While the film, which won the Grand Jury Prize at this year’s Sundance Festival, is ultimately about perseverance in the face of incredible odds, it is difficult to separate the narrative from the meth-ravaged landscape in which it unfolds. Abandoned, ramshackle buildings, the toxic remains of exploded meth labs, and the hollowed-out faces of Ree’s addicted relatives—these are just of a few of the many images that shed light on the destruction the drug continues to cause in this forgotten part of the country.

Although most national surveys suggest that meth use has dropped significantly since 2005—when federal law restricted purchases of ephedrine and pseudoephedrine (meth’s active ingredients)—the movie reminds us that the problem has not gone away. In the words of Richard Rawson, Ph.D., a pioneer in methamphetamine treatment research, “The cocaine epidemic decreased dramatically in the 90s, but in the inner cities of America, cocaine/crack is still a massive public health problem. Similarly, the meth problem may not be bringing in a new bunch of 16-year-olds, but in Southern California and much of the Midwest, meth will remain a substantial problem for the foreseeable future.” Dr. Rawson explains that meth still decimates communities like the one Winter’s Bone depicts, yet we don’t hear about the issue nearly as often as we should. The reason has to do with where the drug is most prevalent—typically working class and rural areas that can easily fall under the radar. “It is easier for the national media and federal policy makers to recognize a problem when it’s on their doorstep than when it is primarily somewhere far away in rural America,” he says.

The tragic result is that many people in these desolate areas need help, but treatment options are scarce. Without treatment, these individuals will continue to ensure a steady supply of meth, which, according to Rawson, costs our country an estimated $25 billion each year in law enforcement, environmental, healthcare and other expenses.

Although filmmaker Debra Granik shot Winter’s Bone entirely on location, cast locals in supporting roles, and spent time observing residents go about their daily lives, some natives of the Ozarks have complained that the movie plays into stereotypes of impoverished “hill people” as mean, violent, uneducated, and strung out. (Notably, the breakout film Precious received similar criticism for perpetuating the 1980s myth of inner city “crack mothers.”) However, I think we can be grateful to Granik for spotlighting a problem that is very real for the communities where meth continues to wreak havoc. This is reason enough to see Winter’s Bone. You may find yourself white-knuckled on the edge of your seat (as I was) and you may have trouble falling asleep afterward (as I did), but hopefully, you’ll leave with this: When it comes to wiping out the meth problem, now is not the time to say, “Mission accomplished.”

Kate Schmier
Blog Editor, Phoenix House

But unfortunately, it isn’t.  Over the past few years, we as treatment professionals have heard this scenario all too often. At Phoenix House, we’ve seen a sharp rise in adolescent heroin use. Three years ago, we treated teens who primarily used pot, alcohol, PCP, or Ecstasy; almost none were addicted to heroin. Today, heroin is the drug of choice for 50 percent of our young clients, many who are just 13 to 15 years old. 

This is evidence of a troubling trend across the nation.  Although heroin use in general has declined or leveled off in many areas, the rate of heroin use among teens has increased dramatically—especially in the suburbs.  And they’re not the kids you’d expect.  They’re kids like Natalie Ciappa of Long Island, an honor student, cheerleader, and star of school plays. In 2008, days before graduation, her parents found her dead from a heroin overdose. That year, Natalie was one of 46 people in Nassau County to die as a result of heroin use, a 75 percent increase from the year before.

What’s scary is that often, the progression to heroin takes place over a short period, sometimes as little as six months.  Kids typically start with pills they find in their parents’ medicine cabinets. Some participate in “pharm parties,” where each person tosses prescription drugs they’ve found into a bowl and party-goers help themselves.  Some begin “doctor-shopping” or buying drugs online. At some point, teens realize that it’s easier, cheaper, and faster to get a $5- to $10-bag of heroin than $40 to $75 Oxycodone.  Many start by snorting heroin and then, chasing a more intense high, they begin injecting.

This short window makes it difficult to recognize the problem before it becomes a life-changing addiction. And kids who are hooked on heroin don’t always look or act the way you’d think a drug-addicted teen would. It’s not uncommon for teens to continue doing well in school and keep up with extra-curricular activities. That’s why—even for the most involved, responsible parent—a child’s addiction may not be apparent until the tell-tale track marks appear.

When this happens, parents must recognize two hard-to-swallow truths about their teen’s substance abuse: They didn’t cause it and they can’t cure it.  What they can do is to support their child’s recovery in every way possible—starting with getting them into a comprehensive treatment program.  Sadly, this isn’t always easy.  In many cases, families must pay out of pocket or the teen must be involved with the criminal justice system in order to receive treatment.  This has led some parents—like Kelly B. whose son Kevin is now in treatment at our Long Island Academy and who recently appeared on Geraldo At Large —to turn their kids over to the authorities in order to get them help.

