What can you do if someone you love is struggling with opiate addiction?
1. Carry Narcan- You can pick it up at any pharmacy and at your local community health center
2. Learn how to use it- I have heard people say “I don’t think I could stab someone”, This is not what you saw in Pulp Fiction. This is a nasal spray, most new ones will come preloaded, you will place the tube in the persons nostril and press the button. It is important to remember that it is likely to wear off before EMTs get to the person, you may have to do it again. I have also heard “I’m afraid if I don’t know why the person is unconscious I could hurt them by giving them Narcan”, If the person is not using opiates Narcan will do nothing. It will be like spraying water up someone’s nose.
3. Stop judging/shaming- Very very very few people (if any) get help through shame. Names like “Junky”, only lead people to use in secret which leads to more overdose deaths.
4. Know all the treatment options- Unfortunately people who have been using opiates need more treatment than just detox. One mistake well-meaning family and friends can make, is thinking that after a person does a 5, 14, or even 30 day stay in detox they are “cured”. First thing first: There is no cure for addiction, only ongoing treatment. Second: Opiates change the brain’s chemistry and structure, this change does not get fixed overnight. Third (and the most scary part) is after a short detox the person is actually more likely to overdose due to a decrease in tolerance when/if they relapse. Another mistake is thinking that Suboxone, methadone or Vivatrol is just another way for your loved one to get high. This is 100% False. Do some people abuse Methadone and Suboxone? Yes. Some people abuse Benadryl too. I am willing to bet that there is someone in your life, whether it is a friend, family member, co-worker, healthcare worker, person that you get your coffee from every morning, etc, that takes methadone or suboxone and you have no idea. A person who is taking their medications correctly will have no signs of use at all. Another option is going from a detox to a long term residential program- I’ll be honest the amount of beds available do not match the need, but if you are interested in this option please contact your local detox, your Community Health Center, or reach out to me, I’ll be glad to point you in the right direction.
5. Love Them, Love Them, Love Them- You may hate some of the things they are doing, but remember you still love them. Be that person that they feel like they can come to if they want to talk or if they want help. You may be the only one they have left.
This past week marked two major awareness days. World Mental Health Day and National Coming Out Day. These days are important for educating the public and helping members of these groups know that they are not alone.
World Mental Health Day
World Mental Health Day was started in 1992 as a way to educate and reduce stigma. This year’s theme was Suicide Prevention. According to the World Health Organization (WHO), more than 800,000 people die by suicide a year, making it the principal cause of death among people fifteen to twenty-nine years old.
Suicide is hard to talk about. I have seen many articles this year talking about signs to look out for, where to reach out for help, and reminding people to check on their friends and families. I love this and I am so happy that people are talking about it.
I remember when I was a counseling intern and my supervisor and I were role-playing suicide assessments. I remember how hard it was for me to even say the word “suicide”. I kept wanting to say “Are you thinking of hurting yourself?” instead of “killing yourself” or “Suicide”. Why is this wrong? Because “hurting yourself” means different things to different people, you may not get an accurate answer. Also, if your client sees that you are uncomfortable talking about suicide, they will not tell you.
Remember talking about Suicide, does not make people kill themselves. If the idea was not there before you cannot “put the idea in their heads”.
I know it is scary reaching out for help with Suicidal Thoughts. Contrary to popular belief, you will not be automatically “locked up” for suicidal thoughts. If you tell your therapist that you are thinking about suicide, your therapist will ask you follow up questions to find out exactly what you are thinking and how they can help you best.
In some cases full hospitalization or partial hospitalization are options. In most cases, your therapist will work with you to develop a safety plan (a plan for what you will do when you have these thoughts) and help you to build coping skills so suicidal thoughts will be reduced.
National Coming Out Day
National Coming Out Day was founded in 1988 by Robert Eichberg and Jean O’Leary. The belief is that exposure is the antidote of homophobia and that only by people coming out, will homophobics realize that they have people they love who are part of the LGBTQ community.
