Affect guides behavior, helps us make decisions, and has a major impact on our mental and physical health. Affect is guided by arousal—our experiences of the bodily responses created by the sympathetic division of the autonomic nervous system. Emotions are the mental and physiological feeling states that direct our attention and guide our behavior. The most fundamental emotions, known as the basic emotions, are those of anger, disgust, fear, happiness, sadness, and surprise. A variety of secondary emotions are determined by the process of cognitive appraisal. The distinction between the primary and the secondary emotions is paralleled by two brain pathways: a fast pathway and a slow pathway. There are three primary theories of emotion, each supported by research evidence. The Cannon-Bard theory of emotion proposed that the experience of an emotion is accompanied by physiological arousal. The James-Lange theory of emotion proposes that our experience of an emotion is the result of the arousal that we experience. The two-factor theory of emotion asserts that the experience of emotion is determined by the intensity of the arousal we are experiencing, but that the cognitive appraisal of the situation determines what the emotion will be. When people incorrectly label the source of the arousal that they are experiencing, we say that they have misattributed their arousal. We communicate and perceive emotion in part through nonverbal communication and through facial expressions. The facial feedback hypothesis proposes that we also experience emotion in part through our own facial expressions. Stress refers to the physiological responses that occur when an organism fails to respond appropriately to emotional or physical threats. When it is extreme or prolonged, stress can create substantial health problems. The general adaptation syndrome describes the three phases of physiological change that occur in response to long-term stress: alarm, resistance, and exhaustion. Stress creates a long-term negative effect on the body by activating the HPA axis, which produces the stress hormone cortisol. The HPA reactions to persistent stress lead to a weakening of the immune system. Chronic stress is also a major contributor to heart disease. The stress that we experience in our everyday lives, including daily hassles, can be taxing. People who experience strong negative emotions as a result of these hassles exhibit more negative stress responses those who react in a less negative way. On average, men are more likely than are women to respond to stress by activating the fight-or-flight response, whereas women are more likely to respond using the tend-and-befriend response. Attempting to ignore or suppress our stressors is not effective, in part because it is difficult to do. It is healthier to let out the negative thoughts and feelings by expressing them, either to ourselves or to others. It is easier to respond to stress if we can interpret it in more positive wa.

1. Affect guides behavior, helps us make decisions, and has a
major impact on our mental and physical health. Affect is
guided by arousal—our experiences of the bodily responses
created by the sympathetic division of the autonomic nervous
system.
Emotions are the mental and physiological feeling states that
direct our attention and guide our behavior. The most
fundamental emotions, known as the basic emotions, are those
of anger, disgust, fear, happiness, sadness, and surprise. A
variety of secondary emotions are determined by the process of
cognitive appraisal. The distinction between the primary and the
secondary emotions is paralleled by two brain pathways: a fast
pathway and a slow pathway.
There are three primary theories of emotion, each supported by
research evidence. The Cannon-Bard theory of emotion
proposed that the experience of an emotion is accompanied by
physiological arousal. The James-Lange theory of emotion
proposes that our experience of an emotion is the result of the
arousal that we experience. The two-factor theory of emotion
asserts that the experience of emotion is determined by the
intensity of the arousal we are experiencing, but that the
cognitive appraisal of the situation determines what the emotion
will be. When people incorrectly label the source of the arousal
that they are experiencing, we say that they have misattributed
their arousal.
We communicate and perceive emotion in part through
nonverbal communication and through facial expressions. The
facial feedback hypothesis proposes that we also experience
emotion in part through our own facial expressions.
Stress refers to the physiological responses that occur when an
organism fails to respond appropriately to emotional or physical
threats. When it is extreme or prolonged, stress can create
substantial health problems.
The general adaptation syndrome describes the three phases of

