Enabling

How I Became A Junkie

It's no news to any of us that addiction is a disease of relapse.  Thing is, we never know if we're going to make it back.  What struck me about this woman's story is how easily it could have turned out otherwise.

What the fuck was in this stuff? Turns out, nothing beyond drugs; sometimes throwing up and convulsions are just going to happen.

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Help or enable — what if the person is mentally ill?

A reader writes:

My adult son plays me like a fiddle, but I am confused as to where do I draw the line because he is mentally ill. I am so stressed about this that I can barely function and I am going broke and he isn't getting better. Can you provide any advice? Thanks.

Mental illness and addiction seem to go together.  Some people learn that they can self-medicate by using alcohol or other drugs, thereby moderating their symptoms.  Others may be less mentally-ill than simply suffering from messed-up brain chemistry due to the drugs.

In any case, the presence of chemicals always complicates treatment for other disorders. In fact, it's nearly impossible to treat mentally-ill people effectively if they are still using.  How, for example, is a physician to treat depression in a person who is addicted to alcohol or opiates, both of which cause depression?

Would that I had an easy answer, but there are none when it comes to addiction and other mental disorders.  So let's approach this problem from a different direction.  You write, “I am so stressed about this that I can barely function and I am going broke and he isn't getting better,” so let me ask you a question.  If you are going nuts and broke, how are you ever going to be able to help your son?  Would it not be better to get your own situation under control, keep your sanity and whatever resources you have left, and stop banging your head against the wall?

The fact is, your son is quite aware that he can “play you like a fiddle,” and he has no reason to try to get better.  It gets back to the simple fact that when you make his life easier, you remove any incentive to change.  You did not state what his mental problems may be, but one thing is sure.  You can't help him if you're losing your own ability to function.

So I suggest you start taking care of yourself.  Begin by attending some support groups — I suggest Al-Anon, and perhaps one for people dealing with mentally disabled dependents.  Your local mental health association should be able to direct you to some of the latter.  As for Al-Anon, there are meetings all over the world, and I strongly urge you to avail yourself of the understanding and companionship of people who know where you're coming from.  Only by dealing with your own confusion and coping problems will you reach a state where you are able to help your son when — and if — he decides to accept effective assistance.

In the meantime, I would suggest that you minimize any “helping” that in any way facilitates his drug use.  If he is unable to care for himself, then perhaps throwing him out is not the kind of tough love that would be helpful.  If, however, he is capable of fending for himself, even at a low level, let him know that he has a choice: give up the cushy life at your house and take over his own life, or go get some treatment.

In any case, you need to take care of yourself first.

How do you separate yourself from friends and family who are using? They’re the only friends I have!

Café Terrace at Night - Vincent van Gogh

Imagine that we are sitting at a sidewalk cafe in Paris, enjoying a cup of great coffee and a croissant.  Most of the folks around us are speaking French, and since we don’t, it’s not very interesting until we hear some folks speaking English a couple of tables away.  Immediately we’re like, “Where are you from?  How long have you been in Paris?  Where were you before?  Where are you going next?  Oh, me too!  Do you know so and so?”  Perfectly natural.  These are our people and they speak our language.

If a person was looking for a sure thing, as far as relapse is concerned, he couldn’t go wrong by hanging around with active addicts, especially family members.  As addicts we thought in predictable ways, behaved in predictable ways, and we even spoke in ways that identified us — to ourselves and others — as members of “the club.”  In early recovery those are, to a degree still “our people.”  They speak our language, and we’re still trying to learn the language of recovery.  They can get us into a world of trouble.

The old people, places and things are big triggers, and smart people avoid them even when they’re no longer beginners.  Old friends — and especially family members — are the ones who wired our buttons, and they can play us like a barroom piano.  It’s the way we’ve always interacted with them, and they can’t help it.  Nor can we help reacting when they do it.  Add familiar circumstances and places — maybe the local pool hall and bar — to the interpersonal stuff, and even an addict with quite a lot of clean time can be in trouble.

Family is hard to deal with.  Those who use have a vested interest in seeing us get high again, and even the sober ones may find the “new” us a little hard to take.  Sort of a “better the devil you know than the devil you don’t” thing.  If they start the same old stuff, we probably will too, and it’s a sure way to end up relapsing — when we start speaking and thinking in that language again.  That’s why we recommend halfway houses, sober houses and other lodging away from home for beginners, places where the folks around us know where we’re coming from.  When we attend family functions, we make sure we bring a sober person with us.  What host is going to turn down our friend for Thanksgiving dinner?  Then the two of us can sit there and watch the drunks, giving each other an occasional knowing look, and split when things get really rowdy.  “Gee, I’m sorry Mom, but Joe has to go and I need to give him a ride.”

