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As I write this, Major League Baseball hasn’t quite decided what to do about Josh Hamilton. Reports have suggested that Hamilton has met with league officials to discuss an incident during the offseason in which he used drugs, reportedly including cocaine and alcohol. Hamilton, who has had well-documented battles with substance use in his past, brought the incident to the attention of league officials himself. Now MLB is trying to figure out what the punishment should be for Mr. Hamilton.

There’s some debate about what should happen. Given his history, should he be treated as a multiple-time offender? Since he has previously reformed his life and was upfront about this latest episode, should he be treated as a first-time offender? Should he be banned for a year? A month? Not at all?

Let me make a suggestion. Maybe we’re asking the wrong question. Every once in a while, I like to put on my “other” hat. I’m probably one of the few members (the only?) of the baseball media—and I’m only sorta a member of the baseball media—who also has experience as a mental health worker. (I hold a Ph.D. in clinical psychology, although I am no longer practicing nor do I hold a license now, by my own choice.) And right now, I think we need to talk about Mr. Hamilton, substance abuse, and how baseball even approaches the subject.

Let me start off with a better question. What actions can Major League Baseball take to help Josh Hamilton overcome his problems with substance use? If you start from there, which I would argue is the more humane approach, then the list of things to do looks a little different. Let’s start from the position that Josh Hamilton is an actual human being who needs help rather than some sort of avatar for a broader cultural issue.

Honesty About the Problem
I don’t know how many players in baseball have a substance use problem, but I can at least draw a few reasonable conclusions. The National Study of Drug Use and Health is a Federal study on the drug use habits of people in the United States. In 2013 (most recently available data), they estimated that roughly 8 percent of adults had a diagnosable substance use problem that would require treatment, but that only a small handful of those people were receiving treatment. Even among the 12-17 age group, that number is roughly 5 percent (and jumps to around 10 percent for the age group 18-25). Even if you restrict the percentage to those with a “hard” drug problem the numbers come in around 2 percent. Now, it’s not likely that the rate of substance use problems is that high among MLB players (or minor leaguers), because someone with a serious substance use problem isn’t likely to be able to maintain elite athletic performance. But it means that there are probably guys out there, and that they have come into baseball with a substance use problem that started in high school.

Prolonged substance abuse physically changes the structure of the brain. It isn’t that the drug goes in and starts whacking neurons. In fact, most of what illicit drugs do is to turn on the dopamine pumps in the pleasure center of the brain. But the brain is a very delicate environment. When it sees that there is that much dopamine floating around, it pulls back some of the receptors that the dopamine binds to. That’s why it takes more of a drug to get the same high. There are fewer receptors, which means you need more dopamine around to activate them more quickly. It becomes a nasty cycle. Those receptors come back very slowly. In the meantime, when someone is abstinent from the drug, it means that there aren’t a lot of dopamine receptors around to feel happy about normal things in life. That’s something else that someone in recovery has to deal with.

I wouldn’t wish substance addiction on my worst enemy. It’s awful. Even in the recovery stage where someone has been abstinent for a long time, it’s rough. Imagine that you are told that the only way that you are going to stay alive is that you have to leave your hometown, go to another place entirely and begin a new life from scratch. You have to build up your entire sense of identity there, and worse, you can never ever go back to the old hometown and visit, even though it would be easy to get there. It’s kinda like being in witness protection. Some people do build their lives back up and that deserves some major congratulations, but understand that’s what Mr. Hamilton and others like him are up against. Before you point fingers, ask yourself if you could do the same.

I realize that there’s a conversation about how any substance user got to this point and whether there’s a moral component to whether “he shouldn’t have done it in the first place.” Maybe. I find that whole conversation rather fruitless. He’s here. If we’re lucky, he wants help. Seems an odd time to argue whether, more than a decade ago, he is morally culpable for taking the first hit. When someone is having a heart attack, yes a poor diet might be to blame, but in that moment that conversation can wait.

