This is a list of quotes about addiction, suffering, and hope that spoke to me – as an addictions professional – as well as on a human level.
These quotes about addiction are raw and relatable, with perhaps my favorites being from the memoir Drinking: A Love Story, in which the author, Caroline Knapp, bares her soul so compellingly that she becomes a kindred spirit in her vulnerability. Carrie Fisher also has a way with words, frank and darkly witty on the topic of addiction.
Read on for quotes about addiction from famous actors, singers, writers, sex workers, and more.
Quotes about addiction: on why people become addicted…
“And then I realized I was high. I loved the sensation. It felt like medicine to soothe the soul and awaken the senses. There was nothing awkward or scary – I didn’t feel like I had lost control – in fact, I felt like I was in control.”
Anthony Kiedis (Founder & Lead Vocalist of the Red Hot Chili Peppers)
“Drugs don’t really fix anything, except for everything.”
— Ashly Lorenzana (American Sex Worker, Freelance Writer, & Writer of the Memoir Sex, Drugs & Being an Escort)
“The priority of any addict is to anaesthetize the pain of living to ease the passage of day with some purchased relief.”
Russell Brand (English Comedian, Actor, & Author of My Booky Wook)
“To a drinker the sensation is real and pure and akin to something spiritual: you seek; in the bottle, you find.”
Caroline Knapp (American Writer & Author of Drinking: A Love Story)
On what it’s like having an addiction…
“It has been the desperate attempt to escape from torturing memories, from a sense of insupportable loneliness and a dread of some strange impending doom.”
Edgar Allan Poe (American Writer, Poet, & Literary Critic)
“The attempt to escape from pain, is what creates more pain.”
Gabor Maté (Canadian Physician & Author of In the Realm of Hungry Ghosts: Close Encounters with Addiction)
“Imagine trying to live without air. Now imagine something worse.”
Amy Reed (American Author)
“Drugs are a sort of dusk that grant us the illusion that we’re the ones who decide when the light goes out, but that power never belongs to us. The darkness takes us whenever it likes.”
Fredrik Backman (Swedish Author, Blogger, & Columnist)
“If you have a need to be comfortable all the time—well, among other things, you have the makings of a classic drug addict or alcoholic.”
— Carrie Fisher (American Actress & Writer)
“If you’re one of us, the bottle takes your shit, that’s all. First a little, then a lot, then everything.”
Stephen King (Best-selling American Author, the “King of Horror”)
“I drank when I was happy and I drank when I was anxious and I drank when I was bored and I drank when I was depressed, which was often.”
Caroline Knapp
“I’ve been asleep and I don’t know if it’s the same day or week or year, but who the hell cares anyway?”
“Your addiction is not your identity, but you won’t know that until you’re in recovery; that’s when the two separate.”
Toni Sorenson (American Author)
“The opposite of addiction isn’t sobriety. It’s connection.”
— Johann Hari (Journalist, Writer, & Admitted Plagiarist)
“Getting sober was one of the three pivotal events in my life, along with becoming an actor and having a child. Of the three, finding my sobriety was the hardest.”
Gary Oldman (English Actor & Filmmaker)
“When you quit drinking, you stop waiting.”
— Caroline Knapp
“Recovery is an acceptance that your life is in shambles and you have to change it.”
Jamie Lee Curtis (American Actress, Producer, & Author)
Share your favorite quotes about addiction and recovery in a comment!
I’m a little late in publishing Mental Health in 2022; I’d planned on posting at the start of 2023, but then… life happened. Anyway, I think it’s worth the wait, and I hope you enjoy this article as part of an ongoing post series that highlights the major findings and stories in mental health each year.
According to the National Center for Health Statistics, nearly 40% of adults reported symptoms of depression and/or anxiety in 2022. Younger adults, as well as racial minorities, LGBTQ individuals, and persons with disabilities were disproportionally impacted, consistently reporting higher rates. In comparison, only 11% of adults reported experiencing anxiety or depression in 2019.
What’s more, nearly 2 in 5 Americans rated their mental health as “poor” or “fair” in 2022, and were anticipating more stress at the start of 2023 according to a news release from the American Psychiatric Association.
What are Americans the most stressed about? 64% are worried about personal finances, 55% are concerned about uncertainty in 2023, 49% are worried about their physical health, and 41% are worried about their mental health. Other major stressors include relationships, job security, and traveling.
What word would you use to describe the state of America in 2022? What about your own state of mind this past year?
Mental Health in 2022: A Few Stats
The latest stats from Mental Health America indicate that the most “unwell” states, ranking high in rates of mental illness/substance use and low in access to treatment services, are (with Kansas being the most “unwell” state in the U.S.):
5️⃣ Idaho
4️⃣ Alabama
3️⃣ Arizona
2️⃣ Oregon
1️⃣ Kansas
The most “well” states, ranking low in rates of mental/substance use disorders and high in access to care, are (with Wisconsin being the “wellest” state in the U.S.):
5️⃣ Connecticut
4️⃣ Delaware
3️⃣ Massachusetts
2️⃣ Pennsylvania
1️⃣ Wisconsin
A WalletHub study examined additional wellness factors, such as physical health, work, community, and environment to rank states on overall happiness.
The bottom 5 ranking states for happiness (with West Virginia being the unhappiest state in America):
⬇️ Alabama
⬇️ Kentucky
⬇️ Arkansas
⬇️ Louisiana
⬇️ West Virginia 😞
The top 5 ranking states for happiness (with Hawaii being the happiest state in America):
5️⃣ New Jersey
4️⃣ Utah
3️⃣ Minnesota
2️⃣ Maryland
1️⃣ Hawaii 😀
What state do you live in? Do you consider your state a happy place to live?
Mental Health in 2022: Research & News
JANUARY
January 1, 2022
A law goes into effect in Tennessee, requiring beauty professionals to complete training on how to recognize and respond to signs of domestic violence.
January 3, 2022
An article published in The Hill informs that New York will establish public health vending machines (PHVMs) throughout the city that will dispense sterile syringes, naloxone (an opioid overdose reversal drug), and other medical supplies as a harm reduction method to combat the opioid epidemic.
Researchers find racially discriminating language in electronic health charts by analyzing medical documentation from January 2019 to October 2020. “Compared with White patients, Black patients had 2.54 times the odds of having at least one negative descriptor in the history and physical notes.” Stigmatizing language persists, even in medical and professional communities; these biases contribute to systemic racism in America.
A study suggests that medication-assisted treatment for opioid use disorder reduces recidivism in individuals who are incarcerated. These findings highlight the need for treatment (versus punishment) as a more effective method for reducing crime.
February 1, 2022
Researchers discover a novel treatment that may play a major role in the treatment of alcoholism. The study, published in Cell Metabolism, illustrates how a liver-to-brain circuit is interrupted to significantly reduce alcohol consumption.
February 2, 2022
A third of Americans say social media does more harm than good to their mental health, and nearly half say that social media has hurt society at large, according to a national poll.
February 11, 2022
The National Highway Traffic Safety Administration publishes research indicating that a lower legal blood alcohol content level for drivers reduces fatalities and fatal crashes. Since Utah enforced a .05% BAC limit (the strictest limit in the U.S.), the fatality rate fell by 18.3%. (In comparison, the rest of the U.S. saw only a 5.9% decrease during the same time period.)
February 15, 2022
A woman who received an umbilical cord blood transplant becomes the third person in the world to be cured of HIV, the virus that causes AIDS. The implications for both physical and mental health are far-reaching.
February 15, 2022
Psilocybin, the psychoactive property in magic mushrooms, continues to show promise as a treatment for depression. A study looked at efficacy and safety over a 12-month period and found that not only were the antidepressant benefits long-lasting, there were no adverse reactions or consequences to psilocybin-assisted therapy.
February 24, 2022
The president of the American Psychological Association releases a statement condemning Texas governor for calling on members of the public as well as licensed professionals to report parents of transgender minors. He calls the directive “ill-conceived” and asserts that it will put high-risk children at an even higher risk.
“We are gravely concerned about the immediate and long-term trauma and psychological impacts on people of all ages, families, communities, and the environment. We deplore the human cost of such aggression, including violations of human rights, adverse humanitarian consequences, deep psychological distress, and the loss of dignity and freedom. We stand in solidarity with all who are raising their voices and working tirelessly to protect and safeguard human life.”
American Psychological Association
MARCH
March 2, 2022
The American Psychiatric Association releases a statement on the impact of the war in Ukraine, asserting that “the war in Ukraine will have adverse mental health effects on individuals and communities around the world.”
“The American Psychiatric Association sends our support to all who are experiencing pain and suffering from these deeply troubling events, including those directly exposed to armed conflict, those displaced from their homes and country, those providing care and protection to civilians, friends and family of Ukrainian citizens, and the Ukrainian diaspora around the globe.”
In a news release, the National Institute on Drug Abuse (NIDA) asserts that non-suicidal self-injury shares commonalities with addiction, including craving, tolerance, escalating severity, getting “clean,” “relapsing,” and being in “recovery.” Researchers came to this conclusion based on an extensive analysis of posts and comments on a Reddit self-harm forum. More research in this area is needed to explore self-injury as a behavioral addiction.
March 27, 2022
During the Oscars, Will Smith slaps Chris Rock, who was presenting an award on stage, after Rock made a joke about Jada Pinkett Smith’s shaved head. Pinkett Smith, who struggles with hair loss due to an autoimmune disorder, has been outspoken about her condition since 2018. Since the famous slap, she’s had guests on her talk show share about the devastating effects of alopecia, bringing attention and awareness to the issue.
