What is driving this problem and how can we combat it? In front of an engaged audience at Downtown Independent on Wednesday night, people immersed in the legal, medical, and cultural aspects of this problem offered their experiences, research, and thoughts, beginning with the origins of the epidemic.

UCLA legal scholar and health policy expert Jill Horwitz, who has been studying the laws that regulate doctors, patients, and pharmacies, said that the causes are multifaceted and include the economy, addiction, bad medicine, and corrupt pharmacists.

Sam Quinones, author of Dreamland: True Tales of America’s Opiate Epidemic, pointed to two separate causes. The first is OxyContin, which was promoted as a cure-all for pain beginning in the mid-1990s. The second is that in the 1980s, heroin—which had previously come from the Far East—started coming into America from Colombia or Mexico, making it much cheaper. “It’s potent, it’s cheap, and it’s extraordinarily mortal,” said Quinones. “It is deadlier than any epidemic we’ve ever had.”

Turning to Assistant U.S. Attorney for the Central District of California Benjamin Barron, Girion asked how law enforcement is trying to attack opioids.

Barron, who said deterring corruption among doctors is a primary focus, likened stopping opioid addiction to cutting off a many-headed monster. You can stop doctors from prescribing drugs, but you still have to deal with the black market. You can stop the abuse of prescription drugs, which has plateaued in recent years, but heroin use skyrockets. At the same time, stronger synthetic drugs are coming in from labs in China and Mexico.

Many states have instituted prescription drug monitoring programs to ensure that one person isn’t getting the same prescription from three different doctors, Girion said. But is it working?

Horwitz said that her research, including a paper she co-authored in the New England Journal of Medicine on opioid use among disabled adults, hasn’t found evidence that legal interventions make much difference.

Barron, however, disagreed. “From our perspective this has made a huge difference in taking bad actors off the market,” he said, adding that the data these programs provide is vital to his work. Furthermore, “every time we get a conviction it sends a message to doctors.”

What about helping people get medical treatment?

“The gold standard of treatment for opiate addiction is medication treatment,” said UCLA Addiction Medicine Clinic Director Larissa Mooney—drugs like methadone and naltrexone that “take the place of and break the cycle of intoxication, withdrawal, chasing the high, and trying to recover from the low.”

Another much-discussed solution, especially during the recent presidential election, is stopping the flow of heroin into the U.S. from Mexico. Girion asked Quinones, would a wall have an effect?

Walls won’t work because heroin is very easy to conceal and traffic, he said. “What we really need to do it seems to me is not alienate [Mexico],” he said. “We need to be pushing them to make the kind of changes that will make that country a kind of place that people aren’t dying to leave,” which includes better systems of law enforcement and criminal justice.

The panelists also all agreed that America’s attitude toward prescription opioids needs to change. Until the mid-1990s, doctors were reluctant to prescribe these drugs to patients unless they had terminal pain or cancer, said Girion. “Doctors’ prescribing tendencies shifted,” she said. “It got to the point where doctors were prescribing opiates quite frequently for all kinds of pain, including dental extractions and short-term pain.”

Mooney recalled seeing this “dramatic” transformation take place in medical school. “Doctors were told actually that opioids for pain are both effective and had minimal risk of addiction,” she said. “We’re learning that that is not true.”

Quinones said that the change isn’t simply limited to doctors and pointed to a larger cultural shift. “We became a country that really above all wanted comfort, convenience, and a lack of pain,” he said, citing padded playgrounds and trigger warnings in college classrooms as examples. It’s also a “story about the end of community and isolation in America,” he said. The crack epidemic largely took place in public housing, in “crack houses” where people gathered; by contrast, this epidemic is taking place in private bedrooms. “This is not a story about dope. It’s a story about who we are as a country, who we are as Americans, and what we think will lead us to happiness,” he said.

Quinones called football “a gateway to heroin addiction in America.” He found, anecdotally, that athletes with injuries are often prescribed pain pills; they’re considered the cool kids at school and on campus, and thus the drugs spread.

Girion said that her reporting supported this idea. “You go from the surgeon in the hospital to your family practitioner and your rehab, and no one pays attention to how many refills you’re getting,” she said.

“This is a supply story,” said Quinones. “If you multiply [one prescription] by millions of doctor visits and millions of surgeries over a 20-year period, that’s what creates this massive supply of opiates that transitions to heroin.”

The audience question-and-answer session pulled at one thread the panelists had touched on at various points in the discussion: race and opioid abuse. Quinones had called it a problem primarily in white America, and the panelists had all agreed that unlike other drug epidemics, this one cuts across class, affecting both affluent and poor, primarily white, Americans.

Medicare and Medicaid are contributing factors, particularly in impoverished areas. But why is there a market, asked one audience member, in more affluent places?

Quinones said that it is the result of “a generation of doctors accepting the idea that these pills can be prescribed with virtually no risk,” thanks to the work of pharmaceutical companies and pain specialists. “It was a magnificent piece of marketing,” he said.

Another audience member asked if the panel thought the level of attention given to this issue would be different if it wasn’t mainly in white communities.

Barron cautioned that at least in Los Angeles, he sees opioid addiction crossing ethnic groups, a point with which Horwitz agreed.

