Substance Use and Suicide Risk

 WM: Substance Use, Suicide Risk, and the American Health System, March 2, 2022

Substance abuse is a mental health issue. It should not be a criminal one. As I stated last month, primary responsibility for mental health and substance abuse calls (including alcohol related ones) should be under the control of mental health professionals.  The death of George Floyd had as much to do with his alcoholism as his race. Intoxicated arrestees are more likely to be combative and met with unnecessary restraint, from choking to tasing.

I am sure that there will be plenty of statistics provided by invited witnesses. Let me add an anecdotal one that illustrates my point.

My family is no stranger to addiction issues. Some of them have become rather public - largely because it was impossible to intervene quickly and effectively due to requirements in law that prevent mandatory detention until after a crime has been committed. My situation is slightly different, as I sought treatment before my family could stage an intervention and before too much legal trouble. (My mother informed me when I was in treatment that one had been planned for the coming Christmas holiday).

The reason that I was to be intervened on was that I had been brought home by a police officer for walking with a blood alcohol level just above the legal limit, but because I know how to talk to police (and had a DC government ID card), I was released into the custody of my family. They should have been able to say no and have me sent to a treatment facility right then.

Sadly, aside from jail, it is not that easy to get into treatment for either alcoholism or mental health care (and especially not for medication management - which is a time where hospitalization could be the difference between life and suicide). For most in recovery, addiction is seen as suicide on the installment plan. Prompt care is the best mitigation in either case.

I have a sibling who was hospitalized at death’s door twice in the last month for almost drinking himself to death. He was discharged this past Sunday with no placement and a promise to go to meetings. No beds were available (especially not for a Medicaid patient) and there was no avenue for the rest of us to put him into treatment without his consent. As I write this, he is not in communication and may not be alive.

That he cannot find a bed and be forced into one are serious flaws in the system. Were he a cardiac patient, he would get the care needed immediately. As it is, over last weekend, he was treated for an orthopedic condition that he had been ignoring (I am not sure whether opioids are part of the story, but it would not surprise me). The reason he was hospitalized, however, was not dealt with satisfactorily.

In the 1970s, there was a rush to deinstitutionalize long-term mental health facilities. This led to the criminalization of mental healthcare (or the medicalization of crime - take your pick). Our national experience with medical liberty has not worked out well at all. - even budgetarily.

There is another item that merits attention - child custody. One of my relatives, in a custody battle and under the influence, absconded with her daughter. This was on the national news (see above). Had her use not been a custody issue - and with the ability to mandate care (from a relapse) had existed, there would have been no news to report.

Our foster care system is littered with stories of people losing their children because of addiction. When this occurs, getting their child back often becomes a priority over their own sobriety - or is the reason for it. The truism is that whatever you put in front of recovery will be lost - although sometimes the person who does so simply dies.

Foster whole families, not children. Fostering the child of an addict should not be the answer to a prayer for having one’s own children. Indeed, if the child has the same genetic predispositions as the parents, the fantasy of adoption will turn into a nightmare for the unprepared sober couple. 

This leads us back to last month’s attachment. Addicts deserve a chance to be the parents of their children once they have sound recovery. This includes making this decision affordable. This is an area where we must Build Back Better. Removing financial uncertainty by increasing the child tax credit to middle income levels and making it refundable takes away pressure that could lead to relapse. 

If readmission to treatment is automatic if relapse occurs, foster care can be resumed - or arrangements made - until recovery is on a sure footing.

Compassion is the answer to dealing with addiction in families. The current punitive system works for no one - especially the children of alcoholics and addicts.  Seeing addiction as a health issue, rather than a criminal one, makes reentry for those formerly convicted for drug offenses all the more possible.

Comprehensive reform of both welfare and a higher minimum wage are also important. The current “job training” system readies women for low wage labor - as does parole for men. Labor should never be “low wage” and the social welfare system should feature paid education, rather than job or job readiness training. By paid - I mean with a stipend at minimum wage levels with a child tax credit - not simply paying for tuition. 

Again, we must build back better.

Attachment: Mental Health Care, February 2, 2022