By Travis Ramsey

It was a standard first call with parents until I began fielding their questions.  “How will Brad* get his clothes cleaned?  Who fixes his meals for him?  How will he wake up on time in the morning?”  As I began to understand these questions better, I soon realized that mom and dad had basically taken care of all Brad’s responsibilities his entire life.  A young adult, Brad was now at MARR, the furthest he had ever lived from his parents, addicted to alcohol and drugs, and having never learned to wash his clothes, wake up on his own, or make a meal.

Another term often used to describe addiction is chemical dependency.  It’s literally true, as addiction is more than a liking or craving, but actually registers in the brain as a need along the same pathway as oxygen and food. Addiction requires not only a substance but another person.  While an addict is forsaking all else to take in a substance, he/she will die (or hit their “bottom”) unless someone else is taking care of the things needed to actually survive, i.e. food, shelter, finances, and relationship.  Initially, this was the definition of codependency: being in a relationship with an alcoholic or addict.  This is someone who needs the addict’s life to be okay as much as the addict needs their drug.  And the only way they can continue their addiction is if someone else is cleaning up the wreckage of it.  While this remains the natural and normal state for families in active addiction, the characteristics of codependency can arise in a variety of relationships and carry over into all areas of one’s life.

Codependency always develops out of an adaptive change to correct a problem.  In families, this problem might be a parent who has just lost his job, a child who is failing in school, a mother suffering from depression, a lonely or bullied child, or a father who becomes abusive when he drinks too much.  Because this is too painful for other family members to experience, they lovingly step in to “help” with the problem.  Parents might do their child’s homework for them or lobby with school teachers and administrators to make changes in their child’s education.  Spouses might cancel their own activities to focus on being sensitive to their partner’s needs.  Brainstorming, problem-solving, and long conversations about the problem begin to dominate the family’s time and energy.  While these behaviors might actually alleviate the problem temporarily, it may also create the breeding ground for addiction.  For addicts, their drug of choice is the solution to their problems.  So while the person with the problem is feeling better by using drugs, others in the family, not knowing about the drug use, are trying to fix these problems (which just seem to be getting worse).  It’s a vicious and exhausting cycle.

Maintaining his sobriety in his MARR community, Brad felt less need to depend on his parents and his calls home tapered off. His parents were beside themselves. Dad was livid. How was he going to know what to do with Brad’s bills, what to tell Brad’s friends, and how to take care of Brad’s legal troubles? He was adamant that no one else would do these things for his son. Mom took the avoidance personal; she wondered if he felt abandoned by her. Her son’s treatment at MARR meant that she had failed her son, that her love and support weren’t enough to help him, and now he was shunning her.

Though it’s quite healthy to feel concern for someone we love, codependency uses this concern to justify boundary violations as attempts to help the person we love. Their bad feelings make us feel bad, so their problems are our problems. The only way to feel better ourselves is to make them feel better by trying to fix their problems. Brad’s parents knew they were doing too much for their son, but couldn’t stop. Not only did Brad’s addiction grow under their caregiving, but their own sense of purpose depended on Brad’s needs. It’s difficult to know which comes first: many times someone else’s problem brings up our own codependent tendencies, but other times, our own need to be liked and feel important lead us into behaviors that handicap others from addressing their own issues successfully. Why is it so important to us that others around us be happy, comfortable, and pleased with us all the time? Often, codependency is learned at a young age within our own families.

Brad’s father and mother each had their own reasons to be codependent with their son. Like many families, alcohol use was an important part of their leisure activities. His father had also used drugs recreationally as a young adult. How could he possibly tell his son that using drugs and alcohol were not okay when he himself wasn’t sure if his own use was a problem? When Brad’s addiction landed him in treatment, the father felt guilty for his silence. Taking responsibility for his son’s illness, he was compelled to handle all of Brad’s consequences. Brad’s mother grew up with an alcoholic parent. Feeling lost and neglected, children like Brad’s mom may believe there is something wrong with them that caused their family problems. They often attempt to “keep the peace” and make their parents happy so that their own needs are met. Doing everything for her son gave her the feeling of being needed and important, feelings she was deprived of as a child.

In our society, codependency is as deceptive as addiction. It often hides behind “doing the right thing,” obeying God, taking one for the team, and coming to the rescue of others. Though it looks benevolent, codependency serves the giver more than the receiver. Those who suffer from it use other’s dependence and approval as a means to feel loved without risking the disclosure of their own needs and doing that which is truly best for them. Like addiction, codependency is a way of coping with our true feelings by avoiding them and managing our external world. Drugs make the world a safe place for addicts and alcoholics; the neediness and approval of others make it safe for codependents. And it is a terrifying endeavor to reach out for help.

