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Screenshots that show the unethical and often illegal practice of body brokering, in which rehabs pay third-party agents to fill detox and treatment spots (those agents, in turn, often "break off" some of the money that they receive for the addicts themselves after they spend the agreed-upon amount of time in whatever facility they are placed in). I'll start with a Department of Justice notice about two brothers operating the treatment facility mentioned in the first set of screenshots below (Compass), who were convicted of multiple counts of fraud and other crimes (link here ). Here's a long quote from this article, which shows just how flagrant these operators were: "According to court documents and evidence presented at trial, Jonathan Markovich, 37, and his brother, Daniel Markovich, 33, both of Bal Harbour, conspired to and did unlawfully bill for approximately $112 million of addiction treatment services that were never rendered and/or were medically unnecessary, and that were procured through illegal kickbacks, at two addiction treatment facilities that they operated, Second Chance Detox LLC, dba Compass Detox (Compass Detox), an inpatient detox and residential facility, and WAR Network LLC (WAR), a related outpatient treatment program. Jonathan Markovich, who owned both facilities, was also convicted of bank fraud in connection with PPP loan applications in which he falsely stated that Compass Detox and WAR were not engaged in illegal conduct. The evidence showed that defendants obtained patients through patient recruiters who offered illegal kickbacks to patients (such as free airline tickets, illegal drugs, and cash payments) . The defendants then shuffled a core group of patients between Compass Detox and WAR to fraudulently bill for as much as possible. Patient recruiters gave patients illegal drugs prior to admission to Compass Detox  to ensure admittance for detox, which was the most expensive kind of treatment offered by the defendants’ facilities, therapy sessions were billed for but not regularly provided or attended, and excessive, medically unnecessary urinalysis drug tests were ordered. Compass Detox patients were given a so-called “Comfort Drink” to sedate them, and to keep them coming back. Patients were also given large and potentially harmful amounts of controlled substances, in addition to the “Comfort Drink,” to keep them compliant and docile, and to ensure they stayed at the facility. Certain patients were also routinely re-admitted and repeatedly cycled through Compass Detox and WAR to maximize revenue." *** When you love an addict and see their life endangered by their use, perhaps even lose contact with them for a while when they're on the street or on a bender, then learn that they're finally entering treatment, the relief is ineffable. Now they have a chance , you think. And most of the time, this is true. *** As I wrote about in " 9 Factors to Consider When Choosing an Inpatient Rehab ," selecting a facility that fits your needs plays an important role in treatment success. There are some facilities that are just plain rotten. In New York State, we are protected to some (limited) extent by the Office of Addiction Services and Supports (OASAS), which is fairly active as state addiction treatment regulators go; they have a helpline for people in treatment who feel that they are being abused, and they tend to take action (eventually) when enough complaints build up. In other areas of the US, however, and even in some circumstances in NYS, addiction treatment facilities essentially have carte blanche to abuse their clients. During my time in treatment, I've heard people told that, because their counselor could call their probation / parole officer and send them to jail or prison, they had essentially no rights in the treatment process. I've witnessed both male and female patients being sexually exploited. I've seen multiple patients getting treatment outside of their home state told that, if they chose to leave the facility they were being treated at, they would be left on the side of the road - even though the facility promised transportation to and from bus hubs, airports, etc. *** I wrote about my treatment at Palm Partners' facility in South Florida a couple of weeks ago (article here ). In terms of the quality of treatment provided, at least during the time that I was treated there, this was actually one of the better facilities in the Delray Beach area (which, during the for-profit rehab boom of the early- to mid-2010s earned the tagline "the recovery mecca of the US and the relapse mecca of the universe"). During my stay at Palm Partners, I was drug tested every single day for every drug under the sun. The drug tests included weird sh*t like kratom, Darvon, Demerol, quaaludes (are we stuck in the '70s?). Given that I was in inpatient treatment, which involves being closed off from the world and monitored 24/7, this was highly irregular, as was the fact that they were billing my insurance for GCMS - highly specific, confirmatory testing that is expensive and ordinarily only used after cheap screening tools like immunoglobulin drug tests first indicate a positive. As patients, we knew what this was about (cough: insurance fraud). Because every single urine or saliva sample is worth hundreds to thousands of dollars, these facilities either create in-house labs or develop kickback relationships with external testing facilities. And the racket, which is worth millions of dollars per year in drug testing profits alone, begins. A couple of years after I finished treatment at Palm Partners, I received notice that my treatment records were being subpoenaed in redacted form as part of a regulatory investigation of the facility. It eventually shut down, then rebranded as a weight-loss treatment center (probably because it had been forbidden from billing insurance after fraud was uncovered). *** Unfortunately, that kind of billing fraud is about the mildest sort of unethical behavior that shady treatment facilities engage in. During the boom of for-profit addiction treatment centers in South Florida and California during the 2010s, vast fortunes were made. I'm talking Tudor mansion, Rolls Royce with driver included money. (Or, because this was Florida, gaudy McMansion on a smelly canal with a former cheerleader / escort who is now your trophy wife money). The big-name treatment facilities branded the entire recovery process - from detox to drug testing to inpatient to sober living. They developed cult-like followings who swore that they owed their lives not to recovery, but to that specific program and the people who led it, who were treated as celebrity personalities. These facilities spent millions of dollars on marketing per year - stop and think about that; addiction treatment facilities spending literal millions of dollars recruiting clients - but the competition became so fierce that they had to resort to other methods. This is where body brokering entered the picture. Body brokers are third-party agents who receive fees for each addict that they place into detox and inpatient treatment. If you're thinking about this arrangement as someone who hasn't been on the inside of it, you might be wondering why the facilities don't just use their own marketers to recruit patients. It's a reasonable question that someone thinking ethically would consider. Unfortunately, many of these for-profit facilities are thinking exclusively about the bottom line. They need brokers out on the street mingling with the active addict population and trying to entice them into entering treatment. They need people who aren't bound by ethical or legal constraints, who can find addicts who don't necessarily want to get clean but are willing to pretend that they are for the right amount of money. These brokers, in turn, get a flat fee from the facility for every addict who spends a certain amount of time in whatever treatment center they are placed in. As you'll see in the subsequent screenshot, this often translates into frank exchanges boiling down to: "If you spend X days in Y treatment facility, I'll give you Z amount of cash for it." Because detox and inpatient are worth tens of thousands of dollars in (creatively billed) insurance payments for each short treatment episode, the addicts often decide that it's worth it to spend a few days in a comfortable detox facility if they get - in this example - a thousand dollars ("I'll give you a stack each once they walk in"). Addicts are sometimes offered cash and drugs to use before they enter detox, as well. In the following screenshots, you'll also see that Frankie, the body broker in question, has four addicts in a hotel room waiting to be shipped out to the promised treatment center. However, something has gone wrong (either he hasn't given the addicts the promised fee, he's changed the arrangement from what was agreed upon, etc.), and the addicts are trying to get out of it. The situation ignites into an argument about who promised who - and who owes whom - what. If you've been in the South Florida treatment world, then there's a good chance that you know who this Frankie (Francisco) scumbag is. He applied his craft with all of the subtly of a mob boss, and he's been exposed for illegal practices. Unfortunately, Frankie was just one of the more egregious examples of an exceedingly common phenomenon. Again, these body brokers are rogue agents. They aren't licensed, accredited, or supervised. There is almost no limit on what they can do or promise to do, and their actions are legally separate from the facilities that they funnel people into. Moreover, because they're individual agents, taking civil legal action against them is more complicated and less likely to result in a fruitful judgment than simply suing a facility. Now, you could argue that these facilities have an ethical responsibility to make sure that they're dealing with "recruiters" trained in addiction counseling, intervention specialists, etc., and to investigate claims of mistreatment by the brokers that they work with. That's because you're a good person. Most of these facilities don't give a sh*t about that. *** In any situation with such a skewed power dynamic, the weaker party stands a significant chance of getting taken advantage of. In the screenshots below, which involve another body broker in the South Florida area, the broker asks the addict who is helping him recruit other addicts whether she has a boyfriend (there are literally pages and pages of screenshots of flirty messages and requests for dates that went unanswered or were brushed off; the addict in question told the broker that "she had a man," and he kept on pressing the issue). So now this body brokering arrangement has devolved into a situation in which addicts are doing the work of the brokers by recruiting other addicts for treatment - and there is potentially sexual exploitation involved, as well. *** These screenshots were taken from a blog called B for Vendetta ( https://bforvendetta2.wordpress.com/ ), run by a friend of mine who was an addiction counselor in South Florida along with three compatriots. It was dedicated to exposing widespread abuse in the Florida for-profit treatment mill, and it created quite a stir when it was active in the late 2010s. It's written in an engaging, menacing style that is half V for Vendetta, half Jigsaw from Saw . The writers - who pretend to be a single personality - give exposed individuals / facilities a chance to confess to their crimes publicly or in court. I'm not claiming that every instance of abuse discussed in the blog unfolded exactly how the blog says that it did because these investigations are not my own, but I can vouch for the people who created the blog, who knew the South Florida treatment landscape from the inside, and I am confident that they were writing it for the right reasons. The blog also discusses unethical practices involved in the facilities' marketing, including paying public figures like recovered professional athletes as spokespeople despite the fact that they have no training in addiction treatment. It provides insight / opinions on drug testing policies, billing practices, professionalism of treatment staff, marijuana use policies, and other topics, too. One of my goals is to help elevate small, independent blogs written by active addicts or people in recovery. Unfortunately, writers like us are at a huge SEO disadvantage because the keywords that would help people find us are dominated by treatment facilities, news outlets, and insipid "recovery is amazing; buy my counseling classes or merch" accounts. Being on methadone, albeit on a taper, helps me in a sense because my toes are still in the waters of treatment. If you are reading this and are aware of widespread abuse on the part of a treatment facility, then get in touch using the Contact form here, on Instagram (concreteconfessional), or by emailing concreteconfessionalblg@gmail.com . *** In actionable terms, if you are reading this as a loved one of an addict or an addict him/herself, make sure that you don't ever deal with someone who is not directly attached to whatever treatment facility they are promising to help you get into . Beware of people who claim affiliation with multiple, separate treatment providers; they are almost certainly brokers. Ask detailed questions about their license / certification and their legal relationships with facilities. Be exceedingly careful of anyone who offers plane tickets if you agree to come to a certain facility; this is likely illegal and gives them incredible leverage once you show up for treatment because they know that you probably can't get back home on your own. Independent "body brokers" are never to be trusted. Every force that shapes their shady industry incentivizes unethical and often illegal practices. If you are aware of body brokers operating in your area, obtain screenshots and send them to your state's addiction treatment regulator (OASAS in New York State, for example). If they don't take action, your state's Attorney General's office is also a resource. If you aren't sure who to contact, gather your evidence and send it to me. Even if you don't believe that what you experienced at a treatment facility rises to the level of unethical or illegal abuse, leave a detailed, negative review online anywhere you can possibly put it. Include staff names, dates, specific incidents, and other useful information, and write it as succinctly and objectively as possible. *** There is a reckoning taking place throughout the U.S. right now as family and friends of addicts, as well as addicts themselves, are realizing that not all treatment is good treatment. We are being preyed upon by people who know that we are desperate to stay alive. I wouldn't want to be one of those people - even outside of my conscience's complaints - no matter how much money I was making. You are dealing with people at the end of their tethers, who are close to death anyway. Many have years in prison and inescapable, untenable debt hanging over their heads. At some point, someone is going to decide to make you pay regardless of the consequences. Love you all. Stay safe out there, B.

Reflections on the documentary Emma Wants to Live, which follows 18-year-old Dutch anorexic Emma during her final days. Discussion of the unity of mental illness as seen in the common features of addiction, Eating Disorders, and Obsessive-Compulsive Disorder. The documentary is available on YouTube here . In this scene, a staff member who is an ED survivor holds Emma as she takes one of her meals. As awful as it is to watch her do something that horrifies her so deeply, it is a beautiful moment; the staff member's love, which is so pure and gentle that it's almost holy, radiates through the screen. Emma Wants to Live is the most heartbreaking case study of mental illness that I've ever come across. I watched the documentary weeks ago, and I still can't get Emma out of my head. The juxtaposition of her face, wan and wasted far beyond her years, and her voice, which is rich and humorous and lively, haunts me. Emma Wants to Live is evidence of just how cruel, senseless, and ill-fated human life can be. Some of us are born with brains hell-bent on killing us, and the torture that our loved ones experience as they watch us destroy ourselves is a pain almost beyond reckoning. The film opens in the Netherlands, where Emma's picture-perfect, bourgeois family is completely at a loss when it comes to understanding her anorexia. Emma's Dutch doctors have washed their hands of her. She has been through the ringer of Eating Disorder treatment, been force-fed and then strapped down afterward so that she couldn't fidget away the calories. Her doctor says that she won't force Emma to eat again. Such a treatment, she notes, is only temporarily effective, and it destroys the doctor-patient bond. What this means, both Emma and her doctors tacitly understand, is that Emma is going to die. Emma contacts the Cegonha Clinic in Portugal, which is run by Peggy Claude-Pierre, a woman without medical training whose controversial ED treatment methods - based on unconditional love - got her run out of Canada but also purportedly cured her daughters' severe anorexia. The clinic agrees to take on Emma. "I think I might have pushed it too far this time, guys," she tells the close friends who accompany her to the airport. Her friends, too, are unable to comprehend why this popular, beautiful, big-dream girl is starving herself to death in front of them. It is the last time that Emma's family and friends will see her alive. After she arrives at the clinic in Portugal, the documentary captures footage of Emma's 24/7 obsession with calories. After so long without eating solids, she is only able to take in liquid meals. She insists that she be allowed to supervise the production of these nutrient-rich concoctions so that she can monitor the water temperature, the measuring of ingredients, the cleanliness of the process; above all else, she wants to make sure that no surreptitious sustenance finds its way into her meals. Emma takes her meals outside, surrounded by the bucolic beauty of the Portuguese hillside. She sits beneath a tree and "eats" while a fellow survivor of anorexia hugs her to help her cope with the awful anxiety that taking in nutrition produces in her. Depending on the day, it might take Emma several hours to get down a single, medium-sized liquid meal. This process is truly uncomfortable to watch - her body resists and resents every small muscular movement necessary to get the liquid into her mouth and then swallow it. Emma is sick with an infection that she can't fight off because she is immunocompromised essentially to the point of AIDS from extended lack of nutrition. She is direly underweight, fading fast. She makes endless "deals" with the staff about what she will and will not eat, forever striving to shave off a few more calories from her daily intake. The staff tell her in no uncertain terms that she is going to die if she doesn't eat more. Emma tries - she really fights, perhaps even valiantly - but she can't change quickly enough. Emma has a final, confused phone call with her father, during which she enlists his support for a small business venture that she is imagining in her future. On the last night of her life, the camera captures Emma trying to get warm underneath a blanket in the chair in which she sleeps. She stays upright, we are told, to try to keep herself from falling asleep - because you burn more calories awake then asleep, and if you fall asleep, you burn more calories in an upright position, which some of your muscles are activated to maintain. The image of this smart, soulful, skeletal girl holding her wasted frame upright so that she doesn't fall asleep and get the rest that might save her is so twisted that I can't find the right words for it. My impression is that it's not Emma holding herself rigidly upright or refusing to move the muscles necessary to swallow her shake; it's Anorexia. It's something deeply sick, a force from outside herself - almost demonic. Emma is surrounded by beatific survivors as she passes away. During a flash of lucidity shortly before she dies - right after she makes a comment that shows that she knows that she is slipping away - she reminds a staff member that it's time for her next meal. She knows she's going to die; she wants to try to eat it anyway. *** When loved ones of addicts are trying to get their heads around why addicts behave the way that we do - why we can't just "choose to stop," I tell them to think of addiction as a sort of intense Obsessive-Compulsive Disorder. As with OCD, there is rigid observance of a ritual (the ritual of drug use), without which the individual is unable to function. There is dreadful, disproportionate anxiety attached to the prospect of not observing the ritual, which is pursued even to the extreme detriment of the person suffering from the disease. There is constant preoccupation with small changes in internal state - how much of the drug has been taken; how much remains; when it will be gone from the addict's system. Eating Disorders have a similar undercurrent of obsession and panic. In the case of anorexia, the fixation is on "safe" foods and gastrointestinal purity, on monitoring caloric intake and physical changes down to the infinitesimal details. I make this connection between addiction and EDs / OCD for two reasons. Firstly, in the 21st century, psychiatry is beginning to understand that all mental illnesses are essentially a single illness manifesting along different axes related to internal and external function. The same handful of neurotransmitters and neural pathways are responsible for these conditions; their being out of whack in different areas of the brain is responsible for the varied presentations of the hundreds of recognized mental illnesses. (Not surprisingly, I should note, there is substantial comorbidity between EDs, OCD, and addiction, more evidence of a single "Grand Unifying Pathology" manifesting along a spectrum or spectra). This new conceptualization is already aiding in treatment of mental illness. When it comes to EDs, OCD, and addiction, for example, the focus is shifting from emphasis on the underlying diagnosis / pathology to the driving symptom (e.g., anxiety attached to performing or not performing a certain action) and tools to combat it (mindfulness exercises, DBT / CBT techniques, and other methods). Within this new paradigm, the anxiety is the critical part; what's causing it is of secondary, if any, importance. The second reason is that, as I've discussed elsewhere, much of the stigma around addiction stems from the belief that an addict could simply choose not to use.* *As I've written about extensively, this is emphatically, demonstrably not the case. The neural structures and pathways responsible for executive function, including the apparent capacity to make a decision to stop using, are damaged by addiction to the point that addicts essentially become automatons when it comes to procuring and using drugs. The using ritual becomes so ingrained that addicts sometimes dissociate during the process of obtaining and using their substance of choice, "waking up" at some point after it is ingested. When it comes to EDs and OCD, people intuitively understand that there is a point at which people cannot just choose to eat in a healthy way or to give up their rituals around cleanliness, safety, and so on. It's easier for people to comprehend that someone who can't leave their bathroom because it's the only "germ-free" area of their apartment, who loses their social life and their job and eventually even the bathroom itself because of their mental illness, is not doing so in a deliberately self-destructive way. Likewise with anorexics like Emma, who starve themselves to death. In my experience, people accept with relatively little resistance that these behaviors are not the result of simple choice. Probably because of the perception that we obtain something positive by using (i.e., the high from whatever drug we use), on the other hand, and partly because we can seem so "normal" when we're not heavily under the influence, addicts are judged to be people who could and should make a different choice but choose not to do so. We are viewed as dissolute rather than sick. The social, professional, and criminal ramifications of this view are devastating. The idea that we cannot choose to stop using seems to be exceedingly hard for some people to accept - perhaps, too, because their own use of substances is so easy for them to regulate. *** On the subject of free will more broadly, I have a longer piece on the topic of biological determinism outlined. For now, I'll just note that, in my view, it's not just addicts and ED / OCD sufferers who lack free will to change their behavior, and the absence of free will doesn't just apply to disease states, either. I'm a hard determinist, which means that I completely reject the notion of free will. Specifically, I'm a biological determinist, which in a nutshell means that my scientific understanding of how the brain works is incompatible with the existence of free will. If that sounds crazy to you, I understand why. It was an extremely difficult proposition for me to accept, too, and ultimately I did so only because I couldn't rebut the arguments in favor of it*/**. *One of my professors, Derk Pereboom, wrote a book called Living Without Free Will , which influenced my thinking on these topics great ly. **For a time, I hoped that quantum uncertainty might offer a way out. Unfortunately, however, this is not the case. If quantum uncertainty translated into uncertainty at the macroscopic level, then we wouldn't be able to use Newtonian physics to predict the path of a projectile based on launch angle, initial velocity, wind resistance, etc. - there would be unpredictable variations in path based on quantum probability distributions. The fact that we can predict trajectories with high precision is evidence that quantum uncertainty is confined to the atomic / subatomic level. Many of the most brilliant minds in human history have been hard determinists. David Hume and Immanuel Kant, arguably the two most influential philosophers in modern intellectual history, were both determinists (though Kant advocated soft, rather than hard, determinism). Spinoza, the co-developer of calculus, was a determinist, as well. In the twenty-first century, Stanford neuroscientist / primatologist Robert Sapolsky is one of the most brilliant adherents of the hard determinist view*. *I have a serious cognitive crush on this guy. I highly recommend his book Behave: The Biology of Humans at Our Best and Worst , which offers incredibly rich perspectives on human social behavior, from politics to romance to crime. I recommend this book to all of my AP Bio students because it presents a wonderful overview of cellular and systemic biology, with diagrams and other reference materials that summarize much of high school and introductory collegiate bio. Another objection that frequently comes into play is that "the Bible says" that we have free will. Suffice it to say that, if this matters to you, the Bible offers ample support for determinism (the Calvinist doctrine of predestination was one of the more coherent formulations of Christian determinism). Personally, I don't give a steaming sh*t what the Bible says on the matter. The essence of biological, or scientific, hard determinism is that - given full knowledge of an individual's genetics, their resultant neurophysiology, and relevant environmental influences - we can precisely predict their every word and action. In fact, we're already able to do so using real-time neuroimaging in specific situations involving relatively simple decision trees. When I'm teaching biological determinism, I begin with the premise that we are in control of all of our actions all of the time - which many people accept for their entire lives without ever questioning it. From there, let's begin with obvious instances of reduced free will. First, we'll take the case of a man called Phineas Gage (almost a legend at this point), who had a railroad spike driven into his brain, where it made contact with his amygdala, a midbrain structure that regulates fear and aggression. Afterward, this previously docile, amicable fellow became a complete psycho. I've never met someone who would say that this change was his fault; it's easy for people to grasp that such a drastic shift with such an obvious physical cause is outside of the person's control and responsibility.* *I believe I read that Phineas Gage did revert to a calmer character after some time, a testament to the brain's incredible plasticity. From there, we'll move to a smaller but even more destructive physical change: The deletion of several genes on the paternal copy of Chromosome 15, which results in a condition called Prader-Willi syndrome. Individuals with this condition feel insatiable hunger like something out of a Stephen King novel; they are so hungry that food must be locked away from them, and not infrequently, they die from choking or literally eating themselves to death in other ways. Anyone who has seen a patient with this disorder while they're eating knows that something is spectacularly awry with their biology and their mental functioning; again, it's not hard to understand that the choice to eat themselves to death is being made for them. What we came to understand in the 20th century is that all behavior can be affected by similar biological quirks and accidents, most of which are genetic or epigenetic changes that cannot be observed in the same way that a railroad spike can be - but are equally real and powerful nonetheless. We have identified alleles - variant stretches of DNA that code for proteins - associated with markedly, perhaps even exponentially increased tendencies to be violent, which manifest early on in life. In fact, Stanford Law School is already holding cross-disciplinary, medicolegal symposia to discuss how to adjust the way that the legal system works, as well as the terminology that it uses, to come to grips with the reality that science is revealing - namely, that people who commit crime are biologically determined to do so (or at the very least heavily predisposed to do so) because of the interaction of their genes with their environments. Lousy genes plus a rotten social background leads to a predisposition to crime that is looking less and less like a matter of making poor choices and more and more like a fait accompli incubated in the womb and sealed by early childhood environment. The thing is, even healthy behavior is determined by genes plus environment: We have identified allelic variants that predict prosocial behavior and qualities such as kindness, career success, and marital fidelity as well. If the mysterious, elusive free will exists, then the sphere within which it operates must be exceedingly niche; the cases in which it doesn't apply are increasing by the day. At present, none of modern science has unearthed any evidence in support of the existence of a transcendent faculty of free will. Granted, the illusion of free will is incredibly intense and persistent (though addiction has helped me to see past it and to realize how little control I have over some of my behavior). If you have a human being sit down and play a video game in which their inputs have absolutely no correlation with the program's outputs, they will consistently argue that there is a pattern that describes how their inputs are producing the program's outputs. They cannot accept that their actions have absolutely no effect on the system; they automatically impute causative power where there is none. What this says about the sheer ego of our species is something that I'd rather not dwell on. The idea that we can choose , can do otherwise, seems to be - as my Zoomer students would put it - a massive, longstanding, psychologically comforting cope. After the coping comes the seething, I am told, and seething seems to be the stage at which many religious, intellectual, and judicial authorities are currently stuck when it comes to the reality of determinism. As I mentioned above, I plan to return to the topic of hard determinism as it relates to addiction and give it a proper, more thorough treatment. For today, I just have these scattershot reflections on Emma, addiction / OCD / ED, and free will. I don't believe that Emma had free will, but I fervently hope that Emma is finally free. If you're interested in this kind of content and not totally sick of me already, you might consider checking out " The Selfish Genes That Prospered: The Evolution of Addiction " and " The More I See, the Less I Know: Three Flawed Models of Addiction ." As always, thanks for reading. Keep your heads up! B.