Helping Out Hamilton
Getting Josh Hamilton help is a little more complicated than saying “He needs treatment.” That might be accurate, but people often don’t understand what “rehab” really is. Initially, the goal is to get the person through the physical withdrawal stage and to work with them on handling stress and on a plan to rebuild their life around something else than substances. Sometimes it’s just getting the person to really come to terms with the fact that they have problem. Real recovery takes a while, sometimes years. Even then, you have to maintain it. It’s possible that stepping away from baseball is what Josh Hamilton needs to get things together. Then again, it might be one of the best support systems he has for keeping his life on track. Maybe we ought to ask that question first.

Let’s look at what happened here. Josh Hamilton made a bad decision. I don’t want to excuse his bad decision, but I also want people to understand the full context of everything that went into that decision. This is not the same thing as being a bad person. He is a person in recovery and recovery is really hard. Sometimes life isn’t so black and white.

While I appreciate that Major League Baseball doesn’t want to be associated with drug use, I worry that their decision here will be more rooted in that avoidance than in the best interests of Josh Hamilton’s health and well-being. The truth is that there are people struggling with addiction in every walk of life, including among professional baseball players. Baseball can either pretend that it is a magic land where “that sort of thing never happens” or it can be real about the problem. There’s a way to say “We don’t agree with what Josh did in using drugs, but we’re going to make sure he gets what he needs.”

In MLB’s defense, they have taken some positive steps. Teams are required to have someone on staff who can provide counseling for mental health and substance use problems (although some teams do it better than others). Problems can be handled quietly (as they should be—people have a right to their privacy). It’s fine if MLB wants to say that a player who has a substance use problem must show concrete steps toward getting his life in order, but right now the policy is based on punishment for using rather than encouragement for seeking help. MLB needs to make a calculation. If they continue to base their drug policy on punishment, then there are going to be players who need and may even want help but fear coming forward for it. Speaking as a (former) clinician, if you want them to come forward, you have to accept them as they are, wherever they are on their path to recovery. You want as few barriers in their way as possible. If MLB were to change its primary motivation, it means that it would have to admit that there are people among the ranks who suffer—and I used that word precisely—from addiction, but it might just be able to better help those people.

Thank you for reading

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Your explanations and literal illustrations in this article were dead on point.

My guess is that playing baseball is saving Hamilton at this point in his life. I believe moral self-judgements can continue for years in a person. Self-esteem and daily reprieves from emotional and mental anguish and hopelessness are crucial; a neccessity, as is abstinence.

I had the same thought...that Hamilton might not survive very long if he were to leave baseball and the distraction it provides. I don't know if Hamilton is truly aware of it or not, but he is an addict for life and will always be in recovery. It sounds depressing, and it certainly can be, but people can learn to live with that.
That may be true, but if so he really needs help because regardless of how this season turns out, baseball is not going to be around forever for him. When the contract is up he'll be 36 and may not get another. For the sake of his kids at least, I hope he finds a more permanent distraction.
Unfortunately, this feels like a situation where people ill equipped to make a determination are going to be forced to. I hold out hope, as it is clearly evident MLB hasn't rushed into any decisions, but I have little faith in them to make the right one. I think Josh Hamilton is beyond the point where punishment from MLB will act as an effective deterrent, nor do I think a "deterrent" is what is called for in this case.

I've given it a great deal of thought what I would do if I were in MLB's shoes and how I might parse out a situation where he could prove he is receiving treatment and avoid any kind of suspension as long as that kept on. But the truth is, I'm not any more qualified to think up a "good" solution than they are. I just hope they don't make their decision based on what they think will be best for the business of the sport. I just really and truly hope that they put that aside and try to do what's best for the man.
You are right. If a player is honest and self-reports his lapses and recovery plan, I think baseball and the player's union have to take different positions than those that try to hide and are revealed by testing. Hamilton has been open about his problems. He deserves honest efforts from MLB and the union to put his recovery first and his career second because that is what is in the best interests of baseball, and if he were thinking clearly, Josh Hamilton.

If baseball is a trigger that makes him use, then baseball has to go. It is that simple. Is it the constant injuries, the pain? The stress? The swings from highs to lows? I am not saying this is Josh Hamilton. It could be some ball player. At some point, MLB at some point might conclude it is part of the problem, and that separation is good for both of them. I can accept that could be a right answer in some circumstances where the player would be too deep in his problem to recognize the solution.
This may sound harsh, but I do not see why this is MLB's problem any more than it would be my employer's problem if I myself were a drug addict.

