Answer Addiction

Tag: trauma

  • Chapter 6: The Thrush’s Song

    Shauna Shepard, who works as a receptionist in the local health clinic, visited with me on my back porch. She shared why she drifted into substance abuse, and how she struggled to get — and remain — sober.

    After a man in my small Vermont town who had a heroin addiction committed suicide, I began asking questions about addiction. Numerous people shared their experiences with me — from medical workers to the local police to people in recovery. Shauna Shepard, who works as a receptionist in the local health clinic, visited with me on my back porch. She shared why she drifted into substance abuse, and how she struggled to get — and remain — sober.

    “Drugs,” Shauna finally said after a long silence, tapping her cigarette on the ashtray. “Drugs are really good. That’s the problem. When you’re using, it’s hard to imagine a life without them. For a long time, I didn’t know how to deal with my feelings any other way. It’s still hard for me to understand that getting high isn’t an option anymore.”

    I nodded; I knew all too well how using could be a carapace, a place to tuck in and hide, where you could pretend your life wasn’t unraveling.

    “You can go weeks, months, even years without using, and then you smell something or hear a certain song on the radio, or you see somebody, and — bam! — the cravings come right back. If you don’t keep your eye on that shit, it’ll get you.”

    “It? You mean cravings for drugs? Or your past?”

    “Both,” she said emphatically. “I mean, fuck. Emotions don’t go away. If you bury them, everything comes crashing out when someone asks you for a fucking pen, and they get the last six months of shit because they walked in at the wrong time.”

    I laughed. “So much shit can happen in six months.”

    She nodded, but she wasn’t smiling.

    I rubbed a fingertip around the edge of the saucer, staring at the ashes sprinkled over its center. “What’s it like for you to be sober?”

    “It’s harder. But it’s better. My job is good, and I want to keep it. I have money the day after I get paid. I’ve got my therapist and my doctor on speed dial. I have Vivitrol. But I still crave drugs. I don’t talk to anyone who uses. It’s easy for that shit to happen. You gotta be on your game.”

    “At least to me, you seem impressively aware of your game.”

    With one hand, she waved away my words. “I have terrible days, too. Just awful days. But if my mom can bury two kids and not have a drug issue, I should be able to do it. When my brother shot himself, his girlfriend was right there. She’s now married and has two kids. That’s just freaking amazing. If she can stay clean, then I should be able to stay sober, too.”

    “Can I reiterate my admiration again? So many people are just talk.”

    Shauna laughed. “Sometimes I downplay my trauma, but it made me who I am. I change my own oil, take out the garbage. I run the Weedwacker and stack firewood. I’ve repaired both mufflers on my car, just because I could.” Her jaw tightened. “But I don’t want to be taken advantage of.” She told me how one night, she left her house key in the outside lock. “When I woke up next morning and realized what I had done, I was so relieved to have survived. I told myself, See, you’re not going to fucking die.”

    “You’re afraid here? In small town Vermont?”

    “I always lock up at night. Always have, always will.” Cupping her hands around the lighter to shield the flame from the wind, she bent her head sideways and lit another cigarette.

    “I lock up, too. I have a restraining order against my ex.”

    She tapped her lighter on the table. “So you know.”

    “I do. I get it.”

    *

    As the dusk drifted in and the warm afternoon gave way to a crisp fall evening, our conversation wound down.

    Shauna continued, “I still feel like I have a long way to go. But I feel lucky. I mean, in my addiction I never had sex for money or drugs. I never had to pick out of the dumpster. My rock bottom wasn’t as low as others. I’m thankful for that.”

    I thought of my own gratitude for how well things had worked out for me, despite my drinking problem; I had my daughters and house, my work and my health.

    Our tabby cat Acer pushed his small pink nose against the window screen and meowed for his dinner. My daughter Gabriela usually fed him and his brother around this time.

    “It’s getting cold,” Shauna said, zipping up her jacket.

    “Just one more question. What advice would you give someone struggling with addiction?”

    Shauna stared up at the porch ceiling painted the pale blue of forget-me-not blossoms, a New England tradition. She paused for so long that I was about to thank her and cut off our talk when she looked back at me.

    “Recovery,” she offered, “is possible. That’s all.”

    “Oh . . .” I shivered. “It’s warm in the house. Come in, please. I’ll make tea.”

    She shook her head. “Thanks, but I should go. I’ve got to feed the dogs.” She glanced at Acer sitting on the windowsill. “Looks like your cat is hungry, too.”

    “Thank you again.”

    We walked to the edge of the driveway. Then, after an awkward pause, we stepped forward and embraced. She was so much taller than me that I barely reached her shoulders.

    When Shauna left, I gathered my two balls of yarn and my half-knit sweater and went inside the kitchen. I fed the cats who rubbed against my ankles, mewling with hunger. From the refrigerator, I pulled out the red enamel pan of leftover lentil and carrot soup I’d made earlier that week and set it on the stove to warm.

    Then I stepped out on the front steps to watch for my daughters to return home. Last summer, I had painted these steps dandelion yellow, a hardware store deal for a can of paint mistakenly mixed. Standing there, my bare feet pressed together, I wrapped my cardigan around my torso. Shauna and I had much more in common than locking doors at night. Why had I revealed nothing about my own struggle with addiction?

    *

    I wandered into the garden and snapped a few cucumbers from the prickly vines. Finally, I saw my daughters running on the other side of the cemetery, racing each other home, ponytails bobbing. As they rushed up the path, I unlatched the garden gate and held up the cucumbers.

    “Cukes. Yum. Did you put the soup on?” Molly asked, panting.

    “Ten minutes ago.” Together we walked up the steps. The girls untied their shoes on the back porch.

    “We saw the bald eagles by the reservoir again,” Gabriela said.

    “What luck. I wonder if they’re nesting there.”

    Molly opened the kitchen door, and the girls walked into our house. Before I headed in, too, I lined up my family’s shoes beneath the overhang. Through the glass door, I saw Molly cradling Acer against her chest, his hind paws in Gabriela’s hands as the two of them cooed over their beloved cat.

    Hidden in the thicket behind our house, the hermit thrush — a plain brown bird, small enough to fit in the palm of my hand — trilled its rippling melody, those unseen pearls of sound.

    In the center of the table where Shauna and I had sat that afternoon, the saucer was empty, save for crumbles of common garden dirt and a scattering of ashes. When I wasn’t looking, Shauna must have gathered her crushed cigarette butts. I grasped the saucer to dump the ashes and dirt over the railing then abruptly paused, wondering: If I had lived Shauna’s life, would I have had the strength to get sober? And if I had, would I have risked that sobriety for a stranger?

    In the kitchen, my daughters joked with each other, setting the table, the bowls and spoons clattering. The refrigerator opened and closed; the faucet ran. I stood in the dusk, my breath stirring that dusty ash.

    Excerpted from Unstitched: My Journey to Understand Opioid Addiction and How People and Communities Can Heal, available at Amazon and elsewhere.

    View the original article at thefix.com

  • The Role of Trauma in Treating Addiction

    People who have suffered trauma often need to address its lasting effects before they can get a handle on their substance use.

    The word trauma is used today more than it ever was ten years ago. While some people might feel like the word is overused, many mental health professionals would say that we’ve just become better at recognizing the lasting impact that events — from losses to abuse — can have on our psyches.

    Many people with substance use disorder have trauma in their backgrounds. Trauma causes residual lasting mental pain. If you don’t address the trauma, you might find yourself self-medicating to escape the mental pain. Although that might work for a moment, using drugs or alcohol to cover your mental pain will just cause more difficulties in the long run. That’s why it’s so important to find a treatment center that understands the interplay of trauma and addiction.

    Understanding Trauma

    The American Psychological Association (APA) defines trauma as an emotional response to a terrible event. What constitutes a terrible event varies from person-to-person. An event that is traumatic for one individual might not cause trauma for other people, even if they experience the very same event. Anything from abuse to a natural disaster to an accident can cause trauma.

    It’s normal to experience some psychological distress after a major event. Consider the stress that we all experienced early on during the pandemic. But, for most people, the stress gets better with time. If you find that your stress continues to interfere with your life, you might have trauma. Symptoms of trauma can include flashbacks, headaches and nausea.

    Sometimes, trauma can evolve into post-traumatic stress disorder (PTSD). PTSD is characterized by lasting effects of trauma that impacts life. People with PTSD might have flashbacks or nightmares; they might avoid certain situations that remind them of the traumatic event.

    The Connection Between Trauma and Addiction

    There’s a close connection between trauma and addiction. A 2019 study compared people who were getting treatment for opioid abuse disorder with healthy individuals. It found that the people in treatment reported more severe traumas and more instances of trauma in their lives. The study found that the more trauma people experienced, the more likely they were to experience addiction.

    The connection can be particularly strong for people who experience trauma as teens or children. Among teens who needed addiction treatment, 70% reported trauma in their backgrounds. In addition, 59% of teens with PTSD go on to develop a substance abuse problem.

