By Amanda Holloway, LPC

Everybody knows that “sex sells.” This is true of so much of the advertising we are exposed to, that many of us never consider what is being purchased. Quite simply, these images have bought space in our heads and that gives direct access to our hearts and as a result, our lives.

Many millions of dollars are spent marketing to adolescents, the most vulnerable group. As teenagers, we are trying to figure out who we are, and how to belong and fit in. We are becoming more independent, and beginning to look at the future. One of the primary ways we learn to belong is through watching and imitating others. The average young person in the United States views more than 3000 ads per day on television, the Internet, on billboards, and in magazines. Advertisers are always seeking new and creative ways of targeting young consumers. The sexually provocative images, sounds, and suggestions that are specifically designed to arouse interest in a product can be very confusing.

It should be no surprise, then, that advertising is especially influential for young women during adolescence. The advertiser sells the vison that sex equals the key to popularity, happiness, and dreams coming true. Also, at this age, many young women first begin to first experiment with and abuse substances. For some, using provides the opportunity to fit in and look cool while living out the fantasies in the ads/movies/TV shows. For others, it is the chance to finally feel comfortable in the skin of a changing body seen as ready for sex despite still being led by a mind ill-equipped for adult attention and sexual experiences.

The use of alcohol and drugs during this stage of life as a way to connect with others, become more comfortable with a changing body, and reduce sexual anxieties, creates a deep-rooted connection between sexuality and substances. In early recovery, the idea of a sexual self without drugs/alcohol is either unfathomable or so far in the distant past that the memory seems lost forever. For many women, sex is the last connection left to others; serving as a final vestige of intimacy stolen by the isolation of addiction. Entering treatment, one is confronted with a body that they have either never known or cannot recognize. Bodies that they struggle to find a way to connect with, appreciate and love.

Learning about one’s self in recovery includes learning how to embrace the sexual self and body that may have been avoided during adolescence. This includes learning to overcome feelings of shame related to past sexual choices, trauma work, body acceptance, and ideas about love. Not addressing the role that sex and sexuality have played in the various stages of addiction is to ignore one of the major relapse triggers for women: relationships.

In the midst of discussing feelings and patterns, and learning to take time to develop healthy, safe relationships, a woman in recovery needs to be reacquainted with her body, possibly for the first time since adolescence. She needs to understand that the feelings and sensations are not abnormal or dirty and that substances are not needed to embrace this aspect of self. A woman in recovery needs to recognize that sex is more than what was advertised, not for sale, and that they can be sole owners of their sexuality.

Addiction is an isolating disease, for both the addict and those who love him or her. The addicted individual becomes preoccupied with obtaining, storing, and hiding the supply of drugs and/or alcohol, so much so that relationships to themselves and others take a backseat. Similarly, family members detach from the outside world due to feelings of guilt, shame, fear, sadness, and disappointment. The destruction that addiction leaves behind is unlike any other illness.

Individuals who are in active addiction are unstable and unpredictable. They will lie, cheat, and steal in order to keep the disease alive. Oftentimes, family members live in a constant state of fear — the addict’s erratic behavior causes stress, anxiety, suspicion, paranoia and doubt. As boundaries become distorted, the entire family system deteriorates. Family members may enable, rescue, or attempt to control the addict — with good intentions — but the relationship is all but destroyed.

You, as a family member, are the problem solver and the fixer. You love taking care of the people you love. What you don’t realize, is that each decision you make, like doing something for someone else, might cross an invisible line, which takes you away from doing something for or taking care of yourself. It is not wrong to take care of others, as long as there is a balance with taking care of you. It’s like balancing a scale. If it’s weighted too heavily on one side then the scale is unbalanced. We are people, not scales, and our balance comes from setting and maintaining healthy boundaries in our relationships with others.

It’s time to find balance and set healthy boundaries to begin enjoying life again. Here are a few tips to help you get started.

• “’No’ is a complete sentence.” A co-dependent relationship, especially one that involves addiction, takes power away from the family member and passes it onto the addict and his or her disease. While the first step of codependency recovery is admitting powerlessness over the loved one’s addiction, the end result is to gain control of you. Remember, no one can make you do anything — your actions are a reflection of your choices. “No” is a complete sentence and will serve you well as you embark on your own journey of recovery.
• “If it’s good for you, it’s good for everyone.” Les Carter, Ph.D. is the author of a self-help workbook appropriately called When Pleasing You Is Killing Me. In this book, readers learn about the unhealthy patterns of people-pleasing and find the balance between serving others and proper self care. Similar to putting on your oxygen mask in an airplane before assisting others, making a decision that is good for you will positively impact those around you.
• “If you need an answer right now, the answer is no.” Addicts have a way of manipulating any situation. Oftentimes, this includes putting unnecessary stress and pressure on family members to make important decisions immediately. Most situations that require hefty decision-making take time and prayer. If the addict in your life demands an answer, simply tell him or her no. Remember, No is a complete sentence.
• “No one can make you feel inferior without your consent.” The highly esteemed Eleanor Roosevelt uttered this poignant statement, and it still rings true today. You are in charge of your actions, thoughts, and words. If you feel inadequate or less than, you gave someone permission to treat you as such. Be kind to yourself — you are enough.