March 31, 2022
The CDC publishes a press release illustrating the impact of COVID-19 on adolescents’ mental wellbeing. Over a third (37%) of highschoolers reported poor mental health during the pandemic, and nearly one third reported current substance use. Over half (55%) experienced emotional abuse. Over a third (36%) of teens of all races reported experiencing racism, with the highest rates among Asian (64%), Black (55%), and multiracial (55%) students. What’s more, prior data suggests that the worsening mental health of teens is a trend.
APRIL
April 1, 2022
The House passes a bill (first introduced May of 2021) decriminalizing marijuana. The Marijuana Opportunity Reinvestment and Expungement Act would remove marijuana from the federal list of controlled substances and “eliminate criminal penalties for an individual who manufactures, distributes, or possesses marijuana.”
Asian (21%), Hispanic (14%), and Black (32%) Americans are more likely to worry about being threatened or attacked than White Americans (4%), according to the Pew Research Center.
May 9, 2022
Research published by the American Psychological Association reveals, “People around the world experienced an increase in loneliness during the COVID-19 pandemic, which, although small, could have implications for people’s long-term mental and physical health, longevity and well-being.”
May 15, 2022
After SNL spoofs the Johnny Depp and Amber Heard defamation trial, sex and culture critic Ella Dawsontweets, “Domestic violence is not a joke. Rape is not a joke. Abusers using the legal system to continue to terrorize their victims is not a joke. Abusers using accusations of defamation to silence their victims is not a joke.” The trial was widely followed, and the social media response was generally sympathetic towards Depp while critical of Heard, who had multiple emotional outbursts in the courtroom.
“Domestic violence is not a joke. Rape is not a joke. Abusers using the legal system to continue to terrorize their victims is not a joke. Abusers using accusations of defamation to silence their victims is not a joke.”
Ella Dawson
May 16, 2022
The president of the American Psychological Association releases a statement in response to a mass shooting in Buffalo, NY, calling it a horrific hate crime, and asserting that the APA stands against racism and hate in all forms.
May 23, 2022
According to the American Psychological Association, “People who deny the existence of structural racism are more likely to exhibit anti-Black prejudice and less likely to show racial empathy or openness to diversity.” It was also found that those who denied structural racism were “more likely to endorse stronger beliefs that societal inequality is acceptable” and were less concerned with social justice.
“We implore our elected officials to act on meaningful, common-sense measures and begin to heal the divisions that have prevented progress in this area of public health for far too long. This senseless loss of life must end, and as a nation, we should expect action from federal and state legislative and executive leaders. Our children and communities deserve better.”
APA Statement
June 1, 2022
In Depp vs. Heard, Amber Heard was found liable for defamation, the jury ruling her accusations of “sexual violence” and “domestic abuse” false. In a statement, Amber told the New York Post, “I’m heartbroken that the mountain of evidence still was not enough to stand up to the disproportionate power, influence and sway of my ex-husband.”
“I’m heartbroken that the mountain of evidence still was not enough to stand up to the disproportionate power, influence and sway of my ex-husband. I’m even more disappointed with what this verdict means for other women. It is a setback. It sets back the clock to a time when a woman who spoke up and spoke out could be publicly shamed and humiliated. It sets back the idea that violence against women is to be taken seriously.”
Amber Heard
June 6, 2022
Apple announces a new Safety Check feature for iOS 16, aimed at individuals in abusive relationships. The feature provides users with an enhanced ability to control their communications and privacy.
Research indicates that fewer youth attempt suicide in states with hate crime laws protecting LGBTQ individuals. This is true for both highschoolers who identify as LGBTQ as well as those who identify as straight.
June 24, 2022
The Supreme Court overturns Roe vs. Wade. The ramifications of this are varied and far-reaching; one prediction is that there will be a significant increase in maternal mortality. Additionally, according to The Turnaway Study (University of California San Francisco), researchers found that being denied an abortion was linked to serious health and wellbeing consequences, including an increased risk of poverty, a greater likelihood of staying in an abusive partnership, anxiety, loss of self-esteem, decreased motivation for life goals, poorer physical health, and serious implications for both the unwanted child as well as existing children in the family.
June 24, 2022
Biden signs into law federal gun safety legislation. The Bipartisan Safer Communities Act (S. 2938) includes several gun violence prevention provisions in addition to improving access to mental health care. Notably, it closes the “boyfriend loop,” banning anyone who is convicted of a domestic violence crime against someone they have a “continuing serious relationship of a romantic or intimate nature” from having a gun.
The findings of a JAMA Open Networkstudy indicate that young adolescents who experience cyberbullying are more likely to report suicidal thoughts and/or attempt suicide, even more so than students who are victims of “traditional” (offline) bullying.
June 28, 2022
Americans have complex views surrounding gender identity and transgender issues, according to a Pew Research Report. While a majority of Americans (64%) believe transgender individuals should be protected from discrimination, only 38% believe gender identity can be different from sex assigned at birth. What’s more, approximately 40% of Americans expressed that society has gone “too far” in accepting transgender individuals. Many Americans feel uncomfortable with nonbinary concepts of gender as well as the fast pace of change surrounding gender issues in society.
“The issue is so new to me I can’t keep up. I don’t know what to think about all of this new information. I’m baffled by so many changes.”
Pew Research Survey Responder on Gender Identity and Transgender Issues
JULY
July 1, 2022
A largescale retrospective study indicates that medical cannabis use is associated with significant and lasting improvements in individuals with depression and anxiety. Previous research in this area has yielded mixed results; the implications of such a largescale study provide evidence to support cannabis as an effective treatment for depression/anxiety in some individuals.
July 6, 2022
According to a Pew Research Report, 62% of Americans believe abortion should be legal in all or most cases. 57% of Americans disapprove of the Supreme Court’s decision to overturn Roe vs. Wade while only 41% approve.
July 16, 2022
The 988-suicide lifeline is launched. This new, nationwide easy-to-remember phone number helps Americans in crisis connect with suicide prevention and mental health crisis counselors as an alternative to dialing 911.
July 20, 2022
Researchers discover a neurotransmitter responsible for assigning either positive or negative emotions to events. By targeting this molecule, PTSD and related disorders may be treated more effectively.
AUGUST
August 4, 2022
The American Psychological Association adopts the Racial Equity Action Plan “to utilize racial equity as a critical lens to drive APA’s strategic priorities and measure the magnitude of APA’s impact.” This follows their formal apology issued October of 2021 for their role in and contributions to systemic racism.
August 11, 2022
The American Psychiatric Association reports that most Americans believe mental health programming is needed in schools, including education, staff training, and connecting students to providers. Parents’ top three concerns for K-12 students are gun violence, mental health, and cyberbullying/social media.
The American Psychological Association calls upon U.S. courts to ban the death penalty for anyone younger than 21, citing scientific research that shows adolescents’ brains continue to develop in their early 20’s.
August 24, 2022
According to a study published in Health Communication, individuals who obsessively check the news are more likely to suffer from stress, anxiety, as well as poor physical health.
SEPTEMBER
September 1, 2022
According to a Pew Research Report, “Americans’ ratings of the Supreme Court are now as negative as – and more politically polarized than – at any point in more than three decades of polling on the nation’s highest court.” Positive ratings fell sharply after the Supreme Court’s decision to overturn Roe vs. Wade in June.
“Americans’ ratings of the Supreme Court are now as negative as – and more politically polarized than – at any point in more than three decades of polling on the nation’s highest court.”
Pew Research Center
September 20, 2022
A National Institute on Drug Abuse (NIDA) news release outlines a promising treatment for alcohol use disorder (AUD). Researchers found that spironolactone, a medication prescribed for heart and blood pressure problems, significantly reduced alcohol consumption. Currently, there are only three approved medications for AUD; new pharmacological treatments are needed to improve outcomes.
September 21, 2022
The National Institute on Drug Abuse (NIDA) releases the NIDA 2022-2026 Strategic Plan for advancing scientific research and educating federal agencies; state and local health, education, and human services; and the legal system, as well as policymakers on addiction.
September 23, 2022
The FDA clears a new protocol, named the Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT), for fast and effective treatment of depression. In clinical trials, participants experienced relief after only 5 treatments.
September 28, 2022
A large-scale observational study published in JAMA Psychiatry confirms a link between folic acid and reduced rates of suicide attempts and self-harm, implicating the B vitamin as a potential tool for suicide prevention.
OCTOBER
October 6, 2022
An American Psychiatric Association poll finds that 79% of Americans believe mental health is a public health emergency and warrants more attention from lawmakers.
October 10, 2022
A study published in JAMA Network Open reveals that 4 in 10 Americans surveyed were dishonest about having COVID-19 and/or didn’t comply with preventive measures during the height of the pandemic. Most commonly, survey participants reported misrepresenting their COVID-19 status, breaking quarantine rules, telling others they were taking more precautions than they actually were, and saying they were vaccinated when they weren’t.
October 17, 2022
In an American Psychiatric Association national poll, only 1 in 5 Americans believe individuals who are incarcerated receive the mental health care they need. What’s more, 75% of Americans believe mental health treatment should be available in prisons and jails. (Note: It’s estimated that nearly half of persons who are incarcerated have a mental disorder.)
October 19, 2022
Homicide is found to be a leading cause of death in pregnant women and in women who had recently given birth. Most of these deaths were associated with the lethal combination of domestic abuse and firearm violence.
