5 Things I Must Remember

It’s easier said than done!

This is me talking to myself about myself.

One – Detach

You detach from the emotional obsession and the illusion of control. You do not automatically eliminate the person from your life.

Unless this person is mistreating you. Stealing, putting you in danger, or just wearing you out after years and years of the cycle.

If that is the case, you should consider some more rigid boundaries. It’s a matter of self-preservation. However, all of this needs to be processed and “talked through”.

It’s not easy and it’s not black and white.

Two – Unique Family

Every family is unique. It’s professionally lazy to paint with a broad brush and treat every situation the same.

Factors that need to be considered include:

1. Age of your loved. A 50 year old spouse requires a different response than an 18 year old child.
2. Specific substances involved and the associated “dangers”. Fentanyl, for example, makes every situation more “urgent”.
3. How long have you been dealing with this? Doing the same thing over and over for 20 years is different than intervening for the first time.
4. Are you in danger? Emotional or physical abuse? Stealing your property?
5. Is there a co-occurring mental health issue or history of trauma?

Three – Consultant / Coach

Every family should have a consultant/coach for the long haul.

The ups and downs of recovery require long term support. And the family must be helped along the way. It’s not as simple as detachment and turning it over.

That may be part of the process. But there are a hundred other issues that require expert advice and support.

And things aren’t resolved after 30 days in rehab.

There are many good treatment providers.

However, we can’t expect inpatient rehabs to manage after-care. Specialists need to be deployed to follow the family long term.

Four – Self-Care

Self-care is a process and it works. I have been resistant to “taking care of myself”. I’m not sure why I have been resistant. Unconsciously resistant. However, I have come to believe that self-care is a real thing. Commit to a plan and stick to it. Consistency is important. Some elements of a self-care plan include:

1. Group meetings. 12-step or otherwise. There are undeniable benefits to the group experience.
2. A one to one confidant or consultant as described above.
3. Prayer: if you are so inclined
4. Meditation.
5. Positive psychology programs.
6. Exercise.
7. YOGA.
8. Individual psychotherapist is sometimes appropriate.
9. Marriage or family therapy.

Five – Remember This

Try to remember: treatment and recovery is a process. Not an event.

There is no magic solution.

That said, there are very good programs and specialized interventions that may be helpful.

However, try to stay balanced in terms of your perspective. Not too high, not too low. Believable hope.

There are many more things that could make this list. Whatever works for you.

The key, you must do these things consistently.

“It’s easier said than done”.

Much easier said than done.

About Rich Jones MA, MBA, LCAS, SAP
EVP & Executive Director, Heritage CARES

Executive Vice President (EVP) at Heritage Health Solutions, Inc.
Chief Strategy Officer Co-Founder at Youturn,
CEO at Wellness Partners Group
CEO/President at Jones Solutions Group
Former CEO at FAVOR Greenville

Visit Heritage Health at – Click Here

For Addiction Support Info – Click Here

Please Subscribe to the Recovery Cartel – Click Here

The post 5 Things I Must Remember About Family Recovery appeared first on The Recovery Cartel.

7 “SLOGAN-FREE” Tips

“Tough love” and “let them hit bottom” DID NOT make the list. As our country fights through the “opioid crisis” we see the limitations of an addiction treatment system that came of age in the 1970’s. Today families need as much help as we can give them. Here are a few tips for families dealing with addiction.

(Note: in reality it is addiction crisis not an “opioid crisis”-but the opioid narrative works better for the press. The narrative being that evil pharmaceutical companies got middle class white kids addicted. Addicted and everyone started to die etc…)

These limitations are most evident in the strange phenomenon of recovery slogans that seem to guide healthcare/addiction treatment policy.

Slogans such as “wait until they hit bottom” or “he is in denial” or “these addicts have to want recovery ”.

One Size Fits All

Generated out of mutual support recovery groups, these sayings guide everything from insurance reimbursement to one-size fits all treatment models.

Some slogans are probably grounded and based in fact.

All slogans are generated from a place of wanting to help. But they should not be applied universally and they are not adequate in terms of guiding healthcare policy.

The lack of evidence supporting many abstinence only treatment models is stunning.

The lack of accountability in the industry is baffling.

The unwillingness of some programs to adopt evidence-based models is probably illegal. Certainly unethical.

M.A.T. Resistant

The most glaring example is the lack of acceptance, as well as those being resistance to medication assisted treatment (M.A.T.).

I’m not one of the M.A.T. zealots. I do not promote M.A.T. as the only acceptable treatment for opioid use disorder (that mentality is just as problematic as the current abstinence only model).

However, M.A.T. is an option that is systematically suppressed and ignored by many treatment providers. The only logical conclusion: slogans are taken more seriously than research.

