Punishment Versus Compassion

Punishment Versus Compassion

An idea that Johann Hari explores in his book Chasing The Scream is that people with drug addiction need family and community support to get through their addiction, not punishment and castigation. Throughout the book Hari asks why people develop addictions, what do people do when they successfully get past an addiction, and what structures and systems work against recovery?

 

Early in the book Hari references a conversation he had with pastor and civil rights activist Eugene Callender about singer Billie Holliday. Hari writes, “Callender had built a clinic for heroin addicts in his church, and he pleaded for Billie to be allowed to go there to be nursed back to health. His reasoning was simple, he told me in 2013: addicts, he said, are human beings, just like you and me. Punishment makes them sicker; compassion can make them well.”

 

Hari argues that community is the cure for drug addiction. He sees drug addiction as a consequence of trauma, pain, depression, adverse experiences, and a loss of a sense of togetherness. When people are isolated and don’t truly feel as though they are part of a larger community where they belong and where their lives and actions matter, then people can’t take personal responsibility, they can’t work for more, and they often turn to drugs to blunt the pain and fill the empty voids. What this means, is that addiction is a consequence of everyone’s selfish actions, it is not just a moral failing of the individual. Consequently, we all have a role to play in the recovery of those in our communities dealing with addiction.

 

What Reverend Callender noticed, as highlighted in the quote above, is that people dealing with substance addictions need support and guidance to get through their struggles. People turn to drugs in times of pain when they feel something lacking in their lives. Taking more away from them, limiting their ability to interact with a community, and pushing more challenges at them only worsens the underlying psychological stress and trauma that drove them to addiction in the first place. Punishment is harmful, whereas compassion and forgiveness is what gives people a second chance and encourages them to improve their lives. If we don’t treat people facing addiction with dignity and respect, can we ever expect them to treat themselves with the dignity and respect needed to overcome addiction?
Health Care Supply

Health Care Supply

Dave Chase makes an argument in his book The Opioid Crisis Wake-Up Call that healthcare has a substantial supply side drive, not just a demand side drive. This argument doesn’t align with standard pictures of healthcare, the idea that people seek care when they are sick, and don’t use care when they are well. Its troubling, but evidence does support the idea that the healthcare market is in some very important ways a supply driven market, meaning that as supply and capacity increases, demand also increases.

 

I’m not completely sure I understand this idea, but it is important for us to acknowledge and think about, especially if we live in growing cities, gentrifying regions of the country, and areas of the United States that have real opportunities for reinvention. When looking to the future of healthcare in the United States, Chase includes many elements from Bruce Katz and Jeremy Nowak’s book The New Localism and thinks there is an important role for new models of city and local government to play in shaping local healthcare ecosystems. He is also heavily influenced by Jim Clifton’s book The Coming Jobs War and the importance that local communities invest in sectors that are likely to be highly productive in the future. Chase writes,

 

“Sooner rather than later, we can expect other developments along the same 3.0 spectrum [More info on Economic Development 3.0 here]. Cities will incorporate true health needs into mater planning and review building permit applications with a deep understanding that health care is a supply-driven market. The more supply there is, the more demand will increase, with little regard for value and community well-being. Approving more health care build-out virtually guarantees a massive burden on local citizens.”

 

It is important that we think about what it is in healthcare that actually provides value. If simply adding more healthcare capacity will lead to greater demand and utilization, then we need to take steps to ensure that an uptick in services is actually accompanied by improvements in health. When communities are redeveloping and growing, they should be focused on upstream social determinants of health rather than just hospitals and healthcare service buildings. Designing communities that will have ample green space for outdoor activity, that will control noise, and will have well lit parks and outdoor areas will help build healthy communities. Plopping a hospital in a space that doesn’t include these elements might give people a place to go when they are stressed, overweight, and injured by debris in the streets, but it will not help people actually live healthier, it will capitalize on a broken environment that fails to support health.

 

I think that is part of the idea that Chase argues for. We should maintain the healthcare capacity and services which actually improve health, and we should be weary of systems that provide healthcare but fail to demonstrate real health improvements for citizens and communities.
Harris Rosen's Program to Invest Locally

A Program that Invests Locally

Harris Rosen runs a hotel chain in Orlando Florida. He has eight hotels in total, and his company does something almost no other companies in the country do. They provide real, meaningful healthcare services to their employees. They save a ton of money on healthcare by actually providing more of it, and better quality services at that. With the money Rosen saves on healthcare, he has developed programs in a neighborhood called Tangelo Park in Orlando to ensure children can attend school, get support to graduate from high school, and attend college on scholarships provided by Rosen.