2. physiological change that occur in response to long-term stress:
alarm, resistance, and exhaustion. Stress creates a long-term
negative effect on the body by activating the HPA axis, which
produces the stress hormone cortisol. The HPA reactions to
persistent stress lead to a weakening of the immune system.
Chronic stress is also a major contributor to heart disease.
The stress that we experience in our everyday lives, including
daily hassles, can be taxing. People who experience strong
negative emotions as a result of these hassles exhibit more
negative stress responses those who react in a less negative
way.
On average, men are more likely than are women to respond to
stress by activating the fight-or-flight response, whereas women
are more likely to respond using the tend-and-befriend response.
Attempting to ignore or suppress our stressors is not effective,
in part because it is difficult to do. It is healthier to let out the
negative thoughts and feelings by expressing them, either to
ourselves or to others. It is easier to respond to stress if we can
interpret it in more positive ways—for instance, as a challenge
rather than a threat.
The ability to successfully control our emotions is known as
emotion regulation. Regulating emotions takes effort, but the
ability to do so can have important positive health outcomes.
The best antidote for stress is to think positively, have fun, and
enjoy the company of others. People who express optimism,
self-efficacy, and hardiness cope better with stress and
experience better health overall. Happiness is determined in part
by genetic factors such that some people are naturally happier
than others, but it is also facilitated by social support—our
positive social relationships with others.
People do not often know what will make them happy. After a
minimum level of wealth is reached, more money does not
generally buy more happiness. Although people think that
positive and negative events will make a huge difference in
their lives, and although these changes do make at least some
difference in life satisfaction, they tend to be less influential

3. than we think they are going to be.
A motivation is a driving force that initiates and directs
behavior. Motivations are often considered in psychology in
terms of drives and goals, with the goal of maintaining
homeostasis.
Eating is a primary motivation determined by hormonal and
social factors. Cultural norms about appropriate weights
influence eating behaviors. The desire to be thin can lead to
eating disorders including anorexia nervosa and bulimia
nervosa.
Uncontrolled obesity leads to health problems including
cardiovascular disease, diabetes, sleep apnea, arthritis,
Alzheimer’s disease, and some types of cancer. It is a leading
preventable cause of death worldwide. The two approaches to
controlling weight are eating less and exercising more.
Sex is a fundamental motivation that involves the coordination
of a wide variety of behaviors, including courtship, sex,
household arrangements, parenting, and child care. The sexual
response cycle is similar in men and women. The sex hormone
testosterone is particularly important for sex drive, in both men
and women.
Sexual behavior varies widely, not only between men and
women but within each sex.
The vast majority of human beings have a heterosexual
orientation, but a smaller minority is primarily homosexual or
bisexual. The love and sexual lives of homosexuals and bisexual
are little different from those of heterosexuals, except where
their behaviors are constrained by cultural norms and local
laws.
Respond to the following in a Primary Post of at least 200
words.
Discuss your views on what motivates us based on one of the
theories discussed in your text.

4. A dodgy clinic.
A reality TV crew.
AWOL state regulators.
How a t wentysomething
alcoholic’s last
best hope took
a fatal turn.
BY JOHN HILL
I L L U S T R A T I O N B Y M A X O M A T I C
O n D e c e m b e r 3 0 , 2 0 1 2 , as part o f a series called
Drugged, the N ational Geographic C hannel aired an
hourlong docum entary ab o u t a 28-year-old nam ed
Ryan Rogers. It appeared to be a classic tale o f a drunk
trying against the odds to sober up, albeit with espe-
cially harrowing footage and an unusually charismatic
protagonist, often shown with a radiant smile on his
handsom e face. In one scene, Ryan, in the m idst o f
an o th er day o f drinking vodka straight o u t o f the
bottle, vomits into the trash can next to his armchair
as his distraught grandfather looks on. In another, he
roils aro u n d the passenger seat while badgering the
elderly m an to drive him to the liquor store.
“I apologize, you guys,” Ryan says to the camera
crew in the backseat. W ith o u t a drink, “I can’t even
focus o r th in k o r even understand anything.”
T h ese scenes o f crav in g an d self-ruin u n fo ld
along th e idyllic shores o f R yan’s h o m e n ear Lake
T ah o e , w ith a ch eerfu l, late-sp rin g alp in e lig h t

