A Practitioners Perspective

Meh......

It is easy to demonize or be dismissive of the afflicted. I am not a fan of mood altering substances, but neither am I prepared to support capital punishment or other punishment for the afflicted. Societies have punished and killed those people for thousands of years, yet no society has been without those who use mood-altering substances.

For over 20 years I worked in youth corrections, social work, and youth forensic psychiatric social work. Throughout my years of practice I came to understand some things. The following is a simplified synthesis because this is not a clinical discussion board.

Most of the females with drug dependencies had histories of child sexual abuse. Some were unable to physically escape the abusive situation. They would typically use one or both of two alternative “escapes”. One was to develop a mental disorder to dissociate from the situation. The other was to use a mood altering substance.

Others did physically escape… to the streets… where the only way they could support themselves was by selling their bodies. Yes, this perpetuated their abuse but it gave them a sense of control. Quickly, they discovered that the sense of control was illusory and they too escaped through mental disorder or mood altering substances.

None of those young women ever told me that as a child they wanted to grow up to be a drug addict.

Males had a different typical pattern. They would begin to develop signs or symptoms of a mental disorder. But being “crazy” was a bad thing. Going to a mental health professional was “seeing a head shrinker”.

It was far better to be “a bad boy” than to be “crazy”. The expression was, “Better bad than mad.”

They would begin using mood altering substance to “self-medicate”. By the time their mental disorder was established and diagnosable, they were deep into a drug dependency. (Many mental disorders have diagnostic criteria that result in the diagnosis not being available to youth.)

None of those young men ever told me that as a child they wanted to grow up to be a drug addict.

Their drug dependencies or addictions were the natural result of events beyond their control.

There is a significant problem with fentanyl deaths in the area where I live. Research indicates that addictions and resulting deaths largely have one of two precursors.

One is medical. A person like you is injured at work, in a vehicle collision, skiing, or in some other healthful activity. Their injuries are so severe that they are given medical opioids. They develop a dependency or addition. Then the opioids are cut off medically. But their body’s neuro-receptors still demand the opioids. Their only source is the street.

The other is non-medical. People buy a non-opioid street drug. But they aren’t getting what they thought they were buying. What they buy is laced with fentanyl. This begins the path of addiction.

Some people might think that all or some of these people ought to be punished, maybe even be executed, so that they suffer for their use of substances.

I think that most of these people have suffered enough already.