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This picture has nothing to do with rehab; it's a seaside resort in Southern China. There are rehabs that look like this, though. On the other end of the spectrum, I once attended a program in Upstate New York that was housed in a former tuberculosis sanitarium - the dental "truck" would pull up to what used to be the crematorium. "Throughout human history," where to go to inpatient rehab has been one of the most important decisions of one's life. In fact, given the mortality rate of addiction and the fact that even the “top” programs have unimpressive to abysmal success rates, it may have life-or-death significance. Once you are there, you are essentially stuck, so choosing wisely pays dividends. “I’ve been to six rehabs, and this one is the best, by far!” Is the kind of flex that you never, ever want your life to produce. *This post is intended for people whose lives have been disrupted to such an extent by addiction that they are essentially ready to begin a new life upon discharge from inpatient. If you are returning to your previous house / job / relationship after 30 days or fewer of inpatient, much of this advice is not going to apply to you. Insurance coverage is a deciding factor, I’m well aware, but scholarships are an under-considered option. If you find a program that sounds perfect for you, write them an email explaining why you believe that they can help you; these programs are always looking for success stories and future staff members. Okay; here we go: 1. Find a rehab that offers multimodal treatment. You might think that you want 12-Step-based care, religiously informed treatment, or an experience heavy in one-on-one therapeutic work based on CBT, REBT, DBT, or other approaches (see chart below). The problem is that you won’t really know what is working for you this time until you’re there. Strong programs differentiate and provide options. For my overview of common therapeutic models, click here). Borrowed from We Level Up. If you think that traumatic experiences play an especially important role in your continued use, you might want to look into programs that offer Eye Movement Desensitization and Reprocessing (EMDR) therapy; I have known a couple of people who swear by this, including a state trooper who investigated child homicides for most of his career. 2. Look for a rehab that addresses the mind-body connection by providing time for physical exercise every single day. Yoga, running / walking, swimming, horseback riding, group challenges, sports, whatever floats your boat. Insomnia is one of the near-universal complaints in inpatient treatment, and exercise is Nature's remedy for it. Try to find a facility that will let you out for a group excursion at least once or twice because watching middle-aged alcoholics go full-on The Fugitive to sneak away for a drink is really something to behold. 3. Discuss aftercare in detail. Aftercare refers to the step-down treatment that you receive after inpatient, which often includes time in a half-way or three-quarter house, outpatient treatment at different levels of intensity, and participation in other recovery supports. Because behavior can really only begin to change over the 30 days or fewer that you will spend in inpatient treatment, your chances of success are strongly dependent on what happens after that initial period. If you get a generic “We work with the patient to find a program in their area that will accept them…” kind of response, beware. I would want to hear something along the lines of “We place most of our patients at X and Y Sober Living programs, which provide outpatient in-house [or send their residents to Z Program]; the typical length of stay is six months to a year, and we have a strong network of graduates who remain in the area long-term.” This is possible to find. The most effective program that I attended was in a bougie county in Florida known for being a rehab destination, and the strength of the young recovery there – especially of opioid addicts who were not on methadone or buprenorphine – blew my mind. Many of my peers remained in the area for years, and at least a dozen of them ended up working in the field of recovery. My strong advice is and always will be to avoid returning to your addictive “home base” if you have the option not to. Let’s be honest – if you’ve gotten to this point, your people could use a break from you anyway. Also, your brain will find it much easier to form new, recovery-friendly connections and ignore old, destructive cognitive / emotional patterns if you can physically remove it to a new area without the overlay of a complicated past. 4. Look into “alternative” treatments if the standard addiction treatment model hasn't worked for you. If you have tried “standard” inpatient and found that it didn’t stick, don’t give up. I know two people who did ibogaine treatment in Mexico; one achieved remarkable recovery, and one went right back to addiction. Another attended a “spiritual growth retreat” in Thailand that wasn’t focused on addiction at all, and what do you know? She beat a decade-long addiction without placing primary emphasis on that as her objective. Addicts are a diverse population. We began using for many reasons; we continued using for many reasons; we were unable to stop using for many reasons. Whereas chronic depression or anxiety might drive someone else’s addiction, an unhealthy relationship at the center of my life or lack of a spiritual foundation might keep pulling me back. Good clinicians recognize this and emphasize the differences as much as the similarities because it is often the differences that provide the footholds for change. 5. Find a program that sets aside time for introspection. This is a personal priority. It might sound obvious, but this is my biggest pet peeve for both inpatient and outpatient - that some programs provide so little time in which to process, internalize, and implement all of the insight and therapeutic headway that their patients are making. In particular, as you might guess, I am a fan of journaling. I find treatment vastly more effective when I have time to process growth through writing. 6. Ask about how the program encourages creative expression. This might sound like a luxury (or at least a secondary consideration), but my experiences in recovery have taught me otherwise. I have little to no (visual) artistic talent, but in treatment, I am the High King of Mandalas. There’s something about making beautiful (or horrifying) art that is utterly absorptive and that nourishes a part of the soul that is dampened or depleted by addiction (that’s the best way that I can phrase that). It’s also an exciting feeling to have other people appreciate your work and to take part in creating with them. Rehab is the time to pick up a creative hobby as an adult. Given the circumstances and the crowd, no one is going to shame you for your lack of talent. 7. If you’re an opioid addict, find a program that isn’t going to railroad you onto buprenorphine or methadone. If you really need these medications, you can always start them shortly before or after discharge. However, if you’re going inpatient, it will always be my advice to first try recovery without the crutches (that often seem to shapeshift into handcuffs somewhere along the line). After you have experienced “happiness with a half-life,” as I call the misery of severe opioid addiction, being free of that “how long until I go into withdrawal?” thought-reflex is the greatest gift. 8. Do a quick Google search of each program name once you have a shortlist of contenders. In particular, if you see lawsuits and records of citations by state addiction treatment regulators (OASAS is the pertinent group in New York State), be careful. 9. Don’t worry too much about visitation and phone privileges. You will be encouraged to keep contact with outside parties to a minimum, and this is advice that you should heed. Inpatient should be a “hard reset”; many things about your previous life weren’t working for you, and you need time and physical distance to sort out what needs to be changed. A final note of caution: There are some less-than-savory actors in the addiction treatment sector. Any offer of a program slot and a plane ticket "right now, today only," should be considered with the greatest skepticism. Some of the shadier treatment franchises spend significant sums of money training customer service reps to say the right things, and this can make it hard to differentiate reality from marketing hype. This is where the Internet is your friend. Reach out on recovery forums and try to find graduates of the programs that you are considering. The rule about "too good to be true" applies here; I would expect to compromise and manage my expectations in finding a program. I’d love for my readers to share experiences and advice below! Happy Easter to everyone who is considering the ultimate rebirth for themselves or a loved one!

Remembering some of my weirder moments in therapy. Presents an overview of CBT, DBT, psychodynamic therapy, and EMDR. Addresses how to know which one is right for you and asks four key questions to consider before booking your first session. Contains a directory of searchable provider listings from several national mental health organizations to help you find a suitable clinician. In this scene from Dune, a 2021 movie based on Frank Herbert's astoundingly imaginative sci fi novels, Timothée Chalamet's character Paul of House Atreides must stick his hand in a box that produces tremendous pain - comparable to that caused by holding one's arm in a blazing fire. If he so much as moves a finger, a Bene Gesserit hag will kill him with the poisoned gom jabbar needle that she is holding to his neck. In case you're wondering, I'm mentioning this because I once went to a psychiatrist who used a similar method to measure distress tolerance (except with ice and minus the gom jabbar). Meet 65% Executive Dysfunction Tessa Three statistics to set the scene: ͎• 92% of American adults prefer to date someone who has undergone therapy* ͎• 22.8% of American adults had some form of mental illness in 2021 ͎• 75% of people who undergo therapy have some positive effects *If you’ve ever lived in NYC, you know that it’s 99.99% there So, therapy works. Therapy is important. But anyone who has ever worked in the medical field knows that psych attracts a… unique… set of practitioners. A quick story because I need to unburden myself. I was once in an inpatient addiction treatment center in Delray Beach, Florida, which is a bougie area that became the recovery capital of the U.S. and the relapse mecca of the universe during the rehab craze of the 2010s. This facility was located in a beautiful area with designer McMansions crammed in next to each other along a system of labyrinthine canals so that they could all be considered “waterfront property.” For whatever reason, the patient set at this treatment facility was mostly young, gorgeous people (cue: insecurities about my physical appearance). Now, every treatment center has a no-fraternization policy because burying one's sorrows in another patient's orifices is seldom a sustainable recovery plan. At Palm Partners, there was endless drama around staff discovering 2 a.m. laundry room liaisons or dinnertime hookups in storage closets. I suppose that these relationships were inevitable, especially considering that we played co-ed beach volleyball in skimpy swimsuits every afternoon - what did they think would happen? It would have made good reality TV, honestly. Anyway, on account of the enthusiastic enforcement of its no-fraternization rule, we patients gave Palm Partners a new slogan, “Palm Partners: Where your palm is your partner, and your finger is your best friend.” I’ll let that sink in for a moment. To its credit, the facility offered a variety of treatment options, including some complementary and alternative methods like Kundalini yoga, sober raves, and sweat lodges. Its head psychiatrist was a short, mischievous-looking man with hair sprouting from his nose and ears; he looked like a dwarf from an Eastern European fairy tale. The first time that I saw Dr. L, I arrived outside his office five minutes early. I didn’t see anyone to greet me, so I knocked on the door. There was no response, so I opened it a crack. Inside, I saw a fellow patient named Tessa. She was a coltish, straw-blonde girl from Jersey, and she was wearing a green Ninja Turtles outfit with a backpack for a shell. We referred to her as 65% Executive Dysfunction Tessa due to the unfortunate results of a brain scan undertaken to try to determine why she had absolutely, positively no filter on what came out of her mouth. I should probably mention that Tessa was sitting on the ground in front of Dr. L, who was in a standard office chair with his computer propped up on a small table to his left. “Oh, hey, Brian; I wish you weren’t gay so I could f*ck you,” Tessa called. "I'll be here for another few weeks, looks like; they say that if you're from Jersey, they automatically keep you for double the time." “Be with you in one moment,” Dr. L greeted me. A few minutes later, Dr. L ushered me into his office and invited me to take a seat. There were maybe eight different options arranged in a rough semicircle around his own chair, including a loveseat, a stool, a desk-chair with an L-shaped armrest / work surface, and a spinny office chair. I thought about the desk, but I didn't want Dr. L to think that I was asserting my studiousness to try to impress him or something. Instead, I selected the most unremarkable option, a black, sled-base chair that would have been at home in any office or waiting room. Is he going to think that I don’t want him to know anything about me? That I’m resistant to opening up or dishonest? Dr. L turned to his computer to type a note as I cursed fate for not giving me Tessa's executive dysfunction superpower ("F*ck you and your C-list cliche of a psychological experiment," I imagined telling him). Five minutes later, I plunged my right arm into an icy bath that Dr. L’s assistant had brought in. I kept my hand there until cold had become searing pain and my entire arm was shaking spastically. Anyone who has ever read Dune will understand the Bene Gesserit stress test parallel running through my mind. When I gave in and withdrew my hand from the ice bath, half-expecting the sinister prick of the poisoned gom jabbar, I knew that I hadn't lasted very long; my nerves were hypersensitive from coming off of benzos and opiates, which made ordinary tasks like shaving and brushing my teeth very uncomfortable. “Can we do it again with music?” I asked as I flexed my fingers, enjoying the tingle as my arm returned to room temperature. “Sure,” Dr. L responded with raised eyebrows. I put my AirPods in and selected “Layla” on my iPod, skipping to the hauntingly beautiful electric guitar / piano solo that dominates the second half of the song. This time, as I held my hand in the ice bucket, I fit my pain into the spaces between the notes, tucking it in between E-flats and C-sharps, under codas and in the pregnant pauses between chords. I subtly undulated the muscles and tendons of my hand and forearm in rhythm with the ups and downs of the tune until they became too frozen to feel. I outlasted the fiery pain phase and entered a state of partial dissociation, in which my vision blurred and I couldn’t feel my arm or hand hardly at all. My whole limb all the way up to the shoulder felt like it was floating, and still the melody cradled me. I gave a surprised jerk when Dr. L instructed me to withdraw my arm. “Any longer and it could cause some damage,” he explained. “I’m writing in my notes that you show some distress intolerance, but that it is well-compensated-for with coping skills like music…” Dr. L was trying to assess whether I could tolerate physical discomfort as well as a “normal” person. In this case, he was evaluating this with a physical distress test - whose results, interestingly, closely parallel those of mental ones for a given individual, providing one example of the brain processing physical and mental pain in a unified way. I knew where he was going with this: Dr. L was using this test to determine whether he should approach treating me through the lens of DBT or CBT. Without a little background knowledge, I would have been bewildered. Moreover, I wouldn’t have been able to talk to Dr. L about my own priorities in a way that meshed with his approach. When it comes to treatment, it pays to do your own research* before you engage with the medical system. *It's me; I'm your research. Untangling the Therapy Alphabet: CBT, DBT, Psychodynamic, and EMDR Take a simple issue like anxiety. You decide to meet with four different therapists specializing in four different methods: ͎• The psychotherapist is probably going to talk to you about when in your life anxiety started becoming an issue; they are also likely to be interested in how your parents and other key figures from childhood dealt with their own anxiety and whether you felt safe at home and school growing up ͎• A DBT practitioner is going to teach you to put your face in ice water to calm your heartrate during anxiety attacks ͎• A CBT-based therapist is going to examine the irrational thought patterns that magnify and sustain your anxiety and teach you to create an adaptive mental narrative to counter them ͎• Someone using EMDR is going to select the most disturbing images, thoughts, and memories that provoke your anxiety and present triggering stimuli while having you focus on a counternarrative and watch the therapist move his finger from side to side So, four different therapeutic approaches, four entirely different experiences as a patient. Most therapists employ eclectic methods, and as I mentioned above, if you don’t understand their theoretical framework, you’re not going to be able to track your own progress and advocate for yourself effectively. Alright; let’s get down to the nitty gritty. Cognitive Behavioral Therapy is probably the broadest and most widely used of the therapeutic lenses that I’ll talk about today. Basically, CBT helps you to identify maladaptive thought patterns (see infographic on cognitive distortions below). As an example, consider negative internal monologues that magnify and catastrophize anxiety, such as “Oh my God, my heart's racing, my blood pressure's going to spike and I’m going to die.” CBT corrects cognitive distortions that make mountains out of molehills (“My boss just told me that there are corrections needed on my project; I’m going to lose my job, and I won't be able to get another because I won't have a good reference, then I won’t be able to pay my rent, so I’m going to end up homeless"). I’m using hyperbolic examples, but hopefully you get my drift. CBT teaches you to recognize maladaptive thought patterns that produce and feed into negative emotions. It also gives you practical skills to deal with the problems in your life. If you’re having marital issues, for example, your therapist might model a conversation with your spouse in which he or she plays your partner. The two of you will reenact a typical argument and then model a different set of responses that could shift it in a more positive direction (switching roles is fun with this kind of exercise, too). If you’re experiencing depression, anxiety, or other symptoms that are magnified by negative thought patterns, CBT is likely the way to go; CBT is great when thought dominates feeling. Almost all therapists will have some grounding in this therapeutic approach, which was formally developed in the 1960s but draws on techniques and theories that existed long before. CBT teaches us how to reframe our thoughts to avoid cognitive distortions that produce depression, anxiety, and maladaptive behaviors. I am a proficient catastrophizer; small setbacks act as kindling that my mind uses to create vast apocalyptic forest-fires as I'm up at 3 a.m. worrying about my future. I never have a simple cavity; I suffer from painful oral bone infections that will lead to endocarditis necessitating valve replacement, which will reduce my lifespan to 3-5 years. CBT techniques help me to walk that thinking back and reframe life situations in a more balanced way. Infographic from mentalhealthathome.org. Dialectical Behavioral Therapy is an outgrowth of CBT specifically designed for people with Borderline Personality Disorder (described in my PSA on Cluster B disorders). It’s been used for a variety of other diagnoses, as well. Basically, if you’re someone who sometimes gets so swept up in their emotions that thought becomes almost irrelevant, DBT is for you. Many addicts suffer from severe mental and physical distress intolerance, and DBT can help with multiple aspects of addiction. For example, DBT groups taught me meditative exercises to manage my withdrawal symptoms. Dialectical refers to a back-and-forth; it has to do with reconciling opposites. DBT is meant to shift patients away from black-and-white thinking about the people and situations in their lives. It helps us to understand that two opposite things can co-exist and both be valid. Like CBT, DBT has a module focused on effective communication. As I mentioned above, it also emphasizes mindfulness methods such as breathing exercises and other tools descended from Eastern spiritual traditions. If you have a Cluster B diagnosis or you're hotblooded, irrational, and impulsive due to your addiction or other mental health problems, DBT is a godsend. For people who struggle with these issues, CBT won’t be very effective because in the fury of the moment, emotions override thought for many people, especially those with severe anxiety, depression, and PTSD. See the following chart for a helpful comparison of CBT and DBT. This chart is reproduced from simplypsychology.org, which has some good mental health-related resources. Psychodynamic therapies are often used