5. d an c in g in th e p ines. D u rin g th e rare m o m e n ts
o f relative calm , R y an ’s w arm th an d a loving, i f
fraught, relatio n sh ip w ith his fam ily reveal som e-
o n e w ho m ig h t have a sh o t at kicking addiction.
This episode o f Drugged focused o n the medical
consequences o f alcoholism, so the British produc-
tion com pany, Pioneer Productions, followed Ryan
until he entered a recovery program, which the com -
pany arranged in exchange for his willingness to lay
bare his inner turmoil. Ryan’s first stop was a Texas
medical clinic, where he underw ent a comprehensive
evaluation. After palpating his pancreas and liver, the
doctor told Ryan th at parts o f his body were “scream­
ing and dying” as a result o f all the alcohol. T he hip he
broke w hen he fell o ff his bike, drunk, while pedaling
to the liquor store never healed, leaving him with a
rolling limp and in constant pain. A t one p o in t Ryan
h ad perm ission from a psychiatrist to alleviate his
withdrawal with some vodka, which he knocked back
with an orange soda chaser in the m en’s room . Then
came the pivotal m om ent, a staple o f addiction reality
shows: the interview when the psychiatrist asked if he
was willing to go into rehab.
Ryan said he was terrified, b u t vow ed, “I w an t to
am aze p eo p le, to let th e m know : I was gone, b u t
here I am .”
The next day, Ryan arrived at Bay Recovery, a luxu-
rious San D iego center where treatm ent ran about
$1,800 a day. In a baggy white T-shirt, sagging jeans,

6. H U N G O U T T O D R Y
and a blue bandanna, he earned his navy-
blue duffel bag from a taxi to the front door
o f his new residence, one o f several Bay Re-
covery houses in a neighborhood overlook-
ing M ission Bay and SeaW orld. His room
was in a tree-shaded four-bedroom house,
set back from the road.
Ryan looked at the ocean and the verdant
lawn. “I m ight n o t w ant to leave,” he said.
The frame froze o n his smiling face.
“Ryan to o k a courageous step,” the nar­
rator intoned. “But 17 days into rehab, he
died. H e was only 28 years old.”
But things w eren’t quite th a t simple. A
look at the government records surrounding
Ryan’s case—and the rest o f the poorly regu-
lated rehab industry-suggests th at it m ight
n o t have been just the drinking th at killed
him: It was the treatment, as well.
The docum entary to u c h ed a ch o rd w ith
viewers. “I’m sitting here just fucking devas­
tated,” one wrote o n Reddit after the film
was posted on the site. “G ood G od, that was
absolutely crushing,” another wrote. “I was
rooting so hard for him .”
Ryan’s story is a very specific tale o f addic­
tion and loss. But it’s also a case study o f the

7. fragmented, expensive, and poorly regulated
rehab system. Desperate families struggle to
find affordable treatment. Those w ho do all
too often discover facilities subject to m ini-
mal standards, with regulators who do little
to track w hat happens to patients o r to as-
sure th a t programs are following evidence-
based best practices.
At the time o f Ryan’s death, California’s
medical board had opened the latest o f four
cases against Bay Recovery’s executive direc­
tor, D r. Jerry Rand. A m ong the concerns
that they cited was the death o f another pa-
tient several years before. A nd yet the center
had been allowed to stay in business, leav-
ing Rand responsible for Ryan and scores o f
other vulnerable addicts.
O f America’s estimated 18.7 m illion al­
coholics, only 1.7 m illion—8.8 percent—are
treated in specialized facilities, according to
a 2012 report by C olum bia’s N ational C en­
ter o n Addiction and Substance Abuse. That
five-year study reviewed m ore th an 7,000
publications, analyzed five national data-
sets, co nducted focus groups and surveys
o f addicts and treatm ent professionals, and
investigated how rehab centers are licensed.
Its conclusion: “Despite the prevalence o f
these conditions, the enorm ity o f the conse-
quences that result from them , and the avail-
ability o f effective solutions, screening and
early intervention for risky substance use is
rare, and the vast majority o f people in need