    Research like the ACEs study — which looked at adverse childhood experiences — have solidified the connection between trauma and addiction. Even seemingly minor ACEs, like growing up with divorced parents, can increase the risk for substance use disorder later in life.

    Treatment for Trauma

    If you have experienced trauma or ACEs, and particularly if you believe you may have PTSD, you need to access a recovery center that is trauma-informed. Trauma-informed treatment centers have knowledge about the ways that trauma impacts the brain. They are able to help you address your substance abuse disorder, while also helping to control your trauma.

    Of course, it is also a great idea to get specific treatment to help you overcome PTSD, if you are experiencing that condition. EMDR — Eye Movement Desensitization and Reprocessing — is a type of therapy that is particularly effective for treating PTSD. During EMDR, you recall your traumatic event while doing to back-and-forth eye movements. Scientists don’t understand exactly why this is so effective at reprocessing the traumatic event, but research shows that people make huge improvements in just a few sessions.

    The Takeaway

    Trauma is extremely common: up to 70% of American adults have experienced a traumatic event in their lives. Some people recover on their own, while the trauma lingers for others. Too often, people use drugs or alcohol to try to numb or escape the trauma.

    Oftentimes, people need help to overcome trauma in their lives. Finding and utilizing a treatment center that has a trauma-informed approach to treating substance use disorder can help you understand the role that trauma plays in your addiction. Then, by addressing the underlying cause of your addiction, you’re better able to stay sober long-term.

    Learn more about Oceanside Malibu at http://oceansidemalibu.com/. Reach Oceanside Malibu by phone at (866) 738-6550. Find Oceanside Malibu on Facebook.

    View the original article at thefix.com

  • Forgive and Remember

    Better to face the discomfort than continue to trudge along under a false impression that it’s not dormant inside, oblivious to the ticking of the time bomb that will eventually go off.

    Weekday morning programming kept me company in the background. The crispy and cold bedspread gave me some solace. My parents had just left the apartment and I was curled up like a fetus at the foot of the bed. It had been a while since I entertained the unwelcome visitor. What the hell was he doing here? Everything was going great, or so I believed. Two days with them proved me wrong. What seemed to be progress in acceptance and personal growth was only a by-product of spending a year on the other side of the world. No wonder I wasn’t feeling good and stayed in that day. The illusion of the enlightened and perfect world I’d been living in was shattered. The mourning of this started as a slow downward spiral that quickly turned into a tailspin but felt more like a free fall. I had not wished I hadn’t been born for a couple years now. But it was as if it had never left my side felt stronger than ever. I was drowning and didn’t know which way was up. It seemed that no matter what I did, I’d always come back to this powerlessness. What was the point to keep on trying? “Forget this. Life is too hard. You wouldn’t have to deal with all this if you ended it”, he suggested.

    Awakened unresolved issues were kicking and screaming. This is a very scary place to be, especially in this dangerous company. Running in fear was actually the courageous thing to do. It was time to resort to what saved my life a couple years prior. It was time to go back to basics. I knew a lot of meeting rooms in Miami, but this one was my favorite. There were some faces I recognized and others I didn’t. Most were friendly; mine was not. There was a thick fog of negativity inside my head and it was probably clear in my blank stare. Like a good friend used to say, sometimes we go to give sometimes we go to receive. I was in dire need.

    Some say it’s magic, others call it God, to avoid charged debates most refer to a Higher Power. Whatever you choose to call it, there is Something that definitely moves through those present. I lost count of how many times I heard exactly what I needed in those circles. The first times it was unbelievable how the day’s conversation addressed exactly what was eating away at me. It’s not just me. Others share this surprise as well. Even though it’s happened too many times to keep count, I am still at awe when it happens. It makes me feel special and reminds me that I am not alone. It doesn’t surprise me like it did at the beginning. Don’t get me wrong, I don’t take it for granted. I guess it has to do with worthiness and accepting that I am loved and cared for. I appreciate it deeply and it definitely keeps me coming back.

    As soon as the chairperson started the meeting it was obvious, we’d be talking about forgiveness. There were many nuggets of wisdom as each person shared their experience, strength, and hope. I had not forgiven, or rather accepted parts of my childhood. Spending a year on the Beautiful Island made me believe I was at peace with my past, but crossing the Pacific was a wake up call I needed to escape denial once again. It’s always a rude one, but an awakening, nonetheless. Better to face the discomfort than continue to trudge along under a false impression that it’s not dormant inside oblivious to the ticking of the time bomb that will eventually go off.

    The last person that shared might as well have been the first and only. Her share is the only one I remember from that day and one I will never forget. She helped me see things in a new light. She was molested at a young age by her uncle. Hard to believe but she said it was fairly easy for her to forgive him. She had finally forgiven herself after years of struggle and anguish. Her reasons for this challenge had to do with guilt, shame, and self-image. It was a very moving story. It made me uncomfortable to hear, but honored and grateful at the same time. There are details that escape me, but she closed with a line that changed it all for me and I have shared with many when discussing these issues. She said, “forgive and forget? That’s bullshit! We forgive and remember without pain”.

    View the original article at thefix.com

  • Failing

    Would we be able to reach across the distance—and our failings—to touch each other, to smile?

    We’re together for the first time in five years, the three of us. Three sisters. Terry, the oldest, pastes us together with persistence and illusion. She believes we can be a family, that we are a family. Julie, the youngest, bites her lower lip and wears a worried brow, even while she drives her red Miata with the top down to her job as a South Carolina attorney. She left home for law school fifteen years ago and comes back only for weddings or other landmark celebrations like this, or for Christmas every two years. And me, in the middle. I moved to Connecticut almost twenty years ago to cut free from my tangled roots, I thought, and to be near the hospital where I learned to stop drinking and to want to live again.

    I suspect my newest illness—Chronic Fatigue Syndrome—structures my life in a way my family must find limiting. At least that’s what I think when I hear their voices in my head. You’re tired all the time? Go to bed earlier. You can’t think straight? You’re an Ivy League graduate, for heaven’s sake. Start jogging again. You’ll feel better.

    But when I’m tucked away, writing in the pretty place on Long Island Sound I call home, half an hour from Manhattan, surrounded by people who drive German and Italian cars and wear Prada and Polo, I pretend their success is mine and that my medical bills and dwindling bank accounts and lost jobs and derailed relationships don’t much.

    When I return Upstate to the tricky terrain on chilly Lake Ontario, though, my creative ambitions seem paltry and a little suspect. I feel I’ve failed. But, I remind myself, I’m thin. And I used to have enviable, respectable jobs. And I saw the Picasso exhibit at the Met. I hang onto those vanities like life preservers tossed to me in rough seas.

    We’re together to celebrate our mother’s birthday, her seventy-fifth. Each of us brings her gifts to the party. Collectively, we also bring 130 years of survival skills, learned, not on some Outward-Bound wilderness adventure with a trusted coach, but in this family, where I, at least, believed no one was to be trusted.

    *****

    For three weeks, we made plans. When I called to ask Terry what I could contribute to the buffet, she discouraged me from bringing anything other than Tom. “As for sleeping arrangements,” she mused. “I’ll put Julie and Ken in the guest room. You can sleep in Katie’s room, and Tom can take the den.” She paused. “But the pullout sleeps two if you want to stay with him.” 

    Terry and I have been sisters for forty-four years. We emerged, screaming, flailing, from the same womb, played hide and seek in the same neighborhood, suffered algebra in the same high school. But before that clause (“. . . if you want to stay with Tom.”), we never talked about touching men or sleeping with them. When I hung up and told Tom about this tender talk between my sister and me, I was baffled when he said, “I guess they think I’m okay.” How could he shape so private a moment between Terry and me into something about him? But I shook off his self-absorption. He’s not Catholic. He wasn’t raised in a home where no one touched without wriggling to get free. And he doesn’t know how important it is to try to get to know your sister when you’ve spent three decades shoring up the distance from her and you’re no longer sure why.

    When I called Julie, she railed because Terry decided the party date and time without asking her. “Why did I offer to help if she’s taking care of everything?”

    I’m the middle sister. I’m in the middle, again and always, but I welcomed Julie’s rant. Any connection would feel better than the unexplained plateau we tolerated between us since her marriage ten years earlier. “I don’t know what to wear,” she said, trying to regain her equilibrium.

    “Pants and a sweater maybe,” I posited gingerly, not wanting to sever the tentative thread between us. “April’s still winter upstate.”

    “I might need something new.” The thought of a shopping mission jumpstarted Julie’s party stride. “They’re all on special diets,” she said, “so we’ll need to make sure everyone has something to eat. Dad can’t have nuts, remember?”

    * * * * * *

    Tom and I set out late Friday morning, my mood dipping as we rode the thruway into Rockland County and beyond. The sky hung as heavy and gray as it did six months ago when we went home for Thanksgiving, me with the same faint hope. Maybe this time things will be different.

