As our nation wakes up anxiety-ridden, collectively uncertain of whether we’ve been delivered from political catastrophe, many of us who are members or allies of the drug-user community are experiencing a particularly poignant feeling of powerlessness. Under a drug war sold on the false promise of keeping us safer, a procession of administrations on both sides of the party line have long instilled in us a sense of impotence over the events that shape our lives. Through social cataclysms and the attritional, mundane blur of quarantine, 2020 has distributed that same sense across the nation, culminating in today’s communal, tense wait for news.
But while one outcome will certainly offer greater hope for positive change, neither is poised to do enough to assuage one of the biggest issues faced by the drug-user population: the confusion of punishment and coercion with addiction treatment.
Such measures might sound like progress when touted in a campaign speech, but those of us who’ve lived through them know otherwise.
During his term, Trump has thoroughly demonstrated his commitment to a heavy-handed, supply-targeted approach that defies the recommendations of research and has fostered increasingly dangerous, often lethal instability in the illicit market. Biden’s plan to address the “opioid crisis” includes promising measures such as universalizing access to medications for opioid use disorder, but more supply-side actions, too—and, just as concerning, emphasizes replacing incarceration with forced treatment and social-services interventions. Such measures might sound like progress when touted in a campaign speech, but those of us who’ve lived through them know otherwise.
I don’t remember what my husband and I were arguing about two years ago on a day weighted by the thick wet heat of South Florida. What I do remember is the agitation it incited in me that I could feel spiraling in my chest. It’s a discomfort I know well, anger mixed with helplessness. Since eighth grade, when I began coping with negative feelings by using substances, that feeling has been one of my strongest triggers. But instead of rushing out to score drugs that day, I went for a jog.
My two young daughters had been removed from my custody by the state of Florida in April 2018, a few months before that fight. After my daughters were taken, I was angry. Really angry. I was a good mom, and even the investigator who filed for the removal admitted under oath that my girls appeared well bonded to me and their father, and showed no signs of abuse or neglect. All of my drug tests had come back negative, including the hair test that was able to detect use up to three months prior.
It was totally unfair, but I still had hope. Various delays by the people in charge of my case meant I was unable to access formal trauma or addiction support for more than six months, but I was determined to get my daughters back, which meant remaining abstinent. I designed a personal support system that included writing, utilizing online supports and rigorous exercise.
When I got home from the run that day, drenched in sweat but buzzing from the endorphins and no longer angry over the argument, it hit me just how effective exercise was for my recovery. But the state of Florida would find a way to take even that from me.
At my next case review hearing, the judge decided that my low creatinine levels meant I was intentionally diluting my urine to hide drug use. I explained that I was hydrating due to exercise, and that I ate a vegan diet (which is sometimes associated with lower creatinine levels), but she didn’t care. She marked my slew of negative tests as positive, stated that I was noncompliant with my case plan, and refused to move my case forward, keeping me on once-weekly supervised visits with my daughters.
I felt as though everything had been taken from me, and then when there was nothing left to have taken, the state still managed to take more. It was not long after that hearing that I finally did what they had been accusing me of the whole time—I relapsed.
Negative reinforcement as a recovery motivator has become such a staple that it often goes unchallenged.
“When we look at individuals who are involved with, perhaps the criminal justice system or whatever… instead of actually putting more involvement with community support, we do the opposite. We isolate them and punish them and those are actually more detrimental,” said Nelson Perez, an addiction counseling instructor at Minneapolis Community and Technical College. “We continue to utilize those things when it comes to criminal justice-involved individuals … Those things are not evidence-based, and people know that, but they continue to utilize those punitive measures.”
Negative reinforcement as a recovery motivator has become such a staple in mainstream treatment and recovery circles that it often goes unchallenged, despite the fact that it defies best practice—and common sense. In my case, there was a clear (if unarticulated) belief among everyone, from the state to my and my husband’s families, that taking away my kids would throw me into the condition of rock-bottom despair that would serve as that final motivator to never, ever take a drug again.
Instead, it broke my heart, robbed my life of purpose, and eventually sent me seeking some sense of peace and pleasure elsewhere, through the opioids that had filled that role before my elder daughter was born.
“The concept that as a condition or illness or disorder that you know is a behavioral health condition, that it’s best addressed through aversion and punishment and isolation to me feels one: unethical, and two is not scientifically grounded,” said Mishka Terplan, an OB/GYN and addiction medicine physician who consulted on my case. “Then somewhere in all of this too is this idea that you can’t trust people with addiction. They lie, they manipulate, that sort of stuff. I think that’s also really common currency amongst those who endorse those punitive things.”
“The idea that someone with substance use disorder must reach rock bottom in order to recover: It’s an assumption that is not accurate,” he continued. “For what other human condition is the solution withdrawing love and support?”
The harms of this approach are exemplified by the various systems that intersect with drug use in the United States, all of which punish and disempower, and have become so normalized that punishment has become, for many, an expected part of an addiction trajectory.
“The criminal justice system and the [addiction] treatment world are even becoming more connected.”