What you need to know about xylazine. a veterinary sedative being added to "tranq" dope throughout the United States. Beginning in the early 2000s, the veterinary anesthetic xylazine was detected in illegal drug supplies in Puerto Rico. From there, it spread to the East Coast of the United States, beginning in Philadelphia, where this so-called "tranq" dope attracted an ardent fan base. At present, xylazine has been found in fentanyl and heroin samples from throughout the continental United States. It is most prevalent in the South and Northeast. Drug Enforcement Agency statistics indicate that in 2022, 23% of seized fentanyl powder contained xylazine. As these DEA figures released in October 2022 indicate, xylazine was most often found in fentanyl samples seized in the Northeast and Southern United States. Its prevalence continues to increase nationwide. These data, released in October 2022, indicate that overdoses involving xylazine, the vast majority of which also involve fentanyl, are increasing throughout the continental United States, most dramatically in the Southern United States. From 2020 to 2021 in the South, the number of xylazine-positive fatal overdoses increased from 116 to 1,423 (a rise of over 1,100%). Fast Fact #1 - Xylazine is a Veterinary Tranquilizer Xylazine belongs to a group of chemicals known as phenothiazines. Significantly, this group of structurally related compounds also includes tricyclic antidepressants and the alpha-adrenergic agonist clonidine, a blood pressure regulator that is used to mitigate the Restless Legs Syndrome (RLS) and anxiety caused by opioid withdrawal. In veterinary medicine, xylazine is used as a surgical anesthetic for horses, rabbits, and other animals because it produces sedation, muscle relaxation, and analgesia (decreased pain). Possible medical uses of xylazine for humans were investigated, but its side effects, particularly bradycardia (slow heart rate) and hypotension (low blood pressure), were judged to be too severe. Fast Fact #2 - Xylazine Boosts the Effects of Fentanyl The vast majority of the xylazine available in the United States is combined with fentanyl in so-called "tranq" dope. When taken on its own, xylazine is unlikely to be particularly recreational.* However, when mixed with fentanyl, it increases the sedation, respiratory depression, and other effects of fentanyl. *During college, I injected veterinary xylazine; trip report available here . Previously, I wrote about xylazine hitting the dope supply in my home city in Upstate New York here . Mixing xylazine with fentanyl causes a "nod" that is much closer to anesthetized unconsciousness than to your average, in-and-out heroin or fentanyl high. Fast Fact #3 - Xylazine Increases the Chance and Severity of Overdose Because it increases the respiratory depression and low blood pressure caused by fentanyl, xylazine greatly increases the risk of OD. Because xylazine is not an opioid, Narcan [naloxone] is not effective in reversing xylazine overdose. However, Narcan should still be administered in cases of suspected OD because the majority of xylazine in the U.S. is sold in combination with illicit fentanyl powder and pills. There is no approved antidote or reversal agent for xylazine overdose; treatment consists of supportive care involving mechanical ventilation in an Intensive Care Unit (ICU). Fast Fact #4 - Xylazine Causes Skin Sores That Can Lead to Sepsis and Amputation For reasons that are not yet understood, in some users, xylazine causes widespread skin lesions that appear 24 to 48 hours after first use. These ulcers begin as pea- to penny-sized, semicircular lesions found on the arms, legs, face, and other areas (see pic below). They grow rapidly for as long as xylazine is ingested, and they have a tendency to become infected. Infection of the ulcers can lead to sepsis, in which bacteria spread to the blood, causing multi-organ-system damage and death. The rate of amputations is very high in xylazine users relative to users of fentanyl, heroin, and other illicit opioids not mixed with xylazine. Once the user stops ingesting xylazine, the ulcers gradually disappear over a period of days to weeks (so long as infection is resolved and they are kept clean to promote healing). However, the sores can cause significant, long-term scarring. Important note: These xylazine sores are not related to route of administration. They appear whether the xylazine is snorted, injected, or smoked. Sores from xylazine, which appeared 24-36 hours after my friend Mike ingested the drug (it was combined with fentanyl and procured in the Indianapolis, IN area). These are early-stage lesions; if you Google "xylazine sores," you will see arm and leg bones exposed because great tracts of tissue have been eaten away by the ulcers. Unless the user stops ingesting xylazine, the sores rapidly spread over the face, legs, arms, and other areas of the body. They enlarge until they extend over entire hands / feet / arms / legs. The sores frequently become infected, which can lead to sepsis, a disseminated infection in which bacteria enter the bloodstream and cause multi-organ-system damage and even death. There seems to be some genetic / immunological predisposition to developing the sores, perhaps akin to an allergy. Interestingly, people can begin reacting to xylazine in this manner even if they haven't developed sores after taking the drug in the past (this happened to Mike's girlfriend, who'd thought she was "immune" to developing them). Harm Reduction / Risk Mitigation Strategies If you are using fentanyl in the United States in 2024, it is very likely that at least some of the dope that you are snorting or injecting contains xylazine. It is imperative that you obtain test strips for xylazine, which are available for free from a variety of government divisions / agencies as well as nonprofit groups. In New York State, for example, the Office of Addiction Services and Supports (OASAS) will send you xylazine test strips for free (order form here ; Narcan [naloxone] and other harm reduction supplies are available as well). If you have recently ingested what you believe to be tranq dope and have even a single sore anywhere on your body, you need to go to a doctor and obtain a broad-spectrum antibiotic immediately. It is quite possible that life and limb depend upon it. Carpe Diem Before There Isn't Any Diem Left To Carpe The wave of fatal xylazine-fentanyl overdoses that the U.S. is currently experiencing is reminiscent of the period in 2015-2016 when fentanyl began replacing heroin in the U.S. illicit opioid supply, as a result of which addicts were dropping like flies. There has never been a better time to get clean and sober - while you still have all four limbs and haven't sustained severe brain damage from an OD! Use the resources below to find a 12-Step meeting and / or an opioid maintenance treatment provider. As always, feel free to use the "Contact" form or Instagram (concreteconfessional) to reach me with questions. Buprenorphine and Methadone Provider Directories Find a Sublocade treatment provider (injectable buprenorphine) *Brixadi is another injectable formulation that you might want to look into SAMSHA's Buprenorphine Treatment Practitioner Locator *In certain states, you might be able to obtain buprenorphine by e-consultation. I recommend avoiding this whenever possible because A) these doctors tend to be more expensive, and B) I have heard about too much sketchiness tied to these providers. Very few ethical clinicians are willing to dole out buprenorphine without seeing you face-to-face and drug testing you randomly. Zubsolv find a doctor (sublingual buprenorphine) SAMHSA Opioid Treatment Program Directory *Includes methadone clinic listings 12-Step Meetings (Alcoholics Anonymous [AA] and Narcotics Anonymous [NA]) Intherooms.com  has daily, digital meetings at many different times and with different foci / themes 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).  Intherooms.com has a meeting directory, as well. Alternatively, you can call your state's addiction treatment division for help finding 12-Step and SMART Recovery meetings. In New York State, the Office of Addiction Services and Supports (OASAS) has a helpline that will help you to connect with treatment resources ( 1-877-8-HOPENY). Stay safe and keep your heads up!

Dedicated to my friend Zack B., who passed away in 2020. I’m so tired but I can’t sleep Standin’ on the edge of something much too deep It’s funny how we feel so much but we cannot say a word Though we are screaming inside oh we can’t be heard I will remember you Will you remember me? Don’t let your life pass you by Weep not for the memories "I Will Remember You," by Sarah Mclachlan I always say that if you need to fall in love with humanity all over again, check into rehab. The courage, the camaraderie, the charisma. Watching people who have spent years running from pain, trauma, and their own bad decisions go head-to-head with the bullet train of reality as they try to turn things around, some of them discovering unexpected hope and some reconciling themselves with the ways in which it's too late. I met Zack B. in rehab in Delray Beach, Florida, a balmy city in Palm Beach County on the state's southeastern coast. This was during the for-profit rehab boom of the 2010s, during which Delray Beach became known as the "recovery mecca of the U.S. and the relapse mecca of the universe." It was a wild time. If you had decent insurance, you could call one of dozens of Florida treatment providers - there were in some in Jersey and California too - and they would pay for your plane ticket to Florida for treatment that very day. Their chirpy call center salespeople advertised bougie detoxes with low-carb food where you'd be stuffed until comfortable with Xanax bars and buprenorphine (in reality, these sketchy detoxes sometimes left people on the side of the road after failing to book them longer-term inpatient care). If you were inclined to relapse after your 30 to 60 days in inpatient and / or a few weeks to months in a halfway house or sober living environment, there were shady treatment providers that would quite literally give you money to relapse with so that they could then justify billing your insurance for a whole new treatment cycle. Everyone was in on the grift, it seemed. If you wanted to get clean, you could certainly do that, but if you weren't ready to get out yet, there was a place for you, too. These treatment providers were smooth operators; they knew how to keep parents and probation officers pacified. Zack was my roommate at a treatment center called Palm Partners, which offered apartment-style living arrangements on the grounds of a converted motel. The facility's common areas boasted tiki huts for outdoor meetings, a sand volleyball court, and other beachy amenities. The color scheme was Florida pastels, mauve and teal; what I think of as benzo colors. The clientele was mostly drug addicts in their 20s and 30s, and - although the facility was later shut down amid allegations of billing fraud, if I remember correctly - I actually think that it offered a strong program. Although most of us were opioid addicts, due to a quirk of Florida rehab regulations, there was no buprenorphine or methadone maintenance available. Instead, the facility's philosophy relied on copious gabapentin and the healing effects of plenty of exercise, sun, and healthy food. In addition to the core treatment activities, we had wake-up sober raves / sobriety hype sessions, sweat lodges, Kundalini yoga practice. There was a focus on positive psychology, setting and achieving life objectives, and social connection* that I've found totally absent in other treatment programs, especially those that are focused on the 12-Step philosophy, which can tend toward the austere and moralistic. *It was the strong social nature of the experience that really helped so many people to get and stay clean, I'm convinced. As British journalist Johann Zari notes , "The opposite of addiction is connection." Almost all of the patients at Palm Partners were transplants from other states, and most of them stayed on in halfway house or sober living programs after 30 days of inpatient rehab (60 if you were from New Jersey, as the joke-that-wasn't-quite-a-joke went). People got jobs, cars, apartments. They continued their 12-Step involvement together; became close friends; dated. There was real, continuing recovery community around Palm Partners and this area of Florida in general, which is almost impossible to find as a young opioid addict elsewhere because the recovery rates are so low. So, strong program. Unfortunately, due to the high concentration of taut, glistening, scantily clad young bodies, keeping the male and female patients from becoming too friendly took up a good quarter of each day. In fact, the facility's no-fraternization policy was so enthusiastically enforced that it inspired our motto for it: "Palm Partners: Where your palm is your partner, and your finger is your best friend." *** I'm not going to say too much about Zack because I know that the video speaks for itself. Zack was a shining human. He was my roommate for most of my stay at Palm Partners, and - as he was a few years older than me and had been at the facility for longer - somewhat of a rehab big brother. He was the quintessential Florida surfer guy: Laid back, funny, mischievous. He knew when to poke fun at authority without detracting from what we were there to accomplish recovery-wise. Zack's kind of chill wasn't a result of being checked out, either. Rather, his cool was his contribution - something that put other people at ease and balanced out stronger personalities among the patients and staff. He was a prime example of a totally sane, balanced, popular person who became an addict after being overinvolved in partying as a young person. (I'm not saying that he didn't have family history of addiction or his own psychological challenges, but compared to someone like me, Zack just seemed so normal, so unneurotic outside of his addiction problems). Zack's health had already begun to decline by the time that I met him. Like 90% of IV drug addicts, he had viral hepatitis, and the toll on his liver was starting to age him. I remember one conversation we had while laying on our twin beds as early-morning Florida rain thumped down outside. Zack described how shooting dope had begun to hit him differently in the past few months, especially in terms of the mental effects. "It's started to make me delirious, almost." He described driving home on the freeway one night after shooting up. Apropos of nothing, he began freestyling nonsensical, vaguely rhyming phrases. "I'm going crazy. Like, I'm actually starting to lose my mind," Zack realized that night. He continued head-bopping to the nonexistent soundtrack, nonetheless. This kind of story is why I hate when loved ones of mentally ill people say things like "he's not there anymore" or "he's not himself" or "there's nothing left." Most of the time, this is a total cope on the part of people who don't want to confront the much more frightening, painful truth: That at least some of the time, their loved one knows exactly what is happening; that they are the same old person trapped inside an existence (no longer a life) that has become nothing less than a waking nightmare. As I mentioned above, life after discharge from inpatient rehab was a golden time for many Palm Partners treatment grads. Free from the exhausting, impossible-to-satisfy demands of active addiction and the equally limiting restraints of being the black sheep of their families and hometowns, they became the young, free, responsibly irresponsible twenty- and thirty-somethings that they had always been meant to be. Many sustained over a year of clean and sober time. Several became counselors and began working in the treatment field. At least two couples got married. Eventually, they began to migrate to other parts of the country on all sorts of errands - cheaper cost-of-living, work opportunities, being near to family and friends again. Because I didn't stay in Florida after my weeks of inpatient treatment at Palm Partners, I missed out on the months of early-sobriety hijinks that Zack and my other friend, Mike (Zack's best friend), had in the halfway house that they stayed in after leaving Palm Partners.* *Mike was clean and sober for years after finishing at Palm Partners; he became very involved in the 12-Step community and was certified as a counselor. Right now, he's in Indianapolis - relapsed, death camp skinny, and covered head-to-toe in ulcers from xylazine (tranq dope), which I wrote about in this post  and will be covering again in a fact sheet / emergency announcement coming later this week. I am direly afraid that I am about to lose another friend, and I'm trying to help him in any way that I can at the moment. Zack and I kept in touch via Facebook. I know that he had a solid year-plus of recovery, that he moved to California, that he began struggling again. I don't remember when we spoke for the last time or what we said during our final conversation. *** Mike sent me this video of Zack at the same time that he informed me that Zack had died of an overdose in 2020. Mike had met Zack's mom while he was in the halfway house with Zack. Mike let me know that, around Christmas and Zack's birthday each year, he still communicates with her to share music and memories. This kind of relationship is a common experience among addicts who have lost friends to OD. One day about six months after he died from an overdose, a former friend / hookup of mine, another Mike (this one from my hometown), messaged me on Facebook. It turned out that it was Mike's mom, who I had met once very briefly while he was still alive. Over the coming weeks, we occasionally chatted through his account - about Mike, about me, about life in all of the sh*ttiness that we wouldn't trade for anything. I can't imagine what it feels like to see someone else's child taking themselves away from their family in the same agonizing, permanent way that your child took himself away from you. There is a passage from I-don't-remember-where, which I shared with Mike's mom. In it, the mother of a departed child arrives at the gates of Heaven, where she notices two long lines of women waiting at the gates. One line, she discovers, is for mothers who have lost a child, and the other for those who haven't. It's the thing that matters most to a mother, the fundamental division. I won't know the pain of losing a son or a daughter, but I've lost more friends than almost anyone else my age. Out of a group of four roommates from another rehab that I was in, I'm the only guy who is still alive. It's hard to grok that every single one of the guys who I shared months' worth of daily life with was gone from this world forever within 18 months of us leaving the facility. You don't process or make peace with grief on that level. Loss like that becomes a part of you. I'm not even sure that I identified what I was feeling as grief or even sadness. I remember that, for a time after losing Micah and Kris, I became a genuinely angry person for the first time in my life. I had always hated that my mom and dad yelled so much when I was growing up. Nevertheless, I found myself filled with rage and acting out in similar ways. I became physically violent in the sense of breaking objects and looking for occasions to get into "justifiable" fistfights. I sometimes think that I have more in common psychologically with soldiers and denizens of war-torn republics than I do with most of the Americans around me. May they never, ever be made to realize how good they have it. The thing that brings me a little peace is remembering the smiles, the laughs. The hugs, the pranks; the confessions, the apologies. The night when the staff forbid us from congregating outside to celebrate New Year's at midnight, so I declared that we would celebrate a San Fran New Year's at 9 p.m. instead. (It was two days until any of us realized that we should've picked a time zone in the other direction). The time when my group's Gingerbread Baby Jesus came in second place in a Christmas decorating contest*, after which I was butthurt for half a day. *Due to nepotism influencing the counselors who voted for Number 1, of course. None of us could ever sleep, so there was always someone else up in the middle of the night to talk to. So much artistic talent: Every day a fresh sketch, a new story, an impromptu performance. Hidden talents revealed when cars broke down, wiring went crazy, somebody needed stitches. Relapse, too, as a group enterprise. Seeing the darker side of all of these people who I had met at their best. Them seeing my dark side, too, and continuing to love me anyway. Hatching bigger dreams than many people could even conceive of. Just so much condensed life, mainlined humanity. The good times. The close times. The clean times. For each of my friends who is gone, I have a mental montage of video like this clip of Zack. I try very hard to remember how lucky I am to have known such people at all.

