Dopesick

I first heard the term in the county jail from a male inmate who was describing the lengths to which he would go to buy a few heroin bags when he was out and his last hit was wearing off. He was fast becoming sick for dope — dopesick, to be precise.

Today’s New York Times included a great review of a book by the same title, written by Roanoke Times reporter, Beth Macy. I haven’t read the book but I want to. The link to the review is here.

I have written before in this space that at least ninety percent of the men and women we meet in the local jail have some history with illicit drugs. All of them are regular users of marijuana and a disturbingly high number of them have been addicted to heroin.

In her book, Beth Macy notes that “four out of five heroin addicts come to the drugs … through prescribed opioids.” That is consistent with the stories I hear — endlessly it now seems — from those in custody, or recently released from custody.

We just met last week with a man who is awaiting trial who described back injuries, back surgeries and an endless supply of prescription narcotics.

In 2011 I fell down my basement steps and ruptured the patella tendon in my left knee. After surgery to repair the tear, the doctor sent me home with ten pills of a relatively mild opioid drug. The instructions were to take only two at first and then one every so often afterwards — if the pain was too uncomfortable. The afternoon I got home I felt pain somewhere between a five and a ten and took two of the pills.

To this day I can still remember how quickly those two pills erased all the physical pain. I can also remember how they erased as well any anxiety or stress I was feeling. The phrase “feeling no pain” is an apt description of what that relatively mild dose of an opioid did for me.

From time to time I share this story in my Smart Recovery group inside the jail. All around the table, heads are nodding in total understanding. But whereas I didn’t take another of those pills after the first day, most of them continued on and on until they were in full blown addiction. Heroin came next. And then came jail.

I would agree that some of the pharmaceutical companies are complicit in the opioid crisis that has engulfed so many of our young people. But I must also add that addiction to opioids would not be nearly as big a problem as it is if so many people were not in pain. As Gabor Mate so wisely suggested in his book, In the Realm of Hungry Ghosts, the question is not why so much addiction, but why so much pain?

Grit

Angela Duckworth, Professor of Psychology at the University of Pennsylvania, has played a leading role introducing a new generation of Americans to the concept of grit.

As in “True Grit.”

You are likely familiar with the movies by that title, the older one starring John Wayne and the more recent remake — a memorable effort with predictable weirdness by the Coen Brothers — starring Jeff Bridges. The novel on which both were based was written by Charles Portis in 1968.

The story is ostensibly about the dogged determination of Reuben J. “Rooster” Cogburn, a US marshal hired by 14-year old Mattie Ross to find Tom Chaney, the man who murdered her father. She learned of Cogburn’s reputation from the local sheriff as the “meanest” of the marshals, “a pitiless man, double-tough, and fear don’t enter into his thinking.” Later, young Mattie approaches Cogburn saying, “They tell me you are a man with true grit.”

Before the story ends we discover that Cogburn has less grit than his young employer, who shows twice the determination and perseverance in ultimately seeing that her father is avenged and justice is served.

I use this story in the lesson, “Hope and Perseverance,” which is part of the integrity material I use with inmates. I also use Angela Duckworth’s “Grit Scale,” an assessment tool she developed to help people quantify their “grittiness.”

Duckworth defines grit as “perseverance and passion for long-term goals.” She considers it the single most important trait, (perhaps it is more accurate to say it’s first among equals), in the ability to succeed in life. She rates it as more important than intellect, physical strength or innate talent.

After taking my students through Duckworth’s “Grit Scale” and asking them if they are surprised at their score, I move on to a specific question: “When were you at your grittiest?” In other words, can you remember a time when you saw a task through to completion, overcoming whatever serious obstacles stood in the way?

In a recent class, we started around the table with each participant having a chance to offer his answer. When we came to an inmate I’ll call Mickey, without a moment’s hesitation he said, “I was at my grittiest when I was dope sick and needed to find my next bag of heroin.”

I looked at him without speaking, but signaling with my facial expression that he was welcome to add any clarifying explanation he wished to. He said very simply that when a man needs his next fix he’ll do just about anything to get it.

Such is the power of an addiction.

I nodded and moved on to the next participant. He looked at Mickey and said, “He spoke for me too.” I asked if he really meant it and he said yes. Before I could ask the next man about his grittiest time, he offered that he, too, had to agree with Mickey’s answer.

Though I would have loved to hear a more noble tribute to the virtue of perseverance, I knew this was reality for someone with a long history of opioid addiction. Addictions of any kind, substance or behavioral, can be all consuming at least some of the time. And indeed, grit is probably not the wrong word to describe the effort and determination one will employ to satisfy the craving, even if it falls short of being “dope sick.”

Other participants, to be sure, did offer examples of grittiness that enabled a more positive outcome and resulted in what any of us would celebrate as success. Mickey later noted that he had experienced positive results from gritty determination, but not after the age of 16 when his substance abuse first started.

Before the session ended I specifically addressed Mickey, who was trying to arrange for in-patient treatment for his addiction and was ultimately successful in having the court factor that into his sentence. I said something like this: If it took grit to find your next bag when you were dope sick, remember that it will take grit to make the most of your time in treatment and living in recovery. Down the road, when you have gained strength and learned better how to stay clean, and you begin to set better goals for your life, remember how important grit is in doing what you have to do to get where you want to go.

He said he would call me at his first opportunity after getting out. I have heard that before and no phone call ever came. I hope, of course, this one is different and that I can report good news in a future post.

How gritty are you? If you’d like to try out Angela Duckworth’s “Grit Scale,” you can find it here:

 

Breaking out of the fog

The masthead image above was chosen to make a vital point about incarceration and release. The figures on the left, wandering aimlessly or lost in the fog, remind me of a great many of the men and women we encounter in our work in the local jail. They are without direction, lost in pain and addiction, and isolated from a community of support. Even after release, for far too many of them, the fog remains.

Those on the right of the image have clarity and direction because they can now see. They undoubtedly still face challenges and difficulties, but they can see clearly the outcome of their choices. Most importantly, they can see the light and walk toward it.