At least players in MLB get second and third chances. Most people would simply be fired from their jobs, without several million dollars in the bank to fall back on.

Young people see athletes doing drugs, and see that it's no big deal -- if you get caught, you serve some suspension, and tada!, all is forgiven. Perhaps if there were harsher punishments (instant lifetime ban), drug use would not appear as glamorous as it does now to the nation's youth.

Why should we take the normal person scenario as the moral norm?
But Eddie, does your employer not have a safety net in place for someone who tests positive? Many, if not most, employers do these days; a positive test does not automatically equal losing your job.

Regarding your theory that increased punishment would deter more from using, I would suggest that the punishment has little bearing on someone's decision. If someone is an addict, as I am, the punishment will mean nothing.

Certainly there need to be consequences, but those need to be balanced with what is best for the person who is using, whether it be a casual situation or a true addiction.
It's your employer's problem if they value the service you provide and want to ensure that you are able to continue providing it to them.

If that is the case, it's in their business self-interest (and hopefully their human self-interest) to assist you in getting treatment as opposed to firing you.
Few employees offer such unique value that it is worth putting up with misbehavior of any kind, including a substance abuse problem.

As an employer, I've dealt directly with such issues, and recently. Yes, employers do have programs and procedures in place to assist those employees that have a problem. We can provide benefits and leaves of absence so the employee can deal with the situation. But it is up to the employee to change the direction in which his life is headed and if he fails to do so, he will suffer those consequences that should be spelled out for him at the get-go. For many employees, this might be the first time anyone actually laid down the law. Which is really too bad, because, invariably, they assume you don't mean it either, at least until you sit them down and tell them they don't work there anymore, frequently to their great surprise. Such is the delusion of the addicted.

I've seen employees deal successfully with problems and I've had employees relapse almost as soon as they returned to work, including the last guy who ended up in jail less than a week after a 30-day rehab. I summarily fired him, just as I promised I would if he screwed up again. At least he's still alive, another employee ended up dead from drugs at a young age shortly after being fired for being habitually under the influence while on the job. Some eventually get the message. Some don't.

Unfortunate for those employees, yes, but my first responsibility is to the business and to those employees who do not have a problem and who show up for work not having to wonder if they are being put at risk by drug- or alcohol-abusing co-worker. I'm not going to give that kind of employee endless chances. I also honestly believe that losing your job under such circumstances can be the cold dose of reality that many of these guys need to experience before they get serious about turning their lives around.

Then again, addiction is a tragic and unpredictable thing, mostly because nobody does anything that they don't really want to do, believe it or not. When an addict finally decides to change their life, then they will. Until then, all the lip service, threats, support, programs, jail time - none of it will mean a damn thing. In that respect, addiction is the most predictable thing in the world.

So, in Hamilton's case, it is kind and human to try to put his interests first, no matter what course you think that may take. But the terrible truth is, Josh Hamilton will continue to do whatever it is Josh Hamilton wants to do, good or bad. MLB and the Angels just have to decide at what point his behavior is so detrimental to the business of baseball that it is better if he isn't around any longer. Looking at his history, if I were the Angels, I'd void his contract if possible. MLB should give him a suspension as spelled out in the CBA. Then Josh Hamilton should be allowed to seek employment with any team he likes, if he can find one who wants him. If not, he'll have to deal with the consequences of the situation he created. To do otherwise is stunt the personal growth that Hamilton dearly needs in order to be able to live the rest of his life as a well-functioned adult.

You know, if I'm one of Josh's family members (or teammates), I'd make sure a large photo of Steve Howe was hung where he'd have to look at it everyday before he starts work.
Even with the death penalty for the possession of marijuana, Singapore still has drug users.

The country only has a population of five million, but still whacks about a half dozen of its citizens each year who managed to get caught for drug possession.

