On the subject of "Thoughts and prayers"

Pray if you want, no one is asking you to stop. No one is judging you because you do.  We are imploring you to see your prayer is SIMPLY NOT ENOUGH! Take action where you can and demand action where u cannot. If you cannot start doing that here and now, then you have rejected the first gift given to you by the God you claim to live for. Unless you act, as empowered by the God you follow – your faith is worthless here. In fact, the responsibility for all living things is the ONLY thing your faith has that is valuable to this earth. on some level you know being responsible here is the true test of your faith. Yet, you have so eloquently squandered it all.

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On Addiction, Phillip Seymour Hoffman's death, and Selfishness

This post was lost in error due to to a site upgrade. It was originally posted : February 08, 2014 at 09:07 PM EST - retrieved thanks to "The Way Back Machine!"

February 3rd, 2014 was a day I wanted to seem normal.  It was my goal this year not to notice that day.  For 21 years, that day had been my A.A. anniversary.  In 1990, that was the day I walked into a room of alcoholics and accepted the idea that I was a hopeless drunk that needed help.  I was twenty years old.  

For those of you that have read Leaving the Rest, it will come as no surprise to you that I no longer identify as “Sober.”  In fact, I no longer identify as an “Addict” or an “Alcoholic.”  I have spent the past few years trying to remove those labels from the construct of my self-image.  And I am succeeding, but it is a daily journey, much like getting sober was.   For the past few years, a cloud of doubt has hung over me on February 3rd.  A fear that my choices were a form of hubris that could ruin me—how dare I claim to be different than other addicts, how dare I suggest that I could be healed in some way—that fear, combined with a real sense of loss for a sober community that I once called home, meant that day has been filled with melancholy and reflection of late.  For me, this year, it seemed a sign of symbolic growth that February 3rd had approached and almost passed with out me realizing it.  

This year, on February 2nd, I launched this blog.  I had not even considered that the next day was my former sobriety anniversary.  As I proudly posted the notices of my first blog entry on to Facebook, my heart sank to learn that Philip Seymour Hoffman had died of an apparent drug overdose.  He was not a personal friend; I had only met him in passing at a few parties.  But since I have no less than twelve Facebook friends who did know him, or who had at least worked with him in some capacity, my timeline was full of the news and gossip.   His tragic death, and the subsequent outpouring of shock, regret, and affection that always accompanies the unexpected loss of someone famous, somehow seemed magnified.  Perhaps this was because this particular celebrity and I shared a social degree of separation equivalent to about 1.1333 degrees.  The result for me was I would once again spend February 3rd pondering the nature of “Addiction.”   In the wake of PSH’s death, what struck me was the number of posts that pondered the suggestion that the nature of addiction is “selfish.” These lit up my social media timeline through out the one day I had willed for myself to be free of the topic.  

Many of these posts included links to scientific arguments, interesting videos about the biology and psychology of an addict.  And the biology studies are compelling.   There is real science that makes one want to believe that indeed, the addict lacks some from of self-control that others have.  The condition of addiction can also be mapped onto a chart proving recurrence rates are similar to diseases like Asthma, Lupus, Hep C, and other chronic conditions.   That these mathematically correlate in astounding ways is compelling.  But in other posts, people pondered why some “addicts” could get sober while others could not.  This question is the foundation of the mystical element of the twelve steps and other spiritual “recovery” methods, and one that I think is more easily answered than we want to believe.  

Psychologically there is a big difference between the addict, and those that suffer from other such chronic illnesses.  In people who suffer from addiction, the rate of childhood abuse and/or neglect, in one from or another, is much, much higher.  And this brings us to the questions that make addiction such a tricky thing to wrestle with.  In order to become an addict, the addict must be active in the process.  Addiction is learned.  It is also earned.  It is rarely something that happens to people who walk out the door of their well-adjusted home at age twenty-one, and have their first beer.  Those lucky people rarely fall into the throws of an addiction that makes the quality of their life unbearable.  

Instead, it is a group of people who, like me, in youth, sought ways to escape the pain of their lives.  They discovered the use of a substance could provide that escape.  Most addicts have availed themselves of that escape often.  It is also most common that addict will avail themselves of this behavior throughout a stage of life called Emergent Adulthood, where the prefrontal cortex of the brain is finishing its growth and formation.  Essentially, this is the final stage of brain and cognitive development.  In those years, beginning at age eighteen and lasting until our mid-twenties, our brain stops growing and locks in our individual neural pathways.  Essentially our personality is formed.  Changing the way we think after age twenty-five is much harder than it is in the years before.  Further, the amount, frequency, and duration of substance use also further defines the way these neural pathways are developed.   

To make this more accessible, let me use an analogy (and I apologize that it sounds so much like that Reagan-era inspired, “This is your brain on drugs,” PSA).   Imagine that the formation of your brain is like growing tree.   Now, imaging that pot is a small butter-knife.  Imagine the meth is a giant serrated saw.  Depending on the substance used, each cut has a different depth, and creates a different kind of mark.  Each user and each substance forms a different groove, mark, or scar.  And between ages eighteen and twenty-five, depending on the consistency and frequency of use, these grooves, marks or scars are gradually becoming permanent, and un-repairable.  Our mind literally adapts in its growth and assumes the substance, much like this tree assumed this bike as it grew.

