If You Want to See Inequality in the U.S. at Its Worst, Visit an Impound Lot

For millions of Americans a towed car can lead to a crippling spiral of stress, debt, joblessness, illness and, in many cases, incarceration.

On a recent San Francisco afternoon, I returned to where I’d parked my car, but it was gone. A “No Parking” sign indicated that parking was prohibited after 3:00 PM on weekends. It was 3:15. I called the telephone number on the sign and a clerk affirmed that my car had been towed to an impound lot.

I took a cab and entered a single-story brick building where a few dozen people were crowded together in a scene that evoked Kafka; weariness, frustration and anger were palpable. Some stood in line, some paced and some sat hunched on the floor. A family huddled in a corner, an infant asleep on the father’s shoulder. A woman on a pay phone wept as she begged whomever was on the line to find money so she could get her car back–she said she needed $875. “I’m gonna lose my job if I’m not there at 5.”

Clerks sat on stools behind Plexiglas. At a window, a man pleaded with an agent, “I have to pick up my kids in less than an hour. What am I supposed to do?” At the next window, another man railed loudly and furiously, yelling, “How the hell am I supposed to get my goddam money if I can’t get to goddam work?” The clerk said, “If you can’t get cash, you can pay by credit card or cashier’s check.” The man shouted, “And if I had a goddam limousine, we wouldn’t be having this conversation.”

A man waiting in line with me told me that he owned a landscaping business that depended on his truck, which had been towed three days earlier. “I can’t work,” he said. “The crew don’t work. Everything I need is in the truck.” It had been towed when he parked in a red zone in front of an auto-parts store. He’d been late to a job and ran into the store to buy a spark plug for a broken lawn mower. He didn’t have money enough that day to pay the $472 towing fee. After the first four hours, charges began accumulating—about $65.00 a day. (They didn’t include the $72 cost of the parking ticket.) He had borrowed $700, which he held near his chest in an envelope. He said it would take “I hope no more than a year” to repay the loan, for which he was being charged 50% of the loan amount. “I had no choice,” he said. He had already lost four days’ income and didn’t know how he was going to pay his bills, including rent, due that week.

When I reached the front of the line, I handed the clerk my credit card, on which she charged $472. I retrieved my car and drove home. I left behind the roomful of my fellow citizens, a disparate group bound together by the fact that they didn’t have the cash or credit required to free their impounded cars, a fact that threatened livelihoods, stressed families and broke budgets, forcing some people to choose between essentials and paying fees that would continue to accumulate and leave them without another essential, transportation, which in turn could lead to other calamities. If they didn’t find a way to pay the fees, they would ultimately lose their cars (the city auctions them), a loss that for some would be a devastating setback. For me, a towed car was an inconvenience. For them, it was a catastrophe.

Some cases of injustice in America are reported far and wide, such as the horrific shooting of Michael Brown, the unarmed man in Ferguson, Missouri, targeted by police in what many view as an egregious case of racial profiling. However, we don’t often hear about the countless quieter injustices suffered by tens of millions of Americans on a daily basis. They experience inequities of access to opportunities, quality medical and dental care, quality education, healthful food, affordable and safe housing, childcare, credit, psychological counseling, legal representation, insurance and more. For them, events that others weather unhappily but routinely—a towed car, for example—can lead to a crippling spiral of stress, debt, joblessness, illness and, in many cases, incarceration.

The final injustice comes when they die early, which many do—and not only by violence. More often, death comes slower, from under- or untreated physical and mental illness, poor nutrition and chronic stress as it impacts health. Several years ago, Senator Bernie Sanders presented a report to the Senate Subcommittee on Primary Health and Aging, in which he highlighted research that showed that the wealthiest Americans on average live at least 6.5 years longer than those in the lowest income group. In 2009, the mortality rate for African American infants was more than twice that of white infants. The poor in this country have higher rates of diseases such as diabetes, heart disease and depression, according to Dr. Steven Woolf, director of the Center on Society and Health at Virginia Commonwealth University. According to the Health and Aging report, “The lower people’s income, the earlier they die and the sicker they live,” Woolf said. “Neighborhoods in Boston and Baltimore have a lower life expectancy than Ethiopia and Sudan. Azerbaijan has a higher life expectancy than areas of Chicago.”

When events like the Michael Brown shooting occur that inflame people and motivate them to take to the streets to protest, we are reminded that there is not justice for all in America. We must also acknowledge and condemn the daily injustices born of a system that slowly grinds down the people who can least afford it, and, in too many cases to count, leads to their early death. In the line at the San Francisco impound lot, I overheard the crying woman ahead of me telling the clerk, “I need my car to get home to my children.” The clerk responded, “I wish I could help you, ma’am, but if you don’t have the money, there’s nothing I can do.”