“It’s not that people of color cannot get hurt from this, and people of color are getting hurt from this,” she said. What’s shocking is that opioid addiction has caused a massive turnaround in the life expectancy of white people for the first time in 75 years, one that’s not seen in other racial groups, she said. As to the question about attention being paid, she wasn’t sure. “We have a fairly lousy history with dealing with problems that hit some racial groups and not others,” she said.

The post The Painful Truth About America’s Opioid Addiction appeared first on Zócalo Public Square.

It wasn’t, however, because he was moderating in front of a full house, or because Turkle is an esteemed sociologist and psychologist who was there to accept the sixth annual Zócalo Book Prize for Reclaiming Conversation: The Power of Talk in a Digital Age. It was because Turkle’s book argues “that our fixation on technology is making us less empathetic,” and that an “empathy gap” has opened up between human beings as a result of our obsession with being digitally connected.

Turkle didn’t disagree that our decreased capacity for empathy can be scary. Studies have shown, she said, that even having a silenced, turned-off phone on a table between two people “disconnects us, because it reminds us symbolically of all the other places we can be.” Researchers have found a 40 percent decline in empathy in college students over the past 30 years, with the majority of the change taking place in the past 10 years.

So why, asked Rodriguez, is Reclaiming Conversation ultimately optimistic about our chances of overcoming the empathy gap? After all, he himself missed having his phone on, even while speaking onstage.

“I think people sense that we’re in trouble, and they’re not happy with where they are,” said Turkle, citing a recent Pew study showing that 89 percent of Americans said they took their phone out during their last social interaction—and 82 percent said that doing so somehow diminished the interaction. “I think we’re in a moment of inflection,” she said, “a kind of tipping point” in which we can change our behavior and seize control back from technology.

Turkle recalled interviewing a father of 11-year-old and 2-year-old girls. The conversations he had with his older daughter in the bathtub when she was a toddler formed the basis of their relationship. Today, he checks his email while he bathes his 2-year-old. “We love our phones; we’re going to live with them,” said Turkle. “But we’re going to live with them better in ways that are better for us and better for our children.”

“What compels the father to take out his iPhone in that moment?” asked Rodriguez.

Turkle said that phones, like benevolent genies, offer us three gifts: We will always be heard. We can put our attention wherever it wants to be. And we will never be bored. But just like fairy tale genies, phones bestow curses along with the gifts.

“Constant stimulation is not good for you,” she said, adding that boredom is necessary for us to be creative, to learn how to listen to others, and to achieve a stable sense of self.

Our sense of who we are is also plagued by being constantly connected. Thanks to social media, “we know in excruciating detail what other people are doing,” said Turkle. But it’s “a glamorized version of what they’re doing.” Turkle said she herself might post on Facebook that she’s in Los Angeles to accept an award. But what she won’t post is a photo of her dressed “in a sweatsuit, coming off the plane from Boston to L.A. looking like a bag lady.” As a result of these glamorous social media lives, we become jealous of other people, and even of ourselves. It’s alienating, said Turkle.

Rodriguez asked about Turkle’s notion “that we have edited lives, that we’re always performing.”

The trouble, Turkle replied, is that when we rely wholly on performance to connect with others, we “shy away or find ways around a certain kind of conversation.” We don’t go off on tangents, make spontaneous jokes, or free-associate.

Young people today, she said, fear real-time, unperformed, unedited conversation. The college students she studied “get together and write romantic texts in groups” to make the messages perfect.

But, Turkle argued, it is showing weakness and vulnerability that helps us be more empathetic. “The experience of empathy basically comes in situations where you get to see someone thinking, and you get to be able to learn how to project yourself in the mind of the other,” she said. Turkle added that, in her book, her ideas are at their most polished—but seeing her talk about them in person offers a different window into her way of thinking.

“You’re arguing for engaging with imperfection, messiness,” said Rodriguez.

“I’m engaging with human beings, because that’s who we are,” said Turkle.

If we go back a half century or so, asked Rodriguez, were we more centered, more connected, because we were less distracted by technology?

“I don’t want to paint a golden era,” said Turkle. There are plenty of people who never liked being alone, or whose families didn’t have deep conversations well before the onset of these technologies. But “what’s going on now is undermining our ability” to empathize, she said. “Visibly around us, we’re seeing our children not developing that capacity. I don’t want to say it used to be perfect. Let’s just get a grip on how we’re behaving ourselves and with our kids.”

Turkle took questions from the audience that ranged from asking about parallels between the digital divide and road rage (which she likened to cyber bullying) to her inspiration for Reclaiming Conversation (it arose from her previous book, Alone Together).

One audience member asked Turkle about how to make digital life less overwhelming. Trader Joe’s, the audience member noted, originally became successful because the store didn’t offer a ton of choice—it carried just one kind of black beans. “How do you make a Trader Joe’s experience for people so they don’t feel overwhelmed with all of the possibilities?”

Turkle thinks that a consumer movement could grow out of our dissatisfaction with all our choices, one that’s similar to the way our eating habits have changed over the past half-century.

Growing up in post-World War II Brooklyn, Turkle ate fruit and vegetables from cans. “We didn’t have anything fresh,” she said. But she fed her own daughter a different diet, with fresher foods. That shift, she said, didn’t come from the food industry. “It was a hard-won fight,” said Turkle, about obesity, diabetes, and our health. We need to ask designers of technology to create phones that don’t try to keep us glued by our screens but that let us do what we want to do, then turn away. That would include phones that don’t let us text while we’re driving.