 

Dave Chase writes about his efforts in his book The Opioid Crisis Wake-Up Call, “The cost over 24 years of the Tangelo Park program has been $11 million – roughly the amount Rosen saves in one year on health care. … For Harris Rosen, the approach is simple: Get involved; care for your people.”

 

$11 million is not a small amount of money, but what Rosen’s example shows is that you don’t have to be billionaire to make a meaningful impact in your community. $11 million is not an unattainable sum for many companies, communities, and philanthropists who want to make real changes. Mayor Bloomberg spent $500 million on failed presidential election campaign, money that could have helped almost 50 Tangelo Park neighborhoods.

 

What is important to see here, is that we can actually provide people with more healthcare, better preventative services, and easier access to good healthcare to save money in the long run. Money that could be invested back into the communities where it can have the greatest impact. Reducing crime means more savings for local communities by reducing resource demands for policing and jails. Improving education achievement means more people have the tools they need to grow and pursue the American dream. Improved health for employees means they are more productive and live happier, healthier lives.

 

We don’t make these kinds of investments for lots of reasons in the United States, but Rosen shows that we can. We are spending the money that we could use for these programs, but we are spending it in the wrong areas. If we looked critically at where we put the money, and where it could go to actually improve lives, then we could really make a difference in our communities and our countries. It starts with caring for people, helping them to become their best, and encouraging our communities to build together.
Addiction and Community

A Final Thought on Addiction and Community

In the afterword of his book Dreamland, author Sam Quinones includes a quote from an obituary written for a 24-year-old man who lived in Avon Lake, a town of about 24,000 people just west of Cleveland. The parents of the young man who died from addiction wrote in their son’s obituary, “They say it takes a community to raise a child. It takes a community to battle addiction.”

 

Everyone, including those of us who are not parents, know that it is true when we say it takes a community to raise a child. Historically, new parents have been in their early to mid twenties (this is changing now – possibly for these communal reasons), and with lower incomes in early stages of their careers and fewer immediate resources, new parents have relied on family members and friends to help with child rearing. As kids get older, they enter public schools, where everyone, parents and non-parents, contribute financially, typically through local property taxes. We know that it is hard to raise a kid on your own, and that it makes a big difference to live near family, to have close friends who are raising kids at the same time, and to have supports from work for the times when our kids are sick and need extra love and attention.

 

The quote from the parents in their son’s obituary, and all of Dreamland demonstrate that the same is true for how we should approach addiction. Asking someone to overcome addiction on their own is like asking a child to raise themselves. It can happen, but it doesn’t often turn out well. People battling addiction need supportive relationships in their lives. The family members and friends of people with addiction need help, because it can be challenging and taxing to help someone else stay sober and find meaning in life beyond addiction. We need communities where we can help each other, watch out for one-another, and provide support in times of need. Many of us have lost this along our way, as our culture has pushed us toward staying inside, watching TV in our own homes, and filling our lives with stuff rather than with the people we love and care about.

 

This is a tough time to find new connections and community as we work to prevent the rapid spread of a new virus, but we should be thinking forward nonetheless to a time where we can better connect with those around us and find new ways to live in community with those who matter. It might just save the life of someone we know whose struggle with addiction has been hidden from us.
More on Isolation and Addiction

More on Isolation and Addiction

I previously wrote about pain medicine ideas that Sam Quinones presents in his book Dreamland. He is critical of the idea that we can take a pill to alleviate chronic pain without making substantial changes in our lives to address the root cause of our pain. Even if we can’t completely stop chronic pain by changing our habits, our environment, and our lifestyles, Quinones shares information which suggests that our experience of pain is connected to many parts of our lives, and that we can change how we think about and relate to pain, even if we cannot eliminate it completely. This is a holistic approach to pain and pain management that Quinones thinks is a crucial piece for understanding our nation’s current opioid epidemic.

 

Chronic pain and its mismanagement is a common route to opioid addiction. Quinones views opioid addictions similarly to how he views chronic pain. In his book he writes, “Chronic pain was probably best treated not by one pill but holistically. In the same way, the antidote to heroin wasn’t so much Naloxone; it was community.”