Slogan Driven

Families are also subject to slogan driven “professional” help.

Unfortunately, the slogan-based model has been extended into professional work with family members. Family members looking for information related to addiction are met with their own version of one size fits all treatment.

Family members are labeled enablers and co-dependents.

They are told “you are loving your child to death”. They are told “let them hit bottom”.

OF COURSE THEY ARE TOLD “YOU NEED TO START PRACTICING TOUGH LOVE”.

90% Never Get Help

Most family members, like most people in addiction, run from professional advice and recoil from this approach.

We know that 90% of those in need of addiction treatment never get help.

I would argue even more than 90% of families in need never get help.

They vote with their feet. Also, they don’t come back.

They can’t tolerate the professional judgement. They can’t tolerate being chastised for their “enabling behavior”.

What Does Work

The concept of “working on yourself” is also difficult for families to grasp. In our Family Recovery Groups at FAVOR Greenville we spend a lot of time on this issue.

• We know there is validity to the idea of family members focusing on themselves.
• Too often, family members are automatically told: “you’re sick too” and “you need to detach”.
• These ideas have a place in the family recovery process, however, they should not be mechanically applied to every situation.
• Furthermore, there is a matter of timing to the conversation.
• You want the family to stay engaged in the process. Don’t chase them away with this type of label.
• When someone comes to realize the seriousness of their loved one’s substance use, they are confused and terrified. They are looking for expert advice. That advice should be grounded in sound theory, research and compassion.
• We also need to over-emphasize the importance of individualized family interventions.
• We need to understand how the structure of each individual family influences the approach we take with that particular family.

Opioid Use Disorder

For example, there is a big difference between talking to the wife of a 40 year old struggling with alcohol and the mother of a 20 year old with opioid use disorder.

Say it again for the people in the back of the room:

There is a big difference between talking to the wife of a 40 year old struggling with alcohol and the mother of a 20 year old with opioid use disorder.

Cultural Context

Detachment and tough love were developed in the 1950’s to help wives deal with alcoholic husbands.

These ideas made sense in that cultural context. They made sense in the context of a married couple.

Wives should not over protect and rescue husbands. It is not healthy. It is not natural.

Natural For Parents

However, parents are certainly going to react in a protective manner. It is natural for parents to try to rescue kids. Especially young adults.

The impulse to control and fix is natural. It’s not pathological to want to rescue your child. It is biologically hardwired into you as a mother or father.

You are compelled at an instinctual level to “save your child”.

When people dismiss you out of hand and scoff at your desire to help they are being short-sighted. They are demonstrating a fundamental lack of understanding.

When people tell you to detach and “kick the bum out” they are being cruel and engaging in classic “do as I say not as I do” behavior. These good people would not follow their own knee-jerk advice. If we were to reverse the roles.

What About Rescuing

Rescuing can, however, become counter-productive. Rescuing and ignoring bad behavior can enable the addicted individual to engage in ongoing self-destructive behaviors. In addition, you are going to personally self-destruct.

You can only handle so many sleepless nights and anxiety filled days.

I know what it is like to find yourself in the worry cycle.

That endless path of chasing scenario after scenario. All the “what ifs”.

Impact of Stress

The negative impacts of stress on the physical health is documented very well.

Up to 70 serious health conditions are directly caused or exacerbated by chronic stress. The addiction will take you out as quick as it will take out your loved one.

This is why people say: “work on yourself”.

The added bonus is, as you work on yourself, you increase the likelihood of change in your loved one.

Family Systems Theory

The family is a system; changing one part of a system influences all other parts of the system.

Family systems theory holds that individual family members fall into predictable roles and serve particular functions within the larger family system.

In addition, the family system (indeed any system) exists to preserve itself.

Unless acted upon by a strong internal or external force the system will proceed down the path of collective destruction. Given this reality, it is self-evident then that any individual part of that system could impact the system as a whole. This means the addicted individual will need to adjust to changes in any other part of the system.

Therefore, when in doubt. Work on yourself. It seems to me that all family recovery addresses three interrelated issues: Anxiety, Worry, and Chronic Stress. Focus on positive actions that reduce anxiety, worry and stress.

Helpful and Healthy Suggestions:

Become part of a group. We are social creatures.

You don’t even need to enjoy the content of the group. Just being around people with similar struggles will prove uplifting.

The benefits of group are clear:

• Universality — you realize you are not alone
• Altruism — you get to help others
• Imitative Behavior — you hear from others who have gone through the same thing and
• Develop Coping Skills — more adaptive responses.
• Instillation of Hope — Perhaps the most powerful factor

The “FREE THREE”

Practice the “FREE THREE”. Easily accessible activities which have proven to reduce stress:

1. Go outside, take a walk
2. Listen to your favorite music
3. Smile and laugh

Do something fun for yourself. Something meant for entertainment.