My colleagues and I in this ministry recently took a big step. To the work we have long been doing inside the jail, we have now added a post-release component. We have been thinking and praying about this for many months. Every sign pointed to the necessity of doing it. (Actually, the signs demanded it.) We are tired of watching the revolving door of the jail, through which a distressingly high number depart, only to return due to parole violations, usually involving drug and alcohol relapse.

Enough! So we developed a plan, talked about it incessantly when we were doing our programs with the inmates, and sold the idea to the wardens and treatment counselors. They even put our information sheet as page one of the release packets given to every county inmate!

We offered — what else to call it? — a bribe. “Call us when you get out of jail and we’ll take your to dinner to celebrate your release.” In the first month, three men called us. We’ve taken one out to dinner and are setting up a time with another one. We offer them something few probation officers will do. We tell them we are there to accompany them as caring and supportive friends as they navigate their way back into life on the outside. In other words, we want to help them find their way out of the fog and into the light.

We will offer more in due time, especially if a grant proposal we made to a foundation comes through for us. In the meantime, let us be a reliable friend. You can call us anytime.

One did. To be exact, it was at 2:20 A.M. — the middle of the night between Friday and Saturday. I was on-call and answered the phone beside my bed. The man (I’ll refer to him as James) had just polished off a bottle of whiskey and 12 cans of beer. He’d been out of jail less than two days and his anxiety level was in the danger zone. The alcohol had not helped, he admitted. (I am still amazed he was able to form a coherent sentence.)

“Honestly,” he said, “I am ready to call my dealer, but I thought I’d at least try to reach you guys first.” He went on, “I really didn’t think anyone would answer. I expected to hear a recording telling me to leave a message.”

Remembering a line from Young Frankenstein, I replied, “Come by anytime; we’re always open.” We both laughed. Then the conversation turned deadly serious.

James, I knew from our time together at the jail, had a serious addiction to opioids. He got it legitimately (if such a thing is possible) when hospitalized for surgery on more than one occasion. When he said he was “this close” to calling his dealer, I knew he was neither kidding nor trying to be dramatic.

I asked if we could unpack what was going on. He was eager to get it out. For the next hour we talked about his anxiety and fear and how hard he found it to control either. He gave examples of things that were bothering him. Chief among them was his fear that he would use again and that his family would disown him for good after several repeated relapses in the past.

In my past, I have always hated phone calls or face-to-face encounters where the person was out of control or in danger of doing something they would regret. My fear was that I would never know what to say. Or that I would offer to help in a way that was not realistic. A couple of times during the call with James I was wondering why I agreed to sign up for this.

Somehow, though, with God’s help, I did know what to say. I walked him through a simple cognitive process that seemed to help him realize that he could think rationally and make the right choice. I was rather amazed at how helpful he found this. When we finally ended the call, he was profuse in his gratitude that I’d taken the call and helped him “off the ledge,” so to speak.

The next day, my colleague Gean visited James at his workplace. He found him badly hung over, but much less anxious and feeling more in control. I’ve seen him twice since then and he seems stronger each time.

Is James out of the fog yet? Undoubtedly, there is still a ways to go, but he’s walking toward the light. And we are accompanying him to make sure, as best we can, that he gets there.

It’s an encouraging start for our post-release work. We’ve found some really good people in the county who share our concern and have come alongside us to help give shape to this new effort. We would appreciate your prayers as well.

 

Such a waste

It was inevitable, I suppose. With annual drug overdose deaths in America reaching the 50,000 mark, why would I be surprised to hear that the opioid scourge claimed the life of someone I knew? Nevertheless, I was not expecting the bad news.

When I entered the program room, I glanced around the table to see who was present. The group appeared to be short a participant. So when one of the men somberly said they had “bad news” to report, I assumed it was word that someone had been expelled from the program. That was indeed the case, but it wasn’t the bad news I was about to hear.

“Larry is dead.”

I scrambled to connect the name to my memory bank. Before I could make the connection, the group’s spokesman went on to fill in the details. “You know. Larry ________. He was in the program with us. Remember? He just got out on the 10th. Died of an overdose less than two weeks later. They just had his funeral on Friday.”

“Holy cow!” It was all I could say as the memories finally came forward. Larry was a bright, confident and articulate 38-year old with an easy-going smile who loved to get high. He reminded me of that fact numerous times as we dug into the program material on addiction during the 12 weeks he was with us.

At nearly every turn, Larry resisted. He had used drugs for many years. And, as he reminded us on several occasions, it had landed him in jail only once in 38 years. He thought the odds of making it through the rest of his life without being incarcerated again were pretty good. He was right about that, though not in the way he imagined.

At various times during the 12 weeks, other members of the group confronted Larry with what was obvious to everyone but him: he had a serious addiction problem. There was a lot more going on than just his simplistic explanation that “I like to get high.”

When I introduced the idea that addictive drug use is always a response to pain, Larry objected. “I didn’t have a bad childhood. I haven’t been traumatized. In fact, I’ve had a very good life. And, believe it or not, I have become a very successful and prosperous businessman.” And then, as if to make the point one more time, “I just like to get high.”

Several days before his release, I shook his hand and wished him well. I asked him to remember the things we talked about. I suggested he should especially remember how other members of the group had urged him to stop using and get help. Smiling, he thanked me.

Larry’s obituary in the local paper said simply that he had died at home. Age: 38. The names of his four children were listed, along with his parent’s and step-parent’s names. Calling hours and a funeral service time were also included. The lack of details spoke volumes about the shame that still drives many to be silent about addiction and overdose deaths, which in the past year alone have claimed more American souls than the Vietnam War.

I asked the ten men at the table how they were feeling about the news of Larry’s death. One or two said it was sad. One or two said something like, “it happens.” I suggested that news like this should get the attention of everyone who abuses drugs. No one nodded. No one agreed. They have seen it before. More than half of them have known someone who died of a drug overdose. One participate estimated he’d known at least 15 men and women who died of a drug overdose.

Larry was my first. If the opioid epidemic is as bad as the statistics suggest, he probably won’t be my last. But still. Such a waste of a life with some much potential.

 

Red-headed stepchild

The question went something like this: So what is your opinion of your relationship to your own body?

