Blog

The biggest reason it’s so hard to find a mental health practitioner

We don’t have enough of them.

As I run around in my real job discussing mental health, I consistently come back to this one central truth: The biggest issue in the area of mental health is that we simply do not have enough people to provide care, or who take Medicare or Medicaid. This means that, when you call a psychologist or psychiatrist, the most likely response is, “I’m sorry, but the Doctor is not accepting patients at this time.”

Consider this: According to a 2016 study, the supply of mental health practitioners by 2025 is expected to be 250,000 short. This disturbing trend is occurring despite the fact that rates of mental illness and suicide continue to increase, and increase alarmingly among the youngest members of our society.

Interestingly, the above article notes that a big part for the rise in demand of mental health practitioners has been a lessening of the stigma which surrounds mental health. As more people become more comfortable with seeking treatment, they put a greater strain on the need for mental health providers.

The problem is particularly bad in rural areas, where, according to this 2018 CNN article, “a majority of non-metropolitan counties (65%) do not have a psychiatrist and almost half of non-metropolitan counties (47%) do not have a psychologist.” This shortage contributes to higher rates of mental illness, addiction, and suicide in rural communities. Indeed, it helps explain why rural areas typically have higher suicide rates than their urban counterparts.

So, what can we do about this?

I’d argue the biggest challenge is the need to increase mental health reimbursement rates, which are historically lower for mental health services. These low rates typically steer prospective doctors away from mental health specialties and into more lucrative practice areas like cardiology and oncology. Increasing these rates would help recruit more practitioners.

Additional funding is also needed for recruitment and loan forgiveness programs. Many states – including Pennsylvania – have begun enacting these programs in an effort to increase access.

Private practitioners and hospital systems also need to step up their game when it comes to this area, but according to the article above, the good news is that they are doing just that. I know that both of the major health networks in my area have said they are looking to expand capacity and recruitment when it comes to psychologists and psychiatrists, and they aren’t the only ones

If you are interested in the interaction between mental health and public policy, you really should pay attention to this space. There will be a lot more in this area in teh next few years.

Yes, people really are this stupid about mental illness and suicide

Sometimes, I find myself falling victim to the availability heuristic, and if you read this blog on a regular basis, I bet you do too.

For those of you unaware, the availability heuristic is defined as: “A mental shortcut that relies on immediate examples that come to a given person’s mind when evaluating a specific topic, concept, method or decision. The availability heuristic operates on the notion that if something can be recalled, it must be important, or at least more important than alternative solutions which are not as readily recalled.”

Why am I mentioning this now? Well, if you read this blog, I’m guessing you have an interest in mental health and mental illness. It’s probably a subject you follow closely and in which you are are well educated. I bet you have more evolved views on the causes and symptoms of mental illness and understand it’s complexities. And, I’d bet that the vast majority of people you interact with feel the same way.

Ahhhh, dear reader, allow me to share portions of an Email I just received. Among it’s gems:

  • “People commit suicide because they lack hope. True hope comes from putting your trust in the Lord Jesus Christ.”
  • “A troubled person who believes in evolution and does not know anything about the Bible, may turn to suicide as an escape.”
  • “If you want to reduce suicide, introduce the Bible back into school and stop teaching the fairy tale of evolution.”

First, a disclaimer, and let me make it crystal clear: The purpose of this entry is not to mock anyone’s faith or sincerely held beliefs. Rather, it’s to point out an absolutely ridiculous example of thinking. Faith absolutely assists some in the fight against depression and hopelessness. That’s wonderful. If that’s something which may work for an individual, I highly, highly encourage them to find a method of counseling which fits their views on religion, God and spirituality.

But the notion that prayer, Jesus or teaching creationism will cure depression and suicide for everyone is absurd.

Mental illness is highly complex. It often requires time, resources and multiple, simultaneous methods of treatment and lifestyle changes in order to fully address and treat. There is no one size fits all bullet. But what absolutely will not help is judgmental statements like the above, or the adherence to a one-sized fits all approach.

I’d also challenge anyone who makes a statement about reducing depression, mental illness and suicide to make sure that their comments are backed up by research. As I’ve noted in previous entries, there is a complex relationship between religion and mental illness, but as best I could find, there is ZERO relationship between teaching evolution and mental illness. Someone correct me if I’m wrong.

