The Fentanyl Crisis Isn't Over. In Fact, It's Getting Worse.

You may recall reading alarming stories in the media about the synthetic opioid fentanyl in the last few years. The Centers for Disease Control and Prevention noted that the drug was responsible for a spate of overdose deaths that rose dramatically from 2013, when the first cases made headlines, to 2019.More than 36,000 overdose deaths from fentanyl took place during that year, which federal, state, and local officials battled through resources guides, community action, and efforts to expand access to naloxone, the opioid antagonist drug that can reverse the effects of a fentanyl overdose, to first responders.By 2020, fentanyl stories appeared to drop from the media spotlight, supplanted by news about the presidential election and the COVID-19 pandemic. But don't think that the drug went away. On the contrary: fentanyl use, and overdose deaths related to the drug, is steadily on the rise again.According to the CDC's National Center for Health Statistics, synthetic opioids like fentanyl were at the heart of a recent and dramatic spike in overdose deaths during a 12-month period ending in May 2020. Approximately 81, 230 drug overdoses involving synthetic drugs occurred during this time period, which is the largest number of such instances ever recorded. The increase after a relative decline in overdoses from 2017 to 2018, which began to reverse in June 2019 and climbed rapidly by May 2020. Drug overdose deaths increased in more than 25 states and the District of Columbia; in some states and major metropolitan areas like New York City, the increase was between 10 and 19%.How has fentanyl managed to retain a grip on the U.S. population? Part of the reason is its potency: fentanyl is a legal drug, used to treat severe or "breakthrough" pain, especially after surgery, or for patients who have a tolerance to other opioids. When prescribed by a doctor, fentanyl can be given as an injection, patch, or as a lozenge. Though similar in composition to morphine, it's actually 80 to 100 times more powerful, and equally as addictive. As little as two milligrams of fentanyl has the potential to be fatal.The other reason for fentanyl's longevity is that it's relatively cheap and easy to produce an illegal street version of the drug, and its potency makes it a frequent choice to be mixed with other opioid narcotics like heroin or cocaine for a cheap and powerful high. Many individuals with substance dependency issues are unaware of the presence of fentanyl in these narcotics, which can overwhelm their systems and lead to an overdose.While China has been in the past the primary source of fentanyl and dangerous analogues, or imitation drugs, like carfentanil, which were sold primarily through illegal web sites on the "dark web," the majority of fentanyl in 2021 enters the United States through Mexico. U.S. authorities estimate that 90% of all fentanyl entering the country originates in Mexico, where it's produced by drug trafficking cartels who buy the chemicals to produce the drug from China and India.Data from the United Nations found that while seizures of marijuana smuggled into the U.S. from Mexico dropped in 2020, seizures of fentanyl rose nearly 500%. COVID-19 has done little to halt the cartels' smuggling operations; as the DEA noted, they've simply sent larger shipments of fentanyl and methamphetamine to meet the growing demand in the States.The third factor in the recent fentanyl surge was undoubtedly the global pandemic. Experts predicted that quarantine conditions would cause a host of issues that would negatively impact mental health, from isolation and anxiety over financial and medical worries to the inability to access proper treatment from both doctors and treatment facilities. Studies corroborated these fears, as did data from the CDC's National Vital Statistics System (NVSS), which found that overdose deaths skyrocketed throughout 2020 before declining at the start of 2021: the center has estimated that the final total of such deaths could ultimately surpass 90,000 – the highest annual number on record. How to combat this rising tide of opioid and fentanyl overdose? At Waismann Method, an opioid treatment program and rapid detox center, they believe that mental health care should be accessible not just to those who can afford it, but also to those who need it most. In today's post-pandemic world, in which so many people are dealing with trauma caused by COVID and its attendant restrictions, it is critical that medical treatment for opioid dependence be available in public hospitals along with necessary psychological support. Additionally, we need a stronger commitment to combating the rise of opioids (and the influx of fentanyl in particular) at local and government levels. "We believe that additional resources need to be put into decreasing the availability of fentanyl in our communities and the demand for drugs by our citizens,” Clare Waismann, RAS/SUDCC, founder of Waismann Method and Domus Retreat, explains. “By protecting our borders and focusing on the root causes behind addiction, we can reduce overdose risks, crime, homelessness, and suicide."Sources:https://www.ama-assn.org/system/files/2020-12/issue-brief-increases-in-opioid-related-overdose.pdfhttps://jamanetwork.com/journals/jamapsychiatry/fullarticle/2775991?resultClick=1http://publichealth.lacounty.gov/lahan/alerts/CDC-HAN-00438%20Opioids12172020.pdfhttps://www.commonwealthfund.org/blog/2021/spike-drug-overdose-deaths-during-covid-19-pandemic-and-policy-options-move-forwardhttps://www.ft.com/content/a667a8b6-a306-4656-b153-b83897df323ehttps://www.wilsoncenter.org/publication/mexicos-role-the-deadly-rise-fentanylhttps://www.camh.ca/-/media/files/guides-and-publications/straight-talk-fentanyl.pdfhttps://www.kqed.org/news/11874651/fentanyl-is-killing-more-people-in-the-pandemic-in-santa-clara-county-victims-are-getting-younger

Mental Health Awareness in Sobriety