October 19, 2022
An American Psychological Association nationwide poll reveals that 27% of Americans are stressed to the point where they can barely function. The top stressors were inflation, violence/crime, the current political climate, and the racial climate. What’s more, 76% of Americans reported having a stress-related health issue.
Antisemitic Campaign Slogan Inspired by Kanye “Ye” West’s Comments
October 26, 2022
A promising study published in Pharmaceutics validates a highly effective vaccine for fentanyl use disorder. This groundbreaking vaccine essentially blocks fentanyl from entering the brain, eliminating the drug’s euphoric (and lethal) effects. Once approved by the FDA, the vaccine will be tested in human subjects in clinical trials.
October 27, 2022
In the largest ever analysis conducted on mass school shootings, researchers find that of the nearly 100 mass killings examined, the shooter/killer did not have a severe mental illness. In academic settings, most mass killings were U.S.-based and involved firearms. Perpetrators were primarily white males. In the mass killings where psychosis was a factor, the killer most often used a weapon other than a firearm. Nearly half of the killers died by suicide. This analysis lends to a body of research that will help policymakers and law enforcement officials better identify risk factors and prevent mass shootings from occurring. This research also supports the American Psychiatric Association’s stance on violence and mental health.
“It is important to note that the overwhelming majority of people with mental illness are not violent and are far more likely to be victims of violent crime than perpetrators thereof. A vast majority of firearm violence is not attributed to mental illness. Rhetoric that argues otherwise will further stigmatize and interfere with people accessing needed treatment without addressing the root causes of firearm violence. Although there is no single cause of firearm violence, individuals can and have been emboldened to act violently by inflammatory public discourse and provocative, hateful and destructive rhetoric.
American Psychiatric Association
NOVEMBER
November 1, 2022
Researchers find that nearly 30% of kratom users showed signs of addiction (i.e., increased use, cravings, tolerance, impairment in major life areas, withdrawal, etc.). The DSM-5-TR does not recognize kratom use as a disorder, and previous studies indicate that kratom may be a harm-reduction measure for opioid users. This highlights a need for more research.
November 3, 2022
An American Psychiatric Association Healthy Minds poll finds that nearly 40% of Americans face declining mood in the upcoming winter months.
(Learn more about seasonal affective disorder here. If you’re considering light therapy, go with a research-proven [backed by the Yale School of Medicine] lamp such as the Carex Day-Light Classic, the North Star 10,000, or the BOXelite.)
Researchers aim to better understand the factors that contributed to physician burnout during the height of the pandemic; the most frequently cited stressors were concern related to exposure, the burden of patient deaths, workload volume, medical uncertainty on how to provide care for COVID-19 patients, caring for patients with no family or outside support, and dealing with mistrust or skepticism for COVID-19.
November 15, 2022
An increased demand for mental health treatment places a strain on providers who are already at capacity. The 2022 COVID-19 Practitioner Impact Survey revealed that 6 in 10 practitioners had no openings for new patients, with nearly half reporting being unable to meet current demands. Meanwhile, compared to pre-pandemic years, providers reported an increase in patients seeking treatment for anxiety, depression, substance use, and trauma.
In a press release, the American Psychiatric Association condemns the shooting at Club Q Nightclub in Colorado Springs, asserting, “Bias toward LGBTQI people, whatever form it takes, hurts mental health. We stand opposed to laws and rhetoric that discriminate against this community, whether it is promoting dangerous conversion therapy or restricting provision of health care services to trans or gender-diverse individuals.”
DECEMBER
December 8, 2022
In a press release, the American Psychological Association applauds Congress for passing the Respect for Marriage Act.
“APA has long been a strong advocate for marriage equality, based on the psychological research indicating that marriage provides substantial psychological and physical health benefits due to the moral, economic and social support extended to married couples. Conversely, empirical evidence has illustrated the harmful psychological effect of policies restricting marriage rights, particularly for same-sex couples.”
Frank C. Worrell, APA President
December 22, 2022
Research suggests that the AI driving ChatGPT may one day be able to detect early signs of Alzheimer’s by identifying speech patterns and/or features associated with early stages of dementia.
32% parents of K-12 students who are either very or extremely worried about a shooting happening at their child’s school 6
23% workers worldwide who say they’ve experienced violence or harassment (including psychological harassment, i.e., bullying, intimidation, etc.) in the workplace 7
80% Americans who say they enjoy the work they do 8
5% young Americans who say their gender identity differs from their assigned sex at birth 9
61% Americans who say they believe the legalization of same-sex marriage is good for society 10
88% Americans who say that marijuana should be legal for medical or recreational use 11
To conclude, 2022 was the beginning of the end of the pandemic, leaving Americans feeling uncertain about the future. Burnout, higher rates of mental illness and substance use, increased overdose deaths, and firearm deaths were common themes in 2022. Tragically, 2022 was the year that gun violence became a leading cause of death in children.
While many adults and children experienced mental distress in 2022, at the same time, measures were put in place to help Americans heal as well as feel safe again. The Biden Administration awarded over $1 million in funds to reduce burnout and improve retention in healthcare workers impacted by the pandemic, and the House passed the Restoring Hope for Mental Health and Well-Being Act to address the nation’s mental health crisis. A nationwide suicide hotline was established for individuals at risk for suicide or bystanders to quickly get the help they need.
In 2022, President Biden also signed the Violence Against Women Act and the Safer Communities Act to reduce gun violence. Controversially, the Supreme Court overturned Roe vs. Wade. It remains to be seen what the repercussions will be.
Regarding the opioid epidemic, while overdose deaths skyrocketed in 2022, groundbreaking research led to a vaccine that can prevent fentanyl addiction and overdose. This vaccine, which may be available as early as next year, will be a gamechanger.
To close, while many Americans expressed feeling mental distress and uncertainty about the future, a majority also reported feeling satisfied with their work and in their personal lives. Half of Americans, in fact, said they were not just satisfied but thriving! Despite some of the tragedies and the setbacks of the year, it appears that 2022 is the light at the end of the tunnel.
When Trust Falls Apart: A Look at Addiction, Family, and Healing
Families will often come to me, astounded by how their addicted loved one can look them right in the eye and calmly lie that he/she is not drunk or high, when it’s evident that he/she is. This type of interaction feels so very personal to the family.
In a healthy brain, one that is unencumbered by the highjacking of addiction…they likely wouldn’t. That’s why it’s so confusing and painful. Many families will report that the dishonesty about drug and alcohol use causes more wounds to the relationship than the use itself!
However, with education about how addiction works, we can come to understand how the bizarre nature of this disease can actually be fairly predictable – and why our loved one has deviated in this way from values we hold dear (and maybe they once did too).
Getting High to Survive
As addiction progresses, the addicted person becomes more and more captive to the demands of the disease. Because the disease greatly impacts the “survival circuitry” in the brain, the perceived need for the drink/drug becomes a profound compulsion.
The logic that an addicted person would follow is similar to that of a starving man who easily justifies the theft of a loaf of bread, “I gotta do what I gotta do. I’ll deal with the consequences later.”
Stuck in the Middle
I often envision an addicted person in a tragic tug-o-war. On one team is the Disease, fierce and manipulating them into submission. On the other team are Societal Expectations: the shared belief structure of right vs. wrong, laws, and norms.
The notion of a healthy family structure falls under the umbrella of this second team, holding expectations of mutual respect, consideration, honesty, and the like.
While most addicted people never fully abandon these values in their heart of hearts, the pull of the disease tugs progressively stronger until the person is being yanked between others’ expectations and their own compulsions.
At this point, it can feel to the addicted person that the most adaptive solution is… lie like your life depends on it.
In other words, the addicted person attempts to keep society/family satisfied (or at least at bay) while keeping the disease satisfied by continuing to feed it.
It’s Not Because They Don’t Love You
As personal as the dishonesty can feel, this was never about love. I have come to consider dishonesty as an actual symptom of substance use disorder. It’s an adaptation the addicted person makes to continue surviving in “normal life” in spite of the profound changes that have occurred in their brain.
To be clear, I do not share the above explanation as a justification of hurtful behavior. I share it as a clinician who happens not to have a personal history of addiction.
In my early years as a provider for the substance-misusing population, I too, struggled with the bewilderment, and at times admittedly hurt feelings, when my addicted clients would lie to me about their recent use. After all, I was there to help them, right? Why would they lie to ME?
I’ve come to truly understand however, that dishonesty serves as an odd… but reliable ally that shields the addicted person from their shame, consequences, and need to explain their actions.
While a growing body of neuro-scientific understanding continues to shed light on the “WHY?” many of my clients would admit that on a personal level, they truly don’t understand why they do what they do.
What they do know however is that in order to get to their next fix, they need to evade those that love them the most. A loving family who wants to save you from addiction is the greatest threat to your next high.
Breaking Up and Waking Up
That powerful allegiance between the addicted person and their drug/drink seems only to be broken when they themselves come to understand that this intimate affair they’ve had with their substance has become a nightmarish relationship with a toxic abuser, the kind of abuser that controls their life and takes everything else they love away.
At that point, we hope they can finally reconsider their allegiances.
Recovery: Not Just for Substance Users
When a loved one enters recovery from addiction, it often takes the family a very long time to trust again. Understandably there is skepticism and disillusionment. After all, if a person has looked us in the eye and lied so calmly to us during active addiction, what is our barometer for honesty now?
The notion that “time takes time” is a reality that a recovering person must humbly accept. The addiction caused great damage, and that will take time to heal.