You know how everyone is always talking about developing a support system, going to meetings, getting a sponsor, getting involved in service, and so forth?  That’s because we need to find new people, places and things.  That’s where we meet the sober people, make new friends and hang out with our recovery family.  Then we branch out and have fun in other places, but always with one or more of our new friends.

Sober people do a lot of things besides sit in smoky meeting rooms, drinking coffee, and talking about the program.  Most of us end up having more fun than we did when we were using.  We go scuba diving.  We ride motorcycles in sober motorcycle clubs.  We organize and put on dances, and attend those organized by other sober groups.  Sober cruises are fairly common, and every cruise ship has a meeting (just check the activity boards for “Friends of Bill”).  There is quite literally nothing that we can do loaded that we can’t do sober — except get high.

So, the answer to the question in the title is simple.  We don’t separate, we just back off.  Chances are that we make our old buds nervous anyway, and they’re not likely to pursue us very hard.  We hang with our new friends in recovery, and that takes care of the second part.  Our using friends are no longer our only friends, and it’s a safe bet that our new, sober, friends will become just as important in our lives as those others were — and they won’t be trying to get us to poison ourselves, either.

When You Relapse, Do You Lose All Your Sobriety?

I get letters in another venue from people in early recovery, asking for information about the variety of symptoms and problems common to all of us when we were newcomers.  I was quite taken with the following letter, because it illustrates an extremely common issue — family members who don't understand what we need, or who passively try to sabotage our recovery.  I thought I'd share the letter and my response with you here.  It has been redacted to remove some unrelated information, and to protect the identity of the writer.

I have abused opiates on and off for four years. Went through detox two times when I had insurance, just from being so afraid of withdrawal. Went to counceling once. Of course my abuse continued to grow. I got to the point of being just sick of it. I quit and used a recipe I found online using vitamins an amino acids. I went to get change from my husbands “spare change cup” and found eight pills there (he takes them because he needs hip replacement). By the end of the night I had taken eight to ten pills out and took the pills over the next 24 hour period. This was on the 101st day of being clean. I am so disappointed in myself and feel miserable, but I am determined to pick up the pieces and move on. …[Your] article was very helpful to me. I realize I need to be in a program and will look in to it. I guess my question is, Have I lost the time of 100 days I put into sobriety, after a one day binge? Have I lost all recovery ? I so want to be rid of this deamon and your article has helped.

Thanks,

“Jenny”

Dear Jen,

Quite the contrary: that 100 day investment may turn out to have been one of the most valuable experiences in your quest for sobriety. You now know that you cannot trust your disease. It is going to be with you — in spirit, as it were — for a long time. Recovery is about learning that, and learning to live without drugs.  Addiction is a disease of relapse.  Those who have done so one or more times are far more common than those lucky ones who made it on the first try.

Your picking up should have taught you three things:

  • You must speak with your husband about keeping strict control of his medication so that you will not be tempted “accidentally” again;
  • You need a support group that you trust enough to call and talk through urges to use, and that will help you learn to cope with life — comfortably — without using;
  • Life goes on. Beating ourselves to death for being human and giving in to temptation is not productive. Learning from our mistakes is, however, imperative.

Relapse occurs long before we pick up; using simply makes it official. If we keep ourselves in a healthy state of mind and body, follow suggestions and generally live our lives as someone who is IN recovery, as opposed to someone who is thinking about being in recovery, we do not reach the state of mind that will make it easy for us to pick up the random pill laying around the house.

As the song would have it, “Pick yourself up, dust yourself off, start all over again,” using the very important lessons you've learned to help avoid further slips.  Addicts have to be extremely careful about falling down to begin with, because sometimes we find ourselves unable to get up. The good news is, as long as we learn not to make the same mistake again (and, hopefully, none similar as well) we can profit from them.

I’m seeing some wishy-washy thinking here: “I realize I need to be in a program and will look in to it” needs to be “I will call and find the location of a meeting immediately and get to it as soon as possible.” Please get to some meetings! You cannot do it alone. Your best thinking got you where you are, and you need some fresh input. The lifelong friends you will make in the process are a bonus.

Remember one other truism: Anything that you place ahead of your recovery, you will eventually lose.

Keep on keepin’ on,

Bill

How Can I Help My Alcoholic Or Other Addict?

The short answer is, “You can't.”

Addicts of all kinds, including alcoholics, have to help themselves. They do not seek relief until they are so miserable that they see no alternative.  Therefore “helping” one is usually the worst possible thing that a friend or loved one can do. Making sure they have enough to eat, helping out with the rent, giving them a place to stay when they blow the rent on liquor or drugs, giving them rides to the liquor store, bringing them booze so that they don’t have to go out themselves, bailing them out of jail, allowing them to get away with stealing you blind — all of those things that seem like the sort of thing friends and loved ones do, in reality allow the person to continue in their alcoholism/addiction without truly facing the consequences. This is called enabling.

