Tag Archives: Addiction Advocacy

Thank you for coming back to my blog site.  In case you have missed any of the previous eight blogs on the Ten Reasons for the Current Heroin Epidemic, please do scroll down to check them out.  Today we will be discussing how Mental Health Treatment or actually the lack thereof has contributed to the overall increase in illicit drug and alcohol use, and opiate/heroin dependency.

Mental Health Parity Picture


It is well documented that patients with mental illness are still greatly underserved, and despite some positive movement to increase treatment funding and access, the drastic cuts from the distant and recent past have not been eliminated.  NAMI, the National Alliance on Mental Illness, released the report State Mental Health Cuts: A National Crisis which documented the drastic cuts implemented by states between 2009 and 2011 for spending for children and adults living with serious mental illness. These cuts led to significant reductions in community and hospital based mental health services, with a direct effect also on access to psychiatric medications and crisis services. The Medicaid funding issue is a complex analysis, but there is no question that too many patients are left without viable treatment options.  In an article by the Pew Charitable Trusts, Some States Retreat on Mental Health Funding, Medicaid expansion “may also have persuaded some states to pull back funding for community mental health centers and other mental health initiatives, including school and substance abuse programs.”

The lack of access is not limited to the Medicaid insured population, as many commercial insurers also do not cover mental health services in parity with medical and surgical illnesses. In addition to private insurance companies not abiding by parity laws, the federal and state governments, who are responsible for overseeing compliance, apparently are not doing a good job,  Despite Laws, Mental Health Coverage Often Falls Short.  It was also reported that “NAMI found that patients seeking mental health services from private insurers were denied coverage at a rate double that of those seeking medical services … [and] patients encountered more barriers in getting psychiatric and substance use medications.”

Enough with the statistics! How does this lead to the heroin epidemic?  Simply stated, patients with mental illness are no different than patients with a wide variety of complaints – they all want to feel better.  However, when there are roadblocks related to funding and access to treatment and medication for psychiatric illnesses, patients look elsewhere to feel better.  It is a well-known phenomenon that patients who cannot access care are more likely to self-medicate. So it should not surprise us that patients with depression, anxiety, bipolar illness and other psychiatric health issues reach for drugs that make them feel better: alcohol, stimulants such as cocaine, and opioids such as OxyContin or heroin are commonly used.

When I started this blog series, I promised that I would not only assign blame for the Heroin Epidemic, but also offer solutions.  So here is another solution:  Federal and State Governments must enforce parity laws and we must increase access and funding for mental illness. As they say in the Midas commercial, “You can pay now or you can pay later, but you are going to pay.”  Inadequate mental health treatment can lead to substance use, crime, dysfunctional family dynamics and an overall increase in financial costs to society.

Bad things can happen when mental illness goes untreated, and especially when drug use compounds the situation.  In Addiction On Trial  this is illustrated by Aunt Betty’s conversation with Jimmy’s father:

Adam continued, “Jimmy’s in jail. He was arrested for possession of drugs. But now they are trying to pin a murder on him, but there’s no proof, and well, it’s really a case of mistaken identity.” Adam tried to ground his runaway emotions, but with a trembling tone he blurted out what he so desperately wanted to believe. “Jimmy had nothing to do with it!”

Adam’s anxious moment gave Betty the opening she needed. “Adam, how can I help? And don’t lie to me. We both know that just because Jimmy may not have intended to do anything bad, well, you know what I am saying. When people are high on drugs, accidents happen and sometimes it looks like it wasn’t an accident.”

And during the trial, Venla Hujanen, the Finnish born District Attorney, also focuses on drugs and mental illness while cross examining Dr. Saul Tolson:

Dr. Tolson spoke softly while nodding affirmatively. The District Attorney proceeded, “So Dr. Tolson, it sounds like you do agree that if a person is addicted to drugs—even though he may have been ‘clean’ for a while, and even though when not using drugs he is able to process things better—if he returns to drug use and again becomes ‘high,’ his anger can resurface, poor choices can be made, and bad things can happen.”



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I recently had the honor of receiving the 100th review for Addiction on Trial on Amazon.  I am truly honored and appreciative to all who have left such remarkable and heartfelt reviews of my book.

I wrote Addiction on Trial with the goal to entertain as well as educate, and I immensely enjoy hearing feedback about the impact the book is having.  This blog is simply a special thanks to all the reviewers and to take the opportunity to share a few reviews that represent a theme. These types of comments have further inspired me to  finish the sequel to Addiction On Trial and I will continue to work diligently to make Lost To Addiction as enjoyable and as educational as it's predecessor.