“These are simple things we can ask for,” she said.

The post Can We Close the Empathy Gap? appeared first on Zócalo Public Square.

The panelists—UCLA Children’s Digital Media Center researcher Yalda Uhls, High Tech Los Angeles principal Marsha Rybin, and RAND educational policy researcher Lindsay Daugherty—dispensed advice and wrestled with how to strike a balance between preparing young people for a technological world while limiting technological overuse that can lead to addiction and anti-social behavior.

Uhls, author of the new book Media Moms & Digital Dads, noted that adult fears about the effects of technology on children are an old phenomenon. In the 1800s, adults worried about kids’ consumption of a popular new media: popular fiction. “Today, I would be so happy if my daughter read Jane Austen,” she said.

What’s different about digital media than previous technological changes, Uhls explained, is its rapid growth and the fact that even babies can use smartphones and touch screens. The speed of the technology adoption means that researchers have to play catch up to understand its impacts. “The stuff is moving so quickly that it’s taken a long time for us to understand how it’s affecting kids,” Uhls said.

Daugherty, the RAND researcher who has done policy briefs on effective technology use in early childhood education, struck a moderate line. She cautioned against hard and fast conclusions about the amount of internet and technology use, arguing that debating whether technology is good or bad is “the wrong conversation.” Instead, she said, we should evaluate technology by the purposes of its use and the quality of the education it inspires.

Even in preschools, “you can create technology or implement technology in a way … that really allows [children] to learn and move and have peer interactions,” Daugherty said. She saw a socioeconomic divide in how well children are trained to use technology, with upper- and middle-class parents doing more to make sure their children are using it for learning. And she urged early interventions to make sure even very young children are using technology in educational ways.

“If you can’t interact with technology, you can’t be a successful student. … It’s an important school-readiness skill in a lot of ways,” said Daugherty. “If you’re teaching a kid how to use a computer at age 7, they’re way far behind.”

Rybin, the founding principal of High Tech Los Angeles, a charter high school in Van Nuys, said she and her staff have talked extensively about how to encourage technological education in the school without being disruptive.

Recently, the school decided that students wouldn’t be permitted to have their phones on—and everyone has a phone, she noted, even though half the students are on free or reduced lunch. But the school guarantees tablets and home internet access to all students, so they message each other on those. And they use proxy services to go to social media sites that are supposed to be off-limits during the school day. “They are hacking because they can’t stop,” she said.

Still, the school goes to great lengths to make sure the students talk to each other, instead of just texting. “When we make them have these face-to-face conversations, they sometimes are a little uncomfortable,” she said. “But they do a lot of oral presentations, they do a lot of cooperative work, to get them out and talking.”

The discussion’s moderator, science journalist Eryn Brown, pressed the panelists on whether kids have digital needs. Daugherty said students need to develop the ability to filter information—separating reliable information from unreliable. Uhls said that young people need to “create a positive digital footprint”—basically an online persona—because colleges and employers will check for one. And Rybin said that students need parents to be looking over their shoulder—to have the password to their children’s phones, and to look at the texts and photos and social media messages they’re sharing.

During a lively question-and-answer session, the panelists said that media concerns about online predators and sexting are overblown. (Uhls also said there’s not yet enough research about the impacts of online pornography.)

One questioner asked whether today’s schools need mandatory classes in online and technological behavior, just as they have classes in health and sex education. Rybin noted that there is no such mandatory program, but that her school offers quite a bit of help, beginning with a boot camp for freshmen.

Uhls and Daugherty said thinking about technology and online behavior must be part of everything teachers and parents do with young people. “I think everybody has a little internet zombie in them,” Daugherty had mentioned earlier in the conversation. The best way for education to overcome this? “Integrate technology throughout the school,” she said, so that healthy technology use isn’t just a class assignment, but a part of everyday life.

The post We All Have a Little Internet Zombie in Us appeared first on Zócalo Public Square.

Last year, roughly 50 million people in North America played fantasy sports. I was one of them, and spent all Thanksgiving playing daily fantasy football. My son and I opened an account on one of two major companies that organize daily fantasy sports—a fast-paced and hugely popular version of fantasy sports that squeezes online competition into a single day as opposed to an entire season. An entry fee of $50 allowed me to assemble a team of NFL players and pit them against the roster of another anonymous user. The website compared our players’ stats side-by-side in real-time, and awarded $90 ($50 from him, $50 from me, and $10 to the website) to the team that had the most points at the end of the day’s games.

My desire to win surprised me. While football would typically be on my home’s television on a holiday, it would be in the background. This year, I made sure that our plans for the day included time for me to watch games. Every time one of my players did well, I felt a rush of excitement. Every time one of my opponent’s players did well, I felt a pang of frustration. As the games were winding down and it became clear that I would lose my $50, I felt unsatisfied—not at the idea of losing money, but at the idea of losing to someone I didn’t know.

This daily version of fantasy sports rapidly emerged in American popular culture last year, in part because of a $250 million push in advertising. The companies, which include DraftKings and FanDuel, aren’t regulated like traditional forms of gambling, and the companies argue that they shouldn’t be, on the grounds that they’re games of skill. But in recent months, attorneys general in states that are home to some of daily fantasy’s largest markets, including Texas and New York, have made moves to classify daily fantasy sports as gambling, arguing that they’re actually games of chance. The result has been a national debate over how, if at all, fantasy play should be categorized.

