Addiction and Recovery Support - Questions and Answers

Parham : Alright, we are live! It is Saturday, May 14th of 2022. I am here this week on another family education and support group with a co-host that’s been here once before and by popular demand and by request is back again: Ms Sara Rotunno aka the Sarapist, who is one of our valued employees over at Buckeye Recovery Network and a very skilled and talented clinician that is really good at what she does. So I figured we have this platform, we have the opportunity to share and speak and we got Jim already popping up, look at that, Jim’s ready to go! Jim, we got to bring you back for one of these. You’re a good guy, you’re a good sidekick too. Jose and John, everyone’s coming in right now, good morning! So today’s topic I guess, if you will, is actually going to be questions and answers. So I posted this a few days ago and reached out to a few individuals that I know have been watching this and they kind of had some questions that they wanted us to address and answer and we have those questions ready for you and we’re going to gladly answer them. And on top of that if anybody watching this live, throughout this live stream or even afterwards, has certain questions that they want answered by myself or Sara or another treatment professional that watches this, feel free to ask those questions. We’ll gladly answer them and do our part to provide support to you.

Quick background about what this group is and what the purpose of it is: so my name is Parham. I’m here each and every single Saturday, 10 o’clock Pacific Standard Time live. Been doing this for over like two and a half years now on this platform and I personally have a (Sara’s gonna laugh but) master’s degree in marriage and family therapy. I’m a licensed addictions counselor. She’s laughing because I say this nonstop each and every single time I talk. And I’m also in recovery myself: June 13th, 2008 is my sobriety date and Sara, before we get into the questions and answers, if you want to give a quick background about yourself, your education your kind of your modalities that you practice, anything that you want to share feel free to.

Sara : Yeah, good morning and thank you for having me. I’m usually on the other side of this where I’m watching and leaving the comments so it’s interesting to be on the front end this time. I am a licensed professional clinical counselor which is just a fancy way of saying a therapist and I have my master’s degree in clinical forensic psychology, so essentially wherever the law and psychology intersect is where that degree falls. I’ve been working with Buckeye for about five years now as a therapist and they do a lot of individual work, a lot of trauma work, EMDR, brainspotting, CBT and DBT which are just different therapeutic modalities that I use and I’m happy to be here today.

Parham : And so we have a few other people that popped on – whoever just came on, hi, thank you for being here and we’ll just get into this. So the questions – I was able to kind of get them all ready for us – and the first one we have here Sara is: someone asked, can addiction lead to mental disorders? So kind of give us your take and I’m going to sit back and listen if that’s okay, and then see if I can add to that response.

Sara : Absolutely! So there are a few different parts to this. Addiction absolutely can lead to mental disorders – there’s no denying that – but there’s sometimes (or a lot of the time) the talk of, is it the chicken or the egg and which came first? So people begin to use substances and abuse substances for a specific reason which is generally comfort so sometimes there’s childhood trauma or sometimes there’s anxiety and we use the substance in order to help deal with those mental disorders so sometimes it can lead to those diagnoses but a lot of the times it just exacerbates mental disorders that were already there so if there’s some sort of paranoia using marijuana can make it a lot worse, or if there’s depression alcohol use can make the depression a lot worse. So it can lead to mental disorders and it can also exacerbate mental disorders that were already there.

Parham : Perfect, and really well said! I’ll kind of try to – I don’t want to have the same answers because that was a really well thought out answer and you nailed on everything that would need to be covered and for me I’ll try to just break it down a little bit more into layman’s terms if you will. What I mean by that is this: if there is a person in your life (and you’ll hear this a lot so everyone watching this I want you to catch this moment of education) a lot of times people who use substances and use drugs and alcohol or certain type of behaviors they don’t consider that the problem. They actually even say this was the solution to a problem that I was experiencing. So what does that mean? So if somebody’s like around 13, 14, 15 years old and there’s a lot of chaos, there’s a lot of disturbances, loudness, domestic stuff, mom and dad yelling and screaming and the kids starting to feel very, very, very dysregulated and starting to feel a lot of anxiety. So when a 14-15 year old starts to feel a lot of anxiety and they don’t know what to do with it. It’s an overwhelming feeling. It’s like this blanket that overtakes you – you don’t know what to do with that anxiety (which by the way anxiety disorders are mental disorders) and all of a sudden whether the parent says we don’t know what to do with our child, they take them to the doctor and they get some Xanax prescribed to them, or the kid just goes in the medicine or the alcohol cabinet and grabs some alcohol and drinks for that moment or smoke some marijuana for that moment what happens is that Xanax, that alcohol, that marijuana just all of a sudden alleviated all of the symptoms of the anxiety and for them it’s like they can finally breathe, they can finally feel okay. So the substance use was literally the solution to the anxiety and now you can see how this can become a perfect recipe for disaster. Because if the situation and the circumstances of the anxiety doesn’t go away, if there’s continued domestic craziness, if the kid continues to move around all the time, if there’s continued volatility at home and the anxiety doesn’t go away and now they found a way to deal with it with addictive substances that you can build tolerance and dependence on and become physically dependent to and that could seriously lead to addictions. And the part that Sara said (and I think it’s very important talking about) – if somebody has paranoia, delusions, smoking marijuana can exacerbate – to use her word – of those symptoms, if there’s underlying causes of mental illness in the family, if there’s genetic predisposition of certain diagnoses such as bipolar, if a person uses substances it could lead into those mental disorders, so the addiction can lead into those mental disorders. It’s kind of like a triggering event – that’s what we call it. There’s a question I think down here that got asked so that was wonderful to state that. And a lot of times, by the way, there are other disorders that aren’t really diagnosed, like the disorder of loneliness, the disorder of feeling disconnected, which shows up sometimes in things like depression. Oftentimes we hear opiate addicts say this (and to some family members you might not believe this but), opiate addicts might say that opiates are like the warmest hug I always wanted but never got. “The warmest hug I ever wanted but never got,” because that opiate all of a sudden provided a solution for that loneliness and that disconnection.

