Solving the Addiction Crisis Begins With Breaking the Stigma

The stigma around addiction has enormous consequences, not just for our health care system, but how our entire culture views addictive behavior.

This article is the second in a 12-part series about the U.S. addiction crisis. In the interest of compassionate conversation and eliminating stigma, we’ve chosen language that’s cultivated by the Research Recovery Institute and hope it inspires you to as well.
The U.S. drug crisis is impacting everyone, from young children to first responders to librarians. In grappling with this overwhelming life-or-death problem, we may have overlooked one group – drug users – and the way our language generates stigma that only fuels the epidemic.
In his report on Alcohol, Drugs, and Health, former Surgeon General Vivek Murthy argues for a “cultural shift” in how we approach addiction. “For far too long,” Murthy writes, “too many in our country have viewed addiction as a moral failing.” The consequence of this definition is an “added burden of shame that has made people with substance use disorders less likely to come forward and seek help.”
The way in which addiction is framed has enormous consequences, not just for how our health care system treats addiction, but how our entire culture views addictive behavior.

“Choice” has consequences

When addiction is framed as a choice, drug treatment is not a medical necessity, but an elective procedure. Historically, that has meant that drug treatment and recovery programs were prohibitively expensive for many people.
Prior to 2014, only one in 10 addicts sought treatment. That low treatment rate was certainly related to limited access to care. It was also related to the stigma that those in the healthcare profession held toward addicts. One study found that healthcare workers have lower regard for their addicted patients than patients with other conditions.
The choice model doesn’t only impact treatment options for addiction. The phrase “war on drugs” suggests that drug abusers are bad guys who have taken the wrong side. Sentencing laws group drug users alongside others deemed to have moral failings sufficiently poisonous to require removal from society.
“Choice” makes it simple to deny treatment to or promote the incarceration of people who elect to become addicted. The choice metaphor has also allowed anyone who hasn’t made the same choice to ignore the problem. Choice implies blame, and this blame has helped us avoid taking any societal responsibility for the drug crisis.
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Parent Co. partnered with Aspenti because they know that carrying the weight of the addiction crisis is everyone’s responsibility.

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How the disease model reduces stigma

The disease model of addiction shifts our national focus from blame to recovery. Under a disease model, addicts are not immoral. They are ill.
Under the Affordable Care Act, addiction treatment became an “essential benefit,” meaning that 2.8 million people suffering from addiction now have coverage. That coverage – especially in states that accepted Medicare expansions – is almost certainly saving lives, as it now covers not only inpatient detox, but also counseling and medication.
Under a disease model, addicts are not criminals. They’re citizens in need of assistance. Portugal, faced with similar drug problems as the U.S., redefined addiction as a disease both medically and legally, expanding medical treatment and decriminalizing drug use. Rather than jailing drug users, Portugal brings them to hearings with social workers.
When drug users are not afraid of arrest, they are also more likely to seek treatment. Now, the rate of drug-related death in Portugal is six per million. In the United States, it’s 312 per million.
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The language of addiction

Efforts to replace the language of choice with the language of disease are already improving access to treatment. But this is not the only language that needs to change.
We don’t talk about heart transplant patients as being “dirty,” but we do talk about drug addicts that way. We don’t talk about cancer patients “relapsing” when their cancers return, but addicts relapse all the time. We don’t demand that people suffering from cancer apologize for their cancers or that people who have had a heart transplant apologize for their diseased organs, even if these people exhibited many dangerous behaviors that contributed to their health problems.
The very word “addict” is a problem. We don’t describe people with cancer as “cancers,” or people who have had heart transplants as “heart transplants.” When we use the word “addict,” we reduce a person to an illness. That term creates stigma despite efforts to view addiction as a medical problem.
Look back to the preceding paragraphs and notice the use of “addict,” and “drug abuser.” Although those paragraphs argue for a compassionate response to addiction, they unintentionally heap blame and shame on people suffering from it.
The Recovery Research Institute‘s Addiction-ary promotes more specific and compassionate addiction vocabulary. Taking its cue from mental health advocates who have shifted the national conversation from “the disabled” to “people with disabilities,” the RRI advocates “person-first” language.
Terms like “abuser” and “addict” define a person in terms of addiction. This definition generates stigma that leads to lower quality care and even discourages people from seeking treatment. Changing our vocabulary to person-first language can help reduce stigma by textually reminding ourselves that people suffering from substance use disorders are just that: people. Not “junkies” or “abusers” or “addicts.” People.
The RRI also advocates avoiding language that implies blame. Instead of “lapse” or “slip,” the RRI recommends more medically-appropriate terms like “resumed” or “recurred.”
Using person-first, blame-neutral language is a good start. Yet one of the greatest challenges comes from a word we probably don’t even think about: “drug.”
The word “drug” is stunningly unspecific. Culturally, it carries many negative connotations, whether the subject is “illicit drugs” or “drug companies.” The word is so stigmatized that many will often reject drugs even when they would be medically beneficial.
Part of better addiction treatment and recovery is greater specificity. Instead of “drug,” the Addiction-ary suggests “medication” when referring to a properly used drug, and “non-medically used psychoactive substance” when referring to illicit or improperly used drugs.

Treating substance use disorder as a moral issue

Addiction is a moral issue, but not for people with substance use disorders. When our society views substance use disorder as a sign of a flawed moral code, we absolve ourselves of any societal obligation to help.
Murthy describes addiction as a “moral test,” not for people with substance use disorders, but for all Americans: “Are we as a nation willing to take on an epidemic that is causing great human suffering and economic loss? Are we able to live up to that most fundamental obligation we have as human beings: to care for one another?”
Person-first. Blame-neutral. Drug-free. Choosing our words more carefully and demanding that media, healthcare, and research organizations do the same will help decrease the stigma of substance use disorders and pave the way to recovery.
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Parent Co. partnered with Aspenti because they know that carrying the weight of the addiction crisis is everyone’s responsibility.