In the week after Thanksgiving, I went back to play a second round of games because I had money leftover in my account. I played against another faceless avatar, and lost with similar frustration. I realized this time that any success I had entirely hinged on luck, mainly because opponents don’t see each other’s player selections before competition begins. In my case, my opponent and I coincidentally had chosen almost the exact same roster. (Had I been able to see his roster ahead of time, I would have picked other players.) He won because his tight end happened to catch a touchdown and mine did not. As far as I can tell, this wasn’t due to some statistical advantage that he took advantage of. He just lucked into picking the right guy on the right day.

The season-long version of fantasy sports never feels this random. Those games are measured, nuanced, and definitive, and the winner earns victory by outlasting and outmaneuvering the rest of the league. I’ve played season-long fantasy sports for more than 20 years. There are nine people in my baseball league, and it’s always the same three who fight for the top and the same three who don’t pay attention and finish at the bottom. The three who win consistently do research and spend time scouting and analyzing data. They pay attention to injuries, make good trades, and position themselves to take advantage of opportunities.

In daily fantasy sports, players wager money on an event of uncertain outcome in the hopes of winning more money. That feels like gambling, because that’s the essence of the gambling experience. The layouts of daily fantasy sports websites look exactly like online poker and Internet sports gambling websites, with slick graphics, lots of information, and tantalizing promises of big wins. Browsing the sites feels like browsing an Internet casino or reading the betting board in a Las Vegas sportsbook.

Gambling is meant to be recreation. And for the vast majority of people who do it, it’s simply that: a diversion, an escape. I remember the first bet I ever made, a $20 wager that the Chicago Cubs would win the 1993 World Series. I lost, but it imprinted in me the experience that most gamblers have throughout a wager—the anticipation, the excitement, the optimism, the denial, and ultimately the acceptance of defeat. Gambling disorder, meanwhile, is a psychiatric condition that affects 2 percent of the population. It’s characterized by addiction: continued gambling despite harmful consequences, even after defeat. Similar to alcohol or drug addiction, it can be devastating financially, socially, and psychologically. And gambling is often more readily available.

Daily fantasy sports websites are anonymous, easy to access, and even easier to hide. Anyone could place thousands of dollars at risk with a click of the mouse, and no one close to them would know. This is where the risk to develop addiction is highest. There is no maximum amount of money to be lost, and there are no consumer protections like there would be inside brick-and-mortar casinos. Without regulation and oversight, who’s to say that faceless avatar I played was an actual real person and not a preprogrammed piece of software?

Today, my daily fantasy sports account is still active. It sits at $49, with enticements like “deposit more” and “get back in the game.” Every once in a while, I’ll log onto it to see what type of games are being offered. But the draw for me to play is low. I know I won’t enjoy the experience. Besides, the NFL season is over and I need to get my fantasy baseball team in order.

The post Fielding a Daily Fantasy Sports Team Is No Different Than Playing Online Poker appeared first on Zócalo Public Square.

That was the message at a Zócalo/UCLA event at the Museum of Contemporary Art in downtown Los Angeles on Monday night that addressed the question, “Is digital technology destroying our health?” In front of a packed auditorium, moderator Chad Terhune, a senior correspondent at California Healthline and Kaiser Health News, asked a panel of experts, “All this digital technology, this explosion we’ve all seen in our hands, is it doing more harm than good?”

UCLA Chancellor and biobehavioral scientist Gene Block said there are tangible benefits when people can monitor their own vital signs with such ease and take more responsibility for their own health care. But an excessive amount of screen time, especially at night, is starting to take a toll.

“Perhaps the most dramatic impact is the reduction in the amount of sleep,” Block said. Fifty years ago, the average adult got eight and a half hours of sleep, and now we average less than seven hours a night, he explained. Bright light reduces levels of the hormone melatonin, which regulates sleep, and leptin, which makes you feel full; at the same time, it increases ghrelin, which makes you feel hungry. So more time with computers and phones can make us gain weight not just because we’re more sedentary, but because of their effect on our sleep cycles.

Sleep “is a primitive process, but absolutely necessary,” Block said.

Patricia Greenfield, director of the UCLA Children’s Digital Media Center, was most concerned about the “social costs” of our obsession with digital technology. She cited a recent study conducted by her center that found that 6th graders’ ability to read emotions from nonverbal cues improved significantly in just five days when they went to a camp that focused on face-to-face interactions. She also pointed to another of their studies that found that college students felt most “bonded” to their friends by talking face-to-face, and most distant from them when they text messaged. And, yet, of course, these students still most often communicated by text.

“Being able to understand the feelings of other people is extremely important to society,” she said. “I think we can all see a reduction in that.”

Health economist and Milken Institute Fellow Anusuya Chatterjee didn’t want to lay all the blame at the feet of technology. “I feel that actually we should rather say humans are using technology in such a way that it’s affecting their health,” she said. “Humans are making the choice to be so obsessed with technology.”

She noted that sometimes when she is checking her email and her son says something to her, she responds with a distracted “Uh-huh.” And when she says something more to him, “He’s replying back in the same language—‘Uh-huh’— because he’s looking at the iPad,” she said. “Maybe that’s our future. … That’s scary.”