    When we pulled into Terry and Bill’s driveway five hours later, stiff from sitting, Dad rushed to the door, his hair whiter and thinner. For a moment I mistook him for his father. And before he hugged me, I remembered that one Father’s Day brunch, when my father raged at his father because Grandpa couldn’t hear the waitress when she rattled off the holiday specials. “Stop!” I yelled. Why did I need to tell him to stop hurting his father? All I wanted was to be his favorite girl.

    His favorite girl? A dicey proposition. “How’s my favorite girl?” he’d ask when he hustled in, late—again—for dinner.

    “We don’t have favorites,” Mom was quick to point out as she slid a reheated plate across the table to him.

    Stop. I pulled myself back to Terry’s foyer. We hadn’t yet said hello, and I had dredged the silt of the River Past. Say hello. My father hugged me tight—he at least was generous with his hugs, though from him they never stopped feeling dangerous. We don’t have favorites. Although I hugged back, I stiffened in his arms and drew away too quickly. “You remember Tom?” Then I kissed Mom who, smaller than she used to be, still held her affection in reserve. “Hi, hon.”

    “You made it.” Terry said, smiling as she came in from the kitchen, wearing a gingham apron over her Mom jeans. “How was the drive?”

    As soon as I answered— “An hour or two too long”—I wondered if she thought my words meant I didn’t want to be there. We attempted a hug, and I held on a little too long, searching for something bigger, warmer, because in her stiffness, I heard questions. Is she angry because I don’t do my share? (Who wouldn’t be?) That she’s the one who drives Dad to his cataract surgery and perms Mom’s hair? (Of course, she’s angry.)

    “Nice outfit,” she said, and I resisted suggesting a livelier hair color for her.

    When Terry offered her cheek for a quick kiss, I saw Julie at the edge of the foyer, half in, half out, arms crossed. “You look great,” I said, hoping to breathe a little fire into her. “Hi.” She stretched the one syllable to two, an octave higher than her normal speaking voice, trying to sound different than she looked, as if she were frozen, unable to come closer.

    Hungry?” Terry asked.

    “Starved,” I said, not letting on that, more than food, I wanted a belly full of comfort.

    Tom and I brought in the dinner fixings—ravioli and salad greens I bought at Stewart’s market, bread and cheesecake from Josephine’s bakery—and Terry, Julie and I set about making the meal. Before Terry lifted the lid from the cooking ravioli, I knew she would sample one before she pronounced, “They’re done.” Then she would wrap the dish towel around the pot so she wouldn’t burn herself when she lifted it from the stove and dumped the steaming pasta into her twenty-year-old stainless colander with the rickety feet in the sink.

    I knew, too, how Julie would stand at the counter, her shoulders sloping forward, while she diced tomatoes and chopped garlic.

    I knew their rhythms, their postures, but I wanted to reach to them, to ask them please, would they look at me, would they be my friends. Instead, I wondered why it seemed so hard to say something spontaneous, or to laugh from our bellies.

    “Stewart’s was so crowded when I shopped, I had to meditate to steady myself when I got home, even before I unloaded my bags.”

    They turned to me when I took a stab at something genuine, but their tilted heads, their uncomprehending eyes signaled they didn’t know know how post-shopping meditation worked or why it should be necessary.

    “How are the grocery prices in Connecticut?” Terry asked, and my hope for connection vaporized as rapidly as the steam rising off the ravioli.

    *****

    Party day. Relatives arrive from across the county. My cousin, Peter, the accountant, the one I was sure, when I was six, I would marry, with his wife, Marie, still perky, still chatty, still in love. My teacher cousin, Patricia, with her professor husband, Art, who sports a ponytail and more stomach than when I saw him last. Janice, married to Cousin Dave, squints as she walks in the door. “Madeleine?” She needs time to adjust to the light. “It’s been fifteen years!” She stretches out her arms and hugs me the way I want my sisters to hug me. “I’ve missed you.”

    One cousin, Karen, the one who took too many pills ten years ago, isn’t here. But her brothers are, and I feel like a part of them should be missing because their sister is dead. As if maybe each of them should be minus an ear or a hand, some physical part because Karen died. How is it you two are here when your sister isn’t?

    My uncles walk in, proud of their new plastic knees and hips. Here are my aunts, who shampooed my hair with castile soap, taught me to bake Teatime Tassies, and let me dress up in their yellowed wedding dresses in their dark attics. Each of them hobble-shuffles in, looking a little dazed by all the fuss.

    For almost twenty years, I kept my distance from these relatives, these potential friends, visiting every year or so for a day or two of polite, disingenuous conversation. I needed to banish myself, I suppose. After all, there was the drinking, and the fact that I hadn’t amounted to much, given all that potential they all told me I had. But at this party I look them in the eyes when I talk, trying to recover a little of what I lost by staying away. Uncle Frank tells me my maladies must emanate from some emotional twist, or from the fact that I’m alone, away from my family. Like a working man’s Gabriel Garcia Marquez, he confides magically real stories about men from the factory who went blind from jealousy or ended up in wheelchairs from unexpressed fears. “Why don’t you come home, honey?” Home? Is this still my home? Was it ever?

    There’s a lot of red in this house, I notice, when I scan the crowd. Except for Terry, whose hair still imitates the non-offensive light brown we were born with, each of us female cousins wear some shade or other of red hair: medium red beech; burgundy berry; Cinna berry; sunset blonde. And though my mother and her two sisters didn’t plan this, each of them is in red: tiny Aunt Emma in the knit dress she wore for last year’s Christmas portrait with her ten grandchildren; Aunt Anna in a red and black striped twinset with a black skirt; and Mom in a red blazer and skirt. They sit on the couch, one wearing a strand of pearls, another a locket, the other her “good” watch because this is a special occasion.

    All this red surprises me. We’re not what you’d call a red family. We may glower underneath; but as a rule, we don’t flare or flame. The Slavic temperament prefers to smolder chalky gray, while the red burns beneath the surface.

    They look too small, these women, sitting next to each other, after I ask to take their picture. And there’s too much distance between them. I want them to scrunch together—which they won’t—so they seem closer.

    No matter how far apart, though, it’s important that these three little women are together on this sofa, posing. Aunt Anna never used to let us take her picture. But maybe, like me, she knows there is something final about this portrait. Each of them is ill. Aunt Emma is diabetic; and, although we don’t yet know this, a cancer is growing in her left breast, just above her heart. Aunt Anna’s Parkinson’s disease is progressing, and Mom has a bad heart. I don’t know these specifics as I see these three women through my lens, but I know it’s inevitable. Something will happen to them soon.

    The flash goes off on my camera. Once. Twice. “That’s it.” Aunt Anna waves me away with her shaky arm. “Enough pictures.” She pushes herself off the couch and turns on the television to watch a golf tournament. The moment is over, but I have it on film, and in my heart.

    *****

    Mom is failing, Cousin Pat wrote in her holiday note about Aunt Emma. And when I called Aunt Anna on Christmas, she told me how she fell three times during the last month and Terry confirmed that, like Aunt Emma, Aunt Anna was failing.

    My father didn’t use the same word to describe my mother. Failing wasn’t a word that would come easily to him. But he apprised me in detail about Mom’s last neurologist appointment, when she would see him next, how he would adjust her medication schedule: eight in the morning, noon, four in the afternoon, and seven-thirty at night. I admired the way he structured her care. But when he barked at her to come to the phone, my stomach gripped. I worried he might be hurting her.

    After hanging up, I reached for the portrait of my mother and her sisters. I wondered. In twenty-five years, when my sisters and I are smaller, when we sit together for a picture on Terry’s seventy-fifth birthday, how much space would hang between us? Would we be able to reach across the distance—and our failings—to touch each other, to smile? I didn’t know. But I knew this: if I hoped to touch them in the future, I needed to reach to them now, as they are, not as I would have them be.

    Terry and Julie and I won’t sit for a portrait on Terry’s seventy-fifth birthday. She left us last year, victimized by a rare immune disorder, when she was sixty-two. So, there will be no photo. Only the memory of wanting one. And the hope, too long postponed, that the distance between us would narrow if we only reached to one another, even if just a little.

    View the original article at thefix.com

  • The Five Pillars of Recovery from Trauma and Addiction

    Believe in yourself. Tell yourself that you deserve happiness, joy, success, and a life free from the pain of trauma and addiction. You are worth your recovery.

    In my forty-five years, I enjoyed twelve years of quasi-normal childhood, which ended abruptly when I was raped. I spent the next ten years in a dangerous dance with addiction, suicide attempts, and more trauma. But then I reached a turning point, and my past twenty-three years have been spent healing and learning what works for me in building long-term recovery.

    There is no standard set of blueprints for long-term recovery, as everyone is different, but I have identified five pillars that have enabled me to build on a strong foundation of recovery. My daily choice not to use substances forms that foundation, and these rock-solid pillars stabilize that recovery into an impenetrable structure. These five pillars are not unique, and they do require work, but once built, they will stabilize your recovery fortress.

    1. Maintain rigorous honesty. In addiction, our lives were built upon lies and false narratives we told ourselves and others. But recovery demands honesty—only when we can admit the truth can we begin to heal. I had to get honest with myself about my addiction. I had to own it and then take a brutally honest assessment of my life. We cannot build a sustainable recovery on a false narrative. When we lie, we enable sickness, secrets, shame, and suffering.