 

Naloxone is a drug that helps prevent opioid overdoses by binding to opioid receptors in the body to block the effect of opioids like heroin. This drug has helped save thousands of lives, but on its own it won’t stop addiction. Quinones argues that a big problem with addiction is the way in which we hide it from others, whether it is addiction to drugs, gambling, or something else, we don’t allow anyone to know about our addiction. Without talking about addiction, without acknowledging that it has had impacts on our families and lives, and without having meaningful connections with others, we languish in our isolation and addiction.

 

The argument that Quinones makes in his book is that we need more community. We need more things in our lives where we interact meaningfully with others. We need to find more ways to be in service to other people, to work together for meaningful causes, and to have greater social connections with the people around us. By developing meaningful relationships with others, we provide community for everyone, and that helps push back against the forces that drive toward isolation and drive many of us toward substance addiction. Community provides us the space to discuss our challenges, our addictions, and our discontents, and hopefully gives us the chance to build constructive spaces in which we can connect and find solutions to problems that we cannot find in isolation.
Making People Feel Valuable

Making People Feel Valuable

Toward the end of his book Dreamland, Sam Quinones quotes a the VP of sales from a shoelace factory in Portsmouth Ohio named Bryan Davis. Speaking of the company that Davis helps run, and discussing how Davis and a few others took over a failing shoelace company and reinvented it, Davis says, “It’s all been about money, the mighty dollar. The true entrepreneurial spirit of  the U.S. has to be about more than that. It has to be about people, relationships, about building communities.”

 

Quinones writes about how the decline of manufacturing has harmed cities across the United States. He understands why companies have relocated oversees, and in some ways accepts that businesses move and that economies change, but he sees the abandonment of American workers and the lack of supports for those workers when opportunities disappear as a major contributing factor to the Nation’s current opioid epidemic. When people suddenly lose the job they have held for years, when there is no clear alternative for them to turn to in order to feel useful, valuable, and like a contributing member of society, an alternative to ease the pain of their new reality is often pain killing opioid medications. It is an easy recipe for widespread addiction.

 

I don’t understand economics well enough to place criticism on businesses and factories that move operations to different cities, different states, or different countries altogether. I won’t criticize or praise these companies, but what is clear to me, is that we need to find ways to be more respectful of the people who work for and with us. We need to find real ways to make people feel valuable in their jobs, whether they are call center staff, healthcare workers, or a VP of a successful company. We can’t set out with a goal to make money and then withdraw ourselves from the lives of our fellow Americans and communities. We have to develop real relationships with people across the political, economic, and cultural spectrum of the communities where we live, otherwise we turn toward isolation, which isn’t helpful or healthy for ourselves or others in the long run.

 

This is the idea that Bryan Davis expressed. We can be inventive, creative, and push for economic success, but we should do so in a way that supports our community and values relationships with those around us and in our lives. If we only drive toward our own wealth and bottom line, we risk exploiting people, and that ultimately leaves them in a vulnerable position where isolation, depression, and isolation are all the more possible.
Isolation and Addiction

Isolation and Addiction

American’s are isolated, and it’s not just because we have all been asked to work from home, stay inside, and intentionally distance ourselves from others to prevent the exponential transmission of COVID-19. We have been isolated for a while, so much so that former Surgeon General of the United States, Vivek Murthy, recently published a book about loneliness and the importance of human connection. Loneliness and isolation are new problems that we are starting to look at in new ways. In his book Dreamland, Sam Quinones connects isolation and addiction in ways that change the discussion we have about addiction and our values as Americans.

 

Quinones is critical of how our society interacts today, or rather how our society doesn’t interact. He writes, “the most selfish drug [opioids] fed on atomized communities. Isolation was now as endemic to wealthy suburbs as to the Rust Belt, and had been building for years. It was true about much of a country where the streets were barren on summer evenings and kids no longer played Kick the Can as parents watched from porches. That dreamland has been lost and replaced, all too often, finally, by empty streets of bigger, nicer houses hiding addiction that each family kept secret.”

 

To atomize means to convert into very fine particles or droplets, and is used by Quinones to show that we have separated our communities into individual, isolated nuclear units. We hide inside our houses, rarely venturing outside to just be outside. We drive to our suburbs, stop at the mailbox from our car, park in our garages, and rarely spend any time outside. If we do get out, we are in our private backyard where we cannot be seen. We have cut out everyone else, leaving us with just ourselves in our ever larger houses filled with ever more things for our individual enjoyment.