Those who truly wish to help a person with a problem will assure them that they are loved, but that they cannot expect assistance in anything but getting treatment and sobering up. Be aware that they will then pull out all the stops and try to bully or guilt you into doing things their way. They will make all sorts of promises. Don’t believe them. They are terrified of quitting — for excellent reasons — and they will do or say whatever it takes to continue drinking or using. They do not understand that they have a choice.

Well-meaning friends and relatives who try to take the pain and unhappiness out of the addiction are keeping the person from finding a reason to make changes, and until that happens, recovery IS NOT POSSIBLE! Enablers are helping their loved ones to kill themselves.

If you are a family member or employer, you can consult with an addiction professional about arranging for an intervention. Do not attempt to intervene on your own; it almost certainly will not work. Intervention specialists know all the tricks, and are able to set up immediate referrals to detox, treatment and so forth. You don’t have access to those resources, and an intervention that is only done halfway is likely to waste what may be your last effective shot.

All you can do to really help is drive them to detox when they decide they want to go there, and withhold all other assistance. There will be plenty you can do after they have been sober for a while and have learned to function on their own, but there is nothing you can do until they make up their mind to take that first step.

For their sake, don’t stand in their way by “helping”.

Painkillers Aren’t The Only Rx Drugs To Worry About

When we speak of prescription drug abuse, addiction and the complications (including deaths) that accompany their use, we usually talk about Percodan, Percocet, Oxycontin and similar opioid drugs.  There is no question that these are the biggies in terms of unintended consequences — severe dependency, addiction, overdose and death.   There are, however other drugs that are cause for concern amongst professionals and those they treat.

Probably chief among these are the benzodiazepines, which are used for treatment of anxiety, as tranquilizers, to suppress seizures, and for a variety of other purposes.  There is the common perception (even among doctors) that these drugs are not addictive, and that long-term use is perfectly OK.  This is an interesting misconception, since every manufacturer of benzodiazepines provides specific information regarding their use.  This information is always adamant that the drugs should not be used for more than six weeks, except in unique circumstances to treat specific conditions.  We've mentioned before on these pages the need to check out medications with your pharmacist, not just blindly take what the doctor orders, and benzos are a prime example of the reason for that advice.  Benzodiazepines are especially dangerous when use in conjunction with alcohol or other drugs that depress the central nervous system (downers).

Detox from benzodiazepines, which include Ativan, Valium, Xanax, Clonazepam (Klonopin), and about 20 other brands and compounds that are currently available, can take up to three weeks.  Sudden cessation of any of them can be traumatic, causing agitation, sleeplessness, jitters, nausea, and a number of other unpleasant side effects.  Withdrawal from several of the more common benzos can also trigger convulsions.  Chronic use can lead to tolerance, the need for more of the drug to avoid discomfort, and definite addiction.  Some benzos can lead to addiction at low doses, and in far less time than one would imagine.

Ambien (zolpidem) is another common drug that creates dependency problems among both legitimate users and abusers.  Properly prescribed, it is used for short-term adjustment of sleep cycles.  When used for longer periods a dependency on the drug develops rapidly, so that the user becomes unable to fall asleep without it.  Tolerance develops rapidly as well, causing users to need more and more of the drug to get to sleep.  Ambien, at higher doses, often causes severe sleepwalking episodes.  It is not unusual in these episodes for people to seem awake to others, even to drive, but to have no memory of it later.  The safety considerations here should be obvious.

There are a number of other drugs that are easily abused — too many to mention here.  Generally speaking, any substance that can be used for pleasure can cause psychological and/or physical addiction, and often both.  Don't depend on any one person to decide what medications you should be taking.  Doctors have a great deal of information to absorb, and most of them are not trained in pharmacology.  Your pharmacist is your best source.

 

Opioids are now the most-prescribed class of drugs in America

Two reports published in the Journal of the American Medical Association (JAMA) show a huge shift in the pattern of prescribing by doctors.  They suggest that better training for prescribers and assessment of pain management programs are needed, among other steps to reduce opioid abuse.

The JAMA Research Report shows that there has been a drastic increase in opioid prescriptions while prescriptions for non-steroidal anti-inflammatory drugs (NSAIDs) have gone down. Prescriptions for hydrocodone and oxycodone account for 84.9 percent of opioid prescriptions. Over ten years, there has been a fivefold increase in admissions to substance abuse programs for opioid addiction.

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