    Dishonesty makes us vulnerable in all the wrong ways, but honesty conjures the true vulnerability we require to discover authenticity. Start practicing honesty in all your interactions—beginning with yourself. This must be the first pillar because without honesty, the rest will crumble. Anything created in a lie is chaos, and anything created in chaos will end in chaos.

    2. Expose your secrets. You cannot soak in the joy of today if your soul is still filled with yesterday’s garbage. Take out that trash. For me, this meant diving deep and pulling forth all the trauma, pain, and sorrow that I had packed tightly away. I thought this was for my benefit—why bring up old stuff? But in fact my secrets were keeping me sick. They were smoldering under this new foundation I was building in recovery, threating to burn it all down.

    Secrets require silence to thrive, and they allow shame to fester inside of us. Shame is an emotional cancer that, if left untreated, will destroy our recovery. I began by slowly exposing my secrets in my journal. At first, it was the only safe space for me. As I began to trust others in recovery, I began to share those secrets, and the smoldering was extinguished by their compassion and understanding. Begin exposing your own secrets. What thoughts and memories are you afraid to give voice to? Those are the secrets that will keep you sick if you do not get them out.

    3. Let go. All those secrets take up a tremendous amount of space in our mind, body, and soul. We must find ways to process that pain into something productive, useful, and healing. You must unleash this pain so it no longer occupies your mind, body, and soul. When you do this, you make room for hope, light, love, and compassion.

    Writing is my release. But when physical emotional energy rises in me, I need more intense physical activity to push the energy out of my body. I use a spin bike and weightlifting, but you might run, walk, or practice yoga—any activity that gets your heart rate up and helps you sweat, which I think of as negative energy flowing out. When I do this, I am calmer, I am kinder, and I am more the person I want to be. Meditation is another way for me to simply let go and sit with myself when my thoughts are plaguing me or I feel stuck emotionally. I often use mediational apps, guided mediations, or music to help me meditate. When you find what works for you, do it daily. Recovery is like a muscle; when it is flexed, it remains strong.

    4. Remember you aren’t alone. Connection is core to feeling hopeful. By interacting with other trauma survivors and others in recovery, you become part of a group of people with similar experiences who have learned how to survive. Being able to share those pieces of your past with others is incredibly powerful. Seek out support groups in your area, attend meetings, reconnect with healthy people from your past, and pursue activities you enjoy to help you meet like-minded people. Create the circle of people you want in your life—the ones who will hold you accountable yet provide you with unconditional support and love, without judgment.

    In our addiction, we push these people away. We run from them because they act like mirrors to our dishonesty. In recovery, these people become the ones we turn to when things get hard. Even one such person in your life—a family member, friend, sponsor, or trusted colleague—can make a difference. Surround yourself with those who seek to build you up.

    5. Know you matter. In order to grow, heal, and build upon your recovery foundation, you have to believe you are worth it, that you deserve joy and love. At some point in your recovery, you will have to rely on yourself to get through a rough patch. When this happened to me, I had to really dig down and get to know myself. I had to strip away all the false narratives I used to define myself, all the ways I presented myself to the world and to myself. Who was I? What did I love about myself, and what brought me enough joy to feel worthiness?

    I now know what I need to feel calm, to feel beautiful, and to feel deserving of this amazing life of recovery. I matter, and my life in recovery matters so much. It is this core truth that makes me fight for my recovery, my sanity, my marriage, and my job, because they are all worth it. I am worth the fight, and so are you. Believe in yourself. Tell yourself that you deserve happiness, joy, success, and a life free from the pain of trauma and addiction. You are worth your recovery. It is the foundation on which you build your new life.

    Building any structure requires hard work, and recovery is no different. While we each require different tools and plans to create them, these five pillars will sustain our recovery from trauma and addiction.

     

    Jennifer Storm’s Awakening Blackout Girl: A Survivor’s Guide for Healing from Addiction and Sexual Trauma is now available at Amazon and elsewhere.

    View the original article at thefix.com

  • Why cellphone videos of black people’s deaths should be considered sacred, like lynching photographs

    Likening the fatal footage of Ahmaud Arbery and George Floyd to lynching photographs invites us to treat them more thoughtfully. 

    As Ahmaud Arbery fell to the ground, the sound of the gunshot that took his life echoed loudly throughout his Georgia neighborhood.

    I rewound the video of his killing. Each time I viewed it, I was drawn first to the young black jogger’s seemingly carefree stride, which was halted by two white men in a white pickup truck.

    Then I peered at Gregory McMichael, 64, and his son Travis, 34, who confronted Arbery in their suburban community.

    I knew that the McMichaels told authorities that they suspected Arbery of robbing a nearby home in the neighborhood. They were performing a citizen’s arrest, they said.

    The video shows Arbery jogging down the street and the McMichaels blocking his path with their vehicle. First, a scuffle. Then, gunshots at point-blank range from Travis McMichael’s weapon.

    My eyes traveled to the towering trees onscreen, which might have been the last things that Arbery saw. How many of those same trees, I wondered, had witnessed similar lynchings? And how many of those lynchings had been photographed, to offer a final blow of humiliation to the dying?

    A series of modern lynchings

    It may be jarring to see that word – lynching – used to describe Arbery’s Feb. 23, 2020, killing. But many black people have shared with me that his death – followed in rapid succession by Breonna Taylor’s and now George Floyd’s officer-involved murders – hearkens back to a long tradition of killing black people without repercussion.

    Perhaps even more traumatizing is the ease with which some of these deaths can be viewed online. In my new book, “Bearing Witness While Black: African Americans, Smartphones and the New Protest #Journalism,” I call for Americans to stop viewing footage of black people dying so casually.

    Instead, cellphone videos of vigilante violence and fatal police encounters should be viewed like lynching photographs – with solemn reserve and careful circulation. To understand this shift in viewing context, I believe it is useful to explore how people became so comfortable viewing black people’s dying moments in the first place.

    Images of black people’s deaths pervasive

    Every major era of domestic terror against African Americans – slavery, lynching and police brutality – has an accompanying iconic photograph.

    The most familiar image of slavery is the 1863 picture of “Whipped Peter,” whose back bears an intricate cross-section of scars.

    Famous images of lynchings include the 1930 photograph of the mob who murdered Thomas Shipp and Abram Smith in Marion, Indiana. A wild-eyed white man appears at the bottom of the frame, pointing upward to the black men’s hanged bodies. The image inspired Abel Meeropol to write the poem “Strange Fruit,” which was later turned into a song that blues singer Billie Holiday sang around the world.

    Twenty-five years later, the 1955 photos of Emmett Till’s maimed body became a new generation’s cultural touchstone. The 14-year-old black boy was beaten, shot and thrown into a local river by white men after a white woman accused him of whistling at her. She later admitted that she lied.

    Throughout the 1900s, and until today, police brutality against black people has been immortalized by the media too. Americans have watched government officials open firehoses on young civil rights protesters, unleash German shepherds and wield billy clubs against peaceful marchers, and shoot and tase today’s black men, women and children – first on the televised evening news, and, eventually, on cellphones that could distribute the footage online.

    When I conducted the interviews for my book, many black people told me that they carry this historical reel of violence against their ancestors in their heads. That’s why, for them, watching modern versions of these hate crimes is too painful to bear.

    Still, there are other groups of black people who believe that the videos do serve a purpose, to educate the masses about race relations in the U.S. I believe these tragic videos can serve both purposes, but it will take effort.

    Why cellphone videos of black people’s deaths should be considered sacred, like lynching photographs
    In 1922 the NAACP ran a series of full-page ads in The New York Times calling attention to lynchings. New York Times, Nov. 23, 1922/American Social History Project

    Reviving the ‘shadow archive’

    In the early 1900s, when the news of a lynching was fresh, some of the nation’s first civil rights organizations circulated any available images of the lynching widely, to raise awareness of the atrocity. They did this by publishing the images in black magazines and newspapers.

    After that image reached peak circulation, it was typically removed from public view and placed into a “shadow archive,” within a newsroom, library or museum. Reducing the circulation of the image was intended to make the public’s gaze more somber and respectful.

    The National Association for the Advancement of Colored People, known popularly as the NAACP, often used this technique. In 1916, for example, the group published a horrific photograph of Jesse Washington, a 17-year-old boy who was hanged and burned in Waco, Texas, in its flagship magazine, “The Crisis.”

    Memberships in the civil rights organization skyrocketed as a result. Blacks and whites wanted to know how to help. The NAACP used the money to push for anti-lynching legislation. It purchased a series of costly full-page ads in The New York Times to lobby leading politicians.

    Though the NAACP endures today, neither its website nor its Instagram page bears casual images of lynching victims. Even when the organization issued a statement about the Arbery killing, it refrained from reposting the chilling video within its missive. That restraint shows a degree of respect that not all news outlets and social media users have used.

