Community vs. Addiction: Dispatches from Troubled Paradise
On this bone-soaking rainy Monday morning, I ride shotgun beside spry sixtyish Dr. Ira Mandel in his RAV-4 en route to his office in nearby Rockland, Maine. Pelting rain forces Ira to drive below the speed limit. His windshield wipers, furiously slapping back and forth, barely clear his view of Route 1, but the spectacled driver appears as relaxed as if he were puttering down Maine’s coastal highway under a cloudless blue sky. Today, he will see sixteen of his 100 patients, nearly all of whom receive Suboxone treatment for their opioid addiction.
Sturdy of build, Ira exudes confidence and optimism—good traits to muster, considering the overwhelming nature of the addiction epidemic in a corner of the world more known for its lobster-filled waters, white-steepled village churches, and postcard perfect harbors. For his patients, Ira is the man who stands on the bridge between their past life and a better one. Getting across is no small task. I am shadowing him today in order to learn more about his efforts to counter locally the opioid epidemic that is ravaging the nation.
Overdose deaths in the United States are expected to top 70,000 this year, according to a recent article in the New York Times. Overdose now is the leading cause of death for Americans under 50 years of age, and more Americans die because of overdose than from car crashes or gun incidents, with over 200 dying daily.
A year ago, Dr. Mandel was the only Knox County doctor offering medicine-based treatment, but now five others have taken on such patients. Still, demand far outstrips supply. “Every month,” he says, “I get close to a hundred calls from addicted patients looking for a doctor.”
We drive past Pen Bay Medical Center’s Sussman House, the hospice center that he formerly ran, one of the many threads that run through an eclectic work history that includes family practice and obstetrics. But these days, the addiction epidemic consumes his time.
“The Titanic is sinking,” he muses, “and we only have life-rafts for a few of the passengers.”
Last year, I attended one of the town meetings he organized to raise awareness about the opioid problem. Politicians, nurses, doctors, teachers, and lobstermen packed the Camden library and shared stories, more often than not discouraging tales that just as often began with doctor-ordered post-surgery pain meds as with “bad choices.”
“We know we can’t arrest our way out of this problem,” a chief of police had said. Other uniformed law officers solemnly nodded. I came away from that meeting convinced that I knew less about this problem than any responsible citizen ought to know.
In 2016, Ira organized the Mid-Coast Recovery Coalition, a volunteer organization designed to work behind the scenes to facilitate existing efforts to counter the epidemic, spark new approaches to treatment and prevention, and raise money to bolster successful programs, new and old. “It’s a war with many fronts,” he tells people.
Warrior is the term that comes to mind when I think about Ira. And it is easy to conceive of the efforts to counter the national drug addiction as a war, though I remind myself that every time we figuratively refer to a campaign as The War On …., we seem to lose badly.
After that initial town meeting in Camden, Maine, a follow-up meeting drew a smaller crowd. “That’s what happens,” Ira told me afterwards. “Holding interest is not easy in this world.” But he’d hooked me.
Maybe I could help stuff envelopes, I told him, and asked him to phone me if he found himself with a task that called for another set of hands.
The morning that my wife and I were packing the car for our 500-mile drive to spend Thanksgiving with our grown children, Ira called. “This grant application needs to be witnessed by two board members, and I only have one person on the board.”
We pulled over in front of his house, where I signed the papers. “You can quit as soon as you come back,” he assured me.
“I think I want to write about the problem and what you’re doing,” I told him. “So, I probably should not be a member.”
By the time we returned to Maine, I had decided that I didn’t want to quit. “I’m getting more biased by the day,” I told him. “So, if I write anything, I guess readers will just have to deal with it.”
In the last six months, I have attended board and advisory meetings, become Ira’s sidekick, and served as part of his kitchen cabinet, lobbing ideas back and forth, with the four Mandel cats providing background vocals.
Ira and I talk about a theater production we’d both attended on Saturday, a one-act piece created and performed by a small group of inmates in the state prison system’s re-entry program with the collaboration of a handful of local residents. The prisoners, all in the last nine months of long sentences and survivors of a rigorous admissions process, are in the midst of classes, career workshops, and mentoring as they prepare for release. As with so many inmates in our prison systems, addiction dominates the personal history of every man in this group. The short play captures the vicious cycle so common in addiction, as well as the impact of the stigmatization commonly accorded addicts and ex-convicts.
Ira tells me that poet Joe Jackson, the play’s charismatic black director, who once received a life sentence for murder, completed his college degree while incarcerated through a program funded by Doris Buffet’s Sunshine Lady Foundation. Now a free man, Jackson works with inmates who are striving to duplicate his successful return to society.