Most people think they don’t know anyone gay or lesbian, and in fact, everybody does. It is imperative that we come out and let people know who we are and disabuse them of their fears and stereotypes.– Robert Eichberg
This is something I have alway said “The opposite of Hate is Exposure” and “Isolation breeds hate”. This is the basis for much work currently being done in race relations, such as the work of Daryl Davis, who befriended KKK members and has gotten them to leave the Klan. Read more about him here.
All that being said, when a person chooses to come out is a very personal decision. Coming out can be very scary for many reasons. For some people coming out could cause them to lose their job, home, family or even their lives.
Know your biases and understand them. Learn all you can for yourself about LGBTQ issues and concerns, attend trainings, remember it is not the responsibility of your clients to educate you.
I feel like this should not have to be said, but I’m going to say it anyway… The American Psychiatric Association has stated that “the potential risks of reparative therapy (conversion therapy) are great, including depression, anxiety and self-destructive behavior, since therapist alignment with societal prejudices against homosexuality may reinforce self-hatred already experienced by the patient.” If you cannot put your biases aside, you can refer to a trusted colleague. It is healthier for the client to be working with someone who will be their ally.
If you are looking to get support with coming out, relationship issues, anxiety, depression, PTSD, empowerment, and many other goals therapy can be a great resource. One way to find a therapist that is an ally, is to go to Psychology Today. On this website, you can filter your search for therapists in your area that are allied with LGBTQ groups.
If you come out to your therapist and they tell you they can heal or fix you. Remember you are NOT BROKEN. Read that again! Check if you live in one of the 18 states that conversion therapy is illegal and report them to the state licensing board.
Most of all, awareness is about reducing stigma. We must get out of our comfort zone, talk to strangers, travel, and deeply listen to people’s stories. We all have biases. We must understand our biases in order to overcome them.
Go ahead and go to bed angry: They always tell us not to go to bed angry. This is completely false. Sometimes you need time to cool off. If you argue it out before bed you may say something you don’t mean. Go to sleep and wake up with a new perspective.
Just because he is mad, doesn’t mean he is going to leave: If you are a child of divorce like I am, it is natural to expect the worse. You are not your parents and arguments do not mean the end.
There will be times one of both of you can’t/don’t want to have sex: Believe it or not, you more than likely will have sex less often, but it will continue to get better (but you have to work at it). There will be days or weeks that you are too tired, too stressed, or too sick. This does not mean that you love each other any less. Your relationship is more than just sex.
You may never get pregnant: We are told in our teens and early 20s that you could breathe too close to someone and get pregnant. While this may be true for some people, it may not be true for you. It will put you and your relationship to the test time after time.
He will see all your crazy and will love you for it: Anxiety, tears, stress, frustration, feeling overwhelmed, feeling worthless, he will pick you up and make you feel whole.
He is an introvert and will always be an introvert: He will not change a fundamental piece of his personality. He may compromise at times, but he is who he is. You can’t change him.
You will have to remind him of things… over and over again: You will manage the home, this includes your husband. You will tell him to take his pill, ask him to call and make a doctor’s appointment, tell him to take his pill, remind him to call his friend, tell him to take his pill. Did I mention tell him to take his pill? And you will do it joyfully.
You will be introduced to things you never know you needed in life: He will make you watch every comic book movie that comes out and you will learn to love it. You will crave food you never even knew existed.
He will frustrate you more than anyone: He will leave the cabinets open, not put the dishes away where they belong, be in a bad mood when he gets out of work, tell you he does like what you cooked and wear clothes with holes in them. You have never known frustration like being frustrated at the man you married.
He will love you more than you can ever thought possible: He will make you dinner when you are sick, he will rub your head as you cry, he will be your rock while you take care of your God Mother, he will hold you when your God Mother dies, he will literally help sit on/get up from the toilet after you have surgery and he will try not to laugh at you when you ask him to leave so you can pee without him in the room, so you can “keep a little mystery in the relationship“, and he will kiss you every day before you leave and everyday when you get back.
Most of all, after 5 years of marriage, 7 years of living together, and 8 years of love, I can’t imagine my life without him.
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Yesterday, my husband and I went hiking. You know how there are novice hikers? We are below that… We are “I have no idea what I’m doing” hikers. To put it in perspective, I almost wore flip flops and then thought better of it at the last minute.
