After many years of working as an accountant, I decided to enter counseling as a profession in my “retirement” years. After four years in graduate school, including two years of clinical work at an addictions recovery center, I began my new professional career this past January. Here is how it began.
It was my third day as the evening counselor at Ashley Addiction Services. A clinical aide called me and said, “We have a patient here who wants to leave now. He’s calling his girlfriend to get a ride, and he is looking for someone to punch so he can get kicked out. Would you come down?”
The patient was a young man I had met during my training period the prior week. “You look stressed,” I said.
“Of course I’m stressed!” he screamed back.
I coaxed him out of the clinical aide’s office to a quiet place where we could talk. He told me he was on the withdrawal drug Suboxone. He wanted to go out and get high, then quickly get enrolled in another facility so he wouldn’t disappoint his mother.
“Your mother’s opinion is important to you,” I said.
“Of course,” he said.
“What about your dad?” I asked.
“He’s dead,” he told me.
I asked him to tell me more. He had been using for seven years. This was his fourth stay in a recovery facility.
“What happened seven years ago?” I asked.
“Nothing,” he said.
“When did your dad die?” I asked, following a hunch that there might be a link.
“Five years ago,” he said.
No link, I thought.
I had been working in addictions recovery for two and a half years at that point. I spent most of my life as an accountant, working in grants administration at various universities. At age 58, I had a near-fatal heart attack, and during my recovery, I knew that I had to change course in my life. Counseling had always fascinated me, and I had been in and out of therapy myself for about seven years. I made the decision six months after the heart attack to make a major course change in my life and study counseling. I enrolled in the pastoral counseling program at Loyola University Maryland, the same school where I had earned a Master of Business Administration 26 years earlier.
As part of my counselor training, I had worked as an addictions counselor at the Westminster Rescue Mission. I remembered a story about another patient I had worked with there who reminded me of my current patient. I shared that story with my current patient, explaining that my former patient’s parents divorced when he was 5. His dad lived only a few blocks away after the divorce, but he rarely saw his dad. Sometimes his father would tell him he would take him fishing on a Saturday morning, so this young boy would get up early, get dressed, assemble his gear and wait all day at the living room window for his dad to come. His father never came.
My former patient started shooting heroin when he was 18 and continued to do so for the next 24 years. After working with this patient for a year, he said to me, “Until we talked, I never understood the connection between what my father did and my addiction.”
Something in this story seemed to resonate with my current patient. So I asked him again, “What happened seven years ago?”
“That was the year my dad got sick,” he said. “He got diabetes and had to have his foot amputated. He was my rock.”
And then it hit him: the link between his dad’s sickness and death, and his own addictive behavior. He jumped out of his chair, threw his arms around me and shouted, “You just saved my life!”
I breathed a sigh of relief. It was a heady moment for me. We both knew an important bridge had been crossed. We talked a little while longer, then went for a quiet walk outside.
An epidemic of loneliness
People talk of the tragedy of the opioid epidemic. And the tragedy is painfully real. One of my patients lost two friends during his first weekend in recovery, and he believed that if he had not come in for help, he too would be dead. Another patient found his best friend dead from the dope he had shared with him. A third patient stood before the entire patient community and told us that he had lost 42 friends to overdoses in one year, and he knew that if he did not come in for help, he might well be next.
And yet from my perspective of working with people in addiction, the opioid epidemic masks a deeper epidemic. The epidemic I see every day is an epidemic of loneliness.
It is so ironic. We have never been more connected. We have cell phones, email and FaceTime. We can meet anyone, anytime, anywhere. The world I live in today reminds me of the futuristic world I saw pictured in science fiction comic books when I was a kid. And yet, rather than being more connected, we seem more distant from each other than ever before.
I believe that we all need a deep sense of connection with other people in our lives. Emotional connection is an essential part of being human.
People in recovery are in a state of inner conflict. They simultaneously want to recover and stop abusing drugs and alcohol, while at the same time they have cravings to continue to use. When they stop using, once they get through the painful physical symptoms of detoxifying, the painful emotions that led them to use in the first place tend to rise to the surface. Often, there is a painful event or painful circumstance in their lives that caused them to use in the first place.
Substance abuse is often a coping strategy, a way of easing pain, and very often it is some painful event that triggered their addiction. Substance abuse serves a function in their lives; it reduces their pain enough to enable them to cope and carry on with their lives. In that way, it is similar to taking a pill to get rid of a headache. Of course, the circumstances are far more drastic.
I asked one user why he used heroin, and he said it was better than committing suicide. It was hard for me to argue with his logic. From his perspective, heroin use had the positive aspect of keeping him alive, of keeping him from killing himself by his own hand. That is part of the reason that it is so hard for people to give up their addiction. It serves the positive function in their lives of keeping them alive, allowing them to continue to function, in spite of their pain. It numbs out their pain, however temporarily.
Unfortunately, in numbing out their pain, it numbs out all of their other emotions as well. This is why it is nearly impossible to have a meaningful relationship with someone who is addicted to a substance. Meaningful relationships require an emotional connection. How can one have a meaningful connection with someone whose emotions are chronically numbed out?
Breaking the cycle
The damage of addiction spreads out like the ripples in a pond, far beyond the individual who is addicted, to affect all the other people in that individual’s life — friends, family members, co-workers. Children of parents who are addicted grow up with parents who are emotionally unavailable. These children’s lives are shaped by the experience of emotional unavailability, and so the cycle continues.