But as the family nurses its wounds, they must also understand that trust-building is a two way street. We must accept that our loved one lied to us because they didn’t trust us to understand the tug-o-war in which they were trapped.
The only way to become a trusted ally is to begin listening and trying to understand. In this, we also hopefully set the stage for them to eventually hear and understand our pain as well.
About the Author:Karen Perlmutter, LISW-CP, has worked as a therapist in clinic, hospital, and private practice settings for 15 years. She specializes in the treatment of substance abuse and mental illness, with a particular interest in supporting the entire family system through the complex journey of addiction. She has developed an evidence-based course for families coping with a loved one’s addiction. Karen also aims to share education, support and hope with the community through a variety of speaking forums which have included universities, treatment programs, support groups, National Public Radio, professional development events, and an upcoming Tedx Charleston talk.
According to USA Today, a poll that asked Americans to describe 2021 in one word indicated that the year was overwhelmingly bleak for many. The top five most common responses were:
Awful/terrible/bad/sucked (23%)
Chaos/confusing/turmoil (12%)
Challenging/hard/rough (11%)
Disaster/train wreck/catastrophe (6%)
Okay/good (6%)
How were such dismal views reflected in mental health in 2021? Who was impacted the most and why? What helped Americans cope?
This article reviews American mental health in 2021 – a rundown of last year’s notable research findings, statistics, and events.
Mental Health in 2021: Statistics & News
According to a 2021 Mental Health Americareport, the top-ranking states for overall mental wellbeing (based on rates of mental illness and access to care) are:
5) Connecticut
4) Pennsylvania
3) New Jersey
2) Vermont
1) Massachusetts
The lowest ranking states are: Wyoming, Alaska, Arizona, Idaho, and Nevada (with Nevada at the bottom).
January 5– Ketamine shows promise as a treatment for chronic PTSD by reducing symptom severity. Click here to read the study abstract. (Source: American Journal of Psychiatry)
April 1 –The Standard reports that 49% of American workers struggled with alcohol and substance use in 2020. Read the full article.
April 6 –Research indicates mental health complications in survivors of COVID-19 persist up to 6 months and beyond post-infection. (Source: Lancet Psychiatry)
April 22 – 3 in 10 healthcare workers consider leaving the profession due to pandemic-related burnout. (Source: The Washington Post)
July 13 – Over half (53%) of United States public health workers report symptoms of depression, anxiety, post-traumatic stress disorder (PTSD), or suicidal thoughts since the start of the COVID-19 pandemic according to the CDC.
July 23 –Mental health workers are deployed to provide mental health support to first responders, the search and rescue teams, who worked for weeks to find victims after the condo collapse in Surfside, FL that killed nearly 100 people.
November 1 – Aaron Beck, the father of cognitive therapy, dies at 100. (Source: USA Today)
December 13 – Digital (computer and smartphone-based) treatments for mental illness may effectively reduce symptoms of depression. (Source: American Psychological Association)
December 21 – The American Psychiatric Association endorses the Well Beings Mental Health Language Guide intended to address stigma around mental illness and provide readers with person-centered language. Read the news release.
Suicide is the second leading cause of death for individuals between the ages of 10 and 34 in the United States. (CDC)
A 2021 report published by Mental Health America indicates that most American employees are experiencing burnout. Furthermore, employees are not receiving the support they need to manage stress; workplace stress has a significant impact on mental health. Download the full report here.
At the end of 2020, 1 in 5 adolescents as well as 1 in 5 adults reported that the pandemic has negatively impacted their mental health. (Source: 2020 National Survey on Drug Use and Health)
January 1 – A study published in Drug and Alcohol Dependence estimates that the opioid crisis cost the economy over $1 trillion in the United States in 2017.
June 12 – The anti-inflammatory drug ibudilast shows promise as a treatment for alcohol use disorder. A small study found that it decreased heavy drinking. (Source: Translational Psychiatry)
June 25 –Research suggests that life achievements are linked to sustained recovery. (Source: Journal of the Society of Psychologists in Addictive Behaviors)
July 5 – A pilot study indicates that high-dose gabapentin therapy may reduce harmful alcohol consumption. (Source: Alcoholism, Clinical and Experimental Research)
July 21 – Wearable devices measure and track stress reactions to help to prevent relapse. Read the article from Washington State University Insiderhere.
August 3 – Alcohol consumption is linked to nearly 750,000 cancer cases in 2020. (Source: CBS News)
September 27 – Yale researchers predict that graphic photos showing the severe consequences of smoking, which will be printed on all cigarette packages in the U.S. beginning October 2022, will save an estimated 539,000 lives. (Source: Yale News)
In 2019 there were 70,630 primarily opioid-involved drug overdose deaths in the United States. 72.9% of opioid-involved overdose deaths involved synthetic opioids. (Source: CDC)
February 3 – Researchers develop experimental vaccines to block opioid-induced respiratory depression, the primary cause of overdose death. (Source: Scripps Research Institute)
February 17 – Demi Lovato reveals that she suffered from three strokes and a heart attack in 2018 as a result of a drug overdose, leaving her with permanent brain damage. (Source: ABC News)
March 4 – A 75-year old New York doctor who saw patients in a hotel parking lot is charged with murder for 5 opioid deaths after writing massive quantities of prescriptions for opioid drugs. (Source: CSB News)
April 2 – The CDC reports that overdose deaths were at their highest in 2020, a 38.4% increase compared to the previous 12-year period.
September 1 – Purdue Pharma, the maker of the highly addictive painkiller OxyContin, is dissolved in a bankruptcy settlement that requires the company’s owners, members of the Sackler family, to pay billions of dollars to address the impact of the opioid epidemic. (Source: New York Times)
September 9 – Disparities in opioid overdose deaths for Black people continue to worsen. Read the press release. (Source: National Institutes of Health-NIH)
September 22 – An NIH report indicates that methamphetamine-involved overdose deaths nearly tripled between 2015-2019. Read the press release.
October 28 – The American Medical Associationcommends the Biden-Harris Administration “for responding to the spike in drug overdoses with an evidence-based, humane approach to increasing access to care for patients with a substance use disorder and harm reduction services.”
November 22 – Researchers develop a wearable naloxone injector device to detect and reverse opioid overdose. Read the news release from UW Medicine.
December 1 – Fentanyl strips prevent overdose and save lives. (Source: MSN News)
December 7 – The first safe injection sites in America open in New York in Washington Heights and East Harlem. (Source: Psychiatry Advisor)
December 9 – The Metropolitan Museum of Art in New York announces it is dropping the name of the philanthropic Sackler family, whose name is linked to America’s opioid epidemic. (Source: NBC News)
Discrimination & Reform
January 18 – The American Psychiatric Association issues a public apology for their past discriminatory practices. Read the news release here.
February 25 – The House passes the Equality Act, which “prohibits discrimination based on sex, sexual orientation, and gender identity in areas including public accommodations and facilities, education, federal funding, employment, housing, credit, and the jury system.”
April 8 – The CDC director declares racism a serious public health threat. (Read the media statement here.) The American Medical Association releases a response statement applauding the CDC.
May 1 – A study indicates there are significant increases in anxiety among Black emerging adults from exposure to police violence. (Source: American Psychiatric Association)
July 30 –Research suggests that a 2017 executive order banning foreign nationals from select Muslim-majority countries from traveling to the United States harmed the health of Muslim Americans. (Source: Yale News)
August 17 – Researchers find persistent racial and ethnic health disparities in the United States. (Source: JAMA)
October 29 – The American Psychological Association issues an apology for its longstanding contributions to systemic racism.
December 1 – A study indicates that youth who face discrimination are at a greater risk for developing a mental disorder and are twice as likely to experience severe psychological distress compared to youth who don’t experience discrimination. (Source: Pediatrics)
Mental Health in 2021 Legislation
In February, the Mental Health Justice Act of 2021 to create a grant program for training and dispatching mental health professionals (instead of law enforcement officers) to respond to psychiatric emergencies is introduced.
The infrastructure act signed to law by the president in November mandates automakers to install anti-drunk driving technology systems in all new cars.
In 2021, recreational marijuana use is legalized in New York, Virginia, New Mexico, and Connecticut. While marijuana is still federally controlled, it is now legal in 19 states and the District of Columbia and medically allowed in 36 states. Read more about marijuana legalization in the United States here. (Source: U.S. News)
The States Reform Act to end federal prohibition of cannabis is introduced in November, and a Florida representative submits a legislative proposal to decriminalize all illegal drugs.
Mental Health in 2021: Conclusion
2021 – the second year marked by the COVID-19 pandemic – brought with it more distress, loss, and hardship, with no end in sight as COVID deaths in 2021 surpassed those in 2020. While the year delivered a few legislative victories and promising research findings in mental health in 2021, overall, it wasn’t a great one.
Data suggests that mental health in 2021 suffered, with increased rates of depression, anxiety, and substance use. Healthcare workers experienced severe burnout. Overdose deaths skyrocketed while thousands of lawsuits were filed against opioid makers such as Purdue Pharma who started and sustained the opioid crisis in America, profiting off the suffering and tragedy of addiction. (See the Opioid Settlement Tracker to learn more about opioid settlements and how the money is spent.)
Meanwhile, a wave of civil unrest in America, triggered by the murder of George Floyd in 2020, continued into 2021 with protests, rioting, and violence. While the movement gained strength in 2020, in 2021, many Americans looked away. At the same time, there was a political push for a more “patriotic” retelling of history – to limit what schools could teach about slavery. However, steps in the right direction were taken by both the American Psychiatric Association and the American Psychological Association when they issued public apologies for the harm they caused.
