Scott was 16 when I had started treating him at first. He was a sophomore in high school and I was still newer in my chosen field of professional counseling, facilitating an adolescent outpatient group, treating substance use disorders. He, like many of his contemporaries, had not voluntarily sought out treatment, rather having been identified as a high risk youth by a school based counselor. He has been sighted taking a pill during a school assembly. A quick call down to the principal’s office and a policy mandated urine drug screening later and - congratulations, “We believe your child may have a problem with Oxy.”
Oxy, short for Oxycontin or Oxycodone among a myriad of other nicknames, as an opioid prescription pain medication. While now there are ongoing conversations about the regulation and oversight of these prescriptions, with many federal and state-level laws enacted to monitor the prescription and use of these opioid medications, there was a time when getting oral surgery or an appendectomy could score a person a 90 pill bottle of these bad-boys, with the possibility of a refill.
Scott had commenced an Adolescent Intensive Outpatient Program, being treated for Opioid Abuse (now termed Opioid Use Disorder, Mild). He lived in a rural area with his father and two older brothers, his mother having passed several years prior of pancreatic cancer. We later learned that this cancer was fueled by what appeared to be a considerable alcohol habit. He was 12 years old when she had passed. His father, a blue collar laborer, was left to manage the fallout and quickly adapt to being a single parent of three adolescent boys. By time Scott entered into our group room and we had a chance to experience him in a safe, supportive setting, it became clear that he was emotionally inhibited, a likely sign of not having worked through the grief and trauma of losing his mother. Moreover, watching her die in the hospice bed in his family room.
Outwardly, Scott did well within the group setting. He consistently attended, performed the tasks assigned in therapy, and was assessed as being able to abstain through consistent negative urine drug screening. He was eventually seen to invest in the group process, offering thoughts and feedback to others when sharing insights on their own therapeutic tasks. We later had a new member join the group. One who had lost his father to an accidental house fire. As this new member cautiously answered questions of his peers, a routine ritual the group had developed to get to know newcomers, Scott was seen remaining silent, with a somewhat distant look in his eyes, and a single tear running down his cheek.
Complex trauma, although not a predictor, can be a common consideration for those being treated with substance use disorders. The research leading to the development of the Adverse Childhood Experiences (ACEs) demonstrates that people who have more specific traumatic events occur during childhood are at greater risk for developing mental health conditions, substance use disorders, and medical conditions. Perhaps the most notable consequence, a shortened life expectancy. For a variety of reasons, Scott was at risk…
Although he was not receptive to efforts to process emotions surrounding his mother, Scott was open to voicing frustrations with other components of family life, some relational patterns between him and his father being on display in the family group component of treatment. The friction between him, his father, and brother was palatable. The family struggled to talk about the hard issues head on; The loss of their matriarch was viewed as a tough fact of life and Scott’s substance use was viewed as a selfish act of “kids just being kids.” Scott eventually completed treatment and despite recommendations to continue counseling with a private therapist, both he and his father did not seem particularly invested in continuing further.
As Scott’s story would progress further, he would return to the program shortly, just following the summer leading into his junior year of high school. Despite attempting to maintain appearances that his substance use pattern was improved from what it had been prior to initially entering treatment, time would reveal that he had begun using heroin and this time, was unable to abstain while being monitored in treatment. After a notably grueling and emotional family session, all were in agreement that Scott may be best served at a residential treatment setting. We spent the late evening hour on the phone with a local program and he was admitted the following day. That was the last time I saw Scott.
"Staggering new data from the year 2020 are in with the projection of 93,000 lives lost over that twelve month span. This 29.4% increase from the 2019 data is the single largest jump we have seen in the past 20+ years."
As a therapist working in an outpatient treatment program, keeping up with progress or other life happenings for our clients can be rather precarious after a person or family leaves our care. At times we receive ongoing communication from therapeutic resources a client attended following their therapy with us; other times we experience spontaneous joy when we see a former client stop in to say hello. I’ve had the honor on a few occasions of being asked to come as a visitor to a recovery meeting where a former client celebrated a recovery anniversary, and of course, at times we get to reconnect with clients when they return to treatment for another attempt at their recovery.