Breaking that cycle of emotional absence is at the heart of the work I do. When patients stop using, the emotional pain that led them to use in the first place reemerges, and they often are as unequipped to deal with that pain in the present as they were in the past. As their counselor, I help patients to identify past trauma and try to find a new perspective through which to see it.
One way of looking at emotions is to think of them as predictions of what is about to come. If you enter a house filled with the aroma of freshly baked chocolate cookies, you might find your mouth starting to salivate and your stomach starting to rumble — physical signs that your body is preparing for you to eat something yummy. A sudden scream in the night might make your body straighten, your muscles tense, your eyes widen and your ears perk up — all signs that your body has gone into a high state of alert for possible danger, usually accompanied by a sharp rush of adrenalin to be ready for fight or flight. Again, these are the physical signs of anticipation of and preparation for predicted danger.
Emotional pain evokes different bodily reactions. We may feel a loss of appetite, a heaviness of heart and a wish to isolate. The triggers for emotional pain may be less obvious to a person than is the smell of cookies or a scream in the night, but they are certainly quite real to the person experiencing them. And the pain can be overwhelming.
This is where substance abuse comes into play. Often, emotional pain comes about when a person has lost someone with whom they had an important emotional connection in their life, and that emotional connection has been broken. If a parent has died or moved away, a loved one has betrayed you or a traumatic event such as a rape or murder has occurred, there is no way to undo the event. The pain of such events can be overwhelming.
Drink or drugs can provide a means of easing the pain enough that the suffering person can get on with their lives, but they cannot undo the event. Many people find solace over time and find ways to cope with the pain without resorting to drink or drugs; however, many do not. Because drugs numb the pain without addressing the loss, a person remains stuck within the loss, and so the need for the drug endures.
The damaging paradox of a person who uses drugs to deal with the loss of emotional connection is that drugs eliminate the possibility of creating new emotional connections, which are the very thing the person needs to heal. Drugs numb out all emotions — both the painful and the joyful ones — and without the ability to feel the full range of emotions, any new, real emotional connections are impossible to create.
Searching for ‘meaning’
Being with a person in the initial stages of recovery from substance abuse is an awesome experience. As a counselor, I face them in that moment of transition in their life. I know I cannot fix or heal anybody. The thing I can do is to be present with them, offering what guidance and presence I can as I try to help them find healing within themselves.
Often, that is a matter of helping them name and identify those hard emotions that arise within them — the ones that led to substance use in the first place. Once the emotions are identified, then we look for the event or the circumstance in their life that brought that emotion into play. This is the moment when the hard stories come out, the stories of heartache and loss. And then it is a matter of looking at the meaning those stories have had in their lives.
It is the meaning we place on our stories that give them their emotional charge. A child whose parents divorced and whose father moved away might, as a child, believe in some unnamed way that they are worthless. After all, dad delivered the message, in the most obvious way possible, that they were not worth sticking around for. I have known many people struggling with addiction who had just that circumstance in their lives, and that sense of worthlessness was at the root of their addiction.
In this work, we can look at stories like that and change the meaning. The meaning might be that dad was a troubled man. It might be that dad and mom had a bad marriage and their breakup was necessary. It might be that dad had to go away on a job or for military service. By reframing the story, we can change the meaning, and when we change the meaning, the emotions that accompanied that story can change.
This was the case for the young man whose story I shared at the beginning of this article. For him, the meaning of his dad’s sickness and death was that he was losing his rock, and there would be no one there to give him guidance. His story changed to dad was sick and died through no fault of his own, nor by his father’s choice, and now he would have to find his own guidance. In changing the meaning of his story, his emotions changed, and his need to numb out his painful emotions with drugs gradually evaporated.
So, at the heart of my work is the aim of being present with another person so that they can learn to be emotionally present themselves. One of my favorite outcomes was when a patient told me about his 17-year-old daughter. She was the rock of their family, a straight-A student who was always reliable and dependable, emotionally calm and stable.
She came to visit her father a few weeks after he had entered recovery. He told me he could not believe what had happened. His strong, calm and rational daughter had broken down in tears in front of him. I said, “She was emotionally present with you.” After a moment, I asked, “Do you understand why?”
He looked baffled and said, “No.”
I said, “For the first time since she was a little girl, she could sense that you were emotionally present for her, no longer drunk or high, but really right there with her. She felt it, and so she, for the first time in years, was able to be emotionally present with you. That is why she cried.”
My final meeting with the young man whose father had died of diabetes was the night before he completed the program. He told me that he was planning to move back home where he could help his mother. He expected he would be able to go back to work at his job in a restaurant, and he planned to attend school in the fall. I asked what he would study, and he said he was interested in psychology. He said he was thinking of becoming a counselor, which would further motivate him to stay on his path of recovery.
I saw him again the night he finished the program. I was thinking of the years I had spent in grad school — the books I had read, the papers I had written, the checks I wrote and all the time I had invested. And in a moment, it was all worthwhile when he threw his arms around me and said, “Thank you.”
James Rose, a national certified counselor and graduate professional counselor, is a recent graduate of Loyola University Maryland and works in addictions treatment at Ashley Addiction Services. Contact him at firstname.lastname@example.org.
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