8. o f treatm ent do no t receive anything th at ap-
proximates evidence-based care.” N ine o u t
o f 10 people with alcohol o r drug addiction,
it said, get n o treatm ent at all.
C o m p o u n d in g the p ro b lem is the fact
th a t tre a tm e n t is o fte n n o t co v ered b y
in s u ra n c e , b u t p a id o u t o f p o c k e t by
a d d icts an d fam ilies. T ra d itio n ally , p ri-
vate insurance has covered 54 p ercen t o f
A m ericans’ health care costs, b u t o nly 15
p e rc e n t o f a lco h o l a d d ictio n trea tm e n t.
O b a m a c a re —w h ich requires m a n y gov-
ernm ent-subsidized health plans to cover
trea tm e n t-stan d s to im prove matters, b u t
quality o f care rem ains a serious problem .
W hile residential treatm ent programs m ust
be licensed at the state level, standards vary
w idely. “For n o o th e r h ea lth c o n d itio n
A major study of
the rehab industry
found that in
many states,
clinics are barely
regulated and
offer “unproven
therapies” at
“astronomical
prices.”
are such exem ptions from routine govern-

9. m e n ta l oversig h t co n sid ered acceptable
practice,” the C o lu m b ia report concluded.
A great deal o f research supports m odem
evidence-based approaches to addiction,
often involving medically supervised w ith-
drawal, medication to help with withdrawal
sym ptom s, sup p o rt groups, and cognitive
behavioral therapy. But because there are
no national standards, the C olum bia study
notes, “patients face a patchw ork o f treat­
m e n t program s w ith vastly different ap-
proaches; m any offer u n proven therapies
and litde medical supervision,” even at cen­
ters pushing “posh residential treatm ent at
astronomical prices.”
Part o f the problem is th a t alcohol and
drug abuse have been seen less as medical
co n d itio n s th a n m oral failings requiring
self-discipline, according to Scott Walters, a
University o f N o rth Texas psychologist w ho
has studied addiction treatment. The model
p o p u larized by A lcoholics A n o n y m o u s,
though effective in m any cases, is n o t based
o n m o d e rn science o r m edical research.
O n e result are clinics staffed by “counsel­
ors” w ho in m any states are required to have
only m inim al training in responding to the
serious m edical problem s th a t addicts like
Ryan often face.
“T h ere’s really n o quality co n tro l,” Dr.
M ark W illen b rin g , a fo rm er d irecto r o f
tre a tm e n t a n d recovery research a t th e

10. N atio n al Institute o n A lcohol A buse and
A lcoholism , to ld me. “T h e co n su m er is
hard-pressed to know w hat’s w hat.”
Ryan’s mother, Genene Thomas, and his fa­
ther, Tim, m et w hen she was 16, he was 18,
and they were bo th working at restaurants in
the casinos th at line the southern shore o f
Lake Tahoe. W h en she was 20, they married,
and went o n to have four sons.
N ow 51, long divorced and rem arried,
Genene welcomed me into the living room
o f her cozy ranch house, filled with W estern
memorabilia and sepia-toned photos o f her
family wearing cowboy outfits. Genene has a
tendency to smile when other people might
cry. Some viewers o f the docum entary said
she came across as cold, b u t she confesses
th a t she just shuts dow n w hen confronted
with overwhelming em otions. Since Ryan’s
death, she’s filled stacks o f notebooks with
thoughts about her son.
W h e n Ryan was growing up, the family
m oved a do zen times, across the country:
T ahoe to New Jersey, back to California,
C o lo ra d o , an d even Hawaii. “Everyone
w ould ask i f we were in the military,” she
said. “But Tim was just resdess.”
H e was also dangerously unpredictable
and seriously m entally ill: D iagnosed with
paranoid schizophrenia, he drank and heard
voices. Some days he organized scavenger
hunts for his kids; others, he’d smack them

11. around. O nce T im h it Genene for refusing
to give him the bullets he w anted to use to
co m m it suicide. W h e n Ryan was 10, Ge-
nene h ad had enough and took the children
to live in a safe house. After about two years
o f moving around, she took the boys to Las
Vegas, where her parents lived.
Ryan grew into a cheerful teen, so skilled
o n a skateboard th a t a local dealership of-
fered to sponsor him. Like m any kids in his
high school, he drank an d experim ented
4 6 M O T H E R J O N E S I MAY/JUNE 2015
InNeed of a Fix: The grim state of the rehab industry — S a m
a n th a M ic h a e ls
1 8 * 7 m illion A m ericans
needed alcohol treatment in 2010.
million received it.
R easons a d d ic ts g iv e f o r n o t g e t t i n g h elp :
4 5 .5 % I C an ’t a ffo rd it /in a d e q u a t e h e a lth cov e
rag e
W o rr ie d a b o u t t h e ir jo b
c w Clinics
T h e re a r e 14,148 a d d ic tio n t r e a t m e n t fa c ilitie s
in A m e ric a . V e r y f e w in c lu d e in p a t ie n t

