One of the frustrating things about working with substance abuse is a scenario that appears to repeat itself. There might be different people filling the necessary roles, but certain themes present themselves over and over again. For example, there’s usually someone filling a “hero” role, someone filling a “good cop” role and, the one I see within substance abuse treatment, someone filling a “scapegoat” role.
Often, families come to need the substance abuser to continue using. While it may sound strange, it’s a pattern that I do see and I think it’s rooted in the fact that, while the substance abuser is actively abusing substances, the individuals within the family can focus their attention on the substance abuser and not on themselves. The substance abuser can become the scapegoat, of sorts, for those families whose relationships are toxic. That is, the substance abuser is seen as the problem within the…
Welcome to the Lamb in wolf’s clothing podcast. My name is Juan Blea; I’m a writer and addiction counselor from Santa Fe, NM. In this episode I will be discussing how the treaty of Guadalupe Hidalgo killed my great-great grandma and created the conditions from which Northern NM’s heroin problem emerged and what we can do about this historical wrecking machine.
Guadalupe Hidalgo isn’t a person, it’s actually the place in Mexico where the US’s war with Mexico ended with the signing of peace treaty named after that location. Now, while this treaty ended the war, it did so by giving Tx, NM, AZ, and California to the US and allowed the United States to colonize that entire area. But, it wasn’t simply a matter of land, it was also a matter of the people living there who almost overnight, went from being Mexican citizens to territorial assets of the US. For the life of me, I can’t imagine what that was like; however, when I was in grad school, I took a Psychology of the Family class through which I learned about genograms, which are basically a family tree that shows any dysfunction the family members faced. What I saw within my own family was a pattern of depression and alcoholism that reached back for generations.
One of my ancestors really struck me though, and to this day, I still search for the truth about how and why she died, but without much luck. Family legend has it that she hung herself; however, the few documents that I have been able to unearth seem to indicate that my great-great grandfather may have killed her. He spent time, in the months before she died within the state mental hospital for what their records indicate was “exhaustion.” It appears that exhaustion was a precursor to what we know as PTSD and I suspect, strongly, that he had something to do with my great-great grandmother’s death. But in studying her death and the circumstances surrounding her death, I see that the treaty of Guadalupe hidalgo was more to blame than my grandfather because, my grandparents, like many other people in Northern New Mexico lost their land to a US initiated lawsuit and had to move and learn to function in a system that used English, while they all spoke Spanish…
Fast forwarding from those days of early statehood when hundreds of people lost their land to lawsuits and their language to a new system of government and what we’re left with is a whole group of people who had to develop a whole new identity in order to assimilate within the US cultural experience. While many families were able to become Americanized, many were not. Those that could not, seemingly live as though they were in fact traumatized, even though they haven’t really experienced any trauma directly. What’s more, almost every person I’ve worked with who’s addicted to heroin can meet criteria for either PTSD or Generalized Anxiety disorder, or both. And so, from my research into my grandmother’s death and my current work with people addicted to heroin, I am convinced that social and genetic programming in this region has created a community containing “embedded” traumas. This community seeks relief from this embedded trauma through an unconscious drive towards unhealthy behaviors, including heroin abuse. Also, this social and genetic programming has led to generational poverty, which contributes to the region’s struggle with opiate addiction.
And so, I believe with all that I am that the Treaty of Guadalupe Hidalgo with all its consequential losses of land, language, culture and identity have allowed the perfect storm to emerge:
In her book, Chiva: A Village Takes on the Global Heroin Epidemic, Chellis Glendinning describes the path heroin took to get to Espanola and so I’ll leave it my listeners to read that book, but the reality is that the Perfect Storm exists in Northern New Mexico and has led to a real problem with Opiate Addiction and we need to first wake up to this reality and then we all need to come together within our greater community to disrupt this perfect storm.
I tend to look through the lens of empowerment to find answers and one concept that I teach over and over again comes from attribution theory and is called locus of control. Simply put, locus of control describes the way a person approaches life. According to attribution theory, people believe either that they make things happen and rely on their own actions (in which case they are internally locused), or they believe that things happen to them and rely on luck or some other external mechanism to get things done (and they are said to be externally locused). Because people lost so much to the treaty of Guadalupe hidalgo, I believe that whole communities became externally locused and passed on limiting beliefs to subsequent generations. Basically, people came to believe that there isn’t anything they can do to affect their lives, as they were just living their lives and lost everything. What’s worse is they developed GAD and/or PTSD and then passed those genes on. And so those limiting beliefs were passed on socially and became genetically entrenched..
