Rationality devoid of humanity often masks cruelty. “I was only following orders,” is a problematic justification. Which brings me to Gov. Dannel Malloy’s proposed budget and the disproportionate gutting of behavioral health services in Connecticut. This in the midst of an epidemic of heroin and opioid abuse and an unprecedented number of overdose deaths.
Over the past two decades, first with the explosion in prescription opioids, and now with those plus cheap heroin from Central America, often laced with a potent synthetic opioid (fentanyl) flooding the market, we have tens of thousands of Connecticut residents, most of them young, addicted. At a recent round-table in New Britain with Sen. Richard Blumenthal, the mother of a son who had died, and two young people in recovery voiced the reality of what it’s like to be addicted, or to have a child who’s in deep trouble and you can’t find the help she needs.
The mother voiced a refrain I’ve heard too often: “My insurance company told me he hadn’t failed enough at a lower level of care.”
Again, this is a perfectly rational response from an insurance reviewer reading off a script. She’s following orders. But step back and ask yourself, with what other life-threatening condition would we tolerate this response?
“Sir, I appreciate you’re having a heart attack, but try another aspirin and see if it goes away before we approve you for an emergency angioplasty.”
Just as in balancing a budget, this bottom line perspective makes sense. If the patient dies as a result, money is saved.
Another point that emerges from all of these round tables and open forums is that there are inadequate treatment resources throughout the state, including detoxification and rehabilitation slots. What little we have is now in jeopardy.
I deal with this daily. When you have someone with a life-threatening substance use disorder and they are willing to go to treatment, or they’ve just been rescued from an overdose with a shot of Narcan, the time to act is now. Not in the morning, not later in the day, but now.
Here’s why. For those who don’t understand addictive disorders, “Why can’t they just stop?” “I’ve taken pain pills and I never got hooked?” You need to remember the vast majority of people who get addicted to drugs and alcohol are teenagers, that’s when it starts. Our brains aren’t fully wired until we’re in our mid-20s. When you expose the teen brain to the rewarding and intoxicating effects of drugs, they hi-jack the primitive part of that organ called the reward system. That’s where we get the urges to eat and to procreate. Clearly, no species can survive without this.
However, now the strongest urge is to get high. Primate studies have demonstrated that this drug hunger can quickly overshadow our basic survival instincts, to where food, clothing, shelter, and relationships take a backseat to the next fix. When someone says they are ready for help, you must move fast before the next craving hits.
As a psychiatrist, I know that this situation is not hopeless and that people absolutely can and do recover. In the case of our opioid crisis, adequate and immediate access to the right levels of treatment saves lives. Where addictive disorders are chronic conditions, having the right mix of services from detox and residential programs of sufficient duration, to medication-assisted options, to strong peer networks of people in recovery, are crucial.
We’re not there yet, not by a longshot, and budgetary hits to what we do have will have a devastating impact.
This is a time for advocacy. Silence, fear, and complacency have always been the backdrop for letting these kinds of cruel acts goose-step forward. “My voice doesn’t matter.” “What can I do, he’s going to make these cuts regardless.” Every parent, who has lost a child, attach their picture to an email and send it to the governor and your legislators. Every parent or loved one of a person with an out-of-control addiction, or serious mental illness, do the same. If you’re in recovery, let your voice be heard.
It’s a great and rational thing to balance the budget, but to do so over the graves of Connecticut’s youth in trouble is both evil and tragic.
Charles Atkins, M.D., is a psychiatrist, author, and the chief medical officer for Community Mental Health Affiliates with offices in New Britain, Torrington, and Waterbury. He is also a member of the volunteer faculty at the Yale School of Medicine.