Fourteen county jail residents and I were considering how our bodies figure in to the question of integrity. It’s an important question since the body is the vehicle though which our integrity, or lack thereof, is expressed.

As we went around the table, each participant offered a comment on the question. The first three or four answers were not memorable. The fourth, offered by a man I’ll call “Sam,” caught me off guard:

“I’ve treated my body like a red-headed stepchild.”

Anyone who by that point had tuned out fairly quickly tuned back in. Another participant, who had red hair, leaned forward to state unequivocally — to the laughter of all — that he was no one’s step-child.

Having never heard the expression before, I asked the respondent what he meant by it. He said that in just about every way he could think of he had mistreated and abused his body — alcohol, drugs, poor diet, lack of exercise, lack of sleep, and so on. He even opened his mouth to show missing teeth (possibly the result of using crystal meth).

Later, I consulted the Urban Dictionary and found this definition of red-headed stepchild: “A child who is obviously not your own, a child who is treated worse than other children in the family.”

Several other participants, using less colorful metaphors, also indicated their bodies had not fared well under the strain of bad habits, most especially drug and alcohol abuse. One man who has told the group that he’s been incarcerated ten times at this jail, several of those times for a DUI, proudly noted that his liver is still in good shape despite all the drinking. He looked at me as if to say, “No harm, no foul, right?”

This prompted me to refer everyone to something I’d included in the lesson material, a reference to Paul’s argument in Ephesians: “Husbands should love their wives as their own bodies. He who loves his wife loves himself. For no one ever hated his own flesh, but nourishes and cherishes it….”

I asked, “Do you agree with Paul that ‘no one ever hated his own flesh?'” The room was silent. I broke the silence by asking the question another way: Do you think that you love your own body, as Paul suggests? Several participants nodded, a few others said yes. I waited and looked around the room. More silence.

Finally, one of the oldest participants, a man approaching 60, said, “I don’t think I do. The way I have treated my own body over many years makes me now think that I probably must hate my body.” He looked at me for a few pregnant seconds and I just nodded.

Another participant, also older than most and one who often is the stand-up comedian of the group, agreed. “When I look at the way I have abused my body over the years, it’s hard for me to argue that there’s any love for myself in that kind of behavior.”

I am always happy when these classes include older men who are willing to be honest in the presence of much younger men about where their choices have gotten them. It’s one thing for me to draw the line between bad choices and bad outcomes. I’m expected to do that. But it is probably more persuasive when someone old enough to be their father stands before them in prison fatigues and offers himself as the object lesson of poor choices.

Paul’s statement is surely worth pondering. If “no one ever hated his own flesh,” what does that say about the way I’ve been treating my body all these years?

I’m long overdue to revise some of the material in this book on integrity. Driving away from the jail that night I had a thought. When I revise this particular lesson I must include this statement: “Your body is not a red-headed stepchild. When are you going to stop treating it like one?”

 

Crisis or epidemic?

Before writing this post (sometime last year), I did a Google search on “opioid crisis.” In .41 seconds the search turned up over 20 million hits. I followed with a search on “opioid epidemic” and got over 17 million results in about twice the time.

I suppose a greater number of sources, academics and advertisers think we have more of a crisis than an epidemic. In other words, it’s bad.

Nicholas Kristof, an op-ed columnist for the New York Times, published a breathless piece last October titled, “Drug Dealers in Lab Coats.” Teeing off from the previous Sunday’s “60 Minutes” and Washington Post joint investigation, Kristof wrote, “The opioid crisis unfolded because greedy people—Latin drug lords and American pharma executives alike—lost their humanity when they saw the astounding profits that could be made”

While I appreciate the effort to call American pharmaceutical companies to account for their part in shipping various and sundry opioid pills by the tractor-trailer load to vulnerable populations here and there across America, Kristof, in his perhaps justifiable outrage, oversimplifies and misses the big story.

Canadian physician, Gabor Maté, offered a far more timely assessment in his riveting book, In the Realm of Hungry Ghosts: Close Encounters with Addiction: “The question is never ‘Why the addiction?’ but ‘Why the pain?’”

I had watched the “60 Minutes” piece and was attempting to summarize it for the dozen or so men sitting around tables at the county jail shortly after it was aired. Some seemed disinterested but most listened intently. When I finished presenting the indictment of Big Pharma the two media companies had handed down, one of the participants offered a contrary opinion.

“If anyone thinks that disrupting the supply of opioid pills will end the opioid crisis, they obviously don’t know how far an addict will go to find something else to relieve his pain.” Another inmate quickly agreed. The first speaker continued, “I can tell you from experience, you will do anything and everything you have to in order to just get through the day.”

Recalling Dr. Maté, I nodded.

ii

If you have read my blog posts or followed my thinking over the past couple of years, I wouldn’t be surprised if you believe you are hearing the unmistakable sound of a broken record. Fair enough; you could be right.

But I do try to keep balance and perspective in how I analyze what I see and hear when among those I meet in the county jail or the federal prison whose sentence has something to do with drugs. For example, I know that these men and women had a choice in whether to break the law or violate their parole. I know that some of them have a brother or sister who grew up in the same home and who did not abuse drugs or alcohol or steal to support a habit or break laws on drug possession or dealing.

This is a strong argument, one used by Stanton Samenow in his well-regarded work, “Inside the Criminal Mind.” Simplified, his thesis is that people don’t become criminals because of childhood experiences, poverty or any other environmental cause. No, they become criminals because they think differently from the rest of us. They buy into a host of “criminal thinking errors” and make most of their choices and decisions based on them, leading them to actions that victimize innocent people and break laws established for the good order of the community. In other words, it is not outside forces that turn people into criminals. They become criminals by pushing rational thoughts aside and believing irrational thinking errors.

Samenow notes how frequently he hears criminals cite alcohol or drugs as the source of their criminal behavior. Since upwards of 80 percent of those incarcerated abuse drugs or alcohol, Samenow acknowledges the temptation to connect addiction and criminality. But he offers this dispute:

Criminality…does not reside in the bottle, the pill, the powder, or in any other substance. Drugs bring out and intensify only what already exists within a person; they do not transform a responsible person into a criminal. If ten men get drunk, all ten will not rape, rob, or kill. They may fall asleep, become boisterous, or grow argumentative. Their behavior depends on their personality before they took the first sip.