So let’s see what Jim has here – thank you for asking questions. How do you deal with resistance or a client not being able to identify that a problem exists in their lives? So pretty much he’s talking about resistance or denial – how do you deal with that?

Sara : Do you want to take this one away first and I’ll go after you?

Parham : 100% yeah! So first of all Jim, thank you for asking and I know you’re actually a very damn good clinician yourself so you do have the answer for this because you work with us all the time. I appreciate you asking this because I know you’re not asking for yourself – you’re asking for the many people who are going to be watching this later on. So first we have to always realize that people don’t see the world as it is; they see the world as they are. Just because something is a problem, like a glaring problem in the lives of others, to that individual it might not be, and there’s a disconnect that exists there. So the first step is to be able to have the individual identify and see that there is a problem. One assignment that we use in treatment in Buckeye (and I know Jim, you use) for example, we have the 10 Consequences of Addiction Assignment and what that does is to help you look at different areas in your life: you look at your relationships, you look at your health, you look at your finances, you look at your overall mental health, all that kind of stuff and you see what kind of consequences has drinking or substances you’re using caused? And if you look at that objectively and you see it’s impaired and impacted all those different areas it’s one version of being able to break through that level of denial. And also the other thing with resistance is, sometimes people aren’t ready to let go. When someone resists something they’re not willing to let go. I mean, when they let go freedom happens but they’re not letting go, so the question becomes why? What is it that they’re continuing to receive from this drug and alcohol that other people might not be getting but they’re getting? And what’s it going to take for them to be able to let go a little bit at a time? This is why it’s important, so that to answer your question you have to meet people where they’re at. You can’t force someone to become ready, you can’t force someone to exist, to see the problems in their life. You have to meet them where they’re at and hopefully from there raise up together. So Sara, add whatever you want to that.

Sara : I mean, you answered that question really well and I was also laughing when I saw Jim’s question because I know he knows the answer to this really well and deals with it on a daily basis but thank you for asking Jim. I agree with a lot of what you said, Parham. I think the first step is really to try to bring a lot of awareness to the behaviors because sometimes when people are actively using or where there’s a lot of resistance they don’t really recognize the chaos that they are bringing into their world, into family members’ world, into their lives, so to kind of bring awareness to how is this impacting your mental well-being, how is this impacting your social life, how is this impacting work, in school, and to kind of like have them take that information. But the most important thing to remember is that you can’t control someone else and you can’t get them to the place of wanting to be ready to stop using until they’re really ready. So I think the best thing you can do for yourself in those moments is to take care of yourself and to be a really healthy role model for that person, which they soak in and they see and it kind of in a way can really help them to recognize how unhealthy their behaviors are too.

