Living with Addiction: A Developmental, Progressive and Holistic Condition

In the field of substance use disorder care counselors like myself work diligently in support of those nearest to the patients we treat. Whether it is a traditional family member, an elected family member or anyone that shares an emotional bond with the patient, their health and the health of the system they inhabit can be an asset in all measures of patient care. It is vital to have a sound understanding of how the disease of addiction impacts those around the chemically dependent individual. I would like to add a bit to this conversation.

Pre-contemplative

First, it’s important to understand that the evolving methods of compensation that family members and friends create in their efforts to live with someone with substance abuse disorder are mechanisms for survival. Secondly, it is vital to recognize these evolving methods as pre-contemplative; that is to say the individual is not completely aware that they are living in a manner that is all that different. Once the progression begins, previously unthinkable actions or activities come slowly into conception, ultimately working to become acceptable and even commonplace. Without understanding this process it is easy to blame a family member or loved one for “enabling” the behaviors of those with a substance use disorder.

Developmental/Holistic/Progressive

The impact of the disease of addiction is progressive. So, just as an individual with a substance use disorder will become increasingly ill, so too will family members or other loved ones if they remain in proximity of the substance user without intervention. In addition, as clinicians have noted for some time, since the social structures in which family members reside and the physiological responses they have are so similar this progression can be qualified and even quantified to substantiate the level of impact endured. Let’s explore this reality.

Spirituality/Values: At the outset you will see the genesis of this progressive influence on value systems; the impacted family member or other loved ones spiritual nature begins to erode. He or she begins to doubt their own judgment, abilities and senses. They begin to accept violations as to how they might wish to live, or how they are treated. Similarly, a parent, spouse or other loved one begins to feel lost, confused or uncertain and subsequently begins to acquiesce to the previously unacceptable.

Mentally/Rationality: These low-grade violations spark the use of defense systemCapture 1s, or active methods of compensation. The affected family member begins to intellectualize, justify, or minimize what he or she sees and/or how they are now living. Rationalizations become commonplace: “All kids experiment right?” . . . it is just a phase . . . she is just stressed with work . . . it is only weed . . . everything will be better after the holidays . . . and the list goes on. Although these defenses can be quite productive in decreasing discomfort or stress short-term (try saying the word “only” aloud… comforting right?), long-term they add to the mounting violations of self.

Emotionally: Emotions begin to be more high-risk as family members live constantly in fear for the safety and wellbeing of someone they care so much for. They look for control and begin demanding change, and attempt to orchestrate stability. As their confusion and disbelief grows they become angry or dreadfully sad. “How did we get here?”, “why are they doing this?” Members may become defensive and jealous of those not struggling as they are. They begin to feel unsafe in their own home, often consumed with resentment. They can find little hope in most of what is around them and find themselves wishing desperately that things would just change.

Physically/Behaviorally: The substance user and family members have begun to live much differently now; isolating themselves, declining social engagements. As family members grasp for order they become an unwitting detective in their own home, searching for evidence, attempting to fill up the hole that has been created in their heart. They begin to hide valuables, lock rooms; perhaps purchase a safe, or take doors off of hinges. They might sleep on the couch waiting, or drive to a location to see if their loved one got there as they didn’t believe they would, yet could not say “no” to their request. As this progression begins to run full steam family members move into physical distress. They have become hypersensitive to their environment, jumping at sudden noises like when the phones rings or a door slams. Stress responses have led to sleep disturbances in which they might wake hourly, or wake early before the alarm goes off, staring at it each morning as getting out of bed is now a laborious chore. They may even note they have stopped dreaming vividly as they now tend not to enter into REM sleep. Their appetite is diminished, accompanied by other stomach alignments. Finally they might find they are experiencing muscle twitches in their legs or the corner of their eyes, or hair loss, and dry skin. They may notice they are clenching or grinding teeth at night, or biting nails. Breathing is consistently shallow and it feels like a weight is constantly on the chest. Overall they feel sad and unmotivated, have racing, anxious thoughts and forget things easily. Relaxation is a long lost friend as is self-worth and esteem. And yet in spite of the profound impact, in the back of their mind, the thought still remains— “if I could just get them to stop all would be well… “

Moving forward

Those of us who traverse this terrain know well that affected family members and loved ones require and deserve the healing and comfort that accompanies personal recovery. And though not yet its own substantiated diagnosis I believe practitioners should continue to critically evaluate the reality of addiction as a Family Disease and work to classify symptom progression to better support the care we provide clinically.

Be well,

Jerry Blackburn M.Ed., CDP

www.jerryblackburn.weebly.com

If you or a loved one is struggling with a substance use disorder or its impact please seek help.

http://jerryblackburn.weebly.com/resources.html

Becoming Part of the Solution

As with communities all over the country, Issaquah and Sammamish are in the midst of a healthcare crisis. In the last month or so we have witnessed several fatal overdoses involving young adults, and even as a healthcare provider I cannot begin to estimate how many overdoses have gone without response.