All for fun and not work related.

Prayer and meditation. Regardless of your personal beliefs we know that prayer and meditation have positive impact on neurobiological pathways.

The Confidant

Find a confidant. One to one. Sometimes you can’t share at group level and having a one to one relationship can be invaluable.

This could be a therapist, a sponsor, or a coach.

Eliminate toxic people from your life. You have no time for people who drag you down.

Eliminate judgmental people.

And Most Important. –

RESIST THE TEMPTATION TO ISOLATE. ISOLATION FEEDS DEPRESSION.

Isolation makes everything worse.

Some people think it is the main cause of depression, not serotonin.

Get outside, go visit someone. Try to do your life despite your despair.

Give it try… trust me.

The post Tips For Families Dealing with Addiction appeared first on The Recovery Cartel.

Long Term Coach

Assigning a long term coach to the family is the right thing to do. People think they know what it’s like to go thru this journey as a family member.

You don’t. I thought I knew. I did not know.

You simply do not understand this until you actually go through it yourself.

System Navigation

The number of unresolved questions and the system navigation issues are staggering.

Freaking unbelievable.

And the family should be guided. Not the individual. The entire family unit receives guidance and support.

The average family will get chewed up and spit out by the system.

And the Insurance reimbursement process is exceedingly sickening. Disgusting.

Long Term Support

Long term family support provided by high quality professional staff supervised by family therapist/clinician or highly experienced/qualified peers.

Thank God I know who to call and what comes next.

How to advocate and “figure it out”.

But I am a 20 year veteran of this field. Working on the treatment and recovery side of the fence.

I can’t imagine what it’s like for your typical family dealing with this.

That’s how these Facebook ass-clowns take advantage of people.

In the midst of confusion and chaos these ridiculously unqualified people wind up guiding families. And … disaster follows.

Real Solution

We need to provide families with constant access to a qualified system consultant.

I don’t care if you call it a “recovery coach” or case-manager or family coach or whatever.

Long term, consistent support.

The post Assigning a Long Term Coach appeared first on The Recovery Cartel.

Better Than Bottom

We can do better than “hit bottom”. The Family Recovery Coach is becoming increasingly relevant in today’s battle with addiction.

You walk into a support group, your mind is racing and you are scared to death.

The terminology may be hard to follow. It comes at you from all angles.

Angles & Terms

• Detach…
• Don’t rescue…
• Don’t worry…
• Pray…
• Set boundaries…
• Don’t enable…
• Wait until they hit bottom and want it…
• You can’t control it…
• You can’t cure it…
• And you didn’t cause it…
• Let go and Let God…

Good advice! But, many of us need more.

We leave the meeting. Keep coming back and it will get better.

But in the meantime? Please consider the following.

Points to Consider On Family Recovery Coaching

1. Every family should have a family coach attached to them. Regardless of the status of the addicted individual.
2. The family should be able to self-referral and receive long-term, unconditional support. Without “intervention” being the end game.
3. A family coach should be supervised by a clinician(s).
4. There should be an evidence-based model guiding the coach.
5. Family coaches are not Alanon or Naranon sponsors.
6. Family coaches are not marriage and family therapists.

Qualified Recovery Coaching

They have lived experience to build on. They should meet certain qualifications and should be held to high expectations.

This is a professional discipline.

Families should shop around for services.

Be careful, the “Facebook Superstars” are NOT qualified to support families.

Family coaches should be reimbursed by 3rd party payers.

And the entire family should be the “identified patient(s)”.

Commercial insurance should step up.

That may not happen quickly or easily. But, progressive, forward-thinking partners are stepping forward.

The future will bring a paradigm shift.

Additional Info – Family Intervention Consultation

When a family situation is complex and the loved one’s addiction presents particular challenges. A formal family intervention may be helpful.

FAVOR Greenville’s Executive Director, Rich Jones, is an ARISE Interventionist. Offering consultation and support services at the FAVOR. Using a compassionate Invitational Intervention™, the ARISE Continuum of Care is a gradually-escalating process.

A process that leads your loved one into appropriate treatment and recovery.

The addicted individual is invited to join the process. Join in from the beginning with no surprises, no secrets, no coercion, and absolute respect and love.

For more details and information about the “Family Recovery Coach” , please visit – https://favorgreenville.org/recovery/family-support/

The post Considering The Family Recovery Coach appeared first on The Recovery Cartel.

Observations

As I dig deeper into family recovery self-help models. I have a couple of observations.

#1 – Literature

The majority of family recovery literature is very much written from a “spouse” (wife) of an alcoholic point of view.