While we can’t fix the system, we can ensure that the kids we treat get the care they need while they’re with us.  Our adolescent programs, which offer educational services, collaborative services with criminal justice, and provide support to families and siblings, are not fully covered by government grants.  On Long Island, an area that has been hard-hit by the heroin epidemic, a considerable portion of our operating costs is covered by individual donations. That’s why, each year, we host our summer party—to honor these kids and their recovery and to raise funds so that our programs can continue to help them get their lives back on track.  I hope you’ll join us in supporting these young people who deserve a second chance.

Deni Carise, Ph.D.
Chief Clinical Officer, Phoenix House
Adjunct Clinical Professor, University of Pennsylvania
Senior Scientist, Treatment Research Institute 

**Click here to learn more about our summer party in the Hamptons on June 26, benefiting our Long Island programs.

At the age of eighteen, I saw the Air Force as less of a patriotic duty than a means to an end—a way to finance my college education. But the military played a much more pivotal role in my life than I had imagined. Working in inventory management for four years, I had the opportunity to travel to 29 states and nine different countries. The experience opened my eyes to new cultures and places, and taught me the importance of hard work and discipline.

And, it also taught me how to medicate my feelings with alcohol and drugs. One of the only African American women on our base in Texas, I was young and unprepared to deal with the racial and sexual harassment I faced. Adding to the stress, my tours, lasting three to twelve weeks at a time, required constant traveling—often on fourteen-hour flights, strapped in a C-130 aircraft, in the middle of the night. To cope with the intensity of our work, we regularly binged—and the commanding officers turned a blind eye. If we didn’t like to drink, we could easily find marijuana, LSD, or acid. Sometimes, we’d even take speed before getting on the plane.

The structure of the Air Force kept my drug use to a level where I could still meet everyday responsibilities, but my life began a downward spiral once I returned home. I got into cocaine and eventually transitioned to crack. Within two years, my addiction reached a boiling point. I lost my car, my job at a cosmetics company, and ultimately, I became homeless. Still, I didn’t seek help; the Air Force had trained me to be tough and to believe that I could handle my problems on my own.

It was only after my mom refused to let me come home for Thanksgiving and I participated in a summer tent revival that I finally reached out. I asked my mother to call a relative who had completed the program at Phoenix House and had gone on to work there. I entered Phoenix House on October 12, 1989 and have never looked back.

Today, as I march with Phoenix House in the Veterans Day Parade, I will think of the young men and women returning home after so bravely serving our country. According to the latest NIDA research, 25-30% of Iraq and Afghanistan War veterans have reported symptoms of a mental disorder or cognitive impairment—post-traumatic stress disorder (PTSD) being the most common. Between 2004 and 2006, 7.1% of veterans (an estimated 1.8 million people 18 or older) met criteria for substance abuse.

If my story could be an example to any one of these young people, I would tell them, “Psychological wounds are as real as physical ones. If you find yourself turning to alcohol or drugs, don’t think you can manage addiction on your own.”  

As we honor our veterans, we must work to overcome the stigma of treatment. I am living proof that recovery is possible. Twenty years sober, I now have a career that fulfills me in ways that drugs never could—and a marriage to a man I’ve loved for 18 years.

This Veterans Day, I salute both my military family and my Phoenix House family for helping me to become the strong, resilient person I am today.

For information about Phoenix House’s Veterans Program, please contact Tali Shmulovich at tshmulovich@phoenixhouse.org.

On my first visit to Phoenix Academy twelve years ago, I remember the school’s secretary laughing after I asked what kind of private school it was. I wasn’t familiar with the program and, with its pleasant entrance and unusually peaceful atmosphere, it didn’t look or sound anything like the large public schools where I’d taught in the past.

We started playing a guessing game, until she finally explained that the school served students who were recovering from drug and alcohol addiction. It wasn’t a private school, she told me, but they were fully accredited and the class sizes were small—a maximum 17-to-1 student-to-teacher ratio. Wow, I thought, this would be a challenge.

When I came back for an interview and tour, the principal assured me that teaching at Phoenix Academy would be a rewarding career with the at-risk school population in Los Angeles County. What I really got was the opportunity to re-charge my teaching career, change some attitudes about education, and make positive contributions to the communities, families, and students I serve.

Every year, several of my students ask, “Why do you want to teach drug addicts, anyway?” My response is not simple and sometimes causes me to get a big lump in my throat. I teach at Phoenix Academy because I believe I am part of an organization that offers at-risk youth the second chance they so desperately need to get their lives back on track. I am constantly reminded that the challenges I faced growing up in a small town in North Dakota in the 60s and 70s pale in comparison to what my students face every day. The family difficulties, pressure from peers, and access to illicit and dangerous drugs require them to develop a strong character, resilience, and a positive support system to survive.