Tips on managing the physical and psychological effects of tapering from someone who has weaned off of both opioids and benzodiazepines. In Harper Lee's novel To Kill a Mockingbird , which tells the story of a racially charged criminal trial in mid-twentieth-century Alabama, Jem destroys the flowers of a judgmental, elderly neighbor named Mrs. Dubose and is then tasked with reading to her until she falls asleep at a slightly later time each day. Jem doesn't discover until after her death that Mrs. Dubose was terminally ill and determined to leave the Earth "beholden to nothing and nobody"; she had been using Jem's reading sessions to distract her from the pain of morphine withdrawal. She sends Jem a white camellia from her garden, a scene that stayed with me even though I read the novel when I was too young to appreciate anything of addiction. Atticus Finch, the lawyer representing the African American defendant in the trial, calls Mrs. Dubose the bravest woman he knew. "Quitting smoking is easy... I've done it hundreds of times." Mark Twain (Samuel L. Clemens) Contrary to what Mr. Twain had to say about quitting nicotine, there is nothing easy about tapering off of addictive depressants like opioids (hydrocodone, oxycodone, fentanyl, morphine, and other painkillers). In fact, getting off of these drugs once you've become physically dependent upon them is one of the most difficult things that a human being can do. It's also one of the most freeing, resilience-building ones, and it will improve your mental and physical condition more than you can possibly appreciate at present. I call tapering the "boot camp" of recovery because succeeding in it requires the same skills that you will need to maintain your mental health afterward, especially if you have become addicted to your medication. It demands rigorous planning and intention-setting, but your taper must be flexible enough to allow listening to your mind and body as it progresses so that you can adjust accordingly. You will likely require comfort meds, but you will also need the discipline to use them sparingly. You will become proficient in being uncomfortable, in reframing the physical and mental side effects of decreasing your dose so that they don't become overwhelming. You will probably benefit from the support of a community of some type, and you will need to learn how to stay active and invested even when you're feeling lousy. As much as anything, you'll need to be gentle with yourself, to forgive and reward yourself. Before we start: If you're wondering whether your use of prescription benzos or opioids is problematic, check out my 8 Signs That You're Becoming Addicted to a Controlled Substance Prescription. If you're wondering where to get the comfort meds referenced below and how to use them, consult my At-Home Opioid Detox Protocol , which also contains tips for intention-setting and managing difficult withdrawal symptoms. The information contained here isn't meant to substitute for a doctor's advice. It's always best to consult with a medical professional before and during a taper if that is possible. Sometimes, it might be necessary to switch from a short-acting opioid to a longer-acting medication like buprenorphine (Suboxone) or methadone in order to prevent big spikes and dips in blood levels during your taper; a smooth, gradual reduction using a medication with a longer half-life is often best. Similarly, if you're going off of benzos, you might need to change to a longer-half-life benzo like clonazepam, chlordiazepoxide (Librium) or diazepam. All the tips discussed here also apply to tapering off of benzodiazepines, but there is an additional risk involved in that process because benzos cause withdrawal seizures that can lead to permanent brain damage or even kill you. You can obtain a copy of revolutionary British psychopharmacologist Heather Ashton's benzo withdrawal guide here ; it is unquestionably the best resource for understanding how tapering from benzos works and planning your weaning process. With all that preliminary stuff taken care of, let's dive right into it! Tip #1 - Go Slow "Low and slow," meaning implementing gradual decreases before ending your taper at a very low final dosage, is the golden rule of tapering. If your body doesn't have enough time to adjust after each decrease, your withdrawal symptoms are going to accumulate, and before you know it, you'll be so sick that it's going to be necessary to increase your dose to remain functional. For this reason, you must stick to incremental decreases of no more than 5% or 10% of your current dose, and you must give your body enough time to fully adjust in between dosage drops - a process that can take from five days to two weeks, depending on whether you're tapering with buprenorphine, methadone, or another agent. When you approach the final quarter of your taper, you are likely to find that your body needs even smaller decreases and that they need to be spaced out further than at the beginning of your taper. A successful taper has a long, low-dosage "tail" at the end. If you do it properly, you might find that your body hardly notices when you make the final drop from a very low dosage to taking nothing at all. Tip #2 - Go Low When I was first tapering off of Suboxone in the early 2010s, doctors told patients that they could taper down to two milligrams per day and then jump off with little to no withdrawal symptoms. We now know that this is utter BS, and the current wisdom is that ending your taper at a final dose of 250 to 500 micrograms (0.25 to 0.5 mgs) or less will result in a much smoother finish as well as a diminished risk of post-acute withdrawal symptoms (PAWS). This principal holds true for all tapers. The further down you go before you jump off, the closer your body will have come to returning to physiological baseline and the smoother your transition to taking no substance at all will be. Depending on whether you're tapering with methadone, buprenorphine, or another agent, you're likely going to have to get creative about reliably estimating smaller dosages. For example, with Suboxone (sublingual buprenorphine) strips, you can dissolve one two- or eight-milligram strip in a few milliliters of water, calculate the strength of the solution, and then dose by volume using an oral syringe (rather than trying to separate the strip into dozens of tiny, equal pieces, which is impossible). Similar techniques exist for any medication in any formulation. Drop a comment below or use the Contact form if you need help with this. Tip #3 - Rest Areas As discussed above, you shouldn't attempt a second dosage decrease until your body has adjusted fully to the first. Even beyond following this principle, however, it's good to incorporate a few extra plateaus or rest areas into your taper. Tapering is a mentally and physically arduous process, and being uncomfortable most or all of the time will grate on anyone. Insomnia takes its toll, too. I highly recommend that, at two or three points along your taper, you choose a strategic stretch - such as a busy time at work or a holiday period - and linger longer than usual at whatever dosage your body has become comfortable at. These breathers will restore your resilience and give your body time to deal with accumulated tension, discomfort, and exhaustion. Tip #4 - Rescue Doses Used properly as a tool of last resort, rescue doses can save a taper that would otherwise fail. Rescue dosing refers to taking an increased dose - perhaps increased by 50% or 75% of the dosage that you're currently at in your taper - for a single day when you become overwhelmed. Like rest breaks (Tip 3), they give your mind and body a valuable break from stress. However, using rescue doses in any but the most sparing way is playing with fire. Especially with such addictive drugs, it can be very difficult to limit rescue doses to just two or three occasions when you are truly struggling. If you use them too often, your body won't be getting the gradual decrease in drug dosage that it needs to taper off. The best way to manage this is to have someone else supervise your taper. It's good practice to have someone else hold onto whatever substance you're using to taper with, anyway - doubly so if you have addictive tendencies. At the start of your taper, explain to that person what rescue doses are and how often you plan to take them (no more than three to five times in the course of a taper that lasts several weeks to six months, is my advice). Explain that they're intended for when you're reaching the lower doses at the end of your taper and you're really at your breaking point. Ask their input when you think that you're ready to use one, and make sure to space them out sufficiently so that you're not setting your taper back or running out before the roughest, final stretch of the weaning process. Tip #5 - Comfort Meds As I explain in my At-Home Opioid Detox Protocol , it is typically necessary to use comfort meds to manage the physical and mental symptoms of withdrawal, including: Hydroxyzine (Atarax) for anxiety and insomnia Lofexidine and clonidine for Restless Leg Syndrome (RLS) and anxiety Gabapentin for nerve pain / overactivity and agitation / anxiety Immodium (loperamide) for diarrhea NSAIDs such as ibuprofen for aches and pains (avoid acetaminophen if you have Hepatitis C or another reason to suspect that your liver is damaged) All of these medications, as well as a couple of others, can be useful in benzo withdrawal, as well - though gabapentin must be used carefully because it can affect the seizure threshold. Insomnia is perhaps the most serious threat to an otherwise successful taper. It throws more people off than severe physical discomfort, in my experience. It will warp your thoughts and emotions until you do something impulsive that you'll later regret (such as giving up on your taper or taking a massive dose). Thus, it is crucial to get at least four or five hours of sleep per night. In addition to the meds listed above, Seroquel (quetiapine) is an antipsychotic that works well for insomnia for many people who are detoxing. I wouldn't recommend trazodone or antihistamines other than hydroxyzine, as they can leave you very uncomfortable and make RLS worse if you take them and don't fall asleep. I would not recommend taking a benzo or z-drug for opioid withdrawal unless you absolutely cannot avoid it and are sure that you will be able to take it in a limited way for a very limited time. Benzo withdrawal is worse than opioid withdrawal, lasts longer, and can actually kill you, and the risk of cross-addiction is just too high. Leave time for naps!* *"Lack of sleep never killed anybody," a sarcastic psych nurse who never knew how close she came to getting punched once reminded me when I was on day four of less than two hours of rest per day during withdrawal. That's not exactly true - there's a prion disease called Fatal Familial Insomnia that drives you insane and then kills you. Plus, on a more practical level, lack of sleep can lead to impulsive decisions that defeat your taper, and it can cause traffic accidents and other mishaps, as well. One final note: While it is foolhardy, in my opinion, to attempt to taper without using the comfort meds available to you (which help to decrease the strain on your mind and body), getting off of these drugs requires building up resistance to physical and mental discomfort. It's important to get away from the mentality of "I feel X uncomfortable symptom, so I need to take Y medicine immediately." Use these comfort meds respectfully, according to their dosage instructions; set limits on your use of them and stick to those limits. Oftentimes, if I'm feeling mild to moderate withdrawal symptoms, I'll set a timer for taking a comfort med. For example, "If I'm still feeling this anxious in two hours, I'll take a gabapentin"; "If I haven't fallen asleep by one a.m., I'll take Seroquel or hydroxyzine." Practicing using coping skills other than popping meds, which reinforces the addictive mindset and erodes your personal agency, is an essential part of surviving a taper. Tip #6 - Physical Exercise During the roughest parts of your taper, you will likely want to do nothing less than go out and get some exercise. However, it's imperative that you do just that. Exercise helps to rid your body of toxic byproducts of extended substance use. It accelerates healing from the damage caused by months or years of chemical dependence, and it releases feel-good neurotransmitters like endorphins, which you will need to compensate for the loss of the cheap, easy lift provided by mind-altering drugs. Taking a hot shower after a long run has been the wellbeing high point of many of my methadone taper days. Tip #7 - Tools from Therapy If you haven't ever engaged in therapy, tapering is a great time to start. If you have learned some tools from Cognitive Behavioral Therapy (CBT) or Dialectical Behavioral Therapy (DBT), now is the time to cling to them like you're Rose and they're the floating door during the final scene of Titantic. During my benzo taper, I had to keep reframing my anxiety - to remind myself that fear and excitement are almost indistinguishable neurologically, and that what I was interpreting as overload was really just my body and mind waking up after a really long time of being sedated. I learned to look at these hypomania-like symptoms as similar to the come-up from MDMA or another stimulant drug and to appreciate the energy and creative ambition that came with them. DBT is the set of tools that you want for your taper. It includes physiologic hacks for dealing with out-of-control anxiety, such as immersing your face in ice-cold water. It emphasizes radical acceptance of mind-body state and employs mindfulness techniques that will allow you to inhabit your radically-accepted mind and body without going crazy during this time of tumult. Although working with a trained therapist is the gold standard option, you can learn many CBT and DBT skills through workbooks and YouTube videos available for free online. If you're not sure where to start, I wrote an article called Four Key Questions to Ask Yourself Before You Book Your First Therapy Appointment to help you determine what therapeutic approach will suit you best. Tip #8 - Journaling I highly recommend buying a journal before you start your taper and setting aside at least 10 minutes a day to write in it about how things are going. This is an excellent way to take stock of your overall progress. When you're having a particularly rough day, it's great to be able to look back to see how far you've come. During the first day or two of your taper, I'd make a list of your reasons for getting off of whatever drug you're tapering off of. Looking back at this list later on is a great way to remind yourself of why you're doing what you're doing. During particularly difficult dose decreases, sometimes I'll write a detailed description of how liberating it's going to feel to be completely off of methadone. I'll list all of the things that I hate about being dependent on an opioid - especially that constant, back-of-the-mind monitoring of long it's been since you've taken the medication and how long it will be until your physical withdrawal becomes noticeable again. I call recovery happiness without a half-life ™ , and I use my journal to remind myself of why I'm enduring this discomfort. For many creative people, tapering is a time of enhanced verve. One of my heroes, the rock goddess Stevie Nicks of Fleetwood Mac , talks about how the month that she spent in the hospital getting off of the benzo Klonopin (clonazepam) was like "being pushed through the door into hell" (paraphrased). However, she also spoke about how this was an immensely creative period for her. Even if you're not an artist in the professional sense, there is great joy and healing in creating beauty through art, music, or writing. This is a great time to pick up a new hobby. If you're not feeling up to joining a group, then maybe pick up a book of mandalas and color at home for an hour or two. In general, distraction is three-fifths of the law as far as tapering goes. You'd be shocked by how much your physical and mental discomfort abate when you get absorbed into an interesting book, show, or project. Tip #9 - Avoid the Pitfalls You would not believe how many people become alcoholics during the tapering process. Alcohol dehydrates you and depletes key nutrients; it destroys quality sleep and increases anxiety. It burdens your liver and poisons your nervous system. You will become physically dependent on alcohol more quickly if you start drinking while you're coming off of benzos or opioids. Please don't touch it during your taper. It's probably the worst thing that you can do for your healing mind and body. If you absolutely "need" some form of chemical escape, then marijuana is probably the least harmful option. For many reasons, I wouldn't recommend it, though. You should also be on the lookout for your brain finding creative tricks to get its dopamine fix in other ways. Be alert so that you don't fall into impulsive / compulsive patterns when it comes to sex, food, and gambling, as well. Be on the lookout for signs of excess rigidity in general, even when it comes to healthy things like exercise and cleaning / studying / work. They can be signs of a "dry drunk" mentality emerging, which all addicts / alcoholics are at risk of following cessation of their drug of choice. The key to recovery is letting go of the need to control and the locked-in rigidity of addictive behaviors. We need to learn to be fluid, to live "life on life's terms." It's an auspicious time to seek some spiritual development, if that's something that you're interested in. It's also a wonderful time to find fellowship and to reach out to other people who are struggling ( AA Etiquette: What To Know Before You Hit Your First 12-Step Meeting contains instructions for finding nearby Alcoholics Anonymous and Narcotics Anonymous meetings [at bottom of article]). Tip #10 - Reward Yourself You are doing something that is frightening, difficult, and incredible. Take time to celebrate your progress and to reward yourself. I'm the stereotypical opioid addict sugar fiend, so Dutch apple pies and tiramisu are how I tell myself thank you from the future me. For moms / dads, busy professionals, and anyone else who doesn't want to end up with diabetes, incorporating an extra hour or two of free time / downtime into your schedule can feel nearly as good. At the end of your taper, consider a substantial purchase, a short trip, or a get-together. Anyone who has tapered off of one of these drugs deserves it. Period. Fin Feel free to use the comments section and the Contact form to ask specific questions about taper timelines, comfort meds, and other topics. Don't forget to join me on Instagram (concreteconfessional)! It's usually easiest to message back and forth there if a longer conversation is necessary. Lastly, to anyone who is even thinking about getting off of benzos or opioids: I am so proud of you, and I will support you in any way that I can. I have heard from several readers who used the resources on this site to aid in their withdrawal from buprenorphine, oxycodone, and other drugs, at least two of whom are over 90 days clean at present. Checking in with them and hearing about their progress is a greater reward than I could've imagined at the start of this blog project. Stay well (or at least alive), B.