It just is. Of course, there are some Alanon groups, Naranon groups which focus on parents.

But the program was developed for spouses (wives), and remains, very “significant other” in terms of tone.

This is not a criticism. It’s just a fact.

And, there is a difference between parent and spouse “recovery”.

#2 – ARISE & CRAFT

I’m trained in family systems therapy. And actively practicing for 10 plus years.

The ARISE model guides our work at FAVOR Greenville.

And systems theory guides our family recovery groups. You hear a lot about CRAFT model these days.

CRAFT is similar and it is solid. Has a good family systems vibe to it.

There are groups that follow these models. Not many groups. But a growing number.

See Pam Jones Lanhart for more on this good work.

#3 – My Family Recovery

I have now entered fully into my own family recovery process.

Whereas, for decade plus, I was just a facilitator and a therapist.

I am now a person with lived experience.

#4 – Teachable

And I need to be teachable. For my own good.

I need to be a participant at times. Not a therapist.

#5 – An “Eclectic” Approach

That said. It’s clear that I am going to take a very “eclectic” approach in my own recovery.

Combining principles from several programs. And facilitating, attending and joining multiple types of meetings.

Also … exploring the literature.

However, much of it will not be “conference approved”.

The post Family Recovery Self-Help Models appeared first on The Recovery Cartel.

Family Recovery

At the Recovery Cartel we know that, ultimately, the addiction epidemic will be arrested via empowered families and empowered communities. The “experts” will never be able to touch the majority of the addicted in need. You can’t build enough rehabs or recovery centers. The following basic principles guide our family recovery work:

Family Recovery Principles: 

• The family is deeply impacted-this is self-evident. Chronic stress, sleeplessness, anxiety, panic, substance misuse to cope, and the related health issues destroy millions of families every year.
• Family recovery stands on its own merit. It is necessary yet has been historically neglected and used as an add-on. Quality family recovery programs exist but they exist mainly in connection to inpatient programs and “pockets” of outpatient clinical providers. It needs to become an easily accessible and affordable option on a more universal basis.
• Family recovery is unique process that should be guided by “family systems theory”. Not limited to traditional avenues of “detach with love” and “tough love”. It is important that professional family recovery services are not a mirror or approximation of Al-Anon family group meetings. Interventions should be individualized to the family.
• Family recovery is primary intervention; not an add-on or after-thought. The Family recovery system should become a feature element of community based programs. 
• It should not be dependent on the addicted loved one’s “recovery status”. Family recovery programming should be universally offered. The addicted individual’s recovery status may influence the specific support provided. However, families should have access to professional family recovery support even if the addicted individual is disengaged.
• The family has tremendous power and family recovery contributes to individual recovery. Ultimately, family recovery benefits everyone including the addicted individual. Change one part of the family and you change the entire family.

Furthermore:

1.) We believe that there is merit in family recovery in and of itself. Family members experience profound health concerns when substance use disorders are present. These include chronic stress, physical problems, sleep difficulties, depression and anxiety. Even if the person suffering with a substance use disorder never makes a change the family deserves special focus and support to deal with these issues.

2.) The family has tremendous power that can be harnessed and focused in a way that increases the likelihood their loved one will seek recovery. Frequently, when family members start to change the person with a substance use disorder will start to change. Family systems theory tells us that if you move one part of the family you move the entire family. Like a mobile above a baby’s crib it is impossible to move one part without impacting the whole.

3.) Family members are frequently the first point of contact in the process of recovery initiation. Family members constitute a more willing customer base. They will call for information and options well before their loved one darkens the doors of our center. They are open to feedback and, in many cases, begging for information and options. Therefore, FAVOR Greenville sees the family as a ready-made channel for engagement of those in need.

4.) Family recovery coaching is a unique discipline and the shared experience of families in recovery can be capitalized on in a manner consistent with basic peer support services.

FAVOR Greenville:

With these principles in mind the Cartel’s flagship program FAVOR Greenville started family programs in 2013 with a simple open “Family Recovery Group”. The group was modeled on basic group facilitation processes of universality, mutual support and mutual respect.

Our initial group attendance was 12 people. We held these groups every Monday night at 6:30pm. The group exploded in attendance based nearly entirely on word of mouth. Currently, this group averages 54 people per week with a high this past month of 103 people in attendance. The group has become more didactic and educational in nature. However, we start each group with questions from the week and we make sure the topic of education/discussion is generated by the group.

There are usually 10 to 15 new people at group and an equal number of “veterans” who have been in attendance since the group started. Over time an interesting phenomenon arose. The group was intended for any and all family members. Spouses, children, siblings and parents together in one group. However, the group quickly morphed to 90% parents.

