Picturing Addiction: The Work of Chris Arnade

Chris Arnade

It’s not uncommon to encounter ruinous examples of drug addiction in New York City on a daily basis. When I see grimy, young opiate addicts nodding out on the sidewalk middle of the day or aggressively panhandling, often with their dogs, even though I am substance abuse counselor it’s difficult to feel empathetic. 

Even the most compassionate of us flinch with judgment and hopelessness when confronted with such characters. It looks as if the most seriously addicted — street addicts — have refused help. The assumption is that they have given in to their addiction; they have resigned themselves to the misery of their situations. 

Chris Arnade, the street photographer/activist, focuses mostly on individual addicts and sex workers who stay/work around Hunt’s Point in the Bronx, an area not likely to be in any New York City travel guide. His work is similar to social documentary photographers like Jacob Riis and Lewis Hine, who used photography to expose social problems affecting the poor and the exploited. Likewise, Arnade’s work makes us take account of individuals whom we choose to not see. Considering street addicts as a group conveniently minimizes the problem of drug addiction. Arnade’s startling portraits and text makes us see individuals. His work humanizes a group of people who makes us uncomfortable. We find that we can identify with their desire for a better future.

Sex addiction and recovery: Thanks for Sharing

Here is a link to a really thoughtful piece/film review by Robert Weiss MSW on Thanks for Sharing. http://m.huffpost.com/us/entry/3982933

The movie was released a few months ago and it stars big name actors. I didn't think twice about it but reading the review made me want to see it.

I am interested in addiction to sex even though it's outside my training and professional expertise, because it can and does overlap with other addictions. The movie is also about recovery and the culture (hence its title) of 12 step programs (AA being the grand daddy), an essential part of addiction treatment and maintainence of sobriety.

Couple of points the wise Mr. Weiss wrote stood out for me, and I am going to paraphrase them: he said alcohol, food, sex, drugs and the like are used to fill the "primitive need to self medicate." Also, he said treatment and recovery from any type of addictions does not happen in isolation. Human connection is a necessary ingredient in healing.

More on these two points in future blog entries. 

Again, here is the link: http://m.huffpost.com/us/entry/3982933

Hazards of Molly

I recently wrote about the reappearance of MDMA or ecstasy as Molly. Despite it being touted as a casual and safe party drug, its hazardous potential cannot be underestimated. 

Case in point: Over the long Labor Day weekend, two young people died from ingesting Molly at an electronic music festival here in New York City. "Electronic music festival" is what used to be called a rave, just as Molly was called something else. As long as there are revelers, there will be chemicals that alter the mind.

Again, education is the best defense. 

Pills Are So Hip!

If AA isn't hip, pill-taking is, apparently.
The fashion designer Betsey Johnson for her upcoming fall fashion show in New York has designed invitations to look like prescription bottles filled with breath mints. 

Photo By George Chinsee

I am not sure how I feel about this. 
On the one hand, psycho-pharmacotherapy has helped countless people manage symptoms of mental illness. 
On the other hand, abuse and overprescribing have created unnecessary suffering
and deaths. 

Does it promote irresponsible drug taking? 
Or, should we accept that everyone is medicated and move on?

It seems this is yet another example of what some people do for fun (recreationally using anti-anxiety and narcotic drugs; taking Adderall or Ritalin to enhance mental functioning or just to stay awake to drink more) has the potential to be very harmful.

I hope there is a label on that "funny" invitation to warn people that medications need to be treated with caution.

More to come on psychostimulant abuse...

Blogging for Sobriety

I am a big proponent of journaling as a way to keep things honest between you and yourself. It's an invaluable tool that deepens self-awareness, whether or not you are in therapy.

And, there is blogging, not blogging as marketing, but personal blogging. It is a form of journaling, but it's not the lock-and-key, Dear Diary variety. Personal blogging is like keeping a journal that's meant to be read by whomever. It's personal and public at the same time.


It's therapeutic because making a declaration, which isn't exactly shouting, blogger reminds herself of who she is and what she aspires to become. It's writing for self-reflection and inviting others to witness the process, which CAN be an act of courage and commitment, or just a form of narcissism. It's much like "Hi, I am so and so, and I am an alcoholic" part of AA. 