Deterrence, right...
The concern for Josh Hamilton is, if genuine (and there is no reason to believe it is not), praiseworthy, whether by members of the media or by MLB. Russell, you've done an excellent job of laying out the issues there. However, MLB has some other irons in the fire: handling this situation in a way that also helps future and even current players battling addiction, and thereby, helps MLB as a whole. What is best for that present and future constituency is not necessarily what is best for Josh Hamilton specifically, and I don't see the difference getting addressed as thoughtfully as what you've done here. Suppose you could take a shot at it from your ex-clinician's perspective? What kinds of things serve as deterrents for people teetering on the edge of addiction? Does making an example of a Hamilton (positively or negatively) have any effect at all on the next one in line? Thoughtful, non-political discussion of that would be appreciated.
I'm not sure there is "teetering on the edge of addiction." There probably isn't a window within which it can be said "if you don't stop right now, you will become an addict." For some people the very first use could mean addiction. It's different from person to person. As far as having an effect on future addicts by how one person's case is handled...addiction is very powerful, and addicts only listen to their addiction. Many times it comes down to life or death before an addict will listen to reason. This is a massive topic with many angles. Hamilton, like any case taken singularly, has his own specific set of circumstances.
A thoughtful piece, as always. BP is lucky to have you.
Context is everything.

I think it's hard to almost pointless to compare any national average to professional athletes. How many male gay professional athletes are there? Well, none in baseball and only a handful have openly discussed it or come out in the last 30 years.

Further, we're talking about genetic freaks, here. These are the top .01% of humans playing baseball. Could they perform at a high level while maintaining a substance abuse problem? Yes, of course. Many have and the sport has been plagued by drug use for decades.

But what substances are we talking about? Alcohol should be at the top of the list but always gets a pass (but should not). Marijuana? Yes, players 'get up' from a game and need to come down. Prescription drugs, pain killers, etc.? Oh, yes, by the fistful.

Cocaine was so prevalent in the 1970's and 1980's that it made amphetamine use an afterthought. Amphetamines and cocaine use in baseball are why the 'steroid era' seems to be so pronounced. Players went from being strung out and relying on a speed game (pun not intended) to weight lifting and building muscle mass. In short, baseball player got big because they stopped getting small (yes, it's a Steve Martin reference).

So, I suppose I am asking, what are we talking about when we discuss 'substance abuse'?

The solution according to multiple reports was forcing Hamilton into religion, prayer (my choice of wording) and having a body man watch his every move. Johnny Narron was allowed to be Hamilton's "accountabilabuddy" for several seasons. No surprise that having Narron with him day-to-day in the clubhouse and in the dugout was when Hamilton had his most productive seasons. Because he was drug free? We don't know, but we know Narron is an excellent coach and skirting rules to favor a player with his own hitting coach can only be seen as preferential treatment.

The idea that Hamilton has a substance abuse problem is secondary to how everyone else treats his abuse issue. It would seem it doesn't matter what Hamilton does, his 'team' will just provide the cushion he needs. Sooner or later he'll get bored and push the envelope, again, and his 'team' will find a new way to make sure he gets preferential treatment.
The simple fact is that if left up to Hamilton (or any addict) odds are very good that he will choose the minimum treatment and repercussions for his actions. If given that option Hamilton is unlikely to give up baseball and its financial rewards for any significant period of time.

If left up to MLB they will most likely act in whatever capacity they perceive to be their best interest. And frankly, who knows what MLB will perceive to be in the their best interest? If their best interest happens to align with Hamilton's well, that would be a stroke of luck but it won't be intentional.

It seems to me that MLB should allow the clinicians to determine the proper path for Hamilton. We don't know the extent of Hamilton's relapse, we only know what has been reported. Hamilton may have been completely honest with MLB but he is also unlikely to admit to more than the minimum. In my opinion the proper procedure is for MLB to send Hamilton to an inpatient treatment center for an evaluation and let the clinicians determine the path that gives him the best chance at sustained recovery. Maybe he needs long term rehab, maybe he needs a shorter relapse track of rehab, maybe he doesn't need either. I just think that clinicians should decide that. Send Hamilton for the evaluation with the caveat of "you follow their recommendations, whatever they are and we will too." If the clinical team determines Hamilton is fit to play ball then let him back in with a minimal suspension. If the clinical team determines that Hamilton would benefit from an extended absence from baseball, long term inpatient rehab, and even more drug screening, then that would be the course followed. etc, etc.