for people without mental health diagnoses ("normies") and patients who are seeking insight into why they feel and act the way that they do. Emphasis is placed on the context in which you developed your patterns of thought and feeling; you’re likely to be asked about what home life was like growing up, how you felt about school, how you related to elders / authority figures, and what some of your key early memories are (both positive and potentially traumatic). Your therapist will help you to uncover far-reaching beliefs that were ingrained in you during development and that might have become subconscious, which are still influencing how you think and act in the present (for example, ideas like “I’m not good enough” or “Everybody’s out to get me” or “I’ll never find real love”). Again, the psychodynamic approach is focused on developing insight. This therapeutic mode is less likely to employ direct, practical behavioral methods such as dunking your face in ice water to calm anxiety or snapping a rubber band on your wrist to stop an intrusive thought. The premise is that heightened awareness will naturally give rise to change. From this perspective, understanding your past is the key to controlling your destiny. Psychodynamic theory developed out of Freudian theory and other talk-therapy-oriented schools of thought. It retains their focus on how profoundly early life experiences influence later mental health and behavior. Finally, EMDR, which stands for Eye Movement Desensitization and Reprocessing, is worth mentioning because I have seen it produce positive results for other addicts, including a fellow patient who was a State Trooper whose job involved investigating violent crimes against children. After twenty-five years on the job, this man was deeply traumatized by the remains of child victims and other horrifying sights that had been indelibly imprinted on his mind; he told me that EMDR helped him more than any other therapeutic technique or medication that he had tried. During EMDR, you will be asked to evaluate beliefs connected with traumatic moments in your past (for example, perhaps “I am ruined” connected with a sexual assault). You will formulate a more positive cognitive response, e.g., “I’m a resilient person who is on a positive path in life, and I control my own destiny." After being shown a traumatic trigger, you will focus on the positive thought as your therapist presents a stimulus that initiates side-to-side eye movement, such as a finger moved back and forth in front of your eyes. It’s theorized that this lateral eye movement triggers reprocessing of trauma by both hemispheres of the brain, which allows the brain to bypass “stuck” or “broken” neural networks and form new ones that respond more effectively to trauma-associated pain and anxiety. EMDR is used for people with PTSD, intrusive thoughts, anxiety, dissociative disorders, eating disorders, and substance abuse problems. There is some controversy over its efficacy and potential dangers, but if you have a few unforgettable traumatic moments or intrusive thoughts that dominate your internal life and trigger negative episodes, EMDR is certainly worth looking into. Let's take a moment to review. if you’re someone whose negative thoughts generate anxiety and depression, CBT is probably the way to go. If you’re dealing with emotional overload and need to re-center your mind and body, check out DBT. If you’re interested in gaining insight into your past and how it is producing your present, psychodynamic approaches are likely to be of use. Finally, EMDR is based on reprocessing of key traumatic moments and intrusive thoughts, so if you’re someone dealing with PTSD that is possibly related to a substance abuse or eating disorder, I’d recommend looking into EMDR. Key Questions to Consider Before Your First Therapy Session I’ve put together a list of questions that I think anyone entering therapy should consider before they make that first set of calls. 1. What mental health diagnoses have I been given? Are there any undiagnosed conditions that I suspect that I might have? Are there any problems with my physical health that could be influencing my mental health? 2. What issues in my life do I want to work on? For example, “I want to improve my marriage,” “I want to feel less anxious,” “I want to cut down on my drinking.” 3. What therapeutic modalities am I interested in? Not all therapists will be trained in DBT and EMDR, but most will have some grounding in psychodynamic approaches and CBT. Ask about what workbooks and other materials are used; competent therapists will have an organized approach in applying each therapeutic modality. Remember that only a physician (typically a psychiatrist), certain midlevels (Nurse Practitioners or Physician Assistants), and in some states, clinical psychologists with PhDs and Psy Ds can prescribe mental health medicines. I recommend seeking out a PhD-level clinical psychologist whenever possible, but due to insurance limitations and a dearth of providers, this can be challenging. If you're in standard inpatient or outpatient therapy, your counselor likely has an associate’s degree in counseling or substance abuse treatment. If you’re dealing with a Credentialed Alcohol and Substance Abuse Counselor (CASAC), you need to figure out whether they have sufficient training in any of these therapeutic approaches and seek help from someone else if they don’t. Licensed Clinical Social Workers (LCSWs) are master's-degree-level professionals who are often wonderful to turn to, and they tend to be more prevalent in addiction treatment contexts. 4. How many sessions does your insurance typically cover? How much time per week or month can you devote to therapy? Make sure to budget time outside of your sessions to reflect on what you've learned, practice new techniques, and complete "homework." It’s important that you and your therapist come up with a plan of attack after one or two sessions to make sure that you have defined, measurable goals that will be addressed during your time together. Here are some resources for finding therapists specializing in different approaches and populations: American Psychiatric Association’s find a psychiatrist tool American Psychological Association’s find a psychologist tool Asian Mental Health Collective’s therapist directory Association of Black Psychologists’ find a psychologist tool National Alliance on Mental Illness helplines and support tools National Institute of Mental Health’s helpline directory National Queer and Trans Therapists of Color Network Inclusive Therapists Please share your thoughts and experiences below! I'm getting many responses from people using the contact form rather than commenting. I assume that this is because I write about sensitive issues that people might not want to discuss publicly, and I love hearing from you all either way! I want to facilitate communication within our community by creating a Discord or a forum after the blog has aged out of infancy (2-4 months from now). Make sure to join the email list so that you can give input and keep up with new developments!

Cat Marnell competing with yours truly for the Sloppiest Person of the Century Award (photo courtesy of Getty Images). *4/15/2024: Follow-up addressing the Reddit drama here. Cat Marnell is Cher Horowitz on Adderall If you’re wondering what the Cat Marnell who emerges in her 2016 memoir How to Murder Your Life is like, picture Cher Horowitz from Clueless if she had been on rewire-your-fake-Christmas-tree amounts of Addy (okay, Cher probably was). Imagine if she had gotten pregnant before graduating from prep school, then ignored the “problem” for so long that her parents had to pick her up and transport her to a different state to get an abortion; then lost her Barnard acceptance due to message board shenanigans and decided to move to New York City instead, where she began interning for beauty magazines and k-holing with minor celebrities in between wielding stilettos during Benadryl- and amphetamine psychosis-induced battles with imaginary rodents. That’s Cat as she writes about herself during peak active addiction (and in presenting those messy moments, she is at her finest). Cat Marnell began her writing career at Lucky and other print publications in the beauty industry, and her addiction memoir stays true to her dirty blonde roots. It’s very “What I Wore to My First Abortion” and “How to Conceal Track Marks with Three Products You Already Have in Your Purse.” At times, there is a dark humor to Cat's brand of addictive maelstrom that I can’t help but appreciate. If nothing else, it can be said that Cat is unapologetically herself. For a confessional writer, this can mean everything. What Works: Champagne Problems and Fucked-Up Relationships Cat’s portrayal of her white, upper middle class family’s dysfunction paints a picture that many Millennials will identify with. Cat’s psychiatrist father and Licensed Clinical Social Worker mother were all too ready to believe that prescription amphetamines would be the solution to the troublesome teenage Cat’s issues; they also authorized the kidnapping of Cat’s older sister, Emily, so that she could be hauled out of state to a “school” where she was physically and psychologically abused (a la Paris Hilton). Cat’s parents might seem effortlessly put-together in their own professional and social lives, but they are utterly inept as parents. Her grandmother, who Cat calls Mimi, is Cat’s shelter from this storm; Mimi gives Cat insight into her mother’s college-era anorexia, as well as practical support in pursuing her career aspirations after Cat has taken a flamethrower to her life. Cat is a self-proclaimed weird girl, and her social isolation fuels friendships and romantic relationships that tend toward the intense and codependent. Sometimes, as is the case with her friend Marco, who she later suggests is a malignant narcissist, they even become violent (I wrote a piece on why I detest the current trend of throwing around Cluster B terminology, which says as much about the person using it as it does about who they’re talking about, but for now, I will leave that alone). Cat’s tendency to end up in twisted relationships is something that I can deeply relate to – being so desperate for human connection that I ignored the red flags, all too glad to pretend that someone else’s issues didn’t exist if they did the same for me, that we were in our own little world where societal norms simply didn't apply. Don’t even get me started on my proclivity to meet someone and then become intimate with them on every level far too quickly, justifying this based on my “instant connection” with them (not realizing that I had painted a neon target on my back for anyone who wanted to manipulate me). Cat also does a bang-up job of describing the battle between her addiction and her ambition to become a beauty editor, which leads to her walking away from a key opportunity at Lucky. While reading this scene, I was reminded of the day when pursuing my calling to become a doctor while wrestling with the demons of my opioid and benzo addictions became too much; apropos of nothing, I took a leave of absence from medical school and never went back. Anyone who has sacrificed a lifelong dream on the altar of their addiction will find resonance with this aspect of Cat’s story. What Doesn’t Work: Does Cat Really Know Herself? Cat doesn’t have all the answers; this is okay. In the conclusion to her book, Cat admits that she still uses Adderall, her drug of choice, though she insists that she has curtailed her habit and is attending to her physical and mental health in a more responsible way. In a certain sense, I admire Cat’s honesty. For most people, addiction is a cyclic, lifelong struggle, and it is regrettable that we hear almost exclusively from the small proportion of addicts who believe that they have found the Long-Term Solution™* in complete abstinence through 12-step meetings, DBT, Sufi chanting, or whatever. My own struggle with addiction has led me to pursue recovery in different forms at different times, so I found Cat’s representation of what recovery can look like in the absence of complete abstinence to be a refreshing departure from the usual fare. *I almost said "Final Solution." On the other hand, lacking answers and lacking insight are not the same thing, and there are moments in the book – reinforced by Cat’s comments elsewhere – that lead me to question whether Cat is in a place from which she can write about her life in a rigorously honest way. Cat seems to believe that the combination of a dysfunctional childhood plus an early, medically instigated Adderall addiction led to the downward spiral that began during her adolescence and lasted through her mid-thirties. I was disappointed that Cat's commentary on her own character defects is mostly confined to a couple of sections in which she perfunctorily notes that she has inconvenienced her roommate, Nev “Catfish” Schulman, by subjecting him to the violent fallout of her relationship with Marco; ditto for a coworker from a beauty magazine who Cat stressed out on her coworker's wedding day. I don’t expect performative self-flagellation, of course, but Cat’s attention to her own intrinsic flaws is as superficial as a lipstick review. She has a tendency to paint herself as a victim, placing the blame for much of the mayhem in her life on ADHD or on other people without ever acknowledging or examining the part of herself that clearly gravitates toward chaos, drama, and self-destruction – the part of her that forms unhealthy relationships with people and then lets them back into her life again and again. I would be more inclined to believe that this failure of self-reflection is just an artifact of the writing and editing process if it weren’t for Cat’s conduct before and after publishing the book. In a YouTube video from May 2023 that features Cat talking with British acquaintances, Cat blithely responds to one question with “I know that I’m a good person,” which she goes on to qualify by saying that this means that she never sets out to harm others. In my younger days, I, too, put great emphasis on my good intentions – failing to recognize that perhaps being a “good person” is as much about the objective results of our actions as it is about nebulous intentions. What’s that saying about the road to hell, Cat? After all, when you steal someone’s stereo, it doesn’t really mean much to them that you loathe stealing and promised yourself that you’ll slip a hundred under their door when you have money again someday. Cat looking hazy; I think this was from her Vice columnist / PCP and ketamine arc (photo courtesy of Vice). What Doesn’t Work: Does Cat Really Understand Her Family's Dynamics? Cat’s treatment of her older sister, Emily, reinforces my suspicions that she has a long way to go in terms of character examination and amends-making. In the book, Cat portrays Emily as a devoted sister who is also the victim of their parents’ dysfunctional decision-making. She mentions that Emily lets her stay on her couch when Cat needs a place to crash and that Emily rushes to Cat's apartment when Cat is locked inside overdosing. Imagine my surprise, then, when I learned about Cat’s massive, public falling out with Emily in the years after the book was published. Apparently, this involved Cat staying with Emily and Emily's now ex-husband for a time, during which she allegedly introduced Emily to Adderall, and then, Emily alleges, ditched her as soon as the money ran out due to Emily’s divorce. Cat now presents an entirely different version of the family dynamics in which Emily is a money-hungry, manipulative bully, whereas her father is a healed man. In fact, Cat and her father sued Emily for her comments and actions during a time when Emily was recently divorced, unable to see her children, dealing with severe mental health challenges, and purportedly penniless. I can’t imagine how it feels for Emily, who rushed all over New York City catering to Cat’s crises during the events written about in How to Murder Your Life, to be not just abandoned but also excoriated by her high-profile little sis during her time of need. Again, it leads me to question the depth and authenticity of Cat’s self-examination; this is not the kind of behavior that we expect from someone in recovery. What Doesn’t Work: Are Cat’s Addiction Experiences Relatable? Perhaps Cat’s self-insight would be greater if her privilege hadn’t protected her from some of the wretched lows that most addicts experience. For years after graduating from high school, Cat lived in Manhattan on her parents’ dime, which allowed her to spend her days at coveted unpaid internships and her nights at exclusive clubs frequented by New York City’s Who's Who. Cat was never homeless, and at the lowest points in her active addiction, she always had the option to return to her grandmother’s place down South and “work” in exchange for twenty or thirty grand to catch up on rent and fund her next bender. She was never arrested, partly because her addiction was primarily to prescription drugs obtained from doctors. It is so thoroughly, boringly predictable that the rich, beautiful blonde girl beauty blogger* got the six-figure book deal, likely using contacts built up during her years of partying with similarly privileged people (*How’s that for alliteration? And I didn’t even need 60 milligrams of Dexedrine to get me there). What ever happened to the Basketball Diaries? One of my favorite things about addiction memoirs has been that, like queer art, they traditionally take us to the fringes of society. On this point, in one Vice column, Cat wrote that “Girl drug addicts sleep alone.” I recall reading this line and having a visceral negative reaction. Almost all of the female drug addicts that I know exchanged sex for money at some point. Those who didn’t were nearly all stuck in awful relationships with dealers or other manipulators, forced to rely on men to fund and “protect” them in a dangerous, exploitative subculture. I’m not suggesting that Cat’s story isn’t worth telling because she is from a privileged background, because stories about addiction from every level of society are important and need to be heard. But to the extent that this privileged background has limited Cat’s insight into herself and her disease, it does take away from the power, reach, and authenticity of her story. Let's face it, Cat is so hot that it's hard to say bad things about her (photo courtesy of Rolling Stone). Cat Marnell and the 12 Steps: Sit Down, Cat Marnell There’s a final point that I’d like to touch on, and to me it is the most egregious (it’s also not directly related to the book). In the years since she published How to Murder Your Life, Cat has been honest about her struggle with maintaining sobriety. She admits to overdosing on fentanyl and has expressed wanting to give up Adderall but not being able to because she needs it to be “functional.” In a podcast with Leah McSweeney from March 2023, Cat indicated that she now has 72 days of real-deal sobriety, which she has achieved through 12-Step program participation. (Cat is acting a little, uh, strange in this podcast, but I'll leave that alone). For those of you who are familiar with the Program, you will immediately recognize the problem with this statement. Anonymity is one of the 12 Pillars of the AA / NA programs, a revered tradition that prevents the conflation of programs with personalities. This would be especially dangerous for a disease like addiction, for which lifetime relapse rates are so high and struggles with sobriety are so messy; a high-profile relapse on the part of someone perceived to be a leader of a 12-Step program could seriously damage its public image. Cat herself acknowledges the tradition of anonymity, but she chooses to discuss her participation in 12-Step fellowships nevertheless because “it’s known that all the best people are in the Program” (I’m paraphrasing; I think that what she actually said sounds even more vapid). Coming from someone with only 72 days of sobriety under her belt, this is a shockingly blithe, asinine statement. Cat’s life is precisely the type of public mess that the tradition of anonymity is designed to prevent the Program from being associated with. Like me, she is a chronic relapser, and if / when she has another relapse, she risks giving people who have little experience with the Program the impression that it is ineffective. Speaking frankly, Cat’s discussion of her participation in the Program pisses me off. For decades, involvement in AA and NA programs has allowed people whose lives are in ruins to climb a ladder back to functionality and stability. Oftentimes, key housing and job opportunities for recovering addicts have hinged on the endorsement of a long-time member of AA or NA, who sticks his or her neck out on behalf of someone who is newer in recovery and needs a chance. With her reckless comments, Cat is devaluing the social capital of the AA and NA Programs, and – out of all of the above – this is perhaps what bothers me most about her. That she does this so cluelessly is, unfortunately, on brand for the type of heedless person that her memoir reveals her to be (I’m reminded of the "careless" Daisy Buchanan from The Great Gatsby). Right to the Point How to Murder Your Life is worth reading from a pop culture standpoint if you’re into the Millennial NYC scene and / or the beauty industry. Millennial addicts will likely find points of relatability in Cat Marnell’s description of her family dynamics, high school experience, and active addiction escapades. Beyond that, Cat Marnell shows an unbecoming lack of self-insight in her memoir that is reinforced by her public actions and comments. It’s unfortunate that she has been rewarded with a six-figure book deal when so many people with more interesting stories and better language to tell them with have not (cough: where’s my book deal?).