Which brings me back to sober blogging. I like this blog very much for the reasons cited above and more. I hope it can inspire others to rethink their relationship to alcohol.

http://drunkydrunkgirl.wordpress.com/2013/09/02/inspiration-to-others/

Why AA Isn't Hip

Some of my clients are young problem drinkers whose alcohol abuse is severe enough to warrant their own concern. They come to me and other psychotherapists with the hope that they can gain control over their drinking habit which seems to be winning. Addicts they are not, they say, it’s just a matter of learning why they drink so much and to reassess their priorities and values. The objective is to no longer feel as if they are controlled by alcohol. Most are above average in intelligence with a promising future in one of the creative professions. Before seeking therapy, they have tried to stop drinking on their own and/or have gone to Alcoholics Anonymous for support, some repeatedly. Most of these clients stop going to AA for several reasons.Many complain that the atmosphere is depressing and off-putting. They feel they have little or no common with the majority of other AA members, besides alcohol. To them the typical AA goer is a wizened old timer who appears to have no other options other than to stop drinking entirely and attend AA meetings round the clock. Unlike them, my clients feel they still have options, and they feel they can re-learn to drink moderately, after a period of abstinence. 

I would like to address that sentiment with the following:

It's true that many people in AA are older and even just plain old. AA was originally intended for serious alcoholics who had bottomed out over and over again, meaning nothing else helped them to stop drinking. AA worked because it was a refuge, a place of last resort. It accepted them for who they are, and they found community. 

AA is still around because it does help serious alcoholics recover from active alcoholism and maintain sobriety through community. One reason why you see more older people is that older addicts are more likely to abstain for reasons that are connected to poor health resulting from years of sustained abuse. They may die if they continue to drink, and so they NEED the AA community to not drink again. Also, dealing with or avoiding consequences of addiction is exhausting, and older addicts are emotionally and mentally TIRED from running.

Having said that, it does not mean there is no place for younger people in AA. Which reminds me, there is a great independent feature that deals with this: it's called Smashed.

The role of AA for problem drinkers will be continued...

The Examined Life

Some books are to be tasted, others to be swallowed,
and some few to be chewed and digested.
Francis Bacon, the philosopher, not the painter.

Sometimes a book can come along and make your life better. Reading it feels as though it was meant to enter your life at that exact time.
And isn’t this why we have a life-long love affair with books?

Books can help us answer questions we haven’t yet to formulate. At their best, they rouse us to carry on an inner dialogue and deepen our self-awareness. And awareness is the first step in the process of change.
Yes, change is possible. It’s a slow-going, subtle shifting of your attitude, first to your self, and, over time, it will manifest outwardly in your interactions with the world.

Stephen Grosz’s The Examined Life is one such book. Grosz is an American psychoanalyst based in London. I love this book because the writing is superb; language is simple and precise, without psychological jargons to showcase the author’s expertise. He writes for an audience interested in living a deeper, more authentic life (don’t we all?). Though I am not a book reviewer, if you are interested the literati love his book!

My clinician self found important lessons in how to be a better therapist, both in technique and in philosophy. And as a general reader, I very much appreciate the clinical cases he presents, because I identify with many of the enduring “issues” that had brought people to his office. Some of these universal themes are: the search for and keeping of loving relationships, forgiveness, resolving the hurts from our imperfect childhoods, loneliness, sexuality, raising children, facing death.

If there were to be a syllabus for therapy The Examined Life would be a required reading. 

Quick note about psychoanalysis: It is a type of psychotherapy I DO NOT practice. However, I hope to start training in it in the near future. Its aim is to affect or change the personality structure of the client over an unspecified period of time. Usually a client brings in a complaint of a non-urgent nature, something that nags her but does not interfere with her overall functioning. Free association is the primary technique used in analysis; it means that the client is encouraged to think out loud, to say whatever comes to her mind. The analyst then interprets what was said, noting patterns or other significant content to which the client was unaware. There is little advice giving, and progress or insights are made by the client on their own.

The work I do is more hands on and goal directed. The issues I deal with tend to exist on the surface of day-to-day life, whereas psychoanalysis deals with issues that are more deeply imbedded.

How to Drink Moderately

These are some suggestions that I use with my clients.
By no means is the list complete. 

• Eat something before getting to the bar or party.

• Have a plan for the evening: How long will you stay?
Who are you going to be with?
Know when you will be home.
Goal is to avoid open-ended nights.

• Limit yourself to only one drink within a 30-minute period.

• Limit yourself to 4 drinks for men and 3 for women and the weekly maximum of 14 for men and 9 for women as recommended by the National Institute of Health for moderate-risk drinking.

• Know what a “drink” is. Remember, a pint is 16 ounces.
Drinks you have with dinner also count. 