    A curious double standard

    Critics of the shadow archive may argue that once a photograph reaches the internet, it is very difficult to pull back from future news reports.

    This is, however, simply not true.

    Images of white people’s deaths are removed from news coverage all the time.

    It is difficult to find online, for example, imagery from any of the numerous mass shootings that have affected scores of white victims. Those murdered in the Sandy Hook Elementary School shooting of 2012, or at the Las Vegas music festival of 2017, are most often remembered in endearing portraits instead.

    In my view, cellphone videos of black people being killed should be given this same consideration. Just as past generations of activists used these images briefly – and only in the context of social justice efforts – so, too, should today’s imagery retreat from view quickly.

    The suspects in Arbery’s killing have been arrested. The Minneapolis police officers involved in Floyd’s death have been fired and placed under investigation. The videos of their deaths have served the purpose of attracting public outrage.

    To me, airing the tragic footage on TV, in auto-play videos on websites and social media is no longer serving its social justice purpose, and is now simply exploitative.

    Likening the fatal footage of Ahmaud Arbery and George Floyd to lynching photographs invites us to treat them more thoughtfully. We can respect these images. We can handle them with care. In the quiet, final frames, we can share their last moments with them, if we choose to. We do not let them die alone. We do not let them disappear into the hush of knowing trees.

    [Insight, in your inbox each day.You can get it with The Conversation’s email newsletter.]

    Allissa V. Richardson, Assistant Professor of Journalism, University of Southern California, Annenberg School for Communication and Journalism

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

  • Treating the Growing Trauma of Family Separation

    War, disasters, trafficking and immigration are tearing millions of children from their parents all around the world. A psychologist explores how to help them recover.

    Q&A with Developmental Psychologist Hirokazu Yoshikawa

    The US immigration policy that has separated more than 5,400 children from their parents had spurred psychologists and pediatricians to warn that the young people face risks ranging from psychological distress and academic problems to long-lasting emotional damage. But this represents just a tiny part of a growing global crisis of parent-child separation.

    Throughout the world, wars, natural disasters, institutionalization, child-trafficking, and historic rates of domestic and international migration are splitting up millions of families. For the children involved, the harm of separation is well-documented.

    Hirokazu Yoshikawa, a developmental psychologist at New York University who codirects NYU’s Global TIES for Children, recently looked into research on the impacts of parent-child separation and the efficacy of programs meant to help heal the damage. Writing in the debut issue of the Annual Review of Developmental Psychology, he and colleagues Anne Bentley Waddoups and Kendra Strouf call for an increase in mental health training for teachers, medical doctors or other frontline service providers who can help fill the gap left by the lack of mental health providers available to cope with the many millions of children affected.

    Knowable Magazine recently spoke with Yoshikawa about the crisis and what can be done about it. This conversation has been edited for length and clarity.

    Are there any good estimates of the number of children throughout the world who’ve been separated from their parents?

    Exact numbers are hard to pin down, especially because several of the categories involved — like child soldiers and child-trafficking — aren’t well reported. What we know for sure is that the number of people around the world being displaced from their homes is at a historically high level. In 2018, some 70.8 million individuals were forcibly displaced due to armed conflicts, wars and disasters. That’s a record, and given that these phenomena often result in family separations and that more than half of these individuals were children under the age of 18, it suggests that historic numbers of children have been separated from their parents.

    Why have such family separations become more common?

    Many factors are driving it, but climate change is playing an increasing role in displacement and armed conflict all over the world. Climate change reduces access to dwindling resources and contributes to natural disasters, like floods, droughts, crop failures and famine. All of this increases conflicts, drives migration and breaks up families. This is not a blip in history; it’s a trend we will have to live with for generations to come.

    What’s most important to know about the damage that comes from children being separated from their parents?

    There are thousands of studies on the power of disruptions of children’s early attachments to their parents to cause longstanding problems. We’re talking about cognitive, social-emotional and other mental health impacts.

    The developmental study of the mechanisms that may explain why these separations are so harmful goes back to before World War II, with the work of psychoanalysts and scholars such as Anna Freud, John Bowlby and Mary Ainsworth. In 1943, Anna Freud and Dorothy Burlingame studied children who’d been evacuated from London and learned that in many cases being separated from their mothers was more traumatic for them than having been exposed to air raids. When families left London but stayed together, the children behaved more or less normally. But when children were separated from their mothers, they showed signs of severe trauma, such as wetting the bed and crying for long periods of time.

    Later on, Bowlby and Ainsworth published their more well-known studies of how infants form attachments with their mothers, and how sensitive and responsive parenting is key to forming secure attachments both with parents and later on with others. Researchers have found that this process can be disrupted in prolonged separations — say of more than a week — before the age of 5.

    More recently — for example, in the ongoing and high-profile studies of Romanian children who were raised in abysmally low-quality orphanages — researchers have shown how children in institutional care have suffered from poorer learning and social and emotional behavior due to the lack of intellectual and emotional stimulation and the opportunity to engage in relationships with caregivers.

    How seriously children are affected can depend on factors such as whether the separation was voluntary or not, how long it lasts and what kind of care exists in its wake. Permanent loss of parents can create some of the most severe consequences, while long periods of parent-child separation, even if followed by reunification, can seriously disrupt a child’s emotional health. Children are generally more vulnerable to long-term harm to their social-emotional development in early childhood, up to five or six years, but no period of development is immune.

    One major problem we see is that most children who are separated from their parents have already experienced some other trauma along the way, which then makes the separation even harder. When parents are present, they can often help buffer the impact of extreme adversity from bad experiences.

    What did you learn that most surprised you as you reviewed the scientific literature?

    The sheer range of outcomes was surprising to me — beyond learning and achievement and mental health outcomes, they include very basic human functions like impaired memory, auditory processing and planning. They also include a range of physiological outcomes related to stress that are themselves related to long-term disease and mortality. So parent-child separation as it is currently experienced can shorten lives and increase the chances of physical disease.

    Meanwhile, something that didn’t surprise me because I’m immersed in this literature all the time, but will probably surprise your readers, is that there are now about 8 million children in the world living in institutional care. This is a problem that reflects the lack of robust foster care and capacity of governments to facilitate placement with relatives, who will generally give more stable care than strangers. As we state in our review, even in otherwise good-quality institutional care, children suffer due to the high turnover of caregivers.  

    What relevance does your work have for US policies that have led to many parents and children being separated at the border?

    US officials should know that there’s a global consensus, expressed in the UN Convention on the Rights of Children, on how to respond to children’s needs in this context. Primarily that means avoiding separating children from parents whenever possible and, when it must happen, keeping it as short as possible. An overwhelming amount of research, going back to Bowlby, supports these guidelines.

    Unfortunately, we don’t have a lot of research findings on children separated from their parents while awaiting detention. And it doesn’t make it any easier that the Department of Homeland Security has had so much trouble keeping track of the kids involved.

    Yet there are hints of the kind of negative effects you might expect to see if you look at the research on children whose parents have been detained without warning, for example in large workplace raids to arrest undocumented workers. In these cases, researchers have found that children have missed school and suffered behavior problems and depressive symptoms.

    This brings up the fact that, in the United States, we’re talking about many more than 5,000 children being separated from parents. While the separations at the Mexican border have gotten a lot of media attention, millions of other children across our country are affected by the relatively recent harsher, sweeping policies resulting in more detentions and deportations of immigrants already living in the US. This has created a climate in which the threat of family separation is omnipresent.

    We’re particularly concerned that many children separated from their parents stop going to school, perhaps from lack of supervision or from the need to support themselves or family members. The humanitarian sector tends to focus on basic needs and that’s understandable — they want to save lives. But from a developmental perspective, we have to focus on whether children thrive, not just survive.

    Unaccompanied children who are trying to migrate are an increasing part of this global problem. What kind of special risks do they face?

    It’s true that there has been a significant increase in recent years in unaccompanied minors trying to migrate internationally. At the US border, this increase has been happening since the 1990s, due to both economic crises and increases in urban violence in Mexico and in Central American countries. But the trend is now accelerating. From 2015 to 2016, there were five times as many children estimated to be migrating alone than from 2010 to 2011. In 2017, more than 90 percent of undocumented children arriving in Italy were unaccompanied.

    Compared with refugee children who flee with their families, unaccompanied children are at greater risk for trauma and mental illness. One study of refugee children attending a clinic in the Netherlands found that the unaccompanied children were significantly more likely than those traveling with their families to have been victim to four or more traumatic events in their lives, including during their travels. They also had a higher rate of depressive symptoms and even of psychosis than refugee children living with their families.

    What are some of the best ways that governments and nonprofit organizations can help these children?

    Whatever can be done to avoid the separation from parents in the first place and to avoid detention and institutionalization of children whenever possible is in the children’s best interests. (That’s the guidance from the Global Compact for Refugees, Article 9 of the Convention on the Rights of the Child, and other global rights documents.) After that, it’s a matter of limiting the time away from parents or other caring adults as much as possible. The earlier and younger that children leave institutional care for stable foster care or adoption, the better it is for them.