We drove two hours to a beautiful mountain range, mainly because I wanted to see the leaves (yes I’m an autumn in New England type of a girl). After we took in a few views, we found a hiking spot. All I knew at the time, there was parking, a trail, and it said there was a 1.5 mile, 3.something, and a 7.something (my brain did not even register after 1.5 miles).
We started out and quickly realized that this is going to be harder than we thought. We saw people walking though the trail with walking poles, back packs, and hiking boots. We must have looked really out of place. There I was, in Nikes, skinny jeans and a concert tee and my husband was wearing Nikes, loose fitting jeans and a thin cotton hoodie. We looked like we should be going to the pub, not hiking through the woods.
All the people we passed were super friendly, but I couldn’t help thinking that they were wondering if they would see us on the evening news. You know… “Married Couple Missing after attempting to hike. Rescuers suspect couple has been eaten by a bear”. We also did not bring water, had not eaten, and we both had to pee.
Life’s a journey
All that being said the experience was pretty amazing. The sounds, smells, and sight of the trees brought me back to my childhood. My husband, although he is not a “nature person”, enjoyed being outside and was so helpful in assisting with my balance over the streams.
After about a half hour of trees, tripping over roots, and my Nikes in the mud. I was just about done. I was hungry, thirsty, and had to pee. We decided to take a few pictures and head back.
We moved over to the side as we saw two hikers coming up the trail. They gave us a smile and said “hello”. We said “hello” back and waited for them to pass. One asked us “have you seen the gorgeous stream?”, I looked down at my feet (I’m a terrible liar), “no, we haven’t gotten there yet” knowing damn well we were about to turn around. He pointed down the trail in the direction he came and says “its right around that turn”.
My husband and I looked at each other, laughed, and pressed on. Sure enough, right around the corner the path opened up to a beautiful stream.
How many times in life do we do this?
This experience had me thinking… How many times do we do this in life? How many times have we given up right before the good part?
The journey is not always easy. Sometimes it will be the hardest thing you will ever do… don’t give up. Its ok to not feel ok, to make a fool of yourself, to have no idea what you are doing, to fail… but don’t give up.
We all need to remember… What gifts are waiting for us around the corner?
How many times have you heard “you can’t pour from an empty cup?”. What does this phrase mean to you? In The Cup Theory, we discuss the cup being the metaphorical vessel for your emotional, social, spiritual, and physical energy. If your cup is empty you have no energy to help other people or even yourself.
My inspiration for this theory comes from my love of the Spoon Theory by Christine Miserandino. In this essay Christine writes about what it is like to live life with a chronic illness. Christine states that everyday she starts out with a certain amount of spoons, throughout the day certain tasks require a certain amount of spoons. For example: You have six spoons. You wake up; you lose a spoon. Take a shower; you may lose two spoons depending on if you washed your hair or shaved your legs. Now you only have 3 or 4 spoons for the whole rest of the day and you have to decide how and if to use them. If you have not read this essay do yourself a favor and read it here. It is the best way for someone to understand what it is like to live with chronic illness.
More and more recently, I have heard this theory to describe the lives of people living with anxiety, depression, and even substance use disorder. While I love that this can help a person explain how these conditions feel. I think this theory does not do enough to empower and help a person grow.
The Cup Theory
When working with clients struggling with anxiety, depression, and substance use, (or even my own life, if I’m being honest) I instruct them to visualize a cup with water in it. I ask them to imagine walking through life and experiencing the challenges life can bring. With each challenge, you take a slip from the cup. Some challenges you take little sips and others you take big gulps.
A big gulp may be you lost your job, your cat passed away, or you’re getting a divorce. A small sip can be anything from going into a store or choosing what your family will eat for dinner. Only you know how big of a sip you will need for each task. For some people going to a party is a small sip, but for other people it is a big gulp.
So, you are going along, taking sips from your cup… eventually the water is going to run out. When the cup is empty, you have no water left to sip, you are officially in distress.
