Back to work

It was so much more fun when you prepared for back to school by stuffing together some felts and pencil crayons rather than a bunch of explanations and prepared quarrels.

I was optimistic. I haven’t made much experience with my supervisor/boss, TK, but nothing has led me to think he is unreasonable. And considering his work is on junkies, he’d be remiss to mistreat the only one working for him in a non-token capacity.

And he was. I told him I was on Suboxone but still using, things weren’t ideal, but they could be worse. It was all very congenial. We’ll see if that carries out.

For actual work, I’m resurrecting a paper I was doing on dumpster diving (“informal sector recycling”) and then resuming my thesis. Although we may change that, depending on how things go.

Most importantly, I asked him to give me some work (unpaid even) that required me to be there a couple of days a week. I desperately need that. Some responsibility. This utter freedom is rocketing my habit.


Without Smoke, There’s Fire: e-cigarettes, relevance, and translation

On one level, the Kandel’s new article in the New England Journal of Medicine is really neat. It provides the (best, and first I’ve heard of) biological basis for the much-touted “gateway theory” of drug use: you know, the one where drugs users follow a causative and predictable progression from cigarettes to alcohol to pot to heroin.

That cigarettes are used before heroin is not unreasonable, but it’s far from uncontested that this universally happens. And, more importantly, that this is a causative relationship (you know, the important kind), is not accepted.

But, like most good-faith science, it gives some credence to its main competitor: the “common liability to addiction.” I’m not really here to, or equipped to, go into the details of which one is right, but this article highlights something important I do want to comment on.

Apropos of nothing, at the end of the article, the authors go into a completely unrelated tirade against e-cigarettes. This is really problematic. We’re taking a basic science, physiological study and jumping to a really ground-level, distinct problem.

This is completely irresponsible. 300 words of the 3000 word article, 10%, are devoted to a distantly-related policy platform. At most, in a basic science article like this, you should have one line: “These findings on a physiological mechanism of the controversial gateway theory may have implications for nicotine-containing products.”

Nothing about this study has anything to do with e-cigarettes, the precautionary principle, humans, youth, or legislation.

This is incredibly frustrating, especially since there is a dearth of evidence on what should be done with E-cigarettes. No one has even seriously studied whether they’re effective as a smoking cessation device. To fill in this information gap with unrelated studies helps no one, and the incredibly powerful Kandels should be criticized for this misuse of credentials, pedigree, and article space.


Working Girl 2: 12Steps in power

Gotta get more organized with these posts. This is a follow-up to my last post about JS getting a job.

Her new job is for a social service agency. Housing, I think. She explained it, but I’m still not quite sure what her on-the-ground work would look like.

It’s sounds like she’ll be kind of a landlord at a social housing place. Like she’ll do some of the disciplinary stuff a landlord would do, but with some more social work grace. More forgiveness, less evictions. She has a 2 year social work diploma. From what I gather, she seems over-qualified.

The interview process was multi-staged. First application. Then internet followup application. Then phone interview. Then face-to-face.

In the internet part, she had to answer “How do you feel about working in the Downtown Eastside?” She asked for my advice, and it was kind of hard to come up with an answer.

I think the main point was to see if you wear were comfortable working with junkies. JS is fine with that, she did a practicum there, she is a junkie. All that was fine. But phrasing it without the truth, and without sounding condescending, was rough. We ended up on something like “During my practicum on the DTES I saw the variety of hope and challenges that faced the residents. It was deeply rewarding working with people to empower blah blah blah.”

Next  interesting bit happened in the phone interview. The interviewer led off with: “I just have one: do you know what I mean when I say concurrent disorders.” Apparently, knowing that was enough (which is why I think she’s probably overeducated for the job).

Concurrent disorders (/dual diagnosis) has always struck me as odd. It’s sloppy labeling in that it refers specifically to substance abuse + mental illness, although there’s a myriad other way for someone to have two disorders and thus be more complicated (diabetes + substance, depression + lupus, cancer + COPD). But more than it’s sloppiness, it’s shorthand.

It’s code for “you’re dealing with a shit show, get ready.” A sort of inoffensive short-hand you can put into the chart that means this person isn’t getting any better, they’re gonna be a nightmare, be on your guard. Same way “they’re kind of cluster B-ish” means WATCH OUT.

It doesn’t have to be offensive. And social work probably uses it different than medicine, but it’s still a weird, loaded term.

The last fun bit – kind of pissed me off – was her face-to-face interview. The guy pretty directly asked her what her life story was. Why would she want to work with these people?

That is so 12Step. I felt the guy was probably fishing, just from that.

She lied. Said she used to be a heroin addict, but quit 8 years ago with the help of methadone. “Oh, and how long have you been off methadone?”

“4 years,” she said.

“Clean and sober 4 years.” He marked down.