Healthy Communication
Communication is everything in a relationship. Poor communication leads to frustration and resentment, while effective communication results in understanding and mutual respect. If you feel anxious, resentful, worn out, smothered, disregarded, disrespected or hurt, it’s safe to assume that your boundaries have been violated. Below is a constructive technique for expressing your feelings to the addict in your life:

1)   “When you [ actual behavior ], I feel [ emotion ] because _______________.”

2)   “I prefer/want/need [ specific action ] because ______________________.”

3)   “If you continue [ actual behavior ], I will [ specific action ].”

It’s important to note that once boundaries have been infringed upon, you must follow through with the appropriate consequences. Be patient — implementing effective communication techniques and setting healthy boundaries will not ensure overnight changes, but you will begin to experience improvements in your relationship with the addicted loved one over time. Most importantly, you will notice positive changes in yourself.

Families living with addiction are often families who keep secrets. The anxiety and stress of living with an addict are a daily part of their lives, so in order to cope, individual family members and the family system develop defense mechanisms that allow them to function and avoid exposure of the problem. Instead, this avoidance creates a pattern of secret-keeping that only compounds the stress.

The energy it takes to keep addiction a secret and the isolation it promotes affect the family in many ways. If the secret is being kept from the children, they may become confused and frustrated. They know something is wrong, but they don’t know what it is. Children can become resentful that the parents don’t trust them with the truth and may develop a lack of trust in themselves and others. Extended family may also be confused as to why the addicted loved one never attends family functions. The family may stop attending family functions altogether to avoid uncomfortable questions, isolating them from needed support. Most of all, secret-keeping perpetuates the denial in the individual and family system that something is terribly wrong and needs to be addressed.

There are three main reasons why family members keep their loved one’s addiction a secret. First, the secret-keeping may not be deliberate. For example, if a wife grew up in a family where the father’s addiction was a secret, then keeping her husband’s addiction a secret would feel normal to her. Thus, the pattern of secret-keeping is passed down through the generations. Second, there is a stigma in our culture about addiction. Many people still believe that it is a weakness, not a disease — if the person really wanted to stop, he or she could do so at once. Family members that don’t want to be stigmatized will keep the addiction a secret to protect their reputation.

The third and most common reason families keep addiction a secret is due to the fear of exposing their shame. They believe that if anyone found out, their world would fall apart and their lives would be forever changed. This fear is based on the belief that they are somehow defective or deficient as a family because this has happened to them. The individual or family develops a false self, or mask, to hide behind. Shame-based families live with the rule “don’t talk, don’t trust, don’t feel” as a way to negate the shame they feel (to themselves and others).

What can help a family living with the secret of addiction? Breaking the silence and sharing with others in a safe environment is the first step. MARR offers weekly family support groups that allow families to begin talking about their experiences of living with an addicted loved one. Families are relieved to find that they are not alone — that others also struggle with this problem — and that there is hope for themselves and their family.

A strong support system is an essential part of family recovery. Families must acquire healthy communication skills and learn how to ask for help. It often takes time for family members to “take off the mask” and focus on their own recovery. But, our families tell us it’s worth it. At last, they have found the freedom to live a life without secrets — to be themselves.

It’s certainly no newsflash that opioid dependence has become prevalent in America. But the fact that teenagers and young adults are more likely to abuse opioid painkillers than older adults might just blow your mind. Between 2002 and 2004, 1.1 percent of people aged 12-17 and 1.3 percent of people aged 18-25 were addicted to prescription drugs. That’s approximately twice the percentage of people between the ages of 26 and 49, and six times the percentage of adults 50 and older.*

And the numbers continue to rise.

From teenagers to mature adults, one thing is certain: people are getting hooked — even overdosing — on painkillers. Today, more people die from opioid overdose than cocaine or heroin. Opioids like Vicodin, OxyContin, Lortab and Percocet are effective for individuals who suffer from severe chronic or acute pain; however, more and more people are using these prescription drugs to alleviate stress and relieve emotional pain.

Abusers of opioids use them as a means to ‘numb out’ and deal with anger, depression, anxiety and insomnia. Pain relievers may provide an escape from reality for a while, but the addiction will backfire at some point. The individual develops a tolerance to the drug, whereby he or she must take more pills to get the same effect as before, and life eventually becomes unmanageable.

