stigma – Opiate Nation

Born Imperfect, Complex, & Unique

(Translation into most languages at tab to the right.)

I think we would all agree that each and every one of us is born imperfect. There are so many complex and unique aspects to the human body which generations of genes have contributed. The things that make up our physical and mental attributes. One example is our face. It is estimated that only 2% of the world’s population has a truly symmetrical face. The right side usually appears larger than the left and eyes, nose and ears are not perfectly aligned. When you see a photo of a face with both sides exactly the same, its actually creepy. They lack character and look like AI.

Some of us are born with deficiencies that make life difficult and challenging, like being born blind, or deaf, or with a physical deformity. Because of amazing advances in science and medicine in the last century, many of these problems can be corrected. I had crowded teeth when I was young and am so thankful I was able to get braces and have a normal smile. We would not understand if someone had the opportunity to receive this kind of help and didn’t access it because they or others in their community thought they should just live as they are. We all want to feel comfortable and that we belong, are ‘normal’ in this world.

What about when someone is born with an internal deficiency such as a heart condition or kidney problem or blood disorder? We never think twice about having medical help or drugs and lifestyle changes to remediate the problem if it is possible. So why is there any discussion on whether someone who is born with an imbalance of normal brain chemicals or hormones should live in constant struggle and not access medication?

This thought came up as I considered the reasons behind why some people seem to need something like drugs to make them feel ‘normal’ to themselves and to the people around them. When everyone else seems to easily roll with the ups and downs of life while they get stuck on the downs. When how they think and process input and information is not the same as others. When their ability to be at peace or sleep is chronically unobtainable.

I’m not at all suggesting that individuals who seek drugs all have legitimate genetic or biochemical voids. As we know, many young people start drug use because of peer pressure and the environment that surrounds them. But underlying mental struggles or health conditions may be the determining factor that pushes them into, rather than away from, repeated use. I found it interesting that among my son’s high school and college friends, many tried all the drugs – uppers, downers, hallucinogenic – and some went on to addiction to uppers like cocaine and meth while others to downers like opioids and benzos and some walked away from all of them.

But once repeated and continual use happens, the chemicals and receptors in the brain are changed and more than ever, medication and therapy are going to be a big part of recovery from use and restoration of normalized brain signals. The need for medication may be short term or lifelong. Regardless, we all need to remember that just like shaming someone because they have a physical deformity is totally unacceptable, shaming someone who is struggling with mental health and/or addiction problems is also unacceptable.

This does not mean we enable destructive behavior or stop supporting someone to get professional medical and psychological help along with a supportive community. Never. If we want to see someone who is struggling become as healthy as possible, our love and support are crucial. And we know that in a country where public health care is a privilege rather than part of a foundation of society, finding the right care can be daunting. Let us be there to help our family, friends, and community receive the care they need by being encouraging and supportive.

Stigma of Addiction: The Effects, The Reasons, and How to Reduce Stigma

by Chris Elkins, MA

https://www.drugrehab.com/addiction/stigma/

Cognitive Behavioral Therapy Info Hazelden Betty Ford:

https://www.hazeldenbettyford.org/mental-health-services/cognitive-behavioral-therapy#:~:text=Learn%20more%20about%20this%20popular,techniques%20in%20working%20with%20patients.

The Importance of Friends – Pt 2

(Translation into most languages at tab to the right.)

How do clean and sober friends stay involved with a friend who is in active addiction and/or alcoholism? I ended last month’s blog asking this question. In particular, I want to discuss ways that teens and young adults can deal with this difficult and at times very frustrating problem.

What does being a good friend to someone who is addicted look like?

