The dos and don’ts of helping a drug-addicted person recover
How you talk to people with drug addiction might save their life.
Maia Szalavitz is widely viewed as one of the premier American journalists covering addiction and drugs. A neuroscience writer for TIME.com and a former cocaine and heroin addict, she understands the science and its personal dimensions in a way that few others can. is the first book-length exposé of the "tough love" business that dominates addiction treatment. Her newest book is Unbroken Brain: A Revolutionary New Way of Understanding Addiction.
MAIA SZALAVITZ: There are people who are trying to promote brain surgery for addiction using electrical stimulation of that area and it doesn't work any better than methadone. And that's not to say that methadone isn't the most useful drug we currently have, but it does not involve invasive surgery. I should say methadone and buprenorphine, the opioid agonists, are the best treatments that we have for opioid addiction. And what they do is two things: The first thing is they cut the death rate by 50 percent, which is – this happens whether you continue using on top or not. So that's pure harm reduction and that's wonderful. If we can keep you alive long enough that you stabilize your life, that is a lot better than having you die. The other thing that they do is they allow people, who are ready, to stabilize their lives. So you couldn't tell right now if I was on a maintenance treatment or not because basically once you get a tolerance to these drugs you are not high or impaired, and you can drive and you can work and you can love and you can do all of these things, but we don't understand, we think, "Oh you've just substituted one addiction for another." No, what you've done is you've substituted compulsive behavior despite negative consequences, and now you just have a physical dependence. And that's not a real problem as long as you have a safe and legal supply.
I think the most important place to start is that addiction is a learning disorder; it's not a sign that you're a bad person. And if you want to have a safe and addiction-free, or at least lower level addiction, workplace or school, you want people to feel included and comfortable and safe and you don't want this to be an adversarial thing. The research shows that the best way to get people help is through compassion and empathy and support, and absolutely not tough love. There may be situations in which an employer has to fire somebody because their performance has just degraded so much that there's no other option, but they shouldn't think, "I'm doing them a favor by firing them, because that will make them hit bottom and it will help them." Sometimes that happens, but sometimes they just go on to a life of homelessness and then die. So you can't assume that creating extra-negative consequences is actually going to help a person with addiction. What you want to do is ally yourself with them and, presuming this is an employee that you want to keep, help them realize that this is not a sin. "I am not trying to control you. What I want to do is for you to be at your best – at work, at home. And you're not being at your best right now, so what can we do to help?"
Well, I think the important way to start that conversation is to first not assume that a problem that you think might be drugs is drugs. The person could be having any number of mental illnesses, the person could be having, you know, there's a million things that could look like oh you think they have a drug problem and there's something else going on. So if you approach the person with respect and not assuming that you're going to find a drug thing unless, obviously in some situations it's completely obvious, but in most situations it isn't. And so the best way, I think, is to say, "I've noticed XYZ. I'm worried about you. I'm concerned about you. I want to make sure that I can help you." So it comes from a place of not like, "I caught you!" you know, because there's so much advice that is just like, "Well, threaten to fire them if they don't change, and drug test them immediately," and all of this kind of stuff which destroys trust. So, that's not to say that if somebody is doing something dangerous or clearly inappropriate that that behavior doesn't need to be addressed, but it is to say that you can approach somebody in a confrontational degrading and sort of high-powered manner or you can approach them as an equal human being deserving of respect. And if you do the latter you will have much better results.
And I have to say, it's almost and never going to be easy because people, whether they have addiction or mental illness or anything else going on with them, often don't want to admit to themselves that there's a problem. In the addictions field there's been this whole thing 'we've got to break through denial' and everything like that. Well, people have denial for good reasons. If we didn't have denial everybody would be sitting around obsessing about death, or at least I would be. It's a defense mechanism because we need defending. So recognizing that can allow you to approach somebody not from an attacking stance; approach somebody from a befriending sort of stance. And that is hard to do and some people are going to get very defensive no matter what you do and it's not going to be a pleasant conversation most of the time. But you can minimize harm. I mean, this whole thing always comes down to like reducing harm, making things less unpleasant if you can't make them non-unpleasant or actually pleasant. But the main thing is to see them as a full human being.
And I think really important in getting people into any kind of treatment is that, and I always say this to parents or anybody who has an addicted loved one, the first step should always be a complete, thorough psychiatric evaluation by somebody who is not affiliated with any treatment organization so that you can know going in what the problems may be and what kind of services you should be seeking. There are some absolutely wonderful treatment providers who, if somebody shows up who is not appropriate for their services, they will send them away. There are also unfortunately many people who will just take that person to make a profit off of them and they will not help that person and they will not inform them of that, for example, if they stayed on maintenance they would have a 50 percent reduction in their death risk. They would just say, "We do abstinence; that's good for you." Blah. And so I think, again, this is a sort of "buyer beware" industry. In the rest of the medicine it's pretty easy to say, "Okay, here is PubMed, this is the treatment for this particular cancer that has the most evidence behind it, and here's the guy who designed the best treatment. Let's go find this person." In addiction, it's virtually all based on like reputation and advertising, and it is very difficult to actually find programs that provide evidence-based care.
