Of Mice and Men–or Part of the Difficulty of Working With SUDs

There are a lot of exceptional programs for people with SUDs—substance use disorders—with great people running them.  There are tons of great parents, really caring school administrators and counselors, solid people handling probation and diversion cases, and on and on—please take in this post knowing that while I have thoughts and critiques for the process, I don’t hold myself above anyone struggling with the complex challenge of supporting individuals with SUDs.  -JH

In my experiences, working with individuals using or misusing substances can take on the feel of a “cat and mouse” game.  The cat is whatever authority is in the picture—a parent, teacher or school administrator, law enforcement, SUD counselor, et al.  The mouse is the person using.  I have worked with adults mandated by court to stay away from all illegal substances.  I’ve also worked with teens whose parents had drawn a zero tolerance line in the home that the teens were struggling with.  These teens were often suspended or expelled from school (or close to it), had legal citations and were sent to a juvenile diversion program, required to enter a rehab program, etc.

In many of those cases, part of the problem was the cat and mouse feel that the case had taken on.

Consider the cat waiting at a little hole in the baseboard of the house, pawing at the opening and trying to catch the mouse hiding inside.  If you’re old enough you can picture Tom and Jerry, the cartoon I watched when I was little.  Jerry the mouse constantly eluded Tom the cat by running, hiding, or fighting back (usually in some ultra-violent way—ah the old cartoons!), and Tom relentlessly pursued the mouse, often getting hurt in the process.

Teens and adults caught under the paw of authority are usually straining to escape.  The probationer or parolee just wants to “get off paper”—out of the system and the watchful eye of the law enforcement that’s ensnared them.  The teen attending expulsion school just wants to get back to their regular school and friends.  The young adult at home wants their parents to stop nagging them and let them make their own decisions about using marijuana, or pills, or whatever other substance and behavior of their choice.  The teen in a program is often just dying to get out of the program.  It’s true that some take whatever opportunity they’ve been given forced into, to make some needed changes and improvements, but this dynamic is real and problematic.

One of the only ways that the authority in the picture can know for sure that the individual is complying with home/school/program expectations is to use urinary analysis—UAs, or your basic drug screen.  A UA kit can be purchased over the counter from most pharmacies for home use, and many SUD programs require regular and randomized UAs to monitor compliance from the individual.

There are some common pros and cons to the UA/compliance model.  The pros include knowing that someone has refrained from using substances X, Y, and Z for X amount of time, regaining a sense of control over an out-of-control situation, trusting someone when they claim to be “clean” or identifying when they have been deceitful about their use.  The cons include an individual feeling more trapped and monitored, without control over their decisions, resentful and angry, or another popular strategy:  finding new ways to avoid detection of illicit substances in their urine.  They flush their system by drinking gallons of water, buy cleansing systems from their local head shop or an online source, use someone else’s clean urine, use designer drugs that are still undetectable to common UAs, and a whole litany of other methods I won’t go into great detail on here.

The bottom line is that often, the cat and mouse dynamic only intensifies–at least at the start of treatment.  The drug testing locations monitor the actual urination to make sure the individual is the one providing the urine, intensifying the resentment over being more closely monitored.  The authority in the picture considers any sample that is diluted by those gallons of water to be a positive result, even if that individual hadn’t actually used.  Timeframe goals (e.g., provide 2 months of clean UA results to regain the trust of the parent/school/judge/diversion counselor) are reset to zero, and eventually the individual can feel like they are at the bottom of a deep pit with walls too slippery to climb out of.

A sense of futility sets in.  The authority tires of constantly watching the mouse hole.  The individual tires of constantly losing and trying to regain the trust of the authority, who is really just a great big paw holding them down anyway.  People I’ve worked with have often come down with a severe case of the “forget-its.”  Except the phrase isn’t “forget it,” but a similar F-word phrase I’ll not write here but I’m guessing you know, regardless.  FORGET THIS! they exclaim.  FORGET YOU, and the SCHOOL, and my BOSSES, and the PROGRAM, and the JUDGE, and my PROBATION OFFICER, or the DIVERSION COUNSELOR—FORGET YOU ALL!!

Deep breaths.  Although this is a common dynamic in working with SUDs, it is one we can break out of.  A kid and their family can find common hopes and goals—the success of the system in the home, graduation from high school, holding a job and saving money to move out, etc.  An individual can decide that their job or their family or their relationships are too important to endanger any longer.  The authority in the picture can learn to “roll with resistance” better while still drawing and maintaining reasonable boundaries.  It’s possible to use UAs to demonstrate and celebrate success and gain trust, instead of catching and punishing someone with harsher penalties for their noncompliance, or booting them out of whatever program they are in.  We can view setbacks as the natural and expected process of recovery, and learn from them while still keeping on our upward trajectory—two steps forward and one step back is still one step forward!

graph progressStill going up, right?