What we have begun to acknowledge in our community however is that substance use, abuse and dependence are an ever present reality that require our compassionate attention.   Drug use trends tend to change slowly as is the nature of populations. That being said, at times we can have bursts of change, usually resulting from some atypical event. Take for example what is commonly referred to as our current “opiate epidemic”— in hindsight a clear product of the massive over-prescription of powerful opiate medication. Another example is our state’s rapid comfort with medicinal and recreational use of marijuana impacting youth access and use.

There are fortunately some community investments we can make to support our young folks with regard to risk and protective factors.

Some of the basics are:

  • Be informed- Reality and perception are often distant. For example according to Issaquah High School’s 2012 Healthy Youth Survey, 40% of our seniors report having used marijuana. What percentage of parents might consider it to be their child? http://www.issaquah.wednet.edu/family/health/HYS.aspx
  • Share a consistent message- Often students hear mixed messages. Perhaps one substance is acceptable, and another is not, etc. Law enforcement, parents, schools and the community can work to share a common theme. Bottom line, healthy youth do not use any substances, and alcohol and other drug use always degrades their physiological wellness, health and development.
  • Share your expectations- This is a significant predictor of young people declining to use drugs. They really do hear us!
  • Positively populate- Be a vocal, invested community member. Venture out and provide a community norm that regards health and safety and discourages drug use and other illegal activity.

Our young people look to us for boundaries and a safe place to learn and grow. They thrive in the security and consistency we create. Let us give them the best that we have. The most advantageous of opportunities.

Please join us for substance use specific content and support in our community.

https://www.facebook.com/IssaquahCommunityDrugFreeCoalition

Let’s Learn About Mental Health Parity

All right students, take out your textbooks and turn to page 42, “learning about mental health parity.”

Enough already with the moaning and groaning.  This is an important topic.

Did you know, for example, that “the vast majority of Americans” know nothing about mental health parity?  According to Dr. Gregory Fritz of Brown University, “They are neither ‘for’ nor ‘against’ it – they just don’t think about it.”

Dr. Fritz also says that mental health advocates have a “huge educational task” before them and that the first step is to “educate ourselves.”

So let’s get on with it!  Let’s learn about mental health parity.

The word “parity” means “the state or condition of being equal, especially in status or pay.”  When we talk about “mental health parity” we are highlighting efforts to treat mental health with the same dignity and importance as physical health.

Sounds simple, right?  Unfortunately, for centuries people didn’t think mental health was equal to physical health.  Even in the 20th Century, “It’s all in your head” and “get a grip” were responses given to men and women seeking help for mental illness.  The stigma was so painful that most people feared to seek help.

It’s been a long, hard struggle to bring mental illness out of the shadows.

Less than twenty years ago the first Mental Health Parity Act was passed by the United States Congress.  The MHPA required insurers to provide mental health benefits no lower than the annual and lifetime benefits they accorded to physical health.

It was a good first step, but essentially toothless.  Like today, most patients didn’t know about the law.  Doctors, hospitals and insurers found ways to get around it.  The law itself didn’t actually mandate mental health coverage.  Insurers could simply by-pass the Act by not offering it.  The Act didn’t cover substance abuse treatment, because – even in 1996 – most Americans viewed substance abuse as a moral, not a physical, failure.

Then, in 2008, Congress passed the Mental Health Parity and Addiction Equity Act.  Once again, the MHPAEA did not mandate mental health coverage.  And, once again, the MHPAEA was stymied, this time by regulatory agencies that delayed interpretive rulings until late 2013.  However, for the first time, substance abuse disorders were included.

By 2013 the MHPAEA had already been superseded by passage of the Affordable Care Act (aka Obamacare).  Under the ACA, mental health is one of ten “Essential Health Benefits” (EHBs).  The ACA mandates equal coverage for mental health, substance abuse disorders and eating disorders.

Yes, that’s right Jonah.  Mental health parity is now the law of the land.

Is the fight over?  Doctors report there are not enough psychologists, counselors and therapists to meet the increased need for mental health services.  Along with the law, we need a greatly expanded mental health infrastructure.  In addition, the stigma of mental illness and substance abuse disorders continues to keep patients from seeking treatment.

Even with these challenges, we’re at an historic crossroads in the history of mental health.  Dr. Fritz says, “We are seeing the greatest increase in mental health treatment in a generation,” affecting some 62 million people.

Students, that’s all the time we have for this session on Mental Health Parity.

But before you go, remember this:  you can help.  Tell your friends, family, classmates, and the community that it is okay to seek medical help for mental illness, substance abuse disorders and eating disorders.  Not only are these diseases curable in many cases, the law says they should be treated the same way doctors treat a broken arm, a skin rash or the flu.

Thanks for your attention.  Class dismissed!!