This is also a problem in mental health more generally. But anyway, the point here is that in order to get care that is good for you, you need to advocate for yourself, and if you have an employer that's willing to advocate for you that's even better. The way I think that employers could do an enormous amount of good is by demanding that the treatment providers they work with, the treatment that they cover, is evidence-based, and is not restricted because of money but is restricted because stuff that doesn't work shouldn't be paid for.
- Addiction is a learning disorder; it's not a sign that someone is a bad person.
- Tough love doesn't help drug-addicted people. Research shows that the best way to get people help is through compassion, empathy and support. Approach them as an equal human being deserving of respect.
- As a first step to recovery, Maia Szalavitz recommends the family or friends of people with addiction get them a complete psychiatric evaluation by somebody who is not affiliated with any treatment organization. Unfortunately, warns Szalavitz, some people will try to make a profit off of an addicted person without informing them of their full options.
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Researchers detect a large lake and several ponds deep under the ice of the Martian South Pole.
- Italian scientists release findings of a large underground lake and three ponds below the South Pole of Mars.
- The lake might contain water, with salt preventing them from freezing.
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Mars colony: Humanity's greatest quest | Michio Kaku, Bill Nye, & more | Big Think<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="aa931ba0f8c1152a7c32c5e09c55d138"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/KfKr5Jll88o?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span>
"Nothing but naked people: fat ones, thin ones, old, young…"
"The Yellow Sands", 1888, John Reinhard Weguelin; source: Wikimedia Commons<h3>Naked revolution</h3><p>Yet long before anyone knew about beach fashion, naturism was trendy. Bathing naked in the sea was going on in England as early as 1840. However, during the reign of Queen Victoria, this pleasure was outlawed. But it popped up again among the conservative Germans. In 1898, the first Naturist Club was founded in Essen and in 1900 the Wandering Birds group (<em>Wandervögel</em>) was scouring the country for uninhabited places and naked sunbathing. In the same year, Heinrich Pudor wrote <em>The C</em><em>ult of </em><em>the </em><em>Nud</em><em>e</em>, winning the hearts of contemporary supporters of naturism.</p><p>In the 1920s, on the back of this, members of the Movement for Natural Healing (<em>Naturheilbewegung</em>) organized naked sunbathing for the improvement of health. Persuaded by Pudor's theory of the healing properties of the sun and wind, which could be absorbed through the skin, they launched the naked revolution.</p><p>Pudor's book became the naturists' manifesto and soon after, not far from Hamburg, the Free Body Culture (<em>Freikörperkultur</em>, or FKK) movement was founded. This spread through other German centres and brought together thousands of people. The FKK still operates under the same name today.</p><p>The cult of the naked body even wrote itself into the ideology of fascist Germany, which advocated a pure, Aryan race. But in 1933, Hermann Göring issued an order that defined nudity as "the greatest threat to the German soul" and, with that, criminalized naturist organizations. But this wasn't the end of the movement. The naturists went underground, continuing their activities under the guise of improving physical fitness.</p><p>In 1936, the idea was even floated of having a naturist display to open the Berlin Olympic Games. It was quickly dropped. Despite this, in 1939 the naturists managed to organize their own Games in the Swiss village of Thielle.</p>
A strange weakness in the Earth's protective magnetic field is growing and possibly splitting, shows data.
- "The South Atlantic Anomaly" in the Earth's magnetic field is growing and possibly splitting, shows data.
- The information was gathered by the ESA's Swarm Constellation mission satellites.
- The changes may indicate the coming reversal of the North and South Poles.
Is the Magnetic Field Reversing?<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="e3e0b16dac3b05dab808a4ddf04d198b"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/51usJ74pPP8?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span>
Techshot's 3D BioFabrication Facility successfully printed human heart tissue aboard the International Space Station.
