In 2002 I was in my 20’s, fresh out of graduate school, and ready to take on the world. Armed with my crisply printed Master’s Degree in Addiction Treatment, a certification in addiction counseling, and my zeal to save the world from all things addiction-related, I became a chemical dependency counselor at a residential treatment facility. One of my first clients was a woman whom I will call “Ms. Rose”. I will never forget the day I met her.
Ms. Rose was a 55-year-old married African American woman with five children. She had a long history of heroin and alcohol addiction. As Ms. Rose waited in my office to be interviewed for our program, I was across the hall in the conference room with our team. Wearing hats and gloves in the small frigid conference room with a broken window, we braved our meeting on this Chicago’s winter day. We were under-resourced and under-funded, but we cared deeply about every client that appeared on our doorstep. And now here was Rose, mother of 5, waiting in my office while we reviewed her life and fate.
As the team meeting ended and the room cleared, I blew into my hands to warm them and then went to speak with Ms. Rose. She was no longer sitting in my office and I had to search for her. As I did so, I mumbled a little prayer to myself. I wanted to be guided in this moment as I stood at the threshold of entering Ms. Rose’s story – the part of the story that would finally lead her and her five children to a happy ending, I prayed.
I finally found Ms. Rose standing outside at the main entrance, braving Chicago’s bitter, whipping winds for a few hurried drags on her cigarette. When I introduced myself, she took one last long drag of her Kool mild and tossed it on the sidewalk. Her fingertips were stained from the ritual. As we walked down the hall, she cracked jokes. She was loud and laughed easily, as if any part of her life could still be fun. Maybe she just “laughed to keep from crying” as the old folks used to say. I guess it wasn’t hard to make jokes about the condition of the building, especially my office where we both sat teeter-tottering on broken chairs with me balancing a legal pad and three-ring binder on my knee containing her life story.
Anyway, it seemed that her comical comments about it all had melted the ice and gave the interview a warm start. This kind of interview was something I always dreaded because it was such a personal interrogation into someone’s past, yet it was required to fill out the necessary forms.
I began my questionnaire.
Tell me about your upbringing? Your parents? Problems at work? The history of drugs and alcohol in your family, if any?
It felt so intrusive, but it would get worse.
Tell me about your sexual history. Your legal issues. Have you been involved in domestic violence?
After a few minutes of this, Ms. Rose had transformed from being warm and friendly to being ice-cold and defensive. That easy laughter had been replaced by hostility. She looked at me with a cold stare and said abruptly, “I don’t know you like that!”
She was right. She didn’t. Nor did I know her like that.
I felt awful about having to ask her such personal things about her life, but it was my job to acquire this information before any treatment could begin. I knew it was uncomfortable for her, but over time I would learn that it was much more than that. It was the exact wrong way to start a relationship that will ultimately be made or broken on the concept of trust. Yet, often treatment plans begin with violating the client’s most sacred space; by pervading their inner-most private thoughts and experiences.
Ms. Rose, like many black people had been brought up during a time where you simply did not “put your business out in the streets”. Not only that, she had NOT willingly come to us in search of treatment, but instead was there to attend court ordered therapy sessions as a result of being on parole for theft. She did not want to talk about her private life with a stranger and she particularly did not trust me as a provider because I had not built a rapport with her. Without pause Ms. Rose stated “I don’t trust no Head Doctors…where I come from, we take our problems to GOD and pray.”
On top of her resentment of someone digging around in her personal life, she was my elder. In her opinion our roles should have been reversed because she was an elder no matter how many mistakes she had made.
This was a vital part of our dynamic from the moment she flicked away that Kool mild. She knew her rank and would be quick to “check” me on mine as soon as dared to breach that threshold into her private life. As an elder in the black community, you outrank youngsters in the family hierarchy. Your wisdom automatically trumps others, simply because you are older. Ms. Rose also did not trust “the system”. She did not know what our agency was planning to do with her and whether or not — if she did confide in us — we would betray her trust and have her sent back to jail.
Another aspect of our dynamic was the fact that Ms. Rose had a husband who had never known her sober. In his efforts to be supportive he would often unknowingly sabotage her progress with his homemade treatment program which consisted of them going to church and him watching her every move like a hawk for 23 hours a day. This was the solution that Ms. Rose’s husband had been taught by his family and community. It was the “word on the street” solution which, unfortunately, has no real statistical value.
Nevertheless, Ms. Rose’s husband persisted in his double-blind randomized controlled trial treatment. And thus far, it had produced only one result – Ms. Rose, age 55, opioid addicted, on parole, absent from her children, and sitting in my office, mad.
Ms. Rose’s situation is not unique nor an exception but a norm when it comes to black people who seek treatment for substance use disorders. It is obvious to me that Ms. Rose took pride in being a resilient black woman, but it may be this strength that has kept her from properly addressing her addiction and mental health issues in her past. There are many individual and cultural issues that might serve as barriers for blacks and our ability to receive care for opioid addiction. Here are a few to consider based on quotes from Ms. Rose’s story:
Don’t put your business in the streets...