    You can see this in some of the follow-ups of the study of children in Romanian orphanages. Children who left the orphanages for foster care by 15 months of age had trouble speaking and understanding in early childhood, but not later. Children placed before 30 months showed growth in learning and memory so as to be indistinguishable from other children by age 16. So recovery from early institutionalization is possible, but it may take longer if a child spent more time in the orphanage.

    What kinds of programs for children, if any, can help lessen the impacts of being separated from their parents?

    In general, programs that help equip children for their daily lives can be useful. That includes education in decision-making, problem-solving, communication and stress management.

    Teachers and doctors can play a major role, at minimum by identifying children who need mental health services and directing them to programs. The fact is we’ll never have enough mental health providers, so it makes sense to train members of the education and basic health systems that are already in place.

    In the review, we describe a few of these efforts. One that stood out for us took place in two schools in London where children on average aged 12 to 13 had been separated from one or both parents due to war or migration. They came from Kosovo, Sierra Leone, Turkey, Afghanistan and Somalia. Teachers identified children who needed services, and who then spent one hour a week for six weeks with a clinical psychology trainee doing cognitive behavioral therapy. The treatment helped reduce PTSD symptoms, and the children’s teachers later reported that the children were behaving better in the classroom.

    Granted, this was a very small study with no longer-term follow-up, so you can’t draw very strong conclusions, but it hints that even such a short-term intervention can be helpful in addressing children’s traumas. Studies have shown that even as few as 12 sessions of counseling from people trained in cognitive behavioral principles can help many people.

    Do we have any idea of how many kids are being helped by these sorts of interventions? Are we still mostly talking about small experiments?

    We’re not anywhere close to meeting the need for services. Unfortunately, health systems worldwide continue to overlook all kinds of mental health needs, particularly in low-income countries, even as depression and other mental illnesses take an economic toll, leading to reduced lifespans and reduced economic activity. The economic costs of mental health problems are huge, yet this may be one of the most underinvested areas in terms of health care.

    The largest program you describe is in China, which isn’t that surprising, given how many internal immigrants China has.

    Yes, there are potentially tens of millions of Chinese children and youth whose parents travel to cities to work and leave them behind, in the care of grandparents or other relatives. Between one-third and 40 percent of children in rural areas of China are in this situation. And there’s a lot of research documenting that these children are doing less well than children who are being raised by parents.

    We describe one community-based program involving 213 rural villages with nearly 1,200 left-behind children. For three years, each village designated a space for after-school activities for the youth and hired a full-time employee to provide welfare services. The findings suggest the approach helped reduce disparities between the left-behind and non-left-behind groups.

    What if anything gives you hope that this situation may improve?

    The outcry over the US policies has increased awareness about a very vulnerable population of children. That could be a silver lining of the crisis. These parent-child separations are going on not only at the border, but also all over the country. The hope is that the attention will increase support for organizations, such as the national Protecting Immigrant Families Coalition, that are working to make a difference.

    When it comes to children throughout the world who’ve been separated from their parents, we need a lot more people to be aware and concerned so as to provide the attention, stimulation and care that can help them recover.

    Editor’s note: This article was updated on January 24, 2020, to clarify that in addition to teachers and medical doctors, Dr. Yoshikawa and his colleagues also recommend mental health training for all frontline service providers.
     

    10.1146/knowable-012320-1
     

    Katherine Ellison is a journalist, author and mother with a keen interest in issues related to parenting. Her latest book is Mothers & Murderers: A True Story of Love, Lies, Obsession … and Second Chances.

    This article originally appeared in Knowable Magazine, an independent journalistic endeavor from Annual Reviews. Sign up for the newsletter.

    Knowable Magazine | Annual Reviews

    View the original article at thefix.com

  • When Disaster Strikes: Opioid Use Spikes in the Wake of Hurricanes and Fires

    When Disaster Strikes: Opioid Use Spikes in the Wake of Hurricanes and Fires

    For some people already struggling with opioid addiction, a natural disaster may cause a relapse – even an overdose.

    Before the Camp Fire, Steve Caput saw about one overdose per week. Usually opioids, sometimes meth.

    Then, in November of 2018, the Camp Fire ripped through the Northern California towns of Paradise and Magalia, killing 85 people – many of them older and disabled – and burning nearly 19,000 structures.

    Beginning in December or January, the former Butte County paramedic started seeing “an absolute uptick in just constant opioid overdose.”

    In January, more than a dozen people at a house in Chico were involved in a mass overdose. While several people were treated with naloxone – an opioid-reversing drug – one died, and the incident shook Butte County.

    Caput was on the scene – “it was just absolute chaos,” he said – and, during his last week working in Butte County, he saw three overdoses in three days.

    “People, they don’t care anymore, they’ve just given up,” he said.

    Eventually, Caput left to work as a paramedic in South Lake Tahoe, tired of what he described as a drastic increase in calls of all kinds.

    “You just get burned out,” he said.

    Latonya Narcisse, a licensed chemical dependency counselor at Gulf Coast Health Center in Port Arthur, has been working with opioid-addicted patients for ten years.

    After Hurricane Harvey in 2017 and the 2019 flooding caused by Hurricane Imelda, she observed a significant increase in opioid abuse.

    People who’d been sober for over a year relapsed from disaster-related stress. Recreational users spiraled into addiction. Patients in treatment for opioid addiction, unable to make it to the clinic, turned to heroin. “The drug becomes your coping mechanism,” she said.

    And in Caguas, Puerto Rico, a psychologist treating opioid addiction, noticed a similar uptick. Hurricane Maria had hit Puerto Rico as a Category 4 storm in 2017, creating an estimated $90 billion in damage and causing the deaths of about 3,000 people.

    “After the hurricane, we didn’t have electricity, we didn’t have water, we didn’t have food. People lost their homes,” said Dr. Luis Roman, director of mental health services at Corporacion SANOS, a health center that offers medication-assisted treatment for patients addicted to opioids.

    “In people who [had previously] used drugs, that increased the relapse in their use of opioids, and other drugs, too.”

    James Moore, an emergency room doctor at Enloe Medical Center in Chico, hesitated to draw hard conclusions about what he’s seen since the Camp Fire, but he did offer a similar speculation: “I don’t know if a tragedy would necessarily get people started on opioids,” he said. “My guess is that patients with previous experience on them are now becoming more abusive of those medications.”

    THE CONSEQUENCES OF DISASTER

    In other words: For some people already struggling with opioid addiction, a natural disaster may cause a relapse – even an overdose.

    Evidence already suggests that substance abuse increases in the wake of a catastrophe, natural or otherwise.

    According to Imelda Moise, a health geographer at the University of Miami, people who experience natural disasters are more likely to develop mental health issues, including depression, anxiety, and post-traumatic stress disorder. Substance use disorder rates, in turn, are higher among people experiencing mental health issues.

    “People are traumatized; they are seeking different ways to cope,” Moise said.

    Moise found that hospitalizations for substance use in the New Orleans area increased 30% from 2004 to 2008. New Orleans was devastated by Hurricane Katrina in 2005.

    It makes sense that opioid abuse – which has come roaring into public awareness over the past several years – would also be affected by natural disasters. But the relationship between the two isn’t well understood yet, in part because it’s barely been studied.

    At least one pair of scholars is working to fill the gap. Meri Davlasheridze of Texas A&M University at Galveston and Stephan Goetz of Penn State have been studying the prevalence of opioid-related deaths in communities affected by natural disasters, such as floods and tornadoes.

    They’ve found that communities that experience a natural disaster are likely to see an increase in opioid deaths, beginning about two years after the incident and lingering even nine years in some cases.

    Communities that experience higher numbers of natural disasters will see a correlating rise in opioid deaths, said Davlasheridze, a professor of marine sciences who studies the socioeconomic impacts of catastrophes.

    “Looking at this problem more comprehensively over the long term is very important” for both disaster planning and opioid crisis management, Davlasheridze said.

    CONFOUNDING VARIABLES

    It’s worth noting that not everyone sees the connection. Mark Walker, a Butte County paramedic supervisor, has noticed a definite jump in emergency calls, but only a small increase in overdoses, which he attributes to a redistribution of the county’s population after the Camp Fire.

    And when opioid use or overdose levels change in a community, it’s hard to know why. There are a lot of confounding variables – essentially, factors that make it hard to attribute changes in opioid use to any one source – said Dr. Andy Miller, Butte County’s health officer.

    To give just one example, Miller explained that Butte County has been working to reduce its number of opioid prescriptions.

    The county has also been making naloxone more widely available, which means that friends, loved ones, or passersby can reverse an opioid overdose on the spot – an overdose that’s then less likely to be reported.

    Perhaps because there are so many confounding variables, even people who notice an uptick are hesitant to attribute it to a natural disaster.

    For example, Chris Rosa, deputy administrator of Ventura County’s Emergency Medical Services, noticed an increase in opioid overdoses in 2018, the year following the 280,000-acre Thomas Fire.