Parham : 100%! Thank you for saying that, thank you for asking that Jim! Let’s get to the next one here. This is a question (believe it or not) that was asked: What is fentanyl and why is it in the news? I mean you could look at just yesterday or two days ago – The New York Times had an article about fentanyl and all the people that are dying from it. Fentanyl – let me just give a quick psych education on it for those who don’t know because it sounds like it’s just some drug that’s popped up and it’s killing people left and right, which it is killing people left and right. But it’s not a drug that’s just popped out. Fentanyl in the medicinal world, fentanyl in the pain management world, fentanyl in the severe pain in the hospital world, the chronic pain, the end of life stages is something that’s been prescribed in the United States for a long period of time. It’s a very, very powerful painkiller – some say it could be up to 50 times or a 100 times stronger than heroin, so it is used medicinally in the United States and there’s controlled versions of it, meaning that the dose is controlled, the duration of it, the release of it’s controlled, and all that kind of stuff. The fentanyl right now that’s in the streets – we have to separate those two things. One is being made by pharmaceutical companies and the second one is being made by mega super labs all over the world right now – China, Mexico, all that kind of stuff. It’s just as powerful if not more powerful. Carfentanil which is even more powerful and it is very, very cheap to make and easy to bring in because of the size of it – it’s so small. So what’s happening is now there’s a black market that exists that people might not know of. You think of people that are taking opioid medications – they’re using pills and all that kind of stuff – the oxycodones, those vicodins, percocets, narcos, xanaxes which are anti-anxiety medications. Those medications that we can all get from a doctor and use – there is a black market that they call press pills when you can’t go through legal channels to go get those medications because as you get addicted you can’t keep going back to doctors because the dose that you’re wanting, the amount of medication you want, or the drugs you want, becomes more and more. So you have to go to the black market and that’s where the press pills market exists. In the press pills market you might go in thinking that you’re getting some medication or some drug that does not have fentanyl in it however the people that are in charge of all the drugs and all that kind of stuff – the drug dealers and suppliers – they found out that by adding a little bit of fentanyl to a drug that you can produce significant effects in the user and the user is going to keep coming back to it. Now the problem with this is that fentanyl is very very very strong, fentanyl is very very very powerful and people without any type of tolerance to that powerful drug are getting it in their other drugs so majority of these fentanyl deaths that we’re hearing about is not people who are chasing and pursuing fentanyl – it’s people that are trying to get a press oxycodone, roxycodone pill. It’s people that are trying to get xanax off the black market and believe it or not, somehow it’s found its way into stimulants such as methamphetamines and cocaine so people are looking for other drugs but fentanyl is being added to all of these drugs. And while fentanyl is a very very powerful painkiller which means it’s a powerful respiratory depressant, it slows down your breathing, and when you take it with other things including alcohol by the way, if you take it with other drugs that also slow down your breathing it’s a recipe for a person to stop breathing which were all these overdoses are happening and people are dying. This is not like an exaggeration. There was a study that came out that said from April of 2020 to April of 2021, there were 100,000 deaths because of drugs. That stopped in April or May of 2021. I promise you this: when the statistics comes out for the following year (I know this is not going to age well in case it’s not right) but I promise you it’s going to be somewhere between 150 to 200,000 people in the following year because those statistics are completely chopped off when it started to get really really bad. Why is it in the news? Because imagine if there’s a mass murderer running around killing people left and right it’s going to be in the news. Fentanyl is the same way – it’s in the news because it’s killing people and I could tell you this that we have program participants that have finished our program and they were positive for fentanyl in their urine analysis and they swear up and down – they say they’ve never tried it, they don’t like opiates, they don’t do this, they don’t do that, but somewhere they took another drug and because the other drug was laced with fentanyl that pulled up into their system. So what do you want to say about it? Is there anything about fentanyl that I didn’t say, anything you see? And by the way last one, sorry, I just want to get this before – there are individuals, usually opiate addicts that their drug of choice is fentanyl so when they go looking for drugs they are looking for fentanyl pills and fentanyl is so powerful so a lot of people who are intravenous heroin users (they were using heroin in their veins) have shifted to smoking fentanyl pills because they’re able to get pretty much the same effect without having to to use needles and all that kind of stuff which is a complete shift. It’s always the smoking and the snorting crowd goes to injecting but now the injecting crowd is going to smoking fentanyl because of the power of it and it is true by the way – one time use can kill you. That’s one thing when back in the day when they would try to do these scared straight things with kids and say yeah one time smoking dope, marijuana can kill you, one time drinking is gonna kill you, which it can but it’s not as common. One time using fentanyl can kill you and it does kill and it has killed many people that people like me and Sara have been working with. So that’s my answer on fentanyl. Great question, by the way, thank you for asking that.

Sara : I mean you covered the topic really really well Parham. Are you able to pull up a picture in the thing or you’re not able to pull up photos?

Parham : Of what? What are we trying to see?

Sara : If you Google it, if you can pull it up that would be great but if people can’t pull it up, if you google the lethal dose of heroin versus a lethal dose of fentanyl it’s striking and overwhelming to see the amount of fentanyl it takes to cause an overdose. Are you able to pull that up?

Parham : Oh yeah, for sure, so let me see – we’re going to do some really cool technical stuff right now. I don’t know if it’s going to work. Let’s see – share screen – if it asks me to restart the thing I’m probably not gonna do it.