Sobriety is a major pathway to good mental health, but it does not secure it. Instead, having your brain and body free and clear of addictive substances allows you to make the best choices necessary for mental health, and gives you the strength to do the necessary work. The trauma resulting from the pandemic and a year of social isolation have brought these issues into sharp focus, and this opens up important conversations by releasing the stigma around mental illness as a whole.For some, the conversation could be around acknowledging a mental health issue, whether it is PTSD, bipolar disorder, depression, or something else. It’s common knowledge that undiagnosed and diagnosed mental health issues are often present in people who struggle with addiction. Acknowledging the presence of the issue allows for the beginning of healing--sound familiar?Those in sober living homes, rehabilitation centers such as The Sunshine Coast Health Centre in British Columbia, or therapy already have an easy gateway to receiving help for a mental health issue. Opening up to a trusted person in this environment is the first step to receiving proper care for your particular issue.Sobriety is impacted dramatically by unaddressed mental health issues. Once sobriety begins, there is a freedom from the immediate effects of drugs and alcohol but the the struggle with addiction remains. A true mental health issue does not resolve with a better attitude, a gratitude list or giving back-- it persists despite the circumstances of your life and must be treated specifically in order to be managed effectively.It’s known that there is a link between trauma and addiction, and trauma can lead to PTSD, panic disorder, and other severe mental issues. PTSD, or post-traumatic stress disorder, is the direct result of a trauma experience, and includes a variety of symptoms such as avoidance of movies or talk that triggers the traumatic memory, changes in mood, and nightmares. In sobriety, this barrage of negative emotions cannot be numbed with drink or drugs, and so must be managed with professional care.Sunshine Coast Health Centre has been “developing licensed and accredited mental health programs with an extraordinary record of high-quality care since 2004, as they state on their website. Sunshine Coast HC recognizes that without treating existing mental health issues, a person’s sobriety is tenuous, regardless of how hard they work.To address this truth, Sunshine Coast provides medical withdrawal (“detox”), psychiatric care, rTMS, meaning-centered psychotherapy, family counseling, and post-treatment coaching as part of their roster of evidence-based therapies.Meaning-centered psychotherapy refers to the Sunshine Coast’s focus on meaning throughout their program’s modalities. Viktor Frankl founded logotherapy, a school of psychotherapy, which describes a search for a life meaning as the central human motivational force. While struggling with a mental health issue, the focus on meaning over happiness can be empowering and hopeful; happiness may be temporarily out of reach but creating meaning is not. Based on this work, Paul Wong created Meaning-Centred Therapy, which is the basis for the version Sunshine Coast uses.The clinical staff at Sunshine Coast Health Centre is trained in numerous therapeutic techniques from Narrative Therapy, Cognitive Behavioral Therapy, and Dialectical Behavioral Therapy.Narrative therapy falls under psychotherapy, and helps clients identify their values and the skills associated with those values and how their unique history can be used to further understand themselves and their path forward. This type of highly individual approach gives the patient knowledge of their unique abilities so they can build a stronger psyche and self-image.Cognitive Behavioral Therapy is a tried and true approach that focuses on challenging and replacing cognitive distortions and maladaptive behaviors; cognitive distortions are a common issue in sobriety, and it’s crucial to recognize these faulty thinking patterns, while addressing behavior reinforces a more positive thought process. CBT also works to improve emotional regulation and develop coping strategies for life issues.Dialectical Behavioral Therapy is known to be specifically useful in those with substance use disorder. It is an evidence-based psychotherapy that originally was used to treat suicidal women with borderline personality disorder but is now also used in the treatment of mood disorders, self-harm and suicidal ideation, as well as substance use issues. This therapy relies heavily on techniques to manage and process painful emotions without destructive behaviors, and specific techniques to communicate with the people in your life.“The Wellness Toolbox” offers free toolkits for assisting in coping with and managing stressful situations and negative thinking and emotions. This kind of reading can be the first step toward getting the help that you need for better mental health, and stronger sobriety, centered in a meaningful and unique life.Sunshine Coast Health Centre is a non 12-step drug and alcohol rehabilitation center in British Columbia. Learn more here.

A Cry for Help

It was like being chased by something in the dark. I couldn’t see it, but I knew to be terrified. I was running so fast that I couldn’t get enough air. When the oxygen came, it pierced my lungs and clenched my chest, making it painful to take another breath. At first all that I could think about was moving. Fast. Keeping ahead of whatever it was that was chasing me. I wasn’t thinking about getting away. I wasn’t thinking ahead at all. I was just running and trying to breathe.Eventually my fear evolved into anxiety. I realized that there was no end in sight. Whatever was after me was not letting up, and I couldn’t maintain the pace. Every cell in my body was on the verge of collapse. I had to stop. I was afraid to stop. I wanted my limbs to give out. I wanted to collapse. All that I knew how to do was to keep running.I remember that I didn’t sleep that night. Or at least it felt like I didn’t sleep. I fell onto my bed and closed my eyes in the winter-dark early morning, and as soon as I had found quiet, the lights screamed on. When I opened my eyes, Mom and Sharon were standing there in my bedroom.I was living with a friend named Tiffany then. We had bartended together in the past. The bedroom I stayed in was painted the pale pink that toy manufacturers like to give to the inside of a stuffed bunny’s ear. The carpet was a speckled blue with gray and white, that flat kind of carpet that is almost institutional or designed for the outdoors—with a short, retracted weave braced against impact rather than meant to absorb. Tiffany was redoing the inside of the house room by room, patching walls and repainting. It was surface repair that disregarded, or even disguised, the ancient wiring and rusting pipe in the walls. In the process of redoing and touching up, the structure no longer felt like a house but just spaces divided by walls. Most of the furniture had been removed, including the lights. It was always dark. My room was sparse anyway.It seemed like I might be dreaming as I blinked into the brightness—Mom pressed to a wall and Sharon leaning on the dresser directly across from my bed. I couldn’t process my bedroom ignited by the overheads, or the hour of the day, or the haziness of my own head. I couldn’t think. I could tell that they were angry. I stayed under the covers, as though the quilt could protect me from whatever they were about to launch my way. Then they started talking.It was strange because it was usually Sharon who did the talking, but now she stood stiff and silent, watching me as though trying to decide who or what I was. It was Mom who was yelling. She was saying, “What are you doing?” and “How could you do this to me? How could you do this to Sharon?” and “Are you on drugs?” and again “How could you? How could you? How could you?”I wasn’t fully awake when I screamed back at her. It was a reflex, like a hand jumping away from a hot surface. I sat up and yelled various versions of “Go away” and “Leave me alone” that ended in the repetition of “Shut the fuck up!”That morning the accosting felt like it had come out of nowhere. It seemed a random attack. In hindsight, I can see the events that brought us all to that moment. I still don’t remember stealing money from my sister a week earlier, although I believe that I did it—cocaine is expensive. I took less than twenty dollars from her wallet while I was visiting and ran out the door while she was checking her laundry. It wasn’t a lot of money, but it was enough to be noticed—mostly because she was noticing other things.Then, a few days later, I’d called Sharon from the parking lot of the emergency room in Suffern. Cocaine was causing horrible problems with my nose. It burned, it bled, and the blood clotted so that I couldn’t breathe. I would take scalding showers just to let some air in. I had sat staring through the glass doors into the emergency room, barely able to breathe, and thought about the doctor examining me. As soon as I let them look at me, they would know that I was on drugs. I stayed in the car, mouth open and puffing steam into the cold winter air before eventually driving away.Finally, just the night previous to Sharon and Mom appearing in my room, I’d called Mom at two thirty in the morning. She hadn’t answered. I’d left a message on her answering machine. I had been crying so fiercely that I could barely put words together. I’d told her nobody was there for me, nobody understood me, nobody cared about me. I’d told her that I was alone. I’d told her that I knew she loved me. I’d said that I wanted to die.The truth that I understood later was that I was in a deep depression. I felt sad and alone. So alone. Day after day I had breakdowns. They were constant. I would cry. I would write letters to my sister and Mom. I would pray to God when I went to sleep—“Maybe I don’t have to wake up”—and I didn’t even know if I believed in God. I was too much of a wimp to take my own life. I would look in the Yellow Pages for places where I could get help. I did this every day— the crying, the praying, the searching. Other than finding and doing cocaine, it became my life. It’s hard to explain how truly terrible it was, how empty and worthless I believed I was. I was unbelievably sad. I went through the motions of life, but I wasn’t there. I was a shell, and the real me shrunk away inside, getting smaller and farther away from the surface so that I was barely there. For a while the drugs made things better, then they only distracted me. Eventually they did nothing but clog my nose. I couldn’t go on.The feeling wasn’t new. I felt this way my whole life. All through my twenties, I had thought that there was something wrong with me, but I didn’t think it was the drugs. I knew that I felt bad about myself. I felt like nobody understood me, and I didn’t fit in anywhere. I always felt so alone. Cocaine stopped my head from telling me that I was crazy and bad. It was pretty good medicine until it stopped working.When Mom woke and heard me crying on her answering machine, she called Sharon. I suppose that they had been putting the pieces together for a while.Mom has always come to my defense, especially because I suffered as a child—and still deal today—with juvenile diabetes. Anytime I screwed up in school, or seemed to be acting strangely, or did something rude or inconsiderate, she would say, “She probably meant this … ” or “I’m sure that happened because … ” or “Her blood sugar is probably low.” She never wanted to believe anything bad about me. Even while Sharon was becoming convinced that something was wrong, Mom had trouble hearing it. It wasn’t that she didn’t believe Sharon but rather that she didn’t want the ugliness spoken out loud, as though acknowledging it would cast it in concrete and set things that way forever.But my crying on her answering machine had been so hysterical that it had frightened her into action.That morning, in my bedroom, I was shocked by the reversal of roles. Usually Sharon was angry. Sharon did the talking. Mom was sad and quiet. Mom made excuses for me.On the drive to my house, Sharon and Mom talked about all of the accounts of my misbehavior. Mom came in pumped up like a boxer after a motivational speech and released all of her fear, concern, anger, and exhaustion as a tirade of accusations that she didn’t give me time to answer. Mom is not confrontational and is not very often pushed to anger, but when she gets angry, she gets mean.“What’s wrong with you?” Mom yelled, not as question but as indictment: Something was wrong with me. “What are you doing? Why would you do this?”Years later, when I was responsible for guiding interventions, I recalled that morning. Mom and Sharon did exactly what I warn people against doing. All drug addicts are different and deal with their addictions and the issues that led them to addiction in different ways, but often, when you accuse a drug addict of doing drugs or having a problem, the natural response is fight or flight. If she flees, she may go out and buy more drugs to help deal with the crisis. If she fights, she may return accusations and shift blame so that she can’t hear anything you’re saying. Everything Mom and Sharon did was wrong. Yet it was perfect.“How could you do this to me? How could you do this to Sharon?” Mom yelled.“Fuck you!” I yelled as a final push to stop her diatribe. I had never spoken to Mom like that. It is alarming to think that I was even capable of saying that to her. You don’t speak like that to anybody, especially not to your mother.That’s when Sharon snapped. “How dare you talk to Mommy like that?” she said. “Don’t you curse at her. And she’s been crying the whole way here. You can’t yell at her.”Then Sharon’s tone changed. She came at me from the side, rather than head-on. She said, “Can’t you see how worried we are? We love you, you know. We want you to be better. We don’t want you to die. We want you to be here. Look at what you’re doing to Mommy. Stop and look at what you’re doing.”Then I did stop.Mom had curled into herself, sobs shaking her shoulders and sending tears down her cheeks. I looked at Sharon, who seemed less angry than terrified. Until then, I hadn’t realized what I was doing to my mother and my sister. When you’re in the heat of addiction, when you’re in the death grip of it, you truly feel that you are not hurting anybody but yourself. Addicts often say and believe, “I’m not bothering anybody. I’m not doing anything to anyone, so how can I be hurting them?” But when I looked at Mom, and then at Sharon, I could see how injured they were, and I knew that I’d done it to them. That realization shattered the shell inside my skin that I thought had been protecting me but really had been holding me captive. I shrunk back into the bed, hiding in the covers and crying.Sharon had broken me out of my prison. Sharon is the reason that I got better. She could always see through my lies and would call me on my nonsense. Since my childhood everybody had assumed that I could not care for myself. They had tiptoed around my feelings. They regarded me as fragile and dependent because my parents were divorced, then because I was diagnosed with juvenile diabetes. But Sharon never babied me that way. She wouldn’t make excuses for me or accept the excuses I gave her. She expected more. When she spoke to me, she was direct. She said things that were hard to say and hear. She was honest. Because of that, when I was an addict, I was afraid of her.I knew I wasn’t fooling her that day when I yelled that I wanted her and Mom to leave me alone, told her that I was fine, that they were wrong. Sharon knew me. She saw me, and I was beaten.And saved.