A critical review of Matt Cullen's YouTube series Our Queer Life , which interviews LGBT sex workers, entertainers, Mormons, cowboys, prisoners, and more. The new LGBTQ pride flag, which has pink and blue arrows to represent the trans community and brown and black stripes to represent queer people of color. Whoever designed this flag should be shot twice. In the words of my older brother, it looks the flag of some African banana republic that will only be on the map for 10 or 20 years. Writers dwell on how to reveal their characters through the details of their dress, their speech, their mannerisms. In the case of Matt Cullen, the self-styled " freelance documentarian and journalist with [the] queer digital docu-series 'Our Queer Life'," such a moment arrives not during an interview with a human, but during an encounter with a hateful cat. Matt is in the projects of New York City to interview a trans woman, who advises him that her cat is "a little hood." The cat hisses in Matt's direction and makes her intention to maul him known. Using what I call a gay shopkeeper's voice - a strange combo of camp, condescending, and wheedling - Matt responds, "Oh my God, she's adorable." "So cute," he says again as the cat continues to aggress him and her owner looks on bemusedly. "Adorable," Matt finishes as the cat is scooped up to save him. That's Matt Cullen for you: Even while he's being attacked, he's spouting insincere compliments; he seems constitutionally incapable of saying anything negative. Case in Point: Matt's Sex Worker Interviews The Escort Let's start with Matt's interviews with sex workers, who run the gamut from streetwalking prostitutes to higher-end escorts, porn actors / actresses, OnlyFans stars, and strippers. As I mention below, interviews with sex workers constitute a good chunk of the content on Matt's channel. One of the reasons that I refuse to consider Matt a journalist is that he doesn't perform background research on topics relevant to his interviewees' lives (at least, he never mentions it or indicates that it informs his views or approach); he presents no history or data to contextualize the experiences of his interviewees, ever. Let me start by saying what Matt, in the course of dozens of interviews with prostitutes, has failed to say: The world's oldest profession is also one of the most dangerous - up there with underwater welding and being a soldier on active duty in a combat zone. At least 60-75% of prostitutes have been raped while on the job (and this figure likely represents an underreporting of true prevalence; basically, if you're a prostitute or escort, it is overwhelmingly likely that you will be sexually assaulted). The rates of (non-sexual) assault and murder are astronomically elevated for prostitutes, as well. At least 30% of female prostitutes are underage, and many of all ages are illegal immigrants with no recourse when they are abused. Further, a strong majority are addicted to drugs and alcohol. A significant percentage of prostitutes, especially female and trans feminine prostitutes, end up under the "protection" of pimps who often act like boyfriends initially, then force their girls to take drugs until they are addicted; demand all of the money that they earn so that they cannot escape; and routinely beat and torture them when they get "out of pocket." Although Matt's prostitute / escort interviewees all deny having pimps, this means nothing, as pimps carefully train the people that they are trafficking in how to lie so that the pimp doesn't risk legal trouble by getting dragged into a pandering case. Matt conducts dozens of interviews with prostitutes / escorts, and not once does he acknowledge the brutal, demeaning realities hinted at by these facts and figures. As a case in point, let's consider Matt's interview with a bisexual male escort who usually works in Omaha, Nebraska* (video link here ). *I'm choosing this interview because it is fairly recent, which means that Matt has had well over a year of similar interviews to build his knowledge base and hone his approach. Uh, this interview is titled "The TRUTH About Gay Escorting." And it is an absolute trainwreck. For the first seven or eight minutes, Matt nods along as his interviewee glorifies his profession - the easy money from tricks and his sugardaddy, who sometimes takes him horseback riding (face tattoos and equestrianism don't traditionally go together, but I don't know, I kind of like it). The escort celebrates the ease with which he manipulates such men as he reels them in and then pushes them away when they become too attached. When the escort compliments his own intelligence, we're treated to our first simpering Matt Cullen comment: "I think some of the smartest people are the people who are in the game because they're street smart." Right, Matt, the smartest people choose an illegal and incomparably dangerous profession that most quickly age out of, which leaves them with few skills to leverage and ruins most legitimate, longer-term employment prospects. Matt never pushes back at all. He never questions his interviewee about whether he has savings, retirement plans; never asks whether he has a drug problem or has been arrested. A little further into the interview, the escort confidently states that undercover cops must admit to being law enforcement officers if you ask them straight out whether they are police officers; this is a common bit of misinformation that is absolutely untrue in any jurisdiction in the United States, or, as far as I know, anywhere else in the world. Matt's face makes it clear that he knows this to be untrue, probably because he's talked to so many better-informed escorts. However, he doesn't challenge his interviewee, and he includes the clip in the finished video without any note correcting his interviewee. I can't count the number of occasions that Matt does something similar. It's evident at this point that he simply doesn't care about honest "documenting." He treats his interviewees with kiddie gloves, using an overly supportive model that lends credence to the typical conservative view that liberals are unable to confront harsh realities. Ironically, in failing to ask them more substantive questions, he disrespects his interviewees and creates surface-level, Public Relations-type footage that veers away from more powerful, meaningful treatment of the difficult topics that he touches upon. Nevertheless, the interview shows potential when the escort opens up about his family background. He mentions growing up in the hood and being relentlessly bullied for being feminine when he was younger. He describes living in a "warzone" with gangbanger parents whose house was shot up by rivals, as a result of which the escort and his two younger sisters had to move their mattresses to the ground. There is real pain and sadness in the escort as he describes his background, and he gives Matt a perfect opportunity for a strong follow-up question when he says that sometimes he "doesn't want to wake up." This is Matt's opportunity to break through the glib facade that the escort maintains throughout the first part of the interview, and not only does Matt fail to take it - he doesn't even seem to notice it coming and going. Instead, he lets his interviewee once again wax eloquent about easy money. When his client states that he can see four or five tricks a day, Matt helpfully notes that this is great, "especially because you're topping, so it's not like you're having to take it four to five times in a day," to which the escort cheerfully responds that sometimes, he doesn't have to have sex at all; recently, for example, he made 120 dollars by "p*ssing on two guys first thing in the morning." Sounds like a dream career, Matt. Can't imagine anything more fulfilling than my contribution to the world literally being my waste fluids. Hopefully, you're starting to see why I'm worried about what sort of picture Our Queer Life paints of the LGBT community. Again, I'm certainly not saying that voices such as this escort's don't deserve to be heard. But there is a way to conduct these interviews so that they are deep and dignified rather than scandalous, superficial, and disgusting. Many of the comments for this video were mocking the interviewee, and I'm not surprised. Matt has done nothing to bring out the pathos of his situation. At another point in the interview, the escort discusses tracking down a cokehead client who owes him money at his client's workplace, where he records their interaction on Instagram Live as he smashes a candle against the client's head. Matt nods and accepts this criminal anecdote as though it is the most natural thing in the world. At no point does Matt ask the escort about whether he feels guilty for taking advantage of broken, lonely men, some of whom are still closeted, many of whom were bullied just as the escort was. In fact, in over a dozen interviews with escorts, I've only heard Matt ask one question that even obliquely acknowledges the possibility that prostitutes and escorts might be doing something that is detrimental to the wellbeing of themselves and / or some of their clients. Matt's questions are toothless, and - while this may help him to secure interviews because his interviewees know that he won't ask tough questions - it drastically limits the integrity, value, and reach of his videos. After watching dozens of these interviews, I've come to the conclusion that Matt either: A) Doesn't have the chops to ask substantive, thoughtful questions B) Would rather cover salacious, superficial content because it's easier and gets more clicks Or both. The Madam The challenge of critiquing Matt's videos is that I could write 100,000 words about how fawning and frivolous they are. Suffice it to say that the problems with Matt's approach extend to all of his interviews, not just to those with sex workers. During an interview with a madam who runs the Mustang Ranch brothel in Nevada, for example, Matt takes every single statement from her about her brothel's cleanliness, safety, and work environment at face value. These brothels tend to be fraught environments, with rampant drug and alcohol use; vicious competition between prostitutes; and restrictive rules that often prohibit the women from leaving the establishment unaccompanied (or sometimes at all during the stretches when they are working because hygiene laws require them to be retested for STDs if they leave the facility even for a short time). Worse, these brothels charge their prostitutes a fee for the rooms and hygiene supplies that they use and for food, STD testing, security, and other services. Unfortunately, during slow periods, even some of the more popular prostitutes can end up in the red to the tune of thousands of dollars. The brothels are also known to charge girls fines for small rules infractions and to use other shady tactics to chip away at their profits.* *If you want to hear a true high-end escort give a balanced account of her time at the Bunny Ranch and other Nevada sex-selling establishments, I recommend the Soft White Underbelly interview with Frenchie, the Hungarian-French-American vixen, who also did a No Jumpers podcast ; for my ethical critique of Mark Laita's Soft White Underbelly project, click here . All of this information is available to anyone with an Inernet connection, and yet Matt seems totally ignorant of it - again, willfully so. I say willfully so because Matt interviewed one Only Fans star who escorts independently, who explained that she no longer works out of brothels because of exactly the issues detailed above, including owing the brothel money due to its unfair financial practices. What kind of "journalist" ignores an opportunity to ask a brothel owner pointed questions about the abuses perpetrated against the prostitutes that he has interviewed? It's a follow-up dream. I suppose that Matt could be considered a documentarian in the weakest, most generous sense possible. However, even most documentarians who embrace subjective approaches acknowledge the need for background research and some attempt at a balanced representation that examines the problems attached to whatever is being documented. The Gay Bathhouse Owner In yet another botched interview, Matt speaks with the owner of a gay bathhouse in Nevada, a Chinese-American man who recounts how the bathhouses of San Francisco helped him to come to terms with his own sexuality after he moved to the U.S. for his work as an engineer. My pulse quickened a little bit when the subject turned from a tour of the venue to drug use among attendees; as I've written about elsewhere, chemsex in general and chemsex fueled by meth specifically is a gay plague, which is driving HIV infection rates back up after decades of decrease and facilitating the reemergence of drug-resistant strains of syphilis and other STDs. Matt is presented with an ideal opportunity to question the owner about his establishment's role in these problems. Instead, however, he simply accepts the bathhouse owner's position that if attendees are sober enough to fill out the ticket for their belongings, then they are sober enough to enter and have sex (since he can't "police them" any further than that). The two don't discuss whether or not protection is encouraged or required, and Matt certainly doesn't press the owner about whether providing a facility for anonymous, impersonal sex ultimately damages the people who engage in it - not to mention the public image of the LGBT community. Many gay men struggle with finding stable, long-term relationships with loyal partners, and the promiscuous, partygoer lifestyle facilitated by such establishments contributes to this. Once again, Matt turns away from any serious consideration of the soul-problems that our LGBT community faces. The Porn Star (aka Matt Gets Schooled, and It Is Glorious to Behold) Something amazing happens when Matt interviews TV-news-reporter-cum-porn-star* Dallas Steele, who was actually a journalist: Dallas Steele schools him on how an interview should be done. *I know that this is deeply uncool of me, but I wanted to make sure you don't miss the "cum" pun here. I have so few victories these days. As he describes his experience at the top of his chosen profession, Dallas Steele is careful to ballast his words with data about the grim realities of the porn industry as a whole. Steele notes, for example, that porn doesn't pay the bills for hardly anyone. Out of the thousands of active performers in the industry, he estimates that there are only about 40 performers in the entire world who make a living at it. Steele estimates that roughly 60 percent of male porn stars are escorts, while the other 40 percent have a vanilla job to supplement their meager income from shooting scenes, which most treat as free advertising for their escorting. Only 40 performers in the entire world make a living at porn. It's a shocking statistic that, incidentally, hasn't even been hinted at in any of Matt's other interviews with porn stars, which glorify their profession despite the fact that it regularly pushes performers' boundaries by pressuring them into demeaning, potentially unsafe situations. Steele further notes that porn stars don't receive residuals, which means that they are left with no long-term financial buffer after porn makes it nearly impossible for them to find decent-paying, "regular" work. Matt doesn't prompt any of these valuable disclosures, of course. He sits there in slack-jawed wonder as Dallas Steele essentially conducts a well-paced, rigorous interview with himself. At one point after Steele shares a story about meeting with an escorting client whose wife is dying of cancer, who gives her husband her blessing to explore his bisexuality with Steele, Matt gushes about how "meaningful, beautiful, impactful" his interviews with sex workers are because of the "healing" nature of the work. I've come to think of this sort of over-the-top, fawning language as "pulling a Cullen." I don't want to doubt Matt's sincerity without good evidence for doing so, but something about his manner when he says this sort of thing feels off to me. Perhaps it's because he never acknowledges the obvious other side of the coin - in this case, that many clients pay for escorts so that they can abuse and demean them in ways that they wouldn't feel comfortable treating unpaid partners. His skewed approach leaves the viewer wondering about his true, private thoughts on the matter. I hate to harp on this, but I would pay to watch a series in which Steele interviews everyone who Matt has interviewed. Steele, who was the second openly-gay TV reporter for the station that he worked for back in the day (the first died of AIDS) and who lost his first partner to a drug overdose, has been in a monogamous relationship for over a decade now; he's late-middle-aged but still in prime shape, with no sign of addiction or other mental or physical health problems. I'm willing to bet that series would cut to the heart of the problems facing 21st century America's LGBT community in an interesting, human way. I'm advancing this bad*ss avatar, who I created with GenCraft's free AI image generator, for use in next year's pride imagery. Gay-bashing would stop overnight. Branding: "Our" Queer Life It's not just individual interviews or topics that are the problem. Let's talk about the show's branding. I don't know about you, but when I hear the title "Our Queer Life," I expect an inclusive picture. I expect to hear from gay scientists, policemen, professors, construction workers. On the other side of the coin, I expect to hear from gay excons, escorts, addicts, pornographers. I hope to hear from interviewees whose lives color outside the lines, combining elements from both the socially acceptable and antisocial / rebellious categories. Many of the most brilliant members of our community walk these sorts of paths. Out of the first 42 videos featured on the "Latest" tab of the channel's YouTube page, 14 (33%) have to do with sex work, including street-level prostitution, brothel work, escorting, OnlyFans, and stripping. Another 5 of these videos (12%) have to do with prison, illegal activity such as black-market plastic surgery, and being gay in the mob. Imagine, for a moment, being the parent of an LGBT kid who comes to you and discloses that he or she is questioning their sexuality or gender identity. Perhaps you don't know much about that sort of thing, so you decide to do some research and stumble across Matt's channel - only to discover that, apparently, a whopping 45% of LGBT people interviewed on the channel are sex workers or involved in crime of some sort. This isn't a hypothetical situation. I grew up in a small, conservative town where that sort of drama continues to play out to this day. Matt, I should note, grew up in California with very supportive parents, and as far as I know, he has lived there his entire life. There are many points at which I have wondered whether Matt growing up in an LGBT-positive bubble has resulted in a warped perspective of how the majority of Americans view LGBT people, which, in turn, has rendered him blind to the risks of how he presents our community in his series. The messaging that won us the ability to legally marry and secured other important rights and protections was that gay people are just like everybody else: We live quiet, normal lives, pay our taxes, contribute to our communities. We're just like you, and all we're asking for is fair, equal treatment. By contrast, Matt's channel presents only the fringes of the LGBT community. There is little about the LGBT community as he represents it that I identify with. Again, I shudder to think of what the kind of people who I grew up around - conservative, Christian, small-town people - would make of Matt's content. It would reinforce their worst fears and suspicions, of this I am sure. Once we're past the sex workers and excons, much of the remainder of Matt's content has to do with famous drag queens and kinky sex, including BDSM and gay sauna hookups. To his credit, in two out of his hundred-plus videos, Matt interviews a couple of more "normal" couples, including a lesbian couple that met in Bible school, who have been together for 10 years (video link here ), and a gay couple, one of whom was addicted to crystal meth, who have been together for 18 years and who come from rough, Latino backgrounds and struggle for familial acceptance (video link here) . However, there is not a single video of an LGBT leader who walked a socially acceptable path to success. Matt's failure to interview a gay rocket scientist, politician, doctor, actor, or businessman is both negligent and reprehensible. Pick a discipline, from science / engineering to theatre / film, and gay people have contributed disproportionately to it. We are one of the most intellectually gifted and creative minorities, and it is deplorable and irresponsible that Matt neglects to represent this facet of our community. It's not hard to understand why  Matt doesn't include that type of content, mind you; a video about a gay bioengineer isn't going to draw in nearly as many viewers as a salacious video about kinky sex in a BDSM dungeon. But it is awful nonetheless. Again, it is the next generation, the LGBT youth, who I worry about most when I see this sort of depiction of our community. Gay but Not Queer It's significant that Matt uses the word "queer" in the title for his show - but probably not in the way that he thinks or hopes that it is. When I hear this word in a pro-LGBT context, I think of LGBT people of my parents' generation, who reclaimed the word, which was traditionally an antigay slur meant to emphasize that we were freaks, abnormal, contemptible.* *On my part, I'm not even sure that "queer" or "questioning" belongs in the acronym, but I'll set that aside for now. "Queer" had also been used, historically, in reference to spiritual evil ("there's something queer going on in that abandoned asylum"). Some LGBT leaders decided that being different was a good thing. They threw off the assimilationist idea that LGBT folks should integrate into wider society in favor of the radical position that LGBT people didn't need to, shouldn't have to bow to prevailing social norms - that, rather, we should form our own, separate communities, free of the bigotry and repression of society at large. They embraced radical political affiliations, including Marxism, that they believed would help to create the sort of improved world that they envisioned. This sounds like a brave, attractive proposition at first glance, and I wholly support any LGBT adults who choose such a philosophy and life path for themselves. The problem with this is that, to quote American writer and attorney Michael Nava, homosexuals are the only minority that "get born into the enemy's camp." Most of the damage inflicted on LGBT youth, which contributes to addiction and suicide rates that are much higher than those of the general population, occurs during our childhoods. As I've written about elsewhere, there was no group so scorned and yet so frequently mentioned in the area where I grew up. Without exaggeration, I heard the word "gay" used to describe something negative no fewer than 30,000 times in my youth; I must've heard someone called a f*g at least 10,000 times (lowball). It is literally programmed into us linguistically that being gay is being inferior, broken, outside. Because of the unique vulnerability of our youth, we must be especially conscious of how our portrayal of the LGBT community is affecting its youngest members, who might not have the choice to escape the conservative communities that they're born into. This kind of consideration is crucial at present. For the first time in a long time, public support for LGBT people is dropping in the U.S. There are complex reasons for this, including the focus on trans rights that has dominated LGBT discourse during the past 5 to 8 years. The pushing of a trans-rights agenda that involves puberty blockers and irreversible medical procedures for underage children has damaged public perception of the LGBT community, as has the insistence of some trans activists that wider society bend the knee and accept an outrageous list of neopronouns.* *To be clear, I am fully, nonnegotiably supportive of trans rights, including social transition for minors and medical transition for adults. I'm totally in favor of using whatever standard pronouns someone is comfortable with, and I will always refer to my binary and nonbinary trans friends by he / she / they according to their preferences. However, I don't believe that it's productive to try to force the rest of society to adjust their use of language to accommodate trans people's preferences, and I absolutely will not use Tumblr pronouns like faeself and druidself, which make a mockery of our community and justify people's belief that we are fundamentally out of our minds. Another issue is the dramatic expansion of what constitutes LGBT identity. A Brown University survey from 2023, for example, indicated that 40% of the student populace identified as something other than straight. Again, the issue with this is that it supports the public fear that giving gay people expanded rights has dramatically increased the percentage of gay people beyond the 5-8% or so of the population that our community has traditionally been estimated at. Looking closer, though, it's clear that the majority of the people who classified themselves as non-straight in this survey absolutely do not belong to any group that most of us would recognize as trans or gay. Anyone experiencing any gender identity discomfort at any age - so, anyone other than a testosterone-drenched Chad or a vapid Barbie - was counted as LGBT. Anyone with any sexual contact with the same sex at some point in their life - so, almost everyone - was free to self-identify as bisexual, gender nonconforming, etc. It's not just at Brown that the definition of LGBT is expanding. I've met several couples lately who I consider "straight with extra steps." One or both members is nonbinary in a minor way - perhaps a man who has long hair and likes to paint his nails, or a woman who is a little on the butch side in terms of her presentation. They're the new hippies - people who are exploring self-expression beyond what wider society has traditionally considered acceptable. On his show, Matt supports this sort of construction of LGBT identity. He interviews people like Alexis Neiers, who was married to a man for several years, who apparently identifies as bisexual, now - she mentions not being content with a monogamous, heterosexual relationship, and says that she would likely be the top in a hypothetical sexual interaction with another woman. Matt interviews at least one OnlyFans star and one brothel worker who only mention being bisexual after he asks them, "Oh, and you're bisexual, right?"; my strong suspicion is that he asks this because he wants to justify their inclusion on the show. I applaud anyone who is reconsidering societal norms and expressing themself in an authentic way in their personal presentation and relationships, but doing so does not  make you LGBT. One of the most comforting moments of my youth was when my first boyfriend showed me an article in a major publication that reported on biological research showing that male homosexuals were physiologically and genetically different from their heterosexual counterparts - that we had hair whorls that tended to swirl in a different direction; finger length ratios, which indicate testosterone levels in the womb during key periods, that varied from the norm in a predictable way; functional brain differences that were consistent and predictable. Reading this article substantiated what was obvious to me, namely, that my gay peers and I were biologically different, and that - counter to the Christian programming of the time - this was not a matter of choice. I can't tell you the peace that this brought me, and I can't fully express how worried I am that the LGBT umbrella is being expanded in a way that could endanger our community (you can't protect a class if you can't reliably define it, if anyone can join it on a moment's whim). Again, the sort of definition of LGBT that Matt's content supports is not one that is going to help wider society to accept us, to put it mildly. Moreover, Matt's show doesn't even reflect common understanding of what the word "queer" means. Ironically, his focus on sex workers, criminals, and drag queens supports  the idea that LGBT people are freaks, outsiders, misfits. Matt seems to think that "queer" refers to LGBT people who choose to engage in conduct that society disapproves of. He fails to grasp that "queer" fundamentally denotes a political and sociological worldview aimed at deconstructing harmful aspects of our capitalist, patriarchal society. Matt doesn't interview any of the dozens of LGBT professors who are queer in the discursive sense, who connect their LGBT identity with Marxism and sociological / semiotic theories about the structure of language and society and their essential role in the formation of identity. Instead, Matt presents queer people as freaks, rebels, Others in the cheapest, most shallow sense of the term. It's a dangerous and irresponsible depiction, giving the prevailing societal winds in the U.S. right now. To close this section, I'd like to briefly mention "Love, Victor," a comedy-drama series that follows up on a film called "Love, Simon." In this series, young stud and rising basketball star Victor struggles to tell his Latino parents that he is gay. He navigates his first love with Benji, a rich kid musician and recovering alcoholic.* *I cannot tell you what it means to me to have Benji's 12-step participation normalized. The idea that a television series' plot involves a young, gay character who is addicted, relapses, gets his sh*t back together, and then pauses at key moments to consult his sponsor is revolutionary. This  is the kind of representation, the sort of revolutionary storytelling, that we direly need. My favorite thing about this guilty-pleasure show is that Victor is so normal . The only thing odd or different about him, aside from a couple of lovable quirks, is the fact that he is gay, something that Victor seeks to minimize the importance of (he is uncomfortable at the idea of receiving an award simply because he is an openly gay athlete, for example). Victor's life is the future that I dream of for gay youth - a world in which the homosexual / heterosexual orientation options are no more significant than two different entries on a breakfast menu. It's a view of the LGBT community that is antithetical to the portrayal of our community in "Our" "Queer" Life. Credit Where Credit Is Due Matt has elevated some charismatic and intriguing voices whose stories would have otherwise gone unheard. If you're unfamiliar with his content, I recommend checking out his series of interviews with Mousie, a meth- and fentanyl-addicted, transfeminine LA streetwalker whose wild life and eyebrows reportedly inspired a movie. Mousie died of a fent OD in November 2023, and Matt's interviews with this extraordinarily charismatic trans woman preserved part of a powerful story. Matt's interviews with LGBT individuals who come from underprivileged socioeconomic backgrounds, including Mousie, are among his best. Even when he doesn't interview them very robustly, the pathos and panache of his subjects carries the day. Matt is also well-suited to his interviews with drag stars. In that setting, he's free of the obligation to explore serious issues and can instead focus on catty gossip and wardrobe consideration. His style is much more suited to this type of lighthearted interview, and he brings to the table a playfulness and an ability to connect with his interviewees and make them feel comfortable. In Conclusion Regardless of their position on the political spectrum, most Americans agree that the grave social, political, and economic problems that we're facing in 2024 have been exacerbated and perhaps even partially caused by the decline of quality, objective journalism. This problem extends into the LGBT sphere, where a new leadership of politically radical liberationists threatens our ability to hang on to the right to marry and the grudging social acceptance that previous generations have won for us - less from violent, headlining activism like the Stonewall riots, and more by living quiet, responsible, productive lives and paying their taxes. It would be hard to hate Matt Cullen. I certainly don't even dislike him, although I do have a deep distaste for how he approaches the content that he makes, and I detest how he portrays our LGBT community. In my view, Matt Cullen is the problem, not the solution; he epitomizes the failure of LGBT leadership to take honest stock of our community's weaknesses. He is certainly not a journalist, and he qualifies as a documentarian only in the broadest and most trifling sense of that term. During the first few months of Our Queer Life content, I held back on criticizing Matt. After all, he is a dancer and server by background; he hadn't studied journalism, and I'm not even sure if he'd attended college at all, for that matter. However, after well over a year of pumping out videos that get tens of thousands of views because they depict our community in the worst, most sensational light, during which Matt hasn't shown an iota of progress in becoming a serious journalist or documentarian, I think it's fair to look at his content more critically. Matt Cullen's Our Queer Life interviews are frivolous, disappointing, and - at times - genuinely dumb. Thank you for reading! If you enjoyed this content, I'd suggest checking out my two-part series on addiction recovery and prison reform Youtuber Jessica Kent, a diagnosed sociopath (ASPD) whose lies and deceptions beggar belief. Don't forget to connect with me on Instagram (concreteconfessional)!