Nationally, recividism among released prisoners is near 70 percent. In the eleven years since Maine’s program began, sixty inmates have earned either an associates or bachelors degree. Of the eight graduates who have been released, seven have maintained perfect records, and the one man who was the exception—for a one-time violation of parole terms— is now successfully navigating life outside prison. Apart from this one instance, no released graduate has returned to prison, except as a volunteer, as in Jackson’s case.
Ira sees the contributions of individuals such as Jackson as critical. I tell him that I recently met with Jake and Tanja Barbour, owners of a local construction company, who run a Christian Twelve-Step abstinence program for men transitioning from hard time in the state prison in Warren. Addiction is part of the Barbours’ history too. Housing is an enormous issue for people in recovery, especially for recently released prisoners, and the Barbours have purchased a home, in which as many as four former inmates can live for free until they and the Barbours believe they are ready to move out. The men live by themselves there and are expected to attend meetings at the nearby ministry center—another building owned and operated by the couple. Unlike Ira’s patients, their men are expected to function free of legal drugs like Suboxone or Methadone, as well as illegal ones and alcohol.
At a recent advisory meeting, I met a young woman who leads a yoga-based Twelve-Step program in Rockland, for people “who have a problem with the greater power thing,” she said. The Restorative Justice trainers who work with the men in the re-entry program up in Belfast are grounded in yet another approach, also very much tied to a particular philosophy.
“No one path fits all people,” Ira says. “Folks sometimes need different approaches at certain stages. And relapse is a reality for many folks, no matter how dedicated they are.”
Ira pulls into a parking spot close to the building that houses his office. If anything, the rain has intensified, so we hotfoot it to the entrance then drag our soaked coats up the stairs to a second floor suite: two sparsely outfitted rooms that he uses as office and waiting area. All of the patients he will see today have already given permission for me to observe the sessions and to write about what I observed, not using their real names.
A smiling thirtyish woman wearing a sweatshirt that advertises a local lobster fisherman’s business enters the treatment room. Pammy hugs Ira and then sits across from him on the other side of an old examining table topped with a fitted plastic tablecloth that hangs over its edges. This table serves as Ira’s desk during appointments, and he’s got his laptop and phone resting on the surface.
When Ira asks how she’s been doing since last month’s appointment, Pammy’s chipper demeanor gives way to nervousness and a pause in the back-and-forth. “I don’t feel good,” she admits. “Ran out of meds yesterday.”
“Oh,” Ira replies, waiting for her to elaborate. This might or might not be true. Some patients sell their meds on the street.
“I had to take extra before. I’m sorry.”
“It’s okay,” he says. Patients are expected to use so many doses in a month, and frontloading them, not an uncommon response to difficult times, makes them, even those who remain faithful and honest, vulnerable to street temptations—to sell their own prescriptions or to buy heroin. Trust undergirds these relationships, and he’s made it clear to his patients that even if they’ve stumbled, he needs to know the truth in order to help them.
What Pammy is experiencing feels like withdrawal to her, which suggests that she has indeed been toughing it out after having had to up her own intake. “Nausea?” he asks.
She nods. They talk about the other medications she takes, and Ira explains how their side effects may be affecting her. She’s not sleeping very well. She grumbles about having had to miss a shift at her fast food restaurant job last week. “We need to raise your Suboxone dosage,” he tells her, and prescribes four other medications to ease her withdrawal symptoms.
When he schedules Pammy’s appointment for next month, he asks if she’s met Dr. Strong, the doctor who will take over Ira’s practice in 10 months, when Ira plans to begin something resembling retirement but which will involve running MCRC. His replacement will join him for an appointment with each of the patients seeing Ira long before the changeover. Yes, she already met him. “Very nice,” she offers. She and Ira agree on a June date and time.
“Don’t retire!” she pipes up suddenly. “Please stay.” That perky glow returns. “Ha-Ha,” she adds, smiling ironically.
He laughs along with her, and reassures her that she’s going to be very comfortable with the new doctor. She talks about other doctors she sees and about problems with her insurance. “Obamacare really isn’t good,” she says, shaking her head.
Ira doesn’t accept insurance, so each patient pays cash for the appointment that offers them two services: his counseling and support, and a Suboxone prescription for the next month, a package deal. He’s aware of the potential for manipulation. His patients need him to punch their ticket to get the drug that keeps them functioning. It’s a built-in risk. Not surprisingly, some regulars can’t pay him for long stretches, but he turns away none of his patients.
Jack, a landscaper who might be thirty years of age, talks about his efforts to wean his Suboxone dosage. “I have no self-control. You have to prescribe for me.”
“You’re down to half of what you were taking,” Ira reminds him.