“I need help. Please help me,” I cried into my covers. “I can’t stop doing cocaine.”The reality of what was happening and who I had become was named, and in naming it, it became real. A real thing could be dealt with, understood, and treated. It became undeniable. That was the most terrifying thing of all.By acknowledging my problem that day, I made it visible, and visibility made it vulnerable. That day reversed my course. My addiction was no longer hunting me but rather being hunted by me. I felt free. It was such a great relief to finally have Sharon and Mom know the truth: I was in trouble. I was crying. Mom was crying. Sharon was crying.It was probably the worst day that the three of us have ever had. And also the best day. It was both an end and a beginning, and it held the grief and joy of both.Mom and Sharon sat on my bed beside me and held me. I repeated over and over, “Please help me.” And they did. Excerpted from In Hindsight: The Story Of How Two Sisters Hurt, Hindered, And Healed Each Other by Sharon Bonanno and Lisa Scott, available at Amazon and elsewhere.

The Challenges of Mothers in Sobriety

Women who struggle with addiction and are pregnant or mothers face some of the most daunting challenges in the population of substance abusers. The typical problems of addiction present themselves -- ruined relationships, jail time, financial troubles, bad physical and mental health -- and then include the fears of physically harming a child during pregnancy with either drug use or methadone to manage opioid addiction, an inability to breastfeed with drugs in the milk supply, fears of having a child removed from custody, and paralyzing guilt at how addiction has harmed the child.Women in recovery who are not mothers have already been shown to do better when in a women-focused support system. There are differences in how women recover, such as withdrawal possibly being more intense for women. Research specifically focused on women in sobriety has been lacking and is being advocated for in order to support empirical evidence that could help women get and stay sober. For example, research has shown that the nicotine patch is less effective for women than men. In the past, women were not even included in federal studies on addiction.When women recover together, sex-specific issues can be naturally and purposefully included in the program, and this is true for mothers, as well. Women who enter into sobriety while pregnant might have to cope with withdrawal symptoms, intense guilt, and the possibility that their unborn child has birth defects or health problems as a result of drugs or alcohol. Programs for pregnant mothers in recovery focus on providing any drug treatment necessary, therapy, food, and housing. Churches or state run therapeutic groups can referral a woman in this position to the programs in their state.A mother moving into sobriety with a baby or young child(ren) will need comprehensive support in order to maintain her own sobriety while managing the stressors of not only normal parenting, but any emotional damage done during her active addiction. Groups like Alateen can be helpful, as is individual and family therapy with an addiction specialist. It’s worth the time to ask an addiction therapist if they offer a sliding scale or do any pro-bono work -- many do, and if there is not a current spot for you, waiting lists are often available.A mother might not reach out for help with her addiction out of fear that she will lose custody of her child if she admits there is a problem. Anonymous programs such as Alcoholics Anonymous can be a good beginning step for a woman in this position. Every state has different laws as far as child custody and addiction, and each judge can interpret differently, so using Google to research the specifics in a state is a solid way to understand how to approach telling the family about sobriety. An addiction therapist could be helpful here, too, guiding a woman through the language to use, approach to take, and timing of the discussions necessary.If a mother is in a rehabilitation recovery center, she can utilize the supports built-in -- the therapist, group, and case manager are all possible resources for guidance and support through the process of managing custody.Building a strong community of support is the most important factor for a mother in long-term sobriety. This community can be program-based, such as the long-term treatment group run by the addiction recovery center used for initial sobriety, or Alcoholics Anonymous, or spiritually based, such as a local church group, or simply gender-based, in a group of women with children who meet and are committed to supporting each other’s sobriety and lives.It is this community that can be the difference between relapse or not. Feeling isolated or not understood when in crisis can lead to bad decisions, and having a network of support from other mothers who intimately know the challenges of staying sober while raising children (children who might be angry and sad about their mother’s past addictive behavior) can offer empathy, ideas for specific issues that crop up, and a lack of guilt or shaming during the process. Guilt and shame are powerful triggers for relapse and unhealthy emotional patterns, and receiving help and support without those elements is crucial for maintaining sobriety.Community also builds networks of resources, both actual and referred. In a tough spot, a mother in a community can often find someone in that group who can help or has a referral to a person or agency who can help. Community also provides mothers in sobriety with the chance to help the other women in the group, a powerful way to heal self-esteem and remember that we all have something to offer.Learn more about Oceanside Malibu at http://oceansidemalibu.com/. Reach Oceanside Malibu by phone at (866) 738-6550. Find Oceanside Malibu on Facebook. 

