It’s Easier to Write About Addiction Than It is to Work in the Field
Early in my career, I worked as a nutrition clinician, counseling women and men who were overweight or obese. I then switched to a career of writing books about the same topic, focusing on “success stories” – people who had lost weight and kept it off.
After the switch, I found myself frequently saying, “It’s a lot easier to write about this than it is to work in the field.” Certainly, the “before” sagas people shared with me could be heartbreaking. For instance, one woman attributed the beginnings of her weight problem to sexual molestation by a relative that began when she was in sixth grade. She recalled saying to herself, “If I get fat, then boys will leave me alone.” But in the end, the stories I detailed had happy endings.
After the switch, I found myself frequently saying, “It’s a lot easier to write about this than it is to work in the field.”-Anne FletcherThen I wrote about individuals who had long-term sobriety from alcohol use disorders. (Many had struggled with drugs as well.) They commonly recounted pre-sobriety stories that were painful to hear and I’m sure they were difficult to tell in many cases. One woman shared how a truck tragically struck and killed her four-year old son while she was “having a party.” Once again, however, the stories had good-news endings.
For my latest book, Inside Rehab, participants didn’t have to have found success – some had, while others were still struggling. Many shared how they’d been damaged by their multiple treatment experiences. A few of these people died while I was writing the book. One man told me he’d been to 30-day rehab at least a dozen times and “always went right back to using drugs.” He said didn’t connect with 12-step treatment, but was repeatedly told it was the only way. Sadly, just as I was finishing the book, his mother called to let me know of his death from drug-related causes.
Although I developed long-distance relationships – some that lasted for years – by phone and by email with many of the people I wrote about, I met few of them in person.
A Different Ball Game
Now that I’m working in the field, I find that it’s a whole different ball game working face-to-face with people struggling with addictive behaviors and emotional pain than it is writing about it.
I’m not a therapist, but I get to interact with clients on several levels at a co-occurring substance use and mental health disorder outpatient program, co-leading a family group, teaching skills groups, and peer facilitating (as a recovery coach) a long-term support group. Their pain is often palpable. To see their expressions and to be able to look in their eyes brings things to an entirely different level.
Here are just some of the experiences of individuals I’ve encountered recently:
- In one night, I learned about two of our clients who had been gang raped. Both of them had had a substantial period of non-use of their drug of choice, but had returned to using, which brought them to us. One started using heroin again as a coping mechanism after a family tragedy. The other returned to crack cocaine use after being committed to a mental health facility where she reported drug use was prevalent.
- A young man with a serious alcohol use disorder completed our treatment program and now has to do time in the “work house,” which allows him to work at his physically strenuous day job, but requires his return to jail at the end of the day. He attends our long-term support group. Because of longstanding severe back pain, jail personnel allowed him to go to the emergency room. He lamented, “When I arrived, I made the mistake of first presenting jail papers that required signing before I left.” From there, he said he was treated with disrespect – for instance, he could hear staff laughing about him in the hallway. He said his problems were dismissed, no tests were done, and he was sent on his way with nothing for relief. “They probably just thought I was pill-seeking.”
- In our Family and Friends Group, we have several families with young adult children who have serious mental health problems, ones for which psychiatric medications provide little relief. But alcohol and/or drugs provide temporary escape – usually with enormous consequences. The “children” have been to residential programs and hospitalized multiple times. The parents seem to feel hopeless, which is likely the case for the young people, too. In situations like this, often the goal is to facilitate placement in such places as well-run group homes or to facilitate connection with Assertive Community Treatment (ACT) teams that come to the clients, often enabling them to live more independently.
- Clients with longstanding methamphetamine problems can seem particularly discouraged and demoralized. Unlike addiction to alcohol and opioids, we have no medications to help with meth cravings. And chronic use can cause brain changes that may not be reversible. (See Finding a Fix for Meth Addiction.) A man in one of the groups I work with has been a regular meth user for decades. He recently shook his head as he said, “I don’t care about anything – my kids, my wife…” and the list went on. His sadness and seeming lack of control over his drug use felt heart-rending. (But he does keep coming to treatment, without a court order.)
- Grandparents in our Friends and Family group, who raised a fairly large brood of their own, are now raising a grandchild of their youngest child (approaching age 30) whose long history of substance use problems led to the grandparents taking custody of the grandchild at an early age. As the child approaches puberty, the grandparents are exhausted – not only because they thought raising the grandchild would be a temporary thing – but because they are still dealing with the difficulties of the grandchild’s parent. They also regularly deal with the pain of the grandchild, who is hurt by such things as the parent’s chronic lateness for visits. The grandchild recently said to his grandparents, “What if something happened to you and I had to go live with [the parent]?”
- Another parent (as well as two siblings) of an adult child with an alcohol use disorder came to us looking for support. This parent, too, has assumed much of the parenting of the grandchildren (from the troubled adult child), as has one of the siblings. It was reported that one the grandchildren said to the other, “Let’s face it, our parents [who are divorced] suck at raising us.”
- A very quiet person in one of my skills groups reported struggling with drinking, starting in the early evening – a longstanding behavior associated with the time of day of complete chaos experienced at home while growing up. I recently found out that this person was sexually abused by a family member beginning when the client was a preschooler.
The “children” have been to residential programs and hospitalized multiple times. The parents seem to feel hopeless, which is likely the case for the young people, too.-Anne Fletcher
…the grandparents are exhausted – not only because they thought raising the grandchild would be a temporary thing – but because they are still dealing with the difficulties of the grandchild’s parent.-Anne Fletcher
How Do Counselors Cope?
One person, expressing utter frustration with her loved one, recently turned to our director during our Friends and Family Group and asked, “How do you keep doing this?” Paula DeSanto, MS, LSW responded, “We do it by practicing the skills that we teach our clients. It’s the way to survive.”
The skills include self-care, learning how to detach when you’ve given an effort your best shot, creating a healthy environment (which includes setting appropriate boundaries), practicing acceptance and mindfulness, learning healthier emotional regulation, developing meaningful activity, cultivating hope and gratitude, using cognitive reframing, understanding impermanence, and more.
We offer hope by teaching clients about the brain’s plasticity, helping them understand that, with new skills, they can change neuropathways…and so can we.
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