One Moment at a Time

This is a submission in our monthly contest. October’s theme is Determination. Enter your own here!
Giving up isn’t an option today. One mistake, one wrong decision, one moment of indulgence in self-pity will rip away everything and everyone who brings meaning and love to my life. To an outsider, my life may seem bleak: I live paycheck to (one week before) paycheck in a condo that is too small for my three children and me. It is not out of the norm for me to not know how I will put gas in my car or food on the table. My credit score is a whopping 450. I am divorced. I borrow money from my 70-year-old mother, who also helps me with laundry and other household chores. At 39, I am only at the beginning stages of my first career. I have no husband and I don’t go on vacation. I am scraping by one day at a time, but I am overwhelmed with gratitude.
No one wants to visit the depths of emotional and physical pain that I have. My story is as sad as they get. Every alcoholic mother cliché is true. I am a low-bottom drunk. My final years of drinking were spent chugging vodka straight out of the bottle just to calm the shakes and nausea. My final drink ended with me driving in a blackout at 10 a.m. after disappearing from my place of employment unannounced. My visits with my children were supervised by court order. They still loved me and I can’t comprehend how or why. They still had hope for me. They saw through the sour breath and the phony smile, and they knew the person I am today was hiding in there. They waited for me.
I was full of broken promises and empty apologies. I missed birthday parties, and I passed out in front of my children. Hangover after hangover, alcoholism told me I could drink today and not get drunk. Just a few to keep the shakes at bay, then I will stop. This is a disease that lies. This is a disease that takes over mind, body and spirit and grabs hold of families and innocent children. This disease held me so tightly, and I danced with it for so long, believing the lies and forgiving its betrayal.
I was unemployable, undependable, and (I thought) unlovable. Alcohol was my everything. My best friend and lover. My courage and fear. My entertainment and bedtime story. My motivation to live and desire to die. Alcohol came before my kids, relationships, health, and sanity. I wanted so badly to want to stop drinking, but I still longed for alcohol to run steadily through my veins every waking moment.
During my final months of drinking, I began to sense the end was near. I didn’t make sense of it at the time, but I grew so scared of myself. I would enter a package store, and as I left I would think, something terrible is going to happen tonight, and then wake the next day thanking God nothing terrible happened. This became the beginning of the end. The disease was dying. I no longer felt invincible. I no longer believed the lies of alcoholism.
I bought a gallon of vodka knowing I would drink the whole thing that night. It scared me. I was preparing for my final surrender. Surrender came on February 3, 2014. I did not want to die. I knew I would lose my oldest daughter forever. I saw it in her eyes, in the way she was beginning to pull away from me. She would not be fooled by this disease much longer. I prayed for help in my own desperate way, and God answered my prayers.
Detox. A six-month inpatient rehab an hour and half away from my kids. AA meetings. I learned to like some things about myself. I learned to do things sober. I relearned how to do everything sober. I danced sober, I laughed sober, I cried sober, and I felt things I had been numbing my entire adult life. I embraced a new way of life, and I made a commitment to God and to myself to stay sober at all costs, just for today.
I have caused pain to those I love that I cannot take away. I don’t do that today. My children waited for me, and I am going to make sure their wait was worth it. Today I don’t care how much money is in my bank account or what my credit score is. Today I am sober and God is my provider. I now live in acceptance, self-awareness, and gratitude, including gratitude for my darkest days because they made me who I am today.
Through dedication to God, to the program of Alcoholics Anonymous, and to self-love, I have accumulated 1,347 days sober, one moment at a time.

7 Surprising Impacts of the U.S. Substance Use Disorder Crisis

An estimated 21.5 million Americans over age 12 suffer from a substance use disorder. But the impact of this crisis reaches far beyond.

This article is the first in a 12-part series about the U.S. addiction crisis. In the interest of compassionate conversation and eliminating stigma, we’ve chosen language that’s cultivated by the Research Recovery Institute and hope it inspires you to as well.

[su_dropcap style=”simple” size=”5″]I[/su_dropcap]t’s possible to read about the long-reaching effects of substance use disorder and feel rage. You can be angry at the harsh penalties kids have to suffer for their families’ substance use disorders. You can be angry about how the dying experience unbearable pain when taken advantage of by the people who are supposed to help them. You can be angry at how substance use disorders harm our economy.
In short, you can be mad at people suffering from substance use disorder and blame them for what you see as their “choice.” But that won’t solve the problem. In fact, that angry response unfairly characterizes the problem.
According to the 2014 National Survey on Drug Use and Health, an estimated 21.5 million Americans over age 12 suffered from a substance use disorder.
Although CDC figures for 2016 are not yet complete, deaths from overdose are projected to range between 59,000 and 65,000. That estimate makes overdose the leading cause of accidental death, ahead of both car accidents and shootings.
What follows are seven impacts of the crisis that should inspire all of us to get involved. If there’s one thing that becomes apparent as we struggle to grasp the impact of the national substance use disorder crisis it’s that help is needed everywhere.


Young children are affected by substance use disorder in many ways. Some babies become addicted to the substances their mothers use and develop neonatal abstinence syndrome (NAS) after their births cause withdrawal. NAS do occur as a result of illicit substance use, but can occur even when babies’ mothers were using physician-prescribed opiates only as directed.
Like adults experiencing withdrawal, babies with NAS experience a host of medical complications, including tremors, convulsions, breathing problems, and fevers. Babies with NAS often have low birth weight and have trouble gaining weight after birth. Some have withdrawal symptoms so severe that they need to be treated with morphine, which doctors taper off as babies’ health improves.
Young children feel the effects of substance use disorder in other ways, whether it be direct poisoning after ingesting dangerous substances, or indirectly, when their parents’ substance use disorders make it difficult for them to provide adequate care.
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Children in foster care with parents suffering a substance use disorder

map of united states where addiction impacts children foster care system
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In 2015, 269,509 children entered the foster care system, an increase of nearly 5,000 from the previous year. State-level data suggest that substance use disorders are linked with the growing rate of foster care. In Massachusetts, 30 percent of the children placed in foster care have a parent with a substance use disorder. In Georgia, that figure is 40 percent. In Ohio, it’s 70 percent.
Even kids in comparatively stable homes can have their lives upended by a sibling facing substance use disorder. Parents reasonably give more attention to their affected children, while expecting their children without substance use disorder to assume more independence and responsibility.
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Parent Co. parented with Aspenti Health because they know that the first step toward change is understanding the problem.

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First responders

This year, police officers in Virginia, FloridaNew Jersey, and Maryland have required treatment after accidentally ingesting fentanyl found at crime scenes. Police dogs have also overdosed on fentanyl during raids.
These exposures have led police departments to change their policies for handling potentially dangerous substances. In order to treat overdose victims, first responders wear protective gloves and masks because the substances they encounter are so potent. Some departments have stopped using field kits to identify substances, instead sending samples to state labs. Police officers now carry naloxone, not just for the public, but also for fellow officers and police animals.
Even responders who follow these new protocols can suffer accidental overdose. Ohio police officer Chris Green wiped his shirt with a bare hand after returning to his station from an arrest and, afterward, required naloxone to treat a fentanyl overdose.

Coroner’s offices

Illicit substances are often distributed literally as a mixed bag. First responders and police officers may not know fentanyl is present because the victim of the overdose didn’t know either.
In 2016, Summit County in Ohio saw 312 overdose deaths – nearly a 50 percent rise from the year before. This increase can be partially linked to batches of potent substances mixed with lesser, more common substances. Fentanyl’s cousin, carfentanil, is labeled for use only as an elephant tranquilizer. When veterinarians administer it to zoo animals, they keep a paramedic on hand in case of accidental exposure because it is so dangerous to humans.
When substances like fentanyl and carfentanil are mixed with more commonly-used substances like heroin, everyone – the teenager who just tried heroin on a dare, the first responder called to treat her, that first responder’s two-year-old son – becomes a potential victim.
According to Gary Guenther, chief investigator for the Summit County medical examiner, the county coroner had to rent refrigerated trucks three times that year in order to handle extra bodies when the morgue overfilled.
In addition to the “mobile morgues” required as a result of these overdoses, coroner’s offices have to spend more money on toxicology tests. They also have to spend more time on investigations, creating a backlog of cases, not just for substance use deaths, but all deaths in their communities.
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Fentanyl is 50 times more potent than heroin and 100 times more potent than morphine.