Most importantly, I am pleased that Addiction On Trial is appealing to such a diverse group: lovers of mysteries and legal thrillers; followers of Crighton, Cook and Grisham; addiction professionals; folks concerned about how to educate high school students or personally touched by addiction; and page turning fanatics 🙂  A SPECIAL THANKS TO ALL !!!

This Book Reads Like a Screenplay..and I Can't Wait to See the Movie!

The timing of the publication of Dr. Kassel's book could not have happened at a better time. Since Philip Seymour Hoffman death, there's been a lot of long over due attention to the topic of addiction. Dr. Kassels' book is a gripping tale that graphically illustrates what the disease of addiction brings to a family, and how from there it trickles throughout the community at large. It is in all of our lives, on one level or another. His book reads like a screen play and it wouldn't surprise me if it is made into a movie one day. Plus, there's bound to be a sequel which I can't wait to read it as well.

Riveting Stuff

Once you pick up this book, you find yourself moving faster and faster to the dramatic conclusion. Its an absolute page turner and the courtroom drama was smart and believable! A story that keeps you guessing to the end but more importantly a raw and compelling insight into the complexity and desperation of addiction. I confess to a slight addiction to John Grisham. This was every bit as good. And the fact that Kassels is a guru on addiction gave the book a feel of substance and gave me a base of knowledge that I did not have before. It truly was interesting and enlightening. Cant wait for the next one!

Nuanced Medical Thriller

"Addiction on Trial" is a serious medico-legal mystery and page-turner. If you're a fan of the big names in this field like Crighton, Cook, Grisham, etc, then give Kassels a try as well. My usual complaint with the genre of "medical thrillers" is that the "medical" side of the story is usually grandiose and non-believable. Not so with "Addiction on Trial". Dr. Kassels has weaved a medical storyline that is nuanced, entertaining, factually accurate, and keeps you guessing until the very end. Well done! I'm looking forward to the sequel already!

Don't Miss Out On This Book

WOW, I could not put this book down. Every chapter got better and better. It was loaded with suspenseful moments just when I least expected it. I felt myself getting wrapped up in all of the characters lives and gaining a greater understanding around the challenges of addiction. Kassels is a master of valuable information and experience along with a creative powerful writing talent. Absolutely a dynamite combination. I look forward to the sequel with great anticipation. I wonder what Shawn Marks will get into next?

Page Turner Extraordinaire

I could not put it down, and stayed up till 3AM to finish it. Besides being very entertained, I learned much about an unfamiliar realm.

The book casts a new and sympathetic light on a problem we tend to relegate to unfair stereotypes.

So Insightful!

Dr. Kassels weaves a captivating mystery thriller that takes the reader into the entangled world of drug addicts. He not only skillfully shows the emotional havoc drug addiction creates for the individual, his or her family, and the community at large, but also explains the medical and legal implications of the disease. I think young people would greatly benefit from reading this book and suggest that it be required reading for high school health classes.

Dr. Kassels hits a first serve ace...

Addiction on Trial was a great read and I breezed right through the book. The story line, the characters, their interactions and the author's descriptions throughout kept me engaged. I came away with a better understanding of what doctors and nurses go through in emergency room settings, and the helpless feeling many families have when dealing with addiction issues. The timing of the release comes when coverage of heroin overdoses has taken off. Over prescribed, expensive pain killers morphing into heroin have become a challenge to treatment and rehabilitation. This book gives an accurate account of the perils of addiction and how it affects many lives. By bringing awareness to addiction, Dr. Kassels is shedding light on the problem without being preachy or judgmental. His book is a great vehicle for opening discussions about a topic that is obviously wreaking havoc on all walks of life.

Fantastic, smart, captivating, frustrating and so satisfying!

Fantastic read! Where do I begin? A close loved one was/is affected by addiction, so years ago I started reading blogs by opiate addicts--both active in their addictions and in recovery. I was trying to understand more about the experience of addiction itself and the recovery insights that survivors could share. I learned that addiction IS a disease, harm reduction helps keep more people alive to have a chance at recovery, and maintenance treatment is an important, valid, effective and "respectable" path to being a functional, happy, healthy person. I eventually stopped reading the blogs, but I am still fascinated by the topic.

Imagine my excitement when I found that an expert in addiction treatment wrote a novel about this! Addiction on Trial gives a deeper look into the larger world around an addict: family, relationships, medical treatment and the legal system. It's a fascinating thriller--and so frustrating (and real!) to see how addicts can be their own worst enemies, by trying to do what's "right" for themselves and other addicts. It's heartbreaking to see how a community will judge addicts, when it's a harder experience than any of us can imagine.

The characters are also so fascinating! Each one has their own motive, and they work perfectly together to form one cohesive mission. More like two sides at war, actually. If you have any interest in addiction, or you just enjoy legal or medical thrillers, this is a great read.

Riveting and Educational! Fantastic Read!

