Of drugs, denial, and disappearing teaspoons

I have spent a lot of time lately thinking about drug addiction and stigma. I could go into an entire diatribe about how stigma impacts an addict’s ability to seek treatment and receive adequate treatment. After all, stigma informs our public policies and it is in the best interest of the bottom line for insurance companies and politicians to portray the addict as a leech, a moral reprobate, and a criminal. So the public takes the bait and we continue to let people suffer and die because of it. But aside from stigmatization of the addict, there is an equally as destrutive stigma associated with the addict’s family. There are many popular variations on this theme. If you are the parent of an addict, you’ve probably heard them all, or even used them to pummel yourself. Here are a few of my favorites:

“There must have been abuse in the home.”

“I’ll bet the parents are addicts too. The apple doesn’t fall too far from the tree, you know.”

“They were too permissive.”

“They were bad parents.”

“They didn’t engage in their child’s life.”

When used as a tool for self-flagellation, it takes the form of:

“What did we do wrong?”

“How could we have missed the signs?”

“Was it because of the divorce?”

“Was it because I was stressed when I was pregnant?”

“Should I have done more snooping in her room when she wasn’t home?”

O.K. Let’s can the condemnation right now. There is no one single path to addiction, and if you are the parent of an addict, the path your child chose may have absolutely nothing to do with you. Sure there are absolutely things that parents do or fail to do that may elevate a child’s risk factor for addiction, and if your child was raised like a lab rat with no other influences besides parental ones, we could say definitively whether or not it was your “fault.” But real life is not that simple, (and if it were, face it, it would be brutally boring).

If you review the literature on causality, you find that even the experts can’t agree. After years of playing nature-nurture tug-of-war, researchers in the field found they had to make up a word to account for why people become addicted. That word is biopsychosocial, and it is a word that no one who isn’t applying for a research grant would ever use. The rest of us call it “life.” From conception, a child is exposed to environmental stressors in the form of anxiety hormones, environmental toxins, and sometimes they just don’t luck out at the swim meet in the gene pool. If there is drug abuse, sexual abuse, or physical abuse in the home, sure, the kid is at risk for a whole bunch of psychological problems, but addiction may not be one of them. Conversely, parents of addicts may be Ward and June Cleaver, living in the suburbs with a white picket fence and tasteful furniture. Children of police officers may become addicts. Children of clergymen may become addicts. Children of psychologists may become addicts, for fuck’s sake. And now that heroin is hitting the suburbs – and it is – we now see soccer moms and Little League coaches with addiction issues. The point is, if you are the parent of an addict, don’t buy the stereotype and don’t own the stigma.

Now of all the dumb-ass excuses I’ve heard people use to beat themselves up for their child’s addiction, number one on my hit list is, “I guess I was in denial.” This is probably true for a small subset of parents, but let’s look at what denial really is. Denial is a state of utter refusal to believe the facts even when they are staring you in the face. In other words, you walk into your child’s bedroom, see him with a needle dangling out of his arm, and say, “Oh my. When did you become insulin-dependent?” That would be denial. Or your child has just been arrested and he’s carrying several grams of heroin, a syringe, and a prescription for pain killers that doesn’t belong to him, and you say, “I’m sure someone snuck that into his backpack when he wasn’t looking.” That’s denial. OK?

Denial is not missing the subtle cues that might alert you to the fact that something is wrong. After having watched several documentaries involving interviews with parents who had lost children to overdose, the one question they were always asked was, “Were there any red flags that your child was becoming addicted?” Most parents, presumably after innumerable therapy sessions, had learned to say, “Um…not really…well yes, there were a few. I guess I was in denial.” When pressed for these so-called clues, one mother said, “Well when Sean came home from college for the holidays he looked like a wreck.” She put it down to stress and assumed he wasn’t eating right. He also told her he had just come down with the flu. The woman’s whole family had also just come down with the flu. If your child said he had the flu and looked like hell, you would believe him. And you would believe him not because you were in denial, but because your brain has no frame of reference for dope sick. Unless you have seen it before and had other reasons to think of drugs – and bear in mind, this young man had been away at college for a semester – your brain doesn’t go there. Has he looked like this before? Yes, when he was sick. This is your experience as a mom. Thin, unshaven, a little green around the gills, a bit shakey? You’ve probably seen the same look a hundred times when you were raising him (except the unshaven part because frankly, on a two-year-old, that would be weird). This is the context your brain has for this particular look. When your brain hears hoofbeats, as the old saying goes, you think of horses, not zebras.