We’ve made great strides in the area of mental illness of late, but we still have a long long way to go. And absolute statements like the ones made above will do nothing but drive people further into the shadows.

There are people this uneducated out there, and I hope this is something we can all remember.

Mental health resources when you need advice, support or just to feel like you aren’t alone

A not-so-stunning mental health truism for you now: You don’t have all the answers. Neither do I. Neither do any of us. But together, we can maybe discover the truth, or at least lend support.

Depression, and mental illness in general, are fantastic tricksters. They make you think that you are alone, that you are unworthy of support and of love. That isn’t the case, of course. No matter who you are, you are intrinsically worthy of support, kindness and love. But depression makes you think otherwise – makes you think that you are weak and unworthy of all the good things in this world.

On moments where you feel that way, the best thing you can do is talk to someone who loves you or cares about you. Short of that – or in addition to it – there is the internet. I can’t believe I just wrote that sentence, but yes, the internet and some of its kinder corners can actually be incredibly valuable when it comes to finding support for your own issues or illnesses.

For example, have you been to The Mighty? It’s a website with forums and resources for a whole slew of topics – everything from disability to mental illness to other diseases. It’s a great community with good information, and more importantly, other people who are there for you and each other.

I’ve written in the past about Reddit, but that entry was more about how hilarious it can be and just make you smile. Reddit does have a dark side – but it also has a wonderfully supportive segments. Subreddits about depression, depression help or just for people looking for a self confidence boost are filled with supportive people.

If done right, mental health forums can be a great place to trade information, provide support and receive it. To that end, make sure to check out some of the better ones, including at PsychCentral, NAMI and Mental Health America.

Looking for real medical advice? Check out WebMD, The Mayo Clinic or the Substance Abuse and Mental Health Services Administration. These websites have scientifically-based information which can help you get a better idea of your symptoms and where you can find help. And, speaking of finding help, you can always check out Psychology Today’s Therapist Finder.

Also, cute puppy videos. Cause why not.

Look, I’m sure this goes without saying, but the internet is not a cure all for your pain. But it can at least get you moving in the right direction and thinking about better days ahead.

So, yes, go on the internet. See what you can find to help you get through this dark moment. That’s one of the many good things you can find there!

Veterans and Mental Health: A challenge which must be met

If you are one of my American readers, a very happy Memorial Day to you, and I hope you get to enjoy this three day weekend with your friends and family.

That being said, my hope with this blog has always been to educate, and I wanted to take a minute to do just that when it comes to Memorial Day. This day, which began to be observed after the Civil War, was done to honor veterans who have fallen in the service of the United States. I’ve always believed that the best way to celebrate this day is not just to memorialize the dead, but to do everything we can to prevent the living from joining their ranks.

As such, let’s take a quick look at the mental health challenges our veterans face.

The numbers, as you can expect, are brutal:

  • According to Mental Health First Aid, 30% of active duty personnel deployed to Iraq or Afghanistan need mental health treatment. However, of that 30%, only half actually get the treatment they need.
  • Post Traumatic Stress Disorder (PTSD) rates are fifteen times higher among veterans than civilians.
  • The depression rate is five times higher among veterans.

Tragically, suicide rates among veterans are also extremely elevated. According to a 2018 report:

  • From 2005-2016, there are roughly 6,000 veteran suicides every year.
  • That number has increased at a rate greater than the rate among the civilian population.
  • The rate of firearm suicides is higher among veterans (65.4%) than non veterans (48.4%).
  • Veterans who used Veterans Health Administration care saw a smaller increase in suicide rates (13.7%) than those who did not (26%).

These numbers are truly brutal. More to the point, they’re shameful. We need to honor veterans with more than gauzy words and the Pledge of Allegiance. These brave men and women truly do put their lives on hold in order to protect the rest of us left behind. They sacrifice. They deserve more than our respect and a day where we barbecue. They deserve our care.

What does that involve? As you can imagine, that answer is complicated, complex and expensive – and well above my pay grade. Broadly speaking, however, I’d argue there are at least a few things we need to do.

First of all, if you have a depressed veteran in your family, it’s important that you know that resources are out there to help. It’s also worth noting that the Veterans Administration is clearly trying to address this continuing problem. There has been extensive talk about overhauling the way we provide our veterans health care, and it’s clear that we need to do more in order to tackle this issue. Furthermore, multiple studies have shown that mental health stigma keeps service members from getting the help they need and deserve. As such, clear that the military, and society as a whole, must continue to tackle mental health stigma.