Imagine what removing the bike from this tree today would do to its health.   Imagine your own body and identity forming in in a symbiosis like this.  How easy would it be to let go of the thing that was literally a part of you?  Whether you are formed this way around a drug, or the idea that you are an addict, how easy would it be to survive without either of those things?  Of course there is a way to remove the bike from the tree, but, its possible the tree will die and that’s a big risk.  Can you also imagine the tree might just prefer to have the bike left as it is?  Wouldn’t this tree miss the bike if it were suddenly gone?

This is the kind of relationship an addict has to the substance that scars their life.  But, unlike the tree, these scars rarely start with the drug use.  Instead drug use is used in concert with scars from something more fundamental.  In most cases, drug addiction is the result of a person running a chemical knife across a pre-existing wound.   The wound may be from the abuse or neglect of a parent, the sexual liberties taken by a neighbor, or one of countless possible, nearly fatal blows to the developing self-esteem of a child or young adult.  Children and young adults can only comprehend so much.  The tree couldn’t know what that bike would do to it, and it couldn’t be held responsible because the bike didn’t get moved.  It just followed its growth and development in a way that seemed most natural.  And whether we like it or not, this is also true of most addicts.  They are following the most natural path of the lot they have been given.  They don’t know it, but they are growing around, and into, a bike.  

When we are young, we have no idea how to treat the wounds of abuse and neglect. And usually, the only people we have to help us are the people who are making (or at least contributing) to the wounds in the first place.  Eventually, addicts find chemicals ease the pain of these wounds.  The drug doesn’t heal the wound, but it makes it bearable.  The wound, to the addict, seems to have found a balancing agent.  And as we use that agent, repeatedly, our bodies grow and form around it.  Keep the bike close enough, for long enough, and our bodies become one with it.  The challenge of being in “recovery” is learning how to remove your “bike” and live with the damage it has created.  And it seems so unfair that the thing that provided you an escape from the pain has caused this new scar.  

To make things more complicated, the American Medical Association has two diagnoses for substance abuse.  The first, “dependency,” is what we usually think of when we think of an addict.  This means the addict’s body relies on the chemical.  The bike has been completely absorbed by the tree.  The second, “abuse,” means someone uses a substance to their detriment, but they don’t physically need the chemical to function.  They rely on it emotionally, but not physically.  They have not yet become one with the bike.  Most people who really turn their lives around are those with less damage, the bike just scratches the surface once a week, but the pattern is stopped early enough for a new growth of bark to hide the wounds.  This would be the low end of the spectrum.  The high end is dependency; the bike and the tree are now one.   

It is natural to think, “It didn’t have to be this bad!”, but that’s an irrelevant point when it comes to the treatment of addiction.  The fundamental question is “What do we do now that it is that bad?”  And the next question should be, “What else is causing this? What other wounds are there?” Any doctor will tell you that symptoms can be tricky, and addiction is nothing but a spectrum of symptoms and possible causes.  Each position along that spectrum has a different set of causes and a different set of treatment needs.  Anyone in recovery knows the giant spectrum of addiction is as complex as the mathematical formulas that can be created using an addict’s age of first use, the length of use, the number of chemicals used, and the number of other underlying “original” wounds, all multiplied by a factor of later life PTSD.   

At present, the only proven way to treat addiction is abstinence.  In spite of all these various addictive realities, any and all lay assessments of addictive behaviors reduce the spectrum to only two groups.  Alcoholics and Drug Addicts.   And we believe that abstinence is always the best solution.  But, based on the nature of the dependency, an addict may not be able go cold turkey.  To do so would be like removing the bike from the tree with a chain saw.  A dependent addict must stop, but it is physically unsafe for them to do so.  To treat them, we put the person in a hospital; we build structures around them, support them, and remove the bike slowly, with precision.  

After the bike has been removed, we expect an addict to spend the balance of their life pretending not to have a hole that a bike fits into perfectly.  We tell them they must NEVER store the bike inside that hole again, or they are playing with their lives.  The fact that the loss of the bike might make the tree unstable and vulnerable must not matter.   For the tree, the desire to store the bike where it belongs, where it is a perfect fit, in the slot it and the bike made together, creates a kind of obsession.  The obsession is reduced to the question of whether to live with the bike, or to live with the bike-sized hole.  As the damaged nature of an addict makes them unsure the hole will ever fully heal.  

The tree becomes solely defined by the knowledge that they should never reunite the bike with the hole it left.  That tree will never be known for its leaves, or its bark, or its size.  It will be known because it used to have a bike in it.  And it must never have a bike in it again.  And that doesn’t feel natural, because it has always been a tree with a bike.  That’s what it is and that’s how it is known.  It must begin a practice of saying no its own desire for the bike— and that requires constant work.  Even if a period of living without the bike is achieved, the memory of the once perfect fit of the two is forever seductive.

