H.A.L.T.

What does the acronym HALT mean? And why is it an important part of a recovery plan? Hungry, Angry, Lonely, Tired: these are warning signs, red flags. HALT is a tool to remind us to stop – halt – and take a moment to listen to what our emotions and body are telling us.

I am not an alcoholic or addict – you may not be either. So why did I use ‘us’ as I wrote this blog? Because all of us are subject to these basic needs – human needs – and if they are not met, we will instinctively search until we find a way to have them fulfilled. Our responses may not be as self-destructive as an addict or alcoholic, but they will affect our relationships in one way or another. Let’s be careful to not make such a wide differentiation between addicts / alcoholics and us: the ‘us vs them’ mentality that makes ‘us’ superior and ‘them’ inferior.

Hungry. This can be physical, emotional, or spiritual hunger. Physical hunger is fairly easy to satisfy, but for many addicts, getting nutritional meals can be a struggle. Yet it is still easier than getting the affection and understanding that is even more vital to our well-being. This is why a strong support system is so important – and must already be in place before a time of need. Attending meetings is good, but being part of a small group is even more critical.

Angry. This is a normal human emotion. The key is to self-assess and decide why we are angry and what we can do about it. If the issue is out of our control or we aren’t ready to confront it, we look for other ways to release the anger. Exercising, meditation and prayer, and creative outlets can help, as is having a trusted friend or counselor to discuss our feelings with. Whatever we do, denying or repressing anger will not be healthy for us long term.

Lonely: We can be lonely in a crowd or in our room. It is a sense of being isolated, not understood, not appreciated, fearful. Withdrawing feels safe when we are overwhelmed or anxious, but for many addicts it can lead to relapse. I will never forget a conversation with our son when he said “I hate being alone”. I was shocked because he had always been more of an introvert than our daughter. But once he was addicted to opioids, I think the isolation that occurs while using became like prison to him. Perhaps it made him feel less ‘normal’, which he wanted so badly to be. A healthy relationship where we feel safe reaching out to in times of need will make all the difference.

Tired: We all get out of sorts when we are tired. When our lives are filled with activities such as work, school, family, meetings, our need for rest gets pushed to the side. But it is not healthy for us physically, spiritually, or emotionally and it affects our ability to reason and cope with difficulties. Relapse is just around the corner unless our body and mind are restored. It may be hard and uncomfortable to say we need a break to get some sleep, but it will benefit us and it is critical to maintaining sobriety.

Self-awareness and self-care are not self-ish, as many of us were taught when we were growing up. They are vital steps to help maintain a life on the path of recovery and will not only benefit us, but all our relationships.

 

The Well-Known Effects of Opioids

I was re-reading a book by George MacDonald, entitled The Curates Awakening. I had forgotten an aspect of one of the main characters plight: opioid addiction. What struck me as I read this paragraph was the age-old, well-known addictive qualities of opioids:

“From a tragic accident of his childhood, he had become acquainted with the influences of a certain baneful drug (opium), to which one of his Indian servants was addicted. Now…to escape from gnawing thoughts, he began to experiment with it. Experimentation called for repetition, and repetition first led to a longing after its effects, and next, to a mad appetite for the thing itself…on the verge of absolute slavery to its use.”

This was written in 1870. Laudanum – an opium tincture that contains almost all of the opium alkaloids, including morphine and codeine – was developed in the 16th century. By the 18th century, the medicinal properties of opium and laudanum were well known.

By the 19th century, laudanum was used in many patent medicines to relieve pain, to produce sleep, to allay irritation.The Romantic and Victorian eras were marked by the widespread use of laudanum in Europe and the United States. The early 20th century brought increased regulation of all narcotics as the addictive properties of opium became more widely understood. By mid 20th century, the use of opiates was generally limited to the treatment of pain, and were no longer medically accepted “cure-alls”. (Wikipedia)

How is it that the manufacturers of OxyContin (Purdue Pharma) and other prescription opioids claimed and advertised that they were not addictive? Their scheme was so persuasive that I have friends today that believe that if you are truly in pain, opioids are not addictive. This is absolutely false. And how did the FDA let this go on?

Yes, we can be thankful that new ways to deliver pain relief were developed for patients with extreme pain from cancer and terminal illnesses. I have seen the need for it when I cared for my sister who was dying of brain cancer and had a morphine drip. But the wholesale promoting – pushing – of these drugs for every ache and pain while knowing how absolutely addictive they were is unconscionable. Had we really understood the power of opioids when we first learned our son was addicted, we would have taken a much more pro-active approach to his initial recovery program.