So, again, happy and solemn Memorial Day to you and your family. I hope that this blog entry has made you more aware of the challenges our veterans face and the unacceptable reality that we lose over 6,000 every year to suicide, and thousands more who suffer from pain-filled lives as a result of their service.

We need to do better. Our men and women in uniform deserve nothing more.

Five horrifying statistics about suicide today

As I wrote earlier this week, we’re in a bad way when it comes to suicide as a nation. Suicide rates are rising – badly – and we need to do more to address this ongoing crisis.

We need to have a better understanding about where we are at when it comes to suicide as a country. To that end, here are five things you should know about suicide in America, 2019.

Suicide rates are at near fifty year highs. After hitting lows in the late 1990s, suicide rates began to climb again. They are now at rates which haven’t been seen in fifty years, and have increased 33% since they hit their lowest point in 1999. More than 47,000 Americans died by suicide in 2017, making suicide the 11th leading cause of death in the United States. The number is so high that it has actually begun to drag down the average life expectancy of Americans.

Gun ownership and suicide rates are directly related. This isn’t to say that gun owners are more likely to kill themselves, but it does show a direct relation between the means of suicide and actual suicides. One study revealed that suicide rates are higher in states with high rates of gun ownership, and lower in states with lower rates. Another showed that firearms account for roughly half of all suicide deaths.

For every completed suicide, there are twenty-five attempts.

Women are more likely to attempt suicide, but men are more likely to complete it. This is, in part, due to the method by which each gender typically attempts suicide. Women are more likely to attempt suicide by drug overdoses and other less violent means, giving rescuers a greater opportunity to reverse suicide attempts. Men are more likely to use firearms and asphyxiation related methods, which are typically harder to reverse.

Suicide rates are highest in the Mountain West states, and lowest in the Mid Atlantic. According to the CDC, the states with the highest suicide rates are Montana, Alaska, Wyoming, New Mexico and Idaho. States with the lowest rates are New York, New Jersey, Massachusetts, Maryland and California.

If you are looking for more information about suicide, I highly recommend you visit the American Foundation for Suicide Prevention’s website. After all, the only way to stop a problem is to fully understand it.

Six Questions: An interview with Brad Barkley, Co-Author of Jars of Glass

Today’s interview is with Brad Barkley, co-author of Jars of Glass. From the summary:

Chloe and Shana want the same thing?for everything to go back to normal, the way it was before their mom went to the hospital. But both sisters know that things can never be the same. While Chloe wants their mom to come home so they can be a family again, Shana never wants to see their mother. And while Shana is trying to escape her problems by hiding under a new persona, Chloe is left trying to be the responsible one. Then things go from bad to worse, and the sisters are forced to band together and redefine what it means to be a family.

I really appreciate that this book takes a different look at what it’s like to have a family member with a mental illness. It also bounces between the two perspectives of the two sisters, which is different than usual.

1) Do you think that personal experience with mental illness is necessary to write a story like this?

I don’t think it’s necessary, no, as long as you are a writer who is willing to do your research and use your imagination. I mean, people write novels about the Civil War or living on Mars without having had any experience of that. But it might be a moot question. You know, one of the tricks that fortune tellers are taught is to say to customers, “You are related to someone in the military,” and you go away thinking, Wow, how did she know that? But the thing is, everyone, pretty much, is related to someone in the military. I think it’s the same thing here; pretty much everyone has had someone in their life with some kind of mental illness, either themselves or someone else. Sadly, mental illness casts a wide net.

2) This book is written from a slightly different perspective than most of the ones I’ve seen with mental illness – it deals with what it’s like to have a family member who struggles. What sort of point were you trying to drive home by creating a world like this?

In my mind, novels are not written to “drive home a point,” but rather to explore the lives of characters. Or to put it another way, not to provide answers but to ask interesting questions. The question here might be, “How does it affect your growing up if your parent is mentally ill?” Or, “How does it affect relationships with the people around you?” And not just in general, but specifically for these two girls. The “point” of any novel, I think, is to let us inside other people and their lives, to create empathy and understanding for other people.

3) What sort of feedback did you get from people who had been through similar situations?

