Something’s Missing in the Current Drug Prevention Rhetoric

prevention

I have been an addiction therapist for approximately thirteen years.  While for some professions that may not seem like a long time, for a substance abuse professional, thirteen years in the trenches is a very long time. It is thirteen years of being underpaid, overworked, and underfunded.  It is also thirteen years of working with lost and often traumatized souls who may never ever get better.  Thirteen years as a substance abuse professional can make you weary.  However, you don’t end up in this profession and last for any length of time unless it is a calling.

Unless you are completely cut off from the outside world, you have seen many a news article lately about what is being called the heroin or opiate epidemic.  The apparent meteoric rise of addiction problems due to a prescription pill problem that for many turns into a heroin problem.  In March of 2016, the Centers for Disease Control issued new guidelines for doctors who prescribe opioids for chronic pain.  In 2015, hydrocodone combination products were moved to a Schedule II drug classification, indicating their highly addictive potential.  These changes were made in the hope of curbing the opiate addiction problem in our country, but with little effect.

This blog is not meant to be a discussion of anything related to why the situation continues to decline or what to do about it now.  What I want to talk about is prevention.  Most resources, even good resources like www.PASTOP.org, spend most of their page space talking about prescribing, what to do with unused medication, overdose and treatment information.  While all of this is very useful information, it is what I would call secondary prevention.  This is prevention of use by teens or adults, frequently who are prescribed medication initially by a doctor for a legitimate medical issue.  What is missing from the big picture of this prevention discussion is childhood.

Earlier this year, I finished reading both Dr. Gabor Mate’s, In the Realm of Hungry Ghosts and Dr. Bessel van der Kolk’s, The Body Keeps the Score.  Both are must reads for anyone who works in the addiction field.  I would like to share with you the line from In the Realm of Hungry Ghosts that inspired me to write the post.

“The prevention of substance abuse needs to begin in the crib – and even before then, in the social recognition that nothing is more important for the future of our culture than the way children develop.” P. 443

What is missing in almost all current talk about prevention is that, unfortunately, for all the people already addicted or prone to addiction, it is potentially too late.  Why do people become addicts?  Trust me in that no one wants to be an addict when they grow up or enjoys addiction.  Maybe, in the beginning, they liked the effect of the drug, but that quickly wears off.  What many addicts like is the escape.  The ability to take a substance that makes them not feel feelings they don’t like or can’t handle.  They like the fact that when they are taking the substance, they don’t have to sit in reality.  They like that the drug makes their flashbacks go away.  They like the fact that many drugs make them forget for a period of time.

In 13 years, I have yet to meet a drug addict who, at some point in their life, and most likely in childhood, did not suffer from at least one form of abuse or neglect.  Many drug addicts and alcoholics (gamblers and sex addicts too) endured verbal, physical and/or sexual abuse by their parents or family members growing up.  Many endured neglect in childhood as well, whether that was physical or emotional.  Many addicts were bullied in school and had no one safe at home to talk to about their experiences.  These childhood experiences mean that often, they looked for ways to self soothe, ways to cope or ways to feel better even if it was for a short period of time.

The ACE studies (Adverse Childhood Experiences) have shown scientific proof of what addiction counselors have known for years.  The more ACE events in a person’s life, the more likely they are to not only have physical issues but also mental health issues.  People with higher ACE scores are 2 to 4 times more likely to use alcohol or other drugs and to do so at an earlier age.  If a person’s ACE score is 5 or higher, they are 7 to 10 times more likely to use illegal drugs, report addiction or to inject illegal drugs.

So what do we do?  Addiction prevention starts before a child is born.  The in-utero environment of a child affects their neurobiological reaction to stress as an adult.  To stop drug addiction, we need to stop child abuse.  How do we do this?  Obviously, this is a tall order.  Make parenting classes more accessible to all expecting men and women.  Teach not only about physical care of a child but their mental health care as well.  Talk about attunement to a child and how that affects his or her ability to regulate emotion later in life.  Work to create safe spaces in a home and healthy attachment.  Teach communication skills from the start.  Teach healthy coping skills to even very young children.  Teach healthy coping skills to the adults so that they can model these for their children.  Work as hard as we can to prevent physical, sexual and emotional abuse of everyone.

I realize that my goals are idealistic.  I have always said that if the world gets healthy, I would happily change professions.

We need to start addiction prevention from the beginning by having discussions about childhood abuse, neglect and trauma.  We need to work to take away the stigma of therapy and getting help for emotional problems.  We need to teach everyone how to effectively communicate and cope.

I know that this is a tall order and that many do not have the resources to learn all these skills.  We need to work to provide these resources to everyone.  As a society, we need to do more……….

 

For more information on Dr. Weeks please go to our company website www.sexualaddictiontreatmentservices.com.

Photo credit.  The Watsons, NYC, NY.

