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1. Baltimore’s public school system is vastly majority African-American. The private “independent” schools are vastly white. But no one ever points this out or discusses it! It is purposefully avoided. What can we do to engage in this conversation? Can we ever envision that all these schools would be integrated?

2. How do you begin the conversation about the impact of race in education when there is a perception/belief that colorblindness is the way to think and be, and that raising the topic of race creates dissension?

3. How can we change the attitudes of white communities who seem to react to “tipping points” which, in my mind, are relatively low, i.e. white flight takes place when “too many” people of color move into the neighborhood or enroll in school?

4.How can we bridge the divide between very young, white teachers teaching a predominantly, if not all, black population? Particularly with programs such as Teach for America recruiting mostly young, white, ivy league students with no substantial interaction with the population?

5.When the topic of race comes up, it seems that the majority of people only think of black/white relations. Do you think that it is important to change people’s perspectives on race to encompass multiple races? If so, how do you do this in a classroom setting that may be a poor example of racial diversity?

The second kind of school is the quintessential urban public school in need, in need of everything from pencils, books, paper, Kleenex, to donated musical instruments and computers. Everything in these “at risk” schools is hand to mouth, and unsurprisingly, these schools have little or no life after school because they have few or no resources to engage or enrich their surrounding community.

Our audacious idea is to take this idea of school as community hub that the private school world has already proved viable (and even profitable) and import it into the at-risk, impoverished communities that surround our urban schools. Reliably, we lament the lack of after school or summer opportunities for kids at risk, the rec centers that are closed or under wraps. But it really doesn’t have to be a zero sum game of either providing rec centers or improving schools, or a choice between community gardens vs. schools, or community libraries vs. schools.  The school buildings are here, yet only in use for a woefully narrow portion of a day or a year, often without any library or art, or music, or athletics at all. At heart, any investment in the infrastructure of schools should audaciously be seen as a fundamental, far-reaching investment in the health—physical and intellectual—of every individual in that surrounding community.

If every school had a fitness center, then who wouldn’t want to use it in the evenings, weekends, and during the summer? If every school had a garden, then kids, seniors, and out of work adults could grow more during the summer months, when “school is over and out” than they ever could during the school year. If school seemed like a beacon, open and lit up, then wouldn’t people want to be there, and want to invest?

As the founder and the creative consultant of Bmorefit, which trains older, at risk youth to become fitness trainers and ambassadors of healthy choices, we envision a place where savvy, energized Bmorefit graduates can make core changes in their communities. We envision a place for these formerly at risk youth to become change agents with jobs that are meaningful and sustainable. When a young person graduates from Bmorefit, all they need to create fitness opportunities in their community is a room, some mats and balls, and a boom box. We hope they can return to their urban communities—to the very schools where they didn’t succeed—to be ambassadors who know the basics of nutrition, healthy choices, and the importance of exercising safely to build up stamina, resilience and self-esteem, from the inside out.

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The recession and other health care changes have created a critical time when addiction treatment funding will change tremendously. As the state and nation seek to address health care and increase access to care, it is disturbing to see how much of the conversation is focused on the money and not on the people, not on people getting better and engaging in a full life. Not on people with a chronic disease who need ongoing access to a whole variety of care—addiction treatment or mental health, but also prevention services, vaccines, cancer screenings and the total health care package. 

I realize that cuts are a reality and that the budget crisis means we have to save money. But, part of saving money is looking at what patients need to improve and then looking at the current structure to see if the funding fits with these needs. It means spending money early so that one can reap savings later—i.e. early diagnosis in an effort to decrease long term health care costs, plus, improving someone’s life earlier. The state and city need a map of how to fund addiction as a chronic disease. The state recently held a convening to talk about recovery-oriented systems of care, and ideal treatment systems, but many of these documents and ideas are missing from current discussions. Addiction treatment is more than acute episodic care, in fact, health care for someone with addiction is more than addiction treatment—it is taking care of a whole person to take care of a whole person, the whole person has to enter into budget conversations.

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“The definition of insanity is doing the same thing over and over again and expecting different results.” — Albert Einstein

I have worked for over 30 years in emergency medicine. We have measured that between 60%-80% of our patients who lack insurance are there due to addiction. Coding systems categorize by final diagnosis, e.g. “forearm laceration,” but when the record is closely examined, it turns out that the laceration occurred because the patient broke a window during a burglary to get money for drugs.

I ask addicts three questions. What is the daily price tag of your addiction? Answer: $20-$100/day. What do you do to get the money? Answer: sell drugs, steal, prostitution, work if available. Would you go into a drug treatment program now? Answer: Yes, but none is immediately available.

Quick and conservative estimate: $50/day x 60,000 addicts in Baltimore metro area x 365 days/year = $1.1 billion. 

Analyzed from an economic view, the drug business is amazing. Product (poppy, coca) is grown, refined, and shipped into every city in the U.S. A vast distribution network ensures that product is readily available down to the street corner level. Financial systems turn the cash of the “dime bag” into multi-billion dollar operations, complete with money laundering, banking, and investment, not to mention the expensive security enforcement required by an illegal industry.

