What is an alcoholic/addict? Homelessness, poverty, unkempt appearance, no career, constant legal issues, wearing a trench coat and living under the bridge? As we have seen so far in this series, the majority of people addicted to substances are anything but these things. Interestingly, these wildly inaccurate stereotypes seem to give most substance abusers a layer of deniability. They can point out that they do not fall into one or another of these categories, therefore they really don’t have a problem.
This is only one example of the many misconceptions that stand in our way of recognizing and therefore being willing and able to help those around us who are developing or suffering from an addiction. I recently spoke with a man who, upon realizing he had a problem approached his father and told him that he thought perhaps he was an alcoholic. The father’s response? “If you are, it didn’t come from my side of the family.” The stigma, denial, shame, and fear surrounding addiction runs deep, not just with the addict or alcoholic but with those around them as well. One of the people best positioned locally to see this is Karen Perlmutter, a licensed therapist who works with both addicts and their families at her private practice here in Mount Pleasant.
Fifteen years ago when Karen graduated with a degree in social work, she had no intentions of working with addicts and their families. Both of her parents had worked in careers serving underprivileged populations and Karen envisioned working with some portion of the community that she could feel empathy for such as foster children. There was no history of addiction in her family, so when it came time for her to do her graduate internship and she was placed in a methadone clinic working with heroin addicts, she was skeptical at best.
“I was surprised how quickly I connected with this community,” Karen said. “Addicts as a whole are intelligent, creative and very sensitive people. Watching these qualities being stifled by addiction is painful, but it is amazing to watch people find the best version of themselves as they work their way into recovery.”
After seven years of working directly with addicts and alcoholics, Karen expanded to also working with the families of those afflicted. She ran family groups for men and women in treatment. Their parents, spouses, and adult children joined them for these group sessions, and by leading interactive discussions with both the addicts/alcoholics and their families, she began to see the bigger picture.
“Families suffer too – there is a reason this is called a family disease,” Karen said. “When family members first come to me, they know what isn’t working about their family dynamics, they just don’t know what to do differently. Many families know or have heard about enabling, or have been told about ‘detaching with love’ from the one that is afflicted, but that prospect is terrifying to them. They fear that if they surrender their enabling role, their loved one could face terrible consequences or death. Or, alternately, they are so burnt out and dejected by all of the chaos that they want to abandon the situation entirely. But by the time families show up for treatment, what they all say is, ‘We cannot keep living this way.'”
“Families have to reach their own ‘rock bottom’ before they are ready to get into a healthier solution. Initially, family members don’t suspect that they need help too, as they don’t view themselves as the one with the problem. They often reach out for help trying to figure out what their loved one needs to do to get better. But as soon as they can realize that everyone involved has been living in the problem, we can move beyond trying to place blame and start talking about the impact the disease is having on the whole family unit.”
“Often, family members are shocked to reflect on how badly their own emotional health and behavior has deteriorated. They find themselves isolating and walking around on eggshells, trying to ‘keep the peace.’ They become obsessed with the need to solve their loved one’s problem, sometimes to the point that they are living more in their addicted loved one’s life than in their own. They start telling half-truths and even sometimes outright lying. Sometimes these deceptions are to ‘protect the reputation’ of the addict and sometimes they are attempts to ‘protect the addict from themselves,’ but regardless of the intent they are still untruths. Some families reach a point where they avoid participating in life with healthy people, they stop engaging in healthy activities, they become passive aggressive and before you know it the whole household suffers from a complete lack of truthful conversation. We call this the ‘mirror effect,’ when a families behavior starts to look unhealthy in similar ways to that of their addicted loved one.
“When I first start working with the families, I like to use the illustration of a ‘Value Tree.’ We start out building the family tree rooted in values such as honesty, mutual respect, growth, safety and a host of other worthy ideals. And trees are meant to bend a bit. For instance, when our 5 year old lies to us about the frog they found and hid in their bedroom, we don’t cast them out of the family for lying. But we do adhere to this value tree as best we can as a guide for our decisions and actions.”
“But when addiction comes along it is a gale force wind bending this tree to its limit, and in many cases uprooting it entirely. And when values no longer guide family decision making, decisions are made exclusively in the emotion of the moment. This can be dangerous. The first thing the family needs to do is to get their own value tree back upright. Only after they have reestablished their own core values can they begin determining boundaries based upon principles they believe in, rather than anger, guilt, and fear. And through this the doors to honest and respectful communication can open once again. In a family invested in recovery the addict and the other family can combat the addiction itself, rather than each other.”
“As for the addict and alcoholic, the ones who make it out are the ones who realize they need to put their sobriety first in life. They realize that no other goals in life are possible without sobriety first. They develop a willingness to engage in and develop relationships with other people who have successfully overcome addiction, and they develop a healthy sense of purpose and meaning in life.”
“What I often see with those in addiction is a loss of faith. At some point along the way, they lost faith in everyone and everything besides the drug. In many cases, even with a loving family supporting them, during active addiction, an addict becomes convinced that their family doesn’t understand them and therefore couldn’t help them. But eventually the drug itself turns on them as their life becomes more and more unmanageable. At this point, the addicted person has to make the difficult choice to reconsider their willingness to restore their faith in things like family, community, and a higher power. To see that these are the very things that can help them find their way back to health and sanity is often the beginning of recovery.
But whether the addict finds recovery or not, the family can heal. Twelve step programs offer amazing tools and accomplish things for both the addict and the families that no therapist ever could. But there are also complications that come with addiction that cannot fully be addressed through 12-step programs. Dealing with depression, anxiety, past trauma and complex family dynamics are best addressed through effective therapy.
“Addicts and alcoholics are sensitive souls and more emotionally vulnerable than most would admit. I am constantly amazed at how much wisdom I have gained from working with both recovering addicts and their families through this crisis. Often I find that the personal exploration and hard work required in the recovery process make recovering people some of the most evolved humans I know. But people need to understand that there are solutions and healing is possible. And what seems like the greatest weaknesses for both the addict and the family often turn into their greatest strengths.”
I imagine all of us could use a bit of straightening in our value tree. But if yours is under assault by the chaos of addiction in your family, a therapist like Karen may be a great start.
This article series, written the first and third week of each month, is meant to educate the community about addiction in general and the Opioid Crisis in specific that is affecting communities nationwide. We are hopeful that this series will make a difference. When appropriate the names will be changed of those the articles feature. Contact the author at David@PhoenixSC.org.