Movies for Addiction & Mental Health

(Updated 5/20/20) A list of movies about mental health and substance abuse – includes PDF printable discussion questions

By Cassie Jewell, M.Ed., LPC, LSATP

The following is a list of films that are appropriate to show in treatment settings. This post includes movie summaries and downloadable PDF handouts with questions for discussion. Please note that some of the films on this list are graphic and may not be appropriate for children or adolescents.

Hint: The handouts contain spoilers; do not provide until after the movie ends.


Ben Is Back (2018)

103 minutes (1 hour, 43 minutes), R-rating for language and drug use

Summary: Julia Roberts plays a mother, Holly, whose 19-year old son, Ben, surprises her by returning home for Christmas. Ben is newly in recovery; his addiction has placed a tremendous strain on the family in the past. Ben’s younger siblings are happy to see him, but Holly, fearing that he is not ready, is apprehensive. That evening, the family attends church. When they return, they find their home burglarized and the dog missing. Ben blames himself, believing someone from his past took the dog to get his attention; he leaves to look for the dog. Holly goes with him, but they’re later separated, and Holly attempts to track Ben. Eventually, she ends up at an abandoned barn where she finds her son on the floor, unresponsive. The movie ends with her administering Narcan to Ben.

Girl, Interrupted (1999)

127 minutes (2 hours, 7 minutes), R-rating for strong language and content relating to drugs, sexuality, and suicide

Summary: Winona Ryder plays Susanna, a young woman with borderline personality disorder, who is sent to a psychiatric hospital after a suicide attempt in the late 1960s. She befriends Lisa (Angelia Jolie), who carries a diagnosis of sociopathy (antisocial personality disorder). Initially, Susanna is in denial about her mental condition and is not open to treatment. However, she reaches a turning point after a tragedy.

Pay It Forward (2000)

123 minutes (2 hours, 3 minutes), PG-13 rating for mature thematic elements including substance abuse/recovery, some sexual situations, language, and brief violence

Summary: Trevor (Haley Joel Osment) starts a chain reaction of goodness for a social studies project with a plan to change the world for the better. In this film, Trevor is a high school student whose mother, Arlene (Helen Hunt), struggles with alcoholism and whose father is abusive. He rises above unfortunate circumstances with the kindhearted idea to do a good deed, but instead of requesting payback, asking the receiver to “pay it forward” to at least three people – and on and on. While the movie has a bittersweet end, the message is uplifting and powerful.  

The Perks of Being a Wallflower (2012)

103 minutes (1 hour, 43 minutes), PG-13 rating

Summary: Charlie is an unpopular high school freshman, a “wallflower,” who is befriended by two seniors, Patrick and Sam (Emma Watson). The movie is about their friendship and Charlie’s personal struggles with the recent suicide of his friend and his own mental illness. Throughout the film, Charlie has flashbacks of his aunt, who died in a car accident when he was 7. It’s eventually revealed that Charlie’s aunt molested him; a sexual encounter with Sam triggers Charlie’s repressed memories. Charlie has a mental breakdown.

Rachel Getting Married (2008)

113 minutes (1 hour, 54 minutes), R-rating for language and brief sexuality

Summary: Anne Hathaway plays Kym, a troubled young woman, who returns from rehab to her family home for her sister’s wedding. The film portrays how Kym’s addiction has placed strain on the family.

When a Man Loves a Woman (1994)

126 minutes (2 hours, 6 minutes), R-rating for language

Summary: Meg Ryan plays Alice, a woman with an alcohol use disorder. The film is about how Alice’s addiction impacts her family and how she recovers.

Bonus: The Netflix original films Heroin(e) (2017) and Recovery Boys (2018) have PDF discussion guides with a summary, questions, and resources posted on the Recovery Boys website.


Other great resources for using clinical films as therapeutic interventions include the book Movies & Mental Illness: Using Films to Understand Psychopathy, 4th ed. (by Danny Wedding and Ryan M. Niemiec) and the site Teach With Movies.