When constituents ask me about their rising health insurance premiums or fear of crime, I respond that addiction is at the source. But after 40+ years of the “War on Drugs,” our society is no better off and probably worse. Jammed prisons, AIDS, destroyed families, crime victims, terrorist funding: the toll is immense. Addiction treatment is a critical step but just a beginning. Isn’t it time our society had a full, open, honest, and intense discussion about drugs? Shouldn’t we admit that the War on Drugs has failed and that other policies deserve exploration? Prohibition didn’t cure alcoholism in the 1920s; it only fueled organized crime. Like that well-intentioned but failed experiment, is it now time to end drug prohibition? Is it time to consider a system of regulation, taxation, treatment, and real control?

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When we sent our son to an in-patient addiction treatment program, we were spinning with doubt about the choice we had made, whether he would get better, and how would we deal with him when he came home. The program encouraged parents/spouses to attend educational sessions, so we went with the hope that we would learn how to care for our post-rehab son. We were surprised to learn that our priority while our son was away was to start the process of getting ourselves well.

So, we wondered, if we are not addicts, why did we need to be in recovery, too? Quickly we learned that we needed to heal the insanity that had taken hold of our lives. We needed to stop trying to manage our son’s addiction. We learned that many addicts feel tremendous guilt, shame and regret that are hurting people they love and that sometimes the reactions of family members adds to that burden and prevents them from getting well. Our first steps in the path to our own recovery entailed radical changes in our interactions with our son and our understanding that he has a serious illness.  It is called a path because recovery does not happen overnight—either for us or for our son. It takes time and requires a lifetime commitment to ending our own enabling and judgmental behaviors.

One of the best recommendations we received was to attend Al-Anon, a 12 –step program that is comparable to Alcoholics Anonymous and Narcotics Anonymous, but helps the loved ones who are dealing with addiction in their families or friends take charge of their own recovery. We started, stopped, started again, and went off and on to Al-Anon. Finally after a few months, we realized that we needed to be a regular part of a fellowship of people who want to repair the damage to their lives and the relationships with people they love who are addicted. We are much better, he is much better, and we know that our son appreciates the changes we have made. Now, when we meet people whose lives are in crisis like ours was, we try to share what others shared with us and hope it helps them too.

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Being addicted when you are a teenager does not seem believable. You think people who tell you that you are an alcoholic or an addict are lying. You see other people use drugs and drink and they do not get sick enough to have to go to a rehab program. You just want to be able to be like everyone else and have fun. But soon you realize that you are not really like everyone else if you need to drink or use drugs just to get through the day. And when you are using all the time, your days are awful because you end up thinking so much about getting high or drunk and you lose connections with other things and people in your life that really matter.

Even when you know you are addicted, and you need help, you do not want to go to treatment and you definitely do not want your parents to send you to rehab. It is weird, but rehab is both scary and safe at the same time. If you cannot stop drinking or using very addictive drugs like cocaine, then you need rehab. But you are so scared because you have no idea how you will function without your drugs or alcohol. After a while in rehab, it feels safe there because everyone there is like you–they are trying to stop using.

You learn in rehab that stopping your abuse of drugs and alcohol is just the first thing you need to do. You also learn that what lies ahead is the rest of your recovery. So when formal rehab ends you have to go to outpatient treatment, have a therapist, and go to Alcoholics Anonymous or Narcotics Anonymous meetings. One Day at a Time is a lot easier to handle than thinking about recovery as something that you’ll be doing for the rest of your life.

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“The crisis that’s killing our city” is how Governor Martin O’Malley, former Baltimore Mayor, refers to drug addiction. Beyond the devastating consequences for the individuals who abuse alcohol and drugs, addiction contributes to the spread of infectious diseases and fuels crime. Research conducted by Copersino, Comberbatch, Jones, and Sitzer (2004) states that in Baltimore, injection drug use is the primary cause of AIDS, which is the leading killer of city residents between the ages of 25 and 44.¹ Baltimore’s crime rate is double the national average, and as many as three-quarters of the city’s thefts, robberies and murders are associated with alcohol and illicit drugs. During the 1990s, the city’s drug overdose death rate tripled. The economic costs of drug abuse and addiction in Baltimore alone exceed $2.5 billion a year. Many of Maryland’s leaders are coming to the conclusion already reached in Baltimore: Treatment deserves more support. Elected officials have become increasingly concerned about drug abuse throughout the state, especially over heroin’s resurgence during the 1990s.

Let’s face facts, in Baltimore, as well as across the United States, we are fighting a losing battle. The war on drugs is really a war on people who use drugs. Locking up people who use drugs is a waste of time, energy and resources. Jails become a revolving door for many addicts who could benefit more from residential drug treatment programs than being exposed to hardened career criminals and inhumane conditions which exist in prisons. Offering drug offenders an opportunity to go to treatment as opposed to going to jail would help reduce the stress on an already over-burdened penal system and reduce the recidivism rate among drug addicts. Of course not all drug offenders will benefit from treatment, however, those who do benefit integrate back into society as responsible productive members of their communities. The reciprocal effect of those addicts who make a commitment to change their lives is greatly multiplied when they return to their families and communities as changed people.