Opioid addiction causes long-term damage to the brain and often requires professional treatment for lasting recovery. The biggest challenge in treating those who are dependent on opioids is that long-term use can result in a ‘flat’ effect. In other words, the person becomes apathetic and unmotivated. He or she may no longer care about things, including recovery.

Learning healthy ways to cope and getting professional help are the best ways to overcome opioid dependence. There is hope for the addict, but the road to recovery takes work and a willingness to get better.

*Data based on the 2002, 2003 and 2004 National Surveys on Drug Use and Health (NSDUHs) on the nonmedical use of prescription-type psychotherapeutic drugs.

I had my first drink at sixteen, and what started out as relatively normal teenage rebellion and social experimentation, quickly became daily drinking by the time I was 19. When I drank, it took away all insecurities and helped me feel comfortable in my own skin. As a result, I taught myself that alcohol was the solution to pretty much everything. Consequences from my drinking came relatively quickly, starting with loss of trust with my parents, legal incidents, car accidents, loss of jobs, the dissolution of any and all meaningful relationships, and ending with ultimate feelings of helplessness and hopelessness. I had no idea what was wrong with me and why I couldn’t stop drinking and doing the things that caused me and those around me so much pain.

I was 22 years old and six months sober when I walked into MARR Women’s Center in 2013. Prior to MARR, my first treatment was July 14, 2012 at a 45-day program. I thought it was just what I needed to learn to manage my drinking like “normal” people. I was just going through the motions at this point. Upon completion of that program it was recommended that I go to a recovery residence in order to ease my transition back into “the real world”.  After four months in the residence I ended up back in my hometown. It became very apparent to me and my parents that I had barely scratched the surface. After diligent research on my parents’ part, they came across MARR. My mom and dad felt very strongly about the program at MARR and what it had to offer. I won’t say that I went kicking and screaming but to say that I was thrilled with the prospect of going to treatment again would be an understatement!

I arrived at the WRC January 17^th 2013. I quickly learned that I clearly could not manage my own life and I had to turn it all over to something greater than myself, which at that time was the staff at MARR WRC. I had to make some serious changes in order to not only stay sober, but to live the life I dreamed of having. The therapeutic community and group setting that MARR provided has forever changed my life. I have real friendships that I never imagined possible, and a relationship with my family that I can finally be fully present for. All the blessings in my life today would not have been possible without the scholarship I received. My family and I will never forget that gifts from people we didn’t even know allowed this miracle to happen. I am so blessed and beyond thankful for MARR and the foundation they provided for living a life of hope, serenity and gratitude!

Emily B.

By Jim Seckman, MAC, CACII, CCS

First of all, before you form an opinion based on the title of the article, please let me state as clearly as possible, that the use of buprenorphine (suboxone) is not really my issue here. If we back up for a moment, I can absolutely affirm that the values of programs who prescribe buprenorphine and those of abstinence-based programs are exactly the same: We all want to save lives. That really is the bottom line. I agree there is evidence that shows that the use of buprenorphine allows many individuals to get off heroin and participate in treatment. That evidence is not my issue either.

The issue for me is the unqualified endorsement of the use of buprenorphine as the only viable treatment for opioid use disorder to the exclusion of other treatment modalities that are also proven to be effective.

The opiate epidemic has intensified fears of families and communities, and with good reason. In a reaction to the demands of communities, there has been a movement from legislators and the medical community towards medication-assisted treatment (MAT) that focuses almost exclusively on the use of buprenorphine, which is itself an opioid based narcotic. This has also led to treatment becoming more individualized and away from a longer length of stay and the therapeutic community model.

And, what is even more disturbing, is that many of the most vocal proponents of MAT completely ignore approved medications that are extremely effective, but not opioid based: Naltrexone and Vivitrol (extended release Naltrexone). These medications negate the effects of opiates in the brain and have been shown to reduce cravings, thus allowing clients to participate fully in treatment without any opioid based medications.

MARR has just completed an 8-year study that demonstrates the efficacy of an abstinence-based model that works with clients who are suffering from opioid use disorder. We found that as we modified our program structure to meet the needs of these clients, we began to see higher retention rates and successful completion rates that consistently surpass the national averages for long-term treatment programs.

I have no doubt that evidence shows that buprenorphine works. However, it is unfortunate and misleading, to the public at large and to helping professionals, to ignore existing and emerging evidence that shows that abstinence-based programs, particularly those that are long-term, based in the therapeutic community model, and who use Naltrexone and Vivitrol as support medications, are effective as well.

We are all working very hard to save lives and address this terrible epidemic. It is clear that we need a variety of modalities in our treatment approaches in order to be effective across a broad spectrum of clientele. Please don’t be intimidated by the strong, singularly focused voices out there right now. Let your voice be heard about the practices and modalities that you know work for your population!