In which one of the most spiritually defunct individuals of all time, suffering from an unbecoming existential and addictive panic, goes fumbling desperately back toward God. Step One: We admitted that we were powerless over alcohol / drugs; that our lives had become unmanageable. Step Two: We came to believe that a Power greater than ourselves could restore us to sanity. In this photo taken during a vacation with friends in the mountains outside Beijing, I don't see Brian looking at the camera; instead, I see Terminal Addiction staring back at me. At the time, I had essentially unlimited access to oxycodone and diazepam. Unfortunately, the oxy formulation that I was taking contained only 5 milligrams of oxy but 300+ milligrams of acetaminophen (Tylenol) per pill, which meant that I was habitually taking a massive overdose of acetaminophen (I sometimes took as many as 70 or 80 of the pills in a single day in addition to benzos and sometimes phenobarbital or a drink or two). This led to liver and kidney failure, which left me unable to take in solid food for several weeks, during which I passed out randomly throughout the day. In addition, I couldn't sleep for longer than three or four hours at a time because the oxy wore off so quickly that my withdrawal symptoms would wake me up (with cold sweat-stained sheets and chattering teeth). I began to wonder, to consider in all seriousness, if I had died during an overdose and woken up in Hell. There is something in my expression here that I fail to recognize as me, a combination of a ravening need and a cold, hard appraisal. It's uncomfortable for me to look back on this photo, and I hope that I never have this expression on my face again. The Starting Point To set the stage for my second-step reflection, Ben Franklin’s oft-repeated but seldom-heeded definition of insanity: “...Doing the same thing over and over again and expecting a different result.” In my two-part series on the first step of AA and NA (part 1; part 2), I discussed what powerlessness in the context of the first step means to me: That I have as little control over my drug use as I do over the actions of another person; that it is essentially like having a sinister someone who I seldom like but sometimes love hold a gun to my head and dictate all of my words and actions. Step Two reads as follows: “Came to believe that a Power greater than ourselves could restore us to sanity.”* *For those of you who would like to read all 12 steps now, they can be found here. Remembering the emotional and spiritual context - the state that my addiction brought me to before I approached the Program and engaged with the first three steps - is essential to understanding and explaining exactly what a life-saving paradigm shift they represented for me. Incomprehensible demoralization is two words and twelve syllables. If a high school student used this phrase in a paper, my first inclination might be to recommend simplifying the language to make it accessible to a wider audience. In this case, however, the expression serves because it is such a perfect encapsulation of advanced, untreated addiction. “Incomprehensible” means more than simply inexpressible, ineffable. It isn’t that I can't articulate just how low addiction brought me. It is far beyond that. I cannot even fully wrap my mind around what addiction cost me; there is a fundamental inability to grok the damage. Like the size of the universe and the nature of God, the profundity of the soul-rot caused by addiction is so deep that it is beyond my capacity not just to express, but even to completely understand. Demoralization is an apt double-entendre, for not only had I become incredibly depressed, often to the point of feeling nothing at all*, but I had also lost all sense of right and wrong. I lied and manipulated without guilt and humiliated myself without shame. During those rare moments when I emerged from my using fog, the surge of self-hatred that I experienced simply served as a convenient excuse to go right back to using. *William Burroughs, one of the most famous junkie writers of all time, wrote of the “fibrous grey wooden flesh of terminal addiction.” Can you imagine looking anyone else in the eye once you know that you can't trust yourself to keep a promise? During advanced addiction, anything that came between me and my drugs was ultimately sacrificed. Point-blank, period. Often with a kind of sociopathic calculation that was truly chilling to behold from others, let alone from myself. During the lowest points of my addiction, there were times when allowing myself to do the wrong thing (to lie and manipulate to further my addiction) almost felt like ceding my will to another person, a Dark Brian who relieved the pressure on me by assuming control. In that abject state, I could no longer count on myself, and because of that, no one else could count on me, either. As hazy months of active addiction grew to substance-fogged years, I would commit to my umpteenth effort to stop using, swearing to myself that when the next bundle was gone, I would buy three days' worth of Suboxone and use it to taper off of opioids for good. Sometimes, I would get as far as stockpiling the Suboxone, but when it came time to actually make good on my plans, my own hands would refuse to obey me. This came as a particular shock because I am a disciplined person in many ways: I'm an avid distance runner, an intense and successful student, someone who is no stranger to delayed gratification and who has never had trouble implementing healthy change in other areas of his life (for example, in terms of diet or mindfulness practices). When it came to addiction, however, I might as well have been possessed for all of the good that my planning and self-promising did me. When I talk about not being able to look at myself in the mirror in that condition, I'm not being hyperbolic, and I hope that it doesn't come across as cringey. I'm trying to express that I had gone so far down that to look at the bedraggled, soulless shell that remained was in itself an awful punishment. (“You just made a real face for the first time in so long,” my mom once remarked upon visiting me in rehab; “The light in your eyes is back; you look like yourself again,” many a loved one of an addict has said). The dream of every advanced addict is simply to use and to be alone with that feeling. Under the spell of this obsession, I devolved into a revenant. My enjoyment of my greatest passions, reading and running, left me almost entirely during the depths of my addiction. My body became a prison and a torture to exist in, and I could no longer use my mind to escape into other worlds and other lives. The things that make me me - my quirks of personality and expression, my connections with loved ones, my roles and responsibilities in the world - addiction stripped me of all of them, leaving behind a manipulative, heedless, drug-seeking husk. It became clear to me that nothing within myself could save me. I don't want to go too far astray along a scientific tangent, but again, the neuroscience supports this conclusion. Advanced addicts show severe dysfunction of the Prefrontal Cortex, responsible for executive decision-making, planning, and weighing of risks and consequences, as well as of the mesolimbic reward system, which reinforces behavior into habit. Addiction damages the hardware and software that we would need to make different decisions. You Need a Weird God So, what is the Program’s answer to this untenable mess? In a word, the solution is God. As the second step states, the Program is based upon connection with a Higher Power that can restore us to sanity. It’s a shining concept, to be sure, the idea that a deity can swoop in and save us from our hopelessly corrupted selves. The problem is that not too many active addicts retain a strong, actualized faith in God because the selfishness of addiction is anathema to robust spirituality; another way to say this is that people who are spiritually healthy seldom, if ever, become addicts. Step Two is particularly challenging in that it requires a leap of faith. It was complicated for me because when I came into the Program for the first time, I was not only what philosophers call a hard determinist (someone who rejects the concept of free will, in my case on scientific grounds). I was also agnostic to the point of near-atheism, and I had been cut badly by the realization that many of the leaders of the church that I had been raised in had abused our trust in them in awful ways. I also had a chip on my shoulder about the Roman Catholic Church's position on homosexuality. I loved my small-town priest growing up, and hearing him tell me that homosexuality was incompatible with how the Catholic Church interpreted God’s will was one of the defining moments of my youth. Having a trusted elder tell you that an essential, unchangeable part of you is wrong will do anyone’s head in, I think. So, my first sponsor, an anthropology PhD student named Ben, had his work cut out for him when we began our second step work. I was able to set aside the hard determinism part fairly easily. For hundreds of years, prominent determinists, including the brilliant British philosopher David Hume, have frequently conceded that the truth of their philosophy doesn’t impact daily life and non-technical language very much. On a practical, workaday level, we almost always live and speak as though free will exists. On what I began to refer to as the "God Issue," though, I was unyielding. I felt no connection to a benevolent Higher Power, I averred, and it felt disingenuous and pointless to fake one. Ben was wise; he started small. “God could be literally anything bigger than yourself. He could be that rock over there," he suggested one day. Ben's blue eyes varied in wattage according to how invested he was in a conversation, and I always felt that my own stock value was soaring when I got him interested in one of our chats*. *Although the Program recommends not having a sponsor of the sex that you're attracted to romantically - particularly not someone who you find desirable - I believe that my attraction to Ben actually kept me coming back, motivating me to do well and to make him proud. Perhaps in the long term this undermined the foundation that I was building for my recovery by making it dependent upon external validation, but in the short term, it saved my life. “Okay, but what’s the use of believing in that?” I responded. “That rock over there isn’t going to save me from addiction.” I voiced the same basic objection when Ben suggested that I approach God as the fundamental motive force of our universe, what Aristotelian philosophers referred to as the unmoved mover, meaning a cause that was not itself an effect of another cause. I expected Ben to roll his eyes when I responded with a rejection of cause and effect rooted in Einsteinian relativity, under which there is no objective before and after, as those terms change depending upon one's frame of reference in space-time. Instead of getting frustrated, Ben smiled a little bit as his beautiful blue eyes - any hue that you'd care to imagine - brightened. Later, I'd realize that he was taking heart to see that this broken kid in front of him, who had swollen purple tracks in the crooks of his elbows and a concentration camp physique, wasn’t entirely shut down. I was at least sparring with him, and in those first few pivots of our intellectual repartee, he saw hope. There was something stubbornly principled in my refusal to believe in God, I insisted. Okay, God could be a Sense of Connection to Something Greater or whatever, but that didn't mean that He had a plan for me that would save me from the horrible fates that had befallen many of my addict friends (and a good many non-addicts that I had known who were wonderful people screwed by life, as well). I refused to make myself special, to believe that I was somehow different from all of these beautiful people who suffered and lost. And let's suppose that there was a God and that he had a plan... If God wasn't the omniscient, omnipresent, and omnipotent deity that I had been raised to believe in, the all-loving being who intended only good for us - what was the guarantee that me dying in active addiction wasn't part of the plan? By the time that we reached this point in our talks, Ben was completing the third revision of his doctoral thesis; he looked a little bit like a junkie himself from his endless hours in the library. I wore him down a bit with all of my protests, I'm sure, and after a couple of weeks of theological debate, he changed tactics. His next suggestion was that I consider God as embodied in the goodness of other people instead of as a separate spiritual entity. GOD stands for Good Orderly Direction, some 12-Steppers say; a Higher Power can be as simple and practical as the collective will of a home group or the beneficent guidance of a sponsor. “What about the dangers of giving control of your life to others?” I wondered. “There's dangerous stuff that happens in cults when you let other people make your decisions for you.” “What are you so afraid of?” Ben replied pointedly. “It’s not like you’ve been doing such a good job of keeping yourself safe lately.” It was a touché moment, I had to admit. Emerging from active addiction in early recovery is like waking up in this cave above a river in Guilin, China: Surreal isolation and the certainty of absolutely no recourse. God Appears on Scene as Requested, Almost as Though He Exists I never had a lightbulb moment, a headlining spiritual epiphany, which some 12-Steppers are lucky enough to experience. For me, developing a connection with a Higher Power meant overcoming doubt through deliberate daily action. This involved praying regularly - not in the rigid, formulaic manner of my Catholic upbringing, but in a more conversational way (sort of like blogging with God, if you like). “You need a weird God,” Ben suggested sagely. The idea that I was building a strange altar to my makeshift deity became our inside joke. It was weeks later, and by this time in our sponsor-sponsee relationship, the truth is that I trusted Ben so much that I would have accepted him as my Higher Power. I had seen how he lived his life, and I wanted what he had, as we say in the Program. However, I would've been mortified to admit this to him. I was still very raw, and it felt uncomfortable to depend on someone so direly (I kept waiting for the other shoe to drop, for Ben to reject me or to reveal some ulterior motive for helping me). Plus, I knew that Ben couldn't be by my side forever; I needed a bigger, stronger God to sustain me in the long run. During early recovery, I sometimes received unpredictable jolts of spiritual sublimity as I hiked, wrote, taught. I was reawakening to the world, and I found that as soon as I began to make an effort to connect with my Higher Power, a door was opened to spiritual experience. On some level, it really was this simple, for me: Ask and you shall receive. I came to see that for me, God wasn’t so much about the head as He was about the heart, my intuition. I could debate the intellectual fine points all day and night - and in fact, my cerebral life had acquired disproportionate importance in my life as a whole - but if I got really quiet, it did seem to me, sometimes, that there was something outside of myself that I could connect with, something greater and better. In time, my spirit was soothed and quieted; I began to receive intimations of the still, small voice that Elijah hears in Kings. This force, like the demoralization that I had felt in active addiction, was both incomprehensible and ineffable, but this time in a good way. It guided me along the path that was appearing step by step as I trod through early recovery. My mom is a lawyer and one of the smartest people that I have ever met - two things that rarely go together in contemporary America - and her attention to verbiage borders on the psychotic. In the end, it was this inheritance from her that saved me where the second step was concerned. The formulation of Step Two is an ongoing “came to believe” rather than a completed “believe," and I realized that this was significant; as long as I was headed in the direction of earnest, honest spiritual development, things were on track. Most of all, rediscovering spirituality required me to be of service to others. Starting with a commitment to help set up and take down the chairs for our Wednesday night meetings, I made helping other people a sincere priority in my life for the first time in a long time (ironically, I was studying medicine so that I could heal other people, but in my day-to-day life, I was doing very little to help other people right now; the volunteering and charitable efforts that I did make time for would all be listed on my medical school app someday, of course). Helping others was the cure to virtually every problem that I encountered in early recovery. Nothing so reliably and completely drew me out of my own character defects, my own sore history, my own endless spiritual doubt as small, practical efforts to help others. As I made service a regular part of my life, I started to have experiences - some people would say that I received signs - that seemed to me to be spiritually significant. Almost as though there were a beneficent Higher Power talking back to me, after all. Argument From Necessity I don't currently go to church, although I am reconsidering this. I am still ambivalent about organized Christianity. While I appreciate many of the positive aspects of being raised in the Catholic Church and I admire the character traits of many of the lifelong Catholics that I was raised by, I believe that the Church has moved too far away from Christ's legacy. In the New Testament, Christ made it clear that he stood for radical love of our neighbors. Love that requires us to renounce material things, to repudiate worldly power structures, to embrace the people who disgust us most. Christ associated with prostitutes and drug addicts; he forsook the many in search of the few. In the kind of conservative, suburban Church environment that I was raised in, this aspect of Christ's legacy sometimes seemed to have vanished. Many modern Christians enthusiastically cite Old Testament prohibitions such as the one against homosexuality found in Leviticus, failing to recognize that it is the New Testament that defines Christ's paradigm (the Old Testament was mostly included for historical context and to establish Christ as the prophet whose existence was foretold in ancient Abrahamic holy traditions). The Old Testament is, after all, the same set of books that condones slavery, stoning, and so on, so it's hard not to view such selective Scripture-wielding as bigotry in search of confirmation bias. I remain in need of a Christ-like Christian church. On another note, during recovery I became interested in a transcendental interpretation of the Bible, which moved me further away from the Catholic Church's well-polished dogma. From this perspective, the Kingdom of Heaven is a metaphor for a state of bliss that we can access on Earth through mindfulness combined with diligent spiritual work. This is a conceptual framework that early Christians, including the Coptic Christians of Egypt (the so-called Gnostics) gave credence to. Those of you familiar with the Gospel of St. Thomas are probably already acquainted with transcendental Christianity without necessarily knowing it by that name. If you've never heard of this text, which wasn't included in the Bible despite its historical validity, than I highly suggest that you give it a read. Again, I remain in need of a Christ-like Christian church, and I am certainly open to suggestions. In closing, I would like to reiterate that the strongest argument for God, in my opinion, is from His necessity: I cannot live the kind of life that I want to live without faith to sustain me. On this view, it is not the objective reality of God that matters, but the fact that my belief in God lets me bear light that would otherwise be extinguished by the sin and sadness of our world. I embraced the Higher Power referred to in Step Two, in short, because I would be dead without Him. Whether He exists or not, He has saved my life multiple times; the truth of this lends a form of reality to Him in and of itself. I'm curious to hear about other people's conceptions of their Higher Powers. I still struggle with maintaining a connection to the God of my understanding, and I'm grateful to anyone who is willing to share on this powerful, immensely personal subject.