Using threatening messages from a drug dealer as a case study of how to assess when you're legitimately in danger vs. when you're dealing with a tweaked-out poseur. For today's post, I went deep into the archives - i.e. redownloaded Grindr (LGBT dating / hookup / social app) - and reviewed years' worth of nudies to find these threatening messages from a dealer who I owed 140 bucks to a long time ago. This guy wasn't someone who I usually bought from. In fact, he wasn't a heroin / fentanyl dealer at all, but rather a meth dealer. Anyone who knows me knows that I absolutely, positively don't f*ck with meth. Historians cite military leaders giving their troops amphetamines as a driving factor behind many of history's worst war crimes for a reason. Meth keeps you up for days. If you're lucky, you're repairing "faulty" wiring or baking hundreds of cookies even though you don't have frosting. (Or having marathon group sex if you're gay). If you're more typical, after day two or three, you're hallucinating shadow people who are conspiring with the police and ex-girlfriends / boyfriends in some nefarious, cosmic plot against you (see my "Shadow People Caught on Camera" post here ). Tweakers commit the worst kind of crime - the stupid, poorly planned, sometimes even unnecessary kind. They have too much energy while they're up for days, conniving as they descend into stimulant psychosis, and for that reason, cops follow them like flies on sh*t. Not to beat a dead horse, but "Thou shalt not abide a tweaker" was one of the reasons why I made it through my twenties. Junkies are vampires; tweakers are werewolves. *** Okay, so the backstory on these messages is a little strange. This guy wasn't even someone who I usually bought from; he was someone who messaged me on Grindr wanting to hook up on a day when I was really dopesick. After feeling out that he was a little sketchy, I mentioned to him that I was sick from opioid withdrawal, and he offered meth. When I explained that this would make things worse, arguably, we eventually came to an agreement that involved him lending me 100 bucks and taking me to get dope, after which I would go chill at his place for a while. We got to his place, which was a nice, suburban setup with a Jeep and another recent-model, midrange car in the driveway. Things were off from the beginning. As we pulled up to his house around 2:30 a.m., I noticed a black sedan that was on the shoulder of the road driving slowly forward, which immediately made me worried that he was being watched by the local police or maybe even the feds (even though this seemed sloppy on their part*). *My second worry was that it might have been some kind of group rape situation where the guys in the car would come in the house after I was high / out of it; any time someone is offering you drugs in connection with sex (even though I hadn't agreed to anything for sure in this situation), you've got to be careful. Turns out, it was a group of tweakers who had been hanging out with this dealer, who kicked them out when I said that I would come over so that I wouldn't be put off by their presence. As we got out of the car, the dealer grabbed a black bag - the sort that you'd put toiletries in while traveling - from his glove compartment. We went into the house, where a "friend" who introduced himself as Cash was smoking a glass pipe filled with meth using a blowtorch. (My guess is that the dealer let Cash stay because he knew that I was an addict and was worried I might try to pull something). While we got set up in his basement chill room, the dealer opened the black bag that I mentioned above. I couldn't eyeball meth quantities in the same way that I could dope or coke quantities, but he had enough to make me nervous - a Ziplock sandwich baggie stuffed with the drug. Ounces, not grams. Moreover, as I was getting the dope that he'd bought me ready to inject, he shot himself up with what he said was a gram of his meth, which had the large, translucent crystals that make tweakers salivate. Long story short, I wasn't exactly feeling amorous. I shot up a lot of dope, stayed gamely alert, left early. A few days later, I started getting messages on Grindr of the sort pictured above, which made vague but urgent-sounding threats if I didn't Cash App him the money that I owed him. I was in a really low point in my addiction at the time, and I didn't have a spare hundred to give to anyone. Plus, I was already borrowed out from anyone who would loan me money. I left the area and entered treatment a few weeks later, so nothing ever came of this, but until I left, I had that lingering unease that comes from a tweaker psycho knowing where you live. *** For a few reasons, I was willing to bet that this guy wasn't actually going to do me grievous harm. Here are a few factors to weigh when deciding whether a drug dealer is really planning to f*ck you up. Let's start with some of the warning signs. The thing that I was most concerned with is the amount of meth that this guy had in his possession and the fact that - deep into his addiction as he obviously was - he still had a nice house, new car, an extra hundred bucks. The further up the distribution chain you are, the easier it is for you to farm out violence to those beneath you. At one point during our talk, this guy had mentioned that he "didn't want to be any further up the chain, because then [he'd] have to deal with the Cartel directly." FWIW, I think he was being honest. If he had been trying to impress me, he would've said he did deal with the Cartel (although organized crime groups are like Fight Club; the first rule among the people who actually deal with them is that you never, ever mention that you deal with them). This guy fit the picture of someone who was right where he was describing in the food chain - toward the top of the regional distribution scheme, just below whoever brought it in wholesale to our Upstate New York city. So, far enough up the hierarchy to worry me. The other thing that troubled me was that this this guy was most definitely in and out of meth psychosis (I'm being generous with the "in and out"; he was meth psychosis personified). He messaged me literally around the clock for days, and he threw in the oddest non sequitors insinuating my involvement in a surveillance scheme - note the Wikileaks mention apropos of nothing in the messages above. This kind of confused, counterproductive thought and behavior is common with psychosis. Needless to say, if someone is a government agent sent to entrap you, you write off the 140 bucks that they owe you and go dark. He repeated himself constantly, another testament to an addled and rambling mindset. Psychosis cuts both ways; people lose their inhibitions and become more dangerous, but they also become distractable, less able to plan effectively. In general, though, I think that the paranoia that comes along with stimulant psychosis actually benefits you if you're being threatened by someone who is suffering from it as long as you're not in their immediate vicinity. Someone worried about government and extraterrestrial plots against them is less likely to venture out of their comfort zone into a scenario where they know that they will attract attention. If they do lose all inhibitions and come for you, though, they're likely to be especially unhinged. Given this information, why wasn't I more concerned? The first rule among those who deal in violence is that you don't threaten; you do. If a dealer is going to hurt you, the first warning you're going to get of it is usually when it's happening. They'll lull you into a false sense of security by telling you to forget what you owe them - you've been coming to me a long time, no big deal, et cetera. Then, you'll show up and something ugly will go down. No serious criminal is going to leave a trail of messages to become State's Evidence Exhibits A through Whatever at their aggravated assault / attempted murder / murder trial. The first thing that hit me when I received these messages was the sheer comedy of the wording and grammar. ("You're stupid spending"; "anon,it's" instead of anonymous). I don't know for sure if this guy had done time, but many excons and assorted denizens of the underbelly use inflated language that they think makes them sound intelligent - "breached the agreement and forfeited," "or I will secure those to me to the furthest extent practicable" - but which actually sounds stilted, pompous, and laughable. I am far enough out of college now to have friends who are executives in their fields, and many of them write like cavemen / cavewomen. Real, upper-level dealers are the same. They're too damn busy to write you a novel. Their messages are short, without embellishment. They get annoyed if you send anything wordy. Those are the people that you need to fear. The other side of that coin, though, is that people who are good at drug dealing typically won't pursue minor debts. They understand that they're part of the deal and that threatening or executing violence, especially against someone who comes from a more privileged background than them, is going to bring down heat like nothing else. For that reason, they write small debts off. They're making thousands off of each active addict per year in pure profit; they can afford to. At worst, they'll stop dealing to you, which is punishment enough for an addict. You can't buy this stuff at CVS. (Massive debts or cases in which you've insulted them in front of others and their reputation is therefore at stake are very different scenarios). What's more likely, especially when you're dealing with a smalltime or midlevel dealer like the guy in this example, is that they'll try to ruin your life. Some of this guy's threats sound like that was his intention, and that would've been a much smarter plan on his end. Best of all, calling someone's workplace and leaving a message describing their drug use isn't even a crime! The thing is, I never told this guy my last name and only referred to my job in the most general way. It's possible that he could've found me on Facebook or elsewhere, especially because the gay community in my home city is small and interconnected (we're all friends with whatever three twinks are in this season, haha). For this reason, dealers will often ask for ID or some other proof of your full name, where you live, where you work. Don't ever give it to them. Once they have that, they can ruin your life at will.* Even worse, your family is at risk. *The flip side in this scenario is that I knew where he lived, which was in a middle to upper middle class suburban area. Because of this, he should've been worried about threatening me to the point where I tipped off law enforcement to get him locked up. The best thing about his kind of neighborhood is that I wouldn't even have had to contact LEO myself; a couple of notes and screenshots in nosy neighbors' mailboxes would've worked just as well. If you're in a situation like this and you're worried because information about where you work is online, I'd calmly approach your manager or the Human Resources department where you're employed. Explain that you have a psycho ex who is making your life difficult, and that you're currently pursuing a restraining order. The cops will tell you to scrub your Internet footprint as much as possible in this situation, so you can use that as your justification to request being removed from the company website and other professional listings (present it as temporary, until things blow over). Anyone who has lived a passably colorful life has at least one crazy ex*, so this isn't going to seem too wild. *If you don't have a crazy ex, you should get one. Now. *** So, to summarize today's case study from Brian's School of the Druggie Demimonde, we have a lower mid-level threat. On the one hand, I was dealing with a decently successful dealer who was psychotic enough to randomly mention Wikileaks, which is a meme-worthy digression. When you start whispering about Wikileaks into your Wheaties, it's time to get help. For real. On the other hand, his threats were theatrical, repetitive, blustery. What's more, he didn't take the next step that someone intent on recovering their money would have, i.e. showing up in person where I lived to tell me that I had X hours left to send him the money. The one occasion when I was threatened with a gun by a papi dope dealer who was gang-affiliated and who I have no doubt would've killed me - he had been shot twice in previous altercations - came about as the worst kind of coincidence. At the time, I was working with a nonprofit that does criminal justice system reform, which involved appearing in problem-solving courts from time to time. This papi, who I had been buying from for years, had seen me coming out of the courtroom and assumed that I was an informant testifying or copping a plea. He was alone when he met me, which is how serious guys will do it (they know that anyone else present is a potential witness for the prosecution). He didn't hold the handgun to my head; he kept it on the seat next to him with his hand on the butt. We had a nice chat about criminal justice system reform, during which he let me slowly withdraw my cell phone and access the nonprofit's website to show him my staff photo. Convinced that I wasn't ratting him out, he threw in an extra bundle. From that day forward, he made sure that I was well taken care of and occasionally messaged me to meet in person, during which he asked for legal advice (he was facing an attempted murder case at the time). I'm not qualified to dispense any kind of legal advice, but my feeling was that papi just wanted to talk; he gave off a kind of Tony-Soprano-in-therapy vibe. I'm pretty nonthreatening, you know. *** There's a line from Kodaline that I love: "In my dreams I see the ghosts of all the people who have come and gone." I don't know what happened to either of these guys*, but I wish them both well. *The dealer's Grindr account showed him as still in our city, but he hadn't signed in in ages. Life truly is stranger than fiction. I think back on this time of my life, and it feels like a Tarantino-esque / Pulp Fiction dream. When it comes to memories that are especially traumatic, humiliating, strange, or tragic, I adopt the attitude of Augusten Burroughs, whose memoir Running with Scissors* is a brilliant work of autobiography: I take the item down from the grocery shelf, examine it briefly; throw it my cart, and walk on. *The book details his time under the care of a Yale Med-educated psychiatrist who was eventually convicted of insurance fraud, and, if I remember correctly, lost his medical license. This shrink required his live-in patients to divine their futures in their bowel movements. He allowed young, gay Augusten to spend time alone with a convicted pedophile who the doctor was also treating, who, predictably, sexually assaulted Augusten. Nevertheless, Augusten's wry memoir betrays an appreciation for the entire cast of zany characters. Anyone who has had a dysfunctional childhood that they nevertheless remember as surrounded by that swirling, pink-and-black love-haze that only an insane upbringing can engender should read this book. Crystal meth is a gay plague, which drives chem sex-related acquisition of HIV and other STDs, and not nearly enough people are talking about it. If you need help, I'd recommend starting with Crystal Meth Anonymous , which has a 24-hour helpline. Thanks for reading! Drop your own stories in the comments below.

I call this haircut Ti Qi's little Dutch boy look. I bug Jay for at least two new Ti Qi photos per week. Miss both my guys more than words can express. Those of you who read regularly know that I've been publishing a new, full-length article at least once per week, almost always on Thursday or Friday, for the past several months. Starting this week, I'll be shifting that schedule. From now on, each week's feature article will appear on Saturday or Sunday. At least twice per month, there will also be a shorter, "snapshot" post that will be released between Tuesday and Thursday. I'm making these changes because school has just started, and, by the time I'm home, done with my run, and finished prepping for the next day, I'm dead tired. My Arduous March methadone taper continues on slowly and steadily, which is one reason why I'm feeling so beat. At this point, the blog has been online for almost six months. My plans for the next six months involve me writing guest posts and appearing on YouTube channels / podcasts to attract more readers. I also have a series of interviews of incarcerated addicts planned, which I'm still researching and organizing the logistics of. Finally, I have at least three guest authors who will be featured in the coming months. Thank you all for reading! Hope everyone is well. B.