“If we are not careful about all these minor things right now, the effect in the future when this generation grows up is going to be much, much bigger,” Chatterjee said.

Terhune asked what can be done to ward off these negative consequences. Is the answer just to unplug our devices?

“Part of this is maybe making bedrooms safe spaces, where there aren’t any electronic devices … and reinforcing the idea that most people need seven to nine hours of sleep,” Block suggested. And this might be a boundary that would be particularly good to reinforce in children so they can get started on good habits early. “It’s not something to be embarrassed about, that you need sleep,” he said.

Chatterjee noted that it’s hard to tell her son to stop watching the iPad, especially in the winter. “When I say, ‘Stop using the computer and go play,’ he says, ‘Where will I go?’ So, I cannot just tell him to unplug,” she said. Plus, because she lives in New York City, she’s also concerned about the safety of the parks and recreational facilities she might send him to. So policy makers and city leaders need to get together so parents and kids have viable alternatives to screen time.

She noted, too, that businesses need to do a better job of being mindful of the health of their workers when they sit for hours on end in front of a computer screen. Even if you start to look like the annoying boss from Office Space who seems to have nothing better to do than hang an arm over other people’s cubicles, people should get up every hour from their desks and walk around, Chatterjee said. “People can think you’re weird, but it’s helping you.”

Greenfield agreed with the need for changing workplace expectations. “It used to be if you answered a letter in two weeks, you were doing fine,” she said. “Now, if you don’t answer in a few hours, people think you’re not responsive. … You can’t concentrate because the expectations are so great.”

Block concurred, noting that the brain finds it hard to process two things at once. He noted that he was recently reading a book that talked about how Albert Einstein came up with his theory of general relativity. “These kinds of amazing intellectual accomplishments require full attention. … Could we be losing the ability to have that focused concentration because we have multitasking?”

In a question-and-answer session that followed the discussion, a member of the audience wondered whether digital technology was becoming as addictive and dangerous as cigarettes.

Greenfield noted that when she published her book Mind and Media: The Effects of Television, Video Games, and Computers, in 1984, she thought an addiction to video games was crazy. “If a child wants to finish a book, nobody says, ‘My child is addicted to reading,’” she said.

In the years since, however, the definitions have changed. Just check out the latest diagnostic manual from the American Psychiatric Association

“The same criteria that are used for alcohol and drugs, if you apply them to video games, there is such a thing as addiction,” she said. “We could find such a thing with cell phones in the future.”

The post Technology Doesn’t Ruin Health, People Do appeared first on Zócalo Public Square.

Whittemore, who was born in Massachusetts just before the turn of the 18th century and was the grandson of the first Whittemore to arrive in America in the mid-1600s, was in his late 70s when he saw the Red Coats on this April 17. To his family’s horror, Whittemore snatched his musket and crouched behind a stone wall. Other minutemen begged him to move to a safer position, but Whittemore disregarded their pleas. Whittemore killed three British soldiers; in turn, he was shot, beaten, bayoneted, and left for dead. Refusing to give the Red Coats the satisfaction, he recovered and lived almost two decades longer—long enough to call George Washington his president.

Whittemore was the oldest known combatant in the American Revolutionary War. In 2005, Senate bill 1839 declared him hero of the Commonwealth of Massachusetts, and designated February 3 as the day to commemorate him.

Samuel Whittemore Monument located in Arlington, Massachusetts

That was the day when I found out he was also my great-great-great-great-great-great-great-great-great grandfather. My brother, Andrew, called to tell me about our ancestor’s antics, exclaiming, “They were all over the internet.” It was a big day in Boston, and a day of revelation for me. My brother and I scoured our family archives and the Internet to learn more about him. I thought I was the only Whittemore who acted out on impulse and ignored admonitions of those close to us. I thought I was the only Whittemore who recklessly battled for independence.

The original Whittemores arrived in the Boston harbor from England, no doubt strutting rigidly down the planks of a Mayflower-like vessel with proper comportment and clear-cut intentions on a pre-ordained life course. People in my family attended schools like Wellesley, Colgate, and Babson immediately after high school. There was no question they would obtain degrees, and many started their own insurance companies. They married young, and raised children who would follow direction.

The blue-blooded Whittemores handed these customs down through the generations: Do as you are told without question or deviation. Use salad forks and dessert plates. Live in tidy homes with manicured lawns. Play golf, decked out in L.L. Bean gear and slacks with ducks embroidered on them. Refrain from outbursts of immoral, rash behavior.

The author, with her parents, in 1968

I, on the other hand, dropped out of Boston’s Emerson College in 1985, at age 19. I was enamored with the early punk scene and ran pell-mell to California with a boyfriend, deaf to protests from parents, teachers, and relatives. There was no strategy. No plan. A new horizon beckoned, and I was down for anything.

For a period of time, I was able to do whatever I wanted every minute of the day. I secured full-time employment at Slash Records, and immersed myself in the throbbing, thriving Los Angeles punk scene. Dying my hair a plethora of colors, I wore ratty tutus with velvet hats and knee-high combat boots. I bought a clunker Nova from a Rastafarian, and I spray-painted it leopard.

I was enjoying what seemed like unadulterated freedom—which also happened to include copious amounts of drugs and alcohol. Ultimately, the independence I had so fanatically craved developed into a stifling dependence on heroin.