A lethal dose of heroin vs. fentanyl:

heroin vs fentanyl lethal dose
Photo from New Hampshire State Police Forensic Lab

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Hospice patients

Hospice care is an increasingly-used option for terminally-ill patients who want to die in their homes “pain-free and with dignity.” But as an August 2017 Kaiser Health News report describes, substance use disorder is robbing some patients of that dignity.
These patients, who are prescribed potent painkillers like morphine, hydrocodone, and fentanyl, are vulnerable to theft. The Kaiser report includes elderly patients whose medication was stolen by their children, pediatric patients whose medication was stolen by their parents, and patients of all ages whose medication was stolen by the health aides assigned to treat them. In some instances, medication was stolen by neighbors or by people posing as health aides.
It’s easy to judge these people harshly. But it’s worth pausing to consider that these are nurses who have pledged to care for the sick and dying. These are children who have taken on the burden of caring for their dying parents. These are parents who have taken on the burden of caring for their dying children. Many of these people are as gravely ill as their charges, behaving as no healthy person would.
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Workplace productivity

Contrary to popular belief, many people with substance use disorders are employed. According to a 2015 report from the Substance Abuse and Mental Health Services Administration, 9.5 percent of all full-time workers aged 18 to 64 had a substance use disorder.
The rates of substance use disorders were highest among those in the accommodations and food services industry (16.9 percent) and lowest among those in the educational services industry (5.5 percent). When these workers miss work, whether from substance use or hospitalization, their workplaces suffer from their absence.
Even though the U.S. economy is growing, workers of “prime age” – between 25 and 54 – are not seeking employment. Men of prime age have been even less likely to seek employment. According to an August Brookings Institute report, opioid use is part of the reason for the stagnancy in the labor force.
Princeton economist Alan Krueger notes that almost half of men outside of the labor force take daily pain medication. Two-thirds of that group take prescription pain medication. These figures make the profile of substance use disorder look much different than we often imagine.
The economy isn’t suffering because people addicted to illegal substances don’t want to work. It’s suffering because people who want to work are in too much pain to work, like the dad who fell off a ladder while painting the house and whose pain is poorly managed by opiates.

Service professionals

A WBUR report on substance use in Cambridge includes a public restroom tour from guide “Eddie,” who explains which restrooms are unlocked and which offer privacy. That privacy, however, comes at a cost: “Once you get in, you won’t be interrupted – or rescued.”
Some business and community leaders have responded to the problem by closing their bathrooms. In 2012, after a string of overdoses on its property that its staff did not feel medically equipped to handle, Christ Church in Cambridge, Massachusetts, made the difficult decision to close its public bathroom.
But as some doors have closed, others have opened. Business owners in Cambridge have used a number of creative techniques to prevent overdoses in their bathrooms. One coffee shop owner is training his baristas to treat overdoses by administering naloxone.
Joshua Gerber says that just 10 minutes after he’d sent an invitation to his staff, 25 of them signed up: “You know, just thrilled to figure out how they might be able to save a life.” Gerber’s baristas aren’t the only unlikely population impacted by substance use disorder.


As library overdoses began increasing for Librarians at McPherson Square Branch in Philadelphia, they took action and now practice overdose drills. The library staff was the first in the city to learn how to administer the lifesaving overdose antidote Narcan. Instead of waiting for permission, they asked Prevention Point Philadelphia, a needle-exchange program, to demonstrate the use of Narcan.
The demonstration was held before Library operating hours, but more than two dozen librarians showed from six North Philadelphia libraries. Sandy Horrocks, a spokeswoman for the Free Library, said officials would expand the model to other libraries as needed.
American Libraries, the magazine of the American Library Association, ran an article in June 2017 about “Saving Lives in the Stacks“, which was accompanied by a sidebar piece about needle safety. The coverage suggests that the McPherson Square Branch is not alone. Libraries all over the country are concerned about overdoses.
It’s insufficient to say that people with substance use disorder could be our family members, neighbors, friends, teachers, and soccer coaches. They are our family members, neighbors, friends, teachers, and soccer coaches. The profile of a person with substance use disorder is not an intravenous user without regard for his or other people’s lives. It’s a pregnant mother, an elder care provider, a teenager, or an injured middle-manager.
Despite our awareness that people with substance use disorder could be people intrinsically involved in our lives, most of us continue to ignore the crisis. You can be angry with these people. Or you can be like a barista in Cambridge or a librarian in Philadelphia, two of the unlikely heroes who have emerged to combat this crisis.
You can, as these people have, find novel ways to help.
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Parent Co. partnered with Aspenti Health because they know that the first step toward change is understanding the problem.

Could Drinking Together be the Secret to a Long-Lastingly Happy Marriage?

A recent study suggests when older couples participate in concordant drinking (drinking together), the negativity within their relationship decreases.

If you and your partner drink casually together, keep going. Your relationship may just withstand the annoyance of your spouse.
A recent study found in The Journals of Gerontology suggests that when older couples participate in concordant drinking (drinking together), the negativity within their relationship decreases. Essentially, partners get on each other’s nerves less. Their outlook toward one another is more positive and drinking together increases their ability to live harmoniously. They even have more in common outside of the home.
On the flip-side, those who participate in discordant drinking (where only one spouse drinks), suffer from an increase of negative feelings within their marriage. Simple offenses, like forgetting to empty the dishwasher, rarely go unnoticed.
Specifically, the study shows that this amicability is significantly greater among wives. The study went on to say, “Further, wives are often referred to as the barometer of the marital relationship and thus may be more affected by discordance or concordance in alcohol use.” If they aren’t in-sync, women tend to sense when things are “off” within the relationship. So, when a woman drinks with her partner, she is more likely to shrug off her partner’s daily blunders.
As we live with our partners over the years, it is no surprise that we start irritating each other. Sometimes it feels as though our best friend has evolved into a roommate – one who leaves the dishes in the sink, forgets to pick-up the milk on the way home, or throws his or her dirty socks on the family room floor instead of in the laundry basket. The study claims that drinking with your spouse can help alleviate all of these small grievances that have the ability to pile up – just like those dishes in the sink.
In result, concordant drinking couples may spend more time together and enjoy more leisure activities together. They take trips together, run races, take on watersports, and enjoy other pursuits that bond people together. Not to say that discordant drinking couples don’t share in these activities – it’s just not as likely.
Furthermore, the study says that “Discordant drinking couples may use more destructive conflict strategies.” They may banter on a more regular basis. So, if one drinks and the other doesn’t, the impact is not the same. This explains my parents, who have an imperfect, yet strong marriage of almost 46 years. My dad is 13 years older than my mom. Oftentimes, she plays the role of nurse and maid more than wife. She does not drink. My dad, on the other hand, drinks leisurely at 82 years old. My mother puts on that black and white referee uniform daily, nagging my dad for his fouls and wanting to eject him out of the house.
According to the study, maybe my mom should start drinking a couple glasses of wine in the evenings. Perhaps she wouldn’t want to blow the whistle at my father as often. And my dad, well, he should continue to drink his small doses of red wine and Scotch because it’s helping him live harmoniously with his wife of almost half a century – giving him the ability to shrug off his wife’s protests.
Neither I nor the study recommends picking up a heavy drinking habit with your partner, but if you enjoy a couple of light-hearted cocktails, don’t stop. It just may continue to toughen your marriage as you journey through the sometimes-murky years together.

The H Word: How and Why to Talk With Your Kids About the Deadly Heroin Epidemic

We’re raising our children amidst an unprecedented scourge of deadly opioid addiction, and staying silent is simply not an option.