Pride Month Special: Alcoholism in the LGBTQ+ Community

When you think of the LGBTQ+ community, what's the first image that comes to mind? Was it an image or a Pride parade or a nightclub? Since we've been a visible community, we've been associated with drugs and alcohol. The namesake of the Stonewall riots, which launched the modern gay rights movement, is a bar in the Greenwich neighborhood of Manhattan. We are associated with the nightlife, and many of us also have a problem with substances. It's a topic that's not often discussed but needs to be brought into the open.Statistics on the LGBTQ Community and AlcoholAlthough society is far more accepting of gays and lesbians than during the preceding decades, it's not that way for everyone. People who identify as lesbian, gay, bisexual, transgender, or questioning often face social stigma, discrimination, harassment and violence not encountered by people who identify as heterosexual. There's also still shame and guilt associated with sexual orientation. Drugs and alcohol provide an easy way to cope with—and forget about— the negative feelings some have about who they are. As a result, LGBTQ people are at increased risk for various behavioral health issues, including substance use disorder (SUD).Data from the 2018 National Survey on Drug Use and Health (NSDUH) suggests people who identify as gay or lesbian are twice as likely as heterosexuals to suffer from alcohol addiction. According to the National Institute on Drug Abuse, gay, lesbian, and bisexual adolescents are 90 percent more likely to use alcohol and drugs than their heterosexual counterparts. The NSDUH also found that LGBTQ adults are more likely to engage in casual, binge and heavy alcohol use than their heterosexual counterparts.In addition to LGBTQ adults, youth community members are also at a significantly higher risk than their straight peers. Almost forty-five percent of LGBTQ individuals between the ages of 18 and 28 reported binge drinking at least once in the past month. Another 10.2 percent engage in heavy alcohol use, defined as binge drinking at least five times in the past month.Although alcohol addiction in the LGBTQ community has gained more awareness in recent years, it's still greatly under-treated.Mental Health and the LGBTQ communityLooking at the data on mental health among LGBTQ-identified people in the U.S., the raw numbers are just staggering.According to a 2020 study by The Trevor Project, 40 percent of LGBTQ youths considered suicide in the last year, and the number jumps to more than 50 percent for trans and nonbinary young people. According to SAGE, the largest and oldest nonprofit dedicated to improving the lives of older LGBTQ adults, 53 percent of older adult LGBTQ people feel isolated and are twice as likely to live alone.The COVID-19 pandemic poured gasoline on an already raging fire. Diseases of despair were at already-high levels in terms of addiction, depression, trauma, anxiety, isolation, and loneliness, but the pandemic only heightened preexisting mental health challenges.My colleague and AspenRidge Recovery's Executive Clinical Director Dianna Sandoval spoke with NBC News earlier this year to discuss the impact of the pandemic on the LGBTQ community."We're already seeing higher levels of mental health challenges in the LGBT community being compounded with isolation," Sandoval said. "Because it's so difficult for folks to connect even to the small communities they've built for themselves, due to social distancing, there's an even greater distance between people in the LGBT community. Some people just don't feel that same sense of connection over Zoom."Now, as vaccination rates climb and businesses reopen at full capacity, there's reason to hope the stresses may be reduced. Still, the fact remains that addiction and mental health are underdiagnosed and treated.And let's be honest—alcohol and drugs can be fun. Night Circuit parties (think raves) are also nothing but dancing, drinks and drugs. Alcohol is an ingrained part of the gay community as well as the larger American culture. It's well known that some people use alcohol and drugs as an escape from reality. When your existence consists of disapproving parents or societal shaming, an escape seems deserved and warranted. But using substances as coping mechanisms is never healthy and can lead down the path to addiction.If you or someone you know struggles with substance abuse, call AspenRidge Recovery at 855.281.5588 today or visit AspenRidgeRecovery.com. One of our client advocates will help you find the best treatment option for your situation, even if it isn't with us. We're experienced in treating members of the LGBTQ community and accept most insurance. We also have virtual outpatient programs accessible in multiple states. To learn more, visit ReachOnlineRecovery.com

About Natalie: A Daughter's Addiction, A Mother's Love