Think back to a time where you have been super stressed. Lets say you just had a baby. You have been up all night feeding and changing the baby (big gulp from cup), your trying to clean the house (big sip from cup), baby’s crying (also, big sip from cup), your partner gets home from work and asks you why you haven’t taken a shower (you go to gulp from the cup and there is nothing left). What are you going to do? You are going to bite their head off, cry, or whatever you do when you reach your limit.
Fill up your cup
How does the water get into the cup? You have to actively put the water in the cup. Self care and healthy actives fill up the cup. Times when you are mindful and in the moment are especially cup filling.
Taking a walk
Putting your phone away and talking to your partner
Petting your cat
Dancing around the living room
Going to a support group
Taking an exercise class
You have to keep filling it. You have to continue to find ways to fill up your cup. If you wake up in the morning and feel like your cup is empty what do you do?
A quick and easy morning activity:
Notice your breath: is it fast, slow, shallow, deep? Just notice it, don’t judge it or try to change it
Spend about a minute just noticing your breath
Take a deep breath: In through the nose and out through the mouth, slow and steady, fill up your lungs all the way down to your stomach
Repeat as many times as you feel is needed or as time allows
This may not fill up your cup entirely, but it will give you just enough water in reserve to get up and face the day.
Anxiety, depression, and Addiction
Some people’s cups are bigger than others, but with time and practice the cup can grow. When a person diagnosed with anxiety, depression, or addiction they have a smaller cup and they are taking bigger sips.
For example someone struggling with addiction: In early recovery the cup is VERY VERY tiny. They do not have much in reserve to drink from, so they have to continually fill up the cup.
This explains why, if you are an alcoholic, just going to one AA meeting a week will not work. We also, cannot expect the person in early recovery to be able to go to detox and come straight out, hold down a job, pay bills, and take care of their families. This equals too many gulp/sips, not enough fill ups.
In AA they say to begin each day on your knees asking the higher power to take away the desire to use or drink. This is one way to start each day with a water reserve, but remember the cup is still small. If you hit traffic on the way to work, you have already emptied your cup. You have no water in reserve. The addict in early recovery must ALWAYS be doing something for the benefit of their goal of living in sobriety.
When they have more time in sobriety, more tools and more of a recovery network, the person living with addiction now has a bigger cup. The traffic on the way to work is not as distressing, because the person has a bigger cup of water to drink from. This does not mean that they stop working on their recovery, remember just because the cup is bigger doesn’t mean it never needs to be filled.
When struggling with anxiety and depression the same theory applies. When in an acute state of depression and anxiety, you have a smaller cup. You must continuously work to keep the cup full. As you start to get stronger (medication adjustments kick in, start seeing a therapist, find a self care routine) your cup grows and you can handle more and more of daily life.
Remember you control what goes into your cup. The more you do for self care/growth the more you have in your cup and the more your cup grows. The cup is placed in your hands.
You will have days that your cup feels empty and you will want to stay in bed, lash out on a loved one, or stare off into space at work. Try not to judge yourself on those days. Those are the days when you are either running on empty or your cup is too small. Take care of yourself, eat well, wear comfy clothes, and do something you love. Tomorrow your cup will feel different.
If you are anything like me, you feel like you should be working right now. Maybe you are hiding in the bathroom at work, reading this on your phone. Maybe you are at home, procrastinating cooking dinner, cleaning the living room, or returning emails.
Why are we feeling guilty? Why can’t we just sit and be? Americans, unfortunately are notorious for this. We work 40+ hours a week, are expected to be available by email or phone 24/7, and get two paid weeks off a year. Our culture celebrates the person who never takes a day off and the person who answers emails on vacation.
Last week I took a day. My Aunt passed away and after the emotional day of saying goodbye to my Aunt and seeing family I haven’t seen in about 10 years, I decided to take the day after the funeral off. I went to my favorite deli for hand made bagels and watched Animal Planet. I needed a fill up, I was on empty. There is nothing wrong with what I did. Company policy says I have three bereavement days, I took two. Yet, I still felt guilty.
“Rest and self-care are so important. When you take time to replenish your spirit, it allows you to serve others from the overflow. You cannot serve from an empty vessel.” — Eleanor Brown
When our body tells us to rest, we need to listen to it. If we don’t, we get sick more often, make poor decisions, and express irritability towards co-workers and family members.