Unfortunately, Brad’s parents found it much easier to clean up their son’s messes than to attend a support group for themselves. Though they all agreed that returning home was not the best for Brad’s sobriety, neither Brad, his father, nor his mother were able to make the necessary changes to support Brad’s recovery. If you are in a relationship with an addict or alcoholic, it is natural to experience codependency. It is tempting to believe that your efforts to help your loved one will influence them to stop using. This is simply not true. Finding peace and healing for yourself is the greatest thing you can give an alcoholic or addict in your life. Please reach out for help. You’re worth it.

Two of MARR’s counselors, Patrice Alexander and Travis Ramsey, talk about their experience working with families of MARR clients over the years.

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“We’re just waiting for her to hit rock bottom.”

“I thought this would have been rock bottom for him, but I guess it’s not.” 

Many families wait, hope and pray for their addicted loved one to hit the elusive “rock bottom”; they are convinced that an all-time low will mark the beginning of lasting recovery. For many others, however, rock bottom is a myth that comes with a trap door. Often, families unknowingly “lower the bottom” by bargaining or making accommodations in an effort to keep the peace.

Short-term solutions to the problem lead to more frustration, more hurt, and more disconnection. Addiction is a family disease, and it is easy for the lives of the other family members to become absorbed in the details of damage control and crisis management.

Creating leverage

Families often feel helpless as they wait for their loved one to ask for help or appear “ready” for treatment, but there is a healthier option available. Even if a loved one is not ready to enter treatment or take the next step, family members can still have an active role in the process by creating leverage. Creating leverage to encourage a loved one to seek treatment is often the most effective means in getting him or her into treatment. Leverage does not have to be manipulative or cruel; in fact, it can be healthy. Leverage is established through setting boundaries and communicating concern.

Some families easily identify their leverage based upon the addict’s circumstances, while others have a more difficult time recognizing their influence. Setting appropriate boundaries can include statements like, “I love you, but you can no longer live in my home and use substances. I am more than willing to offer support as you seek treatment.” By not allowing the loved one to live in their home, while also showing support during the process of finding treatment, families effectively “raise the bottom” instead of waiting for him or her to hit rock bottom. A lack of boundaries can feed codependency, which actually gives the power to the disease of addiction, but maintaining boundaries gives you control over you.

Setting healthy boundaries

For some families, raising the bottom can be challenging or seemingly impossible. Depending on a loved one’s life circumstance, such as financial independence, or if family members disagree on appropriate boundaries, creating leverage can prove to be difficult. Boundaries look different for everyone, and there is no “right” answer. There are resources like family counseling that can help navigate tough questions. This often makes the stress and confusion of how to proceed more manageable for family members, particularly when there is a difference of opinion about boundaries.

Once families decide to take a proactive approach in seeking help for their addicted loved one, it is important not to sabotage the urgency of this process. When families embark on their own recovery journey, they become more willing to take direction from professionals who are trained in addiction, join a support group, and/or seek individual and family counseling. Then, waiting for the elusive “rock bottom” diminishes and the real discussion about “raising the bottom” takes place.

When rock bottom seems like the only way forward for your loved one, you are not alone. You do not have to be a victim to this disease, and you are not helpless. You have the power to raise the bottom.

Drug overdoses are currently the number one cause of death for Americans younger than 50, coming in higher than both guns and car accidents. In 2016, there were 42,249 overdose deaths in the U.S. that involved an opioid.

The opioid crisis has been declared a public health emergency, but what does that really mean? What makes this a “crisis”? How is it different than the other drug issues that are facing our country?

This is a complex issue because the category of opioids includes both legal and illegal drugs. For some, legal prescriptions to alleviate chronic pain may lead to addiction. Others start using with pills from friends or a family member. Still others purchase heroin or fentanyl from dealers.

For years, there has been overprescription of opioids in the pharmaceutical industry that has influenced this trend of addiction. Now, use of more potent opiates like heroin and fentanyl are increasing sharply.

This crisis has complex and dangerous implications on healthcare, the economy, and the well-being of millions.

Opioids & the brain

The term “opioids” refers to a category of drugs that includes prescription pain relievers, heroin, and synthetic opioids like fentanyl.

Opioids work by mimicking chemicals that naturally occur in the brain, which is part of what makes them so dangerous. They attach to the body’s opioid receptors in the brain and spinal cord. When these receptors are activated, they inhibit the transmission of pain signals. That is why they are used as prescription pain relief.