According to the Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) National Survey on Drug Abuse and Health (2011), admissions to publicly funded substance abuse treatment programs varied significantly by race. While 59.8% of Whites entered and received treatment, African-American/Blacks were admitted at a rate of 20.9%. The percentages for other races are even lower. There are many reasons why black people are not able to get the help that we need. One thing that we can be sure of is that we must break our silence regarding addiction and mental health issues within our communities. We cannot receive help if we are not willing to share that we have a problem. Talking can lead to healing and we must break our silence to get the support that we need. Addiction and mental illness is already highly stigmatized in society, but for the Black community it can be especially hard to discuss and confront. There’s a fear that “what you say can and will be used against you”. There are many men and women who have talked, snitched, etc. and this vulnerability was used against them as opposed to being used to help them.
Don’t trust no head doctor...
Every Sunday morning, hundreds or thousands of worshipers file into pews awaiting their pastor or spiritual leader. He or she then steps into the pulpit leading with prayer and testimony. Worshipers await that one word or prayer for encouragement because it is our belief that “With God All Things are Possible” (Matthew 19:23-30 NKJV). Religion is an integral part of the Black community and healing experience. Nearly half of all black people attend a religious service at least once a week, according to the Pew Research Center’s 2014 Religious Landscape Study. Religious leaders often encourage their congregations to take their issues to God and pray for Addiction recovery rather than seeking evidence-based help and support within a licensed treatment facility. Seeing a “head doctor” can be seen as a lack of faith or a sign of weakness. Yes, prayer can work but a healthcare provider has specialized training and access to further resources and testing if needed. In addition, healthcare providers within our communities are often of another race. When a medical provider is of a different race or background, a black patient may have expectations that they’re not going to be treated well reducing our desire to seek medical treatment for opioid addiction.
Don’t trust the system...
Blacks often have a general distrust of systems (criminal justice, medicine, academic, corporate etc.) This belief may be amongst the lead reasons why blacks are less likely to seek medical attention for opioid addiction. In 1971, President Nixon declared drug abuse to be public enemy number one. It was stated that the goal was to reduce the supply and demand of illegal drugs. The policies and penalties were and continue to be carried out disproportionately against minorities and created racial inequities in arrests and sentencing. Black communities are still feeling the collateral effects that the War on Drugs established leaving a gaping hole in black families and community trust for the criminal justice system. There is research that shows the public and police possess subconscious biases that make them more likely to view black people and other minorities as less innocent and more criminal. The medical system is no different. Even when there is support available to treat opioid addiction within black communities, people still may not seek help. This distrust goes as far back as the Tuskegee Experiment in 1932 where the U.S. Public Health Service got 400 Black men to participate in an experiment in which they were untreated for syphilis for many years. The study continued until 1972, which was several decades after penicillin became the go-to treatment for the condition. Henrietta Lacks, a black woman whose cancer cells were used for decades without her permission and knowledge became one of the most important cell lines in medical research.
These are only a few of the medical research abuses that have taken place in our history but contribute to the general distrust of medical systems. Blacks are also less likely to participate in medical research than whites. Most research requires a DNA sample and there is fear that their sample will be warehoused, mismanaged and possibly linked to criminal activity that could lead to arrest and imprisonment.
Drug overdoses are now the leading cause of accidental death in the U.S. Using medications for opioid addiction treatment results in decreased healthcare costs, criminal justice expenditures and those receiving medications are 75% less likely to die because of an addiction, according to the Legal Action Center.
Yet, medication assisted treatment (MAT) continues to be underutilized across races. Some black people who have a strong affinity for 12-step and abstinence-based recovery models believe that MAT is simply trading one drug for another and have rejected the idea of MAT while judging those who need it to stabilize their symptoms. When Ms. Rose brought her husband in for a family session where I advised her to see a physician certified to prescribe Buprenorphine based on her symptoms her husband abruptly stated, “She don’t need to take no medicine, she’s already on drugs.” Ms. Rose agreed and refused the referral even though she reported symptoms of debilitating cravings and withdrawal. Every program and approach to treatment had not worked for her. If Ms. Rose had to sit in a group therapy session and participate with craving/withdrawal symptoms that resembled a horrible flu times 30, she would be less likely to receive the information that we were attempting to impart and trigger other clients. Black people are sometimes the reason why we don’t seek or obtain the medical attention that we desperately need while battling opioid addiction.
Treatment is available but there are many barriers to access. Some barriers are political, some are systemic, others are self-inflicted. We are often silent about the issues and trauma that can precipitate Addiction in the Black community. We must discuss these issues with trained professionals and family to break the generational curses that keep us ill. We must also take responsibility for our health by educating ourselves on Opioid Addiction. The result is feeling more empowered and having the confidence to advocate for ourselves within the systems that we often avoid. Lastly, we must avoid judging each other for being open to seeking and receiving help that is offered outside of our cultural traditions.