Counseling Today, Online Exclusives

The opioid crisis and a wounded counselor’s heart

By Antoinette D’Angelo (pseudonym) May 14, 2018

[Editor’s note: Because of the personal nature of the narrative, the author is using a pseudonym.]

 

“Welcome to the club!” This greeting, typically extended to new members, often implies certain advantages, discounts and perks. However, the club my husband and I unwittingly have joined is based on an experience I would not wish on my worst enemy.

We received “the phone call” — the one every parent dreads in their wildest nightmares — at 2:30 in the morning in mid-February. It was the police station calling to tell us that our son had overdosed. He was alive, barely, but they had found him just in time.

A tumult of thoughts raced through my mind. Our son lives 2,600 miles away. Could it be a mistake? Were they sure it was our son? He wasn’t supposed to be in that city. What is happening?

As I write this, I know similar words must have been said or written a million times over by so many other heartbroken parents. In truth, there is nothing new to read here. Yet, it is my son I am writing about, my “kid” (now in his 30s). It is my same son whom I desperately worried may not live when I went into labor at six months gestation. It is my child whom the OB-GYN gave only a 10 percent chance to make it. It is my child who did make it, who went on to do great in school, who had tons of friends, who graduated from college, who got married and had a wonderful job. It is my kid who loved cutting down Christmas trees when he was little, swam like a fish and played soccer until his feet ached. It is my child who loved our annual summer trips all across the country to see major attractions and visit dozens of national parks. And it is my son whom the police were now telling us had almost died of an opioid overdose.

I write this story partly for the cathartic release it provides. Our family has cried more tears over the past few months than we could have previously imagined possible. Perhaps more important though is this: The ultimate irony of this situation is that I am a licensed mental health counselor, a licensed addiction counselor and a master addiction counselor. I am an assistant professor of counselor education and teach courses in addiction and treatment. I “know” so very much — maybe even too much on paper — about this disease of addiction, while simultaneously finding that I know so very little.

 

A quest for treatment

A few hours later, we raced to the airport, my husband catching the first available flight to the East Coast. We decided that once my husband got more information, I would fly out. Unfortunately, his plane was delayed, he missed his connecting flight and he ended up arriving after midnight. With no “new” news about our son, the hours ticked by excruciatingly slow.

The next morning, my husband went to see our son in jail — the words still seem incredulously stark written here. They brought our son out in a wheelchair. He was retching violently, trembling uncontrollably and could barely speak. My dear, sweet, gentle husband wept because he thought our son, who was in full-blown detox, was going to die. My husband and son could talk with each other only through a television screen. After 10 minutes, they took our son away.

I called the jail shortly thereafter and pleaded to find out what was happening. The response was that they weren’t allowed to tell me. Many hours later, I was routed to an “angel” sergeant who explained the jail’s “detox protocol” — they give the inmates Tylenol and a pill for nausea, but the inmates throw that up immediately.

Our son was in sheer agony, and we had never felt so utterly helpless in our entire lives. We could not even get a message to him. The whole experience shook us to our cores, and we felt nearly incapacitated by immobilizing grief.

My husband had his “one allotted visit” for the week, which was on Saturday, meaning that the next visit couldn’t be until Monday. We were distraught with worry about our son’s condition but weren’t allowed any additional information. We contacted an attorney in the area whom we had worked with previously years prior. Blessedly, he took on our son’s case but was likewise unable to find out anything over the weekend — and Monday was a holiday. Our agony continued, piercing our souls.

Tuesday was the bond hearing. Our son had been charged with two felonies and two misdemeanors. Our attorney spoke on our behalf. Amazingly, our son was released from jail in our recognizance, as long as he agreed to go directly into treatment.

The next several days were a blur-filled nightmare that involved navigating the quagmire of insurance situations. We found that because our son was “five days sober,” no detox unit would take him, reasoning that he was not in quite desperate enough straits at that point. No residential treatment center would take him; he didn’t qualify for Affordable Care Act insurance because he had lost his job. He couldn’t get on Medicaid because his physical address was listed a state away. We couldn’t get the best insurance money can purchase because he had a pre-existing condition. Our son was still in a very fragile state, with double vision, horrible stomach pains, crawling skin sensations, major sleep deprivation and continuous hot/cold sweats. He needed help — fast.

With no other viable options, our attorney managed to get an emergency stipulation granting my husband permission to drive our son the 2,600 miles across country to where we live. Meanwhile, I had stayed at our home, spending countless hours investigating insurance options and trying to find a residential treatment center for our son. My husband drove as he never had in his life, making the trip in three and a half days. They arrived in the middle of the night, our son a mere shell of the vibrant, funny, creative, loving soul that he once was.