In which I discuss injecting xylazine sourced from a veterinary lab during my wayward youth, which was a lackluster experience if ever there was one. For those of you who don't know, xylazine is now being added to fentanyl throughout the United States. Perversely, this "tranq" or "tranq dope" has gathered a loyal, if incapacitated, following in areas like Kensington in Philadelphia. Chemical structure of xylazine (C12H16N2S) in case you cared, which you probably don't. It's very similar in structure to phenothiazines such as chlorpromazine - that's the famous Thorazine "shot in the ass" that they give you if you have a meltdown in a psych ward. WHAT IS XYLAZINE, HYPED AS THE NEWEST "ZOMBIE DRUG"? If you read my RIP, Gabapentin post, then you know that the veterinary tranquilizer xylazine, most often used for horses, has long been added to heroin and other recreational drugs in Puerto Rico and other places. It is not currently a federally controlled substance in the US, although I suspect that this will soon change. Xylazine is popping up in the news these days because it is being detected more and more often in fentanyl samples confiscated in the Northeast. In places like Kensington, Philadelphia, this so-called "tranq dope" has attracted a loyal following of users who crave the catatonia that it induces. Alarmingly, in YouTube interviews with these tranq devotees, they describe a withdrawal syndrome worse even that that caused by fentanyl. There are two particularly worrying things about xylazine. First, it causes extensive, necrotic ulcers (see image further down). These festering wounds have earned it the moniker "zombie drug," and they can begin to form after several days to two weeks of use. Although users commonly believe that these xylazine lesions occur only at injection sites, this is not true: They result from changes in circulation wrought by the drug throughout the body, regardless of how the xylazine is ingested, and can therefore appear anywhere. Observers have drawn comparisons to Russia's fever dream of a Krokodil epidemic, which Vice published some decent, if yellow, coverage on: Krokodil: Russia's Deadliest Drug (NSFW) - YouTube. The second frightening thing about xylazine is that because it is not an opioid, the opioid antagonist Narcan (naloxone) will not work to reverse its effects. This means that EMTs and other medical professionals no longer have a "quick fix" for ODs in their arsenals; more patients will require intubation and intensive care (if they even make it to the hospital). In fact, the Journal of the American Medical Association (JAMA) has published data indicating that "Xylazine-involved overdose deaths in the US rose from 102 in 2018 to 3468 in 2021, and 99.1% of these deaths also involved fentanyl." XYLAZINE TRIP REPORT: WHAT HAPPENED WHEN I SHOT XYLAZINE IN MY WAYWARD YOUTH As an Animal Physiology concentration within the biology major at my university, many of my upper-level courses in immunology, endocrinology, and other subjects were held at the vet school (our medical school was off-site in a major city, so if you wanted to study human medicine, sheep and lizards were as close as you could get as an undergrad). One day, I was walking back from a lab that involved stringing up rat uteri in physiologic solution and then adding pregnancy and labor hormones to see how they reacted. Afterward, I thanked God for the simplicity of having a penis as I strolled through an area where horses were kept prior to examination or operation. Not three yards in, my wandering chemical connoisseur eyes caught sight of an empty stall in which there was a steel table with a bottle of (liquid) medicine on it. I didn't even bother to check the label before swiping it; before the hearing- and speech-impaired good angel on my right shoulder could slap me into my senses, the bad angel in his throne on the other side promised that he would be my lookout as I grabbed the bottle and stashed it in my bookbag. Three hours later, after putting my esteemed education to use by reviewing the scientific literature on xylazine to estimate a mg / kg dosage conversion from horses to humans, I selected one of the syringes that I kept on my desk in an organizer that also held my pens and pencils. I drew up a modest 0.8 mL of the solution and injected it into the median cubital of my left arm (that's that big vein in the crook of your arm that phlebotomists usually go to first). My heart thrummed as I ran to the bathroom (JC, is this stuff a laxative?). I felt a tingling in my fingers as I waited for it to hit (God, please don't let me die on the toilet). The buzzing built as I finished my business and went back to my room, envisioning a slow-fuse experience as I yearned for that great warm wave of chemical alteration. Ten more minutes ticked by; I waited patiently for the xylazine to take effect even though no psychoactive chemical put directly into a vein should take that long to work. Still nothing. What I had felt was pure placebo. My hopes were high: I had once tried diethyl ether, an old-school anesthetic of Fear and Loathing in Los Vegas fame / shame*, which delivered me and my genetics lab fruit flies one of the most heady, aeronautic, and euphoric highs of our lives. On account of that experience, and even though xylazine has quite a different chemical structure from ether, I dared to dream that I was discovering the next big thing. *As Hunter S. Thompson put it, "There is nothing in the world more helpless and irresponsible and depraved than a man in the depths of an ether binge." Dosage conversions between species are notoriously tough to gauge, and like every experienced psychonaut who came up on Erowid, I had started with what I believed to be a threshold dose. For round two later that evening, I selected a larger syringe and drew up about 2.5 times my original dose. Maybe I shouldn't inject a chemical meant for horses directly into my veins, I reconsidered as I drew back the plunger and saw a red trickle. Just kidding; I never thought that. Ten seconds later: Here it is. I felt dizzy in that way that makes you aware that all of your atoms are vibrating restlessly, expressively, incessantly. I moved from my couch to my bed in case I lost consciousness. By two or three minutes in, the dizziness had become uncomfortably strong without making me feel like I needed to close my eyes and "sleep." As I stared at my ceiling, I noticed a sort of streaming-water effect in my peripheral vision, in which only a small, central circle of clear sight remained. Meanwhile, the honeybees continued their hive-building in my head, limbs, and supposedly vital organs. There is nothing in the world more helpless and irresponsible and depraved than a druggie who has been denied his expected high. For the next several minutes, I waited to advance past this plateau. I pined for a rainbow-beamed euphoria to abduct me to a better place; a bangin' body buzz from some chemical with an alpha-male backbone embracing every one of my cells like a soulmate; a dissociative elevator that would carry me sideways into another dimension where eldritch gods reigned. Ten more minutes and no change. My journal was next to my bed, so I scrawled one of those quintessentially Millennial ":/" emojis next to my second xylazine entry. Thirty minutes later, I sublimated myself into sleep and had pleasant, unremarkable dreams. For my third xylazine experience, I perched on the edge of my couch as I injected a dose that was about nine times my starting one. Provided that my horse-human conversions were on point, this amount should've been enough to bring me to the brink of unconsciousness; anything more would be dangerous unless I was in the hospital under a full anesthesia protocol. I had hardly had the two seconds necessary to remove the needle with the xylazine in it from my arm before the goblin-y drug seized me by the ankles and dragged me down my ladder of consciousness, which was likely missing a few rungs on account of prior shenanigans. As I plummeted downward, I had the same last thought that any 20-year-old man would have while preparing for death: God, I hope I didn't leave any porn open on my computer. By five seconds after injection, I was out. There was no thrilling rush, no burgeoning euphoria. Nothing. Just black. Three hours and 30-some-odd minutes later, I awoke on the floor of my apartment. It took me a few seconds to recognize the base of my shabby couch next to me (God, who pairs bright red with dark purple? I wondered before remembering that it was me). For the next several hours, I had a minor headache and a lingering dizziness, but aside from that, I felt okay. If there was one kind thing that I could say about my experience with xylazine, I reflected, it was that it didn't cause the kind of intense, hours- or days-long hangover that the tri-drug cocktail currently favored for general anesthesia (in humans) often does. Because my esteemed STEM education had instilled nothing in me if not the importance of replication, I tried xylazine twice more at similar doses before I threw a drug out for the first and only time in my life. Xylazine is the ultimate surgical anesthetic: Take a little, feel nothing; take a little more, feel dizzy; take a lot, you're unconscious. There is no benzo serenity, no barbiturate body-massage, not even some zany hallucinations, as with ether or ketamine. It's worthless. Any dealer who tells you that this chemical has recreational value is a liar or an idiot (and let's be honest, most dealers selling fentanyl are probably both). Mild to moderate lesions caused by xylazine use. Arms, legs, digits, and noses appear to be common sites. Do not Google "Xylazine lesions" unless you are prepared to see rotten skin, subcutaneous fat, and muscle, which leaves exposed bone that sometimes spans entire limbs. Amputation is necessary in many cases. Photo taken from the Cornerstone Healing Center, which has more information on the etiology and treatment of such sores. FINAL THOUGHTS FOR ANYONE YOUNG, BORED, OR STUPID ENOUGH TO LISTEN TO ME Even after experiencing life-threatening physical addiction to two classes of mind-altering substances, I have complicated feelings about taking chemicals to alter brain chemistry. In fact, if someone asked me today how I feel about drugs, my answer would be that it would depend on which drugs they were talking about (and I don't mean that in a glib way). Certain drugs, such as mushrooms and acid, have given me some of the most beautiful, powerful, and spiritual experiences of my life. They have reinforced my connection to other people, helped me to see our weird, gorgeous universe for the interconnected marvel that it is, and allowed me to explore the innermost reaches of myself without fear or judgment. On the other hand, my experience with addictive drugs that cause physical dependence, whether prescribed or not, has been that they are the keys to the doors of the real, capitalized Hell. Even still, I acknowledge that those same drugs can be life-changing in a positive way for people who need them for pain or anxiety and who use them as prescribed. I also recognize that much of the damage caused by my addiction was in fact a result of drug prohibition, which drives prices up, quality down, and leads to ever-more desperate behavior on the part of all involved. Moreover - based on the frequency of mental health problems on both sides of my family that aren't related to addiction and how depressed and anxious I felt before using drugs regularly - I think that perhaps I would have killed myself or just become a truly miserable, awful person (irony) if I didn't have my chemical escape. I'm telling you all of this because I'm feeling philosophical but also as a preamble to my final (drum roll) conclusion about xylazine. I am a person who appreciates chemicals, even the rarer, odder ones that many people find scary or pointless (more posts to come on those). I have tried dozens, if not hundreds, of mind-altering chemicals and devoted years of my life to studying biology and chemistry both formally and through extensive self-experimentation. Xylazine is garbage; simple as. It has no place in the human recreational pantheon, and, frankly, I think that we can do a little better for our friends the horses, as well. If you enjoy trip report-type posts, check out The Incandescent Now, a fraught acid trip that I wrote up in lightly fictionalized form.

The vibe of positive personal change, spiritual growth, and accountability-taking that permeates 12-Step meetings is itself an intoxicant, particularly if your life has been stagnant or in decline. In my experience, there is a shroud of mystery surrounding the Program that can keep people from attending their first meeting. On that note, here are a few things that I wish I had known before heading into the Rooms. There is a 2000 movie called 28 Days featuring Sandra Bullock as a dipsomaniacal NYC reporter given a choice between 28 days in jail or 28 days in rehab. It's a lighthearted presentation of inpatient rehab and 12-Stepping that I'd recommend for anyone in recovery. My favorite addiction movie of all time, however, is Country Strong (2010), in which Gwyneth Paltrow plays a country music icon on a comeback tour after a public disgrace involving losing a pregnancy from drinking. Paltrow's character is torn between residual feelings for her first husband, played by Tim McGraw, and her 12-Step sobriety coach, played by Garrett Hedlund. Although I'm not a fan of Gwyneth Paltrow in general ("conscious uncoupling" instead of "divorce" is as pretentious as it gets), I watched this movie with a bunch of guys who were recently released from state and federal prison, and by its heartbreaking conclusion, there wasn't a dry eye in the room. *Quick note: I’m switching between using Alcoholics Anonymous (alcohol) and Narcotics Anonymous (drugs) for examples in this piece because it’s exhausting and grammatically challenging to include both fellowships in every example. 1. Pay attention to the meeting descriptions when selecting which group you will attend. Closed meetings are for people with a drinking problem who want to do something about it (see 2); open meetings are open to nonalcoholics, as well. If you are interested in support meetings for family members of alcoholics and addicts, Al-Anon and Nar-Anon are wonderful organizations. 2. You don’t actually have to be sure that you’re an alcoholic to start attending AA. The Third Tradition specifies that the only criterion for membership in the Program is a desire to stop drinking, but even that doesn’t have to be fully present when you begin attending (in fact, plenty of people will show up just get to their court-ordered 30 or 90 meetings in after their first or second Driving While Intoxicated (DWI) offense, for example). 3. Most people will introduce themselves as follows: “Hello, I’m X, and I’m an alcoholic,” but you can just substitute “Hi, I’m X, and I’m thinking about taking a break from drinking” or any other language that you feel comfortable with; no one will bat an eye. One of my favorite things about the Program is how old-timers personalize these little bits of formality once they become comfortable with their home groups. At a meeting that I used to go to frequently, there was a woman who introduced herself as “V, career drunk and Christmas ruiner,” after a legendary incident in which she drove her car into her parents' living room while drunk on Christmas Eve. 4. You don’t have to say a thing during the meeting if you’re not comfortable doing so yet. “I’m just listening today” is universally respected; often, old-timers who don’t feel like sharing during a particular meeting will say the same thing, so you’re not giving yourself away as a newcomer by using this language, either. As a newcomer, you will likely be asked to do one of the opening readings. The meeting leader will approach you before the meeting, ask you if you’re interested, and then hand you a big card with the reading on it if you accept. He or she will also indicate when in the opening or closing structure you should begin reading. Remember to introduce yourself first! 5. Addicts can absolutely go to AA, and alcoholics are welcome at NA. In fact, one of the founders of AA was a doctor who had a raging prescription drug problem, so there is a long history of each organization welcoming addicts of all types. However, if you attend AA as an addict who doesn’t drink, you might want to say “other forms of alcohol” instead of “drugs” and “sober” instead of “clean” when sharing. In most groups, people ignore the semantics because they understand that addiction is the same disease across all substances of choice, but there are some crusty AA old-timers who have a purist mentality. Using this language makes it impossible for them to take issue with what you’re saying. Don’t worry about feeling like a “dirty druggie” at a bougie AA meeting, either. Remember that many of our friends the alcs habitually drove drunk, drank mouthwash, gave back-alley BJs, hallucinated during DTs, and so on. There is more than enough humiliation to share; addiction is fun all around. We are all screwed in the head. 6. The basic format of all meetings is the same*. There are opening readings, including the 12 Steps and the 12 Traditions. Newcomers, out-of-towners, and people coming back from a drink will be asked if they want to introduce themselves (keep it very short at the start of the meeting because you’ll have a chance to share in depth later on). There is a moment to acknowledge sobriety birthdays, during which people receive chips for one day clean, one month clean, six months clean, one year clean, and so on (see photo below). Then, two people each propose a topic for the meeting either based on that day’s readings or something going on in their lives. For the next 40-50 minutes of the hour-long meeting, anyone who wants to share can do so. The meeting leader will choose who speaks in what order, as there is no fixed sequence. I recommend letting the more experienced members of the group share before you if you’re new, as it will give you a sense of how long to speak for. As the closing time approaches, the meeting leader will ask if anyone has a “burning desire” to get something off of their chest. Finally, the meeting will close with the Serenity Prayer: God, grant me the serenity to accept the things that I cannot change; the courage to change the things that I can; and the wisdom to know the difference. *There are speaker meetings, Big Book / Basic Text study meetings, and other specialty meetings often held once or twice a month. These will be indicated in the meeting listings, and you should probably avoid them until you are further into Stepwork or at least are sure what those distinctions mean. Example of a one-year AA chip. Getting a one-month chip after thinking that I would die in active addiction meant as much to me as my college graduation. On another note, I knew someone who ordered one of these off of Amazon to try to convince his Probation Officer that he was doing well, which ultimately backfired in a stupendous way when he failed a drug test. 7. The coffee isn’t always free, but you’re probably not going to get punched if you take it without paying. Charging 50 cents or a dollar for the coffee is a way for each home group to take in the modest amount of money that it uses to be financially self-sufficient, as a big part of the organizational credo is not depending on outside entities for funding. 8. If you introduce yourself as a newcomer at the start of the meeting, whoever is leading it will circulate a sheet for people to write their names and numbers on, then hand this to you at the end of the meeting. You can call any of these people at any time for anything related to getting clean and sober. You’d be shocked how many will pick up the phone even when you'd think that they would be at work, sleeping, or otherwise occupied. People know that these meetings save lives, and most 12-Steppers take that very, very seriously. 9. There is no requirement to believe in God to attend meetings, and they are not overtly religious. As you learn early on in your Stepwork, “God” is simply a Higher Power of your understanding. God can be the Program, your home group, nature, a feeling of belonging to something larger, or anything else that exalts your spirit. No one is going to proselytize to you about Christ, Allah, or any other God. 10. Please don’t go to a meeting drunk or high. This is in incredibly poor form, as some of the people there will be new to sobriety and understandably triggered by you smelling like a bar, drooling on yourself, or whatever. This happened at an AA meeting that I went to once. One of the old-timers noticed what was going on very quickly, announced “we’ve got a live one” under his breath to the meeting leader, and quietly led the guy - who used to be a member of that particular home group - into another room to rough him up (just kidding; to give him some individual support and make sure that he had a safe ride home). 11. You won’t get direct advice from anyone in a meeting. Meetings aren’t therapy (I have an upcoming post on this topic). In the 12-Step context, we share our own experience, strength, and hope; “keeping it on the ‘I’” is the favored expression. So, if someone starts a meeting by proposing a topic of “difficult relationships with addict family members who are still using,” you won’t hear anyone respond with a second-person “You should do this or that.” Instead, people will reflect upon related situations that they’ve been through in their own recovery and what worked or didn’t work for them in those. Each person only shares once during the meeting with the possible exception of the people who proposed the topics, who might wrap up their thoughts briefly at the end. There is no cross-talk, which means that no one interrupts, responds directly to what someone else has said in a confrontational way, or otherwise disrupts the orderly sharing directed by the meeting’s leader. If someone says something that you feel is directed at you that rubs you the wrong way, it probably isn't; even if it is, remember why you are there. "Take what you need and leave the rest" is a wonderful slogan for such occasions. 12. If you are female, be a little careful of newcomers of the opposite sex. Twelve-Step meetings are very safe places, but I have heard a couple of stories from female friends in the Program about older guys who sort of offered to take younger women who were new to sobriety “under their wings” with uncomfortable results. Getting into a relationship with another person in early recovery is called 13th Stepping, and it is frowned upon because codependency or even simple distraction often derail recovery. For this reason, staying single is typically recommended during your first year. 13. Plan to hang around for a few minutes after the meeting if you can. Old-timers will refer to this as the “meeting after the meeting,” and this is when you can get to know group members, follow up on things said during the main part of the meeting, and network to find recovery supports. If you need help getting to and from meetings, mention this to the meeting leader after your first group; there are people who pick up other attendees as a service commitment. If you’re active in a 12-Step fellowship, you will never lack for companionship for coffee dates, hikes, sports events, concerts, or anything else that you’re into. When I lived on Maui with my aunt and uncle, there was a group of people from my home group - led by a woman named Robin, who was well into her 60s - who went to the beach to go bodysurfing directly after our Saturday morning meeting. In AA and NA, addiction is sometimes talked about as a disease of leisure, and 12-Steppers understand that this is a hole that needs to be filled throughout recovery. 14. You won’t get a sponsor or a home group right away unless you are very proactive, and this is for a reason. In my opinion, it’s typically best to attend three or four different groups, pick your favorite one, and then connect with a few people in that group before you end up choosing a sponsor. It’s one of the most intimate relationships that you can have in life - this is someone with whom who you will share your most private thoughts and most shameful secrets - so it shouldn’t be entered into randomly or lightly. If you are in need of someone to lean on heavily and right away, which many newcomers are, use your phone list and / or request that someone established in the group act as a temporary sponsor for you. Some closing thoughts: If you’re feeling too anxious or embarrassed to share about something, just remember that every single person in a 12-Step meeting has been a dumpsterfire at some point - most of us spectacularly so, and for extended periods, often with relapse involved. There is truly no judgment, and I promise that whatever weird or bad thought or experience you think is unique to you will have been shared by at least two or three other people in any given meeting. Part of recovery is letting go of the feeling of "terminal uniqueness" that helps us to rationalize why they can get better but we never could. Intherooms.com has digital meetings at many different times and with many different foci throughout the week. The official meeting listings for your area are best found by Googling the nearest town or city or the name of the region that you live in plus "AA meetings" or "NA meetings" (so I use the Syracuse AA Intergroup website and the Heart of New York page on the Northern NY NA site). I have two upcoming posts that are short stories based on my experiences in China, for those of you who are into that side of things! As always, thank you for reading. B. p.s. If you're interested in reading about my Stepwork experience, I wrote a two-part reflection on what the First Step means to me and have more content on the other Steps forthcoming).