Despite these struggles, I’ve learned at Phoenix Academy that every student has the potential to accomplish something great and worthwhile—and my job is to help them find it. As I tell my students, “You may feel like everyone else in your life has given up on you, but I’m not going to give up on you.” To convince them that I was really serious, when I first started, I learned the Phoenix House philosophy—words that they must recite at least twice a day—and delivered it in front of my class. One of the kids got up and presented me with a dollar bill, which I’ve kept to this day. That token of their faith in me—along with the letters I’ve received from former students and their parents—are the fruits of my labor.

Through the years, I’ve witnessed the transformative power of an effective drug-treatment program—in combination with a supportive and responsive education program. Just as traditional approaches to education do not work with every student, not all drug treatment programs work with every client. But the therapeutic community concepts of taking responsibility for your actions, being held accountable, working as a team, and showing concern for others are successful techniques in helping my students live sober and productive lives.

Watching a student make better choices, problem solve, and rise to the challenge instead of running away from adversity is powerful and inspires me to look forward to each day on the Phoenix House campus.

Now, whenever a new student asks me why I do what I do, I think of the following quote from Rep. G.K. Butterfield (D-North Carolina):

“A second chance means an opportunity to turn a life around—a chance to break the grip of drugs…[A second chance] is the humane thing to do.  It is the responsible thing to do. It is the right thing to do.”

A recent study by CASA, Columbia University’s National Center on Addiction and Substance Abuse, found federal and state spending on health care for drug, alcohol and tobacco abusers totaled more than $200 billion a year. A fraction of this money goes to treating addiction and promoting recovery, while the lion’s share is swallowed up by treatment of the many acute and life-threatening conditions caused by the disease. A federal study found 1 out of 14 hospitals stays each year — which account for 2.3 million admissions — are directly related to drug or alcohol abuse alone. 

Not only are substance abusers costly health care consumers, so are their children. One study found children of cocaine users incurred three times the health care costs as children of non-using parents. Another study, examining neonatal health care costs in one hospital, found that costs for newborns of women who had used cocaine during their pregnancies averaged $5,200 more than costs for infants who had not been exposed to the drug.

 Suppose we addressed the cause rather than the effect and invested in appropriate addiction treatment for the estimated 23.3 million substance abusers who need treatment but don’t receive it – and whose addiction will ultimately cost us more?  We now have a wealth of proven, evidence-based programs and practices that deal with substance abuse as the chronic condition it is. Can they bring down the cost of health care? 

They can and they have.

 A California study found that the total medical costs for men who received substance abuse treatment dropped 26 percent, while their in-patient hospital costs and emergency room bills came down by 35 and 40 percent, respectively.   

With substance abusers making up about one eighth of the nation’s Medicaid population, it seems logical to increase what we spent treating the disease, and, in so doing, reduce the enormous economic burden of treating the symptoms.

If you saw my mother and me today, you probably wouldn’t guess that I didn’t really know her until I was a teenager.

When I was four, she made the most difficult decision a parent can make. Battling addiction, she realized that she couldn’t raise me in the way she felt I deserved. For my own wellbeing, she decided it was best that I leave her care and live with my paternal grandparents.

For the next ten years, I saw her only occasionally—even though we lived not too far from one another in Brooklyn. I didn’t resent her (from the beginning, my grandparents taught me that she did what she had to do), but at the same time, we didn’t have much of a connection.

It wasn’t until I was in high school that we began to form the close relationship we have now. By then, she was clean and had started working at Phoenix House. She reached out to me and we began seeing each other more frequently on weekends. If it weren’t for Phoenix House, I wouldn’t have her here with me today.

At 23, I’ve pushed the rare flashbacks of my parents fighting to the deepest parts of my brain—and instead, focus on the wonderful memories my mother and I have worked so hard to create. I think of the volunteering I’ve done with her at Phoenix House—where I’ve had the chance to see the incredible work she does. And I think how much I’ve enjoyed getting to know her side of the family.

Through the years, we’ve come to an understanding. I am who I am and she can’t do anything to change my ways, so she only gives me encouragement and support with all of my endeavors.

Most of all, I appreciate the important lesson she’s taught me: with patience and understanding, a person can truly get through any hardship. It doesn’t hurt to have a little faith in God as well.

My mother’s name is Joan, so I always make the association with Joan of Arc. She’s the best candidate to be chosen as one of the twelve OASAS Spotlight Stories. While addiction is a vicious, chronic condition, she has taken control of her disease—and come out on top.

I have been in the substance abuse field for over 20 years, first as a treatment provider and then as a researcher. But it is through the eyes of a person in long-term recovery who has buried family members and close friends (one who was sober over 17 years prior to relapsing) that I understand the battle DJ AM faced.

Recovery, no matter how many years one has nurtured it, is never fully self-sustaining. It needs continued attention and dedication, just like any other chronic health problem. So, I ask, can someone in recovery ever be 100 percent confident they will not go back to drugs or alcohol?