S.O.S. (Significant Other Support):

In response to this we developed our second family recovery group. Every Thursday night at 6:30pm we hold our S.O.S. (Significant Other Support) group. This group focuses on spouses or adult children. Also, this group has a different tone than the parent group because the dynamics are different spouse to spouse versus parent to child. This group has operated for 2 years and average meeting attendance of 10 to 20 people.

Finally, we have just added an offsite Family Recovery Group in our neighboring town of Spartanburg SC and Laurens County as well as a group in the Nicholtown area. Many more locations are slated for the upcoming year.

Family Recovery Coaching:

Another distinct area of family recovery support at FAVOR Greenville is our family recovery coaching. These are parent to parent; spouse to spouse; family to family coaching relationships put in place to supplement the various groups provided at FAVOR Greenville.

We actively recruited family members who had been “working a recovery program” and developed a specific curriculum to supplement our regular coach academy. These family members completed a specialized training academy to become FAVOR Family Recovery Coaches.

To date we have trained 53 family coaches and currently have 29 active Family Recovery Coaches who volunteer on average 5 hours per week to coach and support other families. We have been over-joyed with the Family Recovery Coaching programming. We have provided over 8,000 hours of family recovery coaching since initiating the program. The family coaches are incredibly enthusiastic and grateful and this is reflected in the way they engage our families in need. This has been magical to watch.

Finally, we offer intervention services to support the family in crisis. We have 2 ARISE interventionists on staff and have completed over 50 interventions to date. We are in the process of developing a second tier of interventionists to address this area of need. The number of interventions have risen dramatically over the past 1 and half years and we need more support to respond to the needs of the community.

Cornerstone of the Center:

Overall, it is important to note, 48% of the service hours delivered at FAVOR Greenville are delivered to family members in need. The distinct difference with our program is the following: Family recovery is not an add on or adjunct to service; family recovery is front and center and a cornerstone of the center. We have found that family members want to be included in the process and they make great volunteers and supporters.

FAVOR Greenville will continue to place formal emphasis on family recovery and we believe our program will expand in the area of family recovery as we move forward in our mission.

This isn’t theory for us… this is real life practice.

A Unique Perspective:

My experience in launching these family programs at the FAVOR Greenville Center has given me a unique perspective on the process of family recovery. I have seen the reality of family recovery. Recovery as it is lived out by the family. parents, spouses, siblings and friends of the person struggling with a substance use disorder. As is the case with many things in the “addiction treatment” industry much of what is done for family recovery springs out of long held views. These views are ingrained in our thinking. Although these approaches may work very well for any given person; their perceived effectiveness is based largely on anecdotal evidence.

Of course, there are good clinical programs and clinicians working with families. There is good work being done in the traditional family groups. This is not about isolated success. This is about an approach that could be scaled in a realistic manner and touch millions in need. On its most practical level, it is about finding and training a workforce that can deliver family services in a cost-effective manner on a wide scale.

This will be difficult to accomplish via traditional clinical routes. Family clinicians may be the ideal answer. If all families could be involved with a licensed Marriage and Family Therapist that would be wonderful. However, that is not realistic. The expenses would be prohibitive. In addition, we are not even close to having a sufficient number of clinicians.

What is a realistic option?

I am of the opinion that this can best be accomplished by developing family recovery coaches. This is an eager, enthusiastic, bright, and teachable group. They are hungry for information. By blending the experiential with professional training and supervision we will build that workforce. The Substance Abuse Mental Health Services Administration (SAMHSA), in their TIP on Substance Abuse and Family Therapy lays out the following continuum as a guidelines.

Family Recovery Coaching Requirements:

Family members must have the ability to articulate their own personal pathway of family recovery. Their process should be consistent and they should be able to reliably manage their own recovery plan. Family coaches will be interviewed and approved by the executive director and will perform duties under the direct supervision of our executive director.

Specialized training hours will be offered for family members. These areas of specialization will be described in detail later in this manual. We anticipate that we will have participants who meet qualifications to do both individual and family recovery coaching. They will be trained accordingly. Primacy of one discipline over the other is the decision of the coach, in consultation with the executive director. Performing both roles is also an option.

Family recovery coaching requires a baseline understanding of recovery coaching and peer recovery support services. The organization should make sure that their candidates have that baseline knowledge, or ensure they acquire that baseline knowledge through training and supervision. If a person meets the requirement of this fundamental base the family specialization will require 16 hours. We also recommend ongoing technical assistance and a tight supervision package as family recovery coaching is a high impact profession.

The post Family Recovery Principles appeared first on The Recovery Cartel.

The Odyssey of Grief

There were three of us standing there. A grieving father, myself and a colleague.