Another woman said she should of known because her teaspoons kept going missing.  This was a lovely, British, middle-class woman in her sixties. She did not strike me as the kind of person who had spent a lot of time watching people inject illegal drugs in their arms (among other places). What was her brain to make of missing teaspoons? Probably not much. Her brain had no context for connecting teaspoons with heroin, yet she too called this denial.

Another woman had packed her son off to college with a credit card which he was to use for text books and living expenses. At first activity on the card was normal, but then it started to escalate. Unless her child had addiction issues before going to college, what is mom going to think? She’s going to get pretty angry and give him a stern lecture about not using the card to take a girl out to dinner, or buy football tickets, or purchase a bitching stereo system for his car. Why? Because moms with kids in college expect that these are the kinds of things a not-quite-financially-responsible college freshman spends money on. Her brain has no context for thinking otherwise so she imagines what other financially irresponsible young people usually do when given a credit card. That’s not denial, but that’s what she called it.

These are examples of contextual thinking, which is, by the way, how our brains operate when dealing with missing teaspoons and maxed out credit cards. It is our default mode for thinking about the mundane things in our lives. Yes, we all have swell imaginations and use them when the context calls for it. If we were decorating a room, reading a novel, watching a movie, or visiting a museum, we’d let that bad-boy imagination machine have at it. If we are dealing with misplaced jewelry (that our addicted child has stolen, but we assume we’ve put down in one of those infamous “safe places” that we never remember later) or a scruffy kid who looks exactly like he did when he had the flu ten years ago, our brain dispatches with these things in terms of what it knows. It cannot do otherwise. Biologically our brain is still on the primordial savannah. If our primitive ancestors heard rustling in the bushes, they knew from experience it was probably a lion. They did not wait around to see if it was a neighbor bringing over Sunday brunch and a pot of tea. The subconscious conclusions at which we arrive when dealing with ordinary life frees up our much over-rated pre-frontal cortex to contemplate the meaning of life, to do complex long-range planning, and to determine what the fuck James Joyce could possibly have been thinking when he wrote Ulysses.

Most parents today hit adolescence in the sixties and seventies. Our experience of illicit drug and alcohol use was scraping together enough change to get our older siblings to buy us a bottle of Boonesfarm piss-poor wine. If we didn’t smoke pot ourselves, we knew people who did. We snuck cigarettes now and then. Some folks dabbled with hallucinogens and everyone knew at least one person who had. It was a phase, we outgrew it, we moved on with our lives and settled into spectacular, blissful normalcy. If we knew addicts at all, they were almost all aging alcoholics. Most of us know what someone smells like when they’ve been drinking. We know what cigarette smoke smells like. Many of us could identify a bong if we found one in our child’s room. That is the only context we have for illicit substance abuse. How on earth are we to connect missing teaspoons to heroin? How are we to recognize early signs of meth addiction or cocaine addiction?

An addicted child, they tell us, becomes withdrawn and isolated. So what? All teenagers do. You don’t ignore it certainly, but you don’t automatically make the leap to addiction until it is so deeply dug in that the child no longer cares about whether or not you know. That’s pretty far gone. You have to watch who your child hangs out with, they tell us. We do, and we make rules and set boundaries, but unless you are willing to spend your child’s teenage years sitting his room every night (that’s every night for six years) with a shotgun, you cannot know what he does in the middle of the night or who he does it with. Also, bear in mind that many young people do not become addicted until they go off to college. If your child is accepted to Stanford and you live in Milwaukee, you are not in any position to monitor his behavior unless you can afford a private detective doing 24/7 surveillance for the next four years. And even that’s no guarantee.