A subscriber who is a fellow writer and who suffers from a mental illness that isn't addiction emailed me with kind words about my piece about famous people in recovery. She shared how my writing had impacted her with words brief and true, and I was gobsmacked. I am still "going through it," as they say, and her message made so much more than my day, and it inspired me to run to the Internet to share like a 17-year-old girl after her first kiss. “It's not catastrophes, murders, deaths, diseases, that age and kill us; it's the way people look and laugh, and run up the steps of omnibuses.” ―Virginia Woolf, Jacob's Room My ratchet little blog is just starting out, and I'm not sure that it will ever be anything more than a place to upload my crazy mind to the Internet to disturb generations to come. I have dreams, and I have at least a little talent shaped by some formal and a lot of informal education, but in the grand scheme of creative people, it is truly nothing. Even still, I got a message from a new subscriber today that meant more to me than I can possibly articulate here. My first thought when I read it wasn't "oh, thank God someone likes my stuff," or even "I'm so glad that what I wrote helped someone a little bit"; instead, it was "When was the last time that I took a break from my own goals and my own pain for long enough to write an email this kind and sincere to someone who I don't know for no (ostensibly practical) reason at all?" Her message was beautiful, and it made so much more than my day. Our world is so dark these days; the Internet in particular feels so much more hateful and accelerated than it used to. It's so easy to forget that our small acts of kindness, praise, and gratitude can do as much as supposedly "big" things to change this wildly entropic world that we inhabit (and perhaps even the warp-holed universes that we help create, too). Being a teacher has made me aware of how much more sensitive to the overall vibe of our country and our world young people are - post-pandemic Gen Z has the most alarming mental health statistics on record, which if you're a Millennial should freeze the blood in your veins - and putting these softer kinds of thoughts out there is helping them, too. We all create the interlocking worlds that we inhabit, moment to moment, atom by atom, in our personal lives, our professional ones, in our tiny, unobserved interactions with people who "don't matter." I'm picking a couple of people whose work I enjoy who I don't know and who I think probably don't receive heaps of praise and I'm sending them my own emails tonight. This post isn't part of my "planned programming," and I'm not sure how many people will end up reading it. But for anyone who does, I hope that you consider sending your own messages, too.

Ready to call your ex-whatever borderline, a narcissist, or a sociopath? Think twice. Put simply, the person calling someone a sociopath or a narcissist is more likely to be a sociopath or a narcissist themself. And no one knows what it's like To be hated To be fated to telling only lies But my dreams they aren't as empty As my conscience seems to be -"Behind Blue Eyes" by the Who Cluster B diagnoses refer to a group of so-called personality disorders, including Narcissistic Personality Disorder (NPD), Antisocial Personality Disorder (ASPD), Histrionic Personality Disorder (HPD), and Borderline Personality Disorder (BPD), which involve persistent, pernicious problems with how affected individuals emote, self-regulate, express themselves, and navigate relationships. Embellished Cluster B terms like malignant narcissist are the ADD / ADHD of the current epoch; they have been so grossly misconstrued and overapplied that they risk becoming meaningless. The first thing that you should know about this group of disorders is that their very existence is still challenged by some psychologists and psychiatrists. Moreover, these disorders tend to co-occur with each other, leading some mental health experts to question whether they are in fact a single disorder on a spectrum (this same concern is manifesting in many important subfields of psych at the moment; it is an emerging theme in our understanding of the human brain). There are specific concerns that some of the disorders, especially ASPD, have tautological definitions (in the case of ASPD, involving criminal behavior as a key criterion). There are cultural factors and issues related to gender that can impact diagnosis, as well. These disorders are frequently confused with other mental health diagnoses; Bipolar Disorder and Borderline Personality Disorder, for example, can be comorbid but are frequently mistaken for each other. The simple fact is that when leading mental health experts advance Cluster B diagnoses - even for famous cases such as Jeffrey Dahmer's, for which abundant information is available - they do not assign them in a standardized, replicable way, as science demands. I decided to write this post after reflecting on a recent conversation with a friend. She is a smart, socially adept art dealer who works for a small gallery in the City. We have known each other for over 10 years, during which time I have observed that her friendships and romantic relationships tend toward the passionate - some would even say turbulent. For what it's worth, she's 33 and has been engaged twice but never married. This friend, who has a sum total of one course of psychological knowledge, launched into a forensic exposition on her ex-fiancé, who she classified as a covert narcissist. (As bestsellers get written and careers get made over yet another area of psychiatry that has captured the public imagination, terms like covert and malignant are used to embellish the general diagnostic labels). "It was all there; I just couldn't see it," she declared. "The love-bombing, then the devaluation, then the discarding, then starting the cycle all over again." I wish I were kidding when I say that I have heard no fewer than half a dozen virtually identical psychological indictments of ex-boyfriends and ex-husbands during the past few years. It's no longer enough to say "Hey, we both had our issues, and it didn't work out; we're focusing on co-parenting"; there seems to be an impulse to utterly character assassinate exes using clinical terms that by their definitions involve lifelong traits that are hard to change or manage. On the surface, this clinical terminology lends a certain sterile appeal, perhaps even an apparent air of detachment, but it carries a powerful riptide: Clinical-izing in this manner is actually crueler and more condescending than simply laying out someone's traits and actions in straightforwardly moralistic terms. The issue with this type of "reading" of someone’s personality is that it depends entirely on one heavily biased, typically ex post facto assessment of the other party's intentions, motivations, and personal qualities. It isn't hard for me to imagine how a very typical, mid-twenties relationship - which begins with ardent, worshipful love and ends six months later when the happy chemicals wear off and reality sets in - would create a trajectory that could be inadvertently or intentionally misinterpreted as reflective of narcissistic abuse by one of the parties who is feeling hurt and abandoned afterward. The crux of the issue in this scenario seems to be whether the "love bombing" and other phases are sincere or manipulative, and it is easy to envision a scenario in which initial passion is overrated by one or both parties, leading to a steep drop-off and a long, cold denouement afterward. Another important consideration is that we all express Cluster B traits to some degree; for this reason, these diagnoses depend on questions of extent, persistence, and level of disruption of daily life. My recommendation is that unless you have a PhD in psych with a specialty in personality disorders or an MD / DO / MBBS with a psychiatry specialization, stop using these terms. Diagnosing these disorders is nuanced, difficult, and debatable even for the experts; it requires a thorough knowledge of every single alternative diagnosis from outside of the personality disorder realm, and it involves ruling out physical disorders such as hyperthyroidism that can create all of the symptoms of a personality disorder (in that case, Borderline Personality Disorder or Histrionic Personality Disorder). There is another level on which people inclined to refer to exes as borderline or narcissistic should be wary. Any mental health provider with experience with these disorders will tell you that, despite them being fairly rare at a population level, it is absolutely shocking how people afflicted by them tend to end up in each other's lives; affected individuals are like magnets for each other. Moreover, the heritability of these disorders, which refers to the percentage of variation in a population that is attributable to genetics, is very high, meaning that if mom was borderline or narcissistic, there is a very high chance that you are, as well. Using these terms suggests that the person applying them has Cluster B characteristics just as strongly as it says anything at all about whomever is being discussed. I know that some of you will read this and question how else you should describe a borderline- or narcissistic-seeming ex who "fits all the criteria perfectly," and my answer is simple: Just describe traits and behavior without the clinical overlay. It's perfectly fine - in fact, vastly preferable - to say that your ex was emotionally volatile, frequently manipulative, and lied a lot. If you are absolutely sure that he or she demonstrated these qualities for long enough and in enough different relationships and areas of life for them to qualify as essential, feel free to call him or her a liar or a manipulator straight out. I tend to keep my assessments of other people's characters as rooted in their behavior and as limited to a certain context or relationship as possible, and I find that this tends to increase the weight that people assign to my judgments about others, but this is certainly not required or appropriate in every case. The one exception to all of the above is when the person in question has been creditably diagnosed with a Cluster B disorder, preferably by at least two doctoral-level psych professionals rendering independent assessments. Please note the "creditably" and forego this damaging, demeaning clinical terminology if you are not absolutely sure that it is being justly applied.