We had letters and emails from teens saying that the book really helped them. But they don’t get too into the specifics of that. They feel a real closeness for the book, but the people who wrote that book are still strangers, so they aren’t going to go into too much detail. But it is gratifying to know that someone in a similar situation has felt like they were understood or that they had a voice because this book spoke for them.

4) The book goes back and forth between the perspective of two sisters; that obviously provides two different perspectives. What made you select these two specific perspectives from the point of view of the two sisters?

I wrote this with my co-author, so I really only had a hand in selecting the perspective of the older sister (the “even” chapters in the book, in Shana’s voice). Again, I think we wanted to explore a relationship between two siblings (both of us have a sibling), who are in many ways very different from each other, yet still love each other. As you write, characters kind of insist upon who they are, and my job is mostly to type and stay out of the way.

5) As you were writing from two perspectives, were there every moments where you thought, “Oh, damn, that’s not something that character X would say, that’s what Y would say”? In other words, was it confusing to write two different emotions, dialogue patterns, personalities, etc?

Well, that is part of the difficulty or fun of writing with a co-author. Of course, I “invented” one sister, and my co-author “invented” the other one, but I would have to constantly write her character into my scenes, and vice-versa. So we came up with one rule: we each have full veto power over our own character. In other words, I could say to Heather, “Nah, Shana would never say that,” or Heather could say to me “Chloe would never do that,” and then we would figure it out. But, over the course of three books, we only had to invoke that rule twice that I recall, so we were pretty intuitive about all the characters in the book and who they were.

6) Anything that you would change about this book, now that it has been years since publication?

It never occurs to me to think of books that way, or even short stories. I’m sure I could read through with a pen in my hand and a few things would make me cringe, and I would start marking this or that change. But a book is a finished work. It is complete in itself, and it’s also kind of a time capsule of where you were in life when you wrote it, and who you were, and all the ways you have moved on. Even if you could change it, why would you want to?

Suicide rates are rising in girls – with the highest rise among ages 10-14

I guess I should warn you ahead of time, but this entry has some absolutely brutal statistics. For those who may be disturbed by such content, please note that the following blog entry will review information on suicide, including methods.

A new study which appeared in JAMA examined whether or not the gap between suicide in boys and girls was narrowing. Broadly speaking, while women are more likely to attempt suicide, men are more likely to complete it. This is for a variety of reasons, but the most obvious one is that men typically use more violent means to commit suicide, and are thus less likely to be saved by medical professionals.

The results of the JAMA study were disturbing. It examined 85,051 suicides of children and teenagers, ages 10-19, between 1975 and 2016. The most painful result:

Following a downward trend until 2007, suicide rates for female youth showed the largest significant percentage increase compared with male youth (12.7% vs 7.1% for individuals aged 10-14 years

From the conclusion of the study:

A significant reduction in the historically large gap in youth suicide rates between male and female individuals underscores the importance of interventions that consider unique differences by sex. Future research examining sex-specific factors associated with youth suicide is warranted.

Further examination of the data reveals that the rate at which women were using hanging and suffocation for suicide were approaching the same rates as men. In other words, girls are starting to use more lethal means to kill themselves, a highly disturbing trend, and one that will lead to additional deaths.

A key and tragic consideration to keep in mind when it comes to suicides is that, for every death by suicide, there are an estimated 25 attempts. A rise in use of more lethal means of suicides means that more suicide attempts will result in death.

To put the above statistic another way: If every suicide attempt led to a death, we’d lose approximately 1,175,000 people every year.

Unfortunately, none of this information is all that surprising, though it is deeply disturbing to know that more 10 year olds are killing themselves at accelerating rates. A study which came out last months showed that the number of children going to the emergency room doubled between 2007-2015. Suicide is the 2nd leading cause of death of 15-34 year olds in America, and rates of mental illness are rising among young adults faster than any other age group.

Clearly, our young people are under more pressure than ever before, and clearly, we are failing them if we don’t do a better of job of addressing this crisis.

Back to the study above. One of the things I’d like to focus on – at least when it comes to trying to reduce this gap – is means reduction. If young girls are starting to use more violent means for suicide, we must do a better job of determining why, and what, if anything, we can do about it. There are public policy options when it comes to guns, but I’m not sure what you can do, if anything, when it comes to suffocation or hanging.

We have to do something. The only way to guarantee failure is not try anything.