Sara : I mean anyone interested can Google and it’s one of the first photos that pops up and I think that’s really important to share to bring awareness to how strong the drug is. I know that fentanyl, like Parham mentioned, has been around for a very long time but it’s within the last few years getting more news coverage and bringing more awareness to it because of the deaths that people are experiencing and the overdoses. People are more familiar with morphine – I would say historically, and fentanyl is 80 to 100 times stronger than morphine is. That’s about how strong fentanyl is so there’s a reason why it’s ending up in the news. There’s a reason why there’s a lot of overdoses happening and that’s why it’s so important to bring awareness and to talk about it so that people can really engage in harm reduction. Abstinence is great but if it’s not there then harm reduction is really important in order to save lives.

Parham : Yeah, and I saw something actually when I was doing my research to answer this question. Just so family members know and those who are testing individuals at home with those cups – those 10 panel cups – even if you get the cup that can test for the most amount of substances out there – you know they call them these 10 panel cups – it doesn’t test for fentanyl. This is really huge! Someone could be using fentanyl in your home and you’re testing for them, they keep showing up negative but they’re actually using fentanyl. You have to get this thing called a dipstick which you can put into the urine sample and that can separately test for the fentanyl. In the research that I saw there were some community colleges and local colleges that were giving out free test dip strips because they assumed that college students on some level will be dabbling in, using substances, whether you believe it or not, that’s what people do at that age, and it was just good to see them offering that type of a harm reduction thing, to be able to test their drugs to see if fentanyl is in it or not. You think that something that’s so deadly is a deterrent but if that was the case then all these people wouldn’t be dying from fentanyl. And again, remember a lot of these overdose deaths are not on purpose – they’re completely accidental. They’re not trying to die – it’s just that fentanyl is that powerful.

Sara : Yeah, and I’m from South Florida – Fort Lauderdale – and it happened a few months ago where a bunch of people rented a house in Fort Lauderdale and they had gotten some cocaine. It was spring break and they just wanted a party and a large majority of the people there overdosed and passed away because it was laced with fentanyl and they had no idea. They thought they were just using a little cocaine, we’re gonna party, stay up late and that’s what ended up happening. It’s laced in a lot of different drugs currently and unfortunately.

Parham : Yeah, the New York Times article, if anybody ever looks it up, is specifically to do with fentanyl and methamphetamines. I mean those are two completely opposite drugs, kind of like what Sara said with the cocaine the party drug, and somehow they’re making it – they’re intertwining them so I’m super sad to see that happening.

So the next one here (this is for sure, I know parents sent this one): What are the signs to look out for that my loved one is using again or has relapsed? You could go ahead and take this one Sara.

Sara : Okay, so I think for parents, for partners, for anyone to look out for any significant change in behavior, anytime someone has a drastic change in their norm or their behavior, it means that something happened. And it doesn’t always mean that there’s a relapse – maybe it’s that depression is getting a little bit worse or maybe that person went through a life transition, but a lot of the times it’s kind of like (I think Parham, you’ve said this before) a road map. Behaviors don’t change for no reason. Some of the things that you can look for is if someone is having shifts in mood and a lot of time rapid shifts in mood, if they’re really really irritable one time and then you see them and a few minutes later they’re really joyful within the hour or two hours. Something else to look for that’s really important is changes in physical appearance. I’m personally a big believer in what you look like on the outside is a huge reflection of how you’re feeling or how you’re doing on the inside. So again, like I said, not a sign of relapse but if someone’s really depressed you’re going to see them not taking care of their wellbeing, they’re not going to have showered in a long time, their hair might be really knotty, their face, but then some of those signs of substance abuse like you’ll see changes in their face a lot of times, if you’re not getting the nutrients that you need because a lot of the times people stop eating when they’re using drugs, so just overall weight changes, just changes in physical appearance in general that happen suddenly and quickly. And I think one of the biggest ones is isolation. Addiction breeds in isolation so if we notice that there’s less connection with family or friends or their support network, like if the person stops going to their 12-step meetings or engaging with their sponsor, and then also isolation in terms of not showing up to work when they’re a reliable person, or not showing up to school, or getting the grades that they used to, those are some indicators that there’s something going on with that person.

