Ruthie and Menachem Schwartz* have five children in day schools and yeshivas who are thriving. An additional child of theirs, Ari, age 16, has not been doing as well. He’s been suffering for the past three years from a form of skin cancer that, after a short remission, has been getting worse. The Schwartzes are beside themselves with worry but don’t know where to turn. Nothing seems to be helping on a long-term basis. They don’t know anyone in the community who has faced this difficult challenge and feel very isolated in their suffering.
Fearing the stigma associated with this serious disease, they have avoided making his condition known, trying to spare their other children the embarrassment of being known as the siblings of a child with this challenge. They are especially concerned that if word gets out, their daughter next in line to marry will be shunned for shidduchim and the younger boys will have problems getting into good yeshivas.
Shira Goldenberg* suffers a similar fate. At age 29, she has been hiding the fact that she has been suffering from type II diabetes for the past 10 years. Even her parents are unaware of the severity. She has had problems at work and school due to this illness, and her old crowd of friends has, for the most part, abandoned her, repulsed by the symptoms of her illness. Her only close friends now are people who are also suffering from the same type of disease.
Are the above scenarios real? Of course not. The discerning reader will probably have guessed that they are parables for another type of affliction. Far too many families in our community have been suffering silently while some of their members have substance abuse problems, usually with alcohol or drugs – very commonly with opioids. They are afraid that if a family member is labeled an “addict,” it will cast them in a negative light, as if they were responsible for this illness.
As this plague claims more and more lives, more attention is being paid to how to prevent and treat it. This article is a part of that effort. It is part one in a more extended treatment of addiction in our community.
The Curse of Stigma
The terrible stigma that accompanies addiction, almost worse than the substance abuse itself, has been preventing many of our children (and adults) from receiving the treatment they need and deserve. Furthermore, the health care system, as it is currently set up, seems to put this health problem on the back burner, usually not allocating enough resources for a full, steady recovery. On top of this, there are many so-called “treatment centers” charging top dollar but yielding very poor results.
Rabbi Larry Rothwachs, director of professional rabbinics at Yeshiva University’s Rabbi Isaac Elchanan Theological Seminary and rabbi of Congregation Beth Aaron, spoke at a recent Amudim community gathering in Teaneck, New Jersey. The stigma associated with substance abuse in general is more deeply felt in frum communities, he said. “As a community we tend to be very judgmental,” which “comes from a good place because we expect a lot of ourselves and our children, valuing hard work and achievement. We place a high value on morality, ethics, and behaviors, and …one might think that a person who indulges excessively in alcohol and drugs must be a person who lacks morality, ethics, and appropriate behaviors. We attribute this to character flaws and lack of self-control.” However, he says, “Alcohol and substance abuse is an illness. The concept that an illness can interfere with one’s free will is far from intuitive and very difficult to relate to….We believe that if we close our eyes to this problem we can somehow protect ourselves and our children.”
In an article published nearly 15 ago, Rabbi Dr. Abraham Twerski, a pioneer in the field, urged, “However great the stigma attached to alcoholism or chemical addiction, it can no longer be allowed to interfere with getting help. It must be understood that chemical dependency…is a malignant condition. It may claim as its victims not only the user but the family members as well. Its consequences are far-reaching and devastating.”
Rabbi Zvi Gluck, executive director of Amudim, recently stated, “The stigma is killing us and our kids.” He suggested that if asbestos were found the school buildings and only a tiny percentage of the students were negatively affected, people would immediately do everything possible to remedy the situation “but for addiction we are not stepping up to the plate.”
How Does One Become Addicted?
Although opioid addiction seems to be everywhere in the news and is “all the rage,” principles discussed in this article apply to any type of addiction – whether to alcohol, marijuana, or other mind-altering substances, and even various addictive behaviors, which also alter the way the brain functions. Experts used to think of addiction as a dependency on a chemical. It is now more broadly defined as “repeatedly pursuing a rewarding experience despite serious repercussions.”