They also activate the brain’s reward center by releasing a neurotransmitter called dopamine. This is what creates the feeling of euphoria or “high.” This reward circuit enhances the highly addictive quality that opioids have.

Over time and with repeated use, the receptors in the brain become less sensitive to the drug, it takes more to achieve the same effect, and physical dependence develops.

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The price of the opioid crisis

Misuse of opioids also places a huge financial burden on society as a whole. It is estimated that this crisis costs the United States over $78.5 billion annually. We are talking about healthcare, criminal justice, and substance abuse treatment costs. It is important to understand the magnitude of this problem, and the massive majority of the population that is affected.

Specifically here in Georgia, there is an area north of Atlanta that has been called “the heroin triangle” because of the increasing concentration of heroin use. This is a largely middle-to-upper class suburban area that includes Cobb and Fulton counties, where heroin-related deaths have increased by 3,844% in the past six years.

The price of the opioid crisis goes far beyond finances. An increasing number of infants are being born with neonatal abstinence syndrome, as opioids pass through the mother’s bloodstream to the fetus. Essentially, babies are born into drug withdrawal, and they experience symptoms like excessive crying, sweating, and tremors. This often requires an extended stay in the hospital, and sometimes even medication.

It is easy to point fingers at brokenness when we are talking about something like this, but stigmas and misconceptions about addiction can perpetuate unhealthy behavior and prevent people from seeking the treatment that they need.Listen to some of our staff members discuss opioid treatment, as well as community and vulnerability.

Treatment challenges

Treating an opioid addiction is challenging because of the way that these drugs change the brain over time. Natural pathways have been interrupted by consistent drug use, and the brain has to re-learn how to operate on its own.

There is a high correlation between opioid use and mental health problems like anxiety and depression. Researchers have concluded that 48% of people who are addicted to heroin also experience depression. This is why comprehensive, whole-person treatment is important. We want to address both physical and mental health, as well as the underlying issues of addiction.

When someone is in active addiction, they often lack healthy coping skills. They have learned to react to tough emotions and challenging situations by using drugs to escape that reality for short periods of time. Learning coping skills is a huge part of treatment at MARR. We want our clients to be prepared for the challenges of a life in recovery and develop new habits to replace turning to drugs or alcohol.

The opioid crisis is a complex and widespread issue that has developed and changed over many decades, and there is no single and simple solution to end it. However, we want to take steps in the right direction. We believe that holistic, long-term treatment is the best way for individuals to step into recovery and begin a journey towards a better life.

There is hope and freedom beyond the crisis.

Sources:

https://www.cdc.gov/nchs/data/databriefs/db294.pdf

https://www.huffingtonpost.com/entry/the-opioid-epidemic-a-national-public-health-emergency_us_598b0179e4b0f25bdfb320c9

https://www.ncbi.nlm.nih.gov/pubmed/27623005

By Todd Valentine, LCSW

At MARR, men enter our care because drugs and alcohol have damaged or completely destroyed their lives. They often embarked on the path of addiction as an unhealthy method of coping with painful thoughts and feelings. Perhaps they experienced early childhood trauma in the form of parental neglect or bullying in school. Or as an adult, they underwent a traumatic event as a member of the military. Regardless of the “whys,” they relied on substances to stop the pain. Feeling absolutely nothing was the intended goal.

Unfortunately, once the substance, and its mind-numbing properties, is negated, the feelings he has so successfully avoided return in full force. He is like a man standing in a severe snowstorm without clothing; he is defenseless and vulnerable.

Consider this example: a man enters treatment because of a severe opiate addiction. Once detoxed, His mind is flooded with ghastly scenes from the past and equally bad future scenarios. How could he have bankrupted his family to buy drugs. Will his wife leave him? What will he do for income when he is sober?

These thoughts and fears spiral out of control; they overwhelm him and threaten to pull him down. This man is a single step away from picking up a pill bottle.

MARR recently integrated a new component into the treatment plans of our male clients to provide an option in this situation. It is mindfulness. Frequently, men are reluctant to engage in the practice, erroneously believing it is somewhat mystical or alternative in nature. Yet, by the conclusion of treatment, it is often these same individuals who prove most grateful for learning this valuable skill.

Mindfulness is the skill of being fully present, living in the moment, neither projecting into the future, nor obsessing on the past. Although easily learned, it is a strategy that necessitates time and practice to refine.

In the case of the man described above, a mindfulness technique is indicated. He is directed to inhale deeply, then exhale. This is followed by inhaling to the spoken count of four, holding for the count of seven, then exhaling to the same count.