Sites with Free Therapy Worksheets & Handouts

(Updated 5/4/20) A list of sites with free printable resources for mental health clinicians and consumers

By Cassie Jewell, M.Ed., LPC, LSATP

If you’re a counselor or therapist, you’re probably familiar with Therapist Aid, one of the most well-known sites providing free printable worksheets. PsychPoint and Get Self Help UK are also great resources for cost-free handouts, tools, etc. that can be used with clients or for self-help.

When I started blogging, I realized just how much the Internet has to offer when it comes to FREE! That being said, I’ve learned the term free is often misleading. There are gimmicky sites that require you to join an email list in order to receive a free e-book, PDF printables, etc.; I don’t consider that free since you’re making an exchange. I also dislike and generally avoid sites that bombard with ads. A third “free-resource” site that’s deceiving is the site with no gimmicks or ads, but turns out to be nothing more than a ploy to get you to buy something.

For this post, I avoided misleading sites and instead focused on government agencies, educational institutions, and nonprofits. I found some sites that offered a variety of broad-topic PDF resources and others that had fewer, but provided specialized tools. See below for links to over 50 sites with free therapy worksheets and handouts for both clinicians and consumers.

(Click here for free worksheets, handouts, and guides posted on this site.)

Please check back frequently; I update regularly.

Mental Health & Addiction (Sites with Worksheets/Handouts on a Variety of Topics)

91 Free Counseling Handouts | Handouts on self-esteem, emotions, recovery, stress, and more

A Change in Thinking: Self-Help Library | A large collection of worksheets and handouts on communication, relationships, depression, and more

A Good Way to Think: Resources | Worksheets and handouts on happiness, well-being, values, etc.

Articles by Dr. Paul David | Clinical handouts on depression, relationships, substance use disorders, family issues, etc.

ASI-MV Worksheets & Handouts | Addiction and recovery handouts

Belmont Wellness: Psychoeducational Handouts, Quizzes, and Group Activities | Printable handouts on assertiveness, emotional wellness, stress management, and more

Black Dog Institute: Clinical Resources | Download fact sheets, handouts, mood trackers, and more on a variety of mental health topics

Brene Brown: Downloads and Guides | Resources for work, parenting, the classroom, and daily life

Bryan Konik | Therapist & Social Worker: Free Therapy Worksheets | A collection of worksheets on stress management, anxiety, relationships, goal setting, and trauma

Cairn Center: Resources | A modest collection of printable assessments, handouts, and worksheets on DBT, anxiety, depression, etc.

Client Worksheets from Treatment for Stimulant Use Disorders (Treatment Improvement Protocols Services) | 44 client worksheets on addiction and recovery

Cornell Health: Fact Sheet Library | A variety of handouts and tracking sheet on various health topics; only a few relate to mental health and addiction

Daniel J. Fox, Ph.D.: Forms, Presentation Slides, and Worksheets | Topics include anger, emotions, borderline personality disorder, etc.

DOWNLOADS from Get Self Help | Free therapy worksheets and handouts on a variety of topics

Dr. Danny Gagnon, Ph.D., Montreal Psychologist: Self-Help Toolkits | Articles and handouts on worry, depression, assertiveness, etc.

EchoHawk Counseling: Materials and Resources | Articles, worksheets, and handouts on a variety of topics (boundaries, emotions, grief, stress, trauma, etc.)

Eddin’s Counseling Group: Worksheets | A short list of free worksheets and handouts

Faith Harper: Worksheets and Printables | A small collection of therapy worksheets and handouts, including a gratitude journal

Forward Ethos: Guide Sheets | Worksheets on mindfulness, anxiety, self-care, intimacy, relationships, and more

Free Stuff for Consumers and Professionals | A short list of downloads (Source: Jonathan S. Abramowitz, Ph.D.)