Parham : 100%! Those are all, I think you nailed pretty much all of them. Changes in sleep pattern too I’d probably say is one of the ones that’s very common. People aren’t sleeping at all because they’re up on stimulants or they’re sleeping too much. Also the thing is, there’s signs and symptoms of relapse. I have this talk I’ve done here so I just want to kind of connect this talk to a previous talk we talked about. I talked about relapse in them so if you go look at one of these previous talks about relapse one of those things in the relapse process I actually talk about this thing called the prelapse, which is the signs and symptoms before the physical relapse happens. And that’s the road map she’s talking about. Once you’re on that road relapse is oftentimes inevitable unless there’s some type of awareness and intervention that happens at that moment. For family members (because I think the family member asked this question, I know there’s a question up there I’ll pull it up in a second), you have one unique advantage to people who don’t know the individual. Okay, so what I mean by that is this: you know your loved one, so whether this is your child, your grandkid or your spouse or your friend you’ve seen them in their addicted state for days, weeks, months and years. Most people in their new environment have never seen that version of them so when you start to see and feel that your spidey senses start going off, that something is starting to feel like the past again, this is like really good insight because you have that insight. They’re starting to do things, say things, behave in ways, hang out with people, or have certain behaviors in the past that existed when they were using, it’s not always the fact that they’re 100% using, but it shows you that they potentially are back closer to that realm than they are to the opposite realm. It’s a unique advantage and then as soon as you start to see that and feel that and hear that and observe that, like Sara said in one of the first questions was, that’s when you got to double down on yourself because myself, Sara, the greatest clinicians and therapists in the world, counselors in the world, we can’t predict the future. Neither can you. We do not know what happens to people in their journey but because of that risk of that vulnerability of not knowing what’s going to happen the only thing that’s certain is taking care of yourself in those moments, literally taking care of yourself. Because if they’re able to get through that and stay clean and sober, wonderful, cool. If they’re not, at least you don’t lose yourself in the process. Because relapse does happen in the recovery process, oftentimes if not more than frequently, with individuals. Once it happens you just go back to the basics. So if it happens once it happens you go back to the basics – what did you do the last time around that you were able to provide help? Do you just say, oh this never works and I’m over it and all that kind of stuff, or you say go back to ground zero and start building forward from there again? Sometimes that journey is very very difficult and challenging and it’s kind of hard to go through it again but it might happen. I’m just giving you some reality that it might happen.

So there’s some good questions over here. This one’s about neuroplasticity, probably of the brain. Could the brain cells damage recover themselves during the recovery from addiction and to what extent? You want to take that one? You want me to go?

Sara : I can take it. I’m sure you’ll be able to expand a little bit better than I can. Our brains have something that we call neuroplasticity and so our brains and our body want to heal and they want to be healthy. So over time it will, but it really just depends on the person – how long they were using the substance, the amount of substance they were using, and also the substances that they were using do impact the brain as well. So it is a time thing a lot of the time and every day that we are sober is a step in the right direction of our brains healing.

Parham : 100% on that neuroplasticity. So Jose, this question that you’re talking about here – I do want to also double down on what Sara said and it’s not just me and her doubling down – there’s other people’s research that doubles down on what we’re saying that the brain does recover. It can recover. Now to what extent is based on the frequency and the duration and the length of time that people are using and if it’s a significant amount of time and a significant amount of duration in an amount that leads to those parts that the brain has a hard time recovering from there. But for the most part let’s say if we have a bell-shaped curve of addiction, most people that fall in the addicted world that stop using their brains do recover in a very powerful way with certain drugs. For example, the highly dopamine related drugs like methamphetamines which is the most powerful drug on the brain, they say it takes up to 18 months for the brain to resolve, to reset to normal functioning with dopamine receptors to be able to function the way that they need to function. So this isn’t like a 30-60-90 day thing, up to 18 months. And also all the other organs and tissues of the body they actually do regenerate. People sometimes don’t know this, that the hair, skin, nails, the internal organs, the surfaces, every seven years or so they also regenerate themselves internally when there’s a healthy conducive environment to it which is a powerful fact. So hopefully that answers that.

There’s questions here from Katalin: How do you gently nudge someone into recognizing that they have an addiction problem, which I recognize, being one myself and in recovery, but gently open their eyes to take action? So pretty much what Katalin is saying here (I just want to open up the question) because of her personal experience in recovery, she’s able to observe someone else in their life and see that they got signs, they got symptoms, they potentially could have a problem with addiction, but the other individual doesn’t know yet, so what can that person do to nudge them or kind of gently expose them to the recovery world? You got anything for that?

Sara : I really like that you said “gently.” I think that’s really important. We talked earlier about bringing awareness to that person and I’m going to go on a little bit of a side tangent with this but I’m really big on communication and the importance of communication and how we can say the same thing in two different ways and it will not land at all if we don’t say it correctly. There’s been a lot of research, there’s a form of therapy that they call the Gottman therapy and it focuses a lot on communication and relationships, and it says the first three seconds of how a conversation starts generally indicates how a conversation will go. So if we start the conversation with a negative tone and really loud and aggressive body language the person we’re speaking to is going to immediately shut down, they’re going to get defensive and they’re not going to be able to hear us, and that’s where that “gently nudge someone” really comes into play. To have a very soft startup when you speak to people and to also speak from “I statements” like, “I notice,” “I feel,” “I have seen,” in whatever follows because if we start with “you’re doing this and you’re messing up your life and you’re ruining your life,” people get defensive and their brain turns off and they can no longer hear you. So I think the gentle approach is really really important. An appropriate communication in terms of speaking to someone at the right timing as well, so if someone has not slept for three days because they’ve been using drugs, it’s generally not the time where they’d be the most receptive towards any feedback about their life. So kind of plan the time where you talk to them and judge them and help them recognize some of their problems.