So what does this have to do with stigma? Simply this. A parent will self-stigmatize by using the word “denial.” If it’s true, by all means admit it and work on that, but merely missing the “red flags” is not the same thing at all. And the more time you waste smacking yourself over the head for something you could not possibly have seen coming, the more guilt you feel, the more you begin isolating yourself, the more likely you are to begin the blame and shame game. The end result of this game is that pretty soon the whole damn family is dysfunctional. Everyone is sitting in their own darkened corner, nursing their own shame, and blaming each other. It is now not only the addict who hates himself. It’s you, it’s your spouse, it’s siblings, it’s grandparents, it’s the kid down the block who unwittingly introduced your child to someone who knew someone who was a dealer. That’s a zero-sum game folks.

There are no positive outcome guarantees for an addicted individual, but there are definitely ways to ensure negative outcomes. Asking yourself “why” is a road with no outlet – unless of course you want to emulate addiction researchers and make up a new word for it. Personally, I wouldn’t worry about linguistic confabulations at this point in your life. Leave that to the experts. If you wait long enough, they’ll come up with something. You have more important things to do. Trust me, if the only commitment you have this week is to drive your addicted child to an NA meeting, you have more important things to do.

 

 

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How we’ve totally fucked up addiction treatment

I debated a bit before using the word “fucked,” but face it. No one is going to read a scholarly dissertation on the subject. Instead, we need some straight talk (no pun intended) because there are too many people dying, too many families suffering, too many people are lost. Show of hands, folks. How many people know an addict, have lost someone to addiction, have struggled with it personally? If there is even one person on my list who doesn’t know someone for whom treatment has failed, and failed multiple times, they are either lying or dead.  I shall presume the former since the latter would be a bit unsettling.

Now most of you will not listen to William White’s youtube presentation on Recovery Oriented Systems of Care because it sounds dull and it takes about three days to listen to the entire series. But you should. If you are an addict, you should listen to it. If you are a family member, you should listen to it. If you are a certified professional, you damn straight should listen to it. Let me give you a quick synopsis of why addicts don’t recover and I can do it in one word: treatment.

Here’s what happens in today’s enlightened age of addiction treatment. Addict comes in. Addict is de-toxed. Addict has thirty days to get his shit together. Addict has graduation celebration. Addict is released from treatment. Addict goes back to old neighborhood and scores before he takes his first shit as a free man. Why?

We know that addiction is a chronic condition, but in our culture, addiction is treated as if it were an acute disease, sort of like the flu plus or minus a felony charge. White puts it like this. It is like taking a dying tree, uprooting it, planting it in good soil and nourishing it, and the minute it starts to bloom, we say, “Awesome. This tree has recovered.” And we dig it up, put it back where it came from, ignore it, and it dies.

Do we use this model with diabetics? Lupus? High blood pressure? Fuck no. How about cancer? Nope. HIV? Nope. Statistics show that alcoholics stand a good chance of remaining sober if they’ve reached their fifth year of sobriety. So how long should we provide follow up care (at minimum)? Hint: If you have to think about that one too long, you’ve got the wrong answer. Opiod addicts take even longer. Just like with any other chronic disease, addiction has a point where it is stable and the patient is able to manage it, for the most part, by themselves. And just like any other chronic disease, there are periods of remission and a potential for relapse. Notice I said “potential.” Not everyone does, but you don’t hear about them. Why? Because a large majority of people who recover don’t ever go into treatment. We can’t identify them, so we can’t study them.

And why can’t we identify them? Stigma. Who in their right mind is going to risk their job or their friendships or their family by telling a well-meaning researcher, “Oh hell yes. Man, I spent a whole year of my life pawning everything I owned, pawning stuff other people owned, crawling through the rose bushes at 3AM vomiting my guts out, and every once in a while, wetting the bed. I was just lucky I never got caught. And dude, that describes about half the guys in my college dorm.”  Even more salient, what former addict who never got caught is going to lead the civil rights movement against the stigmatization of addicts? If you can go public with your addiction it is because you are in one of two positions: either you’ve got nothing to lose because you’ve already lost it all, or you are Betty-freakin’-Ford. Either way, someone who is looking for hope is not finding a role model who looks like them.

If you’ve been in treatment, you’ve got yourself one serious case of stigma. You have to lie on job applications. You’ve got to sweep your former self under the carpet and pray to God that one of your old dealers or drinking buddies doesn’t recognize you when you are on a family outing with your kids. And you sure aren’t going to stand up at the Rotary club and be an advocate for the ones that didn’t make it lest someone sees the ex-addict in you and decides its time your membership expired.