• 12 fluid ounces of beer (about 5% alcohol)
• 8 to 9 fluid ounces of malt liquor (about 7% alcohol)
• 5 fluid ounces of table wine (about 12% alcohol)
• 1.5 fluid ounces of hard liquor (about 40% alcohol)

• Keep in mind BAC (BloodAlcohol Content) and think about why it’s important. Maintaining a BAC lower than .06%* is crucial to moderate drinking because our ability to reason becomes impaired at this point. It is the point of no return for problem drinkers. Even if the intention is to limit alcohol intake, if the BAC is higher than .06% you are more likely to continue drinking. Binge drinking is defined as having a BAC of .08% or higher.
*Disclaimer: these recommendations are for people who don't plan on driving a car. Remember, riding a bike under the influence is dangerous and against the law.
Drivers, please consult regulations for your state.

• Alternate between alcoholic and non-alcoholic drinks.

• Drink water in between drinks.

• Nosh on snacks while drinking. 

• Tell others, friends and acquaintances, of your intention to drink moderately, if you feel they would be supportive.

• Ask yourself what is the primary goal of the event? Is it social
or just for alcohol consumption? If it’s the latter, rethink who you are hanging out with. 

• Plan activities that don’t automatically involve alcohol.
Be creative.

• If you always drank at a certain time, for example after work, have a plan in place for those off nights. Go to the gym, go for a run or plan an outdoor activity. Go to the movies. 

• Remind yourself of the reasons why you want to drink moderately. For example, the hangover next day; money spent on drinks, cabs and food; the pride in knowing that you can practice self control.

• Practice mindfulness with alcohol. Is your goal to enjoy the taste of that IPA or red wine? How does it taste? What is its texture? Describe what you observe about your experience of drinking
and the people around you.

• Notice how alcohol affects people differently. How do you think alcohol affects you?

• Write in your journal about the experience. 

• Remind yourself that it gets easier the more you practice it.

• List the benefits of moderate drinking in the same journal.

• Know how alcohol interacts with the medications (over the counter or prescription) you take. Often, medications amplify the effects of alcohol, so let that be the guide in what moderate drinking looks like for you.

If you have other ideas, add them below.

Who Are These Alcoholics?

Google “alcoholic pictures” and you will find that an alcoholic tends to be an unhappy adult white male who sits in the dark with his head in his hands. He is alone and depressed with only a bottle for company.




An alcoholic, defined clinically, is someone physically dependent on (addicted to) alcohol and unable to control how much they drink; alcoholic also has cravings and increased tolerance, and goes through withdrawal symptoms when alcohol leaves their system. Comparatively, a problem drinker, or an alcohol abuser, is someone psychologically dependent on alcohol but without the physical dependence (although a hang over is a collection of moderate withdrawal symptoms). For the problem drinker, the issue isn’t alcohol (because they can go without) but the reasons why they drink and what happens after they drink.

National Institute of Health and National Institute of Alcohol and Alcohol Abuse classified U.S. alcoholics into five subtypes. These results are from a 2007 national survey, and it is estimated 14 million Americans qualify as alcoholics.

Young Adult subtype: largest group in the U.S. with 31.5 percent of alcoholics. Low rate of mental illness, drug abuse and history alcoholism in their families. Least likely to seek out help.

Young Antisocial subtype: In their mind-twenties, 21 percent of U.S. alcoholics. Early onset of alcohol use and problems related to alcohol abuse. More than half from families with alcoholics. About half are diagnosed with Antisocial Personality Disorder. Many suffer from the trinity of mental illness (depression, bipolar disorder and anxiety problems). More than 75 percent smoke cigarettes and marijuana, and many have problems with cocaine and opiates. More than a third seek help.

Functional subtype: 19.5 percent of alcoholics. They are mostly middle-aged, well-educated, with stable jobs and families. Third have alcoholism in their family histories, a quarter had major depression at some point in their lives, and nearly half were smokers of tobacco.

Intermediate Familial subtype: 19 percent of American alcoholics, they are middle-aged and half withs familial history of alcoholism. Most smoked, half of them had clinical depression, and 20% have had bipolar disorder. Nearly 20% had problems with cocaine and marijuana. In this group only a quarter get treated.

Chronic subtype: 9 percent of U.S. alcoholics. Middle-aged; began drinking heavily at an early age. High rates of Antisocial Personality Disorder and criminality. Highest rate of mental illness (depression, bipolar disorder, anxiety disorder). High rates of smoking, marijuana, cocaine, and opioid dependence. 2/3 of the group get help (many of them to mandated to treatment making them the most prevalent type found in treatment.


Information, which I summarized here, comes from:

http://www.news-medical.net/news/2007/06/29/27074.aspx?page=2

http://www.alcoholic.org/research/alcoholism-statistics-and-information/

Are you an alcoholic? Find out here. 