William Raspberry, an African-American former columnist for The Washington Post, apparently had an ongoing feud with Samenow. Raspberry could not abide Samenow’s stubborn resistance to the role poverty has in incubating future criminals. Samenow acknowledged the disagreement in the last chapter of his book:

When this book was first published in 1984, syndicated columnist Williams Raspberry stated; ‘I’m prepared to offer Samenow a deal: I’ll give up the myth that criminals are caused by their environment if he’ll give up the myth that they are cured by psychiatry.’ Raspberry got the right idea about the ‘myth’ of the environment as creating criminals. However, he got the wrong idea about the rest of it.

iii

Since 2009, when I first walked the long corridor of the federal prison in Waymart, I have seen enough to make me largely sympathetic to the thesis put forward by Stanton Samenow. But “largely” is not the same as exclusively. And in the midst of the opioid crisis that by all accounts is sweeping the nation and destroying tens of thousands of lives each year, I insist that the Gabor Maté question will not go away and demands as much attention as Samenow’s thinking errors:“Why the pain?”

I ask this question—or some form of it—with regularity nowadays. A few weeks ago I was talking with a new addition to my classes at the local jail. I recognized his last name and asked if he was related to a young man who’d been in my class a year or so earlier. Indeed, they were brothers. (His was the third situation I’ve encountered in the local jail where two brothers raised by the same parents have both been incarcerated, in two cases incarcerated at precisely the same time.)

As we talked, we closed in on the reason for his present incarceration—a parole violation. I asked if it was drug-related and he answered that it was. I asked about his history of drug use. It reached back to his teenage years and, as if to anticipate my next question, he noted how many times he’d been in rehab and then relapsed and how many times he’d been incarcerated. Both numbers staggered me.

I then asked Dr. Maté’s question: “Why the pain?” He clearly was not anticipating it. I said, “With the history you just provided, you must also have a history of pain and I’m guessing it didn’t start with a back injury.”

Looking down, he said, “I don’t want to talk about it right now.”

A couple of weeks later, I’d just arrived and taken my seat at the table. The men were already there. As I was getting my papers out and starting the signup sheet around the table, the same inmate began to tell me that all this “cognitive stuff” (part of the Smart Recovery® class I’d come to lead that day) wasn’t going to help him.

“Don’t get me wrong,” he said, “this CBT [Cognitive Behavioral Therapy] approach is good for some things. But it doesn’t even begin to get to the level I’m at.”

“I know,” I replied. I told him that from the moment we met and he told me that his drug addiction began in adolescence, and he didn’t want to talk about the pain, that I suspected that he likely had adverse and/or traumatic childhood experiences that still to this day are just too painful to talk about. I asked him if that was so.

He nodded, and I lamented aloud that the program we were both participating in (the prison’s recidivism-reduction program) was not really set up to do much more than allow him to acknowledge the pain. In other words, this wasn’t a group therapy session. He laughed and I asked him why he’d laughed. He then told this story:

“When I was going through intake here, they were asking me a bunch of questions. So I decided to tell them about some of my experiences. No sooner did I get into the gory details than the officer stopped the interview, called another CO who came into the room and put me in shackles and the two of them took me down the hall to a room and put me on suicide watch.” He paused and added, “That’s how much they want to hear about your pain around here.”

Once again I lamented the limitations of a place where confinement, rules, order and the needs of the prison itself overshadow any effort toward healing of deeply wounded souls. All I could say at that point was, “My colleagues and I want to do our best for you while here and be there for you when you get out.”

iv

I felt uneasy having to reply in such a bland, even if sincere, manner. Isn’t this the place where the Christian teacher assures the pained inmate that God can make everything okay? Isn’t it here where we talk about the problem of sin and the solution in the death of Christ?

When I got involved at the county jail and expanded my involvement at the federal prison, I made a bargain with my overseers that my program would not be overtly faith-based and that I would not seek to evangelize those who participated in the class. It would be okay if I cited scriptural agreement with what I said about forgiveness or integrity, but my major point of reference would not be the Bible.

It was a bargain I accepted for the privilege of having access to men who either would not show up for a distinctly Christian program or who had been mandated by the courts to participate in the program in which I agreed to teach. While recognizing the limits of the bargain, I have not regretted the opportunity to be the believer I am and to hope that Christ is seen in me even when I am not naming the Name or reciting scripture.

v

I recently completed the class on integrity at the federal penitentiary. Two of the 12 chapters are on “woundedness and healing.” In the original edition I placed them in the middle of the book. When the revisions are finished, I’ll move them up toward the front of the book, for I am aware of nothing more likely to tear at integrity than unresolved pain, trauma and shame.

One of the participants in the course is an inmate I’ve known for at least three years. He had previously participated in the studies I’ve offered there and even comes on most occasions when I preach at the Christian services, even though he is the leader of another faith group at the prison. I consider him, in the words of Jesus, as being “not far from the kingdom of God.”

Due to repeated lockdowns and a couple of federal holidays, I ran into difficulty finding available time to finish the 12 weeks. So I made a deal with the class members that we’d get as far as we could and they could then take the remaining chapters with them and work on them until I could return, review them and award completion certificates to those who’d done the work.

The two chapters on woundedness provided the inmate I mentioned above an opportunity to let me in on more of his story. I knew he was serving a life without parole sentence for two murders, since that was public information. I also knew he had been a gang member before coming to prison. But that was the extent of my knowledge. When he turned the course work in, I learned a bit more, admittedly from his perspective.

He wrote about being forced into street life at the age of 14 where he “had to live by all means necessary.” He lost his childhood and his innocence as well. He wrote that when the gang took him in he had to do what everyone else did—sell drugs, murder, steal, rape and rob—or else be killed in retribution. All the while, he wrote, “I was a child!”