In the middle of a crowded room with conversation, laughter, and “good” noise in the background. The kind of background noise that sparks excitement and hope. Upbeat. Lively.

I had just finished speaking on the “opioid epidemic”. The mood in our circle did not match the mood of the room.

He was telling the story of his son’s first trip to rehab and the odyssey that followed.

Multiple Attempts

Several return trips to detox and rehab. Two or three runs at medication assisted treatment and a constant battle around attending meetings and therapy.

All of this was compressed into a 2-year time span.

The story ended in an all too familiar way.

A fatal accidental overdose in his early 20’s.

Listen and Say Nothing

Dad talked rapidly and nonstop recounting the events. Repeatedly processing a traumatic event or loss is good.

Telling the story over and over is healthy. It helps move the process along.

We listened and said nothing.

Then he stopped talking and silence entered the circle.

Time morphs in a situation like this. 15 seconds feels like 15 minutes.

My colleague quickly spoke up.

“We have a grief support group and I think we can get you connected to a good therapist”.

We hate to just stand there in silence when another person is in pain.

My Experience

I am a person in long term recovery from an opioid use disorder since 2001.

Also I am a professional therapist with a wide variety of experiences in the mental health and substance use disorder recovery arena. I have seen a lot. Both personally and professionally.

I know first hand the grip of opioids. The psychological craving and physical dependence. The withdrawal that is beyond description.

I know that feeling all to well. I have dwelt in that pain cave on many occasions.

In recovery I have experienced debilitating panic.

The Struggles

I seem to be able to operate on little sleep and on any given day I can go to the dark side. I believe the struggle is real.

The emotional and mental struggle is real.

I have had countless friends in recovery who have gone through similar issues.

I have had family and friends outside of recovery who have struggled with these demons. I’ve always been in touch with the seriousness of these problems.

Thousands Of People

As a professional I have worked in community mental health, intensive case management, assertive community treatment, in-home family services, private practice, intervention services and nearly every level of care in the substance use disorder treatment and recovery sector.

I have seen thousands of people.

Thousands of families dealing with mental health and/or substance use disorders.

I have worked with the most intractable forms of mental illness and substance use disorder.

My Perspective

These personal and professional experiences give me perspective. We know what the numbers say about “deaths of despair”. Unprecedented levels of suicide, overdose, alcohol related deaths. 

It is impossible to ignore the cloud of darkness that has enveloped the behavioral health.

The level of fatalities we face today is nearly incomprehensible.

The tragic death of a patient was always a possibility; but it was NOT a probability. It happened on rare occasions.

It was a monumental event. As suicide and overdose levels escalate, we risk becoming numb to the event.

The New Normal?

A new normal is creeping in. Talking to people about untimely death of a loved one has always been part of the job description, however, I was rarely called onto to do it.

Now I have the conversation at least once a week.

What have I learned about grief and grief counseling?

No Fix to Grief

For the record. Human beings naturally try to fix other human beings. When we see someone with their shoe lace untied, we reflexively say “your shoe is untied”. It’s known as the “righting reflex”. 

That said, it is a bit strange how we automatically provide unsolicited resources to people dealing with loss of a loved one.

The problem with the “fix the grief” strategy is, unlike tying your shoe, there is no way to fix grief.

There is no right way to deal with grief. There is no such thing as grief counseling.

I believe that things are even more complex when the death was untimely and involves suicide or drug overdose. 

Stigma & Judgement

These stigmatizing factors make accessing a “normal” grief support group counterproductive. Many times, parents and spouses come away feeling judged.

In the midst of their own loss and emotional upheaval, people who lose someone to cancer are prone to thinking: “you’re kid did that to himself”.

This thinking will come through loud and clear in the presence of people dealing with loss from substance use or suicide.

We need to become comfortable with the uncomfortable silence that comes with deaths of despair. So that we can be there as compassionate witnesses.

Experts

There are no experts, therefore, we are all experts.

What do we know about grief in general? Not much!

There is scarce literature and research specifically addressing grief.

Grief tends to get woven into trauma.

The DSM-V

Terms like “traumatic grief” and “complicated grief” bump up against post-traumatic stress disorder.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) has a diagnosis for every condition. Grief is no exception; see here for DSM-V criteria for “complicated grief.

These comparisons make sense. 

Trauma and grief can reach clinically significant levels, interfering with daily functioning, if unprocessed. Having safe, supportive people around, who listen without judgement, is correlated with better outcomes for both trauma and grief.

“Grief turns out to be a place none of us know until we reach it… Nor can we know ahead of the fact … the unending absence that follows, the void, the very opposite of meaning, the relentless succession of moments during which we will confront the experience of meaninglessness itself.” (p. 188–9) Joan Didion The Year of Magical Thinking (1)

Profound Life Event

Grief counseling is basically the same as any other counseling session. Except the grieving person is going through a much more profound life event.