InFocus Resources | Family handouts on addiction

Lynn Martin | A short list of client handouts, including questionnaires

Mark R. Young, LMSW, LCSW (Resolving Concerns): Links & Forms | Links to factsheets, worksheets, assessments, etc.

Mental Health CE | Course content handouts on a variety of mental health topics

Motivational Interviewing Worksheets

My Group Guide: A Collection of Therapy Resources

Oxford Clinical Psychology: Forms and Worksheets | A large collection of therapy worksheets based on evidence-based practices

Peggy L. Ferguson, Ph.D.: Addiction Recovery Worksheets | A modest collection of handouts/worksheets for addiction and recovery

PsychPoint: Therapy Worksheets

Self-Help Exercises from Gambling Therapy

Self-Help Reading Materials | Links to handouts on self-help topics (Source: Truman State University)

Self-Help Tools from Mental Health America | Links to assessments, worksheets, handouts, and more

Sleep and Depression Laboratory: Resources | A small collection of worksheets related to sleep, worry, and depression

SMART Recovery Toolbox | Addiction and recovery resources

The Stages of Change | A 7-page PDF packet (Source: Virginia Tech Continuing and Professional Education)

Step Preparation Worksheets | (Source: treatmentguide4u.com)

Substance Abuse | A 13-page PDF packet

Taking The Escalator: Therapy Tools | Handouts on addiction and recovery

Therapist Aid | Free therapy worksheets

Therapy Worksheets | A therapy blog with links to free worksheets on various mental health topics

Tools for Coping Series | A large collection of handouts on coping skills

Worksheets from A Recovery Story (Blog) | A small collection of addiction and recovery worksheets

Depression, Stress, & Anxiety

Alphabet of Stress Management and Coping Skills | Coping skills for every letter of the alphabet

Anxiety 101 | An 11-page PDF packet (Source: Michigan Medicine | University of Michigan)

Anxiety Canada: Free Downloadable PDF Resources | Anxiety worksheets for parents and self-help

Behavioral Activation for Depression | A 35-page packet

Coping with Anxiety and Panic Attacks: Some Cognitive Behavioural Self-Help Strategies | A 10-page packet

Creating Your Personal Stress Management Plan | A 10-page packet

Dr. Chloe: Worksheets for Anxiety Management | A small collection of worksheets and handouts

Panic Attack Worksheets (Inner Health Studio) | A 9-page PDF packet

Relaxation | A 15-page packet on relaxation skills for anxiety

Stress Management (Inner Health Studio) | A 5-page packet on stress management

UMASS Medical School Department of Psychiatry: Stress Management – Patient Handouts | A collection of handouts on stress management. Some of the other sections, including “General Health and Wellness” and “Nutrition” have links to handouts as well

Trauma & Related Disorders

Center for Sexual Assault & Traumatic Stress: Therapist Resources | More than just worksheets: client handouts, assessments, info sheets, toolkits, training resources, links, etc.

Child and Family Studies: Sex in the Family | An 8-page packet on shame and guilt in relation to child sexual abuse

Common Reactions to Trauma | A 1-page PDF handout

Detaching From Emotional Pain (Grounding) | A 12-page PDF packet (Source: Sunspire Health)

Grounding Exercises | A 2-page PDF handout

Grounding Techniques | A 1-page PDF handout from JMU Counseling Center

Grounding Techniques | A 2-page PDF handout

Healing Private Wounds Booklets | Religious handouts on healing from sexual abuse

Seeking Safety Resources | Printable worksheets on PTSD, substance abuse, and healthy relationships

Selected Handouts and Worksheets from: Mueser, K. T., Rosenberg, S. D., & Rosenberg, H. J. (2009). Treatment of Postraumatic Stress Disorder in Special Populations: A Cognitive Restructuring Program | A 13-page PDF packet

Trauma Research and Treatment: Trauma Toolkit A small collection of trauma handouts