What to listen to when the heebie jeebies are getting the best of you. These tracks are transcendental, poetic, wistful, sublime: A detox mix for a disturbed soul with the most refined of taste. Sunset over Lake Ontario (Oswego, New York). I've been taking my methadone too early when I have take-homes and as a result spending the last 24-48 hours of the weekly cycle in pretty significant withdrawal. I compiled this meandering playlist of the songs / videos that make me feel calm, reflective, and nostalgic. I've inserted some pointless cultural and historical commentary along the way because I'm me. If I bite it (when I bite it?) and this page is memorialized, I also thought that it might be nice for family and friends to have this. It's a real piece of my soul - be kind to it. Enya - Only Time Who can say where the road goes? Where the day flows Only time *If you’re feeling too ill to change tracks, there are YouTube videos that play this haunting track on a loop for hours. Simon and Garfunkel - The Only Living Boy in New York Half of the time we’re gone But we don’t know where Emmylou Harris - Bang the Drum Slowly I meant to ask you how to fix that car I always meant to ask you about the war And what you saw across a bridge too far Did it leave a scar Bang the drum slowly; play the pipe lowly To dust be returning from dust we begin Bang the drum slowly; I'll speak of things holy Above and below me world without end *There is a moving video of this song set to a U.S. military funeral (held at Arlington, I believe). Dvorak - New World Symphony (Second Movement) *Classical selection. My piano teacher had a poster with a quote that is reportedly inscribed on an opera house in Frankfurt (I'll have to take her word for it): “Bach gave us God’s word; Mozart gave us God’s laughter; Beethoven gave us God’s fire; And God gave us music, that we might pray without words.” This song evokes a swelling majesty and an abiding loss. Johnny Cash - Hurt (Nine Inch Nails Cover) I hurt myself today To see if I still feel I focus on the pain The only thing that’s real The needle tears a hole The old familiar sting Try to kill it all away But I remember everything You could have it all My empire of dirt I will let you down I will make you hurt *This video, recorded shortly before Johnny Cash’s death, features a montage of his life with June Carter Cash. Kodaline - High Hopes In my dreams I see the ghosts of all the people who’ve come and gone *See the music video for a story about a tragic love that transforms and lingers. Gordon Lightfoot - If You Could Read My Mind I will never be set free As long as I’m a ghost that you can’t see *I have no real justification for inclusion of this track here beyond the fact that Gordon Lightfoot’s voice is just so rich and comforting; his is the kind of spellbinding tone that makes you believe him when he tells you that everything is going to be okay. Tired Pony - Get on the Road The fire, the wine, the bed and you In this crimson light I find the truth And truth is like a punch or two It hits you hard, it knocks you through So I get on the road and ride to you I get on the road and ride to you Kiss like a fight that neither wins One tender payment for our sins You are the drug that I can't quit Your perfect chaos is a perfect fit *Dedicated to anyone who has ever let love go because they were in the stranglehold of addiction. U2 - Mothers of the Disappeared Where are my sons and daughters? Cut down Taken from us Hear their heartbeats We hear their heartbeats Night hangs like a prisoner Stretched over black and blue Hear their heartbeats We hear their heartbeats *The title is a reference to the Madres de la Plaza de Mayo, a group that publicly demanded that the Videla dictatorship of Argentina release information about their disappeared sons and daughters, many of whom were students and teachers engaged in nonviolent political activism. When I hear this song, I think too about the tens of thousands of Millennial opioid addicts in the U.S. who are either dead or experiencing AWOL of the soul. Dire Straits - Romeo and Juliet And all I do is miss you and the way we used to be All I do is keep the beat, the bad company All I do is kiss you through the bars of a rhyme Juliet, I'd do the stars with you any time *I think that the Kinks, the Dire Straits, and the Libertines are three of the most niche / underappreciated of British rock bands. One Headlight - The Wallflowers Hey Come on try a little Nothing is forever There's got to be something better than in the middle Me and Cinderella We put it all together We can drive it home With one headlight *Bob Dylan’s son Jakob and Jakob’s son Levi are seriously underrated as heartthrobs; Google them, O Ye of Little Faith. Phosphorescent - Song for Zula Some say love is a burning thing That it makes a fiery ring Oh but I know love as a fading thing Just as fickle as a feather in a stream See, honey, I saw love You see it came to me It put its face up to my face so I could see Yeah then I saw love disfigure me Into something I am not recognizing Pink Floyd - Wish You Were Here So, so you think you can tell Heaven from hell? Blue skies from pain? Can you tell a green field From a cold steel rail? A smile from a veil? Do you think you can tell? Did they get you to trade Your heroes for ghosts? Hot ashes for trees? Hot air for a cool breeze? Cold comfort for change? Did you exchange A walk-on part in the war For a lead role in a cage? How I wish, how I wish you were here We're just two lost souls Swimming in a fishbowl Year after year Running over the same old ground What have we found? The same old fears Wish you were here Elton John - Rocket Man And I think it's gonna be a long, long time 'Til touchdown brings me 'round again to find I'm not the man they think I am at home Oh, no, no, no I'm a rocket man Rocket man Burning out his fuse up here alone *Whoever made the animation for this video is a genius; it deserves the 144 million views that it has garnered. Fleetwood Mac - Landslide Well, I've been afraid of changin' 'Cause I've built my life around you But time makes you bolder Even children get older And I'm getting older too *Stevie Nicks has been vocal about her battle with addiction to clonazepam, a benzodiazepine whose withdrawal syndrome left her in the hospital for a month; she admits that benzo addiction made her legendary coke addiction seem like a walk in the park. She also lost a godson to a Xanax / alcohol overdose. Fastball - Outta My Head Sometimes I feel like I'm drunk behind the wheel The wheel of possibility However it may roll Give it a spin See if you can somehow factor in You know there's always more than one way To say exactly what you mean to say Was I out of my head or was I out of my mind? How could I have ever been so blind? I was waiting for an indication, it was hard to find Don't matter what I say, only what I do I never mean to do bad things to you So quiet but I finally woke up If you're sad then it's time you spoke up too *I miss the straightforward ‘90s, when the vibe was overridingly positive and low self-esteem was an acceptable excuse for everything from shyness to being a slut. Counting Crows - Mrs. Potter’s Lullaby Well, I woke up in mid-afternoon 'cause that's when it all hurts the most I dream I never know anyone at the party and I'm always the host If dreams are like movies, then memories are films about ghosts You can never escape; you can only move south down the coast Rufus Wainwright - Hallelujah There was a time you'd let me know What's real and going on below But now you never show it to me do you? And remember when I moved in you? The holy dark was moving too And every breath we drew was hallelujah Oasis - Wonderwall Backbeat, the word is on the street That the fire in your heart is out I’m sure you’ve heard it all before But I’ve never really had a doubt I don't believe that anybody feels the way I do about you now And all the roads we have to walk are winding And all the lights that lead the way are blinding… Bridge Over Troubled Water - Artists for Grenfell (Simon and Garfunkel Cover) When you're down and out When you're on the street When evening falls so hard I will comfort you I'll take your part Oh, when darkness comes And pain is all around Like a bridge over troubled water I will lay me down *This is a heartrending cover of the original by several prominent British artists singing in memory of the Grenfell Tower fire. Elton John - Candle in the Wind (Princess Diana Version) And it seems to me you lived your life Like a candle in the wind Never fading with the sunset When the rain set in *I am a huge Princess Di fan. This video features iconic shots of the most photographed woman of the 20th century. There is something extraordinary, ethereal, and eternal about her photographic presence. Suffice it to say that – despite probable BPD and definite bulimia – Princess Di’s connection with the young, the weak, and the suffering made an indelible impact on the entire world. Among many other touching moments, she held the hand of an AIDS patient on TV at a time when most people were still terrified to be around people with the disease. Passenger - The Boy Who Cried Wolf Well, I am the shepherd's only son And I know what a joke I've become I have an honest heart but I have lies on my tongue I don't know how it started or where it came from And you have no reason and I have no proof But this time I swear, I'm telling the truth I saw that old wolf, from tail to tooth And I know that he's hungry and he's coming down too *Pure poetry; another animated video worth checking out. Guster - One Man Wrecking Machine I built a time machine I'm going to see the homecoming queen Take her to the Christmas dance Maybe now I'll get in her pants Whatever Back with my high school friends Meeting where the train tracks end Passing round a skinny joint Rolling up to lookout point I want to pull it apart and put it back together I want to relive all my adolescent dreams Inspired by true events on movie screens I am a one man wrecking machine *This song became a kind of personal anthem in my early 30s. Fun - Carry On If you're lost and alone, or you're sinkin' like a stone Carry on May your past be the sound of your feet upon the ground Carry on Natalie Merchant - Carnival And I've walked these streets In the madhouse asylum they can be Where a wild-eyed misfit prophet On a traffic island stopped and he raved of saving me Have I been blind, have I been lost Inside myself and my own mind? Hypnotized, mesmerized by what my eyes have seen *Purportedly a favorite of serial killer Aileen Wuornos in the days before her execution. Nice to know who shares your taste in music. Lana Del Rey - Ride I hear the birds on the summer breeze, I drive fast I am alone at midnight Been tryin' hard not to get into trouble, but I I've got a war in my mind I just ride Just ride, I just ride, I just ride I'm tired of feeling like I'm fucking crazy I'm tired of driving 'til I see stars in my eyes All I've got to keep myself sane, baby So I just ride, I just ride *There is a video compilation of Marilyn Monroe set to this song that is another favorite of mine. The Killers - Read My Mind The good old days, the honest man The restless heart, the Promised Land A subtle kiss that no one sees A broken wrist and a big trapeze Oh well, I don't mind if you don't mind 'Cause I don't shine if you don't shine Before you go Can you read my mind? *The Killers filmed the music video for this song in Tokyo; it's definitely worth watching. Third Eye Blind - God of Wine Every glamorous sunrise Throws the planets out of line A star sign out of whac A fraudulent zodiac And the God of Wine Is crouched down in my room You let me down, I said it Now I'm going down * Whether or not Stephan Jenkins lied about being valedictorian at UC Berkeley, Third Eye Blind is unquestionably one of the GOAT’s. Third Eye Blind - Deep Inside of You When we met light was shed Thoughts free flow, you said you've got something Deep inside of you A wind chime voice sounds, sway of your hips round rings true It goes deep inside of you These secret garden beams Changed my life so it seems Fall breeze blows outside, I don't break stride My thoughts are warm And they go deep inside of you Janis Joplin - Me and Bobby McGee But I'd trade all my tomorrows for one single yesterday To be holdin' Bobby's body next to mine Freedom's just another word for nothin' left to lose And nothin' don't mean nothin' , honey, if it ain't free Shawn Colvin - Sunny Came Home Sunny came home with a list of names She didn't believe in transcendence "And it's time for a few small repairs," she said Sunny came home with a vengeance She says, "Days go by, I don't know why I'm walking on a wire I close my eyes and fly out of my mind Into the fire" *Don’t judge me for this one. The Carpenters - The Rainbow Connection Have you been sleeping, and have you heard voices? I've heard them calling my name Is this the sweet sound that calls the young sailors The voice might be one and the same I've heard it too many times to ignore it It's something that I'm supposed to be Someday we'll find it The rainbow connection The lovers, the dreamers, and me *Don’t Judge Me: Part Deux. I remember hearing this song when I very young and thinking that A) Karen Carpenter had the most beautiful voice that I had ever heard, and B) that she sounded deeply, inexplicably sad even when she was singing songs with bright lyrics. With Karen emaciated from the anorexia that killed her at 32 and her brother Richard so stupefied by Quaaludes that he had to be carried to the piano before certain performances, the Carpenters were a uniquely American shitshow. Ripple - Grateful Dead It's a hand-me-down, the thoughts are broken Perhaps they're better left unsung I don't know, don't really care Let there be songs to fill the air *I grew up around Dead Heads. One of my cool aunts on my mom’s side had a sticker on her glove compartment that said “Papa Bear: 1942 - Forever.” Emmylou Harris - Every Grain of Sand (Bob Dylan Cover) I gaze into the doorway of temptation's angry flame And every time I pass that way, I always hear my name Then onward in my journey, I come to understand That every hair is numbered like every grain of sand I have gone from rags to riches in the sorrow of the night In the violence of a summer's dream, in the chill of a wintry light In the bitter dance of loneliness, fading into space In the broken mirror of innocence on each forgotten face I hear the ancient footsteps like the motion of the sea Sometimes I turn, there's someone there, other time it's only me I am hanging in the balance of a perfect finished plan Like every sparrow falling, like every grain of sand Let It Be - The Beatles And when the night is cloudy there is still a light that shines on me Shine until tomorrow Let it be

First Step of NA / AA: We admitted that we were powerless over drugs / alcohol; that our lives had become unmanageable. Doctor please, some more of these Outside the door, she took four more ... She goes runnin' for the shelter of her mother's little helper... -"Mother's Little Helper" by the Rolling Stones I have no memories from between the third and the seventh of each month for a-year-and-a-half-stretch of my early twenties. I have chosen those words carefully. It’s not that I retain hazy or occluded memories for these periods. Neither do I possess fragmented recollections, when – as after an alcohol-induced blackout – the early moments as well as the most intense ones punch through the amnesia, and some of the rest can be recovered with prompting. Rather, I am utterly unable to access any memories whatsoever from these timespans. They have been lost to the void (presumably the same one that devours the memories of the dead): It is as though someone else lived them. On the third day of every month, I would skip my morning lecture – the only one that I ever missed – so that I could take the earliest bus to the grocery store where I filled my Xanax prescription. I would arrive six or seven minutes after the pharmacy section opened, always worried that appearing on the dot would prompt a douchebag “virtuous” pharmacist to call my doctor and report my blatant drug-seeking (by contrast, a college student showing up on the same day of each month at five minutes after 8:30 a.m. opening time, rain or shine, with absolutely no variation, was the height of subtlety; pure genius). My ritual was to drop off the script, inquire about how long it would be until it was ready for pickup, and then pretend to contemplate whether I should stay to wait for it to be filled or come back to pick it up later. “I guess I’ll stay,” I’d always declare in as nonchalant a tone as I could muster. Then, I’d head to the bakery to buy a Boston Creme donut, following which I would bide my time in other sections of the store until the fifteen- or twenty-minute waiting period had elapsed. I would force myself to linger for an additional five or six minutes, and please believe me that those final few ticks of the clock felt longer than entire two-hour molecular biology lectures. I would never eat the donut until after I left the store with my script, incidentally – I wanted those first couple of pills to hit on an empty stomach so as to have maximal impact. And this time, it would only be a couple of pills, I assured myself. Because this month, it would be different. I would space the script out, make it last. Of course, the day of filling the script justified some indulgence, but I wouldn’t, couldn't let myself embark on another benzo bender. I’d limit myself to 1.5 milligrams, a magic number that would leave me in control of my faculties. Mostly. I'd give it 4 to 6 hours to wear off, and then maybe take another 2 or 2.5 milligrams before bed. In the days before my script was filled, I would review my planned dosing schedule scientifically, reverently, ritualistically. I couldn’t let it happen again. And as I waited for my script to be filled, I could almost taste the bitter dust that the generic pills made when they knocked against each other inside the bottle. On the bus ride back to campus, as the first 1.5 milligrams of serenity started to kick in and I finally began to feel comfortable in my own skin, I assured myself that another 1 or 1.5 milligrams couldn’t hurt. My tolerance had increased, of course, and I’d failed to properly account for this fact. Plus, using more benzos would help me to reduce my intake of dope and thus spend less money on that diabolically expensive drug (I laugh derisively as I write that now). Before too long, I'd concocted a veritable cornucopia of reasons for taking more benzos than I had planned to: I’d had too much coffee that morning, or too much food the night before, or was too stressed by my prelim or my boyfriend or whatever crisis I could conjure up. Sometimes I was still humiliated by what I’d done between the third and the seventh of the previous month and thus required the extra Xanax to round off the jagged edges of the memories that I didn’t have from that. That’s what the medicine was prescribed for, after all: To reduce anxiety. Whatever my justification, my inner memory track inevitably faded to black by the end of the 30-minute bus ride back to campus. Sometimes the last memory that my brain encoded was of me munching on my Boston Creme donut between the first and second rounds of pills; sometimes it was of the oval-shaped, blue pills jostling around inside the bottle or lined up in the crease of my palm. Just as predictably, I’d wake up four days later. Scratch that – “wake up” is lazy language. I’d come to back to myself. I’d suddenly become aware of myself again. I’d reappear. A wrenching, mounting panic would swallow me as I realized that it had happened again: I’d gone into another fugue. I’d check the date and time, then search my apartment for the missing pills, because surely they were there somewhere: I hadn’t gone through 60 milligrams of alprazolam in four days on top of my daily heroin habit. It wasn’t possible. When I failed to find them in the pockets of my pants or scattered beneath my comforter, I’d begin a frantic search of my text messages and emails for evidence of places where I might have misplaced the remaining pills; the truth is that I’d be too panicked about where my script had gone to feel properly mortified by what I found there. Besides, it is difficult to feel shame about something that one doesn’t remember doing; I found that imputing the proper horror and humiliation after the fact to be surprisingly difficult. (However, months and years later, when those emotions did surface in unpredictable fits and starts during my stints in treatment, they were vicious, overpowering, and intensely physicalized. To this day, realizing what I did during some of those benzo binges brings an uncharacteristic heat to my cheeks and forehead; I tense everything that can be tensed without showing it as I write this now). The first time that I traded sex for drug money, I found out about it three days after the fact during one of these desperate, seventh-of-the-month forensic forays into my messages from the prior four days. Specifically, I discovered that I had messaged an older guy who I had met at a bar a few weeks ago, offered him fun if he wanted to be “generous.” “How generous?” had been his reply, and the “60” that I sent back, followed by his address and our subsequent communications, let me know that we had sealed the deal. Moreover, it had apparently gone well enough for him to ask if I’d be up for meeting again in the future. During these benzo binges, I sent the graphic nudes that I used to mock other guys for offering before they even introduced themselves. I submitted lewd images with my face in them, heedless of the possibility that they could be circulated by someone else or the very real chance that they could resurface to haunt me in the future. Likewise, I unblocked and messaged lovers who I had sworn I would never talk to again; I sent deranged, vitriolic messages to friends and acquaintances, accusing them of lying to me and abandoning me, causing some of them to block me. To this day, I sometimes have strange, gloaming recollections of houses I have been in and men that I have been with whose names I don’t know and whose faces don’t fully register; they come to me apropos of nothing, often as I enter or exit sleep, like misplaced answers to crossword puzzle clues. For Part II, click here.

