Family, friends, and recovery

A major trend in addiction and recovery, a giant heavy pendulum on a multi-year swing, is moving away from applying stigma and punishment to people with substance use disorder (SUD), and toward offering robust support to help them recover. There is an even newer idea that support should extend to the family/friends of the user, who are often at a loss to know how to help and heartbroken to see their loved one suffering.

NPR's/WBUR's podcast OnPoint featured a great piece this week (February 21rst) called "Is it time to abandon the "tough love" approach to addiction?". It included Alicia Ventura, addiction researcher and Director of Special Projects in Research at the Boston Medical Center's Grayken Center for Addiction Training and Technical Assistance. Alicia specializes in family support in and around recovery, and the Grayken Center is building a robust series of offerings to help those supporting the person with SUD.

If you are concerned about someone you love who needs help to recover from a substance use disorder, I recommend reaching out to the Grayken Center at BMC.

The podcast also included a son who had recovered from heroin use, and his mother who - along with other family members - helped him.

Here's what I learned from the podcast:

• The situation with a given person with SUD will be a unique one requiring a unique package of responses. There are some for whom the "tough love" may be effective, and others for whom it will not be. Often, people reaching for recovery benefit from the support of family and friends; boundaried support so that the family/friends are secure, too. It is common sense that people benefit from the support of loved ones when facing difficult life circumstances.

• The stressors of losing a roof over one's head, meals, common human courtesy, respect and love may increase the need to use, or, be a barrier to recovery because who has additional mental space to tackle recovery when they are looking for a place to sleep, stay warm and food to eat?

• An addicted person may benefit from the outside perspectives of family/friends, their optimism and the motivation they offer, because active users are likely unable to think clearly, rationally, and beyond the needs of their addiction. Helping a person towards recovery requires trust, and trust requires non-judgment.

• It is rare that family/friends know constructive approaches to helping their loved one who uses without outside support. Involvement of family/friends in treatment means learn to understand the program, to contribute and avoid undermining the efforts. Family/friends may support the lessons with their family member for years to come, either overtly or in the background. It also offers the suffering loved ones a chance for support, as they experience health and mental health issues are a higher rate.

• The son who was interviewed, a former heroin user, described his state of mind as a user to be "despair". He took drugs to numb the despair but it always came back again. That is the true enemy of recovery: despair. People around them can help by giving someone under the influence hope.

• The son's turnaround moment came when a staffer in a clinic, a stranger, spoke to him "like he was a human". Just basic human dignity that isn’t often offered to people with this disease. Failing to treat these ill people with dignity and compassion contributes to the disease's spread.

• The whole idea of "rock bottom" as a necessity before seeking recovery is slowly being set aside for two reasons:

  • one, the desperation of "rock bottom" may impede recovery by increasing despair; and,

  • two, many people hit 'rock bottom' and find their death there. It's too big a risk to hit "rock bottom", because a person may not have the option to come back from it.

    I have only recently learned that; on the podcast, it was pointed out that the mother of a former heroin user benefited from her background as a psychotherapist and knew this. That "rock bottom" is often synonomous with "dead", especially in these days of crazy chemicals on the street, is an important message to get out into the world.

• The whole American cultural notion that a person with SUD should "pull themselves up by their bootstraps" needs to be set aside; it becomes a punishment rather than a positive lesson. The truth is that most often, outside help is necessary for recovery. The American cultural obsession with punishment is unhealthy and unhelpful; people learn far better and more quickly from positive reinforcement.

• Not everyone can be saved, but most can be. Many, many more people can be saved than our society is accomplishing yet.