In my practice I work to help problem drinkers with their emotional health, in addition to learning how to become a more mindful, moderate drinker.

Alcoholism Is More Lethal For Women

In the long run, Alcohol is more harmful than other substances. Period. Long-term abuse of alcohol in women has more health consequences than for men. It comes down to biology; women's bodies are more sensitive to alcohol's poisonous effects. Read more here:

http://www.drugrehab.us/news/alcoholisms-effects-in-women/

Minding the Mind: What Is Mindfulness

By now everyone has read and heard about this thing called mindfulness. If you believe the hype it can help you eat less, become nicer, smarter, more relaxed and less stressed. Sounds good, doesn’t it? So, what is it and what’s the catch?

It's difficult to write about it because how do you describe a state of consciousness without sounding hokey? But I hope that the following will pique your interest enough to look into it for yourself. 

First, let’s look at what it is. 
1. Mindfulness is a state of mind we aspire to. It is a meditative state through which we can experience passage of time fully awake and conscious. It is being aware of your senses as you go about life in the here and now. The intention is to center your attention through your physical self and less from your inner, thinking self. Brain is part of the body and so whatever feelings and thoughts that arise throughout the day, they can be experienced for what it is in the present. You can be mindful and enjoy food, feel close to your friends, have a deep a conversation and feel and emotionally connected — meaning, any activity can be experienced mindfully.

2. Regular practice of meditation will make it easier to connect to the mindful state. It’s like running, the more you run, easier running becomes. 

3. It’s paying attention to the “thing” which you are doing, whether you are engaged in deep, meditative breathing, walking your dog around the park, washing dishes, reading, listening to music, or having sex.

4. It’s noticing the chatter that fills your head. When you become more mindful, you will notice many thoughts, memories and feelings come to your awareness; mindfulness is not letting your attention fall on them and letting them take you into the past or the future. Think of it this way: You are walking down the street with a destination in mind, and you run into people you know. You say hello and greet them pleasantly, but do not stop and get into conversations, because you are headed somewhere else.

5. Mindfulness is understanding that the chatter — inner voices, negative self talk, flashbacks, cravings, obsessions — is the source of our anxiety and depression. I don’t mean to say anxiety and depression will cease to happen or that it shouldn’t happen, but that we can quiet the chatter which is responsible for unnecessary anxiety and depression.

And, what it isn’t:

1. Mindfulness isn’t being distracted. Everyone experiences the discomfort of doing something or being with someone without being fully present. Your inner self is elsewhere, thinking or feeling something not in the present. It feels as if you are holding two conversations or doing two things simultaneously, which is exhausting. Focusing on what you are doing will actually enrich your experience.

2. Ignoring physical states: if you are hungry, eat something; if you are tired, take a break or nap; if you are angry, talk or write about it; if you are lonely, reach out for a connection, whatever that may look like; if you are in pain, physical or emotional, do something to lessen or stop the pain. The idea is that we can’t tune in with the here now if these primary needs go unmet. It’s like trying to operate a car that has no gas or has a major mechanical problem. In order for you to function optimally, you need to take care of your self. 

3. Giving up because you can’t “get mindfulness right.” Perfection, or in this case being completely attuned to the present, is something we aspire to; it motivates and gives direction but perfect mindfulness is not possible. Go easy when you find yourself distracted, gently redirect your attention back to the here and now and the task before you.

Here is a link to a guided meditation which is a very good introduction to meditation, and it will actually help you relax!

Addiction, Depression and Antidepressants

I read with great interest this piece on The Fix called The Dumbest Article You'll See About Addiction, and that's about right. The writer, Maia Szalavitz, is responding to a criticism of her original piece, in which she shares how Zoloft had saved her from a deep depression after kicking a serious heroin and cocaine habit she picked up during college. Twenty years later, while still prescribed Zoloft, she describes how it dramatically improved her mood and the way she responded to the world (depressed people, she says, tend to misread other people's facial expressions), that she has had a successful writing career and a very satisfying life. 

The second writer, critiquing on Slate, says that Szalvitz merely replaced one addiction with another, and asks the astoundingly naive question why we are easier on pill poppers than alcoholics. It's difficult to believe that her editor or anyone else on staff, let slide her ignorance and insensitivity to issues of mental health. While it’s true Big Pharma has integrity issues, the fact is anti-depressant medications and other psychopharmaceuticals dramatically improve, if not save, the lives of many, many people.

Be sure to read the many comments on both pages. It's a serious subject matter that affects many people.