How to make at-home opioid detox bearable. I focus on which prescription and OTC comfort medications are must-haves and which should be avoided. I address marijuana and other plant-based remedies, as well, and I touch on non-pharmacologic methods for alleviating detox symptoms. "Giving up smoking is the easiest thing in the world. I know because I've done it thousands of times." Mark Twain (19th-century American writer) Note: This article is a summary of what has worked for me and other opioid addicts who I have known (supplemented with data from medical journals). It is not direct medical advice and should not be used except in consultation with your Primary Care Provider, addiction specialist, or other clinician. When in doubt, a supervised detox in a medical facility is the safest bet. Post Acute Withdrawal Symptoms (PAWS) can resurface weeks to months after acute withdrawal is over. Sometimes this occurs apropos of nothing, but often it is in response to stress or physical illness, causing a relapse into withdrawal symptoms that can feel almost as intense as those experienced during acute withdrawal. Infographic from the Mandala Healing Center. A QUESTIONABLE AESTHETIC I once detoxed in an ultra-low-budget rehab center in Upstate New York that was originally a tuberculosis sanitarium. Each Friday, the dental truck would pull up to a large smokestack attached to the back of the building, which was once the facility's crematorium. Editor's note: If "dental truck" sounds bizarre or even oxymoronic to you, then you are blessed. This facility was rough. It was a sprawling brick structure on four floors, which were organized by race - similar to how things run in many prisons. This was no coincidence, as probably three-quarters of the guys there were on paper, many for much more serious offenses than your standard possession / dealing / repeated DWI starter pack that you find in most rehabs. To give you an idea of the vibe around safety, we had to sign out razors to shave with because of past shanking incidents. In fact, a patient from the Papi floor once offered me two Ramen soups if I gave my razor to him rather than returning it. ("You look like you could get away with it," he offered apologetically when I declined to do so). So, this wasn't a particularly safe-feeling space for a gangly white guy who had never done time. Throw into the mix that I'm gay, which is something that virtually no one discloses in an environment like that, and hopefully you can understand that there were some downright harrowing moments. I plan to write a more detailed account of my experience in this facility, which will include a description of my first night with my detox roomie Steve, a white guy my age who was a manager at a local pizza shop and a total treatment virgin. For now, let me say that much of my first 48 hours was spent praying for a benzo withdrawal seizure to deliver me from Steve's blubbering, endless threats to go home AMA (as though that would've been a tragedy for me), and requests to accompany him to the bathroom. (Each bathroom had two doors that didn't lock, and Steve somehow felt - after knowing me for six hours - that inviting me into the bathroom with him as his bodyguard was preferable to taking his chances by placing a towel under each door, which is how the rest of us signaled that we were using it). At the end of the first night, the danger-haired nurse on duty gave me my 2 mg clonazepam (Klonopin) dose, then added something unexpected: "I'm not logging this one in the system," she promised sotto voce with a knowing look. What I'm getting at here is that a supervised detox in a medical facility isn't always a viable option. Furthermore, it's not even necessarily the most effective option. Whether because your addiction is still a secret from friends and family, you're experiencing a gap in insurance coverage, there're no available beds in the programs in your area, or you just don't feel like sharing a bathroom while projectile vomiting and having Jackson Pollock-inspired diarrhea, sometimes at-home opioid detox is the way to go. If you're undertaking at-home detox, it's imperative to get some comfort meds to help you. Without them, your chances of succeeding are close to zero; true "cold turkey" detox outside of penal contexts is so rare that it's almost a myth. It's best if you can have a loved one* dole them out based on the symptoms that you're experiencing, and it's essential that you be able to adjust your plan to respond to how you feel as you progress through the stages of withdrawal. *Editor's note: Or even an un-loved one, for that matter; just not someone who would rejoice in your suffering. MINDSET AND INTENTION-SETTING I've heard some addicts say that they conceptualize withdrawal as a prison sentence - a miserable period that just has to be gotten through, one day at a time, one way or another. For me, as goofy as it sounds, I preferred a more positive cognitive framework. I told myself that opioid withdrawal was like giving birth to a new me. Just as with labor, there would be more fear and pain than I had ever felt before; but as with birth, in the end there would be new life. I'm not a possessions person. My grandmother's prayer card and the two tattered volumes of my Norton Anthology of English Literature are the only objects in this world that I have any attachment to. However, I found that keeping both of these close to me during withdrawal was anchoring and motivating. The prayer card reminded me that I am loved miraculously, unconditionally, and helped me to reconnect with the person that I know I am deep down and wanted to return to being. The Norton Antho was a symbol of the truth and beauty that addiction had blinded my soul to; it also recalled my love of learning and my potential as a writer, two things that my addiction posed an existential threat to. Pictures of loved ones (and of yourself during halcyon times); beloved books, including children's tales; photos from your travels or postcards of places that you long to visit; spiritual objects, such as rosaries and prayer cards: These are your totems, the reminders that will carry you through when things get really gnarly. Gather them around you; keep them close. Time distribution of withdrawal symptoms during withdrawal from a "typical" opiate / opioid like hydrocodone, morphine, or heroin. The acute phase of withdrawal from fentanyl, oxycodone, morphine, and heroin should be concluded by days 5-7. Keep reading for more information on how the length of withdrawal varies depending on the half-life of the drug of choice. Infographic taken from drstacygreen.com. A FEW OF MY FAVORITE THINGS Now for the meat and potatoes of this post: The comfort meds - prescription, over the counter (OTC), and herbal - that will soften the edges of a truly hellish undertaking. In my experience, the best way to obtain these medications is from your Primary Care Provider (PCP), if you have one. These physicians - or mid-levels such as Nurse Practitioners and Physician Assistants - are much more likely to take into account your overall circumstances and support your decision to detox at home. If you aren't able to see a PCP with whom you already have a relationship, urgent care followed by the Emergency Room are the next best options. Have your rationale ready - either your insurance won't cover you (some will limit you to a certain number of detoxes within a set period), there aren't available beds at the moment, or whatever else is going on. Most prescribers will view sending you off to a medical facility for a supervised detox as the gold standard plan, so you're going to have to be prepared to push back a bit. Remember that, with the possible exception of gabapentin, depending on where you live, all of the medications listed in this section are non-controlled, so you aren't putting these prescribers out that much by asking for them. Also keep in mind that if you are coming off of benzos, barbiturates, or alcohol (if you drink to the point of heavy physical dependence), withdrawal can kill you. In these cases, a supervised, medical detox is therefore the only option. So, if you've been regularly mixing your opioids with other substances, at-home detox is probably not the way to go. Used properly and in conjunction with non-pharmacologic techniques (discussed below), the following meds can decrease the intensity of key withdrawal symptoms by 4-6 points on a scale of 10. In my experience, that is enough to allow you to reclaim sufficient agency so that you won't automatically bolt out the door to score when your withdrawal symptoms peak. Without further ado... Gabapentin. Useful for virtually every withdrawal symptom, from anxiety and insomnia to bone and muscle aches, lack of appetite, and nausea. The key is to dose liberally. Start with 300 milligrams every 4-6 hours for the first two doses, then increase by 300 mg every 4-6 hours until you reach 900 or 1200 mg per dose. The maximum daily dose of gabapentin is 2400 to 3600 mg, so you will need to plan accordingly. Muscle jerks / twitches, especially as you are falling asleep, are a sign that you may need to back off your dosage a bit. Remember that gabapentin affects the seizure threshold, so you will want to taper down after 7-10 days of using it rather than discontinuing this medicine abruptly. Clonidine. This blood pressure medication is an alpha-adrenergic agonist, meaning that it blocks the flight-or-fight hormones that produce much of the dread and panic associated with opioid withdrawal. It is useful for anxiety, insomnia, and high blood pressure (hypertension) caused by withdrawal, and it will likely help with restless limbs, as well*. *Editor's sidenote: The expression "kicking the habit" originated from the flailing of arms and legs that doctors observed in heroin addicts during detox. Do not dose more than 0.1 mg of clonidine three times per day. If your blood pressure tends to run low, or if you are on other antihypertensive medications, you will need to be extra careful with this one. A dose of 0.1 mg twice per day is probably safer if you fall into this category. It's best practice to borrow a blood pressure cuff to make sure that the clonidine isn't dropping your BP too much. If you aren't able to do this, dizziness upon changing position is a surefire indicator that you need to back off on the clonidine. Do not ever take more than 0.1 mg at a time, period. Many an addict in withdrawal has swallowed a few of these pills at once thinking that they are basically equivalent to Xanax or Ativan, which inevitably leads to nasty low-blood-pressure symptoms and a trip to the ER. If you've taken clonidine for longer than 7 to 10 days, you will want to step down your dosage before discontinuing it to avoid rebound hypertension. Zofran (ondansetron). This is a wonderful anti-nausea medication. Make sure to ask your prescriber for the sublingual version, which dissolves under your tongue, rather than the standard pill formulation, as you might not be able to keep down a pill and the sublingual formulation works faster, anyway. This med should decrease the nausea enough that you can get down some light soup, a bowl of plain rice, or some crackers. Hydroxyzine (Atarax). This is a sedating antihistamine that helps with anxiety. In my experience, it is most effective if taken once per day to induce sleep, but many prescribers will recommend taking it every 6 hours during the worst days of withdrawal. Like gabapentin, it will lose its efficacy rapidly if you take it on too many days in a row, so after acute withdrawal is over, it's best if used as necessary (PRN). Hydroxyzine is prescription only, but doxylamine succinate (Unisom) is an OTC alternative that works similarly. Benadryl (diphenhydramine) should only be taken if neither hydroxyzine nor doxylamine succinate can be procured, as it is not as effective and has worse side effects compared to these two medications. In particular, Benadryl is likely to leave you feeling gross if you take 50-100 mg and then cannot fall asleep. Do not exceed the recommended dose on any of these medications. They can cause hallucinations (not the fun kind) and a host of other highly unpleasant symptoms. Loperamide (Imodium). This OTC antidiarrheal is the most effective antidote to the bear carcass diarrhea that is an inevitable part of opioid withdrawal because it is an opioid itself; you are giving the intestinal opioid receptors exactly what they want. However, because it doesn't cross the blood-brain barrier, loperamide won't get you high.* *I am conscious of the Streisand Effect here, but please heed my warning not to exceed the prescribed dosage of loperamide. It is true that massively exceeding the intended dose can push some of the loperamide across the blood-brain barrier, thereby alleviating some of the symptoms of opioid withdrawal. However, this "poor man's methadone" is liable to induce a cardiac arrhythmia that has killed more than a few. It is simply not worth it. Stick around; I need you for views. Ibuprofen. This OTC Non-Steroidal Anti-Inflammatory Drug (NSAID) will help to quiet the aches and pains that flare up during withdrawal. I recommend ibuprofen rather than acetaminophen because anyone with a damaged liver should avoid acetaminophen altogether, and most opioid addicts have some degree of liver damage from viral hepatitis and / or taking acetaminophen overdoses for years because opioids such as oxycodone and hydrocodone are primarily available in combined formulations. Dose every 4-6 hours for the first few days of withdrawal. Watch out for odd bruising or signs of GI bleeding, such as blood in the stool. This chart from uspharmacist.com shows differences in time to onset and duration of withdrawal symptoms for various opioids. In general, the longer the half-life of an opioid, the longer the withdrawal from it will last. So, acute withdrawal from fentanyl, which has a half-life of perhaps 3 to 7 hours depending on the route of administration, might last 4 to 7 days, whereas acute withdrawal from methadone, which has a half-life of 24-48 hours (highly variable), can last weeks or even months. STAY AWAY FROM Alcohol. Contrary to what Trainspotting taught you, drinking alcohol is the absolute worst thing that you can do during opioid withdrawal. As tempting as it may sound to get a few moments of relaxation or perhaps even an hour of sleep, imbibing while withdrawing is entering into a Faustian bargain that will leave you puking, sweating / shaking, and with massively increased anxiety and cravings. It is also very likely to lead to regular drinking after withdrawal, which is a problem that many former opioid addicts contend with after quitting their drugs of choice. One final warning: Alcohol leads to loss of electrolytes and dehydration, which compromise cardiac function and can land you in the ER. What's more, having screwy sodium and potassium levels induces a malaise that you certainly don't want to add to your existing opioid withdrawal symptoms. Benzodiazepines (Xanax, Klonopin, Ativan, et al.). If you are one hundred percent sure that you can confine your benzo use to taking the recommended dosage for just a few days, then benzos are probably the most potent way to reduce the anxiety, insomnia, and muscle cramps that accompany opioid withdrawal. However, I recommend steering clear for two reasons: (1) Benzos are highly addictive, and you are likely to become cross-addicted to them, in which case you've traded one awful addiction for another one whose withdrawal syndrome can actually kill you; and (2) As with alcohol, benzos induce disinhibition, meaning that the mental barriers that prevent you from giving in and using come down after you take them. Don't be fooled into thinking that the z-drugs like Ambien (zolpidem) and Lunesta (eszopiclone) are less dangerous than the benzos. They are every bit as addictive; they also cause withdrawal seizures; and they are likely to leave you in an unpleasantly hallucinatory state if you take them during withdrawal and they don't knock you out. All that, and they won't even help with muscle cramps and nausea in the way that standard benzos do. Kratom. This plant-based remedy, which has been used in herbal medicine in parts of Southeast Asia for at least 250 years, targets opioid receptors and therefore interferes with optimal healing. Moreover, it can induce cramps, nausea, and diarrhea, all of which will exacerbate your existing Gl symptoms. Trazodone. This tetracyclic antidepressant, which is seldom used for depression these days due to its unpleasant side effect profile, is often prescribed for sleep during opioid withdrawal. I caution against taking it. Even in doses of 100 to 200 mg, it failed to knock me out but left me in a twilit state in which my restless limbs were dramatically exacerbated. This reaction isn't unique to me; I have heard enough other addicts complain of this exact effect to make me wary. If you need a stronger sleep medicine to use in conjunction with hydroxyzine, I recommend Seroquel (quetiapine), an atypical antipsychotic that I have found both more peaceful and more effective in inducing sleep. JURY'S OUT ON Marijuana. Many people find marijuana helpful during withdrawal, particularly those who smoke it habitually before they detox. If you don't regularly use weed, I would advise against edibles because it's too easy to take too much, in which case you're in for a long, uncomfortable ride. While weed can help ameliorate the anxiety, nausea / loss of appetite, and insomnia of withdrawal, it can also cause anxiety in some people, and its hallucinogenic properties can be unwelcome in the midst of withdrawal. Unless you're a stoner elder, less is more with weed during withdrawal. A couple of tokes of old-fashioned bud is much preferable to smoking concentrate or taking an edible. Indica is preferable to Sativa because of its calming effect. CBD on its own is also something to consider. Melatonin. I recommend against taking melatonin during the worst 3-5 days of withdrawal because A) it is unlikely to be strong enough to put you to sleep during this initial period, and B) it can intensify REM sleep, which will exacerbate the uber-nightmares that you're likely already having due to a phenomenon known as REM rebound (basically, your brain catching up on REM sleep after months or years of decreased REM sleep due to opioid use). Kava Kava. This plant-based medicine, which has a rich history of use in certain Pacific Island cultures, can help with anxiety, insomnia, and other symptoms. It is a subtle drug that induces a unique, lucid high. I wouldn't recommend starting Kava Kava during acute withdrawal. Like melatonin, it is unlikely to be strong enough to break through severe withdrawal symptoms. Plus - depending on the form that you obtain it in - some adverse GI reactions have been reported. I see occasional use of Kava Kava extract as an excellent option during the several weeks following acute opioid withdrawal, but be aware that there is some risk of psychological dependence or perhaps even addiction with Kava Kava, as well. Ti Qi, exhausted from relapse after relapse on the part of his daddy. As much as some counselors will tell you that "you have to do it for yourself," I don't believe that this is necessarily true. If I loved myself enough, I wouldn't have tortured and damaged myself almost to the point of death in the first place. But to get better to ease the suffering of the people I love - that thought is easier for me to draw power from. Because humans are highly visual creatures, I recommend keeping photos of the loved ones who you are doing this for at your side during detox (if you don't have any available, you can close your eyes and picture them when you're really in the thick of it). Imagine how good it will feel when you call them to tell them that you are three months, six months, one year, five years clean and sober! To go from being a source of chaos and stress to one of positivity and resilience. FINAL THOUGHTS A hot shower - or better yet, bath or jacuzzi session - can bring down discomfort by 2 to 2.5 points out of 10 on its own. The steam will open your lungs and slow your breathing, helping to calm you. I found it helpful to have my favorite cologne on hand during withdrawal (bougie, I know). To put it bluntly, opioid withdrawal smells like shit and death. What's more, your newly awakened olfactory receptors will be more sensitive to these smells than under normal conditions, meaning that even a moment's respite from this barrage of unpleasant odors will be a heavenly escape once you're in peak withdrawal. Some fellow addicts swear by aromatherapy with essential oils of lavender and other substances, and I can imagine that this is an even more effective means of olfactory escape. As your mind and body reawaken and your emotions resurge, music will acquire another dimension, becoming transcendental, ecstatic. For my soothing detox playlist, click here. If music is too much for you at the moment, there are a variety of free and subscription apps that generate custom ambient noise to calm and center you. I find breathing exercises and other mindfulness techniques to be indispensable during opioid withdrawal. If you can maintain control of your breath, much of the panic-laden emotional overlay dissipates. Likewise, being able to train your awareness on various parts of your body before re-situating yourself in it as a whole (a technique I call "body-dropping") helps you to monitor your symptoms, which, paradoxically, lessens them. Both methods draw your consciousness away from the powerful cravings that will besiege you at all of the worst moments. The key with mindfulness techniques is that, as with breathing exercises during labor, you can't practice these methods for the first time when you really need them. Rather, you should prepare for days or even weeks before your at-home detox. YouTube is full of wonderful mindfulness meditations for observing and quieting your thoughts and emotions. Especially after the first 3-4 days, withdrawal is an exercise in distraction. I remember that during my first, cold-turkey Suboxone (buprenorphine) detox from a ceiling dose of 16 mg per day, it took me six full weeks before I could sit down and watch a 20-minute episode of Parks and Rec all the way through. The sooner you can begin to read a few pages of a trashy romance or watch 15 minutes of a sitcom, the better. It will draw you out of yourself, and before you know it, your symptoms will subside into background noise. Creative pursuits - whether it's just coloring a mandala or jotting down some notes in your journal - are powerfully healing as well. Many artists, writers, and musicians have found withdrawal and the weeks that follow it to be times of enormous verve and fresh perspective. During the worst moments of withdrawal - which will be some of the worst moments of your life, no doubt - get your breathing under control and then bring your mind back to your reasons for putting yourself through this pain. Affirm the wisdom of your decision to stop using as you choose it again and again. Imagine the joyous freedom of feeling good without having to worry about how many hours are left before you need to smoke / snort / swallow / shoot more "good" or face comedown, then withdrawal. Remember that this can be your last detox: You need never feel this pain again. Observe it carefully, embracing every moment so that you will remember it months from now when the temptation to revert to old ways arises. Finally, remember that smooth seas never made able sailors, and that the young, brawny deckhands aren't necessarily the ones who are most likely to survive the shipwreck; instead, it's the wiry old-timers who've weathered many a past crisis who will get through today's disaster, as well. I am so proud of you for taking this on! Deciding to quit your drug of choice when your brain and body need it to function is nothing short of heroic. If you can do this, you can truly do anything. Note: The above recommendations are tailored to the United States' medical system. I will respond to any comments or emails from readers living in other countries; I'm glad to help you research possible alternatives if the suggestions above aren't viable in your area. Please share your own experiences and recommendations below! You're all invited to connect with me on Instagram, which will be ramping up in the next several weeks. Also, please remember to subscribe to the Concrete Confessional mailing list, which you can join from our homepage, for access to our soon-to-launch Discord community and to receive a free copy of my Glossary of Opioid Addiction for Patients and Their Loved Ones later this year.

