Why care for addicts?

I posted this in November, 2015. I am reposting it.

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Why care for addicts?

Children. If we do addiction medicine and help and treat addicts, we are helping children and their parents and our elderly patients’ children. We are helping families, and that is why I chose Family Practice as my specialty.

Stop thinking of addiction as the evil person who chooses to buy drugs instead of paying their bills. Instead, think of it as a disease where the drug takes over. Essentially, we have trouble with addicts because they lie about using drugs. But I think of it as the drug takes over: when the addict is out of control, the drug has control. The drug is not just lying to the doctor, the spouse, the parents, the family, the police: the drug is lying to the patient too.

The drug says: just a little. You feel so sick. You will feel so much better. Just a tiny bit and you can stop then. No one will know. You are smart. You can do it. You have control. You can just use a tiny bit, just today and then you can stop. They say they are helping you, but they aren’t. Look how horrible you feel! And you need to get the shopping done and you can’t because you are so sick…. just a little. I won’t hurt you. I am your best friend.

I think of drug and alcohol addiction as a loss of boundaries and a loss of control. I treat opiate overuse patients and I explain: you are here to be treated because you have lost your boundaries with this drug. Therefore it is my job to help you rebuild those boundaries. We both know that if the drug takes control, it will lie. So I have to do urine drug tests and hold you to your appointments and refuse to alter MY boundaries to help keep you safe. If the drug is taking over, I will have you come for more frequent visits. You have to keep your part of the contract: going to AA, to NA, to your treatment group, giving urine specimens. These things rebuild your internal boundaries. Meanwhile you and I and drug treatment are the external boundaries. If that fails, I will offer to help you go to inpatient treatment. Some people refuse and go back to the drug. I feel sad but I hope that they will have another chance. Some people die from the drug and are lost.

Addiction is a family illness. The loved one is controlled by the drug and lies. The family WANTS to believe their loved one and often the family “enables” by helping the loved one cover up the illness. Telling the boss that the loved one is sick, procuring them alcohol or giving them their pills, telling the children and the grandparents that everything is ok. Everything is NOT ok and the children are frightened. One parent behaves horribly when they are high or drunk and the other parent is anxious, distracted, stressed and denies the problem. Or BOTH are using and imagine if you are a child in that. Terror and confusion.

Children from addiction homes are more likely to be addicts themselves or marry addicts. They have grown up in confusing lonely dysfunction and exactly how are they supposed to learn to act “normally” or to heal themselves? The parents may have covered well enough that the community tells them how wonderful their father was or how charming their mother was at the funeral. What does the adult child say to that, if they have memories of terror and horror? The children learn to numb the feelings in order to survive the household and they learn to keep their mouths shut: it’s safer. It is very hard to unlearn as an adult.

I have people with opiate overuse syndrome who come to see me with their children. I have drawings by children that have a doctor and a nurse and the words “heroes” underneath and “thank you”. I  have had a young pregnant patient thank me for doing a urine drug screen as routine early in pregnancy. “My friend used meth the whole pregnancy and they never checked,” she said, “Now her baby is messed up.”

Addiction medicine is complicated because we think people should tell the truth. But it is a disease precisely because it’s the loss of control and loss of boundaries that cause the lying. We should be angry at the drug, not the person: love the person and help them change their behavior. We need to stop stigmatizing and demeaning addiction and help people. For them, for their families, for their children and for ourselves.

you know you are hypoxic when

…..I keep thinking of new ways to nearly strangle myself. I keep thinking that I have hung up the oxygen tubing on every possible thing I could hang it up on. But no, this was a new one. At least with this one I did not lock my car keys in the car. And even if I did, I can take the nasal cannula off. There is that moment of panic: AUGH I AM TRAPPED, but I am not really.

Today’s blog is especially for B who is not trapped.

Have a wonderful Saturday.

the virtue of the disconnect

the virtue of the disconnect
learnt early
as a child

they say we are broken
wired wrong
enduring horror

he wakes at night
sleeps lightly

what was your childhood like?
how did you sleep?

it was not safe
we had to get up
leave in the night
gunshots

you survived your childhood

yes, I did

sleeping lightly saved you

yes, it did

you could rewire that
it takes a lot of time
to change the childhood wiring

or you could just
be ok

with sleeping lightly

dream about privilege, access, and water

For the Ragtag Daily Prompt: dream.

I dream in technicolor with smells, sensations, sounds, all senses. So much so that sometimes I worry about what is happening in the dream and what I should do about it. Then I realize it is a dream.

Other times I know right away that it’s a dream. This one I knew was a dream and it’s closely connected to our reality.

This dream is from August 2018.

I am in a library. There is an archive. I am not allowed in the archive.

There is a man. He listens to me sometimes, but mostly he prefers that I listen to him. He listens less and less as time goes on. He is interested in certain topics, but he likes to do the talking. He doesn’t like or agree with my opinions and prefers that I am silent.

A woman arrives. She is very powerful. Dressed in white, robes, goddess like. She is as tall as the man. They talk and he goes into the archives with her. I am jealous and resigned. Not sexually, but I am just resigned to males coming first, more of them have access to the archives, they expect the attention first, they are rewarded for speaking up where I would be punished for the same behavior. I am sick of it.