During this process, the brain waves actually alter as does the chemical makeup of the brain. As a result, his body begins to relax and release tension. But even more important, his mind refocuses on the act of counting and breathing. The human brain, for as remarkable as it is, simply cannot focus on several things at once. With each inhalation and exhalation, the regret of the past and fear of the future is mitigated.

The beauty of this practice is two-fold: first, it stops the spiral in the moment; and second, it demonstrates that he must not be the ubiquitous victim to his own negative thoughts and feelings. This skill can be utilized anytime to reduce stress and reassert calm.

Another exercise I use is the mindful walk. We start by stretching, perhaps doing a couple yoga poses. The focus is on breathing and physical sensations such as the heart beating in the chest, or the thigh muscles offering slight rebellion. Instead of perpetually hurting their bodies with chemicals, this allows men to reconnect with their physical beings in a positive way. In time, as health returns, they often grow to appreciate, and even, respect their bodies for how miraculous and resilient they are.

Mindfulness is highly engaged with the five senses. Therefore, during our walk, they are encouraged to intentionally exist in the present moment: Smell the air, feel the ground beneath their feet, watch the shifting shadows created by the clouds. The past and future are superfluous; all that matters is the now. The ancient art of mindful Meditation also has incredible value. When in a deeply calm and relaxed state, the mind’s well being is enhanced. In addition, receptivity to positive affirmations about oneself is improved.

Healing from addiction isn’t easy for anyone. But having the practice of mindfulness in the recovery toolbox is invaluable. Reestablishing empowerment helps men feel strong, capable and less victimized by their thoughts and emotions.

As humans, we have an innate desire for connection. We want to feel accepted by the people in our lives, whether it be friends, family, or significant others. We want to feel like we belong. One of the biggest roadblocks to belonging is feeling shame: shame about things that happened in the past, shame about habits or actions or choices.

Author and researcher Dr. Brené Brown defines shame as “the intensely painful feeling or experience of believing that we are flawed and therefore unworthy of love and belonging – something we’ve experienced, done, or failed to do makes us unworthy of connection.”

A disease of isolation

When someone lets shame drive their life, they start to believe that they are not enough. They believe that there is something fundamentally bad about who they are, and they begin to isolate as a result of that.

Addiction is a disease of isolation and disconnection. This isolation comes in many different forms, whether it be losing relationships with family, walking away from community, or disengaging at work. In active addiction, shame causes someone to be disconnected not only from those around them, but also from themselves

Listen to Caryn B.’s story of finding support and acceptance in her community at MARR:

The cycle of shame

At the core of addiction is an attempt to escape reality. If we do not know how to identify and process our feelings and emotions, it can be much easier to run from them than to face them. These emotions can stem from stress, trauma, abuse, or anything in between. For an individual who suffers from addiction, drugs or alcohol become a vehicle of temporary escape.

Addiction perpetuates a cycle of shame. Shame about past actions or experiences can push people towards substance abuse. Society’s stigmas about addiction can fuel more shame, which in turn pushes people back to drugs and alcohol to escape again.

As this cycle goes on and on, it digs deeper into one’s life. It fuels hopelessness, and someone may not think that they even deserve help or treatment because of this idea that they are a “bad” person.

Breaking the cycle: acceptance and community

In order to break the cycle of shame and escapism, we must use tools to combat these patterns. The opposite of escaping is engaging. Engaging with one’s emotions and with people who are willing to listen.

It takes a lot of courage to show up in recovery. It takes even more courage to present your true self: fears, failures, and messy feelings included. But this courage paves the way to true belonging.

At MARR, true belonging is found within the community. We tend to use this phrase a lot, simply because it is at the very core of who we are. We believe that lasting recovery requires growth and support. In order to grow, you need to know that you are not alone.

These communities create a safe space to begin a journey of recovery. With a home-like setting, a balance of daily activities, and group accountability, clients begin to develop the tools that they need for recovery.

These tools include:

• Learning how to identify and process feelings and emotions
• Developing healthy rhythms of work, rest, and responsibility
• Dealing with conflict and setting boundaries
• Setting and working towards goals

This kind of community is built on vulnerability and acceptance. This includes acceptance of others and self-acceptance. If you want to experience true acceptance, you have to be willing to show up exactly as you are and face the parts of yourself that are scary. In turn, you will be met with empathy and understanding from people who are walking alongside you towards a life of recovery.

You will be accepted at your worst. You will be accepted in the middle of the process when everything is messy. You will be accepted without any sign of perfection.