The comedies that I "grew up" on during the 90's and early aughts - raunchy, goofy, campy, cliched; at best, semi-self-aware. Brilliant. I miss the 90's, when Ecstasy was really MDMA, 9-11 hadn't injected fear into the American bloodstream yet, and simple, happy endings seemed attainable for all. This list is populated by movies that my brothers and I had on DVD, which we would pop in a few times a year when we wanted reliable, low-effort laughs. Fair warning: Recreational substance use is pretty in-your-face in Half Baked (go figure), Dazed and Confused , and a couple of other selections. If you're looking for sober humor, I'd start with Mrs . Doubtfire . As a quick cultural aside (because I can't help myself), I'm appalled by how recently it was considered mainstream humor to call someone gay - accuse them of sucking d*ck, being "butt buddies" with another guy, et cetera. That's it; that was the joke. We were the joke. I grew up immersed in this toxic, moronic attitude. During the 90's and most of the aughts in the U.S., the heterosexual paranoia about homosexuality was all-pervading; literally anything negative was referred to as gay. Homework was gay; popular heterosexual couples breaking up with gay; even being gay was gay, but typically only if you took it. Even though I brushed this nonsense off as casual ignorance at the time, I realized later on in life the extent to which the manifold negative associations of the word "gay" had been programmed into me by sheer force of repetition. Needless to say, I'm so glad that we're doing better with this these days. /Rant over. On the whole, there's something soothing about these films. They're filled with low-stakes humor geared around social and romantic / sexual situations, and they hit simple, good-natured notes. The tropes are basic but well-developed, and they work - young rebels vs. older authority figures; geeks or alternate social outcasts vs. jocks or other cool kids; virgins vs. crushes who are impregnable fortresses. This vein of humor is bright, untroubled as a summer sky. (I did sneak in Almost Famous and Cruel Intentions  for viewers who want more depth and drama). With the world hurting as badly as it is right now, it can be nice just to press play and escape for an hour or two. Without further ado, enjoy. Flick #1 - Dazed and Confused This coming-of-age classic takes place in a small town in Texas on the last day of school in 1976. Featuring keggers, stereotypical meathead jocks, and terrified rising freshman who are trying to duck Fred O'Bannion (young Ben Affleck), who plays a believable bully with a penchant for paddling underclassmen. The soundtrack is an homage to 70's rock and roll. It features Alice Cooper, Foghat, Nazareth, Lynyrd Skynyrd, and Kiss. Flick #2 - Out Cold The slacker employees at a salt-of-the-earth Alaskan ski resort smell trouble when a ritzy developer with two beautiful daughters acquires the property with a plan to develop it in a bougie direction. Hilarious hijinks ensue as charismatic, conflicted employee leader Rick falls hard for Anna, his new boss' daughter. Eric Montclare: "Welcome to your first random drug test!" Pig Pen: "I don't have to write a test to tell you I do drugs..." Flick #3 - Clueless Cher Horowitz (Alicia Silverstone) is the quintessential Beverly Hills blonde. She lives in a Greek Revival mansion with her father, a prominent litigator, and uses a custom computer program to organize her closet and visualize outfit ideas. Cher takes on spastic misfit Tai (Brittany Murphy) as a charity case while she assists her ex-stepbrother Josh, a sort of proto-social justice warrior, with trial preparation for one of her father's cases. As Tai supersedes Cher socially and Josh castigates Cher for her Valley-Girl vapidity, Cher's perfect year is blemished by an identity crisis that calls into question everything that she thought she wanted for herself. Flick #4 - American Pie This is the first in a series of movies that generated quite a bit of controversy due to their graphic depictions of sexual acts ("This one time, at band camp..."; if you know about the flute, then you know). This bildungsroman, which takes place at a high school in Michigan, centers on four friends who vow to lose their virginity within three weeks: Jim Levenstein, an awkward but cute everyman; "Oz" Ostreicher, a bro-ish lacrosse player; the cerebral Paul Finch; and Kevin Myers, who already has a girlfriend named Vicky. Flick #5 - Anchorman Will Ferrell plays Ron Burgundy, the reigning TV anchorman whose career in the chauvinistic world of 1970s broadcast news is upended by Veronica Corningstone (Christina Applegate). Burgundy's frustration over their rivalry leads to a serious faux pas on air. With his career hanging in the balance, he chases down a story involving the San Diego Zoo, which has the potential to put him back on top. Flick #6 - Half Baked Three stoners sell pot stolen from a pharmaceutical lab to raise bail money for a fourth friend who is arrested for killing a diabetic New York City Police Department horse named Buttercup by feeding it junk food from his own munchie stash. Dave Chappelle owns in these high-humor escapades, which involve drug dealing, love, and enduring friendship. Jerry Garcia's ghost makes an appearance, too. Flick #7 - Mrs. Doubtfire This heartwarming, family-friendly flick features Robin Williams as Daniel Hillard, a divorced dad who masquerades as a female, British housekeeper in order to spend time with his children, 14-year-old Lydia, 12-year-old Chris, and 5-year-old Natalie. His new role in the family gives Daniel fresh perspective on his hardworking ex-wife Miranda, leading him to reconsider her complaints about his parenting style and general unreliability. From behind his mask, Daniel learns how his children feel about their parents, as well. Flick #8 - Billy Madison No list of 90's comedies would be complete without an Adam Sandler movie (and in some ways, if you've seen one from this era, you've seen them all, to be honest). In this flick, grown party boy / nepo baby Billy Madison must retake and pass every grade in six months - or lose the family hotel empire to a conniving rival named Eric. Flick #9 - Almost Famous One of my all-time favorites. This coming-of-age film, which takes place in 1973, centers upon introverted aspiring writer William (Patrick Fugit), a 15-year-old who lies about his age in order to obtain a gig from Rolling Stone that has him touring with burgeoning rock band Stillwater. "Never meet your heroes" applies as William gets to know the band's lead guitarist and lead singer, who don't just play rock n roll - they live it. William's head is further done in by a gorgeous groupie who goes by Penny Lane (Kate Hudson), who urges him to shed his inhibitions and revel in the now. Flick #10 - Cruel Intentions For those who appreciate humor as bitchy rich kid social commentary, I present this intriguing remake of French writer Choderlos de Laclos' oft-banned, 18th-century epistolary Dangerous Liaisons . Conniving social queen and cokewhore Kathryn Merteuil (Sarah Michelle Gellar) makes a bet with her stepbrother, the insatiable Sebastian Valmont (Ryan Phillippe), that he won't be able to corrupt Annette Hargrove (Reese Witherspoon), the somewhat ingenuous daughter of their new headmaster. As Sebastian catches feelings for Annette, however, Kathryn becomes enraged, and their twisted games spiral out of control. Don’t forget to let me know what you think! Drop a comment with your favorite quotes / scenes as well as movie picks that I missed! As always, thank you for reading. If you're looking to get in touch, I'm most easily reached via Instagram (concreteconfessional) these days.

Part III begins mid-pandemic, during one of my worst ever bouts of opioid / benzo withdrawal, then flashes back to the Hong Kong pro-democracy protests, which led to me being detained and questioned at the Hong Kong-Shenzhen border checkpoint. Because these sections are excerpted from a novel-length manuscript, the jump-cuts are probably a bit hard to follow. The timeline is: Hong Kong protests (spring to summer 2019); outbreak of pandemic (December 2019); quarantine of my flight to Fuzhou (March 2020); beginning of Part III (September 2021). Part I is available here , Part II can be found here , and Part IV (Epilogue), which covers the mid to late pandemic, will follow shortly. Park in Chaoyang District of Beijing during optimistic, pre-pandemic days. At some point, I'll post a photo of the Beijing sky during the annual national government meetings, when the factories in nearby areas shut down and the sky transforms into such a bright, lucid blue that you wouldn't believe that it's the same city and skyline. An orifice shaped like a cat's pupil has opened in the ceiling above my bed. On either side of the slit, folds of whatever gossamer substance it is composed of accordion outward. They have the rainbow sheen of mother of pearl, which may be why the gash seems to be breathing. In, out, in-in-out; in, out, in-in-out. The diaphanous pleats dance as I watch, transfixed. When Stephen Hawking talked about the fabric of space-time, this is it , I realize: This is what it looks like. I wonder again if I'm dying. Perhaps I'm already dead. At first, I think I see a cobweb threaded through the cataract-like cloudiness at the core of the orifice. Then the threads untangle themselves and begin to squirm outward. I squint, and in a moment I discern tiny spiders with pearlescent bodies and legs that look like translucent grains of rice. They are crawling out of the hole, streaming outward over the ceiling. The incision in the ceiling spits out fragments of half a dozen psychiatric textbooks. Delusional parasitosis: the hallucination of infestation by bugs. I look down at my arms and legs, expecting to see larvae wriggling their way to the surface of my skin, centipedes and millipedes writhing away underneath. I'm wearing only my boxer briefs. After months of OG COVID, there are stark, shadowed ridges between my ribs. Formication , the orifice pronounces - not to be confused with its pleasurable cousin with an "n" - is the delusional perception of insects crawling beneath the skin. It is most often experienced by patients in drug or alcohol withdrawal, and it sometimes leads afflicted individuals to claw or cut themselves open. I have no such plans. I don't see any bugs beneath my skin, anyway. A buzzing noise emanates from the orifice-oracle. It's a "G" note, wholesome and major. I intuit what's coming just before they swarm into sight: Light bees ! My mystical protectors, which had first appeared during my maiden LSD voyage over a decade ago. During that trip, I also beheld technicolor strands of DNA-like Celtic knotwork binding me to my fellow psychonauts. The light bees choreograph a playful show, creating intricate, sigil-like formations that dissolve the warp-spiders before they can crawl down the walls and over to the bed. I vomit into the black trash bag waiting next to me on the bed like a body bag. From time to time, I've been holding its cool plastic against my sweaty forehead. The bag is so full that the liquid inside sloshes back and forth. I stash it on the floor, to the right of the bed, and pull on the white V-neck that I'd taken off earlier, which has slipped down the side of the platform bed. I have been without oxy for 38 hours; benzos and phenobarbital, almost three days. It's September of 2021, two whole years into the pandemic and over 18 months after Weston and I were released from our quarantine on the Fujian coast. Going to the hospital or the international clinics to get pills has been out of the question for months. The hospitals are denying access to people with life-or-death emergencies. The truth is that the Zero COVID policies are killing many people with much graver ailments than those typically caused by the virus. Chinese social media presents a panoply of horrifying denial-of-care tales. In one, a pregnant woman dies during labor after being refused admission to a maternity hospital because she doesn't have a clean COVID test from within 24 hours. In another case, the phone app used to document COVID testing, which the entire population must now regularly undergo, doesn't load a woman's test results properly, and she loses her twins after being denied admission to the hospital (despite a doctor breaking protocol by leaving the hospital to help her give birth nearby). A close friend's mother dies of brain cancer because she can't leave her province to travel to the Beijing hospital where there is a doctor who can perform the surgery that will save her life. Thousands of people die because they cannot obtain refills of medications like insulin, blood-pressure regulators, and other staples. Outrage is building, but it isn't directed at the government, yet. From behind their masks, people bicker in elevators and endless COVID testing queues. Petty arguments escalate; blades made of words are sharpened by stress, by pessimism. In the public area outside of our apartment building, I witness a gray-haired couple circling each other like boxers, the man swiping at his wife, who holds shopping bags, until a security guard hurries over and inserts himself between them. Again, for anything other than COVID or life-threatening trauma, the hospital is out. (Selfish of the entire country's medical system not to revolve around my needs, I know). I've been obtaining oxy and benzos through gray-market avenues: Paying pharmacists and doctors who divert them from hospital supplies or order them from India, the pharmacy for the world's poor. But the Chinese government is cracking down on prescription drug abuse, and I recently got a phone call from my pharmacist supplier in Guangzhou. "Bro, I hope you have a valid prescription for those pills I sent you, because the police were here asking about them, and they had the photo from your passport page," he'd warned me. Like hundreds of millions of other people, I'm now essentially on house arrest under the "two points, one line" quarantine system that restricts movement to one's workplace and one's home (with nary a pitstop permitted in between; our food must be delivered). Because my classes have long since been moved online, I'm on the "one point, no line" system, also known as solitary confinement, which you might recognize by its other name, torture. I've come to Beijing by way of a job at a school in Suzhou, outside of Shanghai, because for a time, it was better for foreigners here. Expats are leaving China in droves - even those who have been here for a decade or more, who have Chinese spouses, properties, children enrolled in public school. We're making WeChat groups to coordinate flights, apartments in our home countries, work opportunities elsewhere. There are no special dinners, no airport farewells or last hurrahs out on the town. Chosen family of many years' acquaintance depart frantically, without hugging goodbye. It's becoming more and more difficult to find flights to the U.S. and many other countries. Moreover, by the time that your flight date arrives, COVID regulations have often changed in source, destination, and / or layover countries, creating "airport purgatory" stories that provide morbid entertainment for expat chat groups. At one point, I receive an email from the U.S. Consulate in Guangzhou listing a final flight from Hong Kong International Airport to Dallas-Fort Worth. The U.S. government strongly recommends that any remaining American citizens depart on this flight, after which Consular services will be limited or suspended altogether. Even within China, rules about time since most recent COVID test and when you've last passed through an area where COVID has been detected vary based on province and municipality, which hinders ability to travel by train, to stay in hotels, to reach Hong Kong International Airport (which is now possible only via ferry and has other headaches attached, as well). Foreigners - even those of us who have been in China for a year or more - are scrutinized more closely. Many of us don't have certain Chinese ID documents that the COVID testing system is designed around, meaning that our info has to be entered manually; there is often human error, and test results vanish into thin, virus-laden air. It is a catastrophic clusterf*ck. But none of that big-picture stuff is troubling me at the moment. To paraphrase a quote whose source I've forgotten, the beauty of addiction is that you either have one grievous problem or no problems at all. Right now, I'm a clear case of the former. All of my last-ditch tricks have failed me: I can't even hit up the local pharmacy for an OTC anti-motion-sickness formulation that contains 30 milligrams of phenobarbital per pill (plus the belladonna alkaloid hyoscyamine, quite toxic, which is added to prevent abuse - not that that has ever stopped me from popping six or eight of them at once). I realize three days too late that I'd been taking the potent, long-acting barbiturate so regularly that I've now added barbiturate withdrawal to my woes. Barbiturates are, the orifice reminds me sadly, one of three classes of substances whose withdrawal syndromes can kill you: Alcohol, benzos, barbs. An old mnemonic for GABA-A receptor action follows: Ben wants it more often, but Barb likes it to last longer . The orifice sighs open as though preparing to disgorge timeless wisdom, some truth of my existence that will unravel my mind or maybe even unmake me. It hesitates, then it slides shut again. It is an elegant motion, full of duty, consideration, and regret. I'm convinced that if I could stand on my bed and hoist myself up into the gash, I would transport myself back to that first acid trip in ninth grade. I'd come down, tell my brother what a terrifying vision of the future I'd just beheld. I'd never touch a drug again. I'd be a licensed hematologist-oncologist by now. I'd have a handsome husband, an adopted daughter. A comfortable home, proud parents. I'd be the kind of guy that other people could rely upon. I'm not sure if it's the withdrawal or my self-disgust that makes me puke now. As I wait for Wei to arrive with the medicine, I play a twisted game with myself. What wouldn't I do for opioids and benzos right now? Would I steal meds from a dying person, make his or her last moments more agonizing? If I did, how much would I bogey? One way or the other, his pain would be over soon. Sell the prayer card from my grandma's funeral service, which I've carried with me all over the world, one of exactly two possessions that mean anything (everything) to me? Would I get rid of it for a bundle? A bag? Half a bag? A rinse? F*ck a stranger in front of my fiancé and enjoy the sex more than I do with him? Make a false accusation of rape against a stranger? Against someone I know? I have become a substance-seeking slave, a revenant. It's not that I'm diminished; I have been returned . My soul squirms at the knowledge of what darkness it is capable of. I still don't see any bugs on or under my skin. That proves that I'm not hallucinating, which means that the spiders on the ceiling were real, I conclude. It makes sense. I've been picking up on something big and unusual these past few weeks. During conversations with deliverymen when they drop off food, neighbors in line for COVID testing, coworkers during WeChat video conferences, I've heard the phrase "he knows" again and again. Sometimes it's said to me directly, but more often it's spoken as an aside or directed at someone in the background. What is it that I know? When I look out the 14th-floor window to the triplet, megalithic apartment towers across the street, I see in their windows the outlines of 10 or more denizens looking back at me. They shift positions - one brushing her hair, another lifting her cigarette to her lips in profile. They open and close their shades in synchrony. When I catch a glimpse of myself in a reflective surface like the screen of my powered-down laptop, sometimes it's someone else who stares back at me from there, too. They're peripheral, fleeting impressions, gone as soon as I focus on them directly. I don't need the orifice-oracle to tell me that these are prepsychotic symptoms. Scratch the pre- , I revise. I keep wondering if I died during one of my overdoses. I have flashbacks of no fewer than four doctors telling me how lucky I am to be alive. How I have the highest blood level of X substance that they've ever seen in a non-corpse; how I seized for Y minutes straight; how I stopped breathing, and they were sure that I was gone. The thing is, maybe I really was gone. Perhaps China is a kind of hell for souls that aren't, at their core, evil, but who have massively, irrevocably fucked up. It makes sense. The unbearable heat, the indecipherable language, the jubilant Godlessness. Maybe the pandemic is happening because I started using again while I was here. Perhaps I'd been given a second chance when I'd arrived in China. I'd made good on it, at first, stayed away from benzos and opioids for the first year and a half. Had one of the golden times of my life. But in the end, yet again, I'd thrown it all away without much more thought than I'd put into flushing toilet paper. Perhaps now my perdition is being ratcheted up a notch, my punishment intensified. Whatever's going on, I have my ways to endure. Long before the pandemic, my life had become an apocalypse. Like Jesse Eisenberg's character in Zombieland , I have my rules for survival: Rule 1: Cardio (any way you can get it) Rule 2: Ample hydration, and at least one square meal per day Rule 3: Stay away from stimulants (Corollary 1: Thou shalt not suffer a tweaker) Rule 4: Step away from the psychosis I recite Rule 4 like a mantra. I know that I'm going crazy. It makes sense. *** The orifice gapes in surprise, mortification as my body goes rigid with a sudden surge of voltage. The devil's choreography commences: I fling my limbs outward and downward, clench my jaw, bellow a single-note bray as air is forced out of my chest. When I come back to consciousness, how can I be sure that I've had a seizure? When you fall asleep, whether for a catnap or a 14-hour mini-death, something inside of you is still monitoring, still recording. It tracks the outside world. The sounds and smells around you find their way into your dreams. When you wake up, you have a ballpark idea of how long you've been out for. This isn't like that. I couldn't tell you if I've been out for six minutes or six hours or six days. Truly. And it's not just that I can't identify the room that I'm in, initially; it's that I don't recognize that it's a room at all. Its geometry is abstract, nonsensical. The category "room" has not loaded yet, does not exist. For the past however long, I have simply disappeared. I've been in the realm of anti-time, where peace treaties conclude wars never fought and teenage lovers who died in prom-night car accidents have big, happy families together. The second, more obvious clue to my seizure is the blood smeared along the floor of the apartment. It leads to the front door, where, incredibly, the inner handle has been detached from the rest of the mechanism. Someone's broken in, I panic for a moment before I realize how absurd a conclusion that is. I lay back down in case another seizure is coming. The orifice-oracle is gone, but I don't need it to warn me about status epilepticus, the nonstop seizing that can kill you or worse, leave you a vegetable. My heart is still racing from the seizure, and underneath that, I am terrified by the prospect that I'm about to die. Fear of death is like this for me: I feel nothing as I push closer and closer and closer. Finally, I get close enough that I lose control. I might have gone too far; it might really happen. All of a sudden, that deferred fear comes due - principle, past-due payments, penalties. Plus, extortionate interest. It is its own kind of virus. *** One 45-minute eternity later, I pull on gym shorts as Wei arrives. He has a government job, which permits him some freedom of movement. Wei has the angular features and anatomy-chart musculature of an anime hero. He even has the spiky black hair on top, too. The first few times that I met him, his beauty awed me into awkward silence. Wei scans my face, then his eyes rove around the studio apartment until they spot the trash