Ya, 12stepper for sure. It bothers me when they’re in positions of power. Mainly just because they’re so often in positions of power. Actually, probably more because the only time I’ve felt power lorded over me was from rehab. Gross feeling.

Anyway, it’s great that it’s led him to life of helping others (/doing service/helping himself/spreading the message), but it highlights a bit of an odd difference between the professional and the self-help communities.

Institutional, Western professionalism very strongly maintains that your individual story doesn’t matter. Personal experience is no substitute, and not even really advantageous, over training. The School is all you need to do a good job. Personal stuff just makes you chaotic, unassimilated.

The self-help, recovery, 12step community very much views things the opposite. No amount of training can substitute for personal experience.

It’s a bit hard to reconcile. As a professional, I was given mixed messages. My personal stake in addictions and harm reduction was seen at conflict with my academic, analytic “objectivity.” At the same time, I also was told I’d be great at it. This is just what we needed: a personal infusion of experience. No one could bring what I brought.

This was especially prevalent when I was telling people I was leaving medicine. “But you can’t; you can do so much; you OWE it to other junkies.” But only if I was redeemed. Personal experience is fine as long as it leads you to the same place.

Like most things, the mainstream public is somewhere in between. When the pressure is on me, I kind of want to force them to take a side. They’re mutually exclusive. One is evidence against the other. Pick. I can’t be both professional-tamed, and personally-informed. My experience us at conflict with my education.

That’s my big problem with it. Both roads have to lead to the same place. As long as my final destination is right, the path I take doesn’t matter. As long as I don’t end up deviant, as long as I conform to the right choice, I can take whatever I want from my life and training.

It’s frustrating and perfidious. An exercise in bad faith.


Working Girl: employing junkies

JS got a job! First one in three years.

Actually, let’s try that again.

JS got a job. That’s more in line with how she feels.

She’s been wanting to clean up and get some normalcy back in her life since the inheritance, but it’s been a slog. Partially because of me, partially because that’s just the way it goes. I have pushed a bit for normalcy recently, but I don’t think that’s what did it.

I think it was the welfare hoop-jumping that got to her. She had been on for three months, which they’ll let you do pretty readily. Low barrier. But pretty quickly they try to get you in for job search and skills training stuff. She managed to dodge it last month, but they got to her two weeks ago.

They didn’t threaten to cut her off, but that was the implication, if she didn’t go through with the training. I haven’t been to that kind of stuff in 15 years, but it’s a pretty big hassle. Bigger nowadays. She was going to have to go in for week of resume-building, interview training, using the HRDC’s out-of-date website.

She knows how to do all of that. She’s employable when she wants to be. She knows how to take a shower and not swear in front of an interviewer. They probably would’ve gotten her to upgrade her WHMIS and CPR and other busy-work type skills.

Not that these aren’t needed (most of them), but I do see a subtle coercion to them. They’re horrible to sit through. And apparently the threat of them was enough to get JS to go get a job. Especially the social skills stuff. That’s not really teachable or learnable in an afternoon, especially if all the other is taken care of first.

The direct skill stuff – the FoodSafe, WHMIS, etc. – I wonder how much use it actually is. I should look that up…

Haha, well I just decided to go do it.  Pretty much nothing. One on contact dermatitis showed that, well, basically, that WHMIS was used (turns out I know the author). There was no control, so no way of knowing whether they did anything. A search for MSDS didn’t turn up much either. Although there was the titillatingly-titled “Saved by a Material Data Safety Sheet!”

Maybe I’m just looking it up wrong. Nothing on FoodSafe either. Although there is this one showing how little retention there is.

This supports my theory that maybe these are just busy work. Little barriers to show people are willing and able to enter the working world.

Ugh, I want to talk about this some more, but I feel I’m doing it a disservice. Maybe I should switch to more researchy articles. These little micro to macro, life to society, vignettes are deeply unfulfilling. I also wanted to talk about how JS was interviewed by a 12stepper.


Debt and control in friendships 2

I’ve mentioned  this before: I have issues with controlling JS and TK through money.

I’ve been pretty good recently at backing off from it. I just give them whatever money they ask for, and don’t think much about it. Either they’ll pay me back when the house sells, or I’ll be broke sooner. Either way, I’ll end up broke. A couple of months won’t make a big difference in the grand scheme.

But yesterday, I went snarky again. JS asked me for $660 for rent, which is well over two-thirds of it. And they had just received their welfare cheques -

Ugh. I’m just gonna cut that out right there. The specifics aren’t important. Point is, it wasn’t that they were borrowing the money. It’s that they were doing it wrong. If they just handed over control and responsibility to me, I could do it so much better. And they would still get just as high, and still get just as much food.