The phone rings. I check the caller ID and realize it is rehab. Natalie has been there for three weeks. My heart skips a beat. I answer.“Mommy?” It is Natalie’s voice. She sounds like she is ten years old. She sounds eager but not desperate, and because of the number, I at least know where she is. In the milliseconds in between the time when I first hear her voice and I greet her back, my mind races with a thousand horrible scenarios that explain this phone call. She is usually permitted to call only at six o’clock on Tuesday and Thursday. It is a Monday afternoon.“What’s wrong, baby?” I ask, wondering if this is a poor choice of words. I have been told, by my children, that it is slightly insulting that this is always my first question, that I assume something must be wrong.“Nothing,” she tells me. This is always how my kids first respond to my initial question whether this is fact or not.“It’s good to hear your voice,” I tell her.“Thanks,” she chirps. “Mommy (I love when she calls me this; she sounds youthful and sweet), I don’t have a lot of time. I’m in my therapy. But I wanted you to do me a favor.”I realize then that the counselor is listening in on the line as well. No worries. I really don’t mind. “Anything,” I tell her and visualize the therapist jotting down the words “supportive mother” on Natalie’s chart and adding a few points to my score.“Could you go up into my room?”“Sure,” I tell her and move from the kitchen toward her bedroom. To fill the time while I am hurrying up the stairs, I ask, “How are you?” even though I’m not sure if small talk is encouraged or permitted during such an obviously purposeful call.“Good,” she tells me, her voice sounding a little weak and thin.“I’m proud of you!” I tell her (more points), a little out of breath. I am out of shape and shouldn’t be. It is only a few steps.“I’m in your room. What do you need?” I cleaned the room from top to bottom while Natalie was gone and had tried to make it warm and welcoming, adding some “mom” touches: a new heart-shaped pillow, a new bulb for the lava lamp, and a “welcome back” sticky note on the mirror. I am pleased with how it looks.“There’s shit in my room,” Natalie tells me through the phone. “Censor yourself; language,” I hear the therapist instruct.“There’s stuff in my room,” Natalie amends. “And I need you to get it out so that it’s not there when I get home.”“Oh, okay,” I say, wanting to cooperate but thinking this is unnecessary.Unfortunately, but not unexpectedly, I had found plenty of “stuff ” in Natalie’s room. Some in plain sight, other stuff hidden. I found and stepped on syringes on the floor. There were pills strewn all over the bottom of the closet and empty stamp bags, spoons, and lighters everywhere—out in the open as well as hidden behind her bed and in her pillowcase. And then there were more of all of the above secretly stashed in purses, backpacks, books, pillows, stuffed animals, and jewelry boxes.“I’ve cleaned pretty well in here, honey,” I tell her. “And I did find some things (an understatement). So, we might be okay.”“We’re not, and you didn’t find it all,” she tells me flatly. “Okay,” I agree, noting that now she sounds older and worn.“I need you to go to the air vent,” she tells me. “Crouch down and pull the metal part off.”“Daddy…” I am about to tell her that Peter and I had checked in there, but I let my voice trail off and don’t finish. Peter had seen on a movie or read somewhere that this was a common place for addicts to hide drugs so we, being “on it” parents, had already looked there. But we hadn’t found anything.Natalie tells me to stretch my arm deeper into the vent, “around the corner and reach,” and I pull out a bag full of syringes and pills.Next, she instructs me to take off Miss Lizzy’s head. Nooo! Not Miss Lizzy! I whine in my head, devastated that Miss Lizzy is involved in all this horribleness. She has always been so innocent. Enough pills to medicate an elephant fall from Miss Lizzy’s pretty blond, smiling head.I need to run back down to the kitchen to retrieve a screwdriver to take off the light switch cover in order to get the stamp bags of heroin out of the crevasses between the wires.“I am proud of you, honey,” I say when Natalie tells me this is all of it.“Natalie, are you sure that’s all of it?” the therapist asks, breaking into the conversation.“It is,” Natalie tells her. The way she says it, I believe her.The therapist announces that the allotted time for this phone call is up. We exchange quick “I love yous,” and the line goes dead.I am sure I have done a poor job of hiding my devastation and the fact that I have aged ten years since we began this phone call ten minutes earlier. I visualize the therapist deducting all of my previously given bonus points and marking “exhausted” and “running out of steam” in the chart. I’m not sure I care anymore. Not at the moment anyway. I think I couldn’t love Natalie more. Which is true and will always continue to be. But I am tired. Exhausted, actually, so I lie down on the bed to rest.Miss Lizzy is in my arms; she and I go way back. I lie there for a few moments, wondering how in the world we ended up in this horrible, godforsaken place. I realize that no matter how long I lie there, I am not going to get any less tired, so I begin to get up.But just before I do, still on my back, I catch a glimpse of something above me in the overhead light fixture. I squint to see what it is but cannot tell for sure. I get up and pull the desk chair to the middle of the room beneath the light. I carefully unscrew the center anchor screw and pull down the glass shield covering the bulbs. When I do, a flurry of stamp packets fall on top of my head.This excerpt is from Christine Pisera Naman’s new book, About Natalie: A Daughter's Addiction. A Mother's Love. Finding Their Way Back to Each Other. Reprinted with permission from Health Communications, Inc. Available at Amazon and elsewhere.