Perhaps more accurately, grief counseling is basically listening to someone as they recount the worst experience of their life.

Essentially, there is no “right” way to grieve. Much of what we have been told about grief is opinion only. Not fact.

My Thoughts On Grief

1) No Right Way

There is no right way to grieve.

There are no “stages of grief” to “go through”.

Elizabeth Kubler Ross, in her landmark book on grief (On Grief and Grieving) birthed the stages of grief framework.

This was an off-shoot of the work she had done with individuals and families as they dealt with a terminal illness.

Kubler Ross observed that people awaiting death, or the death of a loved one, went through predictable stages: denial, anger, depression, bargaining, and acceptance.

In my opinion, this model works much better with terminal illness than it does with grief. 

There are many reasons to challenge the stages of grief construct including lack of theoretical orientation underlying the stages and lack of empirical evidence. Most troubling, is conceptual confusion, the misunderstanding that people must progress through these stages in a linear manner. 

As if they are required for healthy response to loss.

What if I don’t go through anger? Am I a bad father? Am I in denial?

Grief stages tell us little about how people might cope with the loss; why they might experience varying degrees and kinds of distress at different times; and how, over time, they adjust to a life without their loved one.

Considering the evidence from other studies that contradicts the idea of an “average” normal response to loss, this is a misguiding message. (p. 2693) Bonanno G. A., Boerner K. (2007) The stage theory of grief. The Journal of the American Medical Association 297(24): 2692–2694

2) Silence

Silence is a powerful therapeutic tool. 

You don’t have to be a licensed professional counselor to sit with someone in pain.

You also don’t have to say anything useful.

I don’t think there is special “protocol” for grief counseling.

Essentially, let the person who experienced the loss talk. Your job is to be a compassionate witness.

Bear their pain with them. Try not to break off too many cliches to fill in the uncomfortable silence.

3)  Unique

The unique nature of grief-related to losing someone to suicide or substance use is something that must be acknowledged. 

It’s not like other deaths. As we discussed above.

Fortunately, there are special groups being formed to address these issues.

Unfortunately, these groups are being formed because the death toll rises unabated year over year.

At FAVOR Greenville we host a Grief Recovery After Substance Passing group (GRASP).

GRASP groups are a nationwide model. I recommend you check out their website to learn more.

4) Peer Recovery Models

The potential for peer recovery models applied to grief support.

I challenge the idea of “grief counseling” as a requirement for healthy outcomes.

However, it is clear that some type of psychological support-in the broad sense-is one of the most important factors contributing to healthier outcomes.

A strong social network is another “ It is well accepted that individuals and families who report having good social support cope with stressors more effectively. These findings have also been found to hold true within the context of bereavement following the death of a child”. 

Some evidence exists surround a peer condition for fathers who lost a child to cancer. 

Fathers who were involved with a peer coach had better outcomes than those randomized to control.

5) The Meaning of Suffering.

Making meaning out of loss and suffering is part of the human condition.

Victor Frankl wrote about it in his epic book Man’s Search for Meaning.

Frankl described a process for finding meaning in the worst of conditions. A Nazi concentration camp during World War II.

People who have lost someone to these deaths of despair are experiencing a uniquely horrible form of suffering. One laden with “what ifs” and, for some, the ever present feeling of being judged. Re-traumatizing the person.

Advocacy & Outreach

In my recovery advocacy work at FAVOR Greenville and my online outreach at YouTurn, I am continuously exposed to people in the midst of this great pain.

I meet hundreds of families living this nightmare.

I am stunned with the strength of these families.These are the best people I know.

These are the most courageous people I know. I am lifted up by their willingness to give back and the fury with which they push for change.

There is veracity to their words: “I don’t want to see this happen to another family”.

They tell the story again.

I listen. I say nothing. Yet everything.

The post Grief Counseling – There Is No Such Thing appeared first on The Recovery Cartel.

Never Enough

For me and my hedonistic treadmill of a brain….Never enough goes beyond drugs.

Obsessive is my default setting.

Moderation in any area requires focus for me. I need to have my head in the game.

Recovery

Recovery from substance use disorder has made it possible to avoid total self destruction in these other areas.

However, I still need to be on top of things and open to support and ideas.

I need to seek out the right mentors.

What worked last month may need re-evaluated this month.

Change plans to change outcomes.

Plans & Outcomes

For example.

Work. It can consume me. Because it’s an escape and the achievement comes with a dopamine hit.

I’m very competent in this area of life so I will gravitate to work.

And if one hour of work is a dopamine hit, then another and another and another makes complete sense…..