We signed our son up for Medicaid in our state, which featured a 45-day backlog. We could request emergency consideration, with the possibility of them meeting us within 48 hours, but there was no guarantee. Our son would have to be assessed, and then there was the issue of actually finding him a bed at a residential treatment facility.

I must have contacted at least 25 treatment centers; none would take Medicaid. So there our son languished. We watched him slipping away from us as he struggled with his new sobriety and no treatment. If our son had been suffering from any other “acceptable disease,” waiting to obtain treatment would have been deemed unconscionable and cruel. From my view, it is beyond words that we ask those who suffer to simply bear their pain and deal with it.

I emboldened myself to share the situation with some trusted co-workers. The disease of addiction is still fraught with stigma, but I was so beyond that now, knowing that if we didn’t find something soon, the agony our son was experiencing would lead him to the streets. Human beings can withstand only so much pain. He was attending 12-step meetings as best he could but was so weak, it was hard for him to focus. He was more than ready for treatment and begged us to help him find something. He was simply too ill to do this on his own.

Through the grace of a co-worker, I was able to contact a treatment center that a relative of hers had attended with great success. I called, and we made an appointment the next day. The center took only private insurance, but we had already explored every other possibility. There were no other viable alternatives. It caused us to ponder, what does a person do who has no access to health care? (And, thus, all the overdose headlines!) We brought our son in for an intake assessment, and three hours later, he was in detox treatment; the timetable was for 35 days.

 

 

An equal-opportunity disease

Our story is merely a reflection of the countless individuals now suffering from our nation’s opioid crisis. Tragically, a huge percentage of those addicted are not so lucky as our son has been to have survived. Our son has an unfathomable journey ahead of him to maintain his sobriety. The shattering statistics confirm that only about 10 percent of individuals who are addicted find treatment — perhaps half of them will remain sober.

Our son’s addiction to opioids started as many others have. He had a back injury at work a few years ago, and his doctor prescribed OxyContin. Our son found some relief from the back pain but, more insidiously, found that it also helped with his longtime struggle with depression. Alas, he was a sitting duck. When the pills were gone, he tried to get more from the doctor, to no avail. He finally asked a friend, who led him to someone who had a few, and the rest is history.

On the streets today, one pill of OxyContin can cost as much as $60; a bag of heroin costs $5. There is no mystery why so many turn to heroin — not to get high but rather to relieve the impossible, all-consuming withdrawal. My son told us he tried countless times to overcome “the beast” on his own. The longest he made it was two and a half days — two and a half days of wretched, skin-crawling, vomiting, horrible agony. And we wonder why so many people are addicted. We treat people like criminals just for self-medicating their pain. We seldom think of them as even being human anymore, deserving of immense care.

As I tell my counseling students all the time, addiction is an equal-opportunity disease. I’m not a person in recovery, but I have attended dozens of 12-step, self-help meetings through the years. I worked as the program director of an outpatient substance abuse clinic for 10 years, often accompanying colleagues to open meetings so that I could honestly recommend them to my clients, know what they were all about and for the knowledge of “keeping it real” (that last one is crucial to me as a counselor and an educator.)

When I teach addiction courses, I ask my students to attend at least two open 12-step meetings if they are not seeking their own recovery but are there to learn, or two closed meetings if they are there to help themselves. They come back to class and share their experiences, which are often incredibly humbling to hear. They include tales of feeling embarrassed, finding it hard to enter the buildings, driving around several times looking for the courage to go in and acquiring sincere admiration and respect for those in recovery who have survived and share their journeys with others. The textbooks we have are tremendous, but nothing replaces the personal epiphany one can attain by witnessing these 12-step meetings. Many students have shared the sentiment, “There but for the grace of God …”

 

Holding on to hope

My irrational side tells me to beat myself up. I have been blessed with all this incredible knowledge and insight as a counselor and still did not know what my son was going through? I have refused to do so, however, not only because I realize that now is not the time for recriminations, but because I fully comprehend that addiction is a baffling and cunning disease.

It all makes sense now, of course — the endless need for money to pay for mysterious car breakdowns and vet bills for the dog, the many trips to see doctors for a once very healthy and fit young man, the horrible pain he was experiencing when his marriage fell apart. We wondered, of course, but were too far away to verify. We spoke frequently with our son but saw him briefly only three times over the past three years. Meanwhile, his addiction truly began to escalate.

It does no good to wallow in self-pity. It is just as futile to assign blame and fault. Pain, hurt, anger, frustration, desperation, sorrow, fear — all of these, and so much more, are ongoing and understandable. However, the one thing this disease cannot take from us is hope. The rational side of my being knows about evidence-based treatments, what has the best outcomes for success and what needs to happen.