In the U.S., 60,000 people died from drug overdoses last year – the most ever. Drugs are now the leading killer of Americans under 50 years old, with more than half of overdoses attributable to opioids/heroin which, alone, now kill Americans at roughly the same pace as gun violence.
As a recovering alcoholic, these figures confirm the frightening trend I see developing in Alcoholics Anonymous: More and more young people are primarily addicted to opioids – including heroin – as opposed to alcohol or other drugs.
Before we go further, some clarification: Generously prescribed painkillers like Percocet, Vicodin, and OxyContin are in the same family of drugs as heroin – namely, opioids. The abuse of both is at crisis level. And though addiction is addiction, all drugs are not created equal. Opioids are simply far more lethal and especially likely to cause overdoses following periods of clean time.
Heroin’s growing popularity stems from accessibility and cost. Since it’s illegal, heroin doesn’t require a prescription and, on the streets, is far less expensive than its pill-based counterparts. The result is widespread “addiction by accident” scenarios in which patients are prescribed painkillers for a legitimate reason, become physically dependent, and eventually turn to cheaper, more obtainable heroin.
Scared yet? You should be. We’re raising our children amidst an unprecedented scourge of deadly addiction, and staying silent is simply not an option. Here are ways parents can communicate the perils of opioids.

“Whatever you do…”

The best advice my father ever gave was, “Whatever you do, don’t drive if you’ve been drinking.” He said this not when I reached legal drinking age, but four years earlier when I got my driver’s license – ceding, without condoning, the likelihood of underage drinking while emphasizing drunk driving as completely unacceptable. One sin was venial, the other potentially mortal.
Similarly, a holier-than-thou approach won’t suffice when it comes to heroin. We must hammer home the singular danger of opioids without explicitly condoning the use of other drugs, alcohol included. Heroin must occupy a never-ever-ever category unto itself.
Whether that makes kids more likely to imbibe other substances is debatable. Regardless, you’d rather your child come home drunk, stoned, or even high on cocaine than find opioids in his backpack.

Arrange a “pre-intervention” – even if your teen doesn’t realize it

Chances are, you know someone in recovery – someone like me. And chances are, they’re very comfortable with discussing their experiences as alcoholics and addicts. It’s something we do regularly in AA, where identifying with fellow sufferers is key to staying sober.
Our checkered pasts and the plainspoken, preach-free manner in which we discuss them make those in recovery ideal to deliver a stern yet unassuming warning about the dangers of opioids and heroin. Know a recovering drunk but not a junkie? No problem. Anyone with a firm foothold in recovery is well aware of the emergency that heroin has become, and can speak to its unique lethality. We’ve been to enough wakes.
A pre-intervention need not be a big production – in fact, the lower-key the better. For example, I once tactfully found a few moments to informally chat with a friend’s kid during a barbecue. He got the message – and he didn’t even know the discussion was orchestrated by his parents.
To those who’d call that deceitful or manipulative, I say this: Welcome to the real world. Desperate times call for drastic measures and, of all the indignities to which we can subject our children, I’d put some pre-planned “Just Say No” stagecraft pretty far down the list.
Hesitant to ask a recovering friend to discuss so personal a topic? Most of us are so grateful to be free of addiction’s grasp that we’re happy to pay it forward and help prevent someone from having to endure the same hellish consequences we suffered.

Play to teenage exceptionalism & rebellion

Every generation of parents ascribes, in some degree, to the “When I Was Your Age” cliché, the idea that our childhoods were tougher than that of our offspring. And indeed, this eye roll-inducing saying is true in certain areas – the sophistication of technology, the four-star resorts most college campuses have become, and so on.
But in terms of navigating illicit drugs, the current youth generation has it worse not only than their parents, but any generation. Again, the difference between marijuana and heroin – or even cocaine and heroin – is the difference between being picked up by the police and being zipped up by the coroner. Opioids have upped the ante to the point where parents need to pitch a near-perfect game.
So use that. Adolescents and teenagers love believing the world is singularly tough on them and their peers. Here’s a novel concept: agree with them. And while you’re at it, play to teen angst and rebellion.
Explain to them what got us here: Lies and profiteering. For decades pharmaceutical companies have reaped massive profits by vastly downplaying the addictive nature of a class of painkillers so similar to heroin that, today, most heroin addicts started with prescription painkillers.
A telling statistic: In Ohio about 20 percent of the population was prescribed an opioid last year. Faceless corporations who didn’t care whether people live or die started, and continue to propagate, this scourge. Let’s tell our children exactly what this is: the epitome of authoritarian evil deserving of their contrarian teenage rage. Most important, don’t help them by becoming just another customer.
And if all else fails, ground them for 18 years.

What My Daughter Taught Me About Addiction

No parent ever wants to think that drug use might explain their child’s upsetting behavior. If only I had known how to spot it and what would help her most.

“I don’t want to come to dinner. I’m not hungry. Just leave me alone!” She slams her door in my face.
I lean against it, listening to her cry. I don’t know what’s gotten into my bright, sociable teenager, besides the fact that something is very wrong. No parent ever wants to think that drug use might explain their child’s upsetting behavior. If only I had known how to spot it and what would help her most.
In a nationwide survey of parents of high schoolers, most said they would know if their kids were using drugs, yet failed to recognize most of the warning signs. Nor did they know that young women are at high risk.
In fact, girls 13 and up is the fastest-growing group of illicit drug users, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). It’s more important than ever for parents to know the signs.
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Know the signs

Of the dozens of tip-offs to possibly risky drug use in teens, two especially set off warning bells about young women. Is her hair unwashed or messy, her clothing rumpled or stained? Has she switched her group of friends? Do you know who she is hanging out with?
Adolescent girls who lack concern about their appearance and stop seeing their friends tend to be depressed and isolated, which puts them at risk of using drugs.

What you can do

Use the experience of other parents of girls with drug dependency. We all wish we’d trusted our intuition that something significant was wrong sooner. If she won’t talk to you, find a therapist trained in adolescent behavior.

Know the why

Depression goes up for both genders when puberty hits, but it’s nearly three times higher in girls, according to Anita Gurian in the study “Depression in Adolescence: Does Gender Matter?”
A major factor: Estrogen levels spike during her menstrual cycle and cause dopamine, a mood balancer, to plummet. That’s when she’s more likely to self-medicate, and if she does, she may feel better – for a little while. But if she continues to self-medicate with illicit drugs, she’ll feel worse.
This is partly because serotonin, another feel-good chemical, decreases with the input of artificial highs in the brain. She’s left feeling worse than ever and needs more of the substance just to feel “normal.” It turns into a vicious cycle.

What you can do

Use carrots, not sticks. Suggest stress-busting activities that stimulate feel-good brain chemicals, such as meditation, yoga, deep breathing, creative expression, and physical exercise.
Trauma can occur after a deeply disturbing or distressing experience. As many as 80 percent of women seeking treatment for drug abuse report histories of sexual and/or physical assault, including young women who’ve undergone date rape – a significant risk for young women.
When highly stressed, her brain produces more of the stress hormone cortisol, which lingers longer in women’s bodies than men’s and leads to the depletion of oxytocin, often called the “love hormone.” Her altered brain chemistry tends to pull her away from relationships, leading to isolation and the risk of self-medicating.

What you can do

Again, find a good therapist. Experts say it takes time, in particular for women, to be able to open up and talk about trauma. But therapy can help rebuild her sense of safety and trust and reach out.

