We are a nation in crisis. There is hardly a family that has not been affected by addiction. The statistics on the matter of opioids, alcohol and marijuana are alarming – 105 American lives are lost each day to an opioid-related overdose, 1 in 8 Americans experience an alcohol addiction, and a recent Gallup poll finds that 1 in 8 smoke marijuana as legalization rolls out across the states.
I am a fierce advocate for systemic change on the micro (individual), mezzo (family) and macro (community) levels. In the wake of our national drug crisis, action must be taken to help loved ones and their families achieve health and wellness.
Let’s begin with unpacking the definition of addiction. Per the American Society of Addiction Medicine (March 2011), addiction is a chronic disease of brain reward, motivation, memory and related circuitry. Like diabetes and heart disease it is chronic, progressive and if left untreated fatal.
The individual pursues relief by substance abuse and other behaviors. Addiction is typically characterized by:
- An inability to abstain
- Impairment in behavioral control
- Craving or hunger for substances or rewarding experiences
- Diminished recognition of problems with one’s behavior and interpersonal relationships
- A dysfunctional emotional response to experiences and circumstances
Addiction takes many forms from alcohol and other drugs to process disorders: shopping, sex, love, gambling, spending, disordered eating, and even digital addiction. These addictions often overlap, twist and twirl together with co-occurring (mental health) disorders. As a clinician/interventionist, when working with families and their loved ones it is important for me to unpack and address the complex nature of these issues.
When folks think of addiction, they typically believe it’s an individualistic disease affecting only the one caught in its grip. In truth, addiction creates a volcano effect. Like a volcano that slowly and steadily builds pressure, steam and corrosive lava, addiction erupts with a powerful force and disrupts families and friends, colleagues and associates, business partners and co-workers. Like the unstoppable lava that flows in the streets, addiction disrupts everything in its path.
And because one form of addiction bleeds into another – co-occurring mental health disorders such as depression, anxiety, personality disorders, juxtaposed with medical problems such as chronic pain, legal or school issues – many family members feel like they are constantly caught in a spin cycle of destruction and despair. They struggle to find a quick fix with the next bail out for a loved one or for an employer. Emotions hiss and pop, a heated concoction of nagging, pleading, begging, lecturing, screaming, etc.
Moreover, there are over 133 million people in the US that experience chronic pain – pain which is persistent and lasts more than 3 months. Digressing, we know that our bodies are designed to heal within 90 days and after that – it is our emotions that fuel our pain and become the culprit making us believe we need more opioids. This is another piece of the pie that fuels addiction for it often starts with a simple prescription and is confusing to many family members as they believe their loved one’s problems have a firm medical rationale. The findings from the University of Arkansas in 2016 on opioid use are alarming. With a 10-day supply of opioids, 1 in 5 become users a year later.
Like the deadly volcano effect, addiction and codependency become soul mates holding each other hostage. Codependency is defined as excessive emotional or psychological reliance on a partner, typically a partner who requires attention due to an illness or an addiction. I call this the ultimate bail-out because in effect a codependent relationship causes the loved one of the person experiencing addiction to make excuses for their behavior.
Here are signs to look for when experiencing a dose of the bail out syndrome, otherwise known as codependency:
- Always saying yes to whatever is asked of you
- Difficulty setting limits or boundaries. “No” is not part of your vocabulary
- Feeling responsible as if it is your fault for your loved one’s problems-hypervigilant
- Feeling trapped or held hostage in your relationship
- Making excuses, apologizing for your loved one’s behavior, calling work, school, rearranging appointments etc.
- Giving money or not realizing money is missing from your wallet
- Difficulties showing intimacy
- Confabulating the truth, making up stories about why your loved one is the way he /she is
- Being secretive, lying to the person so as to hide the truth
- Feeling anxious and fearful about being abandoned or rejected
- Needing to be in control, looking good to the outside world. Keeping addiction a secret.
- Not recognizing how attached you are to your loved one and how your behavior has become part of the problem
If you or a loved one is experiencing an excessive relationship with an individual who has substance abuse or mental health disorder, here are common behaviors you might be taking on:
- Being a martyr, (Look what I do for him/ her)
- Being a victim (look what he/she has done to me and our family – poor little me)
- Being a perpetrator – blaming your loved one who has an addiction for everything that’s not right with your life
- Feeling angry and resentful about someone’s behaviors and still bailing them out. (You wrecked that car and got a DUI and you still pay for the car to get out of impound)
- Refusing or denying there is a problem – “It’s just this way.”