One of the chapters in the book has a section on trauma that includes questions about small traumas and large traumas the participant might have experienced. On the question about the small traumas, he wrote, “I don’t believe I suffered any small traumas. Everything in my life was get it done or DIE.” I was “in jail with a life sentence before I finished adolescence.”

He wrote in detail of the guilt and shame he experienced “What I lived is beyond shame!” He added, “But the guilt caused me to learn what a Man, Father, Friend, Adult is and to never [again] be who I was.”

Finally, he wrote, “I started the journey around 16 years ago and everyday I am trying to heal and understand.”

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Anyone whose knowledge of this man is limited to the crimes for which he was prosecuted and received a life without parole sentence would be grateful that such a criminal will spend his life behind bars. Justice was served and there’s nothing more to discuss.

I would have had the luxury of such a thought had he never engaged with me on the importance of forgiveness and the challenge of rebuilding integrity in a life that had been disintegrated, and had he not listened intently to my preaching and thanked me afterwards for it. Could he just be blowing sunshine my way? Of course, and he wouldn’t be the first inmate to do so.

I know he has an active appeal in the courts and I have been told there’s a good chance his life sentence will be overturned. I wouldn’t mind that outcome for he certainly could be one of those prisoners who, if released, turns his life to the good and makes the world a better place.

He is one of a lengthening parade of men who have confided in me, sharing their stories of pain, dysfunction, addiction, criminal thinking and criminal activity. Some were nowhere near ready to repent and seek genuine healing and redemption. Some were. It is those prodigal sons who need—and deserve—more help than they are receiving from a nation that has grown weary of drugs and crime and seems to know but one response: incarceration.

If the statistics are right about this full-blown opioid crisis, our work has just begun and we all need to learn to ask the Gabor Maté question, “Why the pain?” and help the wounded find healing.

 

The bottomless pit of pain

My last post ended with the suggestion that in this one I would muse on what we should be doing in our work with inmates to help them have a chance at a better life upon their release. Before tackling this question, some background reflections.

Like lots of other Americans I am trying to digest the electoral results from earlier this month. More than one friend suggested that I read Hillbilly Elegy by J.D. Vance as I tried to process the outcome. So I made use of many hours of airport terminal and flight time traveling to North Carolina to visit my father for Thanksgiving by reading this remarkable book.

Mr. Vance has written a deeply engaging memoir, as the subtitle suggests, of his family and the culture in which he was raised. Every page kept my attention.

But what really focused my mind was Chapter 14. Here, Mr. Vance steps back and engages in a frank analysis of the family and culture that proved, simultaneously, to both add to and detract from his personhood. Acknowledging the slow-moving train wreck of dysfunction his childhood and adolescence had been, he sought understanding and help.

“I tried to go to a counselor, but it was just too weird. Talking to some stranger about my feelings made me want to vomit. I did go to the library, and I learned that behavior I considered commonplace was the subject of pretty intense academic study. Psychologists call the everyday occurrences of my and Lindsay’s [his sister] life ‘adverse childhood experiences,’ or ACEs. ACEs are traumatic childhood events, and their consequences reach far into adulthood. The trauma may not be physical. The following events or feelings are some of the most common ACEs:

  • being sworn at, insulted, or humiliated by parents
  • being pushed, grabbed, or having something thrown at you
  • feeling that your family didn’t support each other
  • having parents who were separated or divorced
  • living with an alcoholic or drug user
  • living with someone who was depressed or attempted suicide
  • watching a love one be physically abused.”

This wasn’t the first time I have seen this list of ACEs. In the book I referenced in my previous post — In the Realm of Hungry Ghosts — Dr. Gabor Maté also writes about the dreadful impact of ACEs on the addicts he treated in Vancouver, Canada.

“The statistics that reveal the typical childhood of the hard-core drug addict have been reported widely but, it seems, not widely enough to have had the impact they ought to on mainstream medical, social, and legal understandings of drug addiction.

Studies of drug addicts repeatedly find extraordinarily high percentages of childhood trauma of various sorts, including physical, sexual, and emotional abuse…. Their research, the renowned Adverse Childhood Experiences (ACE) Study, looked at the incidence of ten separate categories of painful circumstances — including family violence, parental divorce, drug or alcohol abuse in the family, death of a parent, and physical or sexual abuse — in thousands of people. The correlation between these figures and substance abuse later in the subjects’ lives was then calculated. For each adverse childhood experience, or ACE, the risk for the early initiation of substance abuse increased two to four times. Subjects with five or more ACEs had seven to ten times greater risk for substance abuse than did those with none.”

It’s a wonder J.D. Vance, along with all else he struggled with, did not also have substance abuse problems. But plenty of those he knew did, including his mother, whose presence in the memoir is relentlessly saddening.

In my teaching on forgiveness and integrity at our local county prison, which I’ve been doing for almost three years, I use a video that includes a chapter on a remarkable woman named Judith Shaw. “I thank God for forgiveness,” she says at one point. At another, “Forgiveness saved my life.” There was much in her story that would destroy a life — alcoholic parents, childhood sexual abuse and a husband who infected her with HIV. In describing her childhood she said that her family portrait was “that perfect picture, but scratch behind the canvas and total chaos.”

“Total chaos.”  What a spot-on description of the lives of children like J.D. Vance and the drug addicts Dr. Maté treated. It is also a description well over half of my county prison inmates agree aptly nails their own childhood. “Total chaos.” I have repeatedly heard all ten of Dr. Maté’s categories of Adverse Childhood Experiences from the inmates in my classes. Actually, I have heard more than ten.

Which leads us back to the original question: What ought we (volunteers, staff, the criminal justice system) be doing to help those currently incarcerated have even half a chance at a meaningful life once they get out of jail?

Every facility in which I current work offers some programs for at least some inmates. Chaplains, churches and other faith groups offer religious services and faith-based programs that make a difference for some inmates.

Someone sent me a news story from the website of National Public Radio (NPR) about a psychologist who conducts a weekly one-hour class at the infamous San Quentin penitentiary in California. His program is called GRIP — Guiding Rage into Power. The waiting list is 500 names long. Fifty-one men have graduated from the program and none has returned to prison.

