,” said Dr. Greenberg. One of Dr. Greenberg’s specialties is treating BPD, so fear not Borderlines, there is indeed someone for everyone. “In my practice I get a lot of borderline personality disorders-I like people who are very energized who really need help; I find that stimulating. Substance abuse on the other hand, I might refer that person to see somebody else who had substance abuse as a specialty.” 

How many psychiatrists does it take to change a light bulb? One, but it has to really want to change it. An acquaintance of mine from high school was in treatment for alcohol abuse, and her doctor ended the relationship upon continuously catching her in lies about her drinking habits. “If the client is not committed to treatment, I would terminate our time together. People come to therapy for various reasons, but I would never accept a patient or keep someone as a client who was there at the wish of someone else,” says Dr. Gurner. 

If you’re suffering with substance abuse, please get some help. Find an AA meeting, or if you’re like me and don’t jive with the 12-steps, understand that there are other options. There’s the Buddhist recovery group Refuge Recovery, the science-based SMART Recoveryharm reductionayahuasca healingSatanism, honestly whatever helps you get your life together, I’m in support of.

Because we all really are different beautiful little fluffy fucking snowflakes, aren’t we? As with recovery, when seeing a shrink, it has to be the right fit, or it’s not going to work out. “There has to be chemistry. I call it the “relational bond.” If that bond doesn’t exist, you really can’t do good therapy,” says Dr. Greenberg. A cool thing for me about quitting drinking, is when I was drunk, I checked off all the boxes for probably dozens of diagnoses. When I stopped, it turned out I wasn’t insane; I’m just someone who absolutely does not mix well with alcohol. One spanking new fantastic shrink and two years later and I’m no longer drinking, and no longer suicidal. Maybe, if it continues to go well, the eventual breakup will be amicable. “The goal of any good therapy is separation, and that you’ve taught them how to manage their symptoms well enough that they don’t need you anymore. You hope for them every good thing,” says Dr. Gurner.

weed Sophie Saint Thomas

Can Weed Really Help Addicts Recover from Alcoholism and Hard Drug Use?

I just browsed through my articles on here tagged “alternative recovery” and there was one one! I knew I had written more than that 😉 This was published on VICE not too long ago. 

Weed is having something of a moment. It seems all of my friends who used to spend their weekends drowning themselves at the bar have given up the bottle for the kush. And although the renaissance may have started out west, it’s rapidly spreading to the east coast. Jersey already has a medical marijuana program, and New York just released regulations for its own slated to start next year. With pot’s rising popularity, many people are wondering if we will see a corresponding decline in binge drinking and hard drug use.

study published last fall in JAMA Internal Medicine showed that states with legal medical marijuana had a 25 percent reduction in opiate overdose deaths. As a strong proponent of alternative recovery methods, I was eager to investigate. The internet is rife with blog posts and message boards about those who benefit from marijuana as an alternative to alcohol, or credit medical cannabis in their recovery from hard drugs and alcoholism. But despite legalization becoming an increasingly mainstream idea, stigmas have stuck around, and saying you’re getting clean by toking up can catch people off guard as much as announcing you’ve gotten sober through Satanism.

To learn more about weed’s use in recovery I spoke with Amanda Reiman, PhD MSW, author of the 2009 study “Cannabis as a Substitute for Alcohol and Other Drugs” in Harm Reduction Journal and manager of Marijuana Law and Policy at the Drug Policy Alliance. After completing fellowships with the National Institute for Health, Reiman now continues her research on the effectiveness of pot as a replacement for hard drugs and alcohol.

VICE: What did you find during your research when looking at cannabis as a replacement for alcohol and other drugs?
Amanda Reiman: I started looking at the medical cannabis patient population. Anecdotally we had heard from patients that they were using cannabis primarily because they didn’t want to use certain prescription drugs; they were looking for medicine that had fewer side effects. But we also found there were groups of people that were using cannabis because they had hazardous use of other substances, like alcohol or opiates. I did a large survey study in Berkeley of 350 patients. We asked them if they were, in fact, substituting: “Are you choosing to use cannabis instead of something else?” What we found was that about 75 percent of them were using cannabis as a substitute for prescription drugs, about half of them said they were using cannabis as a substitute for alcohol, and about 20 percent said they were using it as a replacement for illicit substances. That study was replicated with an additional 400 patients in Canada and we found the same thing. Then it was replicated a third time in Canada with about 1,000 patients, and we found the same thing.

And how does it work as a substitute?
We started to look at the mechanisms. I conducted a very small study a few years ago in San Francisco where we had eight individuals who were methamphetamine users looking to practice harm reduction. They were using [marijuana] to stay within a bound of methamphetamine use. And we tried to figure out what it was about the cannabis that was helping them stay within their boundaries of methamphetamine use. What was really interesting was that when we talked to the participants and asked them, “How is cannabis helping you not use methamphetamine?,” they all said pretty much the same thing, which is that one of their issues in trying to keep their boundaries is that they didn’t have the mindfulness. They would get the urge to use methamphetamine and just act on that urge without really thinking. Cannabis gave them mindfulness. They were able to slow down and really think about what they were doing, and what their body was saying to them. They were able to think about whether they really wanted to engage in methamphetamine use, or if they’d rather smoke some pot and go to sleep.

That makes sense.
The obvious thing is that [cannabis] acts as a psychoactive substitute. You want to get high on substance A, but instead you’re getting high on substance B. That’s a pretty simplistic way to look at it. When you take a little further look what you’re seeing is that there are actual properties of the cannabis plant that can aid in getting off of other substances. When you look at the withdrawal symptoms of drugs like opiates and alcohol—things like nausea, tremors, trouble sleeping—these are all conditions which cannabis is really good at fixing.

So for someone who’s trying to wean themselves off opiates or alcohol, having access to cannabis actually may make it less likely that they’re going to relapse, because the withdrawal symptoms won’t be as severe. One of the reasons people relapse is that the withdrawals get so bad. So if they can use cannabis to help with the withdrawal symptoms, it’s less likely that they’re going to return to that drug that was giving them problems.

If I told people I wasn’t drinking but was fine with smoking weed, some would say I’ve simply switched one addiction for another. What’s your response to that?
That is one very specific framework of recovery: abstinence-based recovery. But that’s only one framework when it comes to recovery. There’s a whole other framework around harm reduction where folks would say, “Look, as long as life is where you want it, and you’re not getting into trouble with the law, and you’re able to keep a job, and your family situation is going well and you’re happy, then that’s the most important thing.” The goal of substance treatment isn’t necessarily to demand abstinence as much as it is to help someone manage their life in a manner where substances are no longer interfering in a negative way.

SOBRIETY THROUGH SATANISM – LATEST FOR VICE

“Some find recovery in a church basement. Others need something with a little more Satan.” In a recent post for VICE I profiled Lilith Starr, head of the Satanic Temple Seattle Chapter on how she beat a nasty nitrous addiction with the power of Satan. Read HERE.