As a licensed addiction treatment professional I am always looking for information that can help educate the public about the issues of addiction and recovery. This book is the ideal balance of providing basic education on addiction side by side with understanding the human side. Dr. Kassels does this exceptionally well by blending them in a way that keeps the reader engaged and informed at the same time. This is a must read that should be in the arsenal of all treatment professionals!

I loved every aspect of this book and really it should …

Rarely would I give a book five stars and I have been meaning to review this book for months, I loved every aspect of this book and really it should be characterized as Literary Fiction because not only was I engaged and entertained, I was thoroughly educated as well. I heard the author today on NPR and his passion and his dedication reminded me that I needed to write this review. Without question it is a five star winner.




Steven Kassels Book Signing Addiction on TrialOver the past several weeks I have received several emails from readers and others inquiring about my background and why I decided to write Addiction on Trial. I want to use this week’s blog to explain why I wrote a novel, albeit based on medical and legal truths, and to share my background. So, bear with me as I babble along!

I am a physician who is the youngest son of a physician. My father came to the United States at a very young age, worked his way through college and medical school and chose to practice medicine in two offices attached to our home in Everett, Massachusetts. My mother was the bookkeeper, secretary, cook, laundry service and most importantly, my Mom. When the home phone rang (which was also the office phone) we all answered it the same, “Doctor Kassels office; may I help you.” Not infrequently, patients would come to the front door on holidays and weekends with “specimens”. These were the same patients that would make holiday gifts for my brother and me. I can still hear my Dad, “Put that bag with the bottle in it on the counter in my little office and then wash your hands – and wash them thoroughly – did you hear me Stevie?” I heard my Dad then and I still hear him now.

Why did I write Addiction on Trial: Tragedy in Downeast Maine? Simple answer: I wanted to.

Through my years of practice in Emergency Medicine and Addiction Medicine I have had the privilege to treat patients from all walks of life. From a medical perspective, it is very clear that we have differences but we are more similar than not – we all need hearts to pump in order to sustain our organs and to perfuse our brains. When we are sick, we all benefit from compassion and care. Society should not differentiate between diseases! But who wants to read another scientific book about addiction? Not me! That's why I wrote Addiction on Trial as a mystery thriller to both entertain and educate through the depiction of the realistic struggles of addiction. I hope you enjoy reading Addiction on Trial as much as I enjoyed writing it.

History repeats itself, unless we learn from prior experiences.  This is true in many aspects of life, and unfortunately it takes a toll on all of us in terms of individual and community well-being and longevity of life. This is evident not only in the wars that are fought around the world, but in our approach to medical care.  Knee jerk reactions have no place in medical decision making, and especially not by politicians who choose to ignore the data of scientifically proven treatments.  This is why I felt compelled to speak out about the recent legislative proposal in Maine to limit treatment options for opiate (Heroin & OxyContin) addiction.

This is also why I wrote the book, Addiction on Trial – to demystify and destigmatize the disease of addiction, but through the back door to reach a wider group of readers.  The book is written in a “novel” approach, as a murder mystery/legal thriller based on medical and legal truths – which will entertain, enthrall and educate; and I am appreciative of the 4.9 star Amazon rating. I hope you will enjoy both my Op-ed below as well as my page turning thriller, Addiction on Trial.

Thank you and please spread the word that repeating historical mistakes with politically motivated knee jerk reactions needs to end!

Sun Journal

Steven Kassels: Drug addiction is a medical issue, not a political issue

By Steven Kassels

Lewiston Sun Journal: Published on Sunday, Feb 8, 2015 at 12:12 am

We, as a society, have arbitrarily differentiated between acceptable and unacceptable drug addictions. Why else would our politicians enter into medical decision making?

After 50 years of accepted science, we know that the cost of not treating opiate addiction is up to 12 times greater than the cost of the treatment itself (National Institute of Health). Likewise, the benefits of having multiple medications available to treat various illnesses (patients respond differently to treatment regimens) have been well documented.

So why do some politicians want to insert themselves into the medical world and make arbitrary decisions about which medications to pay for when it comes to the disease of addiction, particularly when the political decisions fly in the face of medical science?

For those who want to believe addiction has no biological, psychological or sociological components (like the disease of diabetes), surely you will agree that abusing substances can cause disease. It is commonly accepted that Vice President Dick Cheney smoked way too many cigarettes (nicotine addiction) and Hall of Fame baseball player Mickey Mantle drank way too much beer (alcohol addiction). To one we gave a mechanical heart, followed by a heart transplant, and to the other we gave a new liver. They had “acceptable” addictions.

But how about the Vietnam veteran who came home addicted to heroin? Or young men and women who become addicted to painkillers after suffering some type of accident? Are there really “good addictions” and “bad addictions”? Is there really a difference between addictions?