I sold drugs and myself to support my habit. I lost my apartment, my job, and my car. I became homeless, and crashed in shady motels with hookers, dealers, and gang members. I ended up in jail many times. Chained to a habit, I was far from free.

My addiction determined what I’d do, where I’d live. By Christmas of 2000, I had followed it to Chico, in Northern California. I had been strung out on heroin for 15 years at that point, despite sporadic unsuccessful attempts to get clean. My family cancelled plans for me to return home for the holidays after they found out I was using, again.

Broken and hopeless, riddled with guilt and shame, I realized I had smashed hard against the limits of liberty. I was exhausted and chewed up by heroin, and I finally recognized that things were going to get worse if I kept using. I had ridden Captain Whittemore’s notion of independence as far as it would go and it was destroying me. I realized freedom also brought the risk of making bad choices, and I had made a lot of them.

I called a rehab back in Southern California that I had been to twice already. This time, I was willing to do whatever was asked of me. “I am always loaded and can’t imagine life any other way,” I said. “But I can’t continue to live like this. I need help.”

Rather than a plane ticket home to Boston, my mother provided me with a one-way flight to rehab in Pomona. Leaving the airport in Sacramento, I was detained by police officers for appearing suspicious, high, and homeless. I was all three. During the arrest process, I did something I never did. I told the truth.

“You guys have every reason to arrest me. I am under the influence, there are drugs in my bag,” I said. “But I am on my way to check into a rehab. I have made this promise to my family. I have to keep my word. I know this is my last chance.”

Battling with drug addiction is not for the faint of heart. I often felt like a lone soldier with a useless musket trying to keep the drugs, the lifestyle, and the police at bay. During past stints in rehab, I handled the flu-like symptoms of kicking heroin: sweating, fever, chills, and body aches. But the sleeplessness was unbearable. When I was awake, my mind obsessed about the relief I knew only heroin could deliver, and I went back to the streets.

But I did not go to jail that day in 2000 or any day since. I have remained clean and sober for 14 years since that fateful Christmas Eve. I have patched up relationships with my family and friends. I returned to college and earned my degree. I am open and honest about my battles. I am the proud mother of a 12-year-old boy who keeps me on track. And now my concept of freedom is a fierce determination to let no thing control me—to feel free to build, rather than tear down.

The author and her son, Milo

Silent tears run down my face, when my father, who usually keeps his emotions tightly reined in, tells me that he respects the strength with which I clawed my way back to sanity. Centuries separate ol’ Sam and me, and the centuries also separate our concepts of independence. But we survived circumstances where many others have perished, and in this country, we had the ability to will our way home again.

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An upcoming ballot initiative in California includes a provision that would require physicians to be drug-tested prior to practicing at any hospital, or after their involvement in an “adverse event.” This is packaged with other measures that appear political and punitive towards all physicians. But the drug-testing provision bears scrutiny because, while drug testing is widespread in American business, and required of nurses and many hospital and medical workers, private doctors are not routinely tested.

I’d like to tell you it isn’t a problem for doctors, but unfortunately, I’ve seen firsthand that there are physicians who practice while they are “under the influence.” As someone who oversaw doctors as chief of a hospital department charged with monitoring the quality of its members, the idea of a colleague practicing while impaired is terrifying. And while we physicians have a direct responsibility to protect patients, we often find it hard to speak up when we see something. The attitude is: If it isn’t my patient, it isn’t my problem.

Studies on the percentage of physicians who report to work impaired are scarce, but it seems to be very low, less than 1 percent. Still, the thought of any such physician is very troubling.

I personally made it my practice never to have a drink at lunch or in the evening when I was on call. You just never know what is going to happen, and you don’t want to have someone smell alcohol on your breath, even if you drank a small amount. Inasmuch as I was on call for most weekdays for 30 years, I never felt free to drink during my career.

Sadly, that was not always what I encountered from my fellow physicians.

I remember practicing as a young ER physician new to a small community hospital in California, and calling in a prominent surgeon to perform an emergency appendectomy. When he arrived, he strongly smelled of alcohol. I’m not sure if the smell colored my thinking, but I thought he was speaking more slowly than normal. It was the middle of the night, after all. There was no other choice for surgeon, and a delay exposed the patient to significant risk. The surgery went ahead, and the patient did fine. However, as I asked around, I discovered that this surgeon was known as a boozer, and frequently came into the hospital drunk. This still haunts me, and I left that hospital rather quickly.

That was my first experience with the difficulty of dealing with physicians who abuse mind-altering drugs. I didn’t make any sort of formal report on the surgeon; I would have felt intimidated. I passed the word along to colleagues, but that was all I did. Today, as a senior physician in the latter part of my career, I would hope that I’d do more.

That was a case when I recognized a problem. It can be hard to recognize that a colleague has a substance abuse problem even if you’re a trained observer of addicts. Among my professional pursuits, I was the director of a drug/alcohol program for a large medical group, and personally saw every patient who entered the program for several years. I thought I had a pretty good background in spotting the behavior of addicts.

In 1994, I hired an associate, Cindy, a graduate of a famous cancer center who was looking for temp work. She was young, attractive, and very smart. But I was surprised by her poor work habits, and my staff reported strange behavior. Drugs from the office started disappearing. It took too long for me to reach the clear conclusion that Cindy was abusing drugs. I just couldn’t believe it until it was undeniable. (Although she did deny it.) A year later she had her license revoked for drug use, unrelated to my experience with her.