Parham : That’s perfect and I’m all about the compassionate approach to everything and the other one too Katalin, in the program, now you know the 12-step programs for example, they have a statement that works really well. It just says “attraction rather than promotion.” So what does that really mean is when you are in your recovery (and I know that’s what you’re doing right now) you become so attractive, meaning that the way you live your life without the use of alcohol, the way you engage, the way you interact, the way you behave, the way you think, the way you show up, the way you laugh, the way you smile, when all of that stuff starts to be seen by others it always piques the interest of the person that’s closest around you. They say, Wow, something’s different about them, something’s changed about them. And then they ask that million dollar question: What are you doing to get to do that? How did you get to this place? How did you go from what you were to where you are? Because when they ask the question then that’s like the perfect opening: “Oh let me tell you,” and that’s when you can actually start talking about all this stuff so the continued work on self creates an attractiveness, kind of like an attraction to others to inquire about what’s your secret sauce – that’s what I call it. So continue doing you and hopefully that becomes attractive enough to whoever that is around you that you’re trying to gently nudge towards the recovery process.

Jim opened up our pre-lapse discussion. Here’s some good ones. So if there’s increased anxiety, if there’s increased anger, sleeplessness, over-sleeping, bad diet habits, isolation, deflecting (we didn’t talk about that) – if someone asks are you doing okay and you just deflect and talk about something else it’s not a good sign. It’s like they don’t want to get the root of stuff. And defensiveness as well. We could probably come up with a nice list here – defensiveness is a very good one. Argumentative. Debbie said this really resonates when we were talking about the relapse. This question is a little bit older but she said “I no longer do, knowing it seems to lead too deep.” So she used to freak the heck out about pre-lapse and relapse but no longer she does because she realized that if the individual does relapse, which it happens, and they’re able to survive it, which talking about stuff like fentanyl out there it’s a very high risk these days, if they’re able to survive it, it actually helps them get to a deeper level of recovery. So seize the relapse as part of the recovery and growth process. I’ve known Debbie here for a couple years now – Debbie would have never been able to if she would have seen herself write this two years later she would have thought that that’s not her. It’s kind of cool to see how far we can come in recovery. She was just riddled with fear, so much fear, I mean about every decision of their loved one. Jose wanted to thank us. Katalin, this one Jim said is for you because you’re asking how do you approach someone gently? Timing is really important. So as Sara said those first three seconds of not what you say but how you say. Also when you say it and I think Sara you said if someone’s been up for three days they might not be receptive to take it so timing’s really important with everything in life. We have some more questions: Why do family members need to (I probably misspelled that so let me just fix that because my perfectionism right now is going to flare up and I’m going to have a hard time) also do some type of recovery? This was actually a real question – it was a family member that was resistant. I kind of invited them to watch this. I don’t think they’re here so maybe if they come later but I invited them to watch this and they were kind of a little bit defensive and argumentative and all those things that lead to relapse of an individual, they deflected, they said “Why the heck do I gotta be here? I’m this successful human being, I’ve raised three good kids and this one happens to be the bad apple. How come the rest of their lives aren’t?” This person was legitimately angry and upset: “How come they’re all fine and now that this one’s in recovery I have to come here and have to sit and learn these things? I don’t want to learn these things. Why do I have to?” You got anything for that Sara? Because I got way too many things to say.

Sara : I know this is kind of like your forte. I always start by telling family members that addiction is a family disease and it is impossible to look at the strain that it takes on someone’s life and not acknowledge that it impacts the entire family, whether it’s parents, whether it’s siblings, cousins, grandparents, whoever it is. So there’s a lot of benefits to family members needing some type of recovery because when family members do seek some type of recovery they learn things that they previously probably were not aware of, so it helps to overcome enabling behaviors which is really important. Because enabling it can be extremely dangerous for someone in recovery or for an addict or alcoholic. It helps with learning about financial support and the impact that has on someone and it also helps with learning to effectively establish boundaries so there’s a lot of benefits to family members getting some type of recovery. And like we’ve mentioned before the best thing you could do for your loved one is to help yourself because then you’re modeling healthy behaviors, you’re a role model and you increase awareness and education which is really important.