bag beside the bed. "My uncle didn't believe that these were for a friend - thought I'd become a drug addict," Wei remarks drily as he hands me the fentanyl patches that his aunt had been prescribed as she lay dying of ovarian cancer last year. Within the fiercely prideful, face-based Confucian family paradigm, this is a humiliation that will follow Wei for as long as his uncle is alive, I know. Drug addiction is to the Chinese what pedophilia is to Westerners. Wei is a true friend, almost a brother. I've spent holidays with his family in Harbin. I am not a true friend; if I were, I wouldn't have asked Wei to do this for me. There will be time for remorse later, I convince myself. How was I supposed to know that his uncle would react so harshly? American culture ain't so big on face, and I'm long past the point of hiding my desperation, anyway. I rip one of the transdermal fent patches open, snip the transparent square in half, and shove a piece of it under my tongue. "Try to space them out; I can't get any more," Wei reminds me. He scans my face again. He shakes his head slowly, side to side, a small movement. Before he leaves, he squeezes my shoulder. Probably because of how brutally competitive Chinese school and work are, Chinese people are friendly but slow to form friendships, in general. In most parts of China, calling someone a friend is significant; there's nothing casual about it. And once you have made a Chinese friend, he will walk through fire with you. But whatever sense of responsibility our three years of friendship have instilled in Wei has been discharged. Suddenly, I'm sure that I won't see him again. The fent patch still under my tongue, I pace the perimeter of the apartment. I drop for a set of pushups and crunches, but my body is too sore from days of withdrawal. Fent hits differently than other opioids. It is less euphoric, with a much heavier body load. Ordinarily, I hold it in contempt. Today, however, as an amount of fentanyl meant to be released gradually, over three days of absorption through the skin, enters my system through my oral mucosa in a matter of 20 minutes, it feels as though my entire body has been put inside one of those lead vests that they make you wear during x-rays. It is a quantum delight, a molecular massage. I groan, literally moan with relief as the knots in my muscles melt away, my breathing slows, a great warmth rises within me. I expect to fall asleep, but without the help of Ben or Barb, I can't. I find the journal that I've been writing in since my quarantine in Fujian. It's filled with entries, now, with Celtic patterns winding from page to page - intricate, woven motifs ending in dragons' heads and phoenix wings. There's Chinese calligraphy, too, around which I've sketched custom pictographs to help me remember the meanings of new characters. I've been worrying the past like an itchy wound. I'm preoccupied with identifying when I really, royally, irreversibly fucked things up for myself. Has my life been a game of chess that I was doomed to lose from the very first move? Every time I'm sure that I've seized upon a beginning, start writing from it, I discover another hurt or wrong that came before, contributed. It disgusts and agitates me, this idea that I can't find a point in my life at which, had I gone in a different direction, things could've turned out alright. It makes me feel more broken than I could ever explain. What I know with more clarity, though, is when things began to go wrong for me in China. But I don't feel like writing, now. Instead, I lay back on the bed, which still stinks of withdrawal, with the full bag of puke next to me on the floor. I should throw it out, I know, but in this moment, it feels like an absurd achievement. It doesn't take me long. My breathing slows. My eyes flutter shut. I allow myself to drift. The quintessential Hong Kong side street, filled with smells decaying and divine. I don't remember which neighborhood I took this in. "Mr. Brian, could you come in to see Dr. Liu today?" It's the international clinic that I get most of my benzos and opioids from. "My appointment's not 'til tomorrow." "Dr. Liu wants to see you today. There is some trouble in Hong Kong," Cindy explains. "Dr. Liu is afraid that, if there is a lockdown, he won't be able to come into the office later this week." Four minutes later, I hop into a Chinese Uber, called a Didi . The service is so efficient that it seems unreal, like the taxis are an extension of myself. I will never, ever tire of riding through Shenzhen. The city is one enormous, chrome-and-glass cathedral of productivity, prosperity, late-night dreams realized through countless early mornings. I have a sense about my adopted city that I can't really put words to. It's as though all of the parks and shopping malls, the corporate skyscrapers and towering residential complexes - even the trailer homes for migrant workers and the rectangular, blue-and-white police stations found at orderly intervals - are linked together by some huge, invisible superstructure, an unseen rigging that coordinates the movement of every component of the metropolis into its future. I gaze out the window, searching for signs that anything is amiss. It is August of 2019, four months prior to the pandemic, and the pro-democracy protests / riots (depending on who is talking about them) have been going on since early spring. Decades after the UK relinquished control of what was once the prize jewel of the British colonial diadem, Hong Kong falters in a political liminal zone. It has its own government; special financial regulations, including its own stock market; and many other privileges not accorded to any other Chinese region. Originally, Mainland China had signed an agreement with Hong Kong to fully reabsorb it into the rest of the country by 2050. However, the merger is progressing more quickly than promised and certainly more quickly than the Hong Kongese are comfortable with; they understand the loss of culture, liberty, and diversity entailed by the CCP's assumption of control. Carrie Lam, Hong Kong's Chief Executive, has seriously underestimated the level of unrest fomented by recent laws allowing extradition of Hong Kongese to the Mainland Chinese judicial system. Any Hong Kongese citizen who speaks out against the CCP can now be handled by the puppet courts of the Mainland, where a minister once referred to the idea of an independent judiciary as a "Western fallacy." In the Mainland, political prosecutions have already been used against dissenting government officials, human rights attorneys, and intellectuals, several of whom have reported torture. One formerly critical blogger is released from incarceration after making an Orwellian pledge "to devote the rest of her life to encouraging the Chinese youth by writing about the Chinese Dream." A small group of Hong Kongese have decided that this is the moment to press for independence, for democracy. The rest of China, both Hong Kongese and Mainlanders, as well as most of the rest of Asia, recognize them as insane, but it doesn't prevent them from organizing protests in public parks and on rooftops. "Five freedoms, and not one less," they chant as they face off against riot police who arrest them in great roundups. The withdrawal of the extradition bill is one of the five freedoms. The protesters also demand an independent inquiry into the use of force by the police and the release of everyone arrested in the course of the demonstrations. They argue for greater Hong Kongese autonomy. Amnesty International lends its support, and the protests get ample coverage throughout the Western world, whose governments are eager, as always, to depict the CCP in the worst possible light. Although Chinese social media contains videos of PLA tanks advancing toward the Shenzhen-Hong Kong border, I don't see any signs of chaos during the 35-minute drive to the clinic. The face of Shenzhen, like the expressions of its denizens, is placid. However, most people understand that the riots are a portent, a symptom of a wider disease. Almost from the time that I arrived in China in 2017, President Xi began instituting measures that reversed decades of economic and social liberalization. He has violated the two-term limit that had been in place since Chairman Mao infamously botched his political affairs during his geriatric years. Xi has committed to social conservatism, reduced foreign economic and cultural influence, wealth redistribution. He is a neo-Maoist, which means that he dwells with fondness upon the days that older Chinese still have nightmares about. The Chinese people have existed under imperial rule for thousands of years, but this is a lot to swallow, even for them. The protests in Hong Kong have begun a new scene of the first act of Xi's show; Act Two, it is widely believed, will involve annexation of Taiwan. As hearty palm trees and endless, perfectly manicured hedges fly by, I consider the prospect of martial law in Shenzhen and Hong Kong. I remember the face but not the name of a middle-aged black woman who I was in rehab with in Florida. This woman had the voice, manners, and wardrobe of a bank manager. She was facing 15 years in federal prison for heroin distribution. "I remember when the plane hit the first tower," she recalled of 9/11. "The first thing I thought was - I gotta get across Brooklyn for a pickup today. How the hell is that gonna happen?" Cindy, the clinic's receptionist, gives me a friendly wave. It's an ongoing joke that the clinic is opening a new branch in another district of Shenzhen thanks to my patronage. I sometimes spend upwards of 2K or 3K USD a month on alprazolam, clonazepam, and a Chinese Percocet called Tylox, which is frying my liver. Most of the patients in the waiting room are diplomatic staff, foreign teachers, businesspeople and their families. But there are a few who I sniff out as fellow drug seekers, their dilated pupils, familiarity with the clinic's flow, and eagerness to see the doctors giving them away. Dr. Liu knows which kind of patient I am. He's pissed today. He's a miniature guy in his mid-30's, but his facial features and expression are distinguished, almost noble. You'd instantly mark him as a lawyer, a doctor, a professor - some sort of high-powered, cerebral consigliere . Dr. Liu teaches at Hong Kong University Hospital, and, like most of the doctors in these international clinics, he moonlights here for extra income. "This Tylox dose, frankly, is getting ridiculous," he begins. I mangled my left arm badly in a drug-fueled car accident years ago. These days, the injury is my golden ticket; my entire elbow has been reconstructed with titanium hardware with prongs like a garden-weeding implement's. It doesn't trouble me a bit, but it's a reasonable justification for taking opioids. The surgeon who performed the procedure had given me a helpful heads-up that after a few years, sometimes the hardware has to be removed or repositioned as the body's healing forces it out of place, causing pain. I mention the pain so often these days that I imagine I can almost feel it, sometimes. "The pain's been badly, lately," I offer halfheartedly. "I've been typing a lot for work." "Scale of 10?" "Maybe 6.5 to 8," I reply. Don't drug-seek, please. But if you do, don't ever rate your pain as a 10 / 10. If you ever feel a 10, you won't have the ability to speak. Honestly, 9 is a little obnoxious, too. It screams, "I know the game well enough not to rate my pain a 10, but I'm a histrionic baby nonetheless." If I rate my nonexistent and thus unquantifiable pain a 6 or lower, on the other hand, Dr. Liu is liable to recommend a weaker medicine, maybe tramadol or dihydrocodeine. Six-point-five to 7.5 is a comfortable home range for a guy like me. Women can get away with higher numbers than men (lesbians lower than straight women; gays higher than straight men). "I don't think it's just pain that we're dealing with," Dr. Liu says. "Alprazolam doesn't have anything to do with pain, either." Dr. Liu is a good doctor. He knows the dangers of taking this many benzos and opioids. I know that he's afraid that I'll die of overdose, and, because I'm a foreigner, there will be an inquiry. I have a suspicion that Dr. Liu isn't just worried about covering his ass, though. In fact, I'm pretty sure that if I admitted what was going on and asked him for help, he'd work with me as I tapered down. He'd be relieved, protective, perhaps almost fatherly; he wouldn't care about his patient-based commission. I imagine a version of today's scene in which I agree to taper off of both groups of drugs. I have a pretty rich inner world, but this one is a stretch even for me. Next visit , I decide. If there were a Latin motto for the House of Brian, it would be Cras Semper Reformans , "Always Changing Tomorrow." Ten minutes later, the in-house pharmacy has my meds ready in this very chic little black-and-gold bag with a Commie-red bow on top. I recognize the auntie pharmacist, who once confessed to me that she takes Zolpidem (Ambien) for sleep. These under-the-breath disclosures are one of the things that I appreciate most about the Chinese; it's their way of saying, "I can judge you, but I can't judge you that much." "You have a red mark next to your name in the pharmacy computer now," she warns me. "You should give me more then, auntie! They're coming for me." She smiles despite herself. I picture myself through her eyes. For a second, my self-loathing lightens. Victoria Bay, Hong Kong, in blue monochrome (June 2018). Victoria Bay is a place that has a soul. On a clear summer day, the sea here looks more like the sky than the sky itself. It's such a perfect illusion that it makes me wonder whether I've sustained one of those brain injuries where your neural software stops correcting the upside-down version of the world projected onto your retinas, so that you're walking on the ceiling for weeks on end. Jay and I came here for one of our first overnight dates. We ate sushi so fresh that it made me feel like a sea creature, rode the giant Ferris Wheel, which boasts one of the most gorgeous vistas that I've experienced anywhere in the world. Part of the magic of Victoria Bay is its architecture. It's easy to forget, after a while, but most Chinese cities have virtually no buildings older than 30 or 40 years (at most). You might come across a small stone temple used for ancestor worship, a pagoda here and there, but in general, you've got to head out into the sticks to see any structure that stood before modern China. The result is a sort of cultural freefall; the phrase "unmoored in the now" comes to mind. Without the architectural reminders of history to act on the subconscious, the history itself fades away. Victoria Bay has grand, stone structures in the Greek and Renaissance Revival styles, the sort favored for American government buildings like capitols and courthouses. They date back to the 1800s, and they were once used for bureaucratic administration and storage of spices, tea, silk, porcelain. There are hole-in-the-wall dim sum  restaurants with songbird-like waitresses in bright, floral-patterned dresses next to American-style burger joints tended by tattooed Canadian biker chicks. There are British-style schools where orderly files of little Chinese kids wearing the distinctive British school uniform, complete with formal shorts, march by. I crave the rawness, the unrestraint of Mainland China, but Hong Kong has an elegant polish that most of the Mainland lacks. It's top-down British manners fused with high Cantonese culture and the worldly ways of a port that has seen, has been everything. Its people are cultured, tolerant, proud. Most of all, proud: They know that Hong Kong has an essence that can't be replicated anywhere else in the world. Victoria Bay is in ruins. If you told me that there is a civil war going on here, I'd believe you. On this street, there are as many broken windows as intact ones. There are chunks of pavement missing, and there is Cantonese graffiti, much of it difficult for me to understand because it is either slang or more similar to traditional Chinese than the simplified Chinese that I've learned in the Mainland. The fact that I can't understand the graffiti, but that the characters are vaguely familiar, uneases me; they're like sigils from a Lovecraftian dream. Cops, usually a negligible presence outside of Beijing, are conspicuously present everywhere . Some have on the heavier gear of riot police; a few are wearing camouflaged combat fatigues. When I was younger and I acquired a new, prized possession, invariably a book, it would ruin my day, just completely collapse me, when it sustained its first folded page, its first finger-smudge. I feel that way about Victoria Bay, now. Like it was a perfect thing that belonged to all of us, and now it's tainted, ruined. There are few other people walking the streets. The ones I do see move purposefully, businesslike. I try to picture myself through their eyes. I'm out-of-place in this National Geographic cover shot. I'm a waiguoren , a white ghost; I probably wouldn't even show up on film. I don't linger in Victoria Bay. No one would be in Hong Kong by choice today, with the riots and police roundups still popping up unpredictably, like herpes outbreaks. At the moment, I'm on a business visa, which means that I have greater freedom than someone on a work visa, but it also means that I need to leave Mainland China every 60 days. Hong Kong and Macao qualify as outside the Mainland for visa purposes, so once every two months, I make a token trip to Hong Kong. Under normal circumstances, it's a reason to explore, perhaps to engage in a little medical tourism. Under these conditions, it's a liability. Things are especially tense for foreigners these days, with rumors of Western governments funding and stoking the protests in Hong Kong. (In case you're not familiar with the playbook, this is the CCP's go-to explanation for any unrest in China, which could never, of course, originate with its own people). I'd intended to make my visa run earlier in the week, but on Monday and Tuesday nights, I'd worked until midnight. On Wednesday night, I passed out in an unfortunate position after too many pills and too much red wine; I'd cut off circulation and woken up with a right arm that wouldn't work for eight hours. Today, Jay had offered to come with me to the Luohu border checkpoint and wait while I crossed over. I check my watch as I reach the metro station. I've been gone just over 80 minutes. As I wait for the train to arrive at the sparsely populated outdoor platform, I notice a thin, weaselly man hurry through the doors that open onto the platform. His expression is panicked, his thin face a study in smudged charcoal. As he hustles along the platform, he looks over his shoulder. I trace his gaze as the two most physically intimidating Asian men that I've ever seen emerge through the doorway. The thin man, moving frenetically, trips as he turns his head to face forward again. He stumbles forward, catches himself on the heels of his hands. He flips over onto his back, then lifts himself up on his hands and feet, scrabbling backward on all fours while facing up as the pair of men pursue him. My first thought from their physiques and the way that they carry themselves is that they are police chasing a protester. They're wearing short sleeves, though, and I notice that both have ornate tattoos along their upper and lower arms. The man on the right has green and black ribbons that slither from his bulging biceps down around his forearm. These men are not cops. There is something menacing about them; they are thugs of a sort that I've never seen in China. The man who is trying to get away takes advantage of another passenger opening the second set of glass doors on the far side of the platform; he stands, still facing backward, toward the two men, and skitters through. The big guys follow him through the doors after what feels like only a second or two but must be longer. They don't run, but their strides are powerful, purposeful. I don't realize what I've just seen until three weeks later, when I read a Hong Kongese blog published anonymously by one of the groups of protesters. It alleges that the Mainland government has contracted with the Triads, the notorious, highly-organized crime gangs of Hong Kong and Guangzhou, to do their dirty, violent work in intimidating the protesters. As with most Asian gangs, a sophisticated language of ink communicates individual identity and group affiliation. I try to find information about the tattoos favored by different Triad organizations, but I come up dry. Nevertheless, I'm almost certain that what I saw that day was two Triad gangsters going after a protester. Again, there is something that stays with me about the scene, a déjà vu suggesting that I'd dreamt it before I watched it happen. The same feeling creeps up on me when the pandemic finally arrives in December; it is expected, a garbled prophecy fulfilled, almost a relief. *** The line at the Luohu customs checkpoint is much shorter than usual. It's around 6:30 p.m., when Mainland commuters are returning home for dinner and students from HKU and several other Hong Kongese universities are heading into Shenzhen and Guangzhou for some Friday-night fun. I message Jay to let him know that I'm crossing back over. In three or four minutes, I've reached the window, where a fresh-faced customs agent scans my passport. I know that it must look odd, a foreigner crossing over for an hour or so every few weeks, but I remind myself that I could've been in Hong Kong for any number of legitimate scholastic, business, or adulterous purposes. It happens quickly. The agent types something into his computer, reads the screen, and picks up his phone. He says something short, which I don't understand, in a discrete tone. Maybe 45 seconds later, a late middle-aged man with a supervisory air arrives. He speaks to the agent behind the counter, who translates for him. "Go with him, please, sir." The supervisor leads me to an elevator, where we go down rather than up. I count the floors: Sub-one, sub-two, mind blank like it's a meditation exercise. At this point, I have a strange Bell Jar moment. As the elevator descends, I'm conscious of my life as a funnel. It starts out wide open, full of every possibility, and then narrows ineluctably until I am spit out at this moment - the singular, inescapable present. The elevator opens onto a nondescript hallway with doors along one side. They could lead to anything - bureaucratic offices, medical examination rooms, torture chambers. *** At this point, Dear Reader, I wouldn't blame you if you've questioned whether I'm always a reliable narrator. In fact, God bless you, you sweet summer child, if you haven't. But if you believe only one part of this whole saga, let it be this passage that follows, please. Some of the doors along the left wall are open. I can see tight, fluorescently lit rooms with small tables and generic office chairs crammed into them. They contain no desks, no whiteboards, no office supplies or personal effects. Two people could occupy a single room cozily, three would be a crowd, and four would necessitate a game of Twister. These rooms bear an uncanny resemblance to the ones where suspects are questioned in American police stations. The man leading me down the hall, who walks beside and half a step behind me, ignores the empty rooms. We pass one room, then a second. He guides me into the third room, which is configured differently, I notice at once. It is empty save for a low bench that is attached to the back wall. I sh*t you not: The entire room is covered in blue-green, felt-like padding. Bench, walls. That's it, actually - no chairs or table here. The supervisor speaks to me in Mandarin that is hard for me to understand, but I get that he's mentioning my cell phone. I take it out and hand it to him, but he simply places it on the bench, three feet to the right of where I've taken a seat. He makes a hand motion to convey that I'm not supposed to use it. He asks for my passport, the only word that he says in English, and leaves the room with it. The door, whose interior surface is also covered in padding, remains open. For now. Thank you for reading! Part IV (Epilogue), which covers the mid to late pandemic, will follow soon.