David Sheff’s latest book is Clean: Overcoming Addiction and Ending America’s Greatest Tragedy, the follow-up to his New YorkTimes No. 1 best seller, Beautiful Boy: A Father’s Journey Through His Son’s Addiction. Follow him on Twitter @david_sheff.

TIME politics

Marijuana Should Be Legal, but …

Getty Images Nepalese Marijuana

We must treat drug use for what it is: a health, not a criminal, issue

Yes, it’s harmful, and yes, it should be legalized.

It’s not often that the White House responds directly to a newspaper op-ed, as it did last week when the New York Times editorial board published its opinion that the federal government should repeal the ban on the production, sale and use of marijuana. The Office of National Drug Control Policy swiftly responded, reiterating its stand that it “continues to oppose” legalization.

The editorial board listed sound arguments, including the social costs of prohibition. However, the board was remiss when it effectively brushed aside what it acknowledged are the “legitimate concerns” about marijuana’s impact on the development of adolescent brains. Even supporters of legalization, of which I’m one, must not underestimate those concerns. The ONDCP was right when it said, in its response to the Times, “policymakers shouldn’t ignore the basic scientific fact that marijuana is addictive and marijuana use has harmful consequences.”

Some proponents of legalization maintain that marijuana is harmless, but it isn’t — especially when it comes to kids. Indeed, I’ve spoken to many supporters of legalization. They don’t want their children using marijuana any more than those opposed to legalization do.

A body of research shows that marijuana causes structural and functional changes in the developing brains of adolescents. By stunting communication between brain regions, it impairs high-level thinking. There’s evidence that it impacts memory, too, and, for a small minority of kids, can trigger latent mental illnesses like schizophrenia. Also, marijuana users are more likely to suffer from clinical depression than others, though, as Ty S. Schepis, assistant professor of psychology at Texas State University, notes, “It’s unknown if pot causes depression; it may be that depressed people smoke pot.” What is known is that the often stated contention that no one gets addicted to pot is contradicted by the fact that an estimated 9% do. I once visited an adolescent treatment center where most patients between 14 and 20 were there because of an addiction exclusively to pot — anyone who says that marijuana isn’t addictive should talk to these kids. Indeed, in spite of a basketball net outside and other recreational facilities, it wasn’t summer camp; those kids had all suffered devastating consequences from their pot smoking, and most had tried to stop but couldn’t.

There are more reasons to worry that regular pot smoking could significantly impact a child’s life. The drug may cause something called amotivational syndrome, and adolescents who regularly smoke are less likely to have learned to deal with their emotions, to weather disappointments and to work through difficult times in relationships. In a number of studies, long-term marijuana users reported poorer outcomes on a variety of life satisfaction and achievement measures, including educational attainment, than nonusers.

If marijuana impedes kids’ biological and emotional development, why should it be made legal, especially when there’s evidence that legalization may increase the number of kids who try pot in the first place? First, the assumption of an uptick in use doesn’t take into account countermeasures that can and should be put into place. (Following the model of alcohol, the Times advocates a prohibition of sales to people under 21, but that ignores the research that shows that the period of adolescent brain development doesn’t end until the mid-20s.) Science-based regulations must be put in place and enforced. Next, education and other prevention strategies must accompany legalization, and they should be paid for by the savings and revenue that would come with legalization. Harvard economist Jeffrey Miron calculated that if marijuana were legalized, the government would save $7.7 billion annually in law-enforcement costs, and it could bring in an additional $6.2 billion a year if pot were taxed at rates similar to alcohol and tobacco. That’s $13.9 billion per year that could, and should, be earmarked to prevention campaigns, as well as treatment for those who become addicted.

The fact is, the illegal status of marijuana hasn’t stopped millions of kids from smoking it every day, and it may stop many from seeking help. No one should be arrested for smoking pot. Children should be educated and, if problems develop, immediately treated so they don’t escalate. People who are arrested for drug use are likely to descend into more use. Think about it. Take a child who does what so many kids do these days: she’s with friends, someone hands her a joint, and she tries it. Now she’s broken the law. If her use escalates and she winds up in the criminal-justice system, she’s entered one of the highest-risk groups for addiction. Kids punished for using are under great stress, which increases their risk. If they’re expelled from school or lose a job, their prospects are fewer. This recipe creates not only more drug use, but more dangerous use.

Until we become more effective in our prevention efforts, many kids are going to try pot. Some will smoke a lot, and some will become addicted. We must have a new conversation with them, treating drug use for what it is: a health, not a criminal, issue. We must legalize marijuana and take the decision to use or not out of the realm of morality and judgment. We communicate the message that bad kids use drugs, good kids don’t. But as a pediatrician I know put it: these aren’t bad kids; they’re our kids. We mustn’t stigmatize. Instead, we must educate and nurture them, and build their resilience so they grow up safety and healthily.