It is not possible to live life this way.  If you have a wound, and that wound causes you pain, and there is a wound-sized bandage that covers it up, even temporarily, it is our nature to use that bandage.   And if we do that for a certain amount of time, between ages eighteen and twenty-five, our brain will forever tell us that the bandage exists for the wound.  This is the nature of addiction.

But what is missing from this discussion is something even more fundamental.  If someone with addictive behaviors stops young enough, early enough in the process, might they be able to learn the real nature and purpose of a bike?  Must they really be doomed to a lifetime of thinking the bike belongs inside of them as a balm for their scars?  Can they learn to ride the bike, and use it as intended?  Or will they always see the bike in a distorted way?

For me, the “bike” was alcohol.  I used that to suppress the pain of being raised to believe that something was wrong with me, that I was somehow abnormal.  When alcoholism presented itself as a socially acceptable reason for that abnormality, I embraced it as an identity.   I removed the bike, and I began learning how to live without it.

As a teen, I drank like an alcoholic, but as a twenty-something, during the majority of my Emergent Adulthood period, I abstained.  And I spent twenty years in the rooms of A.A. fearing the day I might relapse.  I was told, and I believed, that I could never ride a bike normally, because the bike belonged inside me.   But after twenty years of sobriety I dared to ask, “what if I want to ride a bike?”

Perhaps, because I got sober just after I turned twenty, my brain still had time to heal itself, before resigning me to a life of addictive behavior.  Honestly, in my heart of hearts, I believe this is why I can now comfortably reject the idea that I am an addict, when so many others in my shoes cannot.  I got sober at twenty, in the early part of the developmental stage.  I stayed sober through and beyond it, and my brain healed the bike-sized hole.  Or perhaps, for the more spiritual of you, I just needed to believe that I could be healed, and that optimism drove me to a new set of neural pathways.   Whatever the reason I can’t offer any science to support why I did not turn out to be the addict I believed myself to be for twenty years.  I can only offer my own semi-educated guess.  Keep in mind it comes from a man who has just enough scientific knowledge to be dangerous.


Judging Judgment for Homophobes and Michael Richards

Two decades of politically correct polarization, fed by the POV’s of Fox News and MSNBC have dulled most of us to the most basic of human truths.  At our cores, we are all the same.  We all love, we all fear, we all desire.  And we all face that struggle through our own lenses, whatever they may be.  It is our job in life to balance the needs of those three basic drives.  The truth about this is that we all fear individually, but what society fears most is complexity.  Collectively we fear complexity in all its forms, until the moment it frees us as individuals to be human and to make our own mistakes. 

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Kaepernick, the Anthem, the Pledge, and the question of Honesty.

Lest we fall into an argument of unfounded ideologies and nationalist mythologies, it is important to point out a few facts.  The National Anthem is "The Star Spangled Banner." It was written in response to a scene in the War of 1812, and was not a direct result of the Revolutionary War.  It is not a product of our original government and was not made the official anthem until the 1930’s when a group of vets collected over five million signatures to make it the Nation's first National Anthem.  Most football games only use the first stanza of the song which ends with a question, not a statement:

O say does that star-spangled banner yet wave
O'er the land of the free and the home of the brave?

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The part of Obamacare repeal no one is discussing...

But here it is… Today’s healthcare vote in the house is as much about America’s racism as it is about capitalism.  And I don’t mean in a general sense, I don’t think the bill is specifically formulated to effect people of color disproportionately (it might be, I don’t know).  I mean that it is an active, racist attack on the legacy of the first black president. 

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On my Tattoo #2 - Heroes and more

I have spent most of my life fascinated with heroes - because as an adolescent the only heroes I had were fictional ones.  Most were pulled from the pages of DC and Marvel comics, well drawn dreams of super strong men & women with an almost inhuman code of ethics, gifted ones who valued all life equally, and in many cases whose very existence was a metaphor for my sexuality, a metaphor I understood long before I could articulate it.  This gave me hope where the rest of the world had failed me.

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Dennis Anyone!! Talks to Dr Gary Cohan treating AIDS patients in Hollywood

In discussing his career as a renowned doctor to the stars, my former HIV doctor talks about being an early leader in the front line fight against HIV. Around 30:00 he talks about his treatment philosophy, which spoiled me for other doctors.  I have always demanded the respect he gave me from others, and attribute that as a factor in my longevity...

Here's to you Dr. Gary Cohan.

 Dr Gary Cohan.

Dr Gary Cohan.

Remember World AIDS Day? It's Today.

the past few years the observation of the day has been experienced a kind of renaissance. As the AIDS Free Generation movement has taken hold, and the Berlin Patient, PrEP and other scientific advances in the field of AIDS treatment and prevention, a new hope seems to be inspiring us to rediscover our passion to fight, or at least to make the discussion of AIDS and HIV to return to a place of relevance. 

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