It was very sobering to me that I was fooled by her for so long. Looking back, it was obvious, but at the time, my bias toward people with excellent training and good manners blinded me. I’m still embarrassed by it. But the bottom line was that even with close daily contact in the office, I didn’t recognize it, in spite of my professional experience with addicts.

Until a few years ago, the licensing board for physicians in California had a diversion program for those who were identified as having an abuse problem. It had a 75 percent long-term success rate. It allowed for anonymous reporting of suspected abuse, and it was increasingly used since the 1970s, when it started. However, the licensing board, in its wisdom, recently discontinued this program; in their view, the board’s primary mission was patient protection, not physician rehabilitation. Funding should not have been an issue: The program was paid for by physician licensing fees, not by taxpayers. Nothing has appeared to take its place, and so California is without a confidential reporting system for doctors.

I’ve spoken with a number of practicing physicians recently, and surprisingly, I hear a lot of support for mandatory testing. This support may have less to do with a desire to protect patients than with a feeling of impotence in dealing with colleagues who abuse drugs. Most physicians simply don’t know how to report a problem without potentially endangering their own careers.

Mandatory testing will cost a lot of money, and it is certainly intrusive to the daily practice of medicine. And I think just a small number of physicians would be identified by this process. However, here’s my diagnosis: patient safety concerns justify such testing for physicians, just as air safety concerns justify testing for pilots. And even with testing in place, doctors should not be excused from their obligation to report colleagues, and the government should provide a way to make such reports confidentially.

None of this should be done by a deeply flawed ballot initiative; instead, the legislature should craft a careful law that will work in practice.

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But if given the chance, I would have thanked him for one night on the South Side of Chicago, when he relieved my pain.

The nine timeless innings of baseball are designed to remove us from life’s stressful machinations. In his poem “At the Ballgame,” William Carlos Williams wrote,

the crowd at the ballgame
is moved uniformly
by a spirit of uselessness
which delights them.

Whenever I head to the ballpark, my feet never touch the ground. The first thing I look for are the lights of the stadium as I approach. Inside, that first glimpse of a lit field through the section ramp cures me.

My parents went their separate ways in 1970 when I was seven years old. In that moment, the Baltimore Orioles became my family, and I have lived and died on the outcomes of their games ever since. The Orioles in the ’70s were easy to live with. The players came to our baseball clinics, shopped in our grocery stores, and stayed for many years in the same city. Flanagan was one of those guys. His home was not far from where I grew up.

Then came 1979. It was a promising season for the Orioles. My father and I listened to games on the radio in his cool basement and ate steamed crabs on the kitchen table covered in pages of the Baltimore Sun. Mike Flanagan won the Cy Young award that year with 23 victories.

And, in late summer, as I prepared to start my junior year of high school, I moved from Baltimore to Chicago.

It was my choice. My mother, stepfather, and my younger brother were relocating to Chicago. I could go with them, or stay in Baltimore with my father and stepmother. My younger brother had become ill the previous spring, and I had developed a bond with him. We had stuck together and I couldn’t be without him.

That fall, the Orioles beat the Angels in the playoffs and faced the Pirates in the World Series. Down three games to one, Pittsburgh came back to win the series. The Pirate rallying cry, “We Are Family,” carried a bitter ironic twist. My first Chicago winter was brutal with an icy wind slicing off the lake. I missed the Birds and my Dad back home.

***

In Chicago, I once saw the Orioles play in the old Comiskey Park. It was the summer of 1984. Old Comiskey was a hulking mass of painted white brick on the South Side of the city. While Memorial Stadium in Baltimore was my hometown park, Comiskey became a rite of passage. I had my first baseball beer, an Old Style, within its confines. Years later, its demolition inspired me to write a poem:

When my cleats have reached the warning track
and my innings are almost done
I hope heaven is a grand old ballpark
with bleachers in the sun.

That night in Comiskey, I sat in the upper level of the right field grandstand. We were up so high it was impossible to see what happened to balls hit to deep center.

Hall of Famer Tom Seaver-the movie version of the star pitcher, smooth and rich and powerful-started for the White Sox. Seaver mowed the Orioles down. He stifled the Oriole bats, inning after inning. He glared from the hill with a studied countenance. Seaver was perfect until Gary Roenicke singled with two outs in the fifth.

Mike Flanagan started for the Orioles. He didn’t look the part like Seaver did, but he matched Seaver pitch-for-pitch, striking out eight. On the mound, he resembled a warhorse, carrying a heavy weight but refusing to give in. He held up the team all by himself.

Flanagan surrendered two meaningless singles. The Sox hitters had no answer for him. A basketball player, a fly fisherman, and the owner of a wicked sense of humor, Flanagan was a student of the game. You rooted for him.

In the ninth, Seaver got into trouble. Cal Ripken walked, and Eddie Murray singled for the Orioles. A bunt moved them over to second and third. Gary Roenicke-again!-tomahawked a grounder over the bag at third for a two-run double and the Orioles held on to win. They found a way to win back then.

It was the kind of pitchers’ duel that never happens anymore. More than that, it made me forget that I was in a city that never felt like home. I sat in those seats wondering what I was going to do with my life, and I was scared.