 

Quinones argues that this lifestyle has been brought on by our own selfishness. We want our own stuff, we want to show it off, and it holds more value today than it did in the past. Consequently, we are also more jealous of those who have more than us, and more guarded of our things. We lock out other to protect our stuff, but in the process we locked out a crucial part of our humanity: our connections and community.

 

Community shows us that there is more to life than just our desires. Isolation and addiction are linked because when we withdraw from community, when we focus only inward on what we want, our purpose of helping others and interacting with others disappears. Quinones believes that a lack of interaction with others fueled the opioid crisis. We hid addiction in our homes, withdrew from community, and and took away the joys and connections that made us human. We left ourselves vulnerable to pain killing addictions, and took away the best tools to cure the epidemic we now face.
Excesses and Externalities

The Problem with our Excesses

My previous post was about our desires to live a life that never involves any pain or suffering. We try to build a life for ourselves and our loved ones where every moment is happy, and where we never have to engage in drudgery, never experience physical discomfort, and never face any obstacles. Today’s post looks at another related aspect of our lives and mindsets that Sam Quinones highlights in his book Dreamland as part of our current opioid crisis: excesses.

 

Quinones is critical of our capitalistic culture that creates a message of buying things to find happiness, fulfillment, and meaning. The marketing departments of everything from soap companies, life insurance companies, to take-out restaurants suggests that happiness is right around the corner, as long as we are willing and able to buy more of what they offer. It is owning something bigger, having more, and expanding our consumption that is branded as a good life. But as Quinones sees it, “Excess contaminated the best of America.”

 

I studied public policy and I spend a lot of time listening to podcasts with economists. A common idea in the world of public policy and the mind of economists is the idea of externalities, secondary consequences of policies and peoples actions. Some externalities are positive, such as people developing a sense of civic pride after participating in an election, but many externalities are negative, such as green house gasses polluting the planet as we drive to and from work. What Quinones describes with the quote above, is the reality that our drive for excesses produces negative externalities that damage our planet and ultimately ruin the lifestyle that we chase.

 

By always wanting more, wanting it faster, and wanting it more tailored to our specific desires to make us feel like royalty, we have put ourselves in a place that is unsustainable. Our single use plastic bags have trashed our cities and open spaces. Having our individual cars to drive to everyplace we want to go emits more pollution than a well developed public transportation infrastructure. Over-purchasing consumer goods produces more garbage that has to go someplace.

 

This post has simply highlighted the reality that we live with negative externalities, and that our consumer driven culture is creating externalities which poison the planet. Quinones throughout his book focuses on the idea that our culture’s excesses have fueled the opioid epidemic by turning us inward toward our own wants versus encouraging us to think of others and how we can work together as part of a community. I think he is correct, and I think the space to start in making a change is by getting people to truly reflect on their lives, their purchases, and what they pursue. As Ryan Holiday put it in Stillness is the Key, “Eventually one has to say the e-word, enough. or the world says it for you.”

 

The way out of our opioid crisis, and indeed the way out of so many of our problems today, is to say enough to our own selfish desires. We need to stop the negative externalities that we produce when we purely pursue our own selfish ends, and instead we need to embrace our communities and put others first, to create more positive externalities which can heal our communities and fill the empty holes that consumerism leaves inside of us.
Our Efforts to Avoid Pain

Our Efforts to Avoid Pain

I had an amazing track coach at Reno High School. His name was Mark Smith (everyone called him Smitty) and like all great coaches, he knew what high school students needed in their workouts and in their heads in order to be successful both in sports and in life.

 

Some of the neighborhoods that Reno High School draws from are among the nicest and most expensive in all of Reno. Many students have very dedicated parents who will do anything to help their children succeed, be happy, and avoid pain and suffering. However, these parents often miss an important point, a point that Coach Smitty would always remind parents and athletes, “you can never eliminate suffering, and you can’t protect your child [or yourself] from all pain.”

 

Sam Quinones, author of Dreamland would certainly agree. In his book he writes, “In heroin addicts, I had seen the debasement that comes from the loss of free will and enslavement to what amounts to an idea: permanent pleasure, numbness, and the avoidance of pain.”