Know the talk

Talk to her when you’re both calm. Not, for example, at the end of a long school day or three in the morning when she’s broken curfew. Approach her with kindness, but be firm.
Instead of asking “What’s wrong with you?”, try “What’s troubling you?” Give her choices to get help: “Do you want to go to a therapist or outpatient treatment?” But allow her to face the consequences of her actions: “Do you want to give up your cellphone for a week or miss the party next weekend?”
Don’t stop talking to her. Young women who are stressed, depressed, and/or using drugs can be masters of manipulation and denial. Know that these are symptoms of the brain disorder of addiction. The goal is to get her healthy, so stick to your bottom line.
Mine came when I found drug paraphernalia in my daughter’s room after I thought she had stopped using. I knew that relapse is especially frequent for young women, and it can take more than one try. I framed my ultimatum as a choice: You can go to a recovery center or I’ll help you find a new place to live.
She chose treatment again at a women-centered program, and after a lot of help from addiction counselors, therapists, a peer recovery group, and Medicine Assisted Therapy, she became the vibrant, sociable, productive young woman I knew she could be.

Know the walk

Practically the first thing I learned about dealing with addiction in a child was to lock up medications or dispose of them safely. Many parents also remove alcohol from the home while their child is abusing it or in new recovery.
It was suggested that I needed to model a healthy lifestyle for my children as I am their main female role model. Or, as another mom put it, if we want them to get healthy, we have to walk the walk.
That’s when I heard the phrase “extreme self-care.” During the years of my daughter’s addiction, I came to see that I needed “me time” more than ever: bubble baths, chocolates, old friends, walks with my lug-head of a dog, quiet moments to focus on what I was grateful for – this precious life.

Know you don’t have to do it alone

I never imagined that I’d become part of a very large club that nobody ever wanted to join: the legion of parents of children with addiction, some in recovery, many not yet.
Between 1991 and 2015, the last year official figures are available, over 61,000 young people from 12 to 25 died from a drug overdose (Centers for Disease Control, 2017). The number of parents and other loved ones who have joined together to share support and resources to fight the worst health epidemic in our nation’s history is growing exponentially.
Being with other people who are dealing with a loved one’s addiction cuts down shame and emotional pain. Being able to talk honestly without being judged is a huge relief. I have met so many good, loving parents struggling as I did to accept, understand, and effectively address their children’s disease.
I take comfort now in being part of the solution, of being one more advocate for those who suffer indirectly from the chronic mental disorder that is addiction. Our children deserve nothing less.

 7 Things You Should Know About ACEs

Researchers and medical professionals are beginning to understand the connection between adverse childhood experiences and adult health problems.

The conversation on Adverse Childhood Experiences (ACEs) is still new, but researchers and medical professionals are beginning to understand the connection between adverse childhood experiences and adult health problems. Researchers have found a relationship between childhood abuse or family dysfunction and the leading causes of death in adulthood, including cancer, heart disease, liver disease, and lung disease, along with many common health issues like depression, autoimmune diseases, and inflammation. All of this may seem scary, but there is hope for those who have experienced ACEs and are now struggling with their adult health, and there is hope for those who are currently raising children and trying to interrupt any ACEs in their lives.

This YouTube video provides a background to ACEs research.

Here are seven things you should know about ACEs:

 1 | ACEs exist

Many people do not give ACEs credit for causing adult health issues. They say, “We all had a hard childhood.” “What doesn’t kill you makes you stronger.” “You just gotta toughen up.” Some of this is true. Researchers have found 64 percent of people report at least a score of one on the ACE Survey. Most of us did experience some kind of trauma or unpredictable chronic stress as children. Some of us had very little and some of us had a lot. These childhood events can have a major effect on us and most children do not have the ability to deal with the chronic stress of ACEs. ACEs do not make a child stronger, they break them down.

Research has shown that people who have experienced ACEs are more likely to suffer from health conditions, participate in harmful behaviors, have relationship problems, and struggle with emotions and handling stress.

Our ability to overcome ACEs depends on our resiliency. Some of us were able to work through our trauma and move forward. Others experienced chronic stress while their brains were developing or held onto the stress, which later manifested itself into autoimmune diseases, depression, fibromyalgia, heart disease, or cancer.

We may not even realize we have experienced ACEs, or what effect they have on our health, our social interactions, and our parenting. Diseases and health conditions can arise for a number of reasons, but having experienced an ACE increases the likelihood. When we develop resiliency, we are better able to overcome our past. Once we recognize our hurt, we can understand our position and work toward healing.

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2 | ACEs are scored

Researchers found 10 main areas of chronic, toxic stress that affects children. The survey is available online here. The areas include physical, psychological, and sexual abuse, abandonment, parental drug and alcohol addiction, parental incarceration, parental mental illness, seeing a parent being abused, or needs not being taken care of. Knowing the most important stressors for our children can help us to avoid them as we parent. Knowing our own ACE score can allow us the first step in overcoming our past. When you know your own ACE score, you are better equipped to speak with a medical professional about the impact your childhood is having on your health.

3 | You are not alone

Researchers have found that 64 percent of adults have had at least a score of one on the ACE survey. Of those, 87 percent of those had experienced two or more. The higher the ACE score, the more likely the adult was to have health problems like heart disease, depression, cancer, or autoimmune diseases. Many adults go through life with these illnesses and do not even realize the effect their childhood had on their adult health.

4 | ACEs effected a child’s developing brain

Chronic, unpredictable stress during childhood can cause serious changes to a child or teenager’s developing brain. These biophysical changes can cause inflammation of the brain and health issues as an adult. Damage is done at the cellular level to the developing brain, causing the cells to age and leaving us prone to diseases later in life.

Not only this, but when a young child or teenager is experiencing chronic stress, they are in a constant state of fight-or-flight, releasing the stress hormones adrenaline and cortisol. This causes us to have an unhealthy response to stress hormones when we do experience them. Chronic stress causes us to not be able to regulate our stress hormones, which brings on inflammation. Basically, we are on constant red-alert. This YouTube video shows the effects of chronic stress on the brain.

When stress is healthier for children, they develop the ability to handle stressful situations. When stress is chronic or unpredictable, children are unable to cope effectively with the release of stress hormones. The release of these hormones can actually shrink the developing brain’s hippocampus, further causing trouble for managing stress and processing emotion. What happens to our brains while they are developing is the foundation for the rest of our lives.

5 | We aren’t talking about all stress

There is a difference between the stress that causes an ACE and the regular stress of growing up and it’s important to make the distinction. Chronic, toxic, unpredictable stress includes things like abuse, seeing a loved one being abused, being bullied, not feeling loved, being hurt by loved ones, etc. The regular stress of growing up includes studying for a test, worrying when homework is forgotten, or dealing with the reasonable consequences for not doing chores or talking-back.

Parents should not shield their children from small stressors as they grow. These help the child develop a healthy understanding that the quality of their life depends on their choices, builds character and resilience, and helps them understand how to handle stress hormones effectively. On the other hand, parents do need to be there to protect children from stressors like psychological, physical, or sexual abuse.

6 | This is not about blaming your parents

Many parents parent the way they were raised, or are products of the environment in which they were raised. When our own parents were raised with chronic stress or trauma, it’s hard to expect them to parent any differently. The important part is to give them grace and to use this knowledge to grow yourself and break the generational trauma. Working through your own childhood will help you to overcome your own ACEs and work toward better health and parenting.