“People turn to drugs for many reasons,” says Rabbi Gluck, “ranging from just experimenting, since it looks like fun, to childhood trauma to get away from pain. Many people get hooked on pain medicines. I promise you that nobody ever woke up one morning and said, ‘I want to be a drug addict.’”
Last November, there was an Inter-professional Forum on Ethics and Religion in Health Care downtown at UMBC. One of the speakers was Dr. Carlo C. DiClemente, Ph.D., a professor of psychology at UMBC who directs the MDQUIT Tobacco Resource Center, the Center for Community Collaboration, and the Home Visiting Training Center at UMBC. “Many people start using for pleasure; they continue using to avoid pain.”
Indeed, an addict will feel the need for the drug simply to survive, just as you and I feel the need for oxygen. Dr. DiClemente, who said that it is never a linear path to addiction, described the many stages one needs to take on that path. Not everyone who experiments with substances is doomed to become an addict. But that is a step on the path. According to Dr. DiClemente, the first stage is not even being interested in using the substance. Next comes considering it, then preparing to use and/or committing to try it, using it, experiencing an initial change, and, finally, maintaining the usage, which is sustained change. He says the same steps going in are the steps needed to come out.
“Successful recovery can take a long time,” says Dr. DiClemente. “Treatment that only imposes change but doesn’t involve the individual’s empowerment and ability to choose are doomed to fail. Once the imposed change is removed, they will almost always go back to old habits of substance abuse. To expect an addict to leave directly from detox treatment, go back to his old environment, and not go back to his old behaviors is completely unreasonable. The self-control muscle needs to be strengthened first, during at least a period of abstinence.” (He mentions that required activities, such as making one’s own bed every morning, is one way of strengthening that muscle. There are many others.) “Addiction is not only a brain disease,” continues Dr. DiClemente. “There are interrelated physiological, psychological, and social components.”
For this reason, treatment is not a one-size-fits-all venture but needs to be individualized and modified as time goes on for each person.
Dr. Yngvild Olsen, MD, MPH, Medical Director of the Institutes of Behavior Resources, Inc., spoke on a panel at a community event several months ago. “For a very long time, we have criminalized and have come to see this as an issue of moral failure,” she noted, “a lack of willpower. However, if you look at the science and the risk factors for developing an addiction, about 40 to 60% of it is genetically based. We don’t yet know which genes or combination of genes create this ‘perfect storm’ or how they change people’s brain circuits to put them at risk for addiction. There is a lot of ongoing research on this area.”
Finding Treatment
Dr. Olsen says, “In medical school, I got one hour of training on addiction, and I got another hour of training on how to prescribe opioids. That has changed a little bit, but not a lot, and not enough.”
If this is the case for trained professional healthcare workers, how much more so is the importance, when seeking treatment, to find a facility staffed with medical professionals who are addiction specialists? Unfortunately, there is not a lot of regulation in the addiction treatment field, and there are no national accreditation standards for treatment.
According to an article in The Atlantic by Gabrielle Glaser, “a 2012 report by the National Center on Addiction and Substance Abuse at Columbia University compared the current state of addiction medicine to general medicine in the early 1900s, when quacks worked alongside graduates of leading medical schools.…Most treatment providers carry the credential of addiction counselor or substance-abuse counselor, for which many states require little more than a high-school diploma or GED. The report stated: ‘The vast majority of people in need of addiction treatment do not receive anything that approximates evidence-based care.’”
Rabbi Gluck advises people to do research and find an expert who can advise you on where to look for treatment. He warns to stay far away from Dr. Google.
How Must We Respond?
As Rabbi Dr. Twerski urged in that article of 15 years ago, “Yeshivas and seminaries must begin to introduce courses dealing with chemical dependency. Jewish communal professionals must become knowledgeable in the field. Community education programs must begin to feature programs of substance abuse. All individuals involved in Jewish communal life must learn to recognize the problem of chemical dependency and become familiar with the resources so essential to treatment recovery, be they detoxification, rehabilitation, counseling, or self-help programs.”