Parham : Yeah, that’s a perfect answer. To anybody that’s resistant to the recovery process I always urge them to do this. We say this: individuals are recovering from substances so family members give it a try, be open-minded, and maybe you find something in there that you’ve always needed but never knew you needed. How about that? Actually I have to put something up here – this is legit – you said something my son actually asked me to join Al-anon and I’m grateful to him. You know what I mean? I’m not going to get too much into it but let’s say the son’s going through the recovery process and the son says, “Mom, go to Al-anon, I’ll help you,” and the mom’s like, “Hey, why do I got to go to something?” My mom said the same thing by the way – if she’s watching this – my mom was like, “Why the hell do I have to go to these groups and meet with these people and do all that kind of stuff? I don’t need to do that,” but she went there and all of a sudden she found out she’s like, “Oh my gosh this is all for me, I’m doing this for me, I’m getting to know who I am, what I’m all about, all that kind of stuff.” Because recovery just means (by the way I’ve used this working definition). So why do family members need to also do some type of recovery? Recovery means to regain something that’s been lost, stolen or destroyed – that’s all it means – to regain something that’s been lost, stolen or destroyed and what is that? It’s always our connection to ourselves. If you have a family, a wonderful family, and three of them are doing really well and one of them is really really struggling at some point we get disconnected to ourselves in this journey called life and recovery just allows us to stop, slow down, turn the mirror, look at ourselves and see who and what we are. It doesn’t have to be through traditional 12-step routes – it could be through individual therapy, it could be through support groups, could be through faith-based stuff, but we all need to recover, including myself, including Sara. It’s like life makes us lose ourselves at times – there’s nothing wrong or shameful about working on ourselves. Here’s the thing – I’ll say this because I talk about this every single week literally – there’s some really nice comments I’m going to put up – instead of hearing it from me you can hear from families – but even if you say “I don’t want recovery, I don’t care to go to these programs, I don’t care to learn about addiction, I’ve raised three good kids and this one’s the only bad apple” you want to frame or whatever this family member was telling me and I do a really good job of not talking about people because I just need to but what if I told you as a licensed professional and Sara’s a licensed professional, that your loved one, your child that you say you love so dearly, your adult child that you say you love so dearly, what if for their recovery and for their chance to survive and their chance to heal they need you? How about have you ever thought about what if they need that connection with you to be able to work on themselves and you deprive them of that connection by saying I don’t want to engage with this recovery stuff? They can figure out on their own because like I said even if you have three wonderful kids and one of them struggles that’s saying that if you have two identical plates from Ikea, those white ones that look identical and drop them from the same distance (or in this case have four identical plates and drop them from the same distance) they’re going to have four different break patterns – they’re all going to look different. And guess what? Even if you think you know why, you actually don’t, because people are unique and individual and different and that kid, that loved one, that child, that partner, that friend, might need you in recovery and maybe that’s enough to get you in and you realize you’re there for yourself. So we have this thing in recovery called internal versus external motivation. It’s like I get sober for my mom and then I realize after getting sober I did it for myself. Sometimes as family members you go into recovery for your loved one and then after a while you realize, “Oh [ __ ] this is actually for me,” so you go from being externally motivated to internally motivated. Every single person that watches this – I know there’s not that many of them – but let’s just call 15 or 20 people watch this live every week and I’m cool with that – those 15-20 people all were externally motivated and they finally became internally motivated and they stay here and come back because they’re internally motivated.

Sara : I really like to tell family members too that watching your child or your loved one struggle with addiction is challenging and it’s heartbreaking and it’s sad and it’s anxiety producing and we watch families lose sleep for so many nights in a row that it can just be helpful to be in a room with people going through similar experiences and have that safe place to talk about what you’re going through and to not hold on to it all on your own. So there’s a lot of benefits for someone having recovery themselves and going to the Al-anons and the Nar-anons and the different meetings like that to get some support to navigate a really challenging experience.

Parham : I’m gonna piggyback on you now if that’s cool. When someone’s going through addictions in their family it’s safe to say that miscommunication happens. They don’t understand their loved one, their loved one doesn’t understand them, there’s anger, there’s resentment, there’s frustration, it’s just a cluster of just really really horrible communication. When one person gets exposed to recovery and another person gets exposed to recovery what happens is they start to gain this common language of recovery – they start to say the same things and act the same ways and look at themselves the same way and stop externally blaming others and start looking at themselves. That common language of recovery allows for them to speak in a way they otherwise wouldn’t be able to speak so it helps them create a language that they both understand. There’s a bunch of good stuff here coming in. Tony said hi, John Donahue said hi guys, What is up? The Ohio house manager that’s been there for a long time and he’s a fan favorite. Debbie said “it is absolutely a family disease. I can’t imagine any good changes could happen without the family members going through recovery.” See, this is a family member talking, my friends, it’s not just me. Eileen said, “Loved ones’ recovery is a gift that affects other relationships in your life. It makes all relationships more authentic.” It just makes the relationship with your loved one more authentic – all relationships – this is talking about personal and professional, by the way. We just level up when we go into recovery. And Jim: “For families in recovery you can set a really good example for the loved ones in your life struggling with addiction.” Absolutely! It’s the same thing – model what you want to see. Michael, let’s give him a shout out – he is the gentleman with four years of continuous sobriety that’s doing his internship for drug and alcohol counseling at Buckeye Recovery Network. He wrote, “I finally got sober once my family actually got involved in my recovery. Doing anything on your own can be very difficult.” Well said! It’s kind of like trying to create and assemble an Ikea piece of furniture without the Ikea book – very very hard to do. John just said “what’s up,” so let’s see we have another one – Hossein said, “Being a part of a big family of Al-anon is by itself a blessing and a great help in what is the right way to deal with the disease, thanks for your great knowledge and guidance.” You’re very welcome, thank you for being here. Like I say, if you’re not here then we’re just random people talking in computer screens.