The first thing is to not pretend you don’t know about their addiction. Talk about it openly but without judgment. Understand that they may deny any problem, so you may have to cite specifics that have made you concerned. Express that you care about them and don’t think less of them as a person because of their struggles. Risk your comfort zone. “Greater love has no one than this: to lay down your life for your friends.” (1)

Be a good listener. A problem with drugs or alcohol may start from just experimenting with drugs at a party or concert. It may then turn into addiction and be fueled by problems at home or with friends or underlying mental health issues. When your friend feels cared for and accepted and not confronted with more guilt or shame, they will be willing to open up. Nobody planned to become addicted and nobody wants to be an addict. Here’s links to good info on how to help someone trapped in addiction. (2,3)

But, if you remain a good friend to someone who is living a self-destructive life, how do you help them without enabling their addiction? For young people who are good friends, enabling might be keeping secrets for them about their problem, especially from adults who may need to know in order to take life-saving action. It may be loaning them money or driving them to get drugs. The pressure would sound something like: “If you’re my real friend, you won’t tell…” Or “If you really want to help me you would…” Basically, when you support their problematic behavior in the name of ‘helping’ them, you are actually keeping them from living with the consequences of their poor choices. And this will only prolong their problems and delay change. (4)

Encourage them to get help through programs like SMART Recovery groups or AA for alcohol and NA for narcotics. Very few people overcome addictive behaviors alone. Community is key. Go with them if you can or drive them. And remember, drug and alcohol recovery take lots of time and most people don’t succeed the first time they try to quit. Dr. John F. Kelly, clinical psychologist and addiction medicine expert, says it can take 8 years and 4-5 treatment attempts at recovery to achieve one year of sobriety from opioid and other drug addiction. It can take years to achieve stable recovery and Medication Assisted Treatment (MAT) is an important aspect. Gone are the times when a 30-day detox/treatment was seen as the solution to addiction. It may be an important first step in the process of ongoing recovery. People can and do recover, but it will likely be a lifetime journey. Here’s a YouTube 2025 video of Dr. Kelly giving a session on: The New Science on Addiction Recovery. (5)

You can encourage your friend with each small step and success, even through relapses. In our son’s recovery program, we ended each session by saying together: “Keep coming back ‘cause it works if you work it.” It takes hard work and it can be very discouraging for your friend to relapse because your friend wants to be free. No one wants to live controlled by addiction. No one. Encouragement to stick with it is vital.

If your friend or family member is using opioids, you should get naloxone (a medicine that can temporarily reverse the effects of an opioid overdose) and keep it handy. Available through local community-based programs or pharmacies.

It’s worth saying again: Friends are SO important for people in active addiction.

Don’t ever give up on your friends trapped in addiction. They need friends more than ever, friends who love them and will invest in their lives and let them know they are a worthwhile human – while you also need to encourage them to seek help in order to become sober and stable. And to remind them by example of what a normal and joy-filled life is like and one that they too can have.

A best friend is someone who believes in you

even when you’ve stopped believing in yourself.

– Unknown

John 15:13, New Testament
Helping Someone with a Drug Addiction

https://www.helpguide.org/mental-health/addiction/helping-someone-with-drug-addiction

How to help someone who is misusing drugs or alcohol:

https://www.healthdirect.gov.au/help-someone-who-is-misusing-drugs-or-alcohol#:~:text=Celebrate%20small%20successes%20and%20try,Narcotics%20Anonymous%20and%20SMART%20Recovery.

Four Signs of Enabling and How to Stop

https://health.clevelandclinic.org/enabling

Dr. John F. Kelly, Ph.D. The New Science on Addiction Recovery (lecture)

International Overdose Awareness Day – August 31, 2023

(Translation into most languages at tab to the right)

No one can recover from addiction if they have died from an overdose.

International Overdose Awareness Day (IOAD) is the world’s largest annual campaign to end overdose. It is a day to raise awareness about the risks of overdose, honor the individuals whose lives have been lost, and acknowledge the grief felt by families, friends, and the community

With synthetic drugs made from chemicals in China and added into illicit drugs around the world, the need has never been more urgent to alert us all to the risk of overdose facing millions of people worldwide. What can we do to help prevent further loss of lives for those already struggling with addiction?

Prof. Dan Lubman (Australia) shared a thought that stuck in my mind because it brought up memories of conversations I had with my son while he was addicted. Instead of asking, “Why are you taking drugs?” A more engaging question would be, “What put you in this vulnerable position?”

This question shows the understanding that addiction is not just a matter of choice or will-power but that it is a complex problem that will not be helped with simplistic answers such as “Just Say No.” When a person feels less stigma, that they are not being judged, and that there is hope for them, they are increasingly likely to consider treatment.