Rabbi Gluck urges us, “As parents we must partner with our children’s schools to be able deal with this at a young age. And schools do need to step up. I know, baruch Hashem, that they are far better than they ever were, but we still have so much more to go. Curriculum-based learning for drug and alcohol awareness and prevention is a must in every single school, and not just a one-time speech.”
He emphasized that we must be supportive toward the addict in recovery, who might reach a “bump in the road” and turn to his drug of choice to try to get over it. That can lead to accidental overdose since the body is no longer used to such a high dose of the toxin. “That just shows how much more we must be there for those in recovery.”
Rabbi Shmuel Silber, on a panel of faith leaders at the UMBC event, also spoke of how we can “be there.” He said we should be “giving a message of acceptance and love for all people. If you want to help people change, the best thing you can do is build them up. Failure [such as a relapse] is part and parcel of the human condition. Don’t define a person by their addiction or by their struggles, but help reinforce a healthy sense of self.…In our synagogue, we try to reinforce, ‘the community loves you; the community is behind you, the community accepts you with all of your struggles. We are here to support you.’”
We must also be there for youth who have not yet considered drugs. Ruchie Freier, civil court judge assigned to Brooklyn Criminal Court, writing last year before Tisha B’Av about the tragic saga of Malky Klein, a frum girl from New York who overdosed, decried the attitude of those who protest against children who “don’t fit” from entering their schools. Judge Freier brought halachic sources showing that rejection or expulsion of students is against halacha and akin to murder. She urged that children who “don’t fit into the box” be as unconditionally loved and accepted as those who do. She quotes an article by Devir Kahan, (Times of Israel website), who says, “We mistakenly confuse achdus (unity) with achidus (uniformity.) While we aspire to harmony, we mistakenly demand conformity and stunt creative individuality and inhibit growth.”
How much has changed during the years since Rabbi Twerski wrote the above words? Not enough. Lois*, a frum addict in recovery who has two family members in recovery as well, fears that as much as there has now been talk about substance abuse in our community, “It will be another 15 years before the fear of stigma will change.”
Prognosis
We don’t have another 15 years. If, from Rabbi Twerski’s words until now, overdose deaths have only increased, we can’t afford to wait any longer. A radical mind shift as well as concrete actions are needed now. Just as the journey for the addict that Dr. DiClemente describes is not a simple path “going in or coming out,” so, too, the journey for our community to tackle this problem will not be a simple path with easy one-size-fits-all solutions. We need multiple approaches, but the basis of them all will need to be open communication.
I am happy to report that initiatives are in the works for our schools and community. Some community members have recently met with the principals of all Baltimore’s Jewish day schools and with the Vaad Harabbonim to develop a plan for addiction education and awareness for children and parents. It’s a small beginning but a start towards confronting and dealing with this important issue.
To be continued…
Sidebar, put in box
Resources for Substance Users and Their Families
- IfIknew.org. The Get Help link, brings you to a slew of resources to contact for substance abuse and other issues: www.ifiknew.org/baltimore-resources-for-alcohol-tobacco-other-drugs
- Both Baltimore City and County have crisis hotlines as well as information on how to get Narcan training (administration of the life-saving drug Naloxone at the time of overdose) on their websites. The county’s hotline is 1-800-422-0009 and the city is 410-433-5175.
- Another 24/7 hotline where you can speak with a person with a mental health background is Grassroots Crisis 410-531-6677. They deal with immediate, urgent situations.
- In addition, it is important to note the Maryland Good Samaritan Law, which “provides protection from arrest as well as prosecution for certain specific crimes and expands the charges from which people assisting in an emergency overdose situation are immune. If someone calls 911 in an effort to help during an overdose crisis, or they are experiencing an overdose, their parole and probation status will not affected, and they will now not be arrested, charged, or prosecuted for 1) possession of a controlled dangerous substance​​; 2) possession or use of drug paraphernalia; 3) providing alcohol to minors.”