12. services:
High Prices P o o r ^
8 1 % O u t p a t ie n t
R e s id e n tia l2 6 % ____
6 % ■ H o s p ita l in p a tie n t
o f t h e costs o f alcohol
a d d ic tio n tre a tm e n t.
T h is is w h o ru n s t h e m :
Local
g o v e r n m e n t
S t a t e g o v e r n m e n t
F e d e ra l g o v e r n m e n t
W h ile i t ’s possible t o
g e t fre e t r e a t m e n t a t
c h a ritie s like th e S alvatio n
A rm y, a m o n th o f
re s id e n tia l care can c o s t
as li t t le as $ 1 ,8 0 0 a t a
g o v e rn m e n t-s u b s id iz e d
c e n te r an d up t o $ 6 0 , 0 0 0
a t th e k in d o f f a c ilit y
t h a t h e lp s c e le b ritie s like
Lindsay Lohan.
2 0 states req uire e ith e r
no degree o r o n ly a high

13. school d ip lo m a t o becom e
a c e rtifie d a d d ic tio n
counselor.
O n ly 10 states re q u ire
re s id e n tia l t r e a tm e n t
p r o g r a m s to h a v e a
physician on s ta ff.
O n ly 8 s t a t e s r e q u ir e t h e
sam e o f o u tp a tie n t
tre a tm e n t program s.
O n ly 21 states req uire
th e tra c k in g o f p a tie n t
o u tc o m e s .
S o u rc e s : N a t io n a l C e n te r o n A d d ic t io n a n d
S u b s ta n c e A b u s e ,
C o lu m b ia U n iv e r s ity ; S u b s ta n c e A b u s e a n d
M e n t a l H e a lth
S e rv ic e s A d m in is t r a t io n ; C e n te rs f o r D is e a s
e C o n tr o l a n d P re v e n tio n
Cost to Society
A lcohol a d d ic tio n costs
$230
billion each year.
1 percent ($28 b illio n ) o f
to ta l he alth care costs in
2010 w e n t t o tre a tin g d ru g
and alcohol a d d ic tio n .
For every d o lla rfe d e ra l and
sta te go ve rn m e n ts spent,

14. 95.6
cents w e n t t o pay fo r
t h e consequences o f
s u b stance use; o n ly 1.9
cents w e re s p e n t on any
ty p e o f p re v e n tio n or
tre a tm e n t.
N o t re a d y t o s to p using2 4 .5 %
| D o n ’t k n o w w h e r e t o go
N o t r a n s p o r ta tio n /in c o n v e n ie n c e
T r e a t m e n t b e d s p e r c a p ita
with marijuana. He even dabbled with meth,
but it didn’t seem out o f control. W hen he
was 19, his paternal grandparents asked if he
wanted to live with them to help care for his
grandmother, who’d always doted on him.
There, in South Lake Tahoe, Ryan met
Shaken Miller, an outspoken 28-year-old
single m other with a Bettie Page vibe. Her
interests ranged from the British occult-
ist Aleister Crowley to ribald jokes, and
it was love at first sight. “There was just
something about Ryan,” she said. “Anyone
who met him loved him. He had this light
to him I’d never seen before.” Shaleen’s two
daughters adored him, and they would make
up stories together. Soon Shaleen and Ryan
were engaged.