Dinah Ortiz, a harm reduction and parent advocate, drug user and mother with prior child protective services involvement, described her own version of the ensuing helplessness in her recent account in Filter of the day her son, who used drugs, was sentenced to federal prison during the pandemic. “My hands and legs were shaking. The tears were already streaming down my cheeks … I just saw my son as a six-year-old boy, surrounded by adults who were there to scold him.”
“People don’t realize using punitive measures doesn’t work,” Ortiz said over the phone. “It’s kind of like the definition of insanity: doing the same thing over and over again expecting different results. We’ve been doing this for years and it hasn’t worked. Whenever they terminate your rights due to drug use, whenever they break up a family, whenever they put you in prison for drug use, they don’t realize they are doing more damage and more harm than good.”
“The criminal justice system and the [addiction] treatment world are even becoming more connected,” observed Perez. So-called treatment programs are “becoming more ingrained and joined up with the criminal justice system. It has a lot to do with that they still don’t want to get rid of the same type of mentality that has been going on since forever.”
For me, the impact has been a long, slow decline in my and my family’s quality of life. It has been over a year since my daughters saw their elder brother, my son from a different relationship, who lives in Seattle. He has nonverbal autism and attention deficit disorder, which make communication by phone or video extremely difficult. The last time I saw him was during a brief work visit to Seattle in January, just before the pandemic impeded transnational travel.
My parental rights to my daughters were terminated in March and they were forcibly adopted to the paternal grandparents who initiated the case against me, one of whom suffered an alcohol-induced injury a few months into the case that has left him without executive function, including the ability to consent to the adoption. Although I am seeking signatures for a petition requesting their return and/or a third-party investigation and reopening of the case, the termination is technically and legally final.
Their paternal grandmother is their sole caretaker. As such, she decides when and if we are allowed contact. Recently, when she found out that I referred to her as “ignorant” in an online thread, she cut off all contact between me and my daughters for several weeks without any explanation to them. I only recently regained my three-days-per-week visitation allotment.
“I’ve probably never had a patient who had child welfare involvement who didn’t think about suicide at some point in time.”
A new study out of Canada found that mothers who lost custody of their children were at heightened risk of fatal overdose, and that this risk was especially high for Indigenous mothers. Erin Miles Cloud, a former parent attorney in New York City and the co-founder of Movement for Family Power, an abolitionist-centered advocacy organization that provided pro bono consulting on my case, described the study as “tragic and also an awful truth that we all know to be true.”
“I’ve probably never had a patient who had child welfare involvement who didn’t think about suicide at some point in time, or didn’t think about using, many of whom did use or engage in some kind of self destructive behavior,” observed Terplan.
Last year, the obituary of a mother named Megan Webbley went viral after she overdosed following the loss of her child to the system. This year, on August 29, Dylan Stanley, Harm Reduction Ohio’s illustrious director of community outreach, also fatally overdosed following the custody loss of her beloved daughter.
During our last few correspondences, Dylan and I discussed plans to co-produce a podcast with another harm reductionist mama. She was hurting, but she had plans and goals for the future. We also commiserated about our shared loss; hers was especially painful because her child is medically fragile, which meant COVID concerns limited Dylan’s ability to even visit with her.
The last time we spoke, Dylan was trying to escape an unsafe housing situation, and faced the loss of her belongings due to the cost of storage. She had also been dealing with criminal-justice involvement and high barriers to accessing evidence-based opioid addiction treatment, despite her deep desire to find help.
Megan Webbley and Dylan Stanley are two examples of the insidious, often terminal impact these punitive systems have on people who use drugs, particularly if addiction is a factor. There are many, many more like them—and many, many more to come if nothing changes.
The final outcome of the election will not in itself remove the cloud of misery hanging over millions of us impacted by these systems.
During a recent conversation with my husband, whose parental rights were also terminated, I described my life as a small dark room—one with a small window that is occasionally opened to a view of a sun-drenched idyll that is no longer mine. Every day, I have to decide whether or not I want to continue my life in the small dark room, or take my final exit. Every day that I decide to keep going for one more lunar rotation, I also have to decide whether sobriety has any benefits anymore.
When my rights were terminated, it certainly didn’t seem to. I spent months after the termination injecting fentanyl until my supplier unexpectedly ran out due to a major bust in Florida. If that dry spell hadn’t happened—and if I hadn’t had buprenorphine to help me through the physical withdrawals—I could very well have met the same fate as my friend Dylan. I still could.
The final outcome of the election, even if it’s the one we hope for, will not in itself remove the cloud of misery hanging over millions of us impacted by these systems. It’s vital to remember that.
“It’s tearing me apart,” Ortiz told me of having her 26-year-old son, a father to five children, incarcerated in federal prison for almost three years over a nonviolent offense. “Every day I wake up and try to say ‘today is a new day, today is a day that’s gone by, that is another day off the calendar. But he’s my… son. It’s horrible. When I speak to him, there are times I just sit on my bed after the call and my tears just come down.”