Finally, we can have grace with each other in difficult situations, recognize the humanity in the cat and in the mouse, and never treat people—moms and sons, fathers and daughters, counselors and clients—like cats and mice again.  We can toss a new and smarter and stronger lifeline to the person at the bottom of the slippery-walled pit, as everyone steadily pulls up and out.  Hope is a hard thing to have in some of the situations I’ve described in this post.  But it isn’t cliché to say that hope is the thing we need to protect the most.  And sometimes in my practice, I can only start by saying, “I see you.  I get it that you’re low on hope.  Your motivation is at or near zero.  I have some for you, and I’ll share it until you find yours again.”


The Search for All the Little Lights

What’s black and white and red all over?  (Feel free to give your best joke answers in the comments).  It could be a newspaper (maybe the oldest version of this?), or a sunburned penguin, or…my Facebook page, in a few key ways.  Same as a newspaper, the words are the black and white.  The red could be the blood from countless little battles I have on my page–mostly with those who disagree with me, politically or in matters of faith.  But it is also “read” all over, and over, and over again, obsessively.  I read my damn FB page daily, usually soon after I awaken in the a.m., throughout the day if there is some especially big discussion going on, and at night as I lay there wishing I could just fall asleep.

I’m not going to write today about online addiction, although I guess this is related.  It’s more a confession and a question–requiring some vulnerability from both of us.  I confess that social media is sorta kinda sometimes my best friend, and I wonder if it is yours?  And how does that affect you and your moods?  As a widower, it might be easier for me than my partnered-up friends to use Facebook as my best social outlet.  I would like to wake up, groggy and wiping the sleep out of my eyes and a little grouchy, but feeling good to be alive next to someone I love.  Instead, while I hear my kids’ alarms go off across the hall, I lie there alone thinking about what’s to come that day.  I think about what I wrote the night before on this or that FB thread about White Supremacists and Antifa, our current vs. past presidents, the occasional nice convo about someone’s cool vacation or otherwise nice-not provocative post, or my personal favorite little voodoo doll to constantly prick with pins: political and religious hypocrisy. 

As a matter of fact, I think about the day to come in terms of what I might say to this or that dumbf  person who responds to my last provocative post.  Confession:  I want them on my FB wall, I need them on that wall.  Otherwise I miss human interaction that I dearly need.  Deep down, in places I don’t talk about at parties, I want a good fight and a good pat on the back from my allies when it’s over.  It is my sometimes substitute for love–or loving relationship with people IRL.

Don’t pity, and don’t trip here.  Me and mine are doing fine, I do in fact have real friends, and ultimately this is less about me and more about illustrating some valuable points.  I have my kids, who are always bright lights in my sometimes dark harbor.  And my light still burns, too, if dimmer or a little sadder and angrier than in my more carefree 30s (see: widowhood).  What I know I need but often fail to access is real people to touch and hug and open myself to and laugh and cry with.

About 2 years back, I was more depressed than I was admitting to others.  Some life events had put me very low.  I remember taking a road trip from Denver, through Las Vegas where I grew up, to Los Angeles to see old friends, and back again.  Somewhere along the way I read (on Facebook, so it’s not all silly arguments!) an intriguing article about a depression study that examined mood and social interactions.  It put 2 groups to a different task:  the first group had to go into various stores and run errands throughout the day–strictly without social interaction.  Just get in, buy your gallon of milk, and get out as if always in a rush, not even making eye contact with the person at checkout.  The second group was instructed to make small talk with everyone they ran across–grocery clerks, strangers holding the door for you, whoever crossed their paths.

The first group reported feeling more sad, pessimistic, anxious, and angry with others, and many couldn’t even make it through the whole study acting as instructed–they gave up after day 1 and had to get back to some kind of social interaction, even if just saying “fine, thanks” when a cashier asked how their shopping went.  The second group reported feeling happier.  More energetic, and more optimistic about their lives than before.

So you maybe see where this is going.  I went into a Trader Joe’s in Las Vegas, to get some road snacks with my kids.  I had been really dragging ass, depressed but putting on my smile mask, so I decided to look at and talk to more people.  I did not like the idea; cheerfulness felt fake and dumb, and I hate inauthenticity.  TJ’s is a pretty friendly place.  The guy at the checkout counter asked how I was doing.

“Hi!  How ya doin’ today?” he asked.  He had a big dumb young person-optimistic about life grin on his face, and seemed about 22 years-old, tops.  I looked him in the eye for a second longer than usual, and then I punched him right in his stupid grinning mout said something nice back.  Or as nice as I could muster.

“Doing all right I guess,” I said.

“Huh!  Just all right?”