I have a question for the woman. I wait. I am sitting on a tall stool with a long desk. There are two chairs to my left, empty, and people in the chairs to my right. There is a carved wooden screen walling the other side of the desk off: on the other side are the archives.

I have water. The water is in a bowl. It is to drink and is nourishing and refreshing and it is beautiful too, with herbs and an island of moss in the center. I have drunk enough, and wash my hands in the remaining water.

They come out of the archive. The woman sits by me and the man next to her. I ask my question when there is an opening. She is interested and will take me into the archives. The man is not interested in my questions, as usual, and he leaves. The woman asks for some of the water. I explain that I have washed my hands in it. More people are coming to talk to her. She pours some into her bowl. I am afraid she will be distracted by the people and drink it. I go to get her clean water. I need a pitcher. There is a wall of glass front cupboards with many sizes and shapes of glasses. I get down a large one, but it is very ornate and delicate. I want a plain pitcher but I also want to bring her the water right away. I hesitate, looking for something large and plain.

I wake up.




sky

For the Ragtag Daily Prompt: slapdash. I can’t think of a photograph of something I want to call slapdash. It feels judgemental today, unless it’s something of mine, and that feels vulnerable. And then I start thinking about the sky…..

sky

Is this a careless sky?

Were the angels in a hurry when they painted it?

Did the clouds come out as heaven wanted?

There is nothing slapdash about the sky.

admit deny

For mindlovemisery’s prompt: opposing forces. The prompts are admit/deny and presence/absence.

The pairs bring up my current sadness right away. I am struggling with the realization that we have a pervasive legal substance that works at the opiate receptor, is all over the US, and I have to send out urine tests for ALL of my chronic pain and opiate overuse and anyone on any controlled substance. You say, “but it’s legal”. I say, “Overdose and death risk. I can’t ignore it.” Here is the resulting poem.

admit deny

admit to yourself you deny your addiction
the presence of the drug means the absence of the one I love

 

Container dream

I dream I am at a concert in a park. Or some very big event. With my significant other. It is a beautiful day, the sun is shining, the grass is green, there are rolling hills and trees. People are arriving.

There is a gasp of horror. There is a large box, like the hold of a ship. We hurry to look in: there are three open containers down inside, tops removed. They are full of children. Smuggled? Immigrants? The containers are surrounded by water. My significant other and I drop our things and climb down the long hold ladder into the water, which is cold, filthy, and comes up to my thighs. I’ve kicked off my sandals. We are wading to the containers. An ICE agent in a black uniform, bullet proof vest, belt with tools and guns, and riot helmet, blocks me and says, “You have to be wearing shoes to help.” He is handing out plastic stretchers. He can’t see my feet. Yes, I know it’s dangerous and my feet could get cut, but this is probably sewage and dangerous even with shoes. We should really be in hazmat gear but the kids could be dying. I just look at him, silent, and he hands me a stretcher.

Enough people have come forward, into the water, that all the kids have been placed in one of the containers. None of them are dead. They are being lifted out one by one, to ambulances. Now the hold is surrounded by rubberneckers. I climb out and find my purse and camera and shoes. I am grateful no opportunist has stolen them. The ICE agents are telling people to back off and give them room to work. The news crews are there and a Washington State politician says, “This is Washington State, we will take care of these children, we will not see them separated and incarcerated, I will see that they are returned to their parents.” Good luck, I think, but at least there are tons of witnesses and cameras and news crews.

I need to find somewhere to scrub my legs down with soap and to find my significant other. It’s getting more crowded.

I wake up.

And what I notice is that the water did not stink and was not full of lumps of floating excrement. As I wake I hope that I won’t catch something horrible and die….usually my dreams have full sound, color and smells too. I wonder where the children were from, and why, and whether they had some sort of sanitation….

separation

This is one of the most beautiful and saddest photographs I have taken. It is my sister, about a month before she died of cancer. And her daughter, who was 13.

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On the last visit to my sister, she was in kidney failure, dying. We had conversations that were surreal. All I wanted was to stay with her.

One day a friend of hers, another mother and I, were working to make her more comfortable.

“I am sad!” my sister said, and started crying.

“Why are you sad?” I said, “What are you sad about?”

“I won’t be there! I won’t be there when she graduates from high school! I won’t be there for her first date! I won’t be there when she gets married! I don’t want to die!”

By now we are all crying. “You will be there!” I say. I am certain. “You won’t be in this form. You will be in another form!”

“I will?” my sister said, crying.

“Yes.” I said, crying too. “You have to go. You have to transform. You can’t stay. But you will be there for her.”

We cried and held her.

And I know for certain that she is there, she is here, she is with her daughter as her daughter graduates from high school, goes on a date, does all the things that daughters do.

Now and forever.

And the living children must be returned to the living parents. We cannot do otherwise and call ourselves humans.

 

mother and child

I have a collection of parent and children pictures and sculptures. This is one. A mother ox and her baby. I was born in the Chinese Year of the Ox and so was my daughter. This little sculpture is about 3 by 2 inches, but both my daughter and I love it.

I am so proud of everyone who stood up for children yesterday, and for everyone who is saying, if it was MY child, I would want someone to stand up for them and for me.

Blessing and bring the children back to their parents.