 

Our society, in TV shows and commercials, continually pushes a narrative that we should be happy and have lots of consumer goods in our lives. We seem to believe that every moment of our lives should be nothing but entertainment and enjoyment, and we pursue that, continuously trying to buy our happiness and avoid any possible pain or suffering. As Coach Smitty said, however, this is not possible, and as Quinones shows throughout Dreamland, this can lead to dangerous consequences. Part of the opioid problem in our country, Quinones argues, is that we place too high a value on never feeling pain and suffering, and we under-invest in the real things that would help us actually overcome and reasonably manage and respond to pain and suffering.

 

Our mental health, counseling, and therapy services are under-developed and costly. Our economic system doesn’t provide people the support they need in difficult times, and we don’t do a good job of helping get people into jobs that actually feel meaningful. We have built suburbs and isolated ourselves from community, and when we face hard times, we are afraid to admit it and don’t have many close people to turn to. We seek avoidance from these challenges with chemicals like alcohol, opioids, marijuana, or worse. We try to blunt the pain and reduce the suffering artificially, which doesn’t work, and doesn’t help us feel happy or fulfilled.

 

We have a myth that we can eliminate all the suffering in our lives and in the lives of our loved ones. However, the reality is that we must work to overcome that suffering together. As a team, we can support each other, train each other to be strong during adversity, and learn how to put in hard work and lean into the uncomfortable reality of the world to find a place where we can accept and appropriately respond to suffering and pain.

 

Coach Smitty passed away on October 12th, 2018. He was a truly great influence in my life and in the life of others. I hope everyone has a Coach Smitty in their lives, and please reach out to say hi and thanks if you do.

Where You Live (& Are Born) Matters

Raj Chetty, a Harvard researcher, has done some pretty interesting work that shows that the zip code you are born into can have a huge impact on how much money you earn over the course of your life. Down to the neighborhood level, where you live, the people around you, and the connections you happen to make in life can be major determining factors in what job you take, what college your children attend, and how well off you end up financially speaking. We don’t like to address this very often, but we recognize that it is true, and we have seen increased segregation as we try to separate ourselves from living next to undesirable people and places.

 

In his book The Complacent Class: The Self-Defeating Quest for the American Dream, Tyler Cowen writes, “in 1970, only about 15 percent of families lived in neighborhoods that were unambiguously affluent or poor. By 2007, 31 percent of American families were living in such neighborhoods.” We are moving in directions where we separate ourselves from people who are not like us in terms of socioeconomic status (SES). Today, relative to 30 to 50 years ago, we are less likely to interact with someone who is very poor if we are rich. We are less likely to know anyone who does not share a generally similar SES, and we are far less likely to have any meaningful interactions with someone from a different SES. Cowen continues, “for where you live, income matters more than ever before, as can be shown by a simple perusal of the apartment ads for most of America’s leading cities.” 

 

This segregation by home value and SES has some obvious consequences, such as schools becoming more segregated by income and race and skyrocketing home prices in some regions of town coupled with deterioration and disinvestment of other regions. However, as the research from Chetty shows, there are other, less obvious consequences from our SES segregation. Where you live influences the opportunities available to you and your children.

 

We like to think that it is our own effort, talent, and hard work which determines how much money we make and where we end up financially and in terms of the home we are able to buy. Since talent, intelligence, and work ethic are evenly distributed on a genetic level, we would expect that everyone could achieve the same ends regardless of where they happened to be born. Instead, we see huge disparities by zip codes and neighborhoods in terms of ultimate SES. Our segregation is leading to situations where those who are born in wealthy areas are able to make valuable connections, learn the unwritten rules of networking to getting ahead, and receive visible reminders of what can be achieved through hard work and perseverance. Certainly people from the lowest SES background can still network and can still see the benefits of hard work, but research also suggest that when people from the lowest SES don’t have any interactions with people who are economically well off and successful in their careers, they do worse.

 

Cowen argues that our segregation by SES is making us a less robust society. Partially because we are leaving other people out, but also because it narrows the world for all of us (not just those in low SES neighborhoods) and stymies innovation, development, and progress. We are comfortable in neighborhoods with people who have a similar background and SES to our own, but this does not help us better understand the world, does not help us advocate for and support policy which might help us and others, and does not help us identify and encourage the top talent born in our country. Our complacency as we all search for our own individual American dream is crippling the American dream that we share as a nation by segregating us into complacent bubbles.