Does photographer Mark Laita's YouTube channel "Soft White Underbelly," which chronicles the lives of addicts and others at the fringes of society, itself have a seedy underside? Exploring issues of consent, crowdfunding ethics, and platforming. In his Created Equal portrait series, Mark Laita juxtaposed polygamists and pimps (pictured here), janitors and CEOs, priests and KKK leaders, using posture, facial expression, and clothing to drive home unexpected parallels. This striking series emphasizes the shared humanity of its subjects, and it represents one of Laita's first forays into forbidden subcultures - an interest that he has devoted his YouTube series "Soft White Underbelly" to exploring. Mark Laita has had a career that many photographers would kill for. His diptych series, called Created Equal, won him the esteem of respected critics and A-list celebrities like Elton John during the aughts. His depictions of Apple's iMac, iBook, and other products cemented his commercial success and helped to shape Apple's distinctive, full-saturation aesthetic. Mark has galleries in Los Angeles and New York City, a late-model BMW, and all of the expected accoutrements of top-tier success. He also possesses the opposite of a dad bod and a brand of wholesome, blonde good looks that befits his humble Midwestern origins. During the past several years, Mark Laita's YouTube channel, "Soft White Underbelly," has accrued 5.46 million followers. In this series, Mark interviews addicts of all stripes, including alcoholics, gamblers, and nymphomaniacs. He poses probing questions to polygamists, porn stars, fetishists, and pedophiles. Each interview is accompanied by a black-and-white portrait of its subject(s), and Mark uses GoFundMe campaigns to raise money for the mental health treatment, living costs, and other needs of the people that he interviews. Through this series, tens of millions of viewers have been exposed to the radiant charisma, heart-wrenching pathos, and thoroughly entrancing chaos of people at the edges of society, many of whom would otherwise have lived and died in the dark, so to speak. At their best, Mark's interviews challenge societal assumptions about certain roles and behaviors; some of his conversations with fetishists and Only Fans stars, for example, reveal self-assured, content, and intelligent women who are undamaged and at peace with their decisions. Mark has a gentle way about him that works well for these sorts of interviews. His somewhat old-fashioned manners - he frequently compliments female interviewees on their beauty, for example - come across as authentic and charming rather than creepy. I've followed the channel for years and viewed over a hundred of Mark's interviews. The more I watched, the more my concerns grew, which culminated in my decision to write this post (those of you who read my article on the ethics of commenting on public figures' recovery know that media portrayals of addiction are a subject that I find both intriguing and important). Here, I discuss some of my concerns with Mark's interview methods, transparency (or lack thereof) in crowdfunding, and involvement in the lives of his interviewees. CONSENT One of Mark's most popular subjects is Rebecca, a homeless transgender woman who is an illegal immigrant and a fashion savant with a penchant for quoting old movies. Rebecca's charisma is off the charts, and viewers' highly polarized responses to her have included offers to sponsor her addiction treatment, hire her for a fashion-adjacent job, and help her with her immigration issues. In certain videos, Rebecca is compos mentis after being released from a shelter, a hospital, or jail. In others, however, she is disheveled and manic after taking crystal meth and staying up for days; she is barefoot on the sidewalks of West Hollywood, with grime smudged across her face, arms, and legs, and is wearing stylish rags so skimpy that she risks being arrested for public nudity (again). In the latter sort of videos, Mark films Rebecca as she makes a spectacle of herself in public. In one video, for example, she is asked to leave hotel after hotel as Mark tries to find a room for her. My goal here isn't to analyze the legalities of these interviews. While it would be interesting to hear a professional opinion on the subject, it is mostly beside the point, as most unethical behaviors are not illegal, and sometimes illegal actions aren't unethical. However, I would be very interested to know what type of paperwork Mark requires his interviewees to complete before they are filmed. What comes to mind is that, during the late '90s, I remember hearing that the boob-flashing series Girls Gone Wild had encountered legal challenges around the issue of filming girls when they were too drunk to consent to being filmed (some of them were also underage, I believe). I imagine that similar legal issues are potentially involved in Mark's interviews, as well. These issues are by no means unique to Rebecca's interviews: There are dozens of interviews whose subjects are clearly and / or admittedly intoxicated on a variety of powerful mind-altering substances. In addition, in the case of the inbred family the Whittakers, which fittingly hails from a town called Odd in West Virginia, serious developmental disabilities call into question consent even though the participants are not intoxicated. Anyone who listens to the garbled, sometimes nonsensical speech of some of the family members will quickly realize that the subjects are affected by severe mental handicaps. Nevertheless, these videos are some of the channel's most popular (and it would be naive to fail to recognize that some people watch these videos to mock their subjects or to gratify their desire for schadenfreude). In the case of interviews with victims of severe trauma of a sexual or violent nature, some of whom have not had adequate time or therapy through which to process what happened to them, consent is similarly cloudy. Again, regardless of the legalities involved, I believe that filming someone in an advanced state of intoxication is unethical. Such interviewees can't properly weigh the long-term consequences of their decisions because of substance-induced inhibition of the Prefrontal Cortex (PFC) and other areas of the brain responsible for risk-weighing, planning, and executive decision-making. Moreover, the stakes of their decisions are raised because their intoxication makes them more likely to divulge sensitive information about themselves and their families and to use language that is less cautious than their typical language. Anyone who has ever drunk dialed can imagine the potential mortification involved in having a recording of their conversation broadcast to millions via the Internet. Now, if all of Mark's subjects are properly apprised of the scope of their interviews and of how the footage of them will be used in advance of the interviews, under conditions in which they can make an unpressured decision with a clear mind, then the attendant problems with consent are largely obviated. It's hard to imagine that this is true, though, given their highly chaotic lives. It's tough to know exactly where things stand because - to my knowledge - Mark has never addressed the subject of consent. He has mentioned that he will take down any interviews that interviewees request that he remove. As we all know, however, once the materials are published, they are online forever. Given how young some of his interviewees are and how negatively their discussions of trauma and mental illness are likely to be viewed by potential employers, landlords, and other people who might have power over them in the future, the lifelong ramifications of their decisions to participate in the project should not be discounted. I suspect that Mark would respond to these concerns by emphasizing the importance of bringing what is in the dark into the light, so to speak. I agree that it is imperative to expose the grisly realities of addiction, prostitution, and other social problems. But the end cannot justify the means in these circumstances, when real, already pain-laden lives hang in the balance. It is frighteningly easy for me to imagine an interview subject, humiliated by his or her actions while intoxicated being viewed by millions of people, committing suicide in a moment of terrible clarity. On paper, Rebecca sounds like a Republican fever dream - an illegal immigrant / transgender woman / addicted to meth / arrested for public indecency. In the course of several interviews with Mark, however, Rebecca emerges as stunningly charismatic, a beautiful, creative, comical person who quotes classic movies and spouts old-soul thoughts. If you want insight into what raw, unfettered mental illness looks like, I'd highly recommend checking out Mark's interviews with her. THE MONEY, HONEY Mark Laita has used GoFundMe to raise hundreds of thousands of dollars for the subjects of his videos. Some of these campaigns specify the recipients and intended use of the funds (e.g., this fundraiser for a house for the Whittakers). Others are general campaigns without specific intended recipients or uses, disbursements from which are not ever accounted for by Mark. In the description of one such GoFundMe, which has currently raised $48,684, Mark notes that the funds are used for: "providing housing for the homeless, especially those caring for children, transportation to go visit their children, providing food, clothing and tents for those living on the streets as well as rehab and therapy when enough funds are specifically targeted for a certain individual*" *Donors can specify which interviewee they intend to help, though no proof of how much money has been raised for or disbursed to a given interviewee is provided. Contrary to some commentators' assertions, I don't believe that Mark is skimming funds or doing anything that he believes to be unethical; he just doesn't read as that kind of guy to me. Furthermore - unless he suffers from a hidden, high-stakes gambling addiction or favors ultra-high-end escorts of the type that he occasionally interviews - he's not under financial duress. If anything, Mark strikes me as too ingenuous. This became apparent when a prostitute who he had interviewed extracted increasing sums of money from Mark, ostensibly to escape her dangerous situation; she later admitted that it was in fact her "boyfriend" (almost certainly her pimp, who was facing murder charges) requesting and using these funds. In this case, it became clear that Mark's "help" actually furthered human trafficking and trapped this young woman in a highly dangerous situation. (Several interviewees have passed away of overdose or other causes, and some have allegedly vanished, so the risks involved in these situations are very real). There have been a few moments that made me question whether Mark has a Christ complex of sorts, which under the wrong stars can be as dangerous as malicious intentions. Mark unilaterally makes the decisions about how the raised funds are disbursed. If I were him, I would have long since put together a "Board of Directors" consisting of social workers, mental health clinicians, perhaps a lawyer and a venture capital consultant (to advise about microloans for small business startups). Two or three former interviewees to round the group out would probably be a good addition, as well. As nonprofits that offer direct aid to vulnerable populations universally recognize, having one person control how charitable funds are used is a recipe for disaster. Personal biases, conscious or implicit, run rampant without feedback from other parties. Although Mark consults with doctors, lawyers, and other professionals whose services his interviewees are in need of, he vets these contacts himself and mediates the interactions between his interviewees and these third parties. At times, this comes across as an uncomfortable level of involvement. The fact that Mark provides no public, consistent accounting of how the funds that he raises are used heightens my concerns about him being in a position of too much influence over vulnerable people. In the case of the Whittakers, for example, Mark announced that he would close their GoFundMe and stop filming videos with them after a member of the family made a comment to another YouTuber suggesting financial impropriety on Mark's part. The level of disruption caused by this abrupt withdrawal of Mark's aid, which cannot be overestimated in the case of such a poor and isolated family, didn't seem to occur to Mark (or if it did, to matter to him). This kind of knee-jerk, emotional reaction shows that Mark is too close to his subjects and too invested in his image to be objective in disbursing the substantial sums that his viewers contribute to improve his interviewees' lives. Mark's hubris in the case of the Whittakers is evident when he declares that "The Whittakers' lives have gotten so much better since I came into them...I'm kind and generous and helpful... " and so on as he decries their perceived betrayal. This is a dangerous attitude for someone in his position to have, and again, the extent to which he took Betty's comments personally is highly worrying. Screenshot from Mark Laita's "I'm Done With the Whittakers" video, which does appear to show him sending tens of thousands of dollars to Betty Whittaker. Mark states that he sent this money to Betty because she said that the family needed it for living expenses (even though the funds had been raised to buy the Whittakers a house). He also says that he withheld the taxes from the 100K+ that had been raised because he didn't necessarily trust the Whittakers to do that for themselves. CARNIVAL OF CRINGE Look, anyone who has conducted 7,000+ interviews is going to put his foot in his mouth a few times (for obvious reasons, your boy is particularly empathetic around this issue). There are times when Mark is indelicate, such as when he tells a young woman who is anorexic that "he has seen way skinnier girls than her" (when she gently chides him for this later on in the interview, he responds with "Seems like anything I say, you're going to take the wrong way" [paraphrase]). In one of his interviews with Rebecca, who identifies as a transgender woman and cross-dresses, he says, "Come on, you're not a woman." While Mark's candor is forgivable on account of his close relationships with some of his interviewees and his authenticity, there are moments in his interviews - particularly when he's discussing childhood sexual trauma and issues of comparable gravity - when it seems to me that it would be an asset to have a female co-interviewer who is a mental health professional. There are real concerns around re-traumatization of interviewees and how these depictions might lead young audience members to conceptualize their own trauma. In another worrying case, Mark platforms Kenny Red, a pimp, and his faithful "bottom b*tch" prostitute Martina. Though the two are immensely personable and even seem wise regarding some facets of human nature, their glorification of the despicable, dangerous, and deeply dehumanizing institution of street-level prostitution could put young viewers at risk. Mark gives them airtime without, for example, providing a warning that highlights the un-glamorous realities of sex trafficking - such as the facts that the average age of a prostitute in New York City and other areas is well under 18; that prostitutes are often beaten, branded, and forcibly addicted to drugs by their pimps; that pimps often initially present themselves as boyfriends, then later on coerce their victims into selling sex; and on and on. Likewise, the deeply likable and effervescently philosophical high-end escort Frenchie paints a picture of her profession that is dramatically at odds with the grim experiences of the vast majority of women who engage in prostitution. In such instances, Mark's interviewees elevate the deplorable, and he bears some responsibility for not providing grounding context for their stories. I have caught wind of a couple of other troubling accusations related to how Mark conducts Soft White Underbelly business. The YouTuber Tyler Oliveira, upon requesting the Whittakers' contact info from Mark, was allegedly told that Mark had contractual exclusivity in representing the family on social media. When Oliveira posted a video raising questions about what happened to the GoFundMe money raised for the family, Mark's response (detailed above) was very defensive. The YouTuber BJ Investigates allegedly faces legal action for concerns that she raised about Mark's interactions with interviewees on Soft White Underbelly. Finally and most concerningly, Mark has interviewed underage women, including a 13-year-old runaway named Nova. During her interview, Nova discussed her involvement in illegal activities such as prostitution; this caused me particular worry given that the approximate area in which she operates was mentioned in the video, as it often is on Soft White Underbelly. Interviewing a young woman in such dire straits without connecting her with a shelter, police officer, social worker, or someone else who could help to keep her safe seems downright irresponsible to me. The ability to consent to the lifelong consequences of publicizing her troubles at such a young age pops up again in this situation, as well. My immediate reaction to Nova's video was that no minor in such a situation should have their troubles broadcast to millions of potential predators over the Internet. FINAL THOUGHTS My views on religious groups that live apart from mainstream society, BDSM, nudism, and other subcultures have been enriched by viewing Mark's interviews. His beautiful, powerful portraits of the subjects of his videos bear witness to his commitment to respectfully documenting the lives of people who would otherwise be ignored, ridiculed, or forgotten. My gut feeling is that Mark Laita is sincere in his desire to help and responsible with the money that he raises. However, I also believe that his Soft White Underbelly project has taken off to such an extent that he now needs to implement infrastructure such as a Board of Directors to ensure safe and fair disbursement of funds and to help manage ethical issues such as consent. This is a "watch this space" topic for me, but I am hopeful that no further scandal or controversy will arise. I'm interested to hear what you all think about the ethics of interviewing addicts who are in active addiction, and I'd like to hear if anyone who follows the channel knows of additional examples of worrying content from Soft White Underbelly (please drop a comment below or message me). Though we're still in the early days, our community is growing faster than I had anticipated! Please remember to connect with me on Instagram, which will be ramping up in the next several weeks. Also, you're invited to subscribe to the Concrete Confessional mailing list, which you can join from our homepage, for access to our soon-to-launch Discord community and to receive a free copy of my Glossary of Opioid Addiction for Patients and Their Loved Ones later this year. As always, thanks for reading; it means the world to me. B.