How do we relax?
Remember and give yourself credit for everything you do (at work, for your family, for your dog, for your household). You deserve it
Cover Your Ass: I’m not telling you to call out sick once a week or leave early everyday, make sure you are taking days off responsibly
Carve out time. Use your holidays for self care time. Is Columbus Day at your brother’s house important? If it is and you will have a blast, fine go. If it is not… don’t go
If you can’t take a full day, at least take a full hour, or even a minute. Take a moment to close your office door and breathe
No multitasking: Take a day when you are not allowed to do more than one thing at a time. When was the last time you just cooked supper or just watched a TV show? I am typing this, while talking with my husband, watching football, and snuggling with my cat. If you are going to snuggle your cat, just snuggle your cat, then move on to the next
What are some ways you take a day or time for mental and physical self care?
“I’m sooooo addicted to coffee”. I’m guessing you have heard this phrase before. You may have even said this phrase before. What if I told you that it is not true.
Yes, you may get a headache. No, you may not be able to wake up without a cup. Maybe, you pictured pushing your loving husband out of a moving car because the Dunkin’s drive through line was too long… What? Just me?
Yes… you do have an uncomfortable reaction when you do not have your coffee. The Headache, sleepiness, and not being able to focus are all part of caffeine withdrawal. You may be surprised to know that this is actually listed in the Diagnostic and Statistical Manual of Mental Disorders or DSM-V as a mental health disorder.
Withdrawal by definition is the result of DEPENDANCE. Not ADDICTION.
Dependance, to put it simply, is when your body feels like it needs something in order to maintain its baseline. This happens in more toxic cases such as nicotine, alcohol and opiates, but our bodies are also dependent on water, air, food and a whole host of other things.
Now, what makes Addiction different?
Addiction is the effect that something has on your life and your behaviors. A person who is addicted to something may neglect their lives (friends, family, work) in pursuit of what they are addicted to. They also more than likely have had some kind of consequence in life, but continued to use. Think: Overdose, car accident, wife leaving, loss of job, prison time. Addiction is a compultion and the behavior. Dependence is the body’s physical reaction.
Why do we care?
Have you ever heard someone say, “poor baby, born addicted to crack”. It is not possible for a baby to be addicted to anything. The baby may be born dependent on a substance, but never addicted.
What about someone on Medication Assisted Treatment or MAT? MAT are medications such as Vivitrol, Suboxone, Methadone, and others. These are medications carefully prescribed by a specialized doctor for people experiencing withdraw from opiates and/or alcohol (in the case of Vivtrol).
Knowing what you now know, can we say someone is addicted to methadone? Street methadone?Maybe, if someone was using illegally to get high and continued this behavior despite legal trouble, overdose, or other concerns. Prescribed methadone from a clinic? No. Can we say they are dependent on methadone? Yes.
Again, why does this matter?
When someone says the word “addiction” it has a very negative feel to it. It is a judgement call and it increases stigma. The baby born dependent on cocaine has done nothing wrong and does not deserve that judgement.
Neither does the person who is trying everything to get their life back together. When a person living with addiction walks into a clinic or doctor’s office for the first time they are carrying with them more shame than the average person can imagine. They carry the stigma from society, family and themselves.
Lets help lighten their load and reduce that stigma.
Okay so… I am going to give you a very “therapist” answer (please don’t hold it against me). Only you can answer the question above. I can however, tell you why I’m here and maybe in the process help you get a little closer to answering the question for yourself.
I am a Licensed Mental Health Counselor. I am the director of an addictions program and I work in private practice. My jobs on the outside look very different.
For example: 8am Monday morning I may be sitting across from a woman whose last known residence was a park bench on the Boston Common. By 5pm I could be sitting with a family who made more money in the last five years then most make in a life time.
But you know what? When it comes down to it their goals are the same.
To be able to earn a living
Make connections with others
Live a healthy life
I have been helping people meet their goals for over 10 years. First, as a Case Manger and now as a Therapist.
What are your goals?
Topics I hope to cover:
Mental Road Blocks
Now its your turn, what do you want to know? What would help you achieve your dreams?