Sara : I was going to say something really quickly – so you know it’s really cool that kind of like piggybacks on what all the comments are saying here talking about recovery and working a program, whether your loved one is or not is that I myself am not in a 12-step program, I haven’t struggled with drugs or alcohol but I work with Jim who’s on here every single morning and he took me through the 12 steps when I started working at Buckeye to get a deeper understanding of it and when I went through it I was like, “Holy crap, the world would be such a better place if everyone went through this process, whether you struggled with substances or not,” because to be able to have a situation and it really challenges you to look at your part in situations so moving forward from doing that with Jim every day moving forward I started trying to look at my part in different scenarios and how my behavior impacts others or to make amends to people that you’ve hurt. The world in general would benefit from doing this so I think there’s a lot of benefits to working 12-step programs.

Parham : They really are, and I knew that you and Jim did that – I actually remember in real time when you guys were doing that and that’s a shout out to Jim obviously for making himself available for that but also for you Sara. A good clinician has to know the population they work with, they have to be able to relate with the population they work with, and for you to say you don’t have that much personal experience here but you’re trying to get a lot of professional experience and you want to go through the experience, you want to walk the walk so you can talk the talk so you can connect with people. And that’s what’s made you – I mean you did that about four or five years ago – that’s what made you the clinician you are right now, that even though you never put a needle in your arm or even though you never start snorting a bunch of things not all these consequences, because of it when someone sits down and talks to you you’re able to talk to them human to human and you’re able to go back to the recovery principles even without going through it firsthand. Sometimes for some people with education it helps to have personal experience. But don’t always believe someone says if someone wasn’t an addict I can’t work with them because here’s the thing – when you go get a knee surgery, well the knee surgeon if he’s never had knee surgery himself I’m not going to let him do surgery on me it doesn’t make sense. If the knee surgeon has the ability to effectively help reconstruct and heal your knee without going through knee surgery you allow him or her to do so and recovery is the same way. I’m not saying everybody that has that personal experience can help out those with addictions because if they didn’t do the work like Sara they might just miss the boat – they might just be completely overwhelmed, but if they’ve done the work to really understand that population it doesn’t matter if they use or not themselves, I promise you it does and I know this for a fact. All that matters is, can you connect to people? Can you have compassion? Can you hold space? Can you model what it’s like to be a healthy human being? Can you have unconditional positive regard? Can you give a [ __ ] about the life of another human being? If you can do all those things it doesn’t matter if you were addicted to heroin or jelly beans – you know you could help anybody else out.

This is all the time we have. I know we had about three or four more questions so in the feedbacks what I would encourage you to do is if you can go ahead and let us know if you like the question and answer format If you do we will try to bring this back not every week but maybe a couple times, once a month, something like that. A couple times a month to do the questions and answers thing is a really nice way to kind of broaden the platform a little bit. If you know somebody struggling out there or you know a family member struggling, tell them to come here and post their question for us and we’ll do a great job responding to them and helping them in their recovery and guiding them in the right direction. It’s just such a privilege to do this every week and Sara what are your closing thoughts? How was this for you this time?

Sara : Thank you for having me. It was a lot of fun and I appreciate all the comments and everyone’s engagement in being able to sit up here and talk about some of the stuff that we’re both so passionate about so I really enjoyed it, thank you for having me.

Parham : You did great and thank you everyone for your participation and this whole format was good so we got we got a couple of shout outs and I think those are kind of like air hugs or whatever they are – those emojis – but right back at you Katalin, everyone else, “Great format, love seeing Sara participate,” we got some thank yous, we got great education. Jim, you’re going to come up here too for questions and answers. I know you’re here Tony if you’re around there too it’ll pop you up maybe we’ll do all of us. I could probably pull up four screens and just let questions go wild and out with a bunch of counselors and therapists that’d be wonderful. Love and appreciate all of you. We’ll be back same time, same place next week for another family education support group. Have a wonderful weekend and stay safe out there. Bye everyone!