Last year, DJ AM suffered critical injuries when a Learjet carrying him burst into flames during an aborted takeoff in South Carolina. He and Travis Barker of Blink-182 were the only survivors. After more than a decade of clean living, he found himself needing pain medications with abuse liability; he reportedly developed problems with opiates and benzodiazepines.

Then, he shot MTV’s Gone Too Far—an intervention-style reality show set to premier on October 5. He said his inspiration was to work with other addicts in recovery, his passion since the beginning of his sobriety.

I, like DJ AM, believe it’s important that people with past addiction problems commit to helping others. But he may have truly “gone too far.” The drug-using world might not have been one he was prepared to re-visit, given his recent losses and difficulties with pain medications. “I have to calm down after every shoot,” he was quoted as saying. “It’s very intense.” In video excerpts, he described buying a crack pipe to show how easy it was. Then he said, “I walked out…holding [the pipe]…and I realized my palms were sweaty and I was like, ‘Wait a minute, this is not smart for me.’”

Even after 11 years of sobriety, this isn’t unusual. Ask any one of us in recovery when someone inadvertently changes the TV station and a scene from Scarface shows a group of people snorting cocaine. It’s been over 24 years since I’ve snorted coke, but suddenly, I’m holding my breath—as if I’d just done a line.

So, should DJ AM have done the show? Is MTV at fault for his relapse and death? Here’s the bottom line: Just as people with diabetes are responsible for eating a sensible diet and exercising, we are also responsible for managing our recovery. But, just as the spouse of a diabetic assists their partner in managing their illness, we need people to help us, too.

Based on my research, my clinical background, and my own recovery experience, if I had been DJ AM’s friend, I would have told him, “Examine your motives. Think ahead to any emotions that might arise. Make plans to have the folks who support your recovery nearby when you’re taping and after each session. Talk to them, tell them what you’re feeling, and renew your commitment to your recovery each night. Most importantly, promise you will call me before you pick up a drink or a drug.”

And if I had worked for MTV, I would have advised them, “Make sure DJ AM has someone with him during filming—a long-term recovery mentor who knows him well and will help him process any cravings. Don’t ask him if the show is bothering him; he might be the last to notice it.”

 We have to wonder if this type of support might have saved his life.

This Saturday, September 12, I will think of him when I represent Pennsylvania as the state delegate at the A&E Recovery Rally—one of the key events for National Recovery Month. An expected 10,000 of us will march across the Brooklyn Bridge. I will walk in memory of my stepson, who died of an overdose just 15 months ago at the age of 30, and my old friends Mark and Mike, both of whom lost their battles with addiction.

 And I will walk in honor of DJ AM, who wanted so deeply to offer those in recovery meaningful support.

 It’s now up to us to carry his mission forward.

The great strength of “The Cleaner” is the show’s ability to dramatize the downward spiral of addiction, showing how drug misusers “get stuck,” and the difficulty they have of getting “unstuck.” In life, as on TV, an “intervention” is often the means of “unsticking” someone deep in drug misuse. Interventions may indeed be as dramatic as kidnapping or substituting sugar for the user’s drug of choice. But, while bringing together a team of “significant others” to “confront” the user makes for good viewing, it actually occurs rarely. There is an extraordinarily broad range of intervention strategies and they are employed every day in any number of different venues—family dining rooms and kitchens, therapist’s offices, business offices, factory floors, lecture halls and hospital emergency rooms.

The process of getting the drug misuser “unstuck” can begin in any one of these settings—but it only begins there. An intervention just starts the process, because getting unstuck requires serious engagement of the individual in a program of treatment responsive to his or her unique needs—a process pursued in an appropriate setting and involving others. These others may be trained professionals. They may be men and women with similar histories of drug involvement. A community of faith may be a critical part of this recovery process, as well as friends and family. Medications may be involved, cognitive behavioral therapies, prayer, hope, encouragement and opportunities to learn about oneself and master the skills needed to offset the long-lasting craving that comes with addictive behavior.

In short, while “intervention” may be as dramatic as those of “The Cleaner” or—as is more often the case—slow and guided, what counts is what follows!

We at Phoenix House have learned that what follows is a process of learning how best to achieve lifestyle change and continuing recovery. It is a process that varies from person to person. Each day, Phoenix House cares for more than 7,000 people in various settings and stages of recovery. We pledge that each receives the help he or she needs and each is treated with professionalism and respect. We recognize differences in need and our service delivery continuum is designed to respond to these differences. And, while “The Cleaner” deserves our applause, viewers also deserve to know that, no matter how getting unstuck begins, the greater need is for the rest of the process, which is what most of our field is there to provide.

David A. Deitch, Ph.D
Chief Clinical Officer, Phoenix House