So then, the short answer is that we must collectively build a sense of individual capability in our children, students, patients, or clients. It takes time, but there is hope.
Addiction treatment requires an addict to become aware of the situation in which he finds himself. In order to develop that awareness, we should not oppose the symptomatic behaviors within the addiction, but we should in fact seek to understand those behaviors. I recommend a program that includes reflective journaling in order to provide a mechanism through which a person can see his or her situation in his or her own terms and understanding. To do so, a person must name the situation; reflect upon its meaning, and then act to change the situation.
For example, when it comes to addiction, I propose that the addict: (1), first name the limiting situation or thought, then (2) he or she needs to reflect deeply upon its meaning and come up with a plan to eliminate the limiting thought and/or situation; and then (3), the addict must execute the plan step by step. Treatment providers through various modalities can obviously guide this process, but it’s a matter of developing the belief in personal capability. The battle against heroin may seem to be an external war, but in order to win, it has to be fought internally.
Admittedly, it takes time to build that sense of capability — and as an aside, art/music/creative writing are all great avenues of building that sense of capability – but when an entire region has lost its sense of place, then we all must act to rebuild that identity. I’ll continue to research and share ways and means of rebuilding and creating a healthy identity for my community. The Treaty of Guadalupe Hidalgo and its subsequent and generational psychological occupation of this area will be eliminated some day.
That concludes this episode and I hope you found it valuable. Please do share your thoughts through my blog, jblea1016.com or you can email me at email@example.com and please don’t forget to check out my award-winning book, 49 Tips and Insights for Understanding Addiction.
Episode 2 is here! In this episode, I provide my best advice to anyone who wants to help an addict. I discuss: 1) The 3 most important things to educate yourself about; 2) Talking openly with a loved about his or her relationship with a substance; and, 3) Gathering treatment resources to have available for someone who’s ready for healthy recovery!
Enjoy! and please let me know of any comments/questions/suggestions!
There is an Aesop’s fable that is so resonant and relevant to recovery that I am compelled to share it and describe its significance. Now, people are always wondering how they know their loved one is ready change. I’ve said it before and I’ll say it again, there are no hard and fast indications that signify readiness. However, The Lark and the Farmer provides insight that is quite useful.
The fable (in my words): There was a family of larks nesting in a Farmer’s corn field. The field had grown unruly and one day the Farmer realized that he need to harvest the corn and clean up the field. “It’s time to reap the field, I’d better get the word out to my friends so that they can help.”
One of the young larks overheard the farmer and became worried that they would soon have to move their nest. The…
Recovery isn’t about flipping a switch or waving a magic wand. There are certain elements that must either be in place or be developed before recovery can happen. As much as we want addicts to just simply stop using whatever substance to which they’re addicted, recovery just doesn’t work like that.
Therefore, someone is recovery requires four (4) things:
A support system that’s educated on the relationship between anxiety and compulsion and how each maintains the addictive cycle. This education should include the pharmacology of the respective substance (or substances) of abuse, as someone addicted to cocaine requires different treatment tools than someone addicted to opiates.
Recognition of the spiritual needs of the person in recovery. This does not mean pushing one religion or another onto someone; really, all it means is that each person should find a way to engage with something bigger than him or her self. All people have different needs and throwing a higher power at an atheist may be iatrogenic.
An understanding of the underlying causes of the Addiction. The underlying cause may be a co-occurring issue such as Depression or General Anxiety Disorder or it can simply be a desire to use the substance. Either way though, finding the root cause is critical to developing and maintaining recovery.
Recognition that recovery begins again, every day. The truth is that recovery begins again every day. Addiction isn’t cured; it’s managed and it’s done so over time. There is no quick fix; plus, relapse may be a part of recovery. Daily focus (or refocus) is a basic component to successful recovery and must be renewed every day.
If we can build these four elements, then someone can recovery from an addiction. If, however, we keep hoping that a genie will spring forth from a magic lamp and grant us some wishes, then recovery probably isn’t going to happen…
I challenge anyone to think of heroin and not have an association to bad stuff. Really, heroin evokes images of criminals and addicts and most people who’ve had no real contact with heroin addiction probably think heroin is something evil. And while I do think heroin’s effects are significantly adverse, I think that nothing, in and of itself, is evil. It’s use makes it so…
So, what is heroin and why do people use it? For starters, today’s heroin is a street drug that derives from poppy seeds, just like opium and morphine. As a matter of fact, heroin is a direct descendant of morphine and codeine because, well, codeine is an isolated component of morphine called methylmorphine and when acetic anhydride was mixed with methylmorphine the result was a highly addictive version of morphine called diacetylmorphine, or as we know it: heroin. I don’t provide this information as a chemistry lesson, rather, it’s intended to show that heroin is a close cousin of a very important medicine.