I sent the link for this article (here) to a colleague I respect whose ministry is present in numerous county, state and federal facilities here in Pennsylvania. We had been emailing each other about our mutual experiences of encountering so many emotionally wounded men in our respective ministries. She, a trained counselor, wondered (just as I do) how volunteers can address the deep wounds we all regularly encounter inside prison walls. It’s a hard question.

In the workbook on integrity that I wrote and am now using, I included two chapters on woundedness and healing. It seemed important to acknowledge the reality that woundedness tears at integrity. But it also seemed urgent to exhort my classroom participants to turn from mere pain relief and pursue the much more difficult journey of true healing. But even as I wrote about this and urged it on these men I come to care deeply for, I had to wonder if true healing was even remotely possible.

So I recently asked the men gathered for my integrity class at the federal penitentiary if psychological counseling or therapy was available to them. Some said yes; some said no. But one inmate offered his own experience with a staff psychologist at the prison as proof that it is available and, at least for him, was immensely helpful. I watched the rest of the class watch and listen closely as he shared about how the twelve sessions with the psychologist made a huge difference in his self-understanding and his ability to make better choices.

Another inmate immediately offered his story of successful therapy with a counselor after his PTSD nearly destroyed his life. Again, other inmates watched and listened.

At the end of it all, I distinctly heard two other men in the room muse aloud that maybe they, too, could benefit from some counseling.

What I have begun to conclude is that our prisons are bottomless pits of pain alongside equally bottomless pits of serious criminality. I am comfortable saying that the two pits are frequently connected, though not in every case.

I have concluded one thing more: After almost seven years working closely with prison inmates, I know where the investment needs to be made, at least by me. With all the resources provided by faith, God and the good insights of social science, I want to see real healing in the lives of the men with whom I work.

 

Seven years in, here’s what I’m thinking

My first experience inside a prison took place seven years ago this month. I had reluctantly accepted an invitation from my neighbor, Bob Blatz, now deceased, to join him in a faith-based reentry program at the nearby federal prison. That first visit to USP Canaan began a transformative process in me.

Over the years my views of what kind of people convicted criminals are have changed. Years ago it was easy to paint with a broad brush and see all criminals as really bad people. The annual refresher security training we receive at the federal prison only reinforces the image of the typical criminal as a manipulative, unrepentant and unredeemable cancer on the collective body of society.

This is undeniably true of some criminals. I have met men I would not want living in my neighborhood. In truth, it might be best if some of them are never released from prison.

But it is not true of all. In my opinion it is not true of the majority of men I have met in any of the three facilities I regularly visit: the federal penitentiary, the federal minimum-security prison camp and two county jails.

As I teach forgiveness and integrity classes in all these locations, I ask questions and listen carefully to the answers. Some of the answers involve a short life history. Many of these stories are as profoundly disturbing as the rap sheets that tend to define our stereotypes about criminals.

In a recent forgiveness class at a county jail, I led a group of about six men through a forgiven or unforgiven exercise I included in the workbook I wrote. In a two-column chart, they listed on the left side the names of people who had harmed them that they had since forgiven. On the right side of the chart they listed names of people who wronged them that they had still not forgiven. As we went through the exercise, I asked that they report on just one person who had wronged them.

In turn, I approached each inmate and asked the question, “Forgiven or Unforgiven?” When they answered, I then asked this two-part question: “What happened and why have you forgiven (or not forgiven) the person?”

Over the years of teaching forgiveness, I have come to understand that people forgive or refuse to forgive for reasons that seem reasonable and appropriate as they consider the harm they experienced and the person who did the harm. Hearing the story and the reason forgiveness was granted (or withheld), enables me to ask further questions that shed further light on what is going on inside the men I serve. This is where, increasingly it seems, the stories I hear are profoundly disturbing.

In that class I mentioned above, I came to an inmate whose first answer was, “Unforgiven.” So I asked my follow-up questions, “What happened and why have you not forgiven?” The story went something like this:

“When I was six years old, my mother put me in the car with her and started driving. After we had gone some distance, she stopped the car, opened my door and told me to get out. I got out. She got back in the car and drove off. I didn’t see her again until I was married with a child of my own.”

I was silent for many seconds. Then I asked why he had not forgiven her. He looked at me as if to ask, “And what planet are you from?” He then said, with obvious emotion, “Something like what my mother did to me is not forgivable. By definition, abandoning a six-year old child is unforgivable.”

I nodded, affirmed how unacceptable his mother’s actions were, and thanked him for being truthful. I turned to the next inmate. Same question: “Forgiven or unforgiven?” His answer was intriguing: “It’s both. “ So I asked, “What happened?” His story went something like this:

“My mother gave birth to me when she was sixteen. She was not ready to be a mother and my earliest memories are of her beating the crap out of me. She did this until I was big enough that she couldn’t do it anymore. But I have forgiven her for this.”

I asked why. “Because she was young and not emotionally ready for motherhood. Because of that I have forgiven her for physically abusing me.”

What, I asked, had he not forgiven her for? His face was instantly flushed with pain. He struggled to answer. After a few seconds he continued his story.

“My mother refused to tell me who my father was. I asked her over a period of many years and she refused to tell me. And for this I will not forgive her.”

I asked why not. He went on to say that he was furiously angry with her because he had to find out who his father was from someone else. I waited.

“After I turned 18, I learned that my father is actually my grandfather.” His eyes grew moist. His face was still flushed. The room was still. Every eye was on him.

I ventured to speak. “Are you saying that your grandfather sexually abused his own daughter?”

His answered took me aback. “For all I know it was consensual because my mother is a slut.” The cellblock remained very quiet.

Taking the conversation to a level I knew could be risky, I said something like this: “It makes sense to me that your mother would not want it to be known by anyone what her own father had done to her, and especially that it resulted in a child.” I continued, “Childhood sexual abuse is a horribly traumatic and shaming experience. Your mother’s silence is understandable. Many victims of childhood sexual abuse cannot talk about what happened.”

He listened. I waited for a response. After a few seconds he said, “She should have told me. It was wrong for me to have to learn this from somebody else.” I nodded and decided to move on to others in the group.