***

I drifted away from the Orioles in college. Drinking too much, taking drugs, and listening to the Clash at the University of Virginia distracted me from my obsession with baseball. In the fall of 1984, I would black out behind the wheel and miss a head-on collision by inches. For the next 15 years, I would plumb the depths of depression and explore the dark side of addiction.

As a poet, I had potential but not the discipline or the focus to labor over every word. Accepted into the writing program at Columbia University, I chose instead to partake in the pleasures of New York City that were available 24/7, and was asked to take a leave of absence after the first year.

I worked in the World Trade Center as a temp for a bank and slowly worked up a collection of poems that were good enough for readmission. I still frequented dangerous places, apartments where the only furniture was a table and a scale to weigh rocks of cocaine. I justified this behavior as part of a necessary process in becoming a poet. William Blake, Dylan Thomas, and Jack Kerouac were my idols. I had forgotten about Mike Flanagan.

Then I revived myself, and I revived my interest in baseball. I went back to school. I met an intelligent and beautiful Ph.D. student in Renaissance literature and began working on my poetry thesis. Jill’s best friend had corporate seats nine rows behind the visitor’s dugout and supplied me for years. After the Orioles nearly won the division in the fall of 1989, I proposed to Jill at Rockefeller Center a few days before Christmas. The motto for the Orioles that season had been “Why Not,” and I let the slogan guide my decision.

I didn’t stop drinking or smoking marijuana. I still found myself in dangerous neighborhoods after midnight, stumbling around, inviting harm. When the Orioles headed into the 1997 All-Star break with a 43-17 record, I separated from Jill. I was certain the Birds were going to the World Series, and I didn’t need to answer to anyone. I stayed with friends, roamed the city at all hours like a nomad, and continued to destroy myself.

Nineteen ninety-seven didn’t end well. The Orioles lost in the playoffs, and my marriage ended too. I headed south for a new publishing job in D.C. and a change of scenery. The good news was that I was closer to my team. I found an apartment in Adams Morgan and began revising my unpublished poetry manuscript. I had never lived alone before, and my drinking escalated from beer to vodka and wine-and blackouts ensued. My new job required extensive travel, and I missed flights from drinking. In 1999, I sought help.

I quickly realized why the collection had never been published. Written under the influence, the poems were barely intelligible. I worked on them feverishly and the manuscript won a first book contest. American Boy was published in 2000.

The Orioles were still headed south. In 1998, they would begin 14 consecutive losing seasons. But those same years have been the happiest of my life. My kids wear Oriole jerseys and belong to the dugout club. I am living back in Baltimore after 30 years, and the team is still losing. Life for me has been a journey into acceptance of the wins and the losses.

I have watched or listened to nearly every Orioles game during those 14 years. Flanagan was there too-as a pitching coach, as an executive vice president in charge of baseball operations for a few years, and as a broadcaster. I’ve found the pain of losing can get visceral at times, but it’s nothing like the early days when my entire outlook depended on the performance of nine men in black and orange.

Not everyone learns to live with losing. On August 24, police were called to Mike Flanagan’s home in Baltimore. They found him dead, of a self-inflicted gunshot wound, on a trail on his property. Some reports of his suicide suggested he was having financial problems or was upset about his broadcasting contract with the Orioles.

Other reports-the ones that Orioles fans believe-said that he was despondent about all the losing.

I don’t know exactly what to think, but if I start drinking again after 12 years of sobriety, the losses will pile up.

When my friend Timmy Hodge would run into him at the grocery story he would say, “Thanks, Mr. Flanagan, for your hard work.”

“We’re having a tough time out there,” Flanagan would reply. “But we’ll get ’em.”

Since Mike Flanagan’s death, I have felt the remaining burden of losing lifted. He carried it with him when he decided to take his own life. He died for the Orioles to win, as strange as that sounds.

On the last night of the 2011 season and for the first time in 14 years, the Orioles played a meaningful game in late September. Their game against the Red Sox was important-for the Red Sox, who needed to win to make the playoffs. It was my first trip to Oriole Park since Flanagan passed away. I was struck by the black banner under the Press Box with his number 46 in orange. It stayed in my thoughts as I watched the game.

The park was buzzing with a playoff atmosphere. The weather seemed more like late July. Sox fans teemed at the turnstiles, but so did O’s fans. The game itself seemed suspended in an eerie timelessness. It had its own weight as a one-game season. There were roving ESPN camera teams even though we were in last place.

For weeks, I’d wanted the season to be over. When the winning run crossed the plate, denying the Red Sox a postseason appearance, I suddenly wanted to watch these young Orioles one more time.

I knew the warhorse from New Hampshire who matched Tom Seaver pitch-for-pitch would have loved this game. I also realized that Flanagan’s blood, like mine, was tinged Oriole orange.

When it’s time for me to take the hook and head for the showers in the sky, I have asked my wife to secretly sprinkle my ashes in the outfield of Camden Yards. I’d like to hang around the field with former Orioles greats like Elrod, Cuellar, McNally, the Babe (whose father owned a saloon in what is now center field), and Flanagan.

A ballpark is close enough to heaven for me.

Dean Bartoli Smith, author of American Boy, is a poet, journalist, and father who lives in Baltimore.

*Photo courtesy of wallyg.

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