Neither the patient nor the employer should be making this decision.
I think if I were an MLB team I would institute a policy requiring a counseling session once a month. The simple matter of fact is these are 20-40 year old men. They are "men" and "strong". Most are from areas were mental health issues are frowned upon. A lot think they are too strong to suffer from mental issues. If you require it, it eliminates a lot of the stigma. One of the hardest issues is to get people into the the office and talking. If a player is doing great, it can only help. If a player is simply in a slump, they can talk about it. If a player is having struggles with depression,anxiety, or substance abuse, they can get help stigma free. This especially stands for players on the DL. Baseball keep you busy while injuries are physically painful and mentatally exhusting with a lot of down time. This should ESPECIALLY occur in the minors. Those are young guys who are making massive adjustments to their life and have to deal with a high stress environment and the pressure most college kids do.

It can only help. Seeing a psychologist should be no different from visiting the training. A lot of baseball is mental. It is the " thinking mans sport". We need to start treating thing like anxiety or addiction no differently from a hamstring sprain or UCL tear. You baseball team WILL be better for if and I think that is hard to debate.
This isn't a bad idea. I think it could be effectively implemented throughout baseball with an agreement between the MLBPA and MLB so it can cover the minor leagues. There's even a good way to sell it: career help. Just another piece of the development cycle.
It's nice to say MLB should look at what would help Hamilton the most, but isn't there a side of this where MLB says "We are going to take the route that will result in fewer future MLB drug users"? I don't know that they SHOULD be doing what's best for Josh Hamilton.

MLB has made Josh Hamilton a very rich man with resources to deal with his issues which exceed the resources of almost all people with a substance abuse problem. I'd like to see MLB protect MLB and I'm OK if that's not the same course of action which is best for Josh Hamiliton.
I'll add here also that people who say deterrents don't matter are just not being accurate. Powerful deterrents make huge differences, even if they aren't 100.00% effective.
You would think death is the most powerful deterrent, yet that doesn't make any difference to many addicts.
Most people know that serious drug addiction ruins your life. If that doesn't deter them, I doubt banning them from playing baseball for a few months will make much of a difference.
I agree. The only thing MLB can possibly do is what they perceive is in the best interests of MLB. The second they seriously pretend to do something that is 'in the best interests of Josh Hamilton', then they will become the worst sort of tyrant. The sort of do-gooding tyrant that CS Lewis described - Of all tyrannies, a tyranny sincerely exercised for the good of its victims may be the most oppressive. It would be better to live under robber barons than under omnipotent moral busybodies. The robber baron's cruelty may sometimes sleep, his cupidity may at some point be satiated; but those who torment us for our own good will torment us without end for they do so with the approval of their own conscience.

The only person who can have the will/understanding to deal with Josh Hamilton's addiction is Josh Hamilton (and family I guess). Until he himself takes that seriously, then he will resent anyone else moving him down that path. If that first part of rehab requires him to take time away from baseball to do it, then he has to be the one taking that step. If he fails to take that step, then MLB can only assume he has no serious interest in rehab - and it is rational to treat him as an offender rather than someone who needs help.

Josh Hamilton is extremely fortunate compared to most addicts. He is not a victim - and he will not be a victim no matter what MLB does.
Hamilton has been through the program (yes, that one). Hamilton self-reported his latest relapse. He's taken steps before, and by this action would almost certainly be prepared to take further steps (although that is just speculation on my part). The thing is, this is what happens with addicts. It's beyond hard work. There is this notion that "if they would just try hard enough!" That's not how it's a lifetime of struggle. Not to say he shouldn't face any consequences, but I think the problem needs to be understood.
Thank you Russell for your thoughts here. Your sensitivity and analysis on Hamilton's situation, as well as many others you've publised here at BP, are a delight to see, to read, and to hope on for the betterment of MLB and MiLB players and their organizations.