the ancient Greek world that spawned so many great mythic stories, the tales of
Sisyphus are ones that resonate with many of us. Sisyphus was the King of an ancient city that
is now known as Corinth. He was incredibly
wise and crafty and took delight in playing tricks on the gods. He was also mean and oppressive, terribly abusive
to travelers and guests, a condition that particularly angered Zeus, the king
of the gods. Sisyphus’ disdain and abuse
of the gods and men finally provoked Zeus to doom him to a horrendous eternal
task…that of forever rolling a monstrous stone up a steep hill only to have it
roll back again just as he reached the top, each cycle happening over and over,
story has become a much used analogy to depict those daily mundane tasks and
recurring life cycles that seem to go on and on, endlessly…a mind-numbing
routine job, repeated conflicts with family, keeping a garden free of weeds,
etc. But, to me, it is nowhere more
resonant than in the repetitive acts of insanity that attended our alcoholic
and addictive acting-out. It has been
said that the surest sign of insanity is doing the same thing over and over
again expecting a different result each time.
We drank or used endlessly believing that each time would result in a
different outcome, perhaps a glorious permanent state of the euphoria that
attended the first ingestions of the substance. But all of it, each time, only
made our lives worse. We may even have
pursued this style of living disdaining the presence of any higher power in our
lives, making a mockery of all spiritual beliefs. We didn’t need God…we were God. The alcohol, the drugs told us so…
there is no recovery, no redemption for Sisyphus. He is doomed to his task forever. He is like many of us who never do recover
from alcoholism or addiction and eventually die in the disease. How glorious is it for those of us who, in
the horrid depths of our disease, begin to sense the presence of something
bigger than us and begin that agonizing, gut wrenching crawl to the light. How wonderful is it that we can live forever
in this light and never be Sisyphean again.
In the process of doing these
Notes, I keep coming back to the Odyssey,
by the ancient Greek poet Homer, as a particularly rich text with many stories
that fit the parallel of our own individual journeys to Sobriety. The companion
piece to the Odyssey is the Iliad,
which is the definitive story of the key closing events of the monstrous Greek
war with Troy, the powerful kingdom on the western edge of modern day Turkey.
In many ways, the Iliad is about men
in war, the men of the various Greek states locked in a mad, addictive rage
over deep resentments against their enemy, the people of Troy. It has all the elements of an epic military
struggle in which its protagonists are locked in a berserk-like
confrontation. In this sense, it is very
similar to the states of our own being when we were mired in our own diseases,
engaged in insane actions and behaviors induced by various substances and
But the Odyssey, on the other hand, can be seen as a parallel to the long process
of recovery in which all of us are steeped.
It is the story of the men of Greece trying to recover from the excesses
of the Trojan War and find their way home to lives of peace and family. Odysseus, who was the key figure in the final
conquest of Troy, is the central figure of the Odyssey. His part in the
conduct of the war put him in the center of this analogous process of
recovery. We can see his journey home,
which was the longest and most tortured of all the Greek leaders, as particularly
intense when compared to the events in our own processes of recovery.
Odysseus’ journey takes him
to many places with encounters of both intense danger and beautiful delight. Of
these encounters, three key ones are, first, with the beautiful Calypso who detains
him for 7 years as her lover and offers to make him immortal; then with Circe,
the enchantress, who tries to enslave him, but eventually gives him the key to
find his way to Hades where he gets the information he needs for his continuing
journey; and lastly Nausicca, the young maiden who convinces her father, the
King of Phaeacia, to equip Odysseus for the last leg of his journey home.
Forgetting about the romantic elements of the first two of these, what Odysseus
is receiving from these goddess-like personages are the wonderful elements of
nurturing and recovery that will enable him to return as an authentic ruler of
his homeland. In a sense they are much like what we learn in our tireless working
of the fourth to ninth steps of our own recovery.
In many ways, I see one of
the key themes of the Odyssey story as
that of the futility of war and all the elements of war. His journey to Hades, where he meets many of
his fallen comrades from the war is very poignant here. Achilles, the key
player in the Iliad story, tells him
that all of the glory of his life as a warrior was all for naught. He would take one day as a simple common man
for all his years of glory as a warrior.