Traumatic Stress: The Effects of Overwhelming Experience on the Mind and Body | A 12-page PDF packet (Source: Dan Metevier, Psy.D., Clinical Psychologist)

Wisconsin Hawthorn Project: Handouts & Worksheets | Handouts in English and Spanish

Psychosis

CBT for Psychosis & Trauma Handouts

Early Psychosis Intervention: Client Worksheets | Scroll down to the “Client Worksheets” section for links. Use with clients who are experiencing psychosis

Goal-Setting Worksheet for Patients with Schizophrenia | A 3-page PDF

List of 60 Coping Strategies for Hallucinations | A 2-page PDF

Treatment for Schizophrenia Worksheet Pack | A 6-page PDF packet

ACT, CBT, & DBT

ACT Mindfully: Worksheets, Book Chapters & ACT Made Simple | ACT worksheets and other free resources

Cognitive Therapy Skills | A 33-page packet

Carolina Integrative Psychotherapy | A small collection of DBT worksheets and handouts

Clinician Worksheets and Handouts: Clinician Treatment Tools | A variety of CBT, DBT, etc. therapy worksheets

CPT Web Resources | A short list of worksheets and handouts

DBT Peer Connections: DBT Handouts and Worksheets | DBT resources

DBT Self-Help | Printable lessons and diary cards

Dr. John Forsyth: Free Resources | Download two free packets of worksheets (ACT and mindfulness)

Living CBT: Free Self-Help | 20+ CBT worksheets

Lozier & Associates: Dialectical Behavior Therapy Printables – DBT Worksheets and DBT Handouts | A small collection of DBT handouts and worksheets

Printable Versions of CPT/CBT Worksheets | English and Spanish worksheets (Source: The F.A.S.T. Lab at Stanford Medicine)

Veronica Walsh’s CBT Blog: Free Downloadable Cognitive Behavioural Therapy Worksheets/Handouts | Print/use these worksheets only with blog author’s permission

Grief & Loss

Activities for Grieving Children | A 7-page PDF

Bereavement Handouts (Hospice & Palliative Care) | A small collection of handouts

The Center for Complicated Grief: Handouts | Assessments, handouts, and guides

A Child’s Understanding of Death | An 11-page packet

Handouts to Download and Print: One Legacy | Handouts on grief and loss

Loss and Grief Handouts

Loss, Grief, and Bereavement | A 35-page PDF packet

Grief Factsheets: My Grief Assist

Printable Grief and Loss Resources | A fairly extensive collection of printable handouts on grief and loss

Anger

Anger Inventory | A 7-page PDF packet

Anger Management | A 13-page PDF packet

Anger Management Techniques | A 4-page PDF

Dealing with Anger (Inner Health Studio) | A 7-page PDF packet

Free Anger Management Worksheets: Letting Go of Anger | A small collection of worksheets for anger management

Getting to Know Your Anger | A 42-page PDF packet

Love To Know: Free Anger Worksheets | 7 downloadable anger management worksheets

Steps for Change: Anger Management Worksheets

Self-Esteem

Confidence Activities | A 25-page PDF packet

Free Self-Esteem Worksheets

Growing Self-Esteem: Self-Esteem Worksheets

Improving Self-Esteem: Healthy Self-Esteem | A 10-page PDF packet

Self-Esteem Activities | A modest collection of handouts/activities for self-esteem

Self-Esteem Experts: Self-Esteem Activities | Printable handouts on self-esteem

Self-Esteem Printable Worksheets

Spiritual Self-Schema Development Worksheets: Yale School of Medicine

Values & Goal-Setting

10 Free Printable Goal-Setting Worksheets (from Parade)

Core Values and Essential Intentions Worksheet | A 2-page PDF worksheet

Core Values Clarification Exercise | A 4-page PDF worksheet

Core Values Worksheet | A 4-page PDF worksheet

Life Values Inventory | A 5-page printable PDF (Source: Brown, Duane and R. Kelly Crace, (1996). Publisher: Life Values Resources, pinnowedna@charter.net)