Unfortunately, this country’s approach to drug treatment is more reactive than responsive. This is due mostly to the fact that much of our country’s economy is built on drug use as opposed to drug treatment. Decriminalize drugs and you step on a whole lot of toes. The need for prisons and police are greatly reduced, as well as the infrastructures which support those systems.

In order to change the seemingly insatiable demand Americans have acquired for drugs we must change our way of thinking about drugs. This whole notion we have about “better living through chemistry” must be re-analyzed and remarketed. Treatment teaches people about the effects of drugs, it gives people without hope a reason to live. It helps people examine and re-evaluate their lives and the direction they are headed. Treatment brings families together and helps them examine their roles and relationships it teaches them how to interact in more wholesome and healthier ways. Treatment affords addicts a time out from being caught up in the getting and using and finding ways and means of getting and using drugs, without exposing them to the hardened life of prison. Treatment works, treatment saves lives.

¹ Copersino, M., Cumberbach, Z., Jones, H., Stitzer, M. (2004). Comparative Drug use and psychosocial profiles of opiate dependents applying for medication versus medication-free treatment.  American Journal of Drug and Alcohol Abuse 30(2), 237.

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On Saturday September 12, over 70,000 Americans Rallied for Recovery! at walks, rallies, picnics and other events in 90 communities across the country. People in or seeking long-term recovery from addiction, their families and friends came together as part of a growing movement that is calling for new public attitudes and policies that will expand opportunities for recovery.

Rally for Recovery! and other public events are taking on a new meaning with the growth of an organized recovery community. For too long a great majority of the over 20 million Americans in long-term recovery and their allies have been silent about their experiences and successes.

Times are changing. In addition to the wonderful music, food and festivities that are the hallmark of recovery celebrations, growing numbers feature elected and public officials, celebrities, law enforcement officers, educators and other supporters. There are opportunities to participate in our nation’s civic life through voter registration; contact Congress about pending health reform legislation; and take action on critical local issues. Speakers represent the many pathways to recovery and join with family members to stand up for the elimination of policies that discriminate against people seeking or in recovery.

As we work to make Recovery Voices Count in our communities during the 20th annual Recovery Month observances, it’s time to raise the national profile of the solution. We have a new federal administration that is committed to improving our country’s drug policies. In one of his first statements as Director of the Office of National Drug Control Policy, Gil Kerlikowske made a welcome call for abandoning the divisive “war on drugs” rhetoric.  

What will take its place? It’s time for a high-profile Presidential Commission on Addiction Recovery and a fully-funded Office of Recovery at the Office of National Drug Control Policy that will chart a new direction in public and private attitudes and policies. It’s time to demonstrate our commitment to ensure that all Americans have the right to recover from addiction.

Funding cuts derailed what may have been a successful outcome for  Lamont Davis who reportedly was arrested 15 times since age 10.  And although useful, an ankle bracelet is not a substitute for services, it is a tool. This young man with a vast number of arrests needed more than a GPS system. In order to get back on track, youth need appropriate rehabilitative services based on their individual circumstances and with a continuum of care.
 
When a case does arise where a youth is alleged to have committed a violent act, the system must decide his/her fate. Some violent, repeat offenders may need to be locked up, but we must make sure that every child gets the opportunity to be rehabilitated, not just attached to an electronic box. Investments in youth and communities early on build strong communities and improve public safety in the long-term. Let’s use this tragedy to guide our funding priorities and avoid making the same mistakes in the future.

Clearly this is a problem that needs to be addressed, and many people and organizations are working toward solutions.

This summer is the perfect time to encourage kids to try a new form of transportation, which they can use in the fall to get to and from school: Biking.

Biking to school would eliminate the frustrating experience of waiting for bus transfers, increase visibility of bikers in the city during commute times, and have the added benefit of providing healthy exercise for students in our community.

Along with advocating cycling to school, we must promote safe biking practices. Students should be required to wear helmets, and learn proper cycling techniques. Most importantly, we must pass statewide legislation promoting equal use of roadways and an enforced three-foot passing rule. We must also continue to ask the Baltimore Police Department to live up to their part of the bargain as outlined in the Baltimore Bicycle Master Plan.

Students could also volunteer at a local bike collective, such as Velocipede, and not only learn how to maintain bikes, but could build their own bike for free. In creating their own transportation, students would be engaged in a safe, after-school environment and would learn a marketable trade, rather than being left to their own devices.

Nate Evans, Baltimore’s bike czar, told me that the Department of Transportation has partnered with City Schools, and has already installed bike racks at a few schools where students had previously been locking up to fences.

With more safe parking for bikes and an aggressive campaign to promote cycling over other means of transportation to school, we could continue to promote Baltimore as a bike friendly, green city, while improving student-MTA relations and engaging more kids in beneficial, trade-based after-school activities.