If the differences are so great, why does the medication naltrexone decrease cravings in alcoholics and also block the effects of heroin? Are the addictions really all that different?

Why does methadone treatment still carry such stigma? And why are some politicians in Maine considering defunding it? Is that based in science or bias?

If we look back in history, it was President Richard Nixon who stated in 1971, “ ... methadone is a useful tool in the work of rehabilitating heroin addicts, and that tool ought to be available to those who must do this work” (Special Message to the Congress on Drug Abuse Prevention and Control). And in 1999, Mayor Rudy Giuliani — a mayor as tough on crime as any modern politician — initially recommended ending methadone treatment in New York, but upon review of the scientific data, he reversed his decision (Mayor Relents on Plan to End Methadone Use). Science won out.

By contrast, have you ever heard of politicians trying to prohibit coverage for other medications, such as Valium, because they have addictive qualities and thereby limiting doctors’ ability to treat certain illnesses? Have our politicians ever decided that people who smoke cigarettes should not get blood pressure medications because the condition is self-inflicted, chronic and might last years or decades?

Why do we have a heroin and opiate epidemic? We can blame doctors; we can blame pharmaceutical companies; and we can even blame our elected officials who decided to go to war in Afghanistan (U.S.’s $7 Billion War on Drugs Helped Grow Afghanistan’s Heroin) — but blame gets us nowhere.

Our focus should be a doubling of effort to limit the demand for drugs, and the way we limit the demand is through treatment. Incarceration, which is the failed and more expensive approach proposed by some politicians in Maine, just leads to a revolving door.

Some Maine politicians are also trying to claim that treatment with the medication Suboxone — which is a costly prescription medicine often provided through doctors’ offices, is superior to its less-costly relative Methadone — which is provided through heavily regulated clinics that are required to offer counseling and screening services to patients.

But, this is another political approach to a medical issue, and is short on science. Suboxone not only has a ceiling effect that makes it ineffective for many patients, it also has no mandatory requirement for patient counseling that is essential to effective addiction treatment.

We must remember that not all patients are the same, and every patient does not respond the same. Suboxone works for some and methadone is better for others. Should our politicians enter into the practice of medicine by defunding methadone, which is considered the gold standard for opiate addiction treatment?

Much has been made of government not getting involved between a doctor and a patient. I find the current proposal to defund methadone just that.

We cannot let decisions be based on fear, bias or a lack of understanding scientific studies. NIMBY does not work. Opiate addicts live in our communities and in our families, and they work in our businesses.

Politicians should not practice medicine, and they should not defund methadone. Treatment with this scientifically proven medication is fiscally responsible, and cutting it will put patients back on the street, increase crime, jeopardize public health and raise our taxes.

That is bad medicine for Maine.

Steven Kassels, MD, has been board certified in emergency medicine and addiction medicine. He serves as medical director of Community Substance Abuse Centers in Lewiston and Portland, and is the author of “Addiction on Trial — Tragedy in Downeast Maine.”


Unfortunately, life got ahead of me this summer as I went into a “full steam ahead” mode to get the word out about my book, interspersed with visits from three of my grandchildren.  I apologize for not having kept up with my self-imposed schedule of blog postings about my author endeavors and current addiction medicine related matters. To all of you who have read Addiction on Trial, thank you; and if you posted a review on Amazon, an extra thank you 🙂 

As you can see from my events listings, I will also be doing some traveling over the next few months.  I am looking forward to presenting at the Flight Attendants Drug & Alcohol Conference in Baltimore and at the Union League Club in New York City.  I must admit, the event in New York City is going to be a little extra special, as the Union League Club membership has included fifteen Presidents.  I am honored to be asked to speak about my book and the disease of addiction; and will be returning to the club in December for their annual book fair. The College of the Atlantic has also chosen my book as part of their curriculum for Psychology courses, and I will be visiting the campus this winter to meet with students, who I am certain will keep me on my toes.

Speaking of students, learning about addiction and related diseases need not stop after formal education.  I would like to share with you an article about how the National Basketball Association is educating its players about drugs and to again applaud the dedication and work by Chris Herren.

I hope everyone is having an enjoyable summer, and I again wish to thank all of you who have been so supportive of my book and my mission to entertain while educating through the back door … or maybe the side door 🙂  I will keep you posted on the progress of the next Shawn Marks Thriller, as I am currently working on the sequel, Lost to Addiction.  Shawn Marks, that egotistical but likable big shot Boston attorney, will definitely have his hands full as he attempts to defend the son of a wealthy shipping magnate. The adventures with Marks will continue as he travels to Europe and to the seedy underground of drug distribution centers in Guadalajara Mexico to solve this murder mystery.  Stay tuned!