Morphine s used to treat pain. It is a nervous system depressant – meaning it slows the heart rate and the respiratory system; as well as, desensitizes pain receptacles and clouds thinking. Heroin does the exact same thing, but has a shorter half-life, meaning it’s effects wear off faster and the potential for physical dependency is high due to its effect and to its short half-life. Part of the problem with street heroin is that it’s not pure – it’s often mixed or “cut” with all kinds of stuff which make the risk of toxic impacts from using it very high. Heroin is usually smoked, injected, or snorted and when people overdose, it’s usually because the dose is different than what they normally use and/or the place they use it is different that their normal location. Since heroin isn’t regulated, there’s always a chance that the dosage could change. Due to the respiratory system depressing effect of heroin, overdosing usually means the person has stopped breathing.
Heroin use is scary, but understanding it’s effects is very useful for treatment. It’s critical to treat the physical dependency using legal and regulated drugs like methadone or suboxone. Switching a heroin addict to either of those meds is safer, as they are regulated and administered by medical professionals. There’s a lot more top treating heroin addiction, but I wanted to present a quick overview as a way to show that there are objective mechanisms behind heroin addiction that can make it a lot less scary once they’re understood….
One of the harder aspects of trying to treat addiction and substance abuse is that sometimes people want me to have answers that are somehow easy and/or guaranteed. But, every time I take on a case or follow-up on an existing case, I learn more and more just how much people want someone else upon whom they can either project responsibility or place blame. Here’s the thing, though: I’m not here as a lightning rod to displace the negative emotion that accompanies substance abuse. I’m here, in my opinion, to teach the mechanics of substance abuse and substances, and to also teach tools for coping with those mechanics, once understood. But I can’t teach what someone isn’t willing to learn and to learn, ultimately, means to process and use the information I teach.
I get asked questions, all the time, about things to do…
Q:”What do you call a heroin addict who breaks up with his girlfriend?”
Now, I don’t find the joke particularly funny simply because it’s all too true. There’s a strong relationship between homelessness and opiate abuse and it’s a sad and troubling reality that heroin takes over a person’s entire sense of being to the point that nothing else matters. Literally. The only thing that matters to a heroin addict is getting and using heroin.
But, according to a clinic I attended today, there’s a third element to the heroin abuse – homelessness dyad: Anxiety disorders. I’ve suspected for years that either (or both) PTSD or GAD are hugely contributing factors to developing an opiate addiction. To me it’s always been clear: Anxiety is painful, opiates treat pain, those who suffer from anxiety disorders may then seek opiates to relive their anxiety suffering. The data to support this theory of mine is overwhelming: According to the National epidemiologic Survey on Alcohol and related Conditions, someone who’s addicted to heroin has an odds ratio of 4.27 that the person also struggles with GAD and/or PTSD. What this means is that someone who is addicted to heroin is extremely likely to suffer from an anxiety disorder. According to the clinic, there are three (3) probably reasons for this strong association:
Self medication of anxiety symptoms
Shared neurobiological connections
While the first and third bullet are mostly self-explanatory, the neurobiology of anxiety disorders and heroin addiction are so similar that if someone struggles with an anxiety disorder, he or she is already wired for heroin addiction. It’s like anxiety disorders lay the foundation for heroin addiction.
This data strongly suggests that, as I’ve often discussed, that treating heroin addiction isn’t a matter of focusing on the heroin use. Really, it’s almost always about treating the underlying and co-occurring anxiety or PTSD. In order to do so, clients need:
Education and coping skills training for both disorders
Behavioral interventions for the anxiety disorder (cognitive framing, exposure)
Relapse prevention for the substance use disorders
Furthermore, there are times when medication is needed and it appears that GABAPENTIN has shown to be effective for treating anxiety with a low risk of abuse.
Really, neither homelessness or prison or death have to be outcomes of heroin addiction. The reality is that understanding the layers that lead to the addiction can go a long way towards treating the addiction. Really, some people are “wired” for anxiety and addiction. The important thing to remember is that there are avenues to treat this insidious phenomena and those avenues usually require a deep understanding of the person who’s addicted and what he or she needs in order to find health.