Later we watched a video segment about a man who suffered what he considered to be an unforgivable wrong when he was 52 years old and remained bitter about it for the next 30 years. I led the group in a consideration of his story. We focused particularly on the pain and shame he felt, as well as the anger he could not seem to effectively manage.

Every story of unforgiveness I had heard earlier in the session was also a story of pain and anger. So I asked how many in the group had turned to alcohol or drugs in an effort to deal with their emotional pain. Every hand but one went up. I do not know for sure, but experience suggests to me that every man who admitted to turning to alcohol or drugs to deal with his pain was now incarcerated on a charge of drug possession, drug distribution or a DUI.

In his excellent—and profoundly disturbing—book, In the Realm of Hungry Ghosts: Close Encounters with Addiction, Canadian physician Gabor Maté writes this:

“The statistics that reveal the typical childhood of the hard-core drug addict have been reported widely but, it seems, not widely enough to have had the impact they ought to on mainstream medical, social, and legal understandings of drug addiction. Studies of drug addicts repeatedly find extraordinarily high percentages of childhood trauma of various sorts, including physical, sexual, and emotional abuse.” Maté goes on to say, “…the renowned Adverse Childhood Experiences (ACE) Study, looked at the incidence of ten separate categories of painful circumstances—including family violence, parental divorce, drug or alcohol abuse in the family, death of a parent, and physical or sexual abuse—in thousands of people. The correlation between these figures and substance abuse later in the subjects’ lives was then calculated. For each adverse childhood experience, or ACE, the risk for the early initiation of substance abuse increased two to four times. Subjects with five or more ACEs had seven to ten times greater risk for substance abuse than did those with none.”

Long before I encountered Maté’s book, I had begun to wonder about the connection between the childhood, drugs and criminality of the inmates I got to know in the facilities where I serve. As the connections became clearer, I began to ask myself how the relatively small amount of time I’m allowed to spend with inmates is going to be best spent. I also wondered about what investments our society should be making in its criminal justice budgets to give prison inmates a fighting chance to put their lives back together before they are released.

I’ll speak to these questions in my next post.

 

 

The structure of character

The 11 men seated in the circle I entered last Wednesday at Pike County Correctional Facility were not smiling. It was my first day back at the jail after a five-week hiatus, time I had spent revising the material they now held in their hands. The 12-week course, Choosing integrity: The Structure of Character, arose months earlier in that same room after a previous group of inmates convinced me that nothing-but-forgiveness-all-the-time had worn out its welcome.

They were ready for a change and so was I. So I began to write a new lesson for them each week. Their positive response, evidenced through their eagerness to take a hard look at their lives, surprised me. Repeatedly, someone would say, “This is so helpful; I wish somebody had taken the time to teach me this before.” When I finished the 12th chapter and bid them farewell, everyone was smiling.

Among this new group of inmates, no one was smiling. They started in the kitchen at five in the morning, working until 1:00 P.M. preparing meals for other inmates as well as food for the county’s Meals on Wheels program. It was now 4:30 P.M. and they were tired of work and of other reentry program materials they had to complete before I arrived.

I introduced myself and stumbled through a short history of how the program materials they were holding came to be. One man was gazing up at the ceiling seemingly lost to the present moment. Others were looking down, blankly it seemed, at the papers they held. Some watched me, emotionless and unsmiling.

I knew they wanted to be anywhere but in that room. I wasn’t sure I wanted to be there either after a long day of bookkeeping at the convenience store where I work part-time.

But we began with me reading the introductory paragraphs of the lesson as they, or at least some of them, followed along. The ceiling-gazer never once looked at the material. After the introduction I turned the reading over to several others. Eventually we arrived at the section, “Taking Stock.”

It includes 15 statements, each followed by these word choices: Strongly Agree, Agree, Not Sure, Disagree and Strongly Disagree. Here are the 15 statements:

  1. I have made more than my share of impulsive decisions that I later regretted making.
  2. I have usually had the self-control I needed to keep me from doing things I later regret.
  3. I stay angry longer than I think is healthy for me.
  4. I have forgiven the people who have done the most harm to me.
  5. I struggle with addictive substances.
  6. I struggle with addictive behaviors.
  7. I have achieved the goals I expected to reach by this point in my life.
  8. I feel hopeful about the future.
  9. I have at least one trusted and reliable friend I can turn to in time of need.
  10. I take responsibility for being where I am today, and I do not blame anyone else.
  11. I have suffered serious trauma in my life and feel I have not really gotten over it.
  12. I wish I had a deeper spiritual life or connection with God.
  13. I feel like I keep making the same mistakes and bad decisions again and again.
  14. I have a strong sense of right and wrong that I think most people would agree with.
  15. I have had an experience in my life that still causes me to feel shame when I think about it.

I gave brief instructions on how to complete this section and then watched as the participants worked their way through the statements. I watched men pause and ponder over a few of the statements, but also quickly circle other responses they did not have to think about. No one was gazing at the ceiling now. Everyone was dedicated to the task at hand.

I knew from the first time I had offered this chapter 17 weeks earlier that this would be the turning point in the lesson. The reason is at once simple and discouraging. It is simple because inmates are rarely offered a formal opportunity to express their feelings and opinions, and they really cherish a chance to do so. It is discouraging for the same reason. Prison staff members do not seem to care what prisoners think and feel. Their jobs involve enforcing rules and maintaining security.

After they finished I invited the participants to each share his response to one of the statements and why he had selected that particular response. Time slowed down as each man opened his life to the group and to me. The frankness of their sharing was disarming. As I had expected, each man’s brief story was one of failure, or of disappointment, or of pain and loss, or of shame.

Occasionally I asked a clarifying question. But mostly I just listened, signaling with my eyes and body language that I was really hearing them. It took 15 minutes for all of them to speak. The time of confession seemed therapeutic, as if—at last—there was a person who was not frowning or barking orders but was willing to listen. And show compassion.

I told the group that many of the things they had just shared would be part of an upcoming lesson—that we would dig down into what had caused failure and, in some cases landed them in jail.