So, what does put people into the vulnerable position where drugs/alcohol are helping them cope with life? The 5 main factors that contribute to addiction are:
genetics, mental illness, home and social environment, stress, trauma/abuse.
We can’t do anything about our genes although if you know there is alcoholism/addiction in your family tree there is need for extra awareness and precautions. Mental illness once recognized and diagnosed properly, can be treated with therapy, education, and medication. Home and social environments, stress, and trauma and abuse are absolutely within parents, extended family, and society’s control. This is where raising our children as “a village” is so important, but it is in peril with our upwardly-mobile lifestyles of frequently moving house, not enough time together, and not engaging with our community. Educating our families and involvement in healthy and safe support networks such as service organizations and faith and school communities are a good place to start.

Once someone is using substances to self-medicate, what can we do? First, we need to look for, and reach out to, people struggling with addiction. There may be some in your circle of friends – even in affluent communities. If we truly understand that those individuals will shrivel in shame from stigma, we can start by changing how we speak about them and to them – we’ve changed our language for things a lot less deadly. Building trust over time is critical to someone feeling they can openly discuss their problems. We can find out more about what is being done in our community to support recovery efforts and get involved with clean needle exchanges, Narcan training and distribution, opioid substitution therapy, food distribution, safe injection and health facilities, etc.

In a report from Norway discussing housing for people who are addicted, Jon Storaas, manager of RIO, an organization in Norway working to help substance abusers, said, “We need to provide residences to ensure that addicts can live with neighbors who don’t share their drug problems…meet with them, talk about their problems…this kind of experience and openness can strip people of their ordinary prejudices. You need to create these encounters so people can see that drug addicts are human, too. Extreme examples of ordinary people, you might say. But ordinary nevertheless.” (1)

In 2018 Time reported that in the 1990’s, Portugal was in the grip of heroin addiction. An estimated 1% of the population—bankers, students, socialites—were hooked on heroin and Portugal had the highest rate of HIV infection in the entire EU. But in 2001, Portugal took a radical step. It became the first country in the world to decriminalize the consumption of all drugs… while drug dealers still go to prison.

The results? The drug-induced death rate has plummeted to five times lower than the EU average and stands at one-fiftieth of the United States’. Its rate of HIV infection has dropped dramatically. Drug use has declined overall among 15-24 yr-olds, those most at risk of initiating drug use. And, by eliminating the threat of criminal penalties—and along with it, a great deal of stigma—it has become easier for people to seek treatment.

“What America and other countries can learn from Portugal is to treat people with more dignity.” Portugal has showed that, without spending significant sums, governments can give drug users the tools to put their lives back on track. But to do so, it will have to stop treating them like criminals. (2)

Ultimately, what IOAD is about, what this blog is about, is Awareness: Becoming aware of a problem is the first step towards solving that problem. For this August 31st, I want to remember all those who have died from drug or alcohol overdose, my son included. Remember that they were precious individuals who were loved by their parents, family, friends and God. And although we live in a world where death is something that happens to every person who is born, premature and preventable death is a tragedy that each and every one of us should work diligently to prevent. Let’s find our arena and fight for the lives of those we love.

No one can recover from addiction if they have died from an overdose.

(1)

Addicts Want Sober Neighbours by Georg Mathisen
Saturday 11. January 2014, Norway
https://sciencenorway.no/addiction-drug-rehab-drug-use/addicts-want-sober-neighbours/1395274

(2)

WANT TO WIN THE WAR ON DRUGS? PORTUGAL MIGHT HAVE THE ANSWER By Naina Bajekal | Photos by Gonçalo Fonseca – August 1, 2018
https://time.com/longform/portugal-drug-use-decriminalization/

Regrets: Endless Stairways

(Twenty-ninth in a series of topical blogs based on chapter by chapter excerpts from Opiate Nation. Translation into most languages is available to the right.)

Our family loves the art of Dutch mathematician and artist M. C. Escher: the buildings that open into themselves, the school of fish that become a flock of birds, the circuitous stairways that go up and down throughout multiple buildings without an end point. Yes, stairways that never get you where you want to go, but keep you endlessly retracing your steps. They are no longer interesting art to wonder at. They now mirror how John and I have felt many times since August 2nd—regrets—retracing the steps of our entire lives.