In that sense, it has made things much easier for our family to endure because all of what is unraveling is in the range of “normal,” and that brings great solace. Our family is attending family counseling, going to Al-Anon meetings, reaching out to trusted friends and relatives, and realizing that we are so incredibly not alone. Still, it amazes me that if we were to tell a friend that our son has cancer, heart disease or even HIV, the response would be more understanding, more forgiving, more helpful. We have come light years in the field of addictions during the past two decades (I know — I teach this stuff!), yet we remain in the Stone Age as far as acceptance, understanding, scorn, victimization, blame and judgment go.

My hope is that readers will find some comfort in this writing (counselors are human beings first, with real-life crises of their own). I have found that addiction is an immensely alienating and isolating disease. So many people believe it will not happen to them or their loved ones because, after all, the person does decide on their own to pick up that first drink or drug, right? However, no one ever sets out in life to become an addict of any kind.

As human beings, our physiological needs are the most basic and supersede all others (refer to Abraham Maslow’s hierarchy of needs). We want relief from our physical/psychological/spiritual pain now and resort to self-medicating on a regular basis. I often ask my students, “What is your drug of choice? Is it caffeine, tobacco products, shopping, gambling, exercise, relationships, etc., etc., etc.?”

The point is, we are all slaves to our prefrontal cortexes, and once we find something that works for us, we make those lovely endorphins, the “intermittent positive reward” phenomenon takes hold, and we get positively rewarded for repeating that behavior. We are masters at conning ourselves into believing that the consequences of whatever we rely on continue to be far less than the rewards. And slowly, insidiously, the disease of addiction takes on a life of its own for far too many.

 

A time to take action

We know the physiology behind addiction. Those of us in the field screamed our warnings regarding OxyContin when it was first introduced in the late nineties. It didn’t require a huge knowledge of biochemistry to recognize the effects; its victims were immediately seen and affected so devastatingly.

Addiction professionals continue to scream from the highest pinnacles about the high potentiation for addiction from these drugs; we portended this epidemic well over a decade ago. And yet, here we are, still screaming of the dangers even as countless individuals are prescribed these drugs daily.

In 2017, the Centers for Disease Control and Prevention estimated that more than 115 people die every day due to opioid overdoses. I am not blaming the pharmaceutical companies (though perhaps I should?) or the physicians. Their ultimate goal (one hopes) is to adhere to the Hippocratic oath, to do no harm and to relieve human suffering. However, I believe that we have reached a tipping point, as Malcom Gladwell described in his book of the same name. Our nation is realizing that this crisis affects our mothers, our fathers, our sisters, our brothers, our daughters, our sons, our relatives, our friends, our co-workers, our ministers, our doctors … and ourselves.

The #MeToo movement has shown us the time for action is now. The #TimesUp movement is doing the same. The #NeverAgain movement is gaining immense momentum. It is time for our passions, our sensibilities and our combined courage to demand more research and increased access to treatment. It is time to get over our fear, ignorance and blame regarding addiction. And we need, once and for all, to acknowledge that the disease of addiction is happening at lightning speed all around us, with no letup in sight.

There is no time to waste on blame or recriminations; we need to act. Addiction can take hold of any of us, regardless of our training, our background, our socioeconomic status or our rationale. It happened to my son, despite all of the knowledge I possess as a counselor.

My fervent belief is that with understanding and proper intervention and treatment, we can more readily help those who are afflicted. More importantly, I believe we need to get at the real root of why people need to self-medicate in such powerful ways. We knew our son had problems with depression. He attended a few counseling sessions over the years, but there was no incentive to stay, and even taking the step of seeing a counselor came with perceived stigma. We all have the power to change the paradigms around this.

As of this writing, our son is more than 60 days clean and counting. He has completed his residential treatment and is living with us, taking it one day at a time and trying to deal with life on life’s terms. The neglect of his overall health has taken a huge toll, but together, we are trying to slowly repair its ill effects. This will definitely take time, but the joy is that now we do have that precious commodity.

My message to all my dear counselor colleagues is this: This disease affects all of us. The palpable pain of our nation is excruciating, and we are all awash in its collective anguish. As a nation, we must reach out, not suffer alone. We need to find hope, discover solace and all begin to heal. We also must find the profound courage to act and change our national discourse and paradigms on how we view and treat people who are self-medicating in hopes of finding relief from traumatic pain.

As counselor change agents, we can do this! There can be no higher calling. #EndOpiods.

 

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Antoinette D’Angelo is the pseudonym for an assistant professor of counselor education teaching in a university in the western U.S. She is a licensed mental health counselor, national certified counselor, master addiction counselor and licensed addiction counselor. She has worked in the human services/counseling profession for over 44 years. Her research interests include substance abuse and trauma treatment; crisis and disaster counseling; counselor wellness and alternative holistic treatment methods; and immigration, DACA, and refugee assimilation and reform.

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

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