David Sheff’s latest book is Clean: Overcoming Addiction and Ending America’s Greatest Tragedy, the follow-up to his New York Times No. 1 best seller, Beautiful Boy: A Father’s Journey Through His Son’s Addiction. Follow him on Twitter @david_sheff.

TIME Opinion

How Philip Seymour Hoffman Could Have Been Saved

"The Master" Premiere - The 69th Venice Film Festival
Gareth Cattermole / Getty Images

An apparent heroin overdose is a reminder of why we need to move toward evidence-based treatments for addiction

Like so many of us, I’m brokenhearted about the death of the remarkably talented actor Philip Seymour Hoffman. When I heard about it and learned the apparent cause — initial reports said it was a heroin overdose — my reaction wasn’t only sadness. I was enraged.

My rage about Hoffman’s death — and the more than 100 opiate deaths that occur every day — comes from the fact that it was preventable.

Hoffman was open about his addiction, which is rare in a culture that blames the afflicted and judges them as weak and selfish, bent on getting high no matter the toll it takes on those who love them — and on themselves. In interviews, Hoffman discussed his addiction in college that led, soon thereafter, to rehab. He said he remained sober over the decades since then, until last May, when a relapse led to another stint in treatment. Though addiction is a disease — a brain disease that’s often progressive — addicts who relapse are often blamed. They didn’t try hard enough to stay sober.

But it wasn’t Hoffman’s fault that he relapsed. It was the fault of a disease that often includes relapse as a symptom and the fault of the ineffective treatment he received.

After writing about addiction in a pair of books, I frequently hear from addicts and their family members about serial relapses followed by treatments followed by more relapses. It’s not uncommon for addicts to go through a dozen treatment programs.

(MORE: Viewpoint: We Need to Rethink Rehab)

A parent whose son died two weeks ago wrote to say, “I did everything I could, but I failed him.” “Everything” included eight residential programs and four outpatient programs. It’s not this father’s fault. The tragic fact is that with addiction, like many other illnesses, sometimes you can do everything right and people die.

But with addicts, most treatment centers don’t do everything right. In an article I wrote for TIME.com about the mental-health provisions in the Affordable Care Act, I noted that 90% of those who enter addiction-treatment programs in the U.S. don’t receive evidence-based treatment.

We don’t know what treatments Hoffman received, but it’s unlikely that it was state-of-the-art care rooted in the fact that addiction is a brain disease. He should have received a range of treatments that have been proved to be effective. Traditionally, the only choices offered to addicts were 12-step programs, but now proven treatments include cognitive-behavioral therapy, motivational interviewing and psychopharmacology. Indeed, medications are particularly effective in treating opiate addictions. Richard Rawson, associate director of the UCLA Integrated Substance Abuse Programs, says, “Failure to encourage patients to use these medications is unconscionable. It’s comparable to conducting coronary bypass surgery and failing to prescribe aspirin, lipid and blood-pressure medications as part of a discharge plan.”

We don’t know if Hoffman was, upon discharge from treatment, prescribed medications like Suboxone, which prevents opiate relapse, but it’s unlikely, because most treatment programs eschew them. If he had been (and if he took them as prescribed), it’s almost certain that he’d be alive today. Another medication that may have saved his life is naloxone, a drug that reverses an overdose. All opiate addicts, as well as police and other first responders, should have access to the drug. Also, addicts’ discharge plans should include follow-up treatment, including for co-occurring disorders, such as depression, anxiety disorder and others that often accompany addiction.

(MORE: Glee’s Tribute to Cory Monteith Will Surely Gloss Over Addiction)

Proper addiction treatment works in many cases, but the most tragic fact of Hoffman’s and others’ addictions is that they could have been prevented in the first place. Addiction is caused by a combination of genetic, environmental and psychological factors. For now, genes aren’t fixable, but it’s possible to protect people from becoming addicted by improving their environments and addressing their psychological stresses. Risk factors such as mental illness; learning disabilities; ADHD; trauma; poverty; and growing up in dysfunctional families, where there’s violence and abuse and in neighborhoods defined by drugs and violence, can be mitigated and replaced by protective factors including counseling, social programs, therapy, education and a range of other interventions. If they are, drug use can often be averted or nipped in the bud.

Minutes after Hoffman’s death was announced, on Twitter I was asked if I feel despair because of another overdose death. I do, but I also have reason to be hopeful that this catastrophe may lessen or even end.

These days, most heroin addictions are preceded by addictions to prescription opiates like Oxycontin and Vicodin. These drugs can be hard to get and expensive compared with a cheaper opiate: heroin. If we can prevent prescription-medicine misuse, we can prevent many instances of heroin addiction.

If pain-medication abuse is effectively curtailed, so will the sharp rise in heroin addiction. If the treatment system adopts evidence-based practices, heroin addicts like Hoffman can be saved.

MORE: Give Rob Ford Rehab, Not Ridicule

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