The next patient is a young man who occasionally works for the previous patient. He’s been off heroin for six years. He shakes his head at Ira’s opening question about his condition. “I haven’t been eating much lately, and I got no energy. Very depressed. Bad dreams at night.” He gets $35 in monthly food stamps a month.
Mary Claire enters the room with a broad smile. She is about to receive her AA degree in paralegal studies; however, she’s equally excited about having just landed a job, though it is not in her field. She has a teenaged child. The job will involve mostly housekeeping but will include some maintenance work, a bonus as she sees it. “I’ll bring my toolbox!” she exclaims.
In time, she talks about dealing with an aging father and her alcoholic sister. “It runs in our family.”
“You didn’t cause it,” Ira reminds her. “You can’t control it or cure it. Your sister might need to hit rock bottom.”
She offers good reports on her visits to her therapist, whom she is now seeing twice each month.
“Mainecare—what a mess,” she laments. I am struck by her positive aura, despite her frustration with bureaucracy, and when she asks if the fly on the wall has any questions, I inquire about her longer range plans.
“I want my dosage to go down, all the way down,” she says. “I want to help. I want to improve other people’s lives.” When she leaves to pick up her cap and gown, Ira acknowledges that she is on track in every way. He hints at her troubled history but finds hope in her current personal resources.
Fiftyish Luelle had tapered down in dosage until a bad old boyfriend showed up. “It’s all right,” she sighs. “I got nothing to complain about. I dust around him.” The man is to leave in July, she reports, brightening. Raised by two addicts, she had fallen hard then turned things around, only to relapse after seventeen years of sobriety. She’d been on Methadone, which always made her feel high. “Suboxone is like someone flipped a switch.” On it, she has been able to function in both her work and personal life, but she knows the feeling of being stuck on the bridge. She tells him that working with her therapist is helping her.
Another woman also speaks favorably about her therapist. “I’m just catching on to what he’s trying to teach me.” She speaks more about her concern for her son than about her own condition. Drug use is rampant in her town, and the boy’s father has been trying to get him involved. “He’s a good kid, but he’s been dabbling in it,” she says. “He’s got a good job, welding, but he told me, ‘Mom, if I stay here, I’m going to die.’ Thank God, he’s going to join the Navy. He wants to become a Seal.”
Mark, a 35-year-old factory worker, has recently been promoted to a supervisory position. He comfortably goes back and forth with Ira but keeps his eyes trained on his four-month old daughter who is sleeping in a car seat beside him. The man’s ex has been sending complaints about him to DHS, a tactic that does not seem to surprise him but that frustrates him because it requires so much of his time to fight. Fully in the conversation, he holds his smiling gaze on his little girl, never quite losing his smile. “After I clear this latest court business,” he says, “I want to reduce my dosage.”
I sit in on conversations with a cross section of hard-pressed but mostly functional people, including five restaurant workers, a motel manager, two stay-at-home moms, two plant workers, a carpenter, an electrician, two disabled individuals, and a woman who works as a “stern man” on a lobster boat, AKA, a “stern chick.” By the time the last patient has hugged Ira goodbye, I feel exhausted, and imagine how this must hit Ira. “Not bad,” he says, as if reading my mind. “Last Monday was a nightmare.”
A week later, I attend the open house at Rockland’s new Coastal Recovery Center, a separate volunteer organization, despite the similar name, which serves the same population.
I explore the adjoining rooms on the first floor of the building that once served as the town’s junior high school. The center will open four or five days a week, afternoon and early evenings, as a place for those in recovery and especially, for their families, to gather together, explore resources, and support one another.
Among the welcoming volunteers, I recognize Chris, a recent college graduate who is applying to medical school and hopes someday to do the kind of work that Ira does. I’d seen him at another meeting earlier in the week and at last Saturday’s fundraiser pancake breakfast. The volunteers have converted two rooms in the town’s former junior high school building into a cozy gathering place, its ancient wooden floors freshly waxed, the walls covered with bright signs and artwork, and a table covered by a spread of desserts and snacks.
In the other room, I meet a fiftyish couple, volunteers who quickly tell me that they are Chris’s parents. Over the next twenty minutes, I learn about their addiction history and the path that has led this whole family here. The dad has lobstered most of his life, a line of work historically identified with addiction vulnerability. Both parents used heavily through their only son’s elementary school years, but even in that condition, they struggled to keep their addiction from impacting him. Knowing that adolescence posed great dangers, they enrolled him in a religious school, driving him to and from classes every day. They moved Chris to northern Maine to attend a special math and science high school, while back in Rockland they struggled through various treatment regimens. Their lives changed when they shifted from Methadone to Suboxone, which they subsequently left for complete sobriety—and volunteerism.