We Are Failing Male Sexual Abuse Survivors

I specialize in working with sexual addiction and problematic sexual behavior. Most of my clients are men.  Working with male addicts for over a dozen years has taught me, in person, that many more boys are sexually abused than the numbers tell us.  These boys do not tell anyone and do not seek help.  These boys turn into men who are profoundly affected by their sexual abuse experiences as children and most of the time, don’t even know it.  They do not name what happened to them as abuse, or they don’t want to.  They feel so much shame about being abused that they lock part of themselves away so tightly it can take years (like 5 to 7 years) of therapy before they even acknowledge to a trusted therapist what happened to them.  These men who were abused as boys suffer in silence.

I realize that many people (myself included) will respond to this by saying that many girls and women do not disclose their sexual abuse and that they too live lives that are deeply affected by their abuse histories.  Having spent time working in a Women’s Trauma and Addiction PHP and IOP program, I do not dispute this.  However, I see a difference.

When women finally find the courage to come forward to seek treatment for their sexual abuse, they can find resources.  There are many group, individual and support resources for women who are survivors of sexual abuse.  Finding help is not so easy for men.  I will share an example from my practice to explain.

I have a male client who came to me last year who I will call Tom.  Tom has a pornography addiction and came to treatment after the problem began to cause a great deal of disruption in his life.  He had never gone to therapy and near the beginning of our work together, he disclosed that, when he was a boy, he was sexually abused by a neighbor boy who was near his age.  He had never shared this with anyone in his life and as soon as he acknowledged the abuse, the floodgates opened.  He started to have flashbacks and other PTSD symptoms.  Tom is a take charge kind of guy and we nearly immediately started to look for resources for him to do trauma work outside of our individual sessions.

First, we looked for men’s specific groups.  There was nothing and we are directly outside of a major east coast city.  Then we looked for trauma groups.  Tom talked to a few places that had groups for trauma survivors and was told that, as a man, he would make the women in the group uncomfortable so they could not have him join the group.  He then had an intake with a county resource for group trauma work.  After his intake, they told him that his case was too complicated and he could not join the group.  After months of looking, we literally could not find a group for sexual trauma survivors that was either all men or that would allow men into the group.

Tom continues his trauma work in individual therapy but craves the connection and understanding that one gets in group work.  He wants to know he is not alone and the therapeutic community was unable to tell him that, as a man, he is not alone.

Tom is just one example of many that I could pull from my case load.  To me, he is the loudest example of how we, as a treatment community, fail male survivors of sexual assault.  I have had other clients walk out of public events for sexual abuse survivors because, as the only man in attendance, they felt unwelcome and uncomfortable.

Why do we treatment professionals who work so closely with trauma not offer more resources to men? Are we uncomfortable?  Is there a reason we focus more closely on female survivors of sexual abuse?  These are questions to which I have no answers.  I have only heartbreak.  I can only do my part to welcome male sexual abuse survivors into therapy when they come and to start group programming for them in my practice.

I challenge other treatment professionals to process this issue and see what we can do to create more resources for men and to be more welcoming.

 

For a good online resource for male survivors of sexual abuse, please see www.1in6.org

Why is a Good Couples Counselor So Hard to Find?

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I am going to start this post by adamantly stating that I am not a couples counselor. It’s not my thing and I just can’t do it. I have a great respect for those therapists who train in this area and devote their careers to helping couples find their way. Since I do not do couples therapy, I must refer my clients out to other couples therapists. You might think that this is an easy task. There are many Licensed Marriage and Family Therapists in this world. Then why do I hear so many horror stories from my clients? Why is my list of people to NOT refer to longer than my list of people TO refer to?

I will share with you the story of a newer client’s experience in couples counseling. First, I should share that I work with sex addicts and sexually addicted sex offenders. It is a rather specialized population and perhaps, a controversial one. Many of my clients are caught by the authorities for viewing child pornography. For many of them, this behavior is an escalation of their addiction to pornography.

This man and his wife, not long after her “disclosure by police”, went to see a couples therapist. This was not someone our program recommended but a therapist that they found via their insurance. The therapist had no stated knowledge or expertise in working with pornography addiction nor with offenders. This was glaringly obvious. My client reported that he was very open with this therapist. He told the counselor all about his addiction and how it led to his use of illegal images and arrest. (Let me tell you this is a big deal to share at a first session with anyone!).

When a client comes to you for this type of work, their level of shame gives them an amazing radar for judgment. They are sharing their deepest secrets with you, the therapist. If you move an eyebrow they will know it and likely interpret it as you judging them. Well, my client immediately felt as though the couples therapist did not believe that pornography addiction was a real thing. All from a vocal expression of the therapist. My client continued the session for the sake of his partner.

This therapist asked to see the partner alone during the initial session. Granted, what I relate to you is third party information, relayed from the partner to the client to me. However, even allowing for interpretation of the event, there is some truth here. That truth is very bothersome.

What the partner heard: the couples therapist thought that her husband (my client) was lying. The couples therapist felt that my client was not sorry about anything only that he was caught. The couples therapist then advised the partner that she should leave the relationship. All this assessment was garnered after only an hour intake session.

