The Lifelong Quest for Sobriety…The Ultimate Hero’s Journey – Part 61

In 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, forever.

This 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…

But 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.

The Lifelong Quest for Sobriety…The Ultimate Hero’s Journey – Part 60

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 actions.

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.

Unspoken Legacy: Claudia Black on the Destructive Impact of Trauma and Addiction within the Family

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.

Discrimination, immigration, treatment expectations, and family stigma are among barriers to Latinos seeking treatment

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 rates compared 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 treatment engagement 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.

LIMITATIONS

  1. 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.
  2. 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.
  3. Latino alone is a large group and there may be generational issues to consider in these outcomes related to foreign versus native born Latinos.

BOTTOM LINE

  • 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).

CITATIONS

Pinedo, M., Zemore, S. & Rogers, S. (2018). Understanding barriers to specialty substance abuse treatment among Latinos. Journal of Substance Abuse Treatment, 94, 1-8.

The Lifelong Quest For Sobriety…The Ultimate Hero’s Journey—Part 54

Guest Blogger and long-time Council friend, Bob W. presents Part 54 of a series dealing with Alcoholism and Addiction from a Mystical, Mythological Perspective, reflecting Bob’s scholarly work as a Ph.D. in mythological studies.

Jane Austen is recognized as the premier author of the Regency Period in England, the historical period that preceded the Victorian Era.  Her various works adroitly characterize the highly structured yet anxiety riddled social structure of the upper classes of British society. Perhaps her best such rendition is the story Emma, about a privileged, headstrong society girl in a small fictitious town in England.  Early in adulthood, Emma begins to manipulate her peers in her social structure to pursue the lives she believes they should, according to their standing, whether or not they agree with her or whether it is the right thing for them to do.   

Her penchant for such machinations develops to such increasing levels of bad maneuvers that she is ruining various lives irreparably.  Emma remains unconscionable is her efforts until George Knightly, a friend who is her one constant critic, finally convinces her of the extent of the damage she is doing and provokes a change in her behavior.

Emma’s descent into the behavior that so ruins other lives is similar to that of many of us as we descended into the final throes of our disease. We heaped abuse on others as if it was our right to destroy lives; we believed that relationships meant we could treat others as prisoners.  For many of us, it was only in the shock and final realization of such destruction that we could begin to pursue relief and reconstruction.

Think about how we behaved with loved ones at the height of our disease, the abuse and bad behavior that was so destructive and cruel without our even being aware of what we were doing.  And think how we pushed those same loved ones into behavior patterns to protect themselves, even though such patterns set them up for Al-Anon like pathologies. The repair of both sets of behaviors required almost lifelong efforts of recovery for both.

In a late scene in Austen’s book, there is an exchange between Emma and Knightly in which Knightly castigates her for a particularly mean and outrageous series of comments towards a garrulous societal friend. He says: “How could you be so unfeeling? […] How could you be so insolent in your wit to a woman of her character, age, and situation?” 

Emma tries to explain away her affront by diminishing the target, but Knightly will have none of it.  He adroitly points out that, despite Emma’s innermost self being of much higher quality, her penchant to put down and abuse others is destroying who she really is.  This exchange causes a dramatic change in Emma’s consciousness and the beginning of an ultimate resolution of the story…one that is highly enjoyable and uplifting.

For all of us in Recovery, how much like this has it been that a friend, or group thereof, has finally gotten through to our innermost selves, occasions that finally triggered the Journey that ultimately saved our lives and the lives of those around us.

The Council Receives LegitScript Certification

LegitScript Certification

The Council on Recovery is pleased to announce that it has received LegitScript certification. LegitScript is the certification service for drug and alcohol addiction treatment providers that is relied upon by Google, Bing, and Facebook to vet advertisers for eligibility. The certification is a key requirement for advertising on Google.

The Council’s certification from LegitScript will allow it to fully utilize the
Google Ad Grants that The Council was awarded in 2017. The Google Ad Grants program supports registered nonprofit organizations that share Google’s philosophy of community service. It is an in-kind advertising program that awards free online advertising to nonprofits via Google Ads. The Grant provides The Council with up to $10, 000 per month in online advertising in the Google Ads program .

LegitScript, an independent certification organization, has been by Google since 2018 and is a requirement for addiction treatment facilities to be able to advertise with Google. Both Facebook and the search engine Bing rely upon the seal of certification to assure legitimacy of advertisers.

The LegitScript seal of certification posted on web pages helps differentiate the services of legitimate facilities (like The Council) from those engaged in illegitimate practices or illicit activities. Being LegitScript certified is intended to build trust with prospective patients and clients by letting them know the advertised facility operates safely and legally.