Substance Use, Addiction, and Recovery in the LGBTQ Community

There are many dates that stick right in the mind, for one reason or another. For the LGBTQ+ community in the U.S., and, indeed, across the world, one of those dates would certainly be the anniversary of the “Stonewall Uprising,” a New York City riot resulting from the truncheon-happy local police raiding one of the city’s gay bars, way back on June 28th, 1969 - and the origin of the Pride movement.This historic date is the reason we celebrate Pride Month every year during the month of June.Matthew Shepard (December 1st, 1976 - October 12th, 1998)There’s another date, too - October, 12th, 1998 - a tragic, yet pivotal date, which involved the violent gay-hate murder of 21-year-old Matthew Shepard, a Wyoming student, by other young college students, which led to a national backlash over how the LGBTQ+ community were being treated at that time, and even legislated for.It is still regarded as one of the U.S.’s most famous gay-hate murders.In fact, it was only after lengthy, cross-party wrangling in the U.S. congress over 10 years later that President Obama was finally able to sign the Matthew Shepard Act (2009), a law which defined certain attacks motivated by victim identity as hate crimes.No such law existed prior to this Act. The men who dealt out the horrific beating (and it was horrific - Matthew was tied to a fence-post, and pistol-whipped so hard it crushed his brain stem) that led to the young gay man’s death were convicted of first-degree murder, and rightly each given a life sentence.However, they were not charged with a hate crime, as, in 1998 Wyoming, no such law actually existed, regardless of how obvious the link had been in countless, previous gay-hate murders.Fortunately, some things have changed. However, sadly, some other things have remained exactly the same.Did you know that young gay and transgender individuals, despite tremendous progress in the past couple of decades, are still twice as likely to suffer with a mental health disorder or a drug addiction or both as their heterosexual peers?In this article, we’ll look at why the LGBTQ+ community is at an increased risk of both mental health and substance use issues, the U.S. statistics that support this, the important questions you need to ask when finding professional and affirming treatment for your LGBTQ+ child, and what resources are available to support them in their recovery from substance addiction.It’s 2021, but in many ways, society still has a lot of work to do to make itself as inclusive as it purports to be.The LGBTQ+ Community and Increased Substance Abuse RiskAs the LGBTQ+ community and its allies celebrate Pride Month 2021, this year with a mix of in-person and virtual events to avidly raise awareness about the issues of being LGBTQ+ in today’s America and beyond, the fact remains that those who identify in this way have always been far more at risk of a mental health disorder, a substance use disorder (SUD), or a combination of both, known as “co-occurring disorder” or “dual diagnosis,” and, even now in 2021, they continue to be.In this respect, nothing’s changed.Using data from the annual National Survey on Drug Use and Health (NSDUH), an October 2016 report by the Substance Abuse and Mental Health Services Administration (SAMHSA) was actually the first to identify the extent of substance abuse and addiction among LGBTQ+ people.The latest SAMHSA: LGBTQ+ report, published in 2020 and based on data from the 2019 NSDUH survey, has similar findings, namely:Adults who identify as lesbian, gay or bisexual (LGB) have higher rates of substance use and mental health illness than heterosexual adultsSerious mental illness among the LGB population - ages 18-25 and 26-49 - has significantly increased compared to 2016Major depressive episodes with severe impairment among all LGB men and women, aged 18-25, has significantly increased compared to previous yearsSubstance use disorder (SUD) significantly increased the probability of suicide among those within the LGB population aged 18 and olderThe transgender community experienced an even higher risk of substance use than the rest of LGBTQ+ community“One of the biggest things I struggle with… is accepting myself, honestly. This society does not cater to me or to people like me, so I’m always in a constant battle of validating my own identity while having society tell me to throw it away.”- Alora Lemalu, LGBTQ+ activist and artist, from Springfield, MissouriWhy Is the Substance Use Risk in the LGBTQ+ Community Significantly Higher?The primary reason for this increased risk is “Minority Stress Theory.” This states that, as one of society’s minorities, there are intrinsic yet inescapable elements simply by being the member of a minority, such as greater discrimination and more stigma.“When you are a person who is under chronic stress, that chronic stress results in negative health outcomes. The mind and body may react in multiple ways, and substance abuse is one of those ways.”- Jeremy Goldbach, PhD, LMSW, professor, School of Social Work, University of Southern CaliforniaAdditionally, LGBTQ+ youth face fundamental and unique issues, such as:HomophobiaHarassment (both physical and mental, in-person and online)Lack of family supportFamily ejectionHomelessnessMany of these young people, unsurprisingly, will use and abuse substances just like their peers do, in an attempt to deal with this hostility. Furthermore, common meeting places for the LGBT community tend to be bars and clubs - environments where it is far easier to access substances like alcohol and illicit drugs.U.S. LGBTQ+ Community and Mental Health: Facts and StatisticsIn terms of their mental health, for LGBTQ+ people, the story remains the same. For LGBTQ+ youth, the increased risk of mental health disorders mirrors their increased risk of substance use and addiction. Additionally, these young people are more likely to engage in “polydrug use” - mixing substances to magnify the resulting high and other effects.In doing so, these youth are also magnifying their risk of a fatal drug overdose.The most recent survey regarding mental health within the LGBTQ+ community was undertaken by The Trevor Project, with their “2021 National Survey on LGBTQ Youth Mental Health.” The Trevor Project is the world’s largest suicide prevention and crisis intervention organization for lesbian, gay, bisexual, transgender, queer & questioning (LGBTQ) young people, and the survey they conducted represents the experiences of nearly 35,000 LGBTQ youth (aged 13-24) across the U.S.Following their detailed analysis of the collected data, their expansive report on LGBTQ youth mental health emphasizes the need for greater investment in mental health care and new policy solutions to deal with LGBTQ suicide. The survey’s various findings include:42% of LGBTQ youth, including more than half of transgender and nonbinary youth, seriously considered attempting suicide in the past year; however, nearly half of these could not access the mental health care they neededAn overwhelming majority of LGBTQ youth also reported recent symptoms of generalized anxiety disorder or major depressive disorderMore than 80% of LGBTQ youth stated that the COVID-19 pandemic had made their living situation more stressful70% stated that their