Hopes & Dreams

(Twenty-first in a series of topical blogs based on chapter by chapter excerpts from Opiate Nation. Translation into most languages is available to the right.)

I know how men in exile feed on dreams of hope.

–Aeschylus, Agamemnon

After our son’s death from overdose, John and I truly felt like “men in exile,” forced into separation from our son, banished from each other’s’ lives. We are not just on different continents, but in different worlds, different dimensions. And hope? Any hope would have been just that—a dream, a mirage.

His untimely death took all hope of a sober and content son in this life away. Lost hope is what crushes parents when their child dies a needless death, an ignoble death to many. Had he fought in a war and been killed in action, to society it would have been a noble death. Most people who are separated from the life-and-death battle with addiction can’t see the struggle that this generation of young people are fighting on a moment-by-moment basis against an enemy that is in their brain, in their body—not outside it—one they can’t shoot and kill or put in prison. But we, as parents and friends, see it and wonder how much longer can they fight before they lose?

The Secret Keepers

(Twentieth in a series of topical blogs based on chapter by chapter excerpts from Opiate Nation. Translation into most languages is available to the right.)

National secrecy. Communal secrecy. Familial secrecy. Cloaked as “Discretion” it perpetuates problems. What it did for us when we found out that our son was addicted to heroin was to create a puzzle that we were forced to try to put together in the dark with many missing pieces. No one was talking – not friends, parents, school leaders. When the drug bust happened at his high school in the spring of 2005, and the administration didn’t call a meeting of all parents to alert us to what was going on, one wonders what motivation was behind that decision? Clearly, it wasn’t what was best for the rest of the students, families, or our community.

Years ago, while working through our angst with the systemic problems in organized Christianity, and continuing to run into absolute resistance, secrets, and denial, we came upon a quote that finally explained why we were not, and never would be, making headway: “If you speak about the problem, you become the problem.” This wisdom came from an important and insightful book, The Subtle Power of Spiritual Abuse. But the subtle power of abuse is not limited to churches: governments, schools, communities, families—no one wants to be seen as part of the problem, especially with drug addiction and alcoholism. So, if we just keep troublesome or messy things secret, if we don’t speak about them, we can all just get along.

The Cost of Secrets

(Fourteenth in a series of topical blogs based on chapter by chapter excerpts from Opiate Nation. Translation into most languages is available to the right.)

When Breaking Bad was released in 2008, our son, and most of his generation of young people, watched it. He told us about it and encouraged us to watch it while also warning us that there would be some parts we wouldn’t like – but to keep watching. We did and he was right. But JL knew that we wanted to be connected to his life through the media he viewed and so we became fully engaged and finished the series.

When I think back about it now I realize that we didn’t fully ‘get’ why JL wanted us to watch this series. I believe now that he wanted us to understand the complications and conflicts that drug use brings into a life, perhaps knowing it would reveal secrets that he just couldn’t talk about with us directly. His life was complicated and so he lived with many inner conflicts. It is the inescapable nature of any addiction.

What’s Inside the Shell?

(Ninth in a series of topical blogs based on chapter by chapter excerpts from Opiate Nation. Translation into most languages is available to the right.)

Shells are beautiful and fascinating to me. Each and every one is unique, differing from others just like our fingerprints. John and I just spent time at the central eastern coast of Australia and on our daily walks on the beach I just couldn’t stop picking up shells – especially the Nautilus shells with their logarithmic spirals of every size, shape, and color. These are empty shells that were once the home of a sea creature.

The exoskeleton of mollusks is the hard, outer layer that protects the tender creature inside. As the creature grows, layers are added to accommodate it. One day, as I was picking up shells in the surf, the inhabitant was still inside. It immediately retreated as far back into its shell as possible.

AIRING DIRTY LAUNDRY?

When I was growing up, this metaphor was commonly espoused: “Don’t air your dirty laundry in public.” That is, you shouldn’t reveal things from your private life that people usually don’t want others to know and they don’t want to hear anyway. Things like inappropriate confessions and unpleasant family secrets. Everyone will be embarrassed and people will feel ashamed.

Now we are more likely to hear someone respond with “TMI – Too much information” when someone goes beyond the bounds of information that no one wants to hear – either too creepy or medical or personal. Totally understandable.