Similarly, Odysseus’ stay in Phaeacia at the urging of Nausicca results
in his telling his long grim story to an assemblage in court, much as we do in
our Steps 4 and 5.
The message for all of us
here is to see our recovery, our getting sober, our going to meetings, our
working the steps, and our immersing ourselves in service to the cosmos, as a
journey so very similar to Odysseus’. It is one where all of our encounters,
all the people we meet, all the friends we make, all the advice and direction
we seek of our mentors in recovery form a spectacular web for a life in the
sunshine of the spirit, just as all of Odysseus’ adventures made him a much
more authentic ruler of his homeland once he got there.
Dr. Claudia Black, one of the world’s leading experts on
family systems and addiction, reveals the startling connection between the
psychological injuries experienced in childhood and the long-term trauma and
addictive disorders that are destroying families everywhere. In this in-depth
interview, Dr. Black discusses how trauma and addiction literally change the
brain, and why the unspoken effects of these conditions can reverberate for
generations, uprooting family trees and perpetuating both shame and denial.
But, recovery from trauma and addiction is possible, and Dr. Black illuminates
a simple, yet powerful and effective process for both healing and creating a
new narrative for living. This podcast coincides with the release of Claudia
Black’s 16th book, ‘Unspoken Legacy’, a far-ranging examination of how the
combination of addiction and trauma causes family dysfunction and why it’s one
of the most potent negative forces in people’s lives. Filled with vignettes
highlighting the various causes of trauma, ‘Unspoken Legacy’ helps readers
understand the physiology and psychology of trauma and how it intersects with
addition. The second half of the book covers the vital process for
self-examination, and gives readers proactive steps for healing, recovery, and
building healthier relationships.
The following article was recently published on the research page of the Recovery Research Institute website. It explores a new study that indicates Latinos have the lowest treatment seeking ratescompared to people of other racial and ethnic backgrounds.
WHAT PROBLEM DOES THIS STUDY ADDRESS?
National studies have shown that individuals who identify as Latino are less likely to seek treatment for substance use disorder or complete treatment at specialty treatment facilities. Barriers to treatmentengagement by race and ethnicity have been examined in only a few national studies and results are inconclusive. Identifying barriers to treatment is a foundational step that will allow for public health planning aimed at addressing barriers. The purpose of this in–depth qualitative study was to gain a better understanding of barriers to specialty treatment for substance use disorder that are more prominent among Latinos than other racial and ethnic groups.
HOW WAS THIS STUDY CONDUCTED?
From 2017-2018 the authors conducted a qualitative study which consisted of telephone interviews with participants from Riverside, Los Angeles, San Diego, and Oakland, CA; Brooklyn, NY; Chicago, IL; Miami, FL; and San Antonio, TX, recruited via craigslist (i.e., a web-based advertising platform) to compare barriers to treatment utilization among racial and ethnic groups.
WHAT DID THIS STUDY FIND?
Figure 1. Source: Pinedo et al, 2018
Latinos reported attitudinal barriers to specialty treatment more than other racial and ethnic groups (i.e., cultural, perceived treatment efficacy, and non-abstinent recovery goals). Overall, Latinos commonly felt specialty treatment providers did not understand their unique needs and experience. Specifically, they perceived healthcare providers to be unfamiliar with cultural issues such as discrimination and immigration. Providers were, therefore, discussed in terms of not being able to relate to personal experiences associated with being Latino including alcohol or other drug use which was in turn associated with low treatment efficacy. Being able to have a recovery goal of moderated alcohol use, and not complete abstinence, emerged as a larger barrier for Latinos in seeking treatment at specialty facilities. Its is unclear if these barriers could vary according to generation, meaning, foreign versus native born Latinos.
Social norms barriers towards specialty treatment (i.e., stigma and lack of social support) were more pronounced among Latinos than their White and Black counterparts. Stigma for seeking treatment was strong across all groups but most frequently mentioned by Latinos. Lack of social support from family emerged because it was viewed as “confirming” they had a problem and may tarnish the family.
Control over specialty treatment specifically logistical barriers, such as lack of health insurance, cost of treatment, transportation, and long wait times were highlighted by all racial and ethnic groups during interviews, however, showed no considerable differences in number of times mentioned between groups.
WHAT ARE THE IMPLICATIONS OF THE STUDY FINDINGS?