90 hours later my kids can’t even recognize me.

Being Dad

Being a dad is tougher than work.

I never was taught anything about being a dad. My father was a maniac.

In my mind, I cant do anything well in the parenting area.

I perceive myself as incompetent. Plus it’s so freaking hard.

Therefore, I gravitate to what makes me feel better.

Hardwired

Human beings are hardwired to seek pleasure and avoid pain.

I will be a work in progress forever.

I can’t relate to being “set free”.

Quite frankly I do not trust people who play it off like the struggle is gone. I’m a work in progress.

The Spiritual Struggle

I just don’t believe those people who pretend to be so “spiritual” they don’t struggle.

Spiritual means embracing the struggle.

Suffering well when it’s bad and savoring the good days.

I will try to improve and master myself every single day. Until I die.

Magical Solution – Nope

Because there is no magical solution for me.

I think there are so many fake people out there. Bullshitters.

What you see is what you get with me.

I’m not the poster child for serenity

The post Parenting on the Hedonistic Treadmill appeared first on The Recovery Cartel.

One of my favorite pictures of all time. What you see isn’t always what you get. Behind the polished surface of the Perfect Family there still may be chaos….

In the wake of these teen deaths, the natural tendency will be for some parents, teachers, coaches, clergy, therapists etc… to arm-chair quarterback the situation and cast aspersions.

Uncalled for, and vicious verbal assaults about lack of supervision or “weak relationships”, or not enough God or not enough discipline etc… .

Definition – aspersion – an attack on the reputation or integrity of someone or something.

Divisiveness & Cruel

This happens everyday and divides people but is made more intense in the wake of this type of incident.

This is done for many different reasons.

For example:

Parents are scared and it’s a way of coping.

“We aren’t like them therefore it won’t happen to us etc…”.

We All Can Do Better

Obviously, we can all do better as parents. Try harder. Learn things. But let’s be clear on a couple things.

The guidelines for preventing teen drug use are common sense and it’s awful presumptive to think that these parents weren’t working on those things.

We Just Don’t Know

We simply don’t know the whole story.

Why would anyone make statements that imply lack of parental oversight? And it the parents did “fall short” (I don’t know who gets to make that call) then show some compassion anyway.

Many kids will experiment despite the parents best efforts.

Many of the kids of the people who are judging are experimenting themselves.

Hell, 40-50% of 12th graders underage drank last month.

Is your child or grand-kid in High School?

Did y’all forget to tell them not to drink? Or is that illegal behavior okay?

Educate Parents

There is a productive way to educate parents.

A collaboration rather than an approach that implies a right or a wrong way to parent. We have to go out of our way to empower the family rather than assert our authority as an “expert”.

I’m NOT an expert on anyone else’s family.

Based On 20 Plus Years

I can provide feedback based on 20 plus years of experience and education and my own recovery and my own experience as being as less than perfect parent.

Perhaps most importantly… everyone out there judging these parents.

Y’all got something in your closet as well. The image doesn’t always match the reality.

Look closer at your own family and take care of your side of the street before you pile on.

I know you got your own struggles. We all do. I’m not a scripture dude: but pull the stick out of your eye before you …. (I don’t know the rest 😎).

Is there a list of “good families” somewhere? Who keeps that list?

I’m sure we (the Joneses) don’t make the cut.

The post In The Perfect Family There Still May Be Chaos…. appeared first on The Recovery Cartel.

WE

We believe that the solution lies within you.

We are not experts who are here to diagnosis and label you.

We don’t provide instructions and directions unless you specifically ask us for instructions and directions.

We believe in the power of the human spirit.

We believe this spirit can not be completely extinguished by addiction and our job is to meet you where you are and help you ignite your change process.

You can not “flunk out” of FAVOR Greenville. There is no right or wrong way to do recovery.

STRENGTH IN NUMBERS

We know that there is a wide variety of pathways and we know 46% of people figure it out in their own way.

At the same time, we believe in the power of one recovering person helping another. So we enthusiastically encourage you to come see us.

You may be able to do this on your own but it will probably be much easier with others.

IT’S JUST LOVE

To the family members: we know that substance use disorder impacts everyone.

We know that at least 60% of Americans are directly impacted (probably more).

We know that you have been told to “step back” and wait for “bottom”. We are here to tell you that, although detachment is necessary in some cases, you do not have to wait for bottom.

A PROCESS

There is no such thing as tough love.

It’s just love; or the appropriate expression of love.

We know that one family member has more impact than 8 professionals.

We want you to become experts so you can feel confident as you deal with a loved one’s substance use disorder… because there is no magic solution available.

Recovery is a process not an event.

The post We Just Want Your Life To Improve appeared first on The Recovery Cartel.