Although drug overdose deaths increased, there were significant strides taken in 2021 to win the “war on drugs” – by ending it with an awareness that this is not a war; it’s a treatable illness. 2021 saw the establishment of evidence-based, harm-reduction measures as well as legislation to decriminalize and legalize drugs. Meanwhile, medical research in 2021 revealed promising treatments to heal both addiction and mental illness.
To conclude, last year – in general – sucked. Despite this, it wasn’t entirely bad in mental health in 2021. And, 2022 could be the light at the end of the tunnel! In fact, the same poll that suggested 2021 was a “trainwreck” of a year found a majority of Americans are still hopeful for 2022.
“We must accept finite disappointment, but never lose infinite hope.”
The best TED Talks for addiction and recovery, along with other powerful YouTube videos to play for clients in a treatment setting – or for yourself or for anyone who desires to learn more about substance use.
The following best TED Talks for addiction are entertaining, insightful, and though-provoking.
2. Addiction: A Story of Stigma, A Story of Hope | Scott McFadden (2020)
This 18-minute talk delivered by Scott McFadden is one of the best TED Talks for addiction as it addresses stigma and sends a message of hope.
Excerpt:Scott McFadden is a Licensed Addictions Counselor, who also identifies as a person in long term recovery from heroin and other drugs. He shares a harrowing story of incarceration and a long journey to recovery while explaining the dynamics of addiction and the labels, shame, and stigma which have become the greatest obstacles to turning around the opioid epidemic.
He shows us the need to talk to one another to overcome the secret places where shame resides. This is a story of vulnerability and hope!
5. Addiction Neuroscience 101 (2018)
Approximately 25 minutes, an overview of the neurobiology of addiction.
4. Chris Herren Speaking on His Addiction Recovery Story | PeaceLove (2015)
A 17-minute motivational speech delivered by Chris Herren.
Excerpt:Hear former professional basketball player and motivational speaker Chris Herren speaking about his recovery from drug addiction. Since August of 2008, Herren has been drug-free and alcohol-free, and has refocused his life to put his sobriety and family above all other things.
This fascinating 19-minute video clip from Rachel Wurzman is one of the best TED Talks for addiction as a biopsychosocial disorder.
Excerpt: Addiction to opioids is now officially a national emergency. But why are addiction rates spiking and what can we do about it? Neuroscientist Rachel Wurzman shares new research about how the brain reacts to opioids, replacing the sense of community and belonging human beings are losing. We are beginning to understand that solving the opioid epidemic will require us to focus on social factors surrounding those addicted.
6. Do You Have More Heart Than Scars? | Zackary Paben (2017)
A 17-minute inspirational talk by Zackary Paben.
Excerpt:How can resilience and interdependence impact the arch of our personal narrative to transcend from victim to hero? Since 1991, Zack has been empowering adolescents and adults as a mental health/recovery professional in a variety of modalities, including wilderness and residential.
As he continues to face his own visible and invisible scars, he innately has to acknowledge the wounds of others and encourage them in their own healing process.
7. Everything You Think You Know About Addiction Is Wrong | Johann Hari (2015)
A 15-minute video from Johann Hari. This piece is somewhat controversial because it suggests that addiction is a social/environmental issue while failing to address the impact of trauma, genetics, brain chemistry, etc. This clip is an excellent tool for generating discussions and is one of the best TED Talks for addiction.
Excerpt:What really causes addiction — to everything from cocaine to smart-phones? And how can we overcome it? Johann Hari has seen our current methods fail firsthand, as he has watched loved ones struggle to manage their addictions. He started to wonder why we treat addicts the way we do — and if there might be a better way.
As he shares in this deeply personal talk, his questions took him around the world, and unearthed some surprising and hopeful ways of thinking about an age-old problem.
8. Great Leaders Do What Drug Addicts Do | Michael Brody-Waite (2018)
An 19-minute talk from Michael Brody-Waite, entrepreneur and addict in recovery.
Excerpt:This is my story from drug addiction and homelessness to founding and leading a company on the Inc 500 list. There are 3 principles that saved me from death and set me apart as a leader. They are small enough to fit in your pocket, yet big enough to change your life. The best part is that anyone can take these principles and immediately implement them after watching this talk.
9. The Harm Reduction Model of Drug Addiction Treatment | Mark Tyndall (2017)
This 17-minute video from Mark Tyndall about harm reduction and recovery is one of the best TED Talks for addiction treatment.
Excerpt:Why do we still think that drug use is a law-enforcement issue? Making drugs illegal does nothing to stop people from using them, says public health expert Mark Tyndall. So, what might work?
Tyndall shares community-based research that shows how harm-reduction strategies, like safe-injection sites, are working to address the drug overdose crisis.
10. How Childhood Trauma Affects Health Across a Lifetime | Nadine Burke Harris (2015)
16-minute talk by Dr. Nadine Burke Harris on the impact of trauma.
Excerpt:Childhood trauma isn’t something you just get over as you grow up. Pediatrician Nadine Burke Harris explains that the repeated stress of abuse, neglect and parents struggling with mental health or substance abuse issues has real, tangible effects on the development of the brain.
This unfolds across a lifetime, to the point where those who’ve experienced high levels of trauma are at triple the risk for heart disease and lung cancer.
11. Let’s Quit Abusing Drug Users (2015)
19-minute video clip about addiction and recovery reform from Dr. Carl Hart. He discusses drug use in the context of poverty, social injustice, and ignorance. An excellent video for generating discussion and one of the best TED Talks for addiction and policy reform.
Excerpt:Carl Hart, Associate Professor of Psychiatry and Psychology at Columbia University, offers a provocative, evidence-based view of addiction and discusses how it should impact drug policy.
12. The Merits of Harm Reduction | Melissa Byers (2019)
14-minute video clip from Melissa Byers about addiction, harm reduction, and recovery.
Excerpt: Melissa shares her family’s personal story of addiction and how harm reduction plays a much more significant role to recovery than people realize.
13. Nuggets (2015)
A 5-minute cartoon clip of a kiwi bird who tastes a golden “nugget.” This simple animation doesn’t require words to send a powerful message about addiction. Hauntingly accurate.
14. The Power of Addiction and The Addiction of Power | Gabor Maté (2012)
This 19-minute speech delivered by Gabor Maté is one of the best TED Talks for addiction.
Excerpt:Canadian physician Gabor Maté is a specialist in terminal illnesses, chemical dependents, and HIV positive patients. Dr. Maté is a renowned author of books and columnist known for his knowledge about attention deficit disorder, stress, chronic illness and parental relations.
15. Recover Out Loud | Tara Conner (2017)
One of the best TED Talks for addiction, this 10-minute video clip from former Miss USA, Tara Conner, is all about her personal experience with substance use.
Excerpt:Tara Conner, Miss USA 2006, shares her life-long struggle with addiction and what she has learned from 10 years of sobriety. Addicts are not bad people that need to get good, but sick people that need to get well.
In this challenging and at times humorous talk, she calls for a different response to the addiction crisis.
16. Revitalize | Living With Addiction | Amber Valletta (2015)
16-minute inspirational talk delivered by Amber Valletta.
Excerpt:Supermodel, actress, and fashion icon Amber Valletta opens up for the first time about her daily struggle of living with addiction.
17. Rewriting the Story of My Addiction | Jo Harvey Weatherford (2015)
10-minute video clip from Jo Harvey Weatherford about her personal recovery journey.
Excerpt:Jo Harvey Weatherford develops and implements drug and alcohol prevention programs on the campus of The University of Nevada. In this candid talk she discusses the importance of the stories we tell ourselves about our behavior, and how she rewrote her own story of addiction to alcohol.
18. The Stigma of Addiction | Tony Hoffman (2018)
This 15-minute video from Tony Hoffman is one of the best TED Talks for addiction. He shares about his substance use and stigma.
Excerpt:There is a stigma which many assign to drug addicts, even long after they have overcome their addiction. Tony discusses how his first time smoking marijuana led to his eventual drug addiction, homelessness, prison, and finally redemption.
For Families – The Island of Insanity: Navigating Through Loved Ones’ Addictions | Karen Perlmutter (2022)
A powerful 13-minute video for anyone who is traumatized by the addiction of a loved one.
Excerpt: With a master’s degree in clinical social work, Karen has seen first-hand that addiction is a tragedy with a profound effect on the family. She has ideas on how we can support families in combatting the devastating effects of this disease After earning her undergraduate degree through the University of South Carolina in 2003, Karen began working with teens and families through a therapeutic foster care agency. She pursued higher education in the field, earning her Master’s in Clinical Social Work at the University of North Carolina (Wilmington) in 2007, and continuing on to becoming a Licensed Independent Social Worker.
Karen has over a decade of experience working as a therapist with individuals, couples, and families. She specializes in the treatment of substance abuse and mental illness, and has developed a particular interest in supporting the holistic needs of families who are affected by these struggles.
Despite a large body of scientific research, myths and misconceptions about addiction remain prevalent in today’s society, contributing to stigma, barriers to treatment, and higher health burdens. The following is a list of common misconceptions.
Fact: Addiction is widely recognized as a primary disorder of the brain. According to the American Society of Addiction Medicine, “Addiction is a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences. People with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences.” Heavy and continuous use of drugs/alcohol damages the brain, increasing the likelihood of addiction.