I sort of mumbled a “Yeah, I’m gettin’ through…” which is what I say a lot.  TBH, it’s shorthand for, “yeah, life is hard as effing hell and sometimes I’m like oh God if you’re even there take me now, but I’m up and moving and trying to have a good day, so let’s just say I’m getting through…”

He goes, “Ahhh, with 2 beautiful children like these?  So much to be thankful for, yes??”  The bright joy in his voice felt…nice.  I actually felt envied for my fun-looking life by this guy.

“I suppose so,” I said and smiled bigger and not fake.  We talked about good things in life while he bagged my banana chips and smoky peach salsa.  Whatever else we said I forget specifics.  We walked out to the car, I took funny pictures of my kids with Trader Joe’s stickers on their faces, and we got on the road to L.A.  I felt really good.  A little social interaction, a little reminder of my humanity and the little lights.  Much better than an argument on Facebook with my friend’s husband’s brother’s cousin on the east coast.

“All the Little Lights” is a good song I come back to fairly often–it’s a sad but to me, hopeful song by Passenger (in case you’re wondering, he’s the guy who sings that also super sad one about how you only need the light when it’s burning low, only know your lover when you let her go…).  It makes me think of Steinbeck’s The Winter of Our Discontent, a favorite book that is ultimately about keeping the light alive, or Cormac McCarthy’s recurring theme of carrying the fire in The Road, or No Country For Old Men.  The cashier guy had a little light that he shared with me–bless his soul.  I highly recommend any of these songs or books–more so I recommend making the effort (if you’re the anxious and/or depressed type who finds it difficult) of talking with real people more during your normal day–and glad to give suggestions for others (and hear suggestions below).  Things that help your light burn brighter.  The search is hard, the struggle is real.

With social media I have to look for fire carriers, and lights in the harbor.  I have some–precious to me, and I like finding more.  Like many of us, I have to check myself when I get too caught up in the obsessiveness of social media, and remind myself that it is not everything.  I also have to open myself to others IRL, even the littlest hellos and fine thanks, how are yous at the store or pick-up time at my kids’ school, or neighbors at the park walking their dogs.  I find that if I don’t, then I’m left itching more for something weaker than the real thing–the release that comes from venting at strangers on FB, the virtual pat on the back I feel when a friend “likes” an eloquent putdown on a comments thread.

So. Hashtag social media, depression, human touch, little things matter, carrying the fire, little lights going out if we’re not careful, Colonel Jessup on that wall, Passenger, Steinbeck, McCarthy, good support from good therapy… I carry the fire still; my light-bearers give me reason and hope.  And I search for more, and I take joy in supporting others in the same brave enterprise.  One of my favorite things to tell depressed clients in my practice has been, “I see you there. I see you trying, and it hasn’t been working.  Your hope is now small, but I will have hope when you don’t.  Let’s build it back up together”

spicysmokypeachsalsa*this is the best salsa.

Thoughts on life and growth.

The reason I call this new thing Wildflower Counseling Services is I believe that people can grow in any circumstances, even the hardest and harshest.  So imagine you’re a flower.  Or a tree.  I like thinking of myself as an evergreen–like a pine tree high atop Mt. Charleston, outside of Las Vegas, where I grew up.  Whatever you like to picture yourself as, think of the many things you’d need to thrive–sun, rain, soil, nutrients, and the occasional weeding out of harmful elements.

When you can picture yourself like this it is easy to draw parallels to your own life.  What soil have you grown in?  What nutrients or sun and rain might you be missing?  What nasty weeds or harsh conditions have hampered your growth?  What substances, habits, or people have you relied on for getting through that you realize have become more harmful than helpful?

When we look at our lives with a growth mindset–that no circumstances or environment can ever fully hinder our own development, and we can determine our own path to a new, better way of living, then we are free to become who we were always supposed to be.

Who are you meant to be?  What has hindered your growth?  Grief and loss from death, divorce, or other major life events can knock us on our asses sometimes.  Slipping into dependence on substances, habits, or relationships can postpone our development, or set us back farther than we ever imagined.

But nothing–not rain and hail or weeds or concrete and asphalt–can ever fully hinder our ability to grow and even thrive.  If we find the right support, the right sun and rain and love and care.

I’m a widower.  I’m a child of divorce.  I have known brokenness in my family.  I am more than acquainted with confusion and disillusionment–even in a faith tradition that once was a comfort–and I know that substances do not fill the void or mend the cracks.  I understand depression and anxiety more than I really care to, and I know what it is to wake up and not know how to get up and out of bed and moving through the day–even though you must, even though others depend on you.  I know substances provide a brief respite from pain, but in the end harm far more than they help.  I have worked with all sorts of people on the edge of something–homelessness or runaway, incarceration or unemployment, addiction and dependence, or just plain losing your shit over the accumulation of life’s daily challenges.

The good news here is that in addition to being a licensed therapist and an experienced addictions counselor, I’m also stronger for these experiences, wiser from the journey.  It would be an honor to walk alongside you on yours, and help you find a way through.