As someone who works in the mental health field, I never pictured myself working with individuals who have used or are currently using substances.
In grad school, I found my niche with traumatized children, and that was the population I wished to work with going forward; however, as my experiences grew, and I branched out and worked with different groups, it became inevitable that I would eventually engage with someone using substances.
As time progressed, I eventually began facilitating two groups specifically dedicated to assisting those with substance use.
I was given the title of Team Lead of the Rural Community Opioid Response Program (RCORP), and I began to see how important a clinician with a background in trauma is to a program such as this.
Meaning, that my knowledge of trauma, has proven itself invaluable in this area, as I am able to discuss how their past influences their present.
Understanding Substance Abuse
Over the decades, substance use has been treated as a “choice,” and treatment was not covered by insurance companies.
Eventually, it evolved into being labeled a “disease,” but I personally feel that it leaves out the human component to substance use. Being a “disease” leaves out the person’s desire to be free of difficult feelings and to forget the past. Furthermore, this label places it in the “medical model” of treatment; that is, it says, “take this pill” or “do this” and “you’ll be all better.”
But that is simply not the case.
Rather, there is not a “one size fits all” treatment approach to mental health, and that certainly applies to people who use substances.
Therefore, I hope to explore how we as individuals, both professional and non-professional, can assist people in our lives struggling with substance use.
One of the first changes, that I believe needs to occur, is how we view substance use overall.
For many, substance use stems from the mental health side, meaning there is likely some trauma in their history that they hope to forget. Substances offer an escape from reality and freedom from debilitating shame and guilt. Furthermore, it’s important to remember that no individual sets out with the goal of becoming addicted to any substance. No child, when asked what they want to be when they grow up will respond with, “a heroin user” or “an alcoholic.”
However, this leads into the idea that everyone alive shares the same likelihood as the next person of developing a substance use disorder, with some environmental factors clearly influencing the progression (or lack thereof) of the disease.
The reason people become addicted to substances such as cocaine, heroin, and methamphetamines is the same reason people develop binge eating disorders, gambling addictions, sexual and shopping addictions, and become “workaholics.” There is a part of the brain that craves “feeling good” It makes us want to avoid uncomfortable feelings such as depression, anxiety or physical pain.
The brain is selfish. It wants to feel good, and it wants to protect itself. It will cater to the most primitive sides of ourselves in order to get what it wants.
Meaning, the little internal voice that says, “Go ahead, have another chocolate chip cookie,” or “It’s okay, one more hit won’t hurt anything,” will take control.
When we are emotional, we are most likely to concede to that little voice, because the logic and reasoning part of our brain is temporarily disconnected from the emotional part. This is called “flipping our lids.” The emotional brain then becomes the driving force behind our thoughts and behaviors. This is something that is apparent in all humans, not just those struggling with their mental health or struggling to overcome an addiction.
By understanding how addiction forms, we can be more understanding and empathetic to others’ situations. This compassion for others, which stems from this understanding, is, without doubt, one of the most important aspects of being able to help others achieve their goals of recovery.
However, another important piece, even for us clinicians, is to understand that the individual determines what their recovery looks like.
If an individual, who identifies as an alcoholic, can drink one beer without issue, this is fine. Most people I have met cannot do this, but for some, having the occasional beer is okay. For others, this may mean functioning on Suboxone or Methadone. Still for others, it may mean complete and total abstinence from all substances, despite not having an issue with alcohol.
It is up to the individual to determine what their recovery looks like – not the family, not the clinician, but the individual.
Understanding substance use and mental health is one piece to helping those in our lives achieve their goals, but the question remains, “What can we do to help people?” Can we truly do anything, other than display compassion and understanding? For some, this may come as a surprise, but the answer is unequivocally, yes!
I realize that for those who have family or friends who are using substances, it may feel like it’s a never-ending cycle. It may feel as if we cannot trust them and should “cut them off.” Avoiding enabling behaviors (i.e., providing them with the means to continue engaging in substance use) is one positive way to provide help, but it’s not the only way.
Seeing Things From Their Perspective
I spoke with a few individuals who are in recovery. These individuals gave their perspectives on what worked best (or what would have worked best) for them when they were recovering. The names of these individuals have been altered to protect their identity, but their stories and perspectives are genuine.
Waverly’s Story
Waverly has been in recovery for a little over three years. Prior to that, she was in and out of prison for a good portion of her young adult life and was in a constant cycle of sobriety and relapse. When her father passed away in 2017, and she was unable to attend his funeral due to being incarcerated, she made the decision to officially achieve her goal of a life free from heroin.
She told me that two things most contributed to her success in beating addiction: not being judged by others and engaging with others who have had similar experiences. Having someone to talk to, who accepted her for who she was and provided support, despite her history, truly made a difference for her.
Guiding these individuals in our lives to meetings (i.e., NA or AA) and other support groups can provide some of the best support available. However, we must remember that should not do this, unless the individual is ready. Until they are ready, the best we can do is support without enabling, because if we attempt to push, they may develop feelings of resentment.