One can only imagine what this did to the partner.

What this also does is taint the idea of couples therapy for both of them.

As counselors, therapists and psychologists, we are only supposed to treat within our area of expertise. I treat sexual addiction, sexual offenders, addiction, and trauma and addiction. If someone comes to me with an eating disorder, for example, I don’t treat them. I refer them to a therapist who specializes in eating disorders. If someone comes to me with schizophrenia, I refer them to a specialist. You get the idea.

When we do not abide by this and treat people out of our area of expertise we can do damage to the client. This happens frequently when it comes to sex addiction. Sex addiction is a very controversial topic. Many people think it doesn’t exist and many people do. Personally, the label does not matter to me. For some clients, the label matters very much. If a client feels they have a sexual addiction and identifies with the label in a healthy way and a therapist tells them that it doesn’t exist or treats them in a manner biased by their own beliefs, they can do harm to the client.

If there is a stigma about sex addiction, then the stigma against sex offenders is there tenfold. Even less therapists are trained in treating sex offenders than sex addicts. There are studies that show therapists won’t treat pedophiles. In a profession where we are supposed to be open and nonjudgmental, many of us are just that, judgmental.

I do not write this to bash well-meaning couples therapists. I reiterate that I have the utmost respect for your work! My plea to couples therapists is this: If you do not believe in sex addiction, do not treat a couple where one partner feels they are a sex addict. If you do not believe in sex addiction or pornography addiction, please don’t shame the person with the addiction. If you do not want to treat sex offenders, then simply say that. Please don’t go behind one partner’s back and tell them that their husband or wife is lying and they should leave.

My advice for those seeking couples counseling (or any counseling for that matter) is to investigate your potential therapist. I understand that therapy out of network can be costly. The list of therapists you get from your insurance company means nothing other than they are in network with your insurance. It is your job to do some groundwork on us. Check out the therapist’s website. Consider what their specialties are. Call and ask if they specialize in working with couples (or individuals) who are going through what you are going through. If they don’t, then find another therapist.

Ultimately, we work for the client. Therefore I end every one of my intake sessions with a new client with one question. “Do you think that you can work with me?” I want to know if they feel comfortable with me. If not, even if I have the right training for the client, I am not the right therapist.

For more information on Dr. Weeks and her practice, visit our website:  www.sexualaddictiontreatmentservices.com 

Sex Addiction and Shame

Sex Addiction and Shame

 We have used the Shame Resilience work of Brene Brown in our program for years. Last night one of my long term recovery groups began the first week of Brene Brown’s Connections curriculum.  The group started with a 23 minute video of Brene discussing Shame, Empathy and Vulnerability, followed by discussion.

I never cease to be amazed at the reactions to the initial video.  I am going to talk about what came up last night for the group members, as I am positive they are not alone in their feelings.

So, what came up in group?

“I’m ashamed to be a sex addict.”

“I would never tell anyone”

These gentlemen keenly feel the shame that is attached to sex addiction in our society.  One group member mentioned being a sex addict in an AA meeting and was quickly shut down, being told that “We don’t talk about that here.”  Another group member told his story while in in-patient treatment for another addiction.  He was courageous and vulnerable in the group and included his sex addiction in his story.  He was met with lots of looks and questions afterwards.  His act of bravery was met with judgment by other addicts.

As a clinician working with cross addiction with many clients who have multiple addictions, these events make me sad.  Research states that up to 33% of clients with a substance dependence problem also meet the criteria for a sex addiction.  There is no data of which I am aware that looks at other addictions such as gambling.  If the recovery community maintains a hierarchy of “more acceptable” addictions, we are fostering shame and doing a disservice to recovery.  As long as our society judges sex addiction so harshly, we make it harder for others to feel safe enough to seek help and recovery.

Thoughts on Blame and Accountability

In this introductory video, Brene states that blame and accountability are mutually exclusive.  If we blame others for hurting us, we are letting them off the hook and not holding them accountable.  The suggestion that we should be vulnerable and share our feelings with the person who hurt us in order to hold them accountable was hard for the group members to embrace.

What good does it do to tell someone how I feel and try to set a boundary if they never respect it?  I hear about this conundrum often in my work with clients.  I continue to wish I had a great answer for these questions but I don’t. Why do we need to work on being open, honest and vulnerable?  Is it for others or for us?  I maintain that it is “all about us” in these moments.  When we suppress feelings and hurts they can turn into resentments.  All of the bottled up emotion often ends up coming out sideways. When it comes to addiction, this often means a slip or relapse.

Lessons from week one continue to show me that we need to continue to talk about sex addiction both to reduce the shame but also to reduce the societal stigma.  Brene Brown cites a quote about change coming from a million individual acts.  Last night we did not change the world’s perception about sex addiction, but for an hour and a half in time, a group of men felt courageous enough to share, be vulnerable and sit with each other’s’ darkness.  These are the individual acts that leave me with hope for the future.