So, I’ve begun teaching a writing class (can’t disclose where) that I call: Exploring the space between your ears. The point of this course is to lead addicts through a series of reflective writing exercises such that they learn to “own” the space between their ears (you know, their thoughts, emotions, etc.)
It’s like this: cave exploring is a generally lightless experience. It’s probably a bad idea to explore a cave without a flashlight. What’s an even worse idea is to dive into a cave without an idea of where it leads and how much room there is to navigate and move around. Yet we tend to live our lives without knowing where the space between our ears leads. We don’t explore that area enough, and when we do, we usually find things there like self-doubt or fear. For some, the space between their ears holds unearned shame which then leads to other dark places from which people can’t escape.
Substance dependency further clouds that space between the ears because all it leads to is more substance use. For those addicted to drugs and alcohol, the space between their ears isn’t theirs, really; substances of abuse hijack that space such that people can’t even explore that area because all they’ll find is a never ending desire for MORE….
That’s where the class comes, in – at least, the hope for this class is that participants learn to both explore that space between their ears in a safe and creative way so that they can wrest the map away from substances’ clutches and create their own map to a healthier place from which something good and strong and beautiful can emerge.
Since no one can know anyone else’s space between their ears and I since want everyone to get to know their own, I’m sharing the exercise through which I led the class. I asked the participants to answer:
Have you ever done something that you didn’t understand? In looking back at your behavior, why do you think you acted as you did?
(an aside, this exercise comes from my book, “49 Tips and Insights for Understanding Addiction”)
The class found value in looking inside the space between their ears and I think it was a good introduction for them to reflect on their behaviors that they may not have understood when they first acted as they did. As a matter of fact, their general responses showed real thought and I would even dare to say that they gained some valuable information that they can use along their path towards Recovery. I offer this same exercise to anyone: Really dig in to the space between your ears, addict or not, I can safely say you can learn about yourself in a very deep and real way. Good luck and safe travels down the rabbit hole that can be our innermost thoughts….
When it comes to healing from an addiction, there isn’t a right way or a wrong way. While it may seem like a person trying to recover should do or say certain things to indicate that he or she “really wants” recovery, there is no real indication that a person desires change in his or her life. Sometimes, someone struggling with an addiction will say anything just to get people off of his or her back. It’s important to remember that compulsion reduces all of life to objects that can be manipulated in order to resolve the compulsive cycle. This means that someone with an addiction has become practiced in the art of manipulation.
I’ve heard several stories from people saying things like, “My son is ready to enter treatment, is there any way you can help him?”
I’ll respond, “How do you know he’s ready?”
They’ll always say, “Because he told me.”
I’ll then meet with the person “ready to enter treatment” and almost always, he or she isn’t even thinking about giving up his or her substance or behavior of choice. It’s like I’m there as part of their play: I’m providing the backdrop of proof that change is, in fact, imminent. But, it almost always turns out that change is neither imminent nor desired.
The frustrating truth about all treatment is that patient commitment is the key component to treatment success. Diabetes treatment, for example, shares similar relapse rates as substance abuse treatment. Diabetes patients must adhere to, not only a medication regiment, but they make behavioral changes, as well. People, on average, will remain doing the same things the same way and won’t change a behavior easily. Especially if the behavior is ingrained in the way a person’s diet or substance abuse ritual becomes ingrained. Whenever we do any behavior over and over again, that’s when it becomes as much a part of someone’s life as breathing.
So, how do we “know” if someone is truly ready to make as radical a change in his or her life as entering addiction recovery? Well, we don’t. If we look for “signs” of change readiness, we will drive ourselves crazy with frustration. In my role as a treatment provider, I realize that it’s part of my job to educate people in the art of acceptance. Before anyone around us feels “safe,” he or she needs to understand that he or she is loved, in spite of her behaviors. Therefore, I spend a lot of time simply trying to get people to recognize the love they share, even if an addiction has driven a deep wedge between them. It may sound “touchy-feely,” but the plain truth is that when there’s safety and honesty and love, positive change usually follows. External love can influence and inform a person’s sense of self-love, when that sense of self-love awakens in a substance abuser, he or she can then begin to see and recognize the harm the substance and abuse lifestyle has caused. It takes time, patience, and acceptance. There are no other signs to seek…