This study identified specific barriers that discourage individuals who identify as Latino with alcohol or other drug use disorders from seeking treatment, and compared these to other racial and ethnic groups. Barrier identification is important because Latinos seek treatment at about half the rate as their White counterparts although higher estimates have been reported. Latino expectations that providers do not understand cultural issues like discrimination and immigration was an attitude barrier for seeking treatment. Researchers have suggested acknowledging important social contexts such as immigration and discrimination experiences in the delivery of specialty treatment for substance use disorders may increase service use. Latinos low expectations around treatment efficacy where rooted providers having no lived experience with alcohol or other drug problems and therefore are unable able to relate. Treatment facilities may need to promote their use of, or integration with, peer services as a means of showing that lived experience can be a part of the treatment process. Clinicians should be prepared to work with patients whose recovery goals include an initial goal of moderate alcohol use given about half of people in the US who have resolved a problem with alcohol or other drugs are not completely abstinent.
Stigma was heavily endorsed by Latinos including concerns over being seen by colleagues at a specialty treatment facility. To address this barrier, treatment centers might offer telemedicine which is when treatment is delivered using telecommunications technology like Skype but specially designed for secure health care communication. In fact, a National Recovery Study found that individuals who identify as Hispanic were over one a half times as likely than White individuals to use recovery-related online technology. So, this may be a way to engage more Latinos with substance use disorder in treatment.
Qualitative studies like this use smaller samples to obtain richer ideas and explanations. This study was on only on a total of 54 individuals, of whom only 20 were Latino, recruited by advertisement, so it’s unclear to what extent findings may generalize to Latinos with substance use disorder as a whole. Particularly given the participants were assessed in terms of meeting diagnostic criteria over a 5 year window instead of 12 months, which is more standard.
The barriers to treatment seeking identified in this qualitative study should be further tested in larger samples, and ideally, in a national study to determine the US prevalence of these barriers among racial and ethnic groups.
Latino alone is a large group and there may be generational issues to consider in these outcomes related to foreign versus native born Latinos.
For individuals & families seeking recovery: This study of barriers to treatment for substance use disorder found that expectations of low efficacy were common. This low perceived efficacy of treatment was related to experiences with treatment providers who had no lived experience with substance use disorder, or providers who were perceived to not understand stressful cultural issues like immigration and discrimination and its association with the onset, clinical course, and remission of substance use disorder. Talk to a treatment provider about setting expectations around the likelihood of remission, their use or integration with peer services, and provider cultural competency.
For scientists: This qualitative study found that social norms around low family support and acceptability of seeking treatment may be a barrier among individuals who identify as Latino. Preventative interventions aimed at adolescents and emerging adults that seek to improve the acceptability of using professional services for substance use disorders may have lasting impacts on creating a future culture of support and reduced stigma, that extends to families and communities across generations. In addition, it is important to develop and test strategies that can help engage Latino individuals with services. For example, 12-step facilitation for Spanish speaking Latinos since they value lived experience.
For policy makers: This was a qualitative study that examined barriers to specialty treatment for substance use disorder by race and ethnicity. Latino treatment seeking may be improved (and treatment seeking in general) by promoting the use of peer services (i.e., persons with lived experience in recovery), training providers in “cultural humility” in order to increase education around immigration and discrimination and its effect on recovery, and increasing privacy options during treatment. Telemedicine is an emerging option to increase privacy during treatment and provide access to hard to reach populations but research on effectiveness needs to be studied.
For treatment professionals and treatment systems: This was a qualitative study that examined barriers to specialty treatment for substance use disorder among individuals who identify as White, Latino, and Black. Latino treatment seeking may be improved by (and treatment seeking in general) by accommodating non-abstinent recovery goals around alcohol use, promoting organizational integration with evidence-based peer services (i.e., persons with lived experience in recovery), training providers in cultural humility to increase education around immigration and discrimination and its effect on recovery, and increase privacy options during treatment seeking. Telemedicine is an emerging option to increase privacy during treatment and provide access to hard to reach populations but research on effectiveness needs to be studied. It may be important for clinicians to process and problem solve around Latinos’ mistrust in professional treatment and address the family and cultural barriers they may face if attending treatment (i.e., stigma or lack of social support).