7 | ACEs do not define you or your parenting

A high ACE score does not mean you are doomed to be a bad parent or experience health problems. Just as we can heal a pulled muscle, we can also heal a traumatized brain. Taking steps to recognize past hurt and work through the pain can work wonders on our health. This along with a healthy diet, exercise, and medical and therapeutic help can help us overcome our ACEs. We are able to overcome our past hurts and not pass those along to our children. By allowing them to experience an appropriate amount of good stress, consulting with them and walking them through hardships, providing love, empathy, and loving limits, we can stop the generational spread of ACEs and protect our children’s developing brains.

Let Go of the Guilt, Love Is Enough

Guilt. From the moment our children are born or even when we first feel those little flutters and kicks, it consumes us.

Moms experience almost constant worry and guilt. From the moment our children are born or even when we first feel those little flutters and kicks, it consumes us. We worry about our children every second of every day and for many sleepless hours in the night when things are dark and quiet and our minds can really take control. This worry and guilt, it’s forever. 

With one child now in high school, I am grappling with the very real fact that in three short years, she could be living somewhere other than under my roof. I can only imagine what my nighttime thoughts will be then…

Moms worry about every single step of parenthood: Did I stop breastfeeding too soon? Did I breastfeed too long? Should I have tried harder to breastfeed? Was it wrong to let them cry it out? Was it wrong to pick them up right away? Did I start solids too early and cause allergies? Did I wait too long to start solids and cause allergies? Do they eat enough vegetables? Do they eat enough of anything? Should I be more firm? Why do I yell all the time? Why aren’t they speaking? Why aren’t they walking? Why won’t they use the toilet? Am I pushing them hard enough in school? Should I push them harder in school? Should I know their friends better? Should I respect their privacy? Should I have let them quit the team? Should I have pushed them to try out for the team? On and on and on and on and on, and the emotions are always the same: worry and guilt. No matter which direction we took or which decision we made, moms always feel guilty about the outcome and question if we’re somehow letting our children down. It’s exhausting.

I have a message for all of you amazing moms out there: it’s going to be okay.

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When I was a little girl, my parents rented a farm for the first truly memorable years of my life. My father was an alcoholic and a pathological liar, so obviously things were not easy for my mom. We were extremely poor. My father spent every penny that he could get his hands on to buy alcohol or eat out at a local pub while his children and wife were at home with nothing to eat. 

My mom doesn’t talk about those years very often and I’m always surprised when she does. There’s such sadness and regret in her voice when those memories surface. She talks about the fear, the sadness, and the poverty; about feeding my brother and me oatmeal for breakfast, lunch, and dinner because it was filling and there was no money for groceries. She talks about buying large men’s jeans at the Salvation Army and using them to cut and sew overalls for my brother and me. She talks about surviving thanks to our large garden and our animals. I can hear the guilt in her voice. I can hear how desperately she must have wanted a different life for us. 

Here’s the thing, I don’t remember this time period in the same way she does at all. I remember a magical place filled with rolling fields and animal friends. She remembers a crappy plastic swimming pool and a rusty swing set. I remember a place where I pretended I was in the ocean on hot summer days and swings where I used to imagine I was flying to far-off lands. I had no idea that our garden was the only reason we would have food into the winter. I remember that a carrot pulled from the ground with a bit of dirt still clinging to it was delicious. I remember watching her can and preserve, the jars filled with color, and the time spent with her in the kitchen. I remember her showing me how to knead bread and the laughter we shared while doing it. I had no idea that our chickens were the only reason we ate some days, I just remember how proud I was when she showed me how to collect the eggs and then gave it to me as my own special job. I didn’t know that we were “missing out” on store-bought yogurt, I only knew that I desperately loved the goats that provided our yogurt, and that I got to help my favorite goat bring her triplets into this world when I was a very little girl. I remember adventures in fields where the wind blew grass that was taller than me; finding fiddleheads hidden in the dark, cool woods; where the chokecherry bushes were, and helping my mom pick them and watching in our kitchen as she made jam. 

No matter how much pain, frustration, desperation, and, yes, guilt she may have been feeling, I don’t remember. I had no idea. I know she worried constantly about not being enough and not having enough, and she didn’t need to. I remember a woman who was always laughing with us, a woman who always had hugs and cuddles and read us extra stories no matter how exhausted she must’ve been. I remember a woman who knew how to grow anything, cook anything, bake anything, and who taught me to respect animals and the earth, probably without having any idea she was doing it. I remember thinking my mom was the strongest person in the world. That has never changed.

Fast forward to my twenties. Even though my mom went on to leave my dad and eventually meet and marry my step-dad, changing our lives dramatically for the better, I still managed to meet and marry a man almost exactly like my father. I had my first two children with him. He was also an alcoholic with assorted other addictions and emotional issues. Life wasn’t easy. After our children were born I spent almost every day worrying about what I had brought them into. I was consumed with guilt that this was their lives and powerlessness to change it for them. 

If the funds were not available for their father to spend on his assorted habits or whatever material possessions he felt would make him happier, he would turn into an angry, emotionally abusive person who would fill me with such fear and dread that I would simply give in, letting him have what he wanted to keep the peace. Then the money ran out and, while he got what he wanted, I couldn’t pay our bills and struggled to buy groceries. There were countless dinners of hot dogs and macaroni because I knew the kids would eat it and it was all I could afford on our insanely tight budget. So many hot dogs. I worried and worried about not feeding the kids properly.

I felt like a robot. I was getting up every day and doing what needed to be done to get through the day at work and then the very long nights. I remember the guilt of feeling that I wasn’t emotionally available for my children. There were no vacations or special activities because I couldn’t afford them. However, there were walks in the swamp and the woods, frog catching, and turtle finding. Yet I always felt like I wasn’t doing enough when we watched other families go away on amazing trips or head off to weekends at water parks. 

Then the money became even tighter (if that was possible) and I couldn’t find the funds to indulge their father’s whims. He became even angrier. The yelling and insults increased tenfold.  So we stayed in the tub far longer than we needed to or should have, every single night, waiting for their father to pass out and for the coast to be clear. We sang and sang and made up games and stories in that bathroom, and we survived. 

Yet the guilt continued to consume me. How could I let them live this way? Finally, one day, we ran and didn’t go back. Life became so much better and so much easier, and I married an amazing man who is an incredible father to all four of our children (we had two more). Even though we left that life behind, the guilt followed. The worry followed. I still questioned, every single day, what damage I had allowed to be done to my children by staying for so long. 

Then, one day, my older two children and I were watching television together and the people on the cooking show were asking what memories people had of their childhood kitchens. What did they smell and feel like? My oldest son turned to me and said, “Mom, do you know what I remember from being really little?”

I cringed inwardly. Here it was, the moment I’d been dreading. 

He said, “I remember hot dogs and love.” 

Hot dogs and love? Really? I was as shocked as I was relieved, and then of course amused. The three of us started to chat a bit. The kids talked about all the songs I sang at bath time that they loved so much, and the extra stories at bedtime. They talked about how funny it was to watch Mommy climb into the muddy swamp barefoot to try and catch frogs, and the countless walks and animals we spotted and the trips to our free local zoo. Whether or not they remember how truly awful things were at the time, what they have focused on is the love. They remember the time I spent with them and the love I showed them.