Chris joins us, and I listen to the three of them talk about the center and about their family’s hopes and dreams. It’s hard to tell who is prouder of whom.
Every person I’ve mentioned in this article is an addiction warrior. Each recovering addict I saw on that first Monday has been wounded by addiction and appears to be trying to play the leading role in his or her own survival. These men and women are battle-scarred in ways that make them vulnerable every day. For them, the fight will never end.
The healthiest survivors are changed people. Change is at the heart of Ira’s work. It figures in nearly every story I’ve heard this week.
The life-saving personal alteration that we call Recovery was not the first significant change these people experienced. Earlier, their brains were hijacked by addiction—the wound that keeps wounding. As with addiction, recovery almost always involves a support network of other people. Since addictive behavior often drives away friends and family members, the addicted person’s circle tends to narrow to fellow users. Self-supporting behavior practiced in a state of recovery can’t always bring back alienated loved ones, but it can open relationships with other life-sustaining people—doctors like Ira, therapists, coaches, mentors, and so on—strangers who care enough to get involved.
Sometime in between conversations with helpers this week, I realized how much they had in common. They seem to love life. They might split over preferences in politics, religion, and sports teams, but they all seem fueled by what they do. When I asked them why they volunteered for such a cause, many of them spoke about meaning and purpose.
The recovering addicts I met in Ira’s office did too, in their own way. “If I lose my kids, I won’t have anything to live for.” I heard fear in their words again and again. Their medication enables them to maintain some normalcy—a job, a family, a home—but it alone is not enough. They need people like Ira, their therapists and counselors, family members, and new friends.
A Healthy Community Is Stronger Than Any Drug. That’s the slogan for the Mid-Coast Recovery Coalition. Meaning, purpose, and social connection constitute the strongest weaponry in the war against addiction.
I have another task to do before I can complete this draft. Some months ago, artist Eric Hopkins donated one of his paintings to the coalition, a piece which Ira sees as a kind of logo for the organization. “Parades!” Ira exclaimed a month ago, launching into his scheme to create a presence in every local parade this year. Now, he’s got T-shirts with that design in the pipeline. We’ll all wear them in Rockland’s Memorial Day Parade. A day for veterans of all kinds of wars. When I call Eric Hopkins to ask if he will grant permission for me to use an image of his painting to accompany the article I am writing, he immediately says yes.
The sixty-six-year-old painter lives on North Haven Island and doesn’t use e-mail. He promptly chronicles a list of family members who have succumbed to alcohol or drug related issues, including his twenty-year-old son.
“It’s everywhere,” he laments then points to the cultural roots of the problem. “It’s a soul-spirit kind of thing that’s lacking. We’re experiencing a soul starvation.”
When Eric was ten, his five-year-old brother drowned. “The church ladies around me,” he groans. “Even at that age, I knew that he hadn’t been punished by some harsh God in the sky, like they intimated.” Distanced from religious practice, he discovered his own kind of spirituality at 16 when he participated in Outward Bound on nearby Hurricane Island.
“Nature,” he says solemnly. “That experience changed me. I knew there was something bigger than me.”
I think of how Tanja Barbour, coming from a different spot on the religion-spirituality spectrum, described the life-taking phenomenon in our midst. “Addiction is a byproduct of our hurt soul.”
Mindful of the isolation of island life, I ask Eric if he has people that sustain him now.
“I do,” he assures me, “but I have more dead friends than live friends.” He explains that over the years he’s become increasingly aware of his sensitivity to their influence.
“The night of my son’s car accident, my ex-wife called to tell me. I knew it was bad and that I was likely to get another call telling me where he’d been taken, or worse. I waited. Sitting there, I got a message from my son, as clear as day: ‘Your daredevil son is a grown-up angel tonight.’”
Eric’s people that have left this world seem to be very much in his life. “Conversational” is how he refers to their connection.
“They are the lefters,” he says, “and we are the leftees.”
As I try to complete this piece of writing, I realize that there is no ending. Every time I think I am asking a last simple question, I encounter another story. No one knows where the bigger story is headed, though the picture looks bleak.
Meanwhile in Maine and elsewhere, bands of brothers and sisters hunker down in meeting rooms, volunteer offices, and in ordinary living rooms and kitchens to lean on each other—in some cases, even on the spirits of their dead comrades—and prepare their next mission.
Author and teacher Ned Bachus earned multiple teaching awards during his 38-year career at Community College of Philadelphia, including the Christian and Mary Lindback Award for Distinguished Teaching. His book of short stories, City of Brotherly Love, received the 2013 IPPY Gold Medal for Literary Fiction. His memoir, Open Admissions: What Teaching at Community College Taught Me About Learning, will be published by Wild River Books in 2017.