But back to the acute treatment model. We’ve got other problems in our thirty day, instant recovery plan besides simply the duration of treatment. Here’s the biggie. Administrative discharge. If you’ve not been around people in a program, let me define this for you. The client enters treatment straight out of jail or off the street and we are SHOCKED – simply SHOCKED – that he does not even have rudimentary social skills. He breaks a rule, which may or may not involve using. What happens? He’s kicked out of the program. Now I’m going to paraphrase White again but “in what other chronic illness do we find patients kicked out when they become symptomatic?” He uses this as an example: You go into a hospital for a heart condition. On Day 2 of your stay, you have a heart attack. In other words, you have become symptomatic for the condition that brought you to the hospital. Does anyone come to your room and kick you out of the hospital for being “non-compliant?” No. They move you to ICU because you need more care, not less. Do you see the problem here? The guy that really needs the help, who is seriously a danger to himself or others, is kicked out of a program for exhibiting symptoms of his disease. If you are his counselor, you will see him again. And again. And again. That is provided that your facility allows him back in your program and many do not, thereby causing another problem in that the person who knows your case better than anyone can no longer treat you and you have to start over in a brand new environment with a brand new counselor.

But there’s more. Counselors who really care are actually leaving formal treatment facilities because they feel they can do more good as a volunteer. Why? First of all, they spend more time doing mandatory paperwork than treating clients. Second, there are “boundary issues.” Ethically, if your client walks out of treatment and disappears, you are not permitted to go looking for him. You can’t go to his house, his shelter, his street corner and say, “Hey what’s up? Let’s go have a cup of coffee and talk about what’s going on with you.” If you do that, you will be fired. You can’t interact with the client’s family and invite them over for one blessed afternoon of normalcy doing a backyard barbeque or having a picnic. In the facility, you can’t hug the client or pat him on the shoulder or have any contact whatsoever. Presumably this excludes CPR, but I am guessing that most counselors would even feel uncomfortable  about that. It is such a pervasive concept that I had one instructor at school who said she will not even offer a distraught client a tissue, although of course they are free to reach for one themselves – or use their sleeves.

In one class, we were given the hypothetical situation of running into a client in a shopping mall. The client is doing well and is happy to see you. Bubbling with enthusiasm and gratitude, he or she rushes over to give you a hug. The instructor’s advice? Extricate yourself from the client’s embrace and gracefully slide into a politically correct handshake. Play that scene out in real life and think about how it feels to be a client who has just been stiff-armed by their therapist. To make matters worse, you cannot disclose the identity of this person to your stunned family members. “Who is that?” your hubby asks, narrowing his eyes suspiciously. “Uh…just..ummm…you know…some guy.” This does not exactly model functional social interactions, ya know?

There will be a follow up to this post. It is just a beginning. I’ve caught White’s vision and I get it. And if you are addicted or love someone who is, I can only encourage you to read my meager offerings and then go subscribe to William White’s youtube channel. Here’s the link: https://www.youtube.com/channel/UCi6p8_KWZd2xWCYHg9cdGTw

You owe it to yourself, and to those you know who struggle with addiction, to understand the limitations of the current addiction treatment health care model in the United States. You need to understand why treatment is often a revolving door. You need to understand that there is a vision out there that could work and it needs advocates. Most of all, you need to know recovery is possible even for the most hard-core addict you know. Maybe that person is you. Don’t give up. Take action.

Bowlin’ with Jesus – a meditation

So first of all, let me just say that it doesn’t have to be Jesus. It can be Mother Nature, or Buddha, or Sigmund Freud. It can be Mother Teresa, or Kurt Cobain, or your Guardian Angel. It can even that crazy uncle who passed away ten years ago but whom you fondly remember because he once mooned the mayor right in the middle of a town hall meeting. Here’s the thing though. It has to be someone to whom you have a deeply spiritual connection.

Here’s what you do.

Every night before you go to bed, mentally wrap up your day. Gift box that bad boy and put a ribbon on it. Throw all the junk in there that you really wish would go away – an embarrassment, a social slight, a grudge, guilt, shame, remorse, pain, sadness. Now take your box and hit the celestial highway.  At the end of the road, your bowling buddy awaits. Go on – give ’em a hug. No, no. Hug ’em like you mean it. Not one of those sideways, one-armed guy-hugs. The real deal.