But is it airing dirty laundry for us to speak openly about conditions or situations that are of a communal nature? Topics such as physical or sexual abuse, or complicity and criminal behavior by politicians or leaders, or suicide, or addiction? Of course, there are some details about issues that plague us as a community that do not need to be part of the public discussion in certain situations. But that is different than bringing an issue into the light of day so that it can be discussed in order to work towards a solution.

STIGMA, Part 1: What and Why

In the Greek and Latin worlds, a stigma was a mark or brand, especially for a slave, identifying the person as “inferior”. When stigma began to be used in English, it meant the kind of mark or stain you can’t actually see. (Merriam-Webster). Social stigmas are based on perceivable characteristics, associated with certain behaviors that distinguish a person from other members of society. They convey disapproval and disgrace. Dis-approval. Non-approval. Dis-grace. Non-grace. Being dissed.

In an article on The Stigma of Addiction from Hazelden Recovery we learn: “The stigma of addiction stems from behavioral symptoms of substance use disorder… impaired judgment or erratic behavior, which can result in negative consequences including legal, occupational and relationship problems. Understandably, these consequences cause embarrassment and shame among those affected. They also create stigmatized attitudes and perceptions among the wider public, a response that perpetuates and exacerbates the private shame associated with drug addiction.For generations, this combination of personal shame and public stigma has produced tremendous obstacles to addressing the problem of alcoholism and addiction. Today, the stigma of addiction is seen as a primary barrier to effective addiction prevention, treatment and recovery efforts at the individual, family, societal levels. Addiction stigma prevents too many people from getting the help they need.” The article goes on to discuss the irony that many of these stigmatizing behaviors diminish and/or disappear when a person is appropriately treated in recovery.

In my family, and in most others, alcohol and drug addiction is considered private, and “is something only whispered about. Even when the symptoms of the disease are obvious to all around, individuals and families avoid seeking help for fear of even acknowledging the problem. This is one reason only one in 10 Americans with a substance use disorder receives professional care.” (ibid.) When talking recently with some of our son’s friends and former addicts, they are unwilling to let their past drug use become public knowledge because of the potential negative repercussions they justifiably fear in their careers and relationships. What does this say about us as individuals, communities, employers, and society in general?

Hazeldon, with almost 60 years experience treating alcohol and addiction, says “the same undercurrent of addiction stigma keeps addiction under-diagnosed, under-treated, under-funded and misunderstood by many, especially as compared to other chronic health conditions such as heart disease, asthma and diabetes.” Why? The individual is seen as having a moral failure instead of a health problem. I have an anecdote I share with people when we discuss addiction. When I have been given oral opiates when leaving the hospital after surgery, I take one or two and then opt for the pain because I hate the way they make me feel: disoriented, unable to sleep deeply, and not myself. My husband recently had surgery that he was warned would be painful for 4-6 weeks following the procedure. That was an understatement. He was given a prescription for 10 days of opiates. We thought that would be unnecessary. We were wrong. When he was taking the pain meds as prescribed, he was his normal, cheerful self – it was like magic. As soon as they wore off, he was cranky. Of course he was in pain, but it was more than that. Why?

For us, it’s not difficult to understand. He has the “addiction” gene, as we call it. There were alcoholics in both of our mothers’ families. He got the gene that I seemed to have dodged. Did he ask to have that gene passed down to him? Did he decide he would feel good taking opiates for pain? Of course not. And neither did our son. Nobody makes the decision on how their brain will react to different substances. It happens. The issue is what a person does once they know that a mind-altering substance spells “pleasure” to them? Do they keep a safe distance from it as John has done or do they play with fire? For parents with addiction in our family trees, prevention is our best and most powerful weapon. Two books to aid parents in prevention are:
The Teen Formula : A Parent’s Guide to Helping Your Child Avoid Substance Abuse By Dr Dave Campbell and Drug-Proof Your Kids by Arteburn and Burns.

Had we known then – when our son was an adolescent – what we know now, we would have made significantly different decisions regarding our attitude towards pain medications, drugs, and alcohol – and especially begun discussing addiction in general and in our family in specific. I believe our son would still be alive if we had.

https://www.hazeldenbettyford.org/recovery-advocacy/stigma-of-addiction