A National Plague!

All the Frankendrugs and death they bring, it’s just not normal and it’s not acceptable and it’s extremely sad… and to repeatedly write about overdoses and suicides at such young ages, well it is a major black-spot of all our lives today, not only my own.

The first 12 years of my career (2000-2012) deaths were infrequent and deeply troubling.

Considered a sentinel event for institutions and stunning news for everyone in the community.

I rarely, very rarely, had a client who passed away.

1 Overdose & 1 Suicide

Despite the fact I worked within intense community based programs in the streets of Pittsburgh. For example, I ran an assertive community treatment team during the full out execution of de-institutionalization movement in mental health.

“Dual diagnosis” as it was called back then.

Deep end schizophrenia and crack cocaine.

Bipolar type 1 and decades of alcohol.

Serious and persistent mental illness.

Literally the emptying of the state hospitals; we managed the reintegration.

And in 6 years 2 deaths that I can remember. 1 overdose and 1 suicide.

Tragic Resignation

There may have been others I can’t remember. But not likely.

People are getting numb to these deaths of despair. And the norms around these deaths are changing.

Although universally acknowledged as tragic, there is a resignation among people. As if “shit happens”…..

It makes me very sad.

I guess we all deal with it in our own way.

The Brink Of Madness

I will say this. I get called nearly every week (or a face to face visit) by a family who has lost someone.

The stories are usually similar. “Tried treatment etc….but didn’t stick and stay in recovery etc….”

One really troubling thing. These kids have NO WIGGLE ROOM. No room for a bad day and a slip.

And that is the problem a with all the Frankendrugs and death, it is a –

Problem Without A Solution

No current treatment or medication can account for the desire when it comes full force.

You can be doing great and still take the wrong turn on one random day.
What do you do in the age of Frankendrugs and death….?

All this leaves me at the brink of madness…at times…

“Just myself talking to myself about myself”….

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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.

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.

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