OK now you have to sit down and open the box. It’s pretty damn full, but you and your friend are sitting there on the – well, hell – I don’t know what you sit on when you are roaming around in other dimensions, but for God’s sake, just park it. The box pops open and laying right there on top is the coffee you spilled all over yourself in the middle of an important meeting. Sitting next to it is the coffee that flowed off the edge and onto your boss. Jesus/Buddha/crazy Uncle Bob picks it up, looks at it, and chucks it into the nearest Black Hole. Why a Black Hole? Because nothing ever comes out of a Black Hole. It’s like an intergalactic trash compactor. Now it’s your turn.

What’s this? Guilt? That’s a heavy one. Forgot to call Mom and it was her birthday. Snapped at your spouse when you couldn’t find the remote. Accused the kids of leaving the front door open and then remembered that it was you who didn’t shut it properly, and while you are at it, you know your hubby has been asking you to fix that doorknob for six months now and you still haven’t gotten around to it. Flipped off the guy who cut in front of you just before the intersection and made you miss the light (yes he was an asshole, but you went half a mile out of your way just to catch up to him so you could flip him off. A little over the top, yes?) Now that you’ve inventoried all the shit you did wrong in the past 24 hours, wad the whole thing up into a big ball and aim it right into that Black Hole. In fact, find one a bit more distant because after all, you can’t let Mother Teresa out-bowl you. You have trophies for fuck’s sake. Mother Teresa doesn’t even own a pair of bowling shoes.

What’s next? Loneliness. Some folks look forward to going home to a silent, dimly lit house where they can sit in the dark all night listening to Wagner and weep copiously. You don’t (although that’s pretty much the story of your life). Instead, you were kind of hoping for a night out with the girls but they didn’t even invite you. You are painfully aware of the fact that this is because the last time they invited you out, you turned them down. And the time before that too. And the time before the time before that, you did go, but got shit-faced and threw up all over the inside of your friend’s beloved VW Beetle. But it still hurts to be left out. Well that’s a pretty heavy one too, but Jesus just laughs and throws it half way across the space-time continuum hitting a Black Hole you can’t even see. Credit where credit is due. Nice one, Jesus!

Now here comes some sludge from the past and damn if it isn’t your turn. You don’t even remember why you thought of him today. You sure didn’t summon him, but there he was. Dear old Dad, smelling rank and calling you stupid because you failed your fifth grade math test. And there he was again on your sixteenth birthday telling you that you were too ugly to get a date. And then he showed up at that meeting with the coffee incident calling you a fucking idiot. And the bad part is, you love him and you think throwing him in a Black Hole…well, how can you even think of throwing your Dad in a cosmic compactor? But Mother Nature is looking pretty smug over there. She thinks she’s got this game wrapped up because she’s ahead and you are still sitting there waxing maudlin over a pile of sludge. Sorry, Dad. The game’s at stake and it’s time for you to go. And as he sails through the heavens, you can vaguely hear crazy Uncle Bob chuckling, “I never liked that old bastard, anyway.”

So now you’ve emptied your box for the night. Wrap it back up and take it back to more earthly realms. In the morning, you can peek inside and see that what is left is the things you learned from the day before so you’ve got your morning meditation covered. You can decide to leave your coffee back at your desk next time you have an important meeting. You can decide not to snap at someone you love over a stupid remote control. You can decide to ask your friends to come over for a night of Wagner and weeping. Or you can begin acquiring cats. Either way, you got this loneliness thing under control. As for Dad, while he may come stumbling back in through the back door again, you now know you can make him leave.

So instead of carrying your pain into the next day, you are carrying only the constuctive stuff. After a few nights of doing this you’ll start to notice patterns.  If you are feeling weighed down by guilt every single, damn day, Jesus has it covered. Let him do the heavy lifting. If you keep coming back with loneliness, hand it to Mother Nature. She’ll give you back a stray cat, guaranteed. And if you open the box every night and Dad keeps popping out, just let Uncle Bob deal with him. He never did like the old bastard anyway.