All that's fit to bioprint<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDQ0MTc4OS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY0NjUyMTkxN30.c02tUlYJLxdekTGR5ExOagL2Sh-5rmWN6pYkqger920/img.jpg?width=1245&coordinates=0%2C210%2C0%2C2&height=700" id="c20c0" class="rm-shortcode" data-rm-shortcode-id="681571f2317ce5f65b105b6fb5aabd51" data-rm-shortcode-name="rebelmouse-image" alt="Dr. Eugene Boland" />
Dr. Eugene Boland, Techshot's chief scientist, presents the 3D BioFabrication Facility at NASA's Kennedy Space Center, Florida
A heart from your new BFF<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="1fa24e6ada521bcdac46de275c37f2da"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/p_hauPqouH8?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span><p>In partnership with <a href="https://www.nscrypt.com/about-us/" target="_blank">nScrypt</a>, Techshot developed the BFF to manufacture human tissue in space. In July 2019, they launched the bioprinter aboard the SpaceX CRS-18 cargo mission to be delivered to the International Space Station. There, it was loaded up with nerve, muscle, and vascular bioinks. As the BFF pinned the cells together in a culturing cassette, generating layers several times thinner than a human hair, the microgravity environment ensured the low-viscosity structure kept together. That's courtesy of the same surface tension property that allows for those <a href="https://www.youtube.com/watch?v=H_qPWZbxFl8" target="_blank">moving water spheres astronauts love to play with</a>.</p><p>"So, now you can have a vascular cell where you want a blood vessel to be, the nerve cell where you want the nerve to pass through, and muscle cells where you need a muscle bundle to be," Boland said. "All of those will stay where you put them in three-dimensions and then grow and mature where you want them."</p><p>A non-cellular ink was added to the mix to provide a bit of framework and prevent cells from sliding around during the printing process. But because Earth's gravity had less pull, this framework didn't need to be as ridged as terrestrial scaffolding. This non-cellular ink was water-soluble, meaning it could be washed away after the printing was complete. The end result, a more natural fabrication of human tissue.</p><p>Once 25 percent of the cells needed for the mature tissue were in place, the cell-culturing cassette was moved to another payload, the Advanced Space Experiment Processor (ADSEP). There, the cells lived and grew as they would naturally. Fully differentiated cells signaled to the adult stems cells that they should be heart cells. The stem cells grew and multiplied, supported by the nutrients provided in the ink. A few weeks later and the cassette was home to human heart tissue.</p><p>This January, <a href="https://www.prnewswire.com/news-releases/success-3d-bioprinter-in-space-prints-with-human-heart-cells-300982759.html" target="_blank">Techshot announced</a> the BFF had cultured successful test prints aboard the ISS. These heart prints measured 30 mm long by 20 mm wide by 12.6mm high. In a follow-up experiment, the BFF also manufactured <a href="https://techshot.com/techshot-successfully-completes-knee-cartilage-test-prints-in-space/" target="_blank" rel="noopener noreferrer">test prints of a partial human knee meniscus</a>, the soft cartilage that acts as a shock absorber between your shinbone and thighbone.</p>
The future of medicine is in space?<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDQ0MTc5MS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY2MjQwODUxOH0.VAg1FIZkGz_IOCaGUAHxylX1h44qA2-tk-9odXPoLT0/img.jpg?width=1245&coordinates=0%2C118%2C0%2C94&height=700" id="2176b" class="rm-shortcode" data-rm-shortcode-id="932d3caca0897797883d941a6255885e" data-rm-shortcode-name="rebelmouse-image" />
NASA Astronaut Jessica Meir prepares Techshot's cell-culturing cassettes for their return trip to Earth.
Credit: NASA Johnson/Flickr<p>For its next run, Techshot wants to improve the cell-culturing cassette, refining conditions and more effectively flushing out trapped air. Its researchers are also looking into making cells in orbit. Then there is the process of scaling up from test prints to functioning tissue pieces (say, heart patches) to fully operational organs. Then there are the challenges of space flight and <a href="https://bigthink.com/surprising-science/3d-printing-body-parts" target="_self">the long road of regulation</a>.</p><p>"We're dedicated to the long haul here," Boiling said during our interview. "We have agreements with NASA that permit us to iterate and fly-and-try to continue and improve. We brought the BFF and ADSEP back from the space station late summer to make those improvements based on what we have learned so we can send it back up."</p><p>Yet, the windfall goes well beyond shoring up our stock of donor organs. Bioprinting has the potential to dramatically advance the field of personalized medicine. For example, one danger of transplants is rejection by the host body. This happens when a recipient's immune system views the life-saving tissue as a foreign invader and attacks it. <a href="https://med.stanford.edu/news/all-news/2010/09/researchers-find-faster-less-intrusive-way-to-identify-transplant-recipients-organ-rejection.html#:~:text=If%20organ%20function%20drops%2C%20doctors,the%20first%20year%20after%20transplant." target="_blank">About 40 percent of heart recipients</a> experience acute rejection in the first year, requiring doctors to prescribe immunosuppressant drugs.</p><p>Crafting an organ from a patient's personal stem-cell stock has the potential to reduce this risk. Replacement parts, such as heart patches, could also be patient-specific. Test prints could be constructed to analyze how a patient's system responds to specific drugs and treatments, taking <em>in vitro</em> experiments out of the Petri dish and into a microenvironment more representative of the natural human body.</p><p>"Instead of the trial-and-error medicine of the 20th century, you'll have the personalized medicine that has always been just around the corner. [This technology] may be an answer to that," Boland said.</p><p>And we could take bioprinting farther into space. Boiling foresees a future where the technology could <a href="https://www.nasa.gov/artemisprogram" target="_blank" rel="noopener noreferrer">travel with us to the Moon</a> or beyond. There it could serve personalized pharmaceutical needs for stationed astronauts, or if paired with a Cell Factory, it could print meats made from bovine or pig cells. Ethical, yet potentially indistinguishable from its farm-raised counterpart.</p><p>We've come a long way since the 1950s. Many people are alive today thanks to what that first kidney transplant showed medical science. True, Techshot's test prints are small compared to an entire human organ, with its complex and interconnected network of epithelial, connective, muscle, and nervous tissue. But if printing an organ is equivalent to urban planning a cellular city, then Techshot's accomplishment is certainly the first of many skyscrapers toward that goal. That goal could be the proof on concept that saves many more.</p>