On October 30, 2017, The New Yorker published a must-read multi-page exposé on Mortimer Sackler, Purdue Pharma, and the Sackler family, by Patrick Radden Keefe:
https://www.newyorker.com/magazine/2017/10/30/the-family-that-built-an-empire-of-pain

“The Sacker dynasty’s ruthless marketing of painkillers

has generated billions of dollars – and millions of addicts.”

The article links Raymond and Arthur Sackler’s business acumen with direct pharmaceutical marketing and the rise of addiction to OxyContin. The article implies that the Sackler’s bear moral responsibility for the Opioid epidemic. During the sixties, Arthur got rich marketing the tranquilizers Librium and Valium using techniques were sometimes blatantly deceptive. In 1974 Mortimer renounced his US Citizenship and lived a flamboyant life in his many residences in Europe.

OxyContin was introduced in 1996 and just since 1999, two hundred thousand Americans have died from overdoses related to OxyContin and other prescription opioids.Many addicts, finding prescription painkillers too expensive or too difficult to obtain, have turned to heroin. According to the American Society of Addiction Medicine, four out of five people who try heroin today started with prescription painkillers. Our son is one of those statistics – and fatalities.

Access to Medications for Addiction?

In a conversation with a friend, she felt that drug addiction was basically related to poor choices and that recovery was also just a matter of choosing to stop. I guess at the core of it, she is right. An addict needs to decide they want to stop – but then what? Do they just exert will power, go through withdrawals and possibly a 12-step program, then all is well?

Sadly, this simplistic approach will not work for most opiate addicts. The physical changes that have taken place in the brain that cause the addiction need time – and lots of it – to even partially regenerate. The Ohio Society of Addiction Medicine recently posted this (https://ohsam.org/2018/01/12):

“Studies…have found that opioid addiction medications in general cut all-cause mortality among opioid addiction patients by half or more. The CDC, National Institute on Drug Abuse, and World Health Organization acknowledge their medical value.”

The blog continues to discuss the lack of access that the majority of addicts in America have to the three medicines that specifically treat opioid addiction and some of the reasons for it:

“A major reason for that is stigma. These medications are often characterized as ‘replacing one drug with another’…This fundamentally misunderstands how (opioid) addiction works. The problem is not drug use per se; most Americans, after all, use caffeine, alcohol, and medications without major problems. The problem is when drug use becomes a personal or social burden — risk of overdose or leading someone to commit crimes to obtain drugs.  Medications for opioid addiction, by staving opioid withdrawal and cravings without leading to a significant risk of overdose, mitigate or outright eliminate those problems — treating the core concerns with addiction.”

Then there is the issue of large segments of the country without doctors who can prescribe buprenorphine/naloxone due to licensing limits – and the costs for patients.

“In a 2016 report by the surgeon general, just 10 percent of Americans with a drug use disorder obtain specialty treatment…attributing the low rate to severe shortages in the supply of care, with some areas of the country lacking affordable options for any treatment — which can lead to waiting periods of weeks or even months.” By then, it is too late for many addicts seeking help.

“Another reason for the treatment gap is a lack of federal attention…the Cures Act committed $1 billion over two years…woefully short of the tens of billions annually that experts argue is necessary to deal with the opioid epidemic…the total economic burden of prescription opioid overdose, misuse, and addiction of $78.5 billion in 2013, about a third of which was due to higher health care and addiction treatment costs.”

I can say that our son desperately wanted to be free of his addiction that started when he was too young to realize the ball and chain that would drag him down and keep him from his hopes and dreams – and eventually take his life. Thankfully, he did have access to some medical help. Incredibly, even after so many relapses, his father and I felt he could beat his addiction without medication – if he just worked harder. We were sadly mistaken.

Grieving The Living

For many, 2017 was a year of loss: a job, a home, a relationship, an opportunity. For between 120,000 parents to well over a million friends and relatives of the 60,000 persons who died from opiate overdoses in 2017, the new year will be a continuation of the grief process. Once we are forced to enter this unexpected, unwanted, and uncharted new territory, we have no choice but to travel through it. With support from our communities of friends and God’s love, we will somehow come out on the other side. If we have grieved honestly and fully, we will be better people who see others through different eyes.