"In prosperity, our friends know us; in adversity, we know our friends" John Churton Collins I've never lacked for friends to have a good time with. In fact, especially after moving abroad, I've often taken on the role of social organizer. During my darkest periods of active addiction, however, I felt completely alone. I had almost no one to turn to. The handful of people who really are there for me - for life , whether I'm doing well or not - are miracles to me, gifts of the highest order; all of the purple-prose praise in the world isn't enough to express what I think of them. My generation, the much-maligned Millennials, were the original Generation Diagnosis. No one had typical teenage trouble focusing; everyone had ADHD, which required powerful psychostimulants, testing accommodations, and more. Quotidian stresses and worries became Generalized Anxiety Disorder, and the sort of piquant melancholy that creeps up on all of us from time to time was mislabeled as Major Depressive Disorder. As with many social trends that started in my generation, the Zoomers seem to have taken this one and run with it. The population prevalence of Dissociative Identity Disorder seems to be around 72% (if Tumblr and Tik Tok are any indication). Some Gen Z kids collect rare mental health diagnoses - "my friend the schizophrenic," "my friend with bipolar" - like particularly desirable Pokémon. (Just imagine when the pre-psychotic Charmeleon evolves into the psychotic Charizard!). Part of this, I know, is the naivety and exuberance of youth. In my experience, young people truly do support their friends through mental health crises with admirable loyalty and optimism. Unfortunately, a lot of this rides upon them not understanding the true nature of the adversary, which becomes clear only with time. Protracted, difficult, repetitive, wearying time. Mental health issues have been destigmatized in the sense that psychological problems are discussed more openly, people are encouraged to get treatment, and treatment is more accessible. In terms of accepting the seriously mentally ill into mainstream society, however, I would argue that we have made little, if any, real progress. De-institutionalization does not equal integration when the chronically mentally ill end up homeless on the streets or living threadbare, hermitic lives in Section 8 apartments where their only visitors are social workers. I'm developing another layer of appreciation for this fact now that I'm in my 30s. At this point, I can read the disappointment and exasperation in the faces of friends and family when they hear that I'm back on maintenance, which means, to them, that I'm still struggling with addiction: He hasn't grown out of it yet? God, he's still doing that to his mother? These kinds of perceptions are particularly rough for addicts because A) we're judged more harshly for our disease because people believe that it involves choice, that it doesn't "have to" exist in the same sense that bipolar disorder or schizophrenia does (this despite the fact that all of the genetic and neurobiological evidence runs to the contrary), and B) people believe that we're using because we selfishly "enjoy it" and "get something out of it" (this despite the fact that while, yes, using drugs is sometimes pleasant, once you reach advanced addiction, it's about avoiding severe sickness more than it is experiencing any positive state - plus, the negative physical and psychological consequences are so soul-sappingly awful that they far outweigh any fleeting pleasure; no one in their right mind would choose this, not ever ). Treatment professionals who specialize in opioid addiction are starting to talk about recovery as a cycle, with intermittent relapse as the norm rather than the exception. Based on my own experiences and observations, this seems on point. The cyclical nature of addiction, too, is the rule rather than the exception. After all, most problems in life don't follow the three-act structure. How many people lose / gain weight or struggle with relationship issues or financial management problems only once? Most of the great struggles of life are lifelong. They manifest in different forms during the various seasons of our lives. Many people have the desire and the internal resources to support a loved one through a one-and-done bout with depression or severe anxiety. Some people might even stand by a friend who is exhibiting "serious" craziness - who mentions being surveilled by mysterious forces or who calls them during a manic episode talking a million miles a minute about exciting new business ventures. Once people realize that mental health problems are here to stay, however, they vanish with astonishing rapidity. Everyone wants that successfully recovered friend, whose hard-earned wisdom and strength of character benefit everyone around them, but very few people have the patience and fortitude to stand by and support a recover ing addict; the gerund is a dealbreaker. Few can abide the presence of a struggling mentally ill person in their lives. In some ways, it's almost crueler that we're encouraged to speak about mental health issues more openly these days. Those of us who take the plunge and disclose our darkest thoughts and struggles - unaware that we're crossing tacit social boundaries in opening up about profound, long-term problems rather than short-term, situational ones - might receive some shallow accolades for our bravery or perseverance, especially at first. But that certainly doesn't mean that our phone rings when we need it to (or that the person on the other end of the line answers when we call). I understand that people have careers, kids, creative projects, their own struggles - prosaic and otherwise. They're scared; they don't know what to do; they don't want to make it worse. The funny part of it is that I, like many mentally ill people, practice a policy of strict self-quarantine. My good "normie" friends know that I don't expect or want to dump the baggage of my addictive struggles on them. As I emphasize to them, I want us to enjoy our precious moments together as purely as possible - to form new, positive memories regardless of whether I'm impaired, in withdrawal, or feeling strong in recovery at the moment. As is often the case in life, so much of this dynamic is guided by fear rather than reality. When it really comes down to it, for those of us with mental health diagnoses like addiction, which have lifelong ramifications - severe ones that generate a complicating layer of trauma through the years - I'm not sure that we've made much societal progress at all. *** I guess it's always been this way. The older I get, the more I appreciate the true, sometimes staggeringly steep cost of the social contract that allows us to enjoy such shiny, technologically advanced lives (although unprecedented anxiety, unhappiness, and lack of fulfillment underly that enticing facade). The many enjoying a higher quality of life seems very often to be contingent upon a collective disregard of the abject suffering of the few. Maybe it's how things have to be. Still, we're more than ever running the risk of creating at a societal level the sort of hell experienced by profoundly dysfunctional families that appear "aspirational": the kind of reality where everything seems perfect, and everything is awful. Follow-up: After I posted this, my friend Rose, who is a brilliant epidemiologist, artist, and social leader, sent me an article about the experience of Maslow - of the famous Hierarchy of Needs - among the Blackfoot (Siksika). Maslow himself said: " 80–90% of the Blackfoot tribe had a quality of self-esteem that was only found in 5–10% of his own population." He described a society in which the wealthiest gave away all of their superfluous possessions in yearly ceremonies; in which justice was restorative and people were truly forgiven after they left behind hurtful ways; in which children had their creativity fostered and were treated permissively and with great respect. This reminded me of a passage from Howard Zinn's The People's History of the United States . In general, Zinn is careful not to look too rosily upon the "primitive" societies that existed prior to Western colonialism. He notes, for example, the dependence of the slave trade on African tribes' violence against each other. He is also careful to acknowledge the realities of starvation and poor (or no) medical care in early societies. However, when he is discussing the Iroquois Nation - who inhabited the land that I live on now - Zinn notes that they were a uniquely at-peace-with-themselves people who seemed to have achieved an existence of physical and spiritual abundance that was interwoven with the rhythms of their land. He cites several examples of Westerners who ended up living with the Iroquois for some time, then declined to reintegrate with Western colonists when given the chance; in parallel, Iroquois children who ended up spending part of their youth with Western colonists, but who had been raised among the Iroquois long enough to remember what life was like for their tribe, almost invariably returned to the Iroquois when they had the chance. Life doesn't have to be so brutal. People who came before us have done it better than we are now. As I often note, the United States incarcerates more people per capita than any other nation on Earth - save perhaps North Korea. How can we call this a successful society? No wonder we're all getting f*cked up all the time. We've reached a point at which the shiny facade of progress is being eaten away by the acid rain of the consequences that we've long ignored and averted. We're beginning to see and to sense the true cost of achieving a very specific, exclusive, and shallow vision of advancement. No matter how bad it seems, though, it's always important to keep hope. The only thing standing between us and systemic change is ourselves.

Why I believe that the mythical state of "pure" opioid dependence is really just a prelude to or a less severe form of opioid addiction. As I touched on in my piece on warning signs of prescription drug addiction , some doctors like to draw a line between drug dependence and drug addiction. Someone taking insulin for Type 1 diabetes, they observe, is dependent upon it. They must take it every day, and they cannot function without it. However, they are not addicted to their insulin. They don't crave it, obsess over it, raise their dosage. They don't do dangerous things to obtain it or while under its influence. That's all well and good for insulin; it's not an addictive, dopamine-releasing drug. For drugs like benzos and opioids, which are physically addictive and trigger potent blasts of feel-good neurotransmitters in the pleasure centers of the midbrain, the story is very different. For these latter types of substances, I believe that this mythical dependence versus addiction dichotomy is a convenient fabrication, a distinction without a difference. *** One measure of how addictive a drug is uses the percentage of people who are exposed to it who become addicts. The higher the percentage, the more addictive the drug. By this metric, opioids are one of the most addictive drug types, which is why moderate to strong opioids have always been classed as Schedule II Controlled Substances in the U.S. - the most restricted class of drugs that have a recognized medical purpose. When you take opioids regularly, they change how your Central Nervous System's pain receptors work. (For my review of mu opioid receptor dynamics, which covers tolerance and dependence as well as affinity and precipitated withdrawal, click here ). At first, opioids mimic the action of endorphins - those "endogenous morphines" that your body produces to lessen pain and reinforce behaviors that support survival and reproduction. Thus, you feel a boost of euphoria and a reduction in any pain you might be experiencing. With regular use, however, this system comes to anticipate and depend upon these external painkillers. To maintain balance, your body decreases the sensitivity of its opioid receptors, and it also reduces its production of endorphins. At this point, your body has become dependent on whatever opioid you are taking. You won't feel mentally or physically well without it. Should you stop taking the opioid, you will experience a great resurgence of pain - not just the pain that you originally had, which led you to take the opioid in the first place, but all kinds of pain all over your body (in addition to anxiety, insomnia, GI problems, and the other symptoms of opioid withdrawal). In fact, you don't even need to stop taking your opioid of choice to experience these symptoms; this will happen naturally over time as you build tolerance due to the aforementioned adjustments that your body makes to maintain balance when the drug is being ingested regularly. Tolerance, as well as burnout of the body's pain-blocking pathways from too-frequent stimulation by opioid drugs, lead to an increase in pain called opioid-induced hyperalgesia. The drug that you began taking to mitigate pain is now causing it. Unfortunately, the only way to avoid these negative consequences of regular opioid use is to increase your dosage or switch to a more potent opioid. *** As you take opioids for weeks and months, your psychology begins to change, as well. You begin to monitor your level of physical comfort or discomfort more closely. You become hyperaware of small changes in your pain levels. Just as regular stimulation of the opioid receptor system leads to hypersensitivity to pain because the natural mechanisms for counteracting it stop working, regular bombardment of the midbrain pleasure centers with levels of dopamine that exceed those naturally produced by your body leads to its built-in reward and pleasure pathways being underactive. You begin to measure pleasure against that unfair, preternatural level of dopamine release from opioids rather than against those produced by food, sex, exercise. Naturally, you begin to crave that enhanced feeling of pleasure and to feel blah without it. As a result of these changes, you dwell more and more on when you can take that next dose of your opioid. When you do, the pain relief and euphoria that you experience becomes more important, more reinforcing. It begins to feel necessary. Should you have a bad day, or maybe a few bad days in a row, the temptation to take an extra dose or two - "just this one time," of course - becomes overwhelming. When you eventually do the human thing and give in and take a little extra, you have one foot over the threshold into full-blown addiction. The next time that you encounter a rough patch of anxiety, depression, or situational stress, you can bet your bottom dollar that your brain is going to remember and turn to that pharma hack that worked so expediently before. An example of the type of prescription opioid discussed in this article. These original formulation OxyContin pills, which contained 40 milligrams of the highly potent opioid oxycodone, played a major role in instigating the opioid addiction epidemic in the United States. Their extended-release coating did not work, meaning that the entire dose was released into the user's system almost immediately. This coating could also be wiped off with a damp cloth, meaning that the pills were often ground up and snorted or injected. The high from taking one of these pills was equivalent to snorting two to three bags of high-purity East Coast powder heroin. As I've written about elsewhere, OxyContin was so prevalent during my high school years (2003-2007) that kids would be walking around social events with golden smears on their clothing from wiping the extended-release coating off the pills. Appallingly, there were also an 80-milligram and a 160-milligram formulation originally on the market; despite Purdue's incredible political influence, which it bought with the billions of dollars in OxyContin profit, these ultra-high-dose formulations were withdrawn from the market relatively early on because they caused disproportionate numbers of overdoses (shocker, I know). If you ever need an example of true evil, look no further than the Sackler family that owns Purdue. After Purdue fought for years to conceal or contradict evidence that OxyContin was highly addictive and malfunctional, the United States' Food and Drug Administration (FDA) forced Purdue to reformulate OxyContin to make it truly tamper-resistant and to ensure that its extended-release mechanism worked properly. Despite this history, to this day Purdue continues to market the original formulation of OxyContin in China and other countries (it's easy to tell because the original formulation pills are marked "OC" and the reformulated ones are marked "OP"; plus, the original formulation has a coating that is wiped off very easily with water and is easily ground up, whereas the new formulation is a waxy mess when you try to grind it up, and its coating cannot be removed with water). I obtained the original-formulation, 40-mg pills in Shenzhen, Beijing, and Guangzhou, where Chinese doctors commented on how many foreigners showed up looking for them. I've said it before, and I'll die on this hill: Those Sackler family members who were directly involved in Purdue's operations during the OxyContin epidemic deserve to face criminal prosecution. Reading their emails, which were released during the discovery processes for the many lawsuits brought against them, was one of the most sickening experiences of my life. *** A responsible doctor won't prescribe opioids indefinitely. He or she knows that there is no winning move in the chess game of chronic pain management with opioids, so he or she will A) advise procedures that target the source of the pain rather than masking it; B) recommend Cognitive Behavioral Therapy , mindfulness exercises, and other effective psychological tools for reducing pain; and C) switch to less addictive or non-addictive painkillers, which also pose less risk of overdose and will not cause withdrawal when stopped. My life has provided me with a behind-the-scenes look at pain management medicine. In my experience, ethical doctors would be absolutely appalled by how many apparently "good" pain management patients, the ones who seem stable, are running out of their meds early, buying supplemental meds or other drugs on the street, or are hitting up friends and relatives with similar prescriptions. Their patients will go to shocking lengths to conceal their addictions because their supply of the drug that they are addicted to depends upon it. *** Now, not all of those opioid-dependent patients necessarily meet the criteria for a diagnosis of drug addiction under the current definition. We have a functional definition of addiction, meaning that impairment in one or more areas of life due to drug-taking is necessary to diagnose addiction. Some of these opioid-dependent patients are able to mask their craving, obsession, and dose escalation for months or even years. They hide their loss of function - missed days of work, impairment on the job, social withdrawal - behind whatever diagnosis is responsible for their chronic pain. I have been in addiction treatment with many such individuals, whose spouses and children were floored to learn that there was no money to pay the monthly mortgage because mom or dad had secretly spent all of the family's savings on pills (it's also common for prescription drug addicts to rack up tens of thousands of dollars of credit card debt through online pharmacies and doctor shopping, which their spouses and friends / family are clueless about). *** Again, if opioid-dependent patients seem out of sorts, at times - shaky, sweaty, unable to work or even get out of bed - of course they do; they have chronic pain. If they seem a little groggy, a little loopy at other times - of course they do; they're being treated for chronic pain. And who could be so cruel as to suggest that they stop taking their opioid medicine? After all, it's the Only Thing That Works ™. Addicts are consummate deflectors and deniers, and in this scenario, they have been given the ideal shield. *** In the United States, there are entire lobbies for patients on opioids for pain management, which fight any legislation that restricts the prescription of opioids. This explains why it took so long for the U.S. to curb the prescription of OxyContin, a heinously addictive, high-dose formulation of a high-potency opioid whose extended-release mechanism was malfunctional, meaning that essentially the entire dose of the drug was released into the user's system at once. OxyContin led to millions of addictions - hundreds of thousands of drug overdoses - tens of thousands of cases in which people who could no longer get pharmaceutical opioids turned to heroin and fentanyl (I wrote about this domino-like succession of addictions here ). As casualties mounted, Purdue, the Sackler family-controlled pharmaceutical company that created OxyContin, paid doctors to come up with sophisticated excuses for why the drug was wreaking such havoc. One of these doctors, who has since acknowledged that his theory was the result of motivated reasoning - utter b*llshit contrived to make a ghastly high consultant's fee, in layman's terms - came up with a brilliantly evil explanation for why so many OxyContin patients came to their doctors requesting higher doses of the drug or to be able to take it more often. (Those same patients were often "losing" their prescriptions, running out early, and so on). Purdue explained that such patients were experiencing pseudoaddiction , a phenomenon in which patients seem be drug seeking because their pain is undertreated, leading them to ask for more of the drug, more often. What was the solution to pseudoaddiction, you wonder? More OxyContin, of course. It is a shocking testament to the credulousness or indifference of doctors who studied pharmacology for 12+ years of postsecondary education that they believed and repeated this balderdash from pharma reps. Needless to say, there was nothing "pseudo" about pseudoaddiction. The FDA has finally acknowledged the reality of opioid addiction risk. It is becoming nigh on impossible to obtain a long-term prescription for opioids (unless it is for PRN, "as-needed" rather than daily use). This is exactly how it should be because opioids are not effective with regular use. In fact, not to beat a dead horse, but they actually increase pain when taken regularly for extended periods. These revised FDA guidelines are in line with how most other countries' medical systems use opioids, within which they are almost exclusively administered during surgery and end-of-life care. Needless to say, patients in these countries are not being tortured out of their minds with untreated post-surgical and chronic pain. There are more effective options, albeit ones that sometimes require a bit more work on the part of both doctor and patient. *** I'll end with an analogy involving a much more common and less-addictive drug: alcohol. If someone has one drink in the morning, two drinks at lunch, and four to six drinks a night, every night, for months or years on end, what do suppose are the chances that that person will end up with a healthy relationship with alcohol? Taking opioids daily for chronic pain is an analogous situation. In my opinion, dependence is a state of pre-addiction, early addiction, or hidden addiction. And it's not just opioids that this dependence-vs-addiction distinction is invalid for. The same arguments advanced above in regard to opioid dependence and addiction also apply to benzos and perhaps even addictive stimulant drugs like amphetamines and cocaine. I focused on opioids simply because their mechanism of action means that craving / obsession and tolerance / dependence set in with particular vehemence and relatively early on. Nearly anyone who becomes physically dependent on opioids is eventually - and often quite quickly - going to become addicted to them. Addiction is simply the psychological and behavioral manifestation of the way that the brain's physiology adjusts to the regular presence of these drugs. Let's put this dependence versus addiction dichotomy in the trash along with pseudoaddiction and all of the other bogus science funded by pharmaceutical companies hell-bent on protecting their right to poison people with highly addictive and damaging substances. Bold Brian updates: I'm focusing on finishing the "Last of the Laowai" series about my time in China (Part II here ) before school is in session. I was hoping to have Part III ready for publication this weekend, but it turned out to be longer than expected, and I don't want to rush it. It'll be out within the next few days, though. My methadone taper is going - uh, about as well as a methadone taper can go. I'm pushing the dosage down fairly quickly during the last couple of weeks of summer vacation because I can "afford" to be sick right now. I've definitely experienced a spike in drug dreams and cravings during the last month, which is something that I'm paying attention to. The good news is that I'm starting to realize some of the benefits of tapering off of such a powerful opioid. I've experienced a surge in creativity and energy in general lately, which I've used to write and edit. The downside of that is protracted, severe insomnia, so I've been walking and running eight to 12 miles a day to try to exhaust myself enough to get four to six hours of sleep per night. Overall, I'm feeling okay and very committed to being off of maintenance. Thank you to everyone who has expressed support. Be well and enjoy your summer!