Personal Values Card Sort | A 9-page printable PDF (Source: W.R. Miller, J. C’de Baca, and D.B.Matthews, P.L., Wilbourne, University of New Mexico, 2001)

Values | A 2-page PDF worksheet

Values and Goals Worksheet | A 1-page PDF worksheet

Values Assessment Worksheet | A 2-page PDF worksheet

Values Exercise | A 2-page PDF worksheet

Values Identification Worksheet | A 6-page PDF worksheet (Source: Synergy Institute Online)

Values Inventory Worksheet | A 2-page PDF worksheet

What Are My Values? | A 4-page PDF worksheet from stephaniefrank.com

Children & Youth

A Child’s Understanding of Death | An 11-page packet

A Collection of Anger Management/Impulse Control Activities & Lesson Plans (PreK-3rd Grade) | A 64-page PDF packet

Activities for Grieving Children | A 7-page PDF

Cope-Cake: Coping Skills Worksheets and Game | A 30-page packet for young children/students

Crossroads Counseling Center: Resources | Handouts on depression, anxiety, ADHD, etc. in children

Curriculum Materials from Pennsylvania Child Welfare Resource Center | Links to handouts

The Helpful Counselor: 10 Awesome Behavior Management Resources | Worksheets to use with children

Myle Marks: Free Downloads | Worksheets for children

Prevention Dimensions: Lesson Plans | Downloadable PDF handouts for children from kindergarten to sixth grade (Source: Utah Education Network)

Printable Worksheets | Worksheets for children on physical activity, substance abuse, nutrition, and more (Source: BJC School Outreach and Youth Development)

Social Emotional Activities Workbook | A 74-page PDF packet

Social Skills Worksheets | A packet of worksheets to use with children/youth

Stress Reduction Activities for Students | Link to a 20-page packet (PDF)

Adolescents & Young Adults

Change To Chill | Worksheets and handouts for reducing stress in teens and young adults

Emotional Intelligence Activities for Teens Ages 13-18 | A 34-page PDF packet

Handouts: Eppler-Wolff Counseling Center (Union College) | Handouts for college students

Healthy Living (Concordia University) | Handouts and articles for college students

Just for Teens: A Personal Plan for Managing Stress | A 7-page PDF handout

Oregon State University: Learning Corner | Student worksheets on time management, wellness, organization skills, etc.

The Relaxation Room (Andrews University) | Self-care and stress management handouts for college students

Resilience Toolkit from Winona State University | PDF handouts for college students on resiliency

Self-Help Resources from Metropolitan Community College Counseling Services | Links to articles for college students on a variety of topics (not in PDF form)

Self-Help (Western Carolina University) | Handouts for college students

Step UP! Program Worksheets and Handouts | Worksheets/handouts for students on prosocial behavior and bystander intervention

Teens Finding Hope: Worksheets and Information to Download | Spanish and English PDFs available

Tip Sheets from Meredith College Counseling Center | Student tip sheets on anger, body image, relationships, and other topics

Tools & Checklists from Campus Mind Works | Handouts and worksheets for students

UC Berkeley University Health Services Resources | Links to handouts, articles, and self-help tools for students

UMatter | Tools for college students on wellness, communication, healthy relationships, and more (Source: Princeton University)

Western Carolina University Counseling and Psychological Services: Self-Help | A modest collection of student wellness handouts along with a printable self-help workbook

Your Life Your Voice (from Boys Town): Tips and Tools | Links to articles and PDF printables on a variety of topics for teens and young adults

Marriage/Relationships & Family

21 Couples Therapy Worksheets, Techniques, & Activities | From Positive Psychology

Articles for Parenting from MomMD | Links to various articles/handouts (not in PDF form)