    “The concentrations always seem to hover right around the cities of Oxnard and Ventura. And in particular, the [concentrated] areas around Ventura are right around areas directly affected by the Thomas Fire,” he said.

    However, “it’s a little hard to determine whether it’s impacts from the fire or just normal concentration.”

    THE PATHS TO OPIOID ABUSE

    How might natural disasters cause an uptick in opioid overdoses? There’s likely no single, clear-cut path.

    “It is generally true that you will see a higher prevalence of psychiatric disorders, especially depression, anxiety, and PTSD among opioid patients and patients in opioid treatment,” said Andrew Rosenblum, executive director at the National Development and Research Institutes.

    But disasters bring other complications, including disrupting access to medication-assisted treatment and increasing the risk that a person will try a new, unknown, and potentially more dangerous form of a familiar drug, Rosenblum explained.

    “If their usual supply of opioids is disrupted…they may not know what they’re getting or the dose of what they’re getting, or they may use it in ways that are more harmful,” he said.

    Disasters may affect people more indirectly as well, Davlasheridze suggested. Some people may experience a fairly straightforward trauma, such as losing a loved one, that prompts a turn to opioids.

    But as a disaster works its devastating effects on a local economy or destroys a community’s employment, financial trouble may lead to the same result.

    The idea that a job lost might contribute to opioid abuse fits well with Narcisse’s experiences working with patients after Harvey and Imelda. She saw patients who lost their insurance when their job disappeared, and who then couldn’t afford to continue with a legitimate pain prescription or with medication-assisted treatment.

    “With a loss of job, basically, the person doesn’t have the money to continue the prescription, and the next best thing is to go back to old ways,” she explained.

    And Caput has heard similar stories on the way to the emergency room.

    “I always ask people [about the overdose], because I’m always curious,” Caput said. “I’m with them in the back of the ambulance by myself very often, so I get time to talk to them.”

    A familiar narrative kept emerging in the wake of the Camp Fire. A patient would have had a regular life and job before getting injured – often at work – and receiving an opiate prescription to manage the pain.

    Then something would interfere: The person would lose a healthcare provider, neglect to refill a prescription, or lose their job and insurance. “And basically, without wanting to, they go cold turkey, stop, and what happens is they turn to street drugs.”

    This article originally appeared in DirectRelief.

    Direct Relief has provided both material and systemic support to communities recovering from the Camp Fire, Hurricane Maria and Hurricane Harvey, which includes provisions of naloxone and funding to help combat the opioid epidemic.

    View the original article at thefix.com

  • Rehab Redemption: Faking It in the Fishbowl

    Rehab Redemption: Faking It in the Fishbowl

    As I shared my experience with the group, I knew that I should be expressing some kind of emotion, but the tears simply refused to come.

    There was a group activity – an exercise – they made us do at the inpatient treatment facility where I ended up because I couldn’t stop drinking. It was called “Fishbowl,” and it required an individual to sit in the center of a large circle of folding chairs and describe something horrible that had happened to them, or some shameful act they’d committed against somebody else. The other addicts and alcoholics would sit in these chairs — the “bowl” — and listen as the “Fish” shared this traumatic event from their past. Without fail, by the time the tale was over, the storyteller and most of the people in the room would be sobbing uncontrollably. 

    Often, the Fish would reach a point mid-story when their emotional response would render them incapable of carrying on. The audience would sit there uncomfortably, waiting to hear how the narrative played out, watching in disappointment as a counselor wrapped the Fish in a tight, one-armed hug while holding a box of tissues up to their tear-streaked and quivering face. And yet, regardless of the tears, and despite the very real prospect of either witnessing or suffering a complete mental breakdown, everyone in the facility — staff and patients alike — absolutely loved doing Fishbowl.

    Get That Shit Out of Your System

    It was a 30-day treatment program, and Fishbowl was conducted on a four-week rotation, meaning that with a little luck, you were able to participate twice during your visit. I had essentially won the lottery by walking into the beginning of an intense Fishbowl session on my very first day at the facility. My peer advisor — a skinny 20-year-old in khakis who was trying to quit heroin — told me as much as he led me away from the reception area and down a hallway that ended at pair of steel double doors. “Fishbowl fucking rules,” he told me. “It feels so good to just get all the shit out of your system!” 

    He cautioned me to be quiet as we entered the lecture hall. The doors opened to reveal a ring of people seated in a circle and segregated by gender along a diametric divide. A few people turned to look as he directed me to an open seat between a middle-aged man with a Wyatt Earp mustache and a teen with a shaved head wearing a tattered blue hoodie. The chairs were pointed inwards towards a young woman who was, to my horror, sobbing and convulsing as she gulped down air and twisted a plastic water bottle in her hands as if wringing a towel. 

    The Fishbowl was my first experience in treatment. Before I’d even been shown to my room, I witnessed a stranger scream through tears about how she’d barely escaped a house fire she’d caused by passing out with a lit cigarette in her hand. Her cat, she bellowed, had died in the blaze.

    The young woman finished her story and the audience members thanked her for sharing while providing a light round of applause. As she walked back to her seat, a stocky man with a buzzcut and the general demeanor of a high school gym coach stood up and asked who would like to be next in the bowl. Instantly, 50 synchronized hands shot into the air and a raucous chorus of “Me! I will! Me! Bryan, pick me!” resounded from the perimeter of the folding chair circle. My peer advisor – Mr. Khaki – was the lucky one chosen, and he clapped in excitement as he trotted to his place in the center of the room. 

    Once seated, he placed his hands in his lap, took a breath, and launched into a story about showing up to a trap house to score drugs and being robbed by a pair of dealers who beat him severely and then forced him into the trunk of their car. They drove around for hours, stopping intermittently to exit the vehicle for brief periods of time before returning and driving off to their next location. Mr. Khaki recounted through barely decipherable sobs how every time the car stopped, he assumed they were about to pop open the trunk lid and kill him. That feeling of powerlessness, he explained, combined with his ever-worsening heroin withdrawals, created a hellish experience of total vulnerability that ultimately set him on his current course to recovery. 

    Eventually they stopped and the trunk opened an inch, as if someone had pulled the release handle inside the cab of the car. He heard the dealers exit the vehicle and assumed the worse, feeling around for anything he could use as a weapon to defend himself. But the men simply walked away, the sound of their voices and footsteps quickly fading into silence. He climbed out of the trunk and took off running. After a few blocks he slowed down and then walked several miles to the house where he lived with his mother. He cleaned himself up, and never reported the incident to the police. When his mom asked about his black eye and the cuts on his face, all he would say is that he wanted to stop using, and that’s what led him to the inpatient treatment center where he was now sharing his story. 

    Mr. Khaki’s traumatic experience clearly resonated with the other members of the group. There was an explosion of thunderous applause, along with shouts of appreciation and encouragement as he accepted a tissue from Bryan and stood up from the chair. He was replaced by a girl who told a story about being abused by an ex-boyfriend — a man who, she told us, was currently undergoing treatment at a different facility. Then the gentleman with the mustache fell to pieces as he recalled missing his daughter’s birthday party because he was passed out drunk behind the wheel of his pickup truck in the woods where he’d go to drink in secret. Bawling and quivering, he choked back sobs as he recounted how he’d regained consciousness in the dead of night, unsure of how to get back to the highway. 

    My Turn in The Fishbowl

    Eventually, Bryan, the linebacker of a counselor who was running the Fishbowl session, turned to me and asked if I’d like to give it a try. “How about it… Jason K.?” He squinted at my adhesive name tag. “Why don’t you tell us something about yourself?”

    “Uh… I’m okay. I’m still getting the hang of things,” I replied, wondering if anyone would try to stop me if I made a run for the exit.

    “What’s your D.O.C.?” Mr. Khaki interjected. I wasn’t sure what he meant. I knew that most of the other people at this facility were here by court order. Was he talking about the Department of Corrections? 

    “Um, I’m actually here voluntarily,” I said. “I checked myself in.”

    “No, your drug of choice,” said Mr. Khaki. 

    “Oh, um, alcohol mainly, but once I get started with that, anything is fair game.” There were murmurs of understanding and acceptance from the other members of the group. 

    “How much clean time do you have?” asked Bryan.

    “I’m two weeks sober today,” I replied. “A week in the detox center, then six days waiting for a bed to open up here.” At this admission, a roar of applause even bigger than the one elicited by Mr. Khaki’s story erupted from the circle.

    “I know you just walked into this, and it probably seems overwhelming, but it’s a great way to start your time here. Get something off your chest.”

    “Yeah,” Mr. Khaki chimed in. “You’re gonna have to do it eventually. Might as well get it out of the way.” Other members of the group were urging me on as well, offering words of encouragement to motivate me into that chair at the center of the room. I felt like they were starving for my trauma. Like everyone was eager to get a taste of the new guy’s emotional pain. 

    “Alright,” I said, to a round of anticipatory cheers. “Fuck it. I’ll go.” 