Here’s the thing: this Mother’s Day let’s take a break from the worry and the guilt, shall we? Life is challenging and heartbreakingly difficult at times. At the end of the day, what our children remember most are the stories we read, the snuggles we gave, and the time that we shared with them. They recall when we showed them how important they are, what they mean to us, and when we made them feel safe. Those are the memories and moments that will sustain them through the hard times in their lives. We can worry ourselves sick and let the mommy guilt eat us up inside, but all that truly matters to our children is that we love them and that we show them that every day. Love: that’s what they will remember the most.

Questioning Taboos: A Pregnant Economist Walks Into a Bar

If there’s one question that should teach you to stop googling for parenting advice, it’s “Can I drink while pregnant?”

If there’s one question that should teach you to stop googling for parenting advice, it’s “Can I drink while pregnant?”
Visit any of the big medical publications, and you’ll see the oft-repeated assertion that while a drink or two is “probably” fine, “no amount has been proven safe for baby.”
Visit any of the big-name baby sites, and you’ll likely find breathless articles about celebrities caught with a drink in hand while pregnant.
Visit a parenting forum and you’ll see scores of people excoriating posters for even asking the question, with just as many fervently asserting how mamas-to-be should just calm down and have a drink already.
This article will not add to this chaos by trying to convince you one way or the other about drinking while pregnant. Instead, it discusses how one pregnant economist upended conventional wisdom on the topic of drinking while pregnant, making us rethink the long-range consequences of relying on poor data.

A pregnant economist walks into a bar

In “Expecting Better: Why the Conventional Pregnancy Wisdom is Wrong – and What You Really Need to Know”, Emily Oster, an economist at Brown University, analyzes the existing medical literature on many controversial pregnancy topics. She weaves her own pregnancy experiences with her data analysis to show readers how she applied the findings to her own life.
The result is an unusual and refreshing parenting book that presents evidence without advice. Parents-to-be are instructed to weigh that evidence themselves and use it to make their own thoughtful decisions.
Expecting Better: Why the Conventional Pregnancy Wisdom Is Wrong--and What You Really Need to KnowThe most controversial chapter in the book is certainly the one covering alcohol, caffeine, and tobacco. About alcohol consumption during pregnancy, Oster concludes, “there is no good evidence that light drinking during pregnancy negatively impacts your baby,” and that expectant mothers “should be comfortable with up to one drink a day in the second and third trimesters” and “one to two drinks a week in the first trimester.”
Given the way alcohol is metabolized, Oster argues, the rate of consumption is as important as the frequency. Drink at a slow pace and most harmful bi-products of alcohol won’t make it to the baby.
To talk about the effects of alcohol consumption during pregnancy, Oster asserts, we also have to talk about how alcohol consumption in pregnancy is studied. Given that the safety of alcohol consumption during pregnancy is a controversial topic, and because alcohol consumption in even moderate amounts is suspected to do harm, it would be unethical to randomly group women and have one group abstain from alcohol, while assigning other groups to one drink a day, two drinks a day, and so on.
Instead of randomized controlled trials, then, physicians and other researchers have had to rely on survey data to draw conclusions about alcohol consumption during pregnancy. Oster sifts through the available literature, choosing those studies that best controlled for confounding factors, and finds that alcohol consumed in small quantities has no negative consequences for children.
One of the criticisms of Oster’s work is that she cherry-picked data. But as an economist, Oster is especially well-suited to identifying how a study that initially seems well-constructed might be flawed. She looks, for example, at a paper published in Pediatrics in 2001, in which researchers concluded that light drinking during pregnancy impacts children’s future behavior.
Oster summarizes the authors’ conclusion: “When the authors compared women who didn’t drink during pregnancy to those who had one drink or less per day, they found more evidence of aggressive behavior (although not of other behavior problems) among the children of women who drank.”
That sounds like damning evidence for the danger of alcohol consumption during pregnancy. One drink a day and your child will be the school bully.
What’s missing from the researchers’ conclusions, Oster notes, is that nearly half of the study’s drinking mothers were also using cocaine, while only 18 percent of the non-drinking mothers were. Oster posits that perhaps it’s the difference in cocaine use that made the impact on childhood behavior.
Furthermore, the very fact that “only 18 percent” of the non-drinking group used cocaine suggests that the population in this study may not be representative of the population as a whole. Because cocaine sometimes correlates with other issues that may be considered risk factors for childhood development, it’s not possible to draw strong conclusions about drinking more broadly from this single study.

But she’s not even a doctor!

Given her bold assertions about alcohol consumption, let alone other pregnancy bogeymen, such as sushi and deli meat, it’s not surprising that Oster’s work received a lot of negative attention. It is surprising, however, that her book received so many one-star reviews on Amazon before its publication date.
Most of those reviews, which Amazon has since deleted, appeared to stem from NOFAS, a Fetal Alcohol Syndrome advocacy group, who advised its supporters to review the book. Many of those reviewers openly admitted they would never read the book, so their reviews were eventually deleted in accordance with Amazon’s review policies.
Mothers of children with confirmed Fetal Alcohol Syndrome (FAS) wrote the overwhelming majority of the negative reviews. There were two significant problems with their claims (aside, of course, from the fact they were reviewing a book they hadn’t read and never planned to read, based on what they thought Oster argued in one section of one chapter).
The first was the claim that Oster was telling women to go drink. As she makes quite clear in her introduction, Oster’s aim is not to instruct women how to act, but to provide them with the data they need to make strong risk calculations.
The second problematic claim – which has been even stickier than Oster’s claim about alcohol – is that she should not be dispensing medical advice because she is not a doctor. The problem with these critiques is that Oster is a doctor. Although she’s not a medical doctor, Oster holds a PhD, and it’s her PhD that makes her so good at sifting through the various studies published on maternal alcohol consumption.
One of the defining features of a PhD is thinking (it is a Doctorate of Philosophy, after all). It’s precisely Oster’s training to evaluate large data sets with lots of confounding variables that makes her ideally suited to looking at all of the available data on a medical topic and selecting only the best-performed research.
Before returning to the question of Oster’s qualifications, it’s worth pausing for a moment to consider how medical literature gets made. If you are a physician-researcher or scientist working at an academic institution, you’re generally expected to publish in your field, often multiple times each year. This is especially important for faculty members seeking tenure, as many institutions have a publication threshold for tenure review.
That’s where the phrase “publish or perish” comes from. It refers to the need to publish in order to keep your job. For researchers whose salaries are completely dependent on the grants they bring into their universities, publications earn and retain funding for their work.
The pressure to publish early and often does not mean that researchers will publish “bad” data. There are many checks in place to ensure that scientific papers are of reasonable quality. But a “true” finding is not necessarily a useful finding. The “Pediatrics” paper Oster references in her book is one good example. The data was bad, but, Oster argues, not significant to populations of pregnant women not abusing cocaine.

Why take the risk?