- Challenging to share, know or express feelings – “Everything is alright”
- Putting the addicted loved one’s needs first
- Making excuses for the loved one
- Blaming situations or other people instead of the addicted loved one – “He has such a tough boss” or “She has a mean teacher”
- Ignoring the addicted individual’s negative or dangerous behaviors (i.e. stealing, lying, fighting, legal trouble, etc.)
- Feeling angry with righteous indignation towards the person
- Not being able to label one’s feelings beyond mad, sad, angry
- Finishing one’s sentencing for them
- Using excessive “we” terms; rarely saying “I” or “me”
- Being unable to distinguish the difference between yourself and your loved one’s problems
Despite the destructive and painful reality of addiction and its grip on circles of families, friends and business associates, change is possible. There are several parts to this. The first is to learn about substance abuse, process disorders, mental health and chronic pain.
The second is that you need not be part of the problem – be part the solution! In doing so let the 7 C’s be a guidepost for your new way of being.
- You did not Cause your loved one’s addiction,
- You alone cannot Cure the addiction
- You alone cannot Control your loved one’s addiction
- You can take better Care of yourself
- You can learn to Communicate your feelings
- You can make healthier Choices
- And you can Celebrate yourself and your growth
The third aspect of change is creating healthy boundaries for you and your family members and the loved one with addiction. Here are questions that need to be asked related to building honest and healthy boundaries:
- What is okay behavior and what is not okay?
- What was okay before treatment and how has that changed?
- What was NOT okay before treatment and how can you make it better this time?
- What gets confusing?
I always tell the families I work with that they must be able to wake up each morning, look themselves in the mirror and know that they are worthy and that they can stick to the boundaries they have set and their own personal recovery map. To assist in this process, clients and families in collaboration often develop Change Agreements to help guide the way
Change Agreements are a written document in which one clearly articulates what they are willing to do to support their loved one in recovery in as well as ways in which family members are going to do to take care of themselves. Change agreements often include family members attending Al-anon and other support groups and/or professional counseling as well as setting firm limits in what their financial and other types of support they will render that supports recovery. Expectations are concisely articulated. For example a loved one may engage in treatment as outlined by professional randomized drug testing, attend meetings, attend intensive outpatient treatment, etc.
The key notion is that healthy boundaries are critical for personal health and happiness. Once a loved one experiencing addiction seeks treatment, all family members, friends and colleagues and business associates must take a hard look at their own behaviors and re-draw these boundary lines to find change.
Fourth, it is of paramount importance for the co-dependent to begin to take care of themselves physically and emotionally and to turn to one’s personal values to find strength. This may come in the form of spirituality or a connection with a higher power. Al-anon, other support groups, meditation, mindfulness, exercise and social bonding aid in the healing process.
Lastly, movement starts with a willingness to change, sprinkled with fierce love and commitment to family and loved ones, coupled with the tools necessary to change. When those are in place family members (i.e. You) no longer have to travel down a pity path that leads to cajoling and bargaining. No longer will you mortgage your homes, blame others in an effort to have your loved one stop using.
The great Martin Luther King, once said,” We shall Overcome” and I am here to proclaim, announce , shout that you can overcome the sleepless nights, the GPS tracking of cell phones, relinquish the baited breath waiting for that overdosed unconscious voice on the phone that disrupts the 4:00am reverie of your dreams. No need to start and finish everyone’s sentences or be an indentured to the endless employment of the Royal WE . You no longer have to make up false stories in your head about where your loved one is or is not, nor do you have to sign on that a medical marijuana card for your 15 yo is ok.
You can finally unequivocally tell the truth without shame, guilt, fear, humiliation, fear of recrimination and a lifetime sentence that you are the eternally bad sister, mother, father, brother, husband, wife, partner, lover , grandparent, business manager, personal assistant etc. Because now you know you do not have to have all the actions and NOW you Can Take Positive Action. !
Be the Warrior! Be Strong! Be Vunerable and Be the Non Co-Dependent YOU!