Six Questions: An interview with Laura Silverman, Author of You Asked for Perfect

Today’s interview is with Laura Silverman, who wrote You Asked For Perfect, the story of a super smart, LGBT teenager who is trying to learn to navigate his life in a high pressure world. From the summary:

Senior Ariel Stone is the perfect college applicant: first chair violinist, dedicated volunteer, active synagogue congregant, and expected valedictorian. And he works hard―really hard―to make his success look effortless. A failed calculus quiz is not part of his plan. Not when he’s number one. Not when his peers can smell weakness like a freshman’s body spray.

Ariel throws himself into studying. His friends will understand if he skips a few plans, and he can sleep when he graduates. But as his grade continues to slide, Ariel realizes he needs help and reluctantly enlists a tutor, his classmate Amir. The two have never gotten along, but Ariel has no other options.

Ariel discovers he may not like calculus, but he does like Amir. Except adding a new relationship to his long list of commitments may just push him past his limit.

1) Do you think that experiencing mental illness is a requirement for any author who deals with this topic?
I don’t think it’s a requirement, but I do think if a writer is ever writing outside of their own personal experience, it should be done with a great amount of both research and empathy.
2) Your book obviously deals with a gay teenager, a group which faces enormous mental health pressures. Can you talk a little about writing a character with mental health challenges from that perspective?
Ariel is a bisexual teen, but his anxiety in the book is related to academic pressure not his sexuality. I wanted to write a book about the extreme academic pressure teens deal with today, as I believe it’s something so many teens experience but is rarely written about.
3) As I type this questions, your book is number one in “Teen & Young Adult Jewish Fiction.” What has your experience been like in terms of the interaction between religion and mental health?
I grew up in a very supportive Jewish community and wanted to reflect that in this novel. Ariel’s Jewish community is a place of comfort and warmth for him. Although services certainly take up more time in his busy schedule, adding additional stress, overall his Jewish community is an incredibly supportive aspect of his life. And his rabbi is actually one of the people who helps him the most throughout the book.
4) Your book addresses many of the societal pressures which teenagers face today. What do you think any of us can do to try to tamp down those pressures?
I think we need to send the message that grades do not define you. There’s so much pressure to excel in school and get into top universities, but while education is important, it should be about the learning experience not about top SAT scores and AP credits.
5) Many of the reviews of You Asked For Perfect note that you seem to perfectly capture what it’s like to be a teenager in a high pressure environment. How did you do that??
I went to one of those high schools! Although my experience wasn’t as intense as my protagonist Ariel, I experienced the exhaustion of taking multiple AP classes, taking extra electives, the pressure to excel, the fear of scoring a low grade. I also did a lot of research for the book. I talked to high achieving students about their experiences and watched documentaries and read books.
6) If you could do it again – anything you’d do differently?
With the book? I wouldn’t change a thing!

How mental health is – and isn’t – figuring into the 2020 Presidential race (yet)

One of the great thrills of my political career was when I had the opportunity to meet Virginia Senator Tim Kaine. This was in 2016, about two and a half weeks before the November election, when he was Senator Clinton’s running mate. I spoke at the rally and got to shake his hand, but in the brief time we had together, I told him how much I appreciated their campaign releasing a mental health plan, as that was an issue important to me. He said thanks and agreed – he thought it was necessary.

My own political experience has made me realize that mental health is a deeply salient issue in politics – and one which can have a very serious political impact, and one which is often underestimated. I’ve used these statistics before and I will say them again: 1 in 5 Americans actively suffer from some sort of mental illness, and one in two will over the course of a lifetime. This means that virtually everyone in this country knows someone – or is someone – who suffers. For those reasons, and many more, I wish that more people spoke about mental health. We need to do a better job of addressing this issue, particularly given the way rates of mental illness are rising.

As you may know, there are now north of twenty Democrats running for the Democratic nomination for President. These candidates have a wide, wide range of plans and proposals for what they would do if they occupied the highest office in the land. But, as politics is my life, I got to thinking: Of the candidates, who has any sort of mental health plans, and who doesn’t? The answers of the major candidates:

No specific mental health plan

Actually has a specific mental health plan:

  • Former Congressman John Delaney: Hey, we found one! Among the highlights are enforcing mental health parity, expand access to at-risk populations and increasing reimbursement rates.
  • Andrew Yang: Yang specifically calls for better integration of physical and mental health, anti-stigma campaigns and an increase in access to mental health resources.