15. But when Ryan’s grandm other passed
away, he began drinking more heavily. A
year and a half later, in 2008, his fath er-
who had sobered up and reengaged in the
lives o f his sons—died o f a blood clot at age
47. Ryan helped his grandfather clear out
Tim ’s room in a Carson City hotel and
soon spiraled further out o f control. These
two deaths marked a turning point in Ryan’s
life. Genene grasped the scope o f the prob-
lem when she found him unconscious on
his filthy bed, surrounded by more than 50
empty vodka bottles o f all shapes and sizes.
She couldn’t wake him up.
In 2009, Ryan secured a free charity bed
at a 30-day treatm ent program in South
Lake Tahoe. He liked it, b u t once he re-
turned to his familiar surroundings, he
started drinking again. (The National In-
M A V / J U N E 2015 | M O T H E R J O N E S 4 7
stitute on Alcohol Abuse and Alcoholism
notes that 90 percent o f alcoholics will ex-
perience at least one relapse during their first
four years o f sobriety.) Over the following
two years, he was hospitalized several times
for alcohol poisoning, including a stint last-
ing more than a month in intensive care.
In an attempt to jolt Ryan from his ad-

16. diction, Shaken broke off their engagement,
but she remained determined to try to save
him from himself. The average wait for sub-
sidized treatment was six months, she and
Genene were told, and Ryan would have to
call every morning until a spot opened up.
This was what he had done to get into the
South Lake Tahoe program, but now he was
too far gone to pick up the phone.
Desperate, Genene talked to a police of-
ficer she knew, and learned that her best
shot might be to get Ryan arrested to force
him into treatment. It was reasonably well-
founded advice: The 2012 Columbia report
found that 44 percent of addicts in publicly
funded treatm ent programs are referred
by the criminal-justice system, but only 6
percent come in via health care providers.
W hen Genene heard that Ryan had tried
heroin, she called the police. But his grand-
father bailed him out, and the case stalled.
Then Shaken stumbled upon a Craigslist
ad from Pioneer Productions, a London tele-
vision production company that was look-
ing for severe alcoholics willing to be filmed
in return for free treatment. Shaken wrote
an email and got a call the next day.
Pioneer declined to answer questions
about the case, but Ryan’s family says the
crew told them that they chose Bay Recov-
ery because the clinic treated chronic pain
as well as addiction, making it a good fit for
Ryan’s twin straggles with alcoholism and

17. his damaged hip. The clinic’s website boast­
ed o f its association with reality television
producers like Lifetime and A&E and of the
“unequaled” care provided by its medical di­
rector, Jerry Rand. Genene never found out
who covered the cost o f Ryan’s treatment.
S haken and one o f the Pioneer crew
dropped Ryan off in San Diego. “I just lost
it,” she told me. For two years, she’d been
emotionally preparing for him to die. Now,
she allowed herself to take heart.
“Hope can be a bastard,” she said.
Even as R yan arrived at Bay Recovery, Rand
was fighting for his professional life. In 1988,
when he was a general practitioner in H un-
tington Beach, the Orange C ounty Supe-
rior Court had temporarily ordered him to
stop practicing. The case came about after a
woman whose daughter he was treating for
a possible ear infection bolted out o f Rand’s
office and told a state medical board inves-
tigator-who happened to be sitting in the
waiting ro o m -th a t Rand was so impaired
that his speech was slurred, his eyes were
bloodshot, and he couldn’t even stand up
straight. Though Rand sought treatment
for his addiction to the pain pills he’d been
prescribed after a back injury, the state medi-
cal board moved ahead and put his license
on probation for seven years. By 1990, he
had found work at a recovery center, and in
1992, he launched his own. By 2002, he was

18. an associate director at Bay Recovery.
In 2003, Rand was barred from practic-
ing for 60 days and put on seven years’ pro­
bation for what the medical board deemed
gross negligence and incom petent treat-
m ent o f a homeless patient. The board’s
report does n ot detail what ended up hap-
pening to the patient, b ut in 2 0 0 9 -th e
same year Rand became Bay Recovery’s ex­
ecutive director—the medical board moved
to revoke his license entirely. This time, the
accusations included gross negligence in
treating a 29-year-old woman who drowned
in the bathtub at Bay Recovery. Rand had
engaged in “extreme polypharmacy,” the
board alleged, prescribing drugs to m ul-
tiple patients with little regard for their in-
teractions. Bay Recovery’s operations were
unaffected. The California Department o f
Alcohol and Drag Programs (dadp) investi-
gated the drowning and ordered immedi-
ate steps to secure medications, but it did
n ot issue any citations for 16 months.
W hat transpired at Bay Recovery is one
example o f why the rehab regulatory sys-
C lo c k w is e f r o m le f t : R y a n , as a c h ild , in o n e o
f his
m a n y h o m e s ; t e e n a g e R y a n h a p p y in Las V e g
a s ; a d u lt
R ya n w i t h his o n e t i m e f ia n c e e , S h a le e n M il le
r