Despite this, choice can play a role in long-term sobriety, similar to how lifestyle decisions (i.e. treating symptoms, exercising, eating well, etc.) play a role in the management of other chronic illnesses such as diabetes or heart disease.
2. Misconception: Addiction is a character flaw or weakness.
Fact: The idea that addiction is a moral failing is based on the moral model of addiction. The reality is that addiction has little to do with moral conviction; both inherently “good” and “bad” people are susceptible to developing a substance use disorder.
That being said, a person in active addiction may act in contrast to their values; but that doesn’t mean they’re morally flawed. The moralization of addiction and associated stigma only contribute to guilt, shame, and a decreased willingness to seek treatment.
3. Misconception: Addiction is the result of a lack of willpower (and if someone “wanted it enough,” they would quit).
Fact: Like other chronic illnesses, addiction cannot be “willed” away. Individuals with substance use disorders are not compromised in willpower or lacking in self-discipline.
“The mentality and behavior of drug addicts and alcoholics [are] wholly irrational until you understand that they are completely powerless over their addiction and unless they have structured help, they have no hope.”
Russell Brand
4. Misconception: Some people have “addictive personalities.”
Fact: The truth is that every personality “type” is prone to addiction; we’re all biologically wired for addiction since our thoughts/behaviors are influenced by the brain’s reward system. Risk factors, not personality traits, are linked to the development of a substance use disorders. Risk factors may include biological influences (including genetics and differences in brain receptors), environmental influences, age of first use, and method of use.
5. Misconception: Many people use trauma as an “excuse” for using drugs/alcohol.
Fact: While relapse is relatively common, it doesn’t have to be a part of recovery. There are many contributing factors, both biological and environmental (i.e. stressors), that increase the chances of relapse.
Successful relapse prevention plans involve the avoidance and/or management of risk factors. Also, the less severe the addiction, the more likely someone is to avoid relapse altogether.
7. Misconception: Abstinence is the only path to recovery.
Fact: Recovery is not one-size-fits-all. For some, abstinence may be the only acceptable route, but for others, a reduction in use or the use of a less harmful substance is the desired outcome.
8. Misconception: You have to attend 12-step meetings and work the steps to get sober.
Fact: While AA and NA are often part of sustained sobriety, they are not the only way to stop using drugs or alcohol. Alternative evidence-based treatments for addiction include cognitive behavioral therapy, medication, family therapy, and group therapy.
9. Misconception: You have to be “ready” to stop using in order for treatment to work.
Fact: Addiction is characterized by ambivalence (i.e. you want to get sober and at the same time, you want to get high). Motivation comes and goes. A person may enter treatment with no intention of quitting, and then undergo a significant transformation. Or, someone may feel 100% ready to stop only to later change their mind. Ambivalence is normal.
That being said, the consequences of addiction (or costs of using) are oftentimes what tip the motivational balance, leading to increased motivation.
“When you can stop, you don’t want to, and when you want to stop, you can’t.”
Luke Davies
10. Misconception: You have to want recovery for yourself before you can get sober.
Fact: External motivators (i.e. the threat of losing a job, divorce, legal consequences, etc.) frequently precipitate treatment, and motivation is then internalized during treatment.
Research indicates that success rates of mandated treatment are similar to voluntary treatment; moreover, mandatory treatment is associated with increased rates of completion.
11. Misconception: You have to hit “rock bottom” before you can recover.
Fact: Sustained sobriety can be attainedwithout experiencing severe consequences. While the costs of using are often what motivates someone to get sober, there’s no rule that you have to “bottom out” first. This misconception can be deadly; you may die waiting (or death may be your “rock bottom”).
“Remember that just because you hit bottom doesn’t mean you have to stay there.”
Robert Downey, Jr.
12. Misconception: If you’re receiving medication-assisted treatment (MAT), you aren’t really sober.
13. Misconception: Needle exchange programs and safe injection sites enable continued use.
Fact: Harm reduction methods reduce HIV/HCV infections and decrease overdose deaths. According the the CDC, “the majority of syringe services programs (SSPs) offer referrals to medication-assisted treatment, and new users of SSPs are five times more likely to enter drug treatment and three times more likely to stop using drugs than those who don’t use the programs.” SSPs are proven and effective, and aren’t linked to increased drug use or crime.
14. Misconception: Narcan enables continued use.
Fact:Narcan (an opioid reversal medication) enables life. It gives someone a chance for recovery.
15. Misconception: “Once an addict, always an addict.”
Fact: Having a substance use disorder increases your chances of becoming addicted to other substances, but the belief that you’ll forever be an “addict” can be counterproductive or harmful. People grow and change, and may stop viewing themselves as “addicts” when they leave the lifestyle behind.
The belief that “once an addict, always an addict” also depends on the recovery model you subscribe to; for example, AA/NA principles support the idea of the “lifelong addict,” but those who believe in other models may prefer to call themselves “ex-addicts” or simply say, “I don’t drink.”
“Though no one can go back and make a brand new start, anyone can start from now and make a brand new ending.”
JS is a certified substance abuse counselor who works at a residential treatment center in northern Virginia. The following article is about his work, thoughts on relapse, what it’s like to lose a client, stigma, and valuable advice for anyone considering a career in addiction counseling.
JS works at an intermediate-length residential center for adults with substance use and mental health disorders. The clients live in shared dorms and adhere to a daily schedule that includes counseling, psychoeducation, groups, 12-step meetings, and medication therapy.
Once a client successfully completes the inpatient portion of treatment, they transition to “re-entry.” In re-entry, clients reside in sober living homes and receive continuing care services. They are able to look for employment, start working, and “re-enter” the larger community. JS provides counseling and support services for this component.
Inspired to help
JS has personal experience with addiction. “I am a person in recovery… About a decade ago I found myself in a very dark place and had to get help… I met a substance abuse counselor [who] changed my life. He educated me, engaged me, and challenged me. He was instrumental in turning my life around.”
With his counselor’s encouragement and support, JS made the decision to get back on track. He realized that he wanted to help others who struggled. “My own experiences with addiction allow me to have an incredibly deep empathy for the clients I serve and the fulfillment I receive in return is unreal.”
“Addiction does not discriminate”
JS works with people from all walks of life. He’s worked with individuals who are homeless to young fathers to successful businessmen; from people in their teens to adults in their late 80’s. “There is no age, sex, gender, race, sexual orientation, religion, occupation, or economic class that is safe from addiction.”
As for the substances abused, the list is never ending, but JS regularly sees people addicted to alcohol, opiates (including heroin), cocaine, methamphetamine, and PCP. Many of the clients he counsels also have mental illness such as depression, anxiety, or bipolar disorder.
No typical days
According to JS, “typical” days don’t exist where he works. “There is no way to describe a typical day in this field. One day I could be [providing therapy] and another day could involve a trip to the emergency room or helping out with chores… I never know what to expect and I never get bored.”
Effective treatment planning is important for substance abuse counselors; JS meets with his clients to develop an individualized service plan. Clients come up with their own goals, and JS supplies interventions to help them achieve their goals over the next couple of months.
According to JS, client goals vary, ranging from attending 12-meetings to obtaining a driver’s license to enrolling in school; basically, a goal can be any life skill a person may need for success. Corresponding interventions could include providing bus tokens to get to AA meetings, linking to driving school, and helping to fill out college applications and apply for financial aid.
JS explained that adults who have been incarcerated or dealing drugs for a living miss out on major milestones such as learning to drive, attending college, renting an apartment, etc. Furthermore, basic skills that many of us take for granted, such as filling out an online form or depositing a check can be overwhelming for someone newly in recovery who never learned how.
JS meets with his clients at least once per week for therapy sessions. I asked what comes up in a typical session and his response was “anything and everything.” Sessions may involve reviewing goals, learning coping skills, poop jokes (his clients are all men), or processing childhood trauma.
Substance abuse and relapse
“Not good” was JS’s response when I asked what the success rate was for someone who completes re-entry. He explained that this is a reflection of the general rates of recovery in substance abuse, which are low. “It can be disheartening, working with someone for months and when they leave, they relapse in less than a week.”
JS explained that while relapse is a deterrent to the field for some counselors, he sees it differently. “For me, it will never be a deterrent. My battle with addiction was not easy, nor was it accomplished in a single attempt. Relapse is a part of my story. I would not be here if people gave up or lost hope that I could get better. For that, I will never give up or lose hope that my clients can recover, no matter how many times they relapse.”
For JS, losing a client, not relapse, is the hardest part of the job. “I’ve worked with many clients who didn’t make it. I’ve lost clients to overdose, suicide, and homicide. It never gets easier.”
JS grieves for his lost clients. “I find myself wading through the stages of grief until I reach some level of acceptance.”
What everyone needs to know about substance abuse
“The people I work with are just people. They are your sister, your cousin, your neighbor, or the guy in line at the grocery store. They are people with families, jobs, hobbies, and dreams.”
JS discussed ignorance and stigma; he shared that individuals with substance use disorders are often subjected to mistreatment, even from professionals in the field. “There are substance abuse counselors who perpetuate harmful addiction myths, once widely accepted as fact, but discredited by the scientific community decades ago.”
“The lack of compassion when it comes to substance abuse is mindboggling and painful to encounter. Often, it stems from a lack of understanding or knowledge about substance abuse and those with substance use disorders. They are just people who are struggling with something far beyond their control. And those in treatment? They are just people trying to get better. And in case I didn’t make it clear; they are just people.”
Advice for new substance abuse counselors
“Be willing to learn. The field of addiction treatment is constantly changing. Standard practices from 20 years ago are now ineffective and outdated. If you want to do this work, be open to learning the newest treatment models, medications, and research on addiction. This field is not static, and we do our clients a major disservice when we quit learning.”
As a last piece of advice, JS suggested self-care for substance abuse counselors as a way to combat burnout. “Identify ways to decompress. This job is not easy. Some of the people you help will die. Compassion fatigue is a real thing and you must take care of yourself to care for others.”
As a counselor, you probably have a few “go-to” therapy metaphors that you use in sessions. For example, the “airplane oxygen mask” metaphor is a powerful analogy that demonstrates the significance of meeting your own needs before attempting to help others.
Another example of a therapy metaphor is the “rearview mirror” analogy. If you’re driving, and your entire concentration is on what’s behind you, you’ll crash. Good drivers, in contrast, focus ahead, but also regularly check the rearview mirror. The “rearview mirror” metaphor effectively illustrates how recovery from drugs and alcohol requires learning from, but not dwelling on, past mistakes and regrets.
Powerful Therapy Metaphors: Analogies in Counseling
The following is a list of helpful therapy metaphors and analogies for growth, self-care, emotions, addiction, grief, counseling, and life.
Forming a new habit is like carving a path in the jungle. You trod through the undergrowth and take the same route over and over again, until a clear path is formed. Meanwhile, older pathways become overgrown and wild, disappearing from sight with unuse.
A habit forms the way water carves a new stream or river.
You can’t see the grass growing, but after a week or so, you can see that the lawn needs mowing.
You can’t pour from an empty cup.
Mind the “check engine” light in your car. It indicates that something is wrong; if you ignore it, the problem will likely become worse. The longer you ignore internal cues, the greater the damage to your “car.”
A plant requires the right amount of water, sunlight, and fertilizer to grow and thrive.
You are a battery that needs to be recharged every so often.
Metaphors for Emotions
Our emotions are like a thermometer in the window. You can see clouds or rain or sun, but without a thermometer, you won’t know if it’s 90 degrees or 17 below. Emotions impact how you experience the outside world.
Life is like a heart monitor; there are ups and downs. If it goes flat, you’re dead.
The more you bottle up your emotions, the more likely you are to explode.
Repressing anger is like stuffing trash in a garbage can. Eventually, it’s going to spill over if you don’t take out the trash.
When you resent someone, it’s like drinking poison and expecting them to die.
Anxiety is a hungry monster that gets bigger when you feed it.
Worrying is like riding a stationary bike; you can peddle as hard as you can, but you’ll never get anywhere.
Therapy Metaphors for Addiction
Addiction is a disease of the soul.
When you’re in active addiction, you’re a shadow of yourself.
Addiction is like being in a toxic relationship. It’s all-consuming, lust-worthy, and even thrilling at times… but at the cost of your health and well-being. You have to break up in order to move on with your life.
Addiction is like a tornado, ravaging everything in its path. After the storm, it’s time to rebuild. It won’t look exactly the way it did before the tornado hit… but there’s potential for things to be even better.
Addiction is like other chronic health conditions in that there’s no cure, but it’s 100% manageable with treatment and lifestyle changes.
The longer you sit and stare at a plate of cookies, the more likely you are to give in to temptation. Set yourself up for success by avoiding triggers when possible.
If you hang out in a barber shop long enough you’ll end up getting a haircut.
Temptation is like a muscle that grows weaker with use until it finally gives out.
Living life without drugs or alcohol is like any skill; you first learn how to do it and then you have to practice. You may slip up, but don’t give up; learn from your mistakes. You can’t excel at anything without practice.
Cravings are like waves; ride them out until the wave recedes.
Attempting to save someone from drowning is dangerous. In their frantic efforts for oxygen, they’ll claw over and push the person trying to help underwater. This is an unconscious survival instinct. When your loved one is in active addiction, they’ll fight anyone and anything that gets in their way of a gulp of air.
Metaphors for Grief
Grief is a deep wound that takes time to heal. The wound is raw and painful, but will eventually scab over, although leaving behind a permanent scar.
Every person you lose takes a little piece of you with them.
Metaphors for Counseling
Going to therapy is akin to filling your toolbox with tools.
In a car, your therapist is a passenger in the front seat, but you’re behind the wheel. A passenger offers assistance with reading the map and providing directions, but it’s up to you to choose the turns you’ll take, and ultimately, the destination.
A counselor doesn’t provide the answers, but offers the tools to find them.
Going to therapy is like going to the gym; you may feel sore and you won’t see immediate effects, but the long-term results are gratifying and well-worth the investment.
Therapy Metaphors for Life
Problems in life are like bad smells; you can attempt to mask them or cover them up, but you have to remove the source before they can truly go away.
You can’t choose the canvas or paint in life, but you decide the picture you’ll paint.
Your life is a book with many chapters and pages. Every day is a new page. You write your own story.
Life is like a “choose your own adventure” book. You make decisions, but you can’t always predict the outcome.
Sometimes you’re dealt a really sh**** hand. How are you going to play your cards?
The only difference between a rut and a grave are the dimensions.
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19 Powerful Memoirs About Mental Illness & Addiction
UPDATED MAY 22, 2021
1. The Big Fix: Hope After Heroin (2017) by Tracey Helton Mitchell
Amazon Description: “After surviving nearly a decade of heroin abuse and hard living on the streets of San Francisco’s Tenderloin District, Tracey Helton Mitchell decided to get clean for good.
With raw honesty and a poignant perspective on life that only comes from starting at rock bottom, The Big Fix tells her story of transformation from homeless heroin addict to stable mother of three—and the hard work and hard lessons that got her there. Rather than dwelling on the pain of addiction,Tracey focuses on her journey of recovery and rebuilding her life, while exposing the failings of the American rehab system and laying out a path for change. Starting with the first step in her recovery, Tracey re-learns how to interact with men, build new friendships, handle money, and rekindle her relationship with her mother, all while staying sober, sharp, and dedicated to her future.
A decidedly female story of addiction, The Big Fix describes the unique challenges faced by women caught in the grip of substance abuse, such as the toxic connection between drug addition and prostitution. Tracey’s story of hope, hard work, and rehabilitation will inspire anyone who has been affected by substance abuse while offering hope for a better future.”
2. Come Back: A Mother and Daughter’s Journey Through Hell and Back (2008) by Claire Fontaine & Mia Fontaine
Amazon Description: “In powerful parallel stories, mother and daughter give mesmerizing first-person accounts of the nightmare that shattered their family and the amazing journey they took to find their way back to each other. Claire Fontaine’s relentless cross-country search for her missing child and ultimate decision to force her into treatment in Eastern Europe is a gripping tale of dead ends, painful revelations, and, at times, miracles. Mia Fontaine describes her refuge in the seedy underworld of felons and addicts as well as the jarring shock of the extreme, if loving, school that enabled her to overcome depression and self-loathing. Both women detail their remarkable process of self-examination and healing with humor and unsparing honesty.
Come Back is an unforgettable true story of love and transformation that will resonate with mothers and daughters everywhere.”
3. Drinking: A Love Story (1997) by Caroline Knapp
Amazon Description: “It was love at first sight. The beads of moisture on a chilled bottle. The way the glasses clinked and the conversation flowed. Then it became obsession. The way she hid her bottles behind her lover’s refrigerator. The way she slipped from the dinner table to the bathroom, from work to the bar. And then, like so many love stories, it fell apart. Drinking is Caroline Kapp’s harrowing chronicle of her twenty-year love affair with alcohol.”
4. A Drinking Life: A Memoir (1994) by Pete Hamill
Amazon Description: “Hamill explains how alcohol slowly became a part of his life, and how he ultimately left it behind. Along the way, he summons the mood of an America that is gone forever, with the bittersweet fondness of a lifelong New Yorker.”
5. Drunk Mom: A Memoir (2014) by Jowita Bydlowska
Amazon Description: “Three years after giving up drinking, Jowita Bydlowska found herself throwing back a glass of champagne like it was ginger ale. It was a special occasion: a party celebrating the birth of her first child. It also marked Bydlowska’s immediate, full-blown return to crippling alcoholism.
In the gritty and sometimes grimly comic tradition of the bestselling memoirs Lit by Mary Karr and Smashed by Koren Zailckas, Drunk Mom is Bydlowska’s account of the ways substance abuse took control of her life—the binges and blackouts, the humiliations, the extraordinary risk-taking—as well as her fight toward recovery as a young mother. This courageous memoir brilliantly shines a light on the twisted logic of an addicted mind and the powerful, transformative love of one’s child. Ultimately it gives hope, especially to those struggling in the same way.”
6. Dry: A Memoir (2003) by Augusten Burroughs
Amazon Description: “You may not know it, but you’ve met Augusten Burroughs. You’ve seen him on the street, in bars, on the subway, at restaurants: a twentysomething guy, nice suit, works in advertising. Regular. Ordinary. But when the ordinary person had two drinks, Augusten was circling the drain by having twelve; when the ordinary person went home at midnight, Augusten never went home at all. Loud, distracting ties, automated wake-up calls and cologne on the tongue could only hide so much for so long. At the request (well, it wasn’t really a request) of his employers, Augusten lands in rehab, where his dreams of group therapy with Robert Downey Jr. are immediately dashed by grim reality of fluorescent lighting and paper hospital slippers. But when Augusten is forced to examine himself, something actually starts to click and that’s when he finds himself in the worst trouble of all. Because when his thirty days are up, he has to return to his same drunken Manhattan life―and live it sober. What follows is a memoir that’s as moving as it is funny, as heartbreaking as it is true. Dry is the story of love, loss, and Starbucks as a Higher Power.”
7. Girl, Interrupted (1993) by Susanna Kaysen
Amazon Description: “Kaysen’s memoir encompasses horror and razor-edged perception while providing vivid portraits of her fellow patients and their keepers. It is a brilliant evocation of a “parallel universe” set within the kaleidoscopically shifting landscape of the late sixties. Girl, Interrupted is a clear-sighted, unflinching document that gives lasting and specific dimension to our definitions of sane and insane, mental illness and recovery.”
8. Go Ask Alice (1971) by Alice
Amazon Description: “It started when she was served a soft drink laced with LSD in a dangerous party game. Within months, she was hooked, trapped in a downward spiral that took her from her comfortable home and loving family to the mean streets of an unforgiving city. It was a journey that would rob her of her innocence, her youth—and ultimately her life.”
9. The Heroin Diaries: Ten Year Anniversary Edition: A Year in the Life of a Shattered Rock Star (2017) by Nikki Sixx
Amazon Description: “When Mötley Crüe was at the height of its fame, there wasn’t any drug Nikki Sixx wouldn’t do. He spent days—sometimes alone, sometimes with other addicts, friends, and lovers—in a coke- and heroin-fueled daze.
The highs were high, and Nikki’s journal entries reveal some euphoria and joy. But the lows were lower, often ending with Nikki in his closet, surrounded by drug paraphernalia and wrapped in paranoid delusions.
Here, Nikki shares the diary entries—some poetic, some scatterbrained, some bizarre—of those dark times. Joining him are Tommy Lee, Vince Neil, Mick Mars, Slash, Rick Nielsen, Bob Rock, and a host of ex-managers, ex-lovers, and more.
Brutally honest, utterly riveting, and surprisingly moving, The Heroin Diaries follows Nikki during the year he plunged to rock bottom—and his courageous decision to pick himself up and start living again.”
10. Lit: A Memoir (2010) by Mary Karr
Amazon Description: “Lit follows the self-professed blackbelt sinner’s descent into the inferno of alcoholism and madness–and to her astonishing resurrection. Karr’s longing for a solid family seems secure when her marriage to a handsome, Shakespeare-quoting blueblood poet produces a son they adore. But she can’t outrun her apocalyptic past. She drinks herself into the same numbness that nearly devoured her charismatic but troubled mother, reaching the brink of suicide. A hair-raising stint in ‘The Mental Marriott,’ with an oddball tribe of gurus and saviors, awakens her to the possibility of joy and leads her to an unlikely faith. Not since Saint Augustine cried, ‘Give me chastity, Lord-but not yet!’ has a conversion story rung with such dark hilarity. Lit is about getting drunk and getting sober, becoming a mother by letting go of a mother, learning to write by learning to live. Written with Karr’s relentless honesty, unflinching self-scrutiny, and irreverent, lacerating humor, it is a truly electrifying story of how to grow up–as only Mary Karr can tell it.”
11. Loose Girl: A Memoir of Promiscuity (2008) by Kerry Cohen
Amazon Description: “Loose Girl is Kerry Cohen’s captivating memoir about her descent into promiscuity and how she gradually found her way toward real intimacy. The story of addiction–not just to sex, but to male attention–Loose Girl is also the story of a young girl who came to believe that boys and men could give her life meaning.”
12. A Million Little Pieces (2005) by James Frey
Amazon Description: “At the age of 23, James Frey woke up on a plane to find his front teeth knocked out and his nose broken. He had no idea where the plane was headed nor any recollection of the past two weeks. An alcoholic for ten years and a crack addict for three, he checked into a treatment facility shortly after landing. There he was told he could either stop using or die before he reached age 24. This is Frey’s acclaimed account of his six weeks in rehab.”
13. My Fair Junkie: A Memoir of Getting Dirty and Staying Clean (2018) by Amy Dresner
Amazon Description: “Growing up in Beverly Hills, Amy Dresner had it all: a top-notch private-school education, the most expensive summer camps, and even a weekly clothing allowance. But at 24, she started dabbling in meth in San Francisco and unleashed a fiendish addiction monster. Soon, if you could snort it, smoke it, or have sex with it, she did.
Thus began a spiral that eventually landed her in the psych ward–and then penniless, divorced, and looking at 240 hours of court-ordered community service. For two years, assigned to a Hollywood Boulevard “chain gang,” she swept up syringes (and worse) as she bounced from rehabs to halfway houses, all while struggling with sobriety, sex addiction, and starting over in her forties. In the tradition of Orange Is the New Black and Jerry Stahl’s Permanent Midnight, this is an insightful, darkly funny, and shamelessly honest memoir of one woman’s battle with all forms of addiction, hitting rock bottom, and forging a path to a life worth living.”
14. Parched: A Memoir (2006) by Heather King
Amazon Description: “In this tragicomic memoir about alcoholism as spiritual thirst, Heather King—writer, lawyer, and National Public Radio commentator—describes her descent into the depths of addiction. Spanning a decades-long downward spiral, King’s harrowing story takes us from a small-town New England childhood to hitchhiking across the country to a cockroach-ridden “artist’s” loft in Boston. Waitressing at ever-shabbier restaurants, deriving what sustenance she could from books, she became a morning regular at a wet-brain-drunks’ bar—and that was after graduating from law school. Saved by her family from the abyss, King finally realized that uniquely poetic, sensitive, and profound though she may have been, she was also a big-time mess. Casting her lot with the rest of humanity at last, she learned that suffering leads to redemption, that personal pain leads to compassion for others in pain, and, above all, that a sense of humor really, really helps.”
15. A Piece of Cake: A Memoir (2007) by Cupcake Brown
Amazon Description: “There are shelves of memoirs about overcoming the death of a parent, childhood abuse, rape, drug addiction, miscarriage, alcoholism, hustling, gangbanging, near-death injuries, drug dealing, prostitution, and homelessness.
Cupcake Brown survived all these things before she’d even turned twenty.
And that’s when things got interesting. . .
Orphaned by the death of her mother and left in the hands of a sadistic foster parent, young Cupcake Brown learned to survive by turning tricks, downing hard liquor, and ingesting every drug she could find while hitchhiking up and down the California coast. She stumbled into gangbanging, drug dealing, hustling, prostitution, theft, and, eventually, the best scam of all: a series of 9-to-5 jobs.
A Piece of Cake is unlike any memoir you’ll ever read. Moving in its frankness, this is the most satisfying, startlingly funny, and genuinely affecting tour through hell you’ll ever take.”
16. Prozac Nation: Young and Depressed in America (1994) by Elizabeth Wurtzel
Amazon Description: “Elizabeth Wurtzel writes with her finger in the faint pulse of an overdiagnosed generation whose ruling icons are Kurt Cobain, Xanax, and pierced tongues. In this famous memoir of her bouts with depression and skirmishes with drugs, Prozac Nation is a witty and sharp account of the psychopharmacology of an era for readers of Girl, Interrupted and Sylvia Plath’s The Bell Jar.”
17. Smashed: Story of a Drunken Girlhood (2005) by Koren Zailckas
Amazon Description: “Garnering a vast amount of attention from young people and parents, and from book buyers across the country, Smashed became a media sensation and a New York Times bestseller. Eye-opening and utterly gripping, Koren Zailckas’s story is that of thousands of girls like her who are not alcoholics—yet—but who routinely use booze as a shortcut to courage and a stand-in for good judgment.”
18. Tweak: Growing Up on Methamphetamines (2009) by Nic Sheff
Amazon Description: “Nic Sheff was drunk for the first time at age eleven. In the years that followed, he would regularly smoke pot, do cocaine and Ecstasy, and develop addictions to crystal meth and heroin. Even so, he felt like he would always be able to quit and put his life together whenever he needed to. It took a violent relapse one summer in California to convince him otherwise. In a voice that is raw and honest, Nic spares no detail in telling us the compelling, heartbreaking, and true story of his relapse and the road to recovery. As we watch Nic plunge into the mental and physical depths of drug addiction, he paints a picture for us of a person at odds with his past, with his family, with his substances, and with himself. It’s a harrowing portrait—but not one without hope.”
19. With or Without You: A Memoir (2014) by Domenica Ruta
Amazon Description: “Domenica Ruta grew up in a working-class, unforgiving town north of Boston, in a trash-filled house on a dead-end road surrounded by a river and a salt marsh. Her mother, Kathi, a notorious local figure, was a drug addict and sometimes dealer whose life swung between welfare and riches, and whose highbrow taste was at odds with her hardscrabble life. And yet she managed, despite the chaos she created, to instill in her daughter a love of stories. Kathi frequently kept Domenica home from school to watch such classics as the Godfather movies and everything by Martin Scorsese and Woody Allen, telling her, “This is more important. I promise. You’ll thank me later.” And despite the fact that there was not a book to be found in her household, Domenica developed a love of reading, which helped her believe that she could transcend this life of undying grudges, self-inflicted misfortune, and the crooked moral code that Kathi and her cohorts lived by.
With or Without You is the story of Domenica Ruta’s unconventional coming of age—a darkly hilarious chronicle of a misfit ’90s youth and the necessary and painful act of breaking away, and of overcoming her own addictions and demons in the process. In a brilliant stylistic feat, Ruta has written a powerful, inspiring, compulsively readable, and finally redemptive story about loving and leaving.”