    The seat was still warm from the cumulative body heat of the last dozen people to sit here and make their confessions. I began rooting around in my brain for something to share, wanting nothing more than to escape through a window and suck down ten cigarettes in rapid succession. I’d chain smoked nearly that many on the sidewalk outside the treatment center just one hour earlier while mustering the courage to propel myself inside. It took everything I had left, courage-wise, to flip through the smoke-damaged photo album of my mind in search of a suitable story to share. 

    The Tears Refused to Come

    Should I tell them about the time I got caught breaking into a bar where I worked? How I was fired, couldn’t pay my rent, and subsequently ended up being evicted? Or the time I was kicked out of a rock show for being too drunk, and when the bouncer led me out the door at the back of the club, I fell down the stairs and landed on my face in the alley below? How a police officer sat me on the curb and held napkins to my nose and mouth until an ex-girlfriend of mine just happened to walk by, and how she took me to her brother’s apartment and cleaned my wounds while sobbing and begging me to go to treatment? And even then, how I refused to stop drinking after one of my teeth became abscessed and my jaw swelled up to the size of a grapefruit, and the doctor told me I might die? Or maybe I could share about the time I stole an acquaintance’s wallet out of his coat pocket as we walked through a crowded bar, then pulled out the cash and threw the rest down a storm drain. About how, when he noticed it was missing, I convinced him he’d left it at the last bar we were at, and even helped him look for it. I had hundreds of stories like these to share, each one a reminder of who I’d become and why I now sat there, frightened and confused in the Fishbowl, hating myself. 

    In the end, I decided to share the story of how my mother deserted my family when I was eight years old. Better to throw her under the bus, I thought, than to expose myself as the world’s biggest piece of human garbage. I began by talking about how she simply disappeared one night while we were sleeping. She’d written a note, explaining that she was too young to be married with kids, and she needed a chance to go live her life. I told the group how my sisters and I went to live with my aunt and uncle until my dad was able to figure out how to proceed in the aftermath of being abandoned by his partner. We ended up moving into my grandmother’s house, where we began the laborious process of rebuilding our lives. We didn’t see mom again for several months, by which point she was drinking pretty heavily.

    As I shared my experience with the group, I knew that I should be expressing some kind of emotion — that I should be bawling my eyes out like everyone else — but the tears simply refused to come. I tried forcing myself to cry by thinking about how I’d ended up here — an emotional phone call to my dad at a time when suicide was starting to look like the most sensible option — but it soon became obvious that my emotional moment wasn’t going to happen. I’d already cried so many tears for her over the course of my life that I now seemed to be tapped out at a moment when they actually might have done me some good. I wanted to fit in, to exhibit the vulnerability that my peers had so fearlessly demonstrated before me, but the best I could do was to put on a show, burying my face in my hands and pseudo-wailing while doubled over in my chair, a pale imitation of the genuine anguish I’d so recently witnessed. 

    My performance was a hard sell to this group of master-level bullshit artists. No applause followed, and no thanks were given. Instead, we all sat there blinking at each other for what felt like a decade before someone finally spoke up. 

    “Okay, that’s enough for today,” Bryan said. “Let’s finish with the serenity prayer.” 

    I stood up and made my way back to the circle, joining hands with Mr. Khaki and the blue hoodie kid. I’d learned the words to the prayer a few years earlier, when a previous landlord — herself a recovering alcoholic — convinced me to attend Alcoholics Anonymous, the implication being that it was the only way to save myself from eviction. I went to a few meetings and learned just enough to convince her I was working the program, but I never actually stopped drinking. She eventually caught on to my scam and kicked me out, but still, the words of the prayer had stayed with me.

    “God,” Bryan began.

    “God,” we echoed, linked by our tobacco-stained fingers around the now-empty folding chair. 

    “Grant me the serenity to accept the things I cannot change,” we continued in unison, our words echoing across the high ceiling of the lecture hall. 

    “The courage to change what I can,” we went on, most heads bowed and eyes closed, but not mine… not yet. “And the wisdom to know the difference.”

    “Free time for 30 minutes, then small groups,” said Bryan, prompting the crowd to disperse. Most people went outside to smoke while Mr. Khaki showed me to my room. I expected him to give me shit about my performance, but we walked down the hall in silence until we reached the door marked D402. He showed me around and then left me alone to unpack. I opened the suitcase I’d borrowed from my dad and started taking out the clothes he’d purchased for me just before dropping me off at the bus station. I placed a pair of flannel pajama pants in a drawer with the price tag still attached to the waistband. Then a package of white t-shirts, and socks, and toiletries that we’d shopped for with the enthusiasm of preparing for the first day of school. Rehab and kindergarten were similar for me in that way; the excitement of a new beginning, combined with a sense of absolute, bowel-clenching terror. And finally, at the bottom of the bag was a carton of cigarettes — Camel Lights — with a note taped to the front: 

    You got this, boy
    Love, Dad.

    That’s when I started to cry. 

    View the original article at thefix.com

  • My Family Is My Greatest Disappointment

    My Family Is My Greatest Disappointment

    Even though my aunt knows I’ve scrubbed my stepmom from my life in an attempt to stop and reverse years of psychological abuse, manipulation, and mind fuckery, it’s a reality she refuses to accept.

    HE IS RISEN!

    This was the one-line email I woke up to on Easter Sunday. It was from my aunt, my dad’s youngest sibling. Growing up, my cousins and I agreed that she was the cool aunt, the one who took us to the Philadelphia Zoo in the summer and let us drink gallons of Pepsi when our parents weren’t around. But I wasn’t thinking about that when I opened her Easter email; instead, I was silently fuming over who she publicly copied. As I scrolled through the list, my stepmother’s address appeared directly under my dad’s and if I could see hers, that meant she could see mine.

    I imagined my aunt sitting in front of her computer screen. She would have entered my dad’s email first, because he’s her oldest brother. Immediately after, she’d insert my stepmother because she’s my dad’s wife. And I had no doubt my email was added under my stepmom’s because my aunt thought of the three of us—my dad, my stepmom, and me—as a family, as if we fell into a ditch and were covered over in cement. But we’re not, and we haven’t been for more than 20 years.

    And even though my aunt knows I’ve scrubbed my stepmom from my life in an attempt to stop and reverse years of psychological abuse, manipulation, and mind fuckery, it’s a reality she refuses to accept. As a result, my email address landed, free of charge, in my stepmom’s inbox. Whether she uses it or not is not the issue, it’s that she has it when my aunt knows I don’t want her to.

    This wasn’t the first time my aunt casually glossed over a boundary I erected to preserve my health and well-being.

    Years ago, there was an incident at my grandmother’s funeral. After the burial, everyone headed back to my aunt’s house for lunch. Both my dad and stepmom were there, and by that point, I’d been estranged from my stepmom for nearly a decade. As I climbed out of the car, my aunt, with camera in hand, corralled the three of us together on the front lawn. Looking at me she pulled her arms apart as if holding an accordion.

    “I want a picture of the three of you.”

    I looked at her and shook my head, “What?”

    “Please.” She said firmly. “I need a picture of the three of you.”

    My stepmom stood next to my dad, and I watched as she slowly rolled her shoulders in towards her chest and puffed her bottom lip out like a child on the verge of sticking her thumb in her mouth. Feeling outnumbered, I glared at my aunt, hoping she would give up and back off. But instead, she got angry. In a petulant fit, she slammed her arms down, stomped her right foot, and demanded, “I want a picture.”

    At that time, I didn’t know how to defend my boundaries. Saying no or walking away from my aunt at that moment would’ve been a blatant act of disrespect. I didn’t want to offend my aunt, but today I can’t help but wonder why it was okay for her to offend me.

    In the end, I did what I felt was the right thing to do; I walked over and stood next to my stepmom. Immediately, my body flared up in protest. My stomach cramped, my hands trembled, and my breath got caught in the back of my throat. My aunt raised her camera and took the shot. I don’t know about my dad or stepmom, but I know I didn’t smile.

    Back at my computer, I hit reply (not reply all) and mentally wrestled with my response. I was angry, but I didn’t know what I could tell my aunt about my relationship with my stepmom that I hadn’t already said before. And as my fingertips rested on the keyboard, I acknowledged, for the first time, what I was feeling was beyond anger. It was disappointment.

    I wanted to tell my aunt how disappointed I was in her. But then I realized it wasn’t just my aunt who let me down. It’s also my dad, who drank himself stupid, and my brothers, who in their fifth decade of life have yet to kick their drug habits. It’s a cousin who overdosed on heroin, and every uncle who died of alcoholism. It’s all the other addicts I’m related to who through the years traded blowjobs for crack. And it’s every other family member who, like my aunt, continues to look the other way because they don’t have the guts to acknowledge reality. I want to ask my aunt if she’s ever looked at the miserable picture she took of my dad, my stepmom, and me at my grandmother’s funeral and I want to know if she can see the truth now.

    As I mulled over my response, I decided the email I wanted to send—about how our family has been my greatest disappointment—wasn’t worth the effort. So, I replied to my aunt with a question I knew she’d be happy to answer.

    WHO’S RISEN?

    View the original article at thefix.com