Waverly also told me that, for herself, being honest with others was helpful; however, I believe the reverse is also true. Being honest with people, despite the possibility of rupturing the relationship further, is integral. This way, people know how we are feeling about their substance use.
Again, this goes back to avoiding enabling behaviors.
Here, we want to communicate assertively and be upfront about our feelings, without being rude or putting people down. Finally, she recommended Medication Assisted Treatment (MAT) services for any individual aspiring to meet their goal.
Elijah’s Story
This second individual is a former client of mine, whom we will call Elijah. He was in services to overcome his addiction to cocaine. He once told me that he never thought it was a problem until he almost died. He recommended that no one do this alone.
Elijah told me that anytime he attempted recovery on his own, without any support, he always failed. It wasn’t until he found God and Jesus, coupled with the support from his family, that he was able to overcome his challenges. In fact, for Elijah, he truly recommended getting involved with a religious organization.
He found that being connected to a church, from both the spiritual/religious piece as well as the community piece, he was able to succeed for the first time, whereas other times he had failed.
Although Elijah identified as a Christian, connections to different religions (Judaism, Islam, Buddhism, etc.), can have such a profound effect on recovery because of the concept of being connected to something bigger than yourself. For us, why not simply invite people to attend a service? As individuals, a simple invitation may have a significant effect.
Alternatively, it may not, but we never know what kind of interaction or event can influence change, as seen in Waverly’s case.
Mary’s Story
Finally, the third individual I spoke with was Mary, a peer support specialist, and recovering heroin user. One of the biggest hurdles she experienced while using was not having access to resources and services. This, Mary said, would have benefited her the most, had she had access to them.
One of Mary’s biggest struggles was a lack of access to detox facilities. It was difficult for her to access services, or to even find a detox facility. When Mary found a facility that provided these services, she found that insurance was required. She did not have insurance, so could not afford to detox.
She also said not having access to methadone clinics was a major deterrent in her journey to recovery. At the time, the only methadone clinic in the area was in Portsmouth. To access its services, she needed a Portsmouth address, which she did not have.
While some aspects have changed since Mary’s early attempts at recovery, the concept of limited services and supports continues to be a problem. This was also echoed by Waverly, as she reported a similar struggle.
With that said, when it comes to non-professionals simply wanting to help a friend or family member, we cannot always “create” new services. However, we can find out what resources are available and direct the people in our lives to them.
Ways we can help
By finding and giving as much information as possible, I believe we can empower people to make change because they know they have a source of support. This part is crucial.
When a person knows they have someone in their corner, they know someone cares and, as a result, may not feel as alone or isolated.
In fact, when working with kids who have experienced trauma, I’ve found that one person, one true relationship, is all it takes to make a difference in that child’s life. That same concept, I believe, of it only takes one person, can likewise apply to those using substances.
Mary had one final piece to add. She stated that anything that is inclusive is beneficial.
Any way that we as individuals can include someone is valuable.
For example, using the situation above of asking an individual to attend a religious meeting with us, Mary stated that the individual may turn you down, and keep turning you down. However, she encouraged everyone to keep asking, because maybe, one day, the individual will accept.
This simple repetitive action, that is not enabling, is how they know someone cares. Even though it may be tempting, do not just shut these people out of your life completely. We should be present in their lives as best we can, but also, set boundaries for ourselves. This way, even if they shut down or become defensive, you are letting them know that you will help them, when they are ready to receive the help.
One final piece I considered as I draw this blog to a close, is to simply ask the person, “What do you need? How can I help you? What can I do?” By asking this quite basic and simple question, we are letting the individuals in our lives direct us.
Remember, we do not want to direct them, we want to empower them, give them autonomy to make their own decisions, and not feel “forced” into something for which they may not be ready.
When was the last time you were forced or coerced into something and you were happy about it? Everyone knows their own circumstances better than anyone else.
There is an old Japanese proverb that applies here:
We all have three faces.
The first, is the face we show the world.
The second is the face we show those closest to us, and the third face, is the face that only we can see.
By remembering this, we recognize an individual’s right to self-autonomy, but we provide them with seeds to thrive. It’s important that we do not want enable a person, but at the same time, we don’t want to exclude them completely.
We want to set firm boundaries for ourselves, but we can research support groups in the area or organizations that provide various resources. We can invite people to any event that creates a sense of community, whether it be through a religious organization or entity, or simply a family get-together.
We can also help by avoiding judgment, being assertive and honest when appropriate and necessary, and giving people respect of autonomy.
We Can’t Force Change, But We May Be Able to Encourage It
Finally, remember that substance use is not a choice, it is a disease, but it is also a disease that can apply to any human alive because it is part of how the brain works.
Treatment is never a one size fits all, and certainly takes time; however, by being present and supportive, who knows what the future will bring.
We Are Here for You 24/7
At Western Tidewater Community Services Board, we know that when someone you care about is struggling with substance use, things can seem hopeless. But we want you to stay positive and keep trying to help! You are not alone in this. We can provide you the resources your loved one needs to start the path to recovery today.
We offer 24/7 crisis services, so no matter the day or time, we’re ready to help.
Let’s move forward, together.