The larger implication of this is that I get the desire governments, NGOs, and other institutions have to dictate how others spend their money. Planet Money had a good episode about a charity that did this (GiveDirectly). And generally, I think the tides are shifting away from in-kind, rather than cash, payment (or maybe not, or maybe this is the case in Canada(. This definitely is more dignified, and I support it. Junkies need the support to pushes and motivation to make the right decisions: they certainly don’t need the right decisions made for them.

But personally? Fuck! That’s my money! And it pains me when I see it boiled up in fifty dollars of single-serve home coffee packets from the convenience store in a couple of months rather than an $8 tin of Folgers.My teeth grind when I keep paying fees and penalties for TK, when he could’ve just borrowed a flat $200 to clear the whole debt, but didn’t because of shame and bad money skills. When I had to down to the bank before closing the day past due because they didn’t ask me any number of the weeks before when they knew just as much how much money they needed and by when. 

But again, this is my personal bullshit. And I need to deal with it. And if it has any validity, it is only on this personal level. Institutions shouldn’t behave like me, a petty, slighted person with an emotional stake in the game. They should do what’s best. And most of the time, it’s not in-kind transfers driven out of a DB-like paternalism, but sensible, evidence-supported policies.


Philip Seymour Hoffman’s Friend: cries for blood

Robert Aaron Vineburg got off today. I’m usually pleased when this happens, and I’m pleased this time, although it’s never for the reason I want. They always get off because they can’t be gotten, not because anyone acknowledges the freedom of the junkie.

So often, when a celebrity dies, there’s this big howl for blood. Who did this?! Who can we make suffer for taking this person from us?

Courtney Love. Conrad Murray. Nancy Spungen. Cory Monteith’s/Heath Ledger’s dealers. Now Vineburg. There’s always this witch hunt.

All these celebrities were hardcore users, at least at some point in their lives, if not immediately before their deaths. But they’re pretty aware of how things go, and I can’t imagine anyone one of them blames their dealer/supplier/girlfriend for how things turned out.

The dealer is simply a role someone enters into, and it is in that capacity that they engage with the junkie. For the most part, I haven’t seen many too predatory or uncaring. If you want out, they’re usually supportive.

Even if you don’t, they’re just engaging in the market. It’s far too easy to heap the blame on them.

For some reason, we don’t apply this emotional reasoning to the cigarette or liquor vendor. We acknowledge that they are simply playing a part. Nothing personal.

I haven’t overdosed, but I’m certainly a junkie, and there’s a distinct causal element there. The guy that introduced me, my sire, so to speak. But I see him as the inevitability, or at least the mercurial actor, that he was. I’m sure some people might resent him – probably more when I was cute, and young, and blond – but I don’t. And I would appreciate the respect  for my autonomy to view him how I view him.

And I think the ghosts of these celebrities would want the same. Acting as though their dealers are the sole reason they are dead is an affront to them. We should give them their due.


Day Three Suboxone: Punishment and reward

JS had a job interview this morning, and it was about 24hrs since I got my dose the day before. Maybe I could get high again.

Suboxone was an uncomfortable choice for me. I wasn’t beaten into it this time. I still wanted to get be getting high. Sure, I was just sleeping away my days, and my tolerance was skyrocketing, but I still had plenty of money, and seemingly plenty of time. The bigger reason was for JS and TK.

And that was making me a bit resentful. They were exhausted. They needed to quit. And with me in the next room getting high all day, their chances were just ruined. It’s hard to want the best for your friends when your goals conflict. Pity was a big motivation. And I hate to pity. It’s an awful feeling. Demeaning to both sides. But it’s what I felt.

So when she left, I called the boys. It was nice. I got high relatively easily off the heroin, where the dilaudid didn’t really do much.

Because it was my first heroin in three days, and JS hadn’t done any since the weekend, I decided to reward us with chinese food. We had planned to get it to go, but when I went to the pharmacy, we were told the script would take an hour to fill. Ugh. They don’t seem to understand or care how much barriers will influence junkies. How little of an excuse we need, despite our intentions. An hour wait could easily send me to the dealer. Good thing we were hungry.

So we sat down to eat. In 15 years, JS and I have never sat down to eat at a restaurant together. It felt so grown up and bougie. We’d both changed so much, and not at all. Still just two junkie kids feeling like they were getting away with everything.

She confessed that yesterday she woke up at 0530 and got some cash from her direct deposited welfare cheque. Then bought some heroin and used secretly in her room. She was sure I knew, and sure I was disappointed. I had no idea.

So we kept walking, and I complained about the hour wait for the script to fill. How irresponsible it was. Then, when I got the dose, they didn’t even witness the ingestion. Another tiny barrier, another tiny excuse.

I winked to JS, and spit the slightly-dissolved tablets into my hand, next to the candy aisle.  We were having fun. Might as well continue it.


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