19. tem is so often described as fragmented.
dadp was responsible for licensing the
facility, b u t it’s unclear w hether it knew
ab o u t R an d ’s earlier p ro b atio n s. And
while the medical board had charged that
Rand was admitting patients who were too
medically and psychologically unstable to
be treated at his facility, dadp never ad-
dressed this issue while Ryan was alive.
In 2012, as a nonpartisan investigator
for the California Senate, I wrote a report
that exposed problems in drag and alcohol
treatment facilities, including deaths that
occurred when programs failed to monitor
medically fragile clients or accepted addicts
too sick to be in a nonmedical setting. My
report found that dadp failed to pursue evi-
dence o f violations after deaths, and took as
long as a year and a half to investigate the
serious charges. At the time o f Ryan’s death,
I had been asking the agency for several
months why it was allowing Bay Recovery to
continue treating clients. I also interviewed
Rand about Bay Recovery’s troubles for my
report, but he was dismissive. The woman
who died had hoarded drags, he said, and
had previously overdosed. He refused to talk
about Ryan’s death. I was not able to reach
him for this story.
R y an d id n o t have a cellphone with him,
but he borrowed other residents’ phones to
update Shaken. He told her that detox—the
first 72 hours without a drink—was n ot as

20. bad as he had feared. He said he was “eating
4 8 M O T H E R J O N E S I M A Y / J U N E 2 0 1 5
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like a pig,” putting on weight, and could not
remember when he’d felt so well. He joked
that he was having a tough time sitting in a
hot tub overlooking the ocean. And he was
making friends with staff and fellow patients.
“Everybody loved him,” Kanika Swafford, a
residential technician at Bay Recovery, told

22. me. “He never felt sorry for himself. He nev-
er blamed anyone for the choices he made.”
O n May 30, 10 days after Ryan arrived,
Rand started him on buprenorphine, or
“bupe,” which is often used to treat opiate
addicts and may also help those who suffer
from chronic pain. But it is not for everyone,
and it came on top o f a whole cocktail of
other medications.
The day after starting on bupe, Ryan be-
gan to feel sick, according to a later report
by the San Diego medical examiner, and in
the following days he rapidly deteriorated.
Sweaty and disoriented, he now could not
hold a conversation. He urinated on the
floor and tried to set things on fire. He
grabbed at objects that were out o f reach
and tried to light a nonexistent cigarette.
He told a staff member, “Thank you for the
sandwiches; my ride is here.” One resident
filed a complaint to Bay Recovery’s manage­
ment, stating that Ryan was “hallucinating,
talking to himself, stumbling about and al-
most falling down the stairs” and had turned
a “gray-white color.” A residential technician
told a counselor and one o f the managers
that Ryan needed medical attention.
The evening o f June 5, a 20-year-old
m edical assistant nam ed Giselle Jones
heard banging from Ryan’s bedroom and
found him on the floor o f his closet, dig-
ging frantically through his things. She and
a resident named Robert tried to put him

23. back in bed, but he kept falling out, get-
ting so agitated that he tried to crawl out a
window. Jones tried to reach Rand and his
brother Mitch, who was a manager o f Bay
Recovery, several times.
W hen Rand finally responded to the call,
he prescribed more Ativan, an anti-anxiety
medication, and Risperdal, an antipsychot-
ic. Jones hesitated. The charts noted he’d
already had two prior doses o f both drags
earlier that evening. Was Rand certain she
should give Ryan more? Even after he said
yes, she called her manager, who told her
to follow the doctor’s orders. She did, and
20 minutes later Ryan became listless. Jones
tried to get him into bed, but every time she
managed to move him, he collapsed. She
watched as Ryan’s breathing became more
labored. His pulse stopped for five minutes.
Jones tried to reach Rand again, but there
was no answer. Then she called her manag-
er. Finally, at 3 a.m., she called 911. Robert,
the other patient, performed cpr on Ryan.
They waited for an ambulance.
At 3:40 a.m., Ryan was pronounced dead.
L a te r t h a t m o r n in g , Shaleen tried to text
Ryan via one o f the other residents’ phones
and eventually she got a response: “I’ll
have the director call you back.” She left
more messages, one more urgent than the
next. She finally got a call back. “I could
get in trouble if they knew I had contacted