mental health was “poor” either “most of the time” or “always” during the pandemicNearly 40% of LGBTQ youth who had a job reported that they lost it during the pandemic30% of LGBTQ youth reported having trouble affording enough food in the past month, including half of all Native/Indigenous LGBTQ youth, and more than 1 in 3 Black and Latinx LGBTQ youth75% of LGBTQ youth reported that they had experienced discrimination based on their sexual orientation or gender identity at least once in their lifetime, and more than half said they experienced this discrimination in the past yearThe survey also discovered the immensely negative impact of LGBTQ youth being forced to undertake controversial “conversion therapy”:Those who were subjected to conversion therapy reported more than twice the rate of attempting suicide in the past year compared to those who were not13% of LGBTQ youth reported being subjected to conversion therapy, including 21% of Native/Indigenous LGBTQ youth and 14% of Latinx LGBTQ youthTransgender and nonbinary youth reported being subjected to conversion therapy at twice the rate of cisgender LGBQ youth (cisgender is defined as a sense of personal identity and gender that corresponds with an individual’s birth sex)LGBTQ youth who reported being subjected to conversion therapy were, on average, only 15 years old at the time, with 83% reporting that it occurred when they were younger than 18“Conversion therapy” (also known as "reparative therapy" or "gay cure therapy") is an attempt to change someone's sexual orientation or gender identity. Many U.S. states and other countries, such as Canada, Germany and Mexico, have banned (or are currently in the process of banning) the so-called “therapy,” due to its hugely negative impacts, eg. suicide, depression, and anxiety.“The past year has been incredibly difficult for so many LGBTQ young people because of multiple crises, from the COVID-19 pandemic to the hostile political climate and repeated acts of racist and transphobic violence… LGBTQ youth face unique mental health challenges and continue to experience disparities in access to affirming care, family rejection, and discrimination.”- Amit Paley, CEO & Executive Director, The Trevor ProjectLGBTQ+ Teenage Addiction Treatment: 9 Important QuestionsWhen your child is suffering with a substance use disorder, or a co-occurring disorder, it can make your child and you extremely stressed, and even fearful. The natural temptation would be to grab the first offer of help that comes along. Please, don’t do that. It’s vital you take the time to ask the right kind of questions first.It’s important for you, as their parent or guardian, to understand that not all addiction treatment programs are the same. Unfortunately, LGBTQ patients, and especially transgender patients, have high than average rates of walking out of their treatment, and causes for this can range from a lack of support, therapists who don’t understand, inadequate facilities, disrespectful staff, to unresolved bullying by other patients.So before you sign on the dotted line of the first addiction treatment patient form place in front of you, ensure you ask these important questions of the addiction treatment facility:Do you have any LGBTQ-identified clinicians, counselors, or other support staff?Discussing personal issues and experiences with a counselor can be difficult for most people. However, these discussions are critical in successful addiction recovery. Obviously, a counselor who has experienced similar attitudes and issues will be able to earn the trust of their LGBTQ+ patient far quicker. Be sure to find out if rehab staff are LGBTQ+ themselves, or at least have stated they’re happy to work with members of the community.What LGBTQ certifications / training does your staff have to treat my child’s needs?LGBTQ+-related certifications and training are no guarantee of a perfect program of treatment, but it shows these staff are knowledgeable about identity and gender experience.How will your program make my child feel welcome and included?It’s vital that your child feels welcome, safe and content within an addiction treatment setting. Additionally, it is important that confidentiality is given a high priority, especially with information about sexual orientation or gender identity.Does your program offer specialized groups for LGBTQ people?Research has consistently highlighted that addiction treatment programs with groups specifically for LGBTQ+ patients have far better outcomes and success rates. Effective therapies for LGBTQ+ individuals include motivational interviewing, social support therapy, contingency management, and cognitive behavioral therapy (CBT). Ask if these are available as standard within the program.How does the treatment program address trauma, self-harm, depression or other mental health issues?It is well known that many LGBTQ people who enter addiction treatment suffer with a co-occurring disorder, meaning they have also been diagnosed with a mental health disorder. If this type of disorder applies to your child, make sure that any treatment program you are considering offers co-occurring treatment, and will treat both conditions simultaneously.How will you address the special needs my child has due to their identity?Asking questions about the LGBTQ-specific needs of your child is to ensure as best as you can that they have the best possible chance of success in their recovery. Is the vocabulary prospective counselors are using respectful, up-to-date and informed?Furthermore, will hormonal therapy be adequately managed if your trans child is in residential treatment? How does the treatment facility address HIV, STDs, hepatitis and other health issues if they need to? Obviously, stay away from any programs offering “Conversion Therapy.”What has the provider’s experience been with treating LGBTQ people like my child?Treatment providers should be able to tell you about how they have served your child’s population previously. For example, you can ask how the recovery program has helped other LGBTQ patients in the past. Did those patients complete the program? How successful were those programs?What are the bathroom and sleeping arrangements?If your child is transgender, ask if the treatment facility has co-ed bathrooms, showers and sleeping areas. Will they share a room with people who share their gender expression? Asking for a private room and bathroom can be an option, where possible.How familiar is the program with LGBTQ resources in your community for your child’s continuing care plan?On completion of the program, your child may move to a lower level of care. Understanding your child’s needs from this point on is important. Be confident that any “Relapse Prevention Plan” provided by the treatment facility addresses all of your child’s needs from this point onwards.LGBTQ+ Addiction Recovery Support & ResourcesThe LGBTQ community has many addiction recovery support organizations, programs and groups that can access to help your child, other family members and yourself, such as:PFLAGFamily Acceptance ProjectChild Welfare Information GatewayNational Network of LGBTQ Family GroupsNALGAP: National Association of Lesbian, Gay, Bisexual, Transgender Addiction Professionals and Their AlliesAlcoholics Anonymous (special meetings for LGBTQ+ people)