A word of caution: It’s still early. Really, really early. As in the first Presidential primary is about seven months away, and the Presidential election itself is slightly less than seventeen months away. The Clinton/Kaine mental health plan which I referred to above didn’t come out until October 2016, so there’s plenty of time left. It’s also worth noting that mental health care is likely in many of these candidate’s healthcare pages, not it’s own subheading – a mistaken, in my opinion.

Still. Kind of a bummer. I was hoping that more elected officials would be willing to specifically highlight mental health.

More in the future, I hope!

 

Six Questions: An interview with Mindy McGinnis, author of Heroine

Another day, another author interview! This one is with Mindy McGinnis, author of Heroine, a YA book which deals with a main character who becomes addicted to opioids. Here’s the summary:

An Amazon Best Book of the Month! A captivating and powerful exploration of the opioid crisis—the deadliest drug epidemic in American history—through the eyes of a college-bound softball star. Edgar Award-winning author Mindy McGinnis delivers a visceral and necessary novel about addiction, family, friendship, and hope.

When a car crash sidelines Mickey just before softball season, she has to find a way to hold on to her spot as the catcher for a team expected to make a historic tournament run. Behind the plate is the only place she’s ever felt comfortable, and the painkillers she’s been prescribed can help her get there.

The pills do more than take away pain; they make her feel good.

With a new circle of friends—fellow injured athletes, others with just time to kill—Mickey finds peaceful acceptance, and people with whom words come easily, even if it is just the pills loosening her tongue.

But as the pressure to be Mickey Catalan heightens, her need increases, and it becomes less about pain and more about want, something that could send her spiraling out of control.

Again, I love these interviews and the insight they provide. I wrote Redemption to help people understand mental health challenges from a personal perspective – and it seems like that’s what Heroine does for addiction.

Anyway, here’s the interview.

1) Do you think that personal experience with mental illness or addiction is necessary to write a book which deals with mental health or addiction?

I think a measure of it is useful, of course. And – if we’re being honest – pretty much all of is have that, either in our own experience or through loved ones. Having never been an addict myself (to substances, anyway), I wanted to be sure that I knew what I was talking about when I wrote this book. Research involved reading thousands upon thousands of pages about addiction, but also talking to counselors and addicts. The best compliments I’ve had for HEROINE is when a recovered addict tells me I got it right.

2) It’s clear that society is facing a massive addiction crisis, particularly when it comes to heroin. How much was your book inspired by that ongoing issue?

I got the idea for writing HEROINE after visiting a school district that had been particularly hard hit by the opioid crisis in southern Ohio. That, combined with my own experiences as a school librarian for fourteen years (and an intense love of softball + respect for female athletes) were the two sticks that struck together to create the spark for the story.

3) More often then not, when we’re dealing with books about young adult and sports, it’s written as a male character; yours obviously has a female lead. Why do you think that is?

I was a YA librarian for 14 years in a public school system. I could count on one hand books that featured female athletes, and needed both hands to count off male authors who only wrote about male athletes. As a former high school athlete who was also a reader, I had to wonder – why the disparity? There’s no real reason. So I set out to plug that hole.

4) I noticed that a few of the reviews noted that the book made readers uncomfortable because of the subject matter. Is that level of discomfort a basic requirement when dealing with a topic this heavy?

It depends entirely on the reader. I’ve written books where people get set on fire, or nine year olds are shooting someone to protect their water source. I don’t pull punches and I don’t shy from rough topics. I show teens using drugs – and liking it – in this book. I’m sure it will make some people uncomfortable. That’s reality. It’s not pretty or nice or kind or comfortable.

5) Your book comes with a trigger warning about how has “realistic descriptions” of opioid use, and there has been a good amount of debate over the subject of trigger warnings in recent years. I’d love to hear your thoughts about why you included one and what your thoughts are on the subject generally.

I’ve never used trigger warnings in any of my books, regardless of the fact they all do feature pretty intense content. For this one, I chose to include a trigger warning because of the honest depictions of drug use. It’s not an after school special with people doing drugs and immediately hating themselves or puking. They do drugs and love how it makes them feel. I didn’t want a recovered addict to read a realistic description of the high of heroin, and miss it enough to relapse.

6) If you could do it again – anything you’d do differently with the book?

Too early to say. I can point to things in my older releases that I would do differently because I have some distance and time has passed since I wrote them. HEROINE is still too fresh to have that perspective.