24. you,” the person said. “But we all loved
Ryan so much.”
“I heard ‘loved’ and I just collapsed,”
Shaleen said. She dropped the phone. Soon
after, a police officer, whom authorities in
San Diego had asked to contact the family,
appeared at Genene’s door.
The San Diego medical examiner found
that Ryan had died o f acute respiratory
distress syndrome, in which damage to the
lungs prevents oxygen from reaching the
blood. The deterioration apparently began
around the time Rand started him on bupe,
which—along with some o f the other medi-
cations he’d prescribed Ryan—can depress
breathing. While the evidence was not con-
clusive, “the suggestion is somehow that the
treatment played a role in the development
o f the condition,” Dr. Jonathan Lucas, who
certified the cause o f death, told me.
Twenty days after Ryan’s death, officials
from the D rag Enforcement Administra-
tion, the medical board, and the state licens-
ing agency raided Bay Recovery and Rand’s
home. They had already found that Rand
had had employees illegally call in prescrip-
tions for him under the name o f another
doctor. The state suspended Bay Recovery’s
licenses in July 2012.
O n September 6, 2012, the California
medical board ordered Rand to surrender
his medical license and “lose all rights and

25. privileges as a Physician and Surgeon in
C alifornia.” Police investigated Ryan’s
death, and while no charges were filed
against Rand, the state did find Bay Re-
covery “deficient” for failing to get Ryan
to a hospital. Residents told state inves-
tigators that Rand excessively prescribed
drugs with little regard for their interac-
tions. O ne patient said he hadn’t been on
any medications when he arrived, but now
was taking at least 10. The state finally re-
voked Bay Recovery’s licenses and closed
the facility in late 2012.
Pioneer Productions sent flowers and paid
to have Ryan’s body cremated. It also gave
Genene $1,020—money it had raised to help
pay for Ryan to get his hip replaced. Pioneer
wanted to arrange a memorial service, and a
few weeks later family and friends gathered
at Monitor Pass, an open slope south o f Lake
Tahoe with a dizzying view o f Nevada’s ba­
sins and ranges, to scatter Ryan’s ashes. The
crew filmed one last scene.
About a m onth after the memorial ser-
vice, Pioneer told Genene that the company
was sending someone from London to show
her the film. A lawyer appeared a few days
later and left Genene alone to watch the doc-
umentary on his laptop. She did-twice. The
lawyer returned with a form for her to sign
that stated she had seen the film and wanted
it to ran. Genene, feeling strong-armed so
soon after losing her son, refused, but when

26. the lawyer called from London a few days
later to say that Pioneer had decided not
to air the film on the National Geographic
Channel, she was heartbroken. Genene and
Ryan’s other relatives and friends saw the
documentary as his legacy.
Eventually, things were resolved and
Ryan’s documentary aired. Many viewers re­
sponded, expressing grief as well as concern.
“I find this very strange, folks,” one posted
online comment said. “The danger zone for
any addict is the first 5 days at most. 17 days
in he should have been feeling great and
refreshed...I don’t think this documentary
is telling the honest truth about what really
happened to poor Ryan.”
To this day, Shaleen still gets Facebook
messages from all over the world, and the
shared grief has helped her cope. “That’s
just an amazing thing to be able to hold on
to,” she said. “Knowing his story made it out
there. It gave some kind o f purpose to it.”
But Genene continues to write in her
notebooks the questions that plague her.
Did Pioneer really want to help Ryan, or was
it just about ratings? How could the state
have allowed Bay Recovery to stay open
after the death in the bathtub and the medi-
cal board’s case against Rand? Someone was
bound to die there, she believes: “If it wasn’t
Ryan, it would have been somebody else.
And my son had to pay the ultimate price
for trying to do the right thing.” ■

27. M A Y / J U N E 2015 | M O T H E R J O N E S 49
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