But what about those who are living with a loved one in active addiction, or in a recovery program for the umpteenth time, or whose whereabouts are unknown? What is their 2018 going to be like? I can tell you, because my husband and I were there a few years ago. We were in constant flux between hoping against hope as we prayed and waited for a miraculous change, and discouragement and depression as we watched our young adult son struggle against an unrelenting foe. We were grieving the loss of the son we loved and raised and had hoped to see move successfully into adulthood. We were grieving the living.

Dr. Susan D. Writer wrote an excellent article on “Grieving the Living” posted on the Coalition For Healthy Minds website: http://cahmsd.org/grieving-the-living. The short article is well worth the read, but here are a few highlights:

“For those of us who have a loved one who struggles with mental illness or addiction, we are all too aware of how we can ‘lose the living’.  When that individual is in the throes of…any unmanaged mental illness or addiction, their behaviors are altered. They are not themselves – or at least not the version of the people that we have grown to know and love. In some instances…we can only watch as they spiral down a dark or dangerous path.  No matter what the outcome, our relationship with this loved one changes as a result of what we are experiencing, separately and together, and we often feel a deep sense of loss.  But we must grieve the relationship of the past if we are to create a new one in its place for the future…though there may be remnants of the person we knew ‘before’ the illness or addiction, the change has occurred and all of us must learn to adapt… But we all must honor these changes in our loved ones and recognize that if we are to have any relationship with them we need to learn to adjust and adapt on our end… Grieving is a process and a necessary part of life…In order for us to realize the potential for a new relationship, with new opportunities for connection and intimacy, we must grieve the old relationship, and essentially ‘grieve the living’ to allow for life to move on… On the other side of grief is growth.  And on the other side of grief is also acceptance and peace.  But most importantly, on the other side of grief is love.”

I don’t know if while grieving our living son we ever got to consistent acceptance and peace, but the love between us all remained, even up to his last phone call to us the night before his death. And for that, I am eternally thankful.

Holidays

Holidays – a time for family reunions, shared meals, communal celebrations, watching favorite movies together, reminiscing over photographs and discussing hopes and dreams for the next year.

For many families of opiate addicts, there will be an empty place on the sofa or seat at the table. If 60,000 individuals have died this year alone, the number of people affected by those deaths is multiplied by two parents, siblings, relatives, and friends: the circle of people who knew and loved our addicted ones could be in the hundreds.  If even only 10 people were impacted by the death of one addict each year, there are over half a million new surviving and grieving individuals this holiday season alone. How many more from the last decade?

For my husband and I, this is our third Christmas without our son. We can say that it is not as painful as it was three years ago, but there is still the sense that things are not as they should be. This excerpt from Roger Edwards’ article “Don’t Grieve Like the Rest of Men” from The Barnabas Letter, July 2001, p 4-5 continues to help us:

“What is hard in microwave, quick fix, America is that grief takes time. By necessity, the implications must seep and settle into all the parts of our lives. The process is inherently long, occurring slowly and over real time. Twelve months is a wise time span to remember as you grieve. Give yourself at least a full cycle of holidays, birthdays, and seasons to suffer the loss. But a year doesn’t cover it either. There are longer cycles in our lives. Loss slowly infiltrates all the corners of our lives. It wakes us late at night with memories, reintroduces itself to us when we run across pictures or possessions, and recurs during cycles of holidays and anniversaries.

We wonder, isn’t there any other way to make it through loss? But there isn’t. There is just one honest way to respond to loss. That way is to grieve. Christian grief peers into the hideous face with brutal honesty and tells the truth by deeply experiencing the loss…it mourns, it sometimes even wails. Grief is there to walk with us through despair. Everyone else fights death and loss by pretending. The grieving fight death by the truth. Death is real and is as hideous as it is real. Grief knows that death is the enemy. And it tells the truth with sorrow.”

I wish I had a magic potion for all who are grieving a loss for the first time this holiday season. I don’t. What I can offer is what I have experienced: openly telling the truth not only helps us grieve, it helps others in ways we may never know. As we honestly (and selectively) shared our feelings, we availed ourselves of empathy and comfort from those who love and care for us. And they gained understanding about grief and joy from knowing they were helping us walk through our dark times.

And in the broader scope of a nations’ corporate suffering, it is only by openness and honesty that the tide will begin to turn as solutions are found that will prevent the scourge of addiction from robbing our families of their loved ones and the joy of  holidays together.