In response to the review-bombing she received on Amazon in the wake of her book release, Oster wrote a piece for Slate describing the criticisms she’d received and reiterating the purpose of her book: “The value of the data is not that it leads us all to the same choice, just that it introduces a concrete way to make that choice.”
The comments section of that article is, perhaps unsurprisingly, full of women criticizing other women’s lack of self-control. There are women quoting FAS statistics (some of which Oster refutes in her book). There are women arguing that Oster’s writing is irresponsible because people might misinterpret it and drink unsafe amounts. There are also women discussing grandmothers and great-grandmothers who drank during their pregnancies, only to have healthy, well-adjusted children.
All of these commenters have missed the point. Oster titled the piece “I Wrote That It’s OK to Drink While Pregnant. Everyone Freaked Out. Here’s Why I’m Right.” What makes Oster “right” is not that she weighed the data and found that alcohol consumption is likely unharmful to fetuses when consumed in small amounts.
She’s not “right” because she drank during her pregnancy, any more than her critics were “right” for not drinking during their pregnancies.
What makes Oster “right” – what makes her someone we should want to emulate – is that she approached the entirety of conventional pregnancy wisdom and asked “Why?”
Many of the milder criticisms of Oster’s book include a judgement posing as question: “Why take the risk?” Why not just avoid alcohol for nine months, and, just to be safe, during breastfeeding? Why not skip the deli sandwiches? Why not swap out sashimi for California rolls?
Setting up unreasonably high standards for mothers such that they have failed before they ever see their babies also carries risk. These mothers have failed because they painted the new nursery even though the fumes were considered dangerous. They have failed because they didn’t eat all the right foods during pregnancy. They failed because they changed the litter box.
The value of a few glasses of wine during a pregnancy is not that the mom-to-be gets to relax, or even that the she just enjoys the taste of wine – although these are nice side benefits. The true value rests in the type of analytical thinking she can then rely on throughout the early parenting years to combat the slew of messages telling her she’s doing it wrong.
There’s no reason to suspect that drinking while pregnant will actually make you a better parent, just as not drinking while pregnant won’t make you a better parent. But the type of thinking Oster exhibits in her book can make us better parents, who are less susceptible to the advice du jour, more confident in our choices, and less fearful of the world.

What Breastfeeding Moms Should Know Before Smoking Pot

Many states have legalized marijuana and its use among pregnant women is making headlines. What happens when those women decide to breastfeed?

Many states have legalized marijuana and its use among pregnant women is making headlines. What happens when those pregnant women give birth and decide to breastfeed? Women who use marijuana (the leaves and flowers of the cannabis plant) to alleviate pregnancy-induced nausea or the frequent vomiting associated with hyperemesis gravidarum – HG – may stop using it once their babies are born and symptoms subside. On the other hand, women who find it helps with anxiety or use it medicinally for pain relief find themselves in a tough spot.
At this time marijuana is a Schedule 1 drug, in the same category as heroin. In Colorado, where marijuana is legal both medicinally and recreationally, a fact sheet for healthcare providers urges them to advise breastfeeding women to abstain from using marijuana based on recommendations by the American Academy of Pediatrics.
With little peer-reviewed research on the topic and plenty of stigma around it, many women are hesitant to discuss it with their healthcare providers. A Massachusetts mom I spoke with, who requested anonymity, says she used marijuana about once a month prior to becoming pregnant. Though she seldom smokes while breastfeeding, she would never tell her doctor about her marijuana use, explaining, “I think he would be judgmental about my choice.”
Lea Grover is one mom who speaks openly about marijuana. She calls it her “anti-anxiety drug of choice,” stating that she prefers it to Xanax because it lacks the side effects. Blogger Jeanna Hoch takes it a step further, admitting she uses cannabis daily and did so during her pregnancies and while breastfeeding. She proudly reports her older child suffered no apparent adverse effects; in fact, he was placed in the Highly Gifted and Talented program in first grade.
I interviewed Mary Lynn Mathre, RN, MSN, CARN, founding member and past president of the American Cannabis Nurses Association and president and co-founder of Patients Out of Time. According to Mathre,“it’s safe for breastfeeding moms to use cannabis under most circumstances, but especially if the mother has health problems and needs cannabis for symptom relief.” Mathre advises breastfeeding moms to choose a strain with a lower concentration of THC, the psychoactive component of the cannabis plant. THC concentration can vary widely.  ranging from less than 0.2% to over 20%.
According to Lauren Katz, a sales representative for a Colorado-based cannabis company, dispensaries are required by law to label each product’s THC content. She advises talking to your budtender to determine the right amount for you. Meanwhile, if marijuana is not legal in your state, it’s challenging to determine the concentration of THC. Additionally, there’s the risk that marijuana purchased illegally is laced with other illicit drugs.
Although the research on the effects of THC on infants is very limited, it is known that THC has a long half-life. It is stored in the mother’s fat tissues for weeks, or even months and the urine of infants exposed via breast milk may test positive for marijuana for up to three weeks.
Though limited, some data suggest that exposure to marijuana via breast milk poses no risks for babies. Tests performed on infants up to one-year-old in a 1990 study from Neurotoxicology and Teratology reported no adverse effects on the development of infants who were exposed to marijuana via breast milk at three months old.
A 1985 study published in the NIDA Research Monographs found no significant differences between the age at which infants weaned of mothers who used marijuana while breastfeeding versus those who didn’t. This suggests marijuana didn’t affect the mothers’ milk supply. Additionally, comparisons of measures on infants’ growth, cognitive, and motor skills revealed no differences between infants’ whose mothers reported daily marijuana use versus those who abstained.
A 2001 study in Archives on Pediatrics and Adolescent Medicine found no association between maternal marijuana use and SIDS.
In light of the scant research, the medical establishment advises women to abstain from marijuana while breastfeeding. Groups including La Leche League,  AAP,  and the  American Congress of Obstetricians and Gynecologists agree that no amount of marijuana exposure is safe for infants. While much remains unknown, we know that both secondhand smoke and a mother’s impaired ability to care for her baby while high, are contraindications for using marijuana while breastfeeding.
Some studies support recommendations that breastfeeding women abstain from using marijuana.
A 2013 review in Obstetric Gynecological Survey states that the current evidence suggests mild effects of heavy marijuana use by lactating mothers on their children’s development and that “these effects are not sufficient to warrant concerns above those associated with tobacco use.”
The same 1990 study that identified no adverse developmental outcomes for infants exposed to marijuana via breast milk at three months of age, found that infants exposed to marijuana via breast milk in their first month of life demonstrated decreased motor development at 12 months.
According to a University of California San Diego Medical Center paper, marijuana increases carboxyhemoglobin levels, limiting the blood’s oxygen-carrying capacity.

While the risks of marijuana exposure to babies via breast milk are not totally clear, breast milk is known to be beneficial for babies. This is why some healthcare providers discourage women from using marijuana while breastfeeding but don’t necessarily tell women to stop breastfeeding if they can’t abstain.
A 2015 University of California San Diego Medical Center paper strongly recommends breastfeeding women not use marijuana or expose their babies to secondhand smoke. In that same paper, the authors acknowledge the protective effect of breast milk and recommend that if a mom doesn’t stop using marijuana, that she continue to breastfeed, and that she make sure someone else is available to take care of her baby while she’s intoxicated.
Similarly, a 2015 survey of lactation professionals found 44% of respondents made recommendations on breastfeeding and marijuana on a case-by-case basis, depending on the severity of use. Meanwhile, 41% reported recommending breastfeeding even if the mother continues to use marijuana, as the benefits outweigh the risks. Only 15% said they’d recommend a woman cease breastfeeding if she could not stop using marijuana.
To confuse matters further, guidelines published in Breastfeeding Medicine state, “abstaining from any marijuana use is warranted,” and also that,  “although the data are not strong enough to recommend not breastfeeding with any marijuana use, we urge caution.”
The only thing we know for sure is there is a dearth of evidence. But if the trend toward legalization continues, moms and health professionals may just start demanding answers.