I was unexpectedly updated on Scott, quite unintentionally, several years later when catching up for coffee with a colleague. She had worked for a residential treatment program for several years and generally enjoyed the company and the richness of the therapeutic work. One difficulty she had, as she shared over her latte, was that this specific program held an annual event in remembrance of International Overdose Awareness Day (IODA), on August 31st each year. The intention for the event was to celebrate life and reignite the resident’s flames for living each day, to lead a fulfilling life void of substances and other self-destructive behaviors. As part of this remembrance, they would invite alumni and families to speak, sharing their recovery experiences. In this particular anecdote, she shared of a family who attended the program that year - a father and 2 adult sons - celebrating the recovery of the younger son while mourning the loss of another younger sibling to the grips of addiction. My colleague had mentioned that the father as a staple at the program’s weekly family support group, and it was heartbreaking to watch as he shared his experience of trying to pull himself together after the devastating loss of one child to realize he was on the brink of losing another, propelling him to seek recovery for both his middle son as well as himself
As we talked, the stories were too similar. The family constellation, the approximate ages, and several other factors. As the gears were clicking into place, I looked up, exploring her eyes, and asked if by any chance the father and (what would have been middle) son’s first names were who I was thinking. With a look of shock, she paused - and then asked, “Huh? Oh, did you treat him?”
“No. Not him…” And I sobbed. This was the first time I had become aware that one of my clients, past or present, had lost their lives to addiction. This is but one story of many, from one therapist who specializes in treating substance use disorders. The unfortunate reality is that this experience is far from unique.
In the US, overdose rates have consistently increased since at least 1999 with the exception of data collected from 2018, suggesting a slight drop from the previous year. Staggering new data from the year 2020 are in with the projection of 93,000 lives lost over that twelve month span. This 29.4% increase from the 2019 data is the single largest jump we have seen in the past 20+ years. Of course, we need to acknowledge the role that the Coronavirus-19 has in this steep climb. And yet, the pandemic is not the catch-all for accountability.
There were many factors involved in the development of the crisis state we find ourselves at with The Opioid Epidemic. There’s much room to debate policy when it comes to prescription monitoring and accountability; There are multiple arguments to consider as well as other international models to reference when discussing the viability of legalization or decriminalization of substances; And of course, we need to consider the accessibility to effective, evidence-based treatments with demonstrated positive outcomes.
However, beyond these macro-level issues that desperately need attention, there’s much more need to attend to the needs in our own homes and communities. There remains a strong stigma against substance use disorders and seeking treatment. Community-based programs focused on education and prevention are widely under-attended. Is it truly because the need does not exist? Our data from the Center for Disease Control and Prevention would indicate otherwise. Last year, approximately 255 Americans died each day due to overdose from substance use - that’s just under 11 lives per hour.
According to the National Survey on Drug Use and Health, an estimated 23.5 million Americans can be categorized as having a substance use disorder, and yet rough estimates suggest that a mere 10% receive treatment for these conditions annually. What are these barriers? How do we, members within our own communities, do our part to take them down?
I have always been a proponent of community-based education and programming, volunteering efforts toward prevention. And of course, in my role as a professional counselor, I collaborate with clients and families to intervene when a problematic pattern of substance use has been identified. The reality is, much more consideration is needed to make recovery efforts successful for the masses: increased accessibility to affordable, evidence-based therapeutic services; education and de-stigmatization of Medication Assisted Treatment (MAT - if you don’t know what this is, this is part of the point I’m trying to make!), inroads created for workforce re-entry and vocational training, affordable childcare and housing solutions, community-based recreational events that are recovery friendly… To be honest, this could truly constitute its own separate blog post.
Broadly speaking, our population with substance use disorders is grossly underserved. And even those who do receive services may not have all of their needs met. This may be partly due to accessibility and education, however also partly due to stigma.
Scott’s is but one story. What I was able to share here is simply a snapshot into who he was and what he experienced. He was a kid. He lost his mom and struggled to process this loss with his family and peers. He was a person in pain, seemingly seeking relief. Relief that he wasn’t able to find.
On this International Overdose Awareness Day, I choose to remember Scott. For me, there will only ever be one Scott, and yet we recognize there are many who share this story. And many others who do not need to have the same ending. What can you do, today, to address the stigma attached to substance use disorders and humanize this condition? It’s said that substance use disorders impact one in three American homes. If we all humanize this condition, talk about all of the Scott’s in our lives, what inroads may we open to addressing the issues at hand? How do we address addiction at the home and community level? Let’s talk about it.