The next part of the lesson offered the participants the opportunity to identify up to three of the statements for which they wished they could have circled a different response and to state the reason why. In other words, what was the outcome or consequence they wish could have been different.

Some identified only one thing; others wrote about three. Again, the sharing was personal and sincere. At the end of the class I asked for their papers, saying that I wanted to read them and get to know each of them better.

Not surprisingly, struggles with addiction and cycles of bad choices and unforgiveness and trauma and shame were everywhere. We have a lot of digging down to do in the coming 11 weeks.

Incidental note: New York Times columnist, David Brooks, who is a frequent guest on NPR’s “All Things Considered” and the PBS Newshour, has recently published The Road to Character. He and I wrote, I suspect, to different audiences. I’ll be interested to see how much of the same thoughts we each include in our books.

The heroin nightmare

I have met a lot of drug dealers in the federal prison where I serve. Many of them were alcohol and/or drug addicts as well. Some of them stole food from the dining hall, fermented it in the lockers in their cells and made a rank brew they drank and sold to other inmates. My fellow volunteers and I would learn of this when one of our regulars didn’t show up for program. “Oh, he’s in SHU–got caught for making alcohol.”

It wasn’t until I began teaching at the local county jail, however, that I encountered the real, ongoing power of addiction. The majority of county jail inmates who took my forgiveness class were in on charges related to alcohol or drug addiction. They were caught stealing or forging checks to get the money to buy drugs. They were serving 90 days for a DUI. Or, quite commonly, they failed a drug or alcohol urine test resulting in a parole violation.

Of all the street drugs implicated, heroin was always at the top of the list. A word I heard quite often from them was “relapsed.” Some of them had been in rehab more than once. Every one of them had also relapsed. The jailhouse door is clearly a revolving one.

If you’ve watched the news, you have, no doubt, seen at least one story on the heroin epidemic, especially the one sweeping through rural America. (Pike County, where I live, is about as rural as it gets). The stories are heart-wrenching. And for those of us who have no history at all of drug use, they are puzzling, if not confounding.

“What is it with these people?” some of us are inclined to ask. Surely there’s some moral flaw in them, some character defect that they just haven’t worked hard enough to overcome.

The explanations just aren’t that simple, as I am increasingly becoming aware. People first use an addictive substance for lots of different reasons. For some, it is valid physical pain and a doctor’s prescription of an opioid, such as Oxycontin. For others, it might be the influence of peers and the interest in trying something stronger than marijuana. Apparently, a fair number of people turn to heroin when they can no longer obtain the prescription opioid to which they had slowly become addicted.

What some opioid addicts quickly discover is that an opioid not only addresses physical pain quite effectively, but it also brings amazing relief to emotional pain (or perhaps more accurately, “psycho-spiritual” pain).

This doesn’t have anything to do with moral failings or character defects. It really has to do with brain circuitry. At the risk of a making a vast oversimplification, I’ll put it this way: Some people come out of childhood and into adolescence and adulthood pre-wired for addiction. This is not to say they are destined to become addicts; it is to say that under the right circumstances the likelihood is higher.

Medical research confirms that childhood brain development can be adversely affected by a high-stress environment. The “stress” hormone, cortisol, is helpful during a stressful time of short and limited duration. In a constantly stressful environment, cortisol hinders normal healthy brain development by damaging the mid-brain dopamine system. Dopamine is often called the “pleasure hormone” because it lubricates the “pleasure pathways” in the brain. Cortisol damages the dopamine receptors in the brain.

Drugs such as cocaine and crystal meth stimulate dopamine production, causing an intensely pleasurable effect in the brain. Regular use of these drugs, however, inhibit the brain’s own development of dopamine, creating a vicious cycle. The more one uses a stimulant drug, the more it damages normal brain dopamine function, thus creating the need and desire for more of the stimulant drug. This is the chemistry of addiction.

The other primary hormones implicated in addiction are the brain’s “natural narcotics” — endorphins. Endorphins soothe pain, both physical and emotional. To be more specific, endorphins influence mood changes, physical activity, and sleep and regulate blood pressure, heart rate, breathing, bowel movements, and body temperature. They even help modulate the immune system. Thomas De Quincey described the effect of endorphins as “composing what has been agitated” and “concentrating what has been distracted.”

When the body’s endorphins are not up to the task of soothing intense physical pain, physicians have always turned to narcotics such as morphine and, more recently, a host of opioid pills marketed under a variety of names, to help their patients. Those who use opioids initially to address physical pain quickly find out how effective they are at addressing psycho-spiritual pain. It is easy to understand how addiction begins and why it is so difficult to break.

In a video I use in classes on forgiveness, a woman who affirms that “forgiveness saved my life” described her childhood as “total chaos.” She mentions alcoholic parents and childhood sexual abuse by an uncle. When I ask how many participants in my class would describe their childhood as “total chaos,” the majority of hands always are raised.

This helps me understand the origins of drug addiction, at least for some. Even a seemingly harmless curiosity can lead someone to experiment with a substance that, to their surprise, they find to be amazingly effective in dulling pain or creating a pleasurable sensation that, because of interrupted brain development, they find so satisfying that they choose to return to it, time and time again.

While the news stories (see below) about the opioid epidemic do a very good job of describing the nightmare of heroin addiction, they rarely touch on the chemistry or neurobiology of addiction. When I began to understand this, it made a difference in how I looked at the men with whom I work and how I approached the teaching of forgiveness.

I have come to believe that psycho-spiritual woundedness is deeply complicit in addiction. Unless addicts can find genuine healing, the lure of short-term pain relief through drugs and alcohol will be too strong to resist. The trouble with genuine healing is that it’s very hard work. Even occasional miracles from God do not reduce the necessity of hard work and perseverance on the part of those struggling with addictions.

The Washington Post has published several very good articles in a series chronicling the addiction-related ills afflicting vast numbers of Americans. Here are two:

‘How’s Amanda?’ A Story of Truth, Lies and an American Addiction

The Lonely Road of Staying Clean: In a town where pills are currency, opioid addicts have few options

A sobering view of the opioid epidemic appeared on Frontline and can be found here:

Chasing Heroin