Drawing Effective Personal Boundaries | A 2-page PDF handout (Source: liveandworkonpurpose.com)

Emotionally Focused Therapy: Forms for Couples | A list of forms to use in EFT couples counseling

Exercises for Forgiveness | A 7-page PDF for recovering from an emotional affair

Healthy Boundaries by Larry L. Winckles | A 3-page PDF handout

Healthy Boundaries Program | A 15-page PDF packet (Source: The University of Toledo Police Department)

Healthy Boundaries vs. Unhealthy Boundaries | A 6-page PDF handout (Source: kimsaeed.com)

Hope Couple: Counseling Resources | Assessments and worksheets from a Christian counseling site

Joy2MeU | A collection of articles by Robert Burney on relationships, codependency, and related topics (not in PDF form)

New Beginnings Family Counseling: Handouts | Click on “Resources” to view and download handouts on relationships, anxiety, and depression. You can also download relationship assessment tools

Pasadena Marriage Counseling: Free Marriage Counseling Resources | A small collection of worksheets for couples therapy

Relationship Counseling Forms | PDF forms for couples therapy (Source: Dan Metevier, Psy.D., Clinical Psychologist)

Signs of Unhealthy Boundaries | A 6-page PDF handout (Source: Healing Private Wounds)

Additional Worksheets & Handouts

8 Helpful “Letting Go of Resentment” Worksheets | Links to PDF worksheets

90-Day Health Challenge | Several health worksheets for download (Source: HealthyCampbell)

Acorns to Oaktrees: Eating Disorder Worksheets/Eating Disorder Forms | A small collection of handouts for eating disorders

Activity eBooks from Rec Therapy Today | A collection of downloadable workbooks on self-esteem, social skills, emotions, etc.

Alzheimer’s Association: Downloadable Resources | Handouts on Alzheimer’s

Attitudes and Behaviour | A 9-page PDF packet on criminal thinking

Commonly Prescribed Psychotropic Medications | A-page PDF (Source: NAMI Minnesota)

Conflict Resolution Skills | A 6-page PDF packet

Coping Skills | A 2-page PDF worksheet (Source: Temple University)

EDA Step Worksheets | From Eating Disorders Anonymous

Experiential Group Exercises for Shame-Resilience | A 4-page PDF packet with questions for discussion and group activities

Free Mindfulness Worksheets (Mindfulness Exercises) | A large collection of mindfulness handouts

Go Your Own Way | Downloads for veterans on various topics

Guilt vs. Shame Infographic: National Institute for the Clinical Application of Behavioral Medicine | Printable infographic to illustrate the differences

Handouts and Worksheets | A 21-page PDF packet with handouts and worksheets on selfe-care topics

Homework and Handouts for Clients: ACT With Compassion | Handouts and worksheets related to self-compassion

Integrated Health and Mental Health Care Tools | Downloadable resources from UIC Center

International OCD Foundation: Assessments & Worksheets | Handouts for use with individuals with OCD

Learning to Forgive: The 5 Steps to Forgiveness | A 6-page PDF handout from Thriveworks

Managing Emotional Intelligence | A 7-page PDF packet (Source: inclusiv.org)

Motivation To Change | A 16-page PDF packet on motivation to change criminal behavior

Peers & Relationships | A 12-page PDF packet on how associates impact criminal behavior

Personal Development: Workplace Strategies for Mental Health | Handouts on resilience, communication, etc.

Prochaska and DiClemente’s Stages of Change Model | A 4-page PDF handout

Quick Reference to Psychotropic Medication | Downloadable PDF chart from John Preston, Psy.D.

Radical Forgiveness: Free Tools | A small collection of worksheets on forgiveness

Reducing Self-Harm | A 5-page PDF

Self-Care and Wellness Resources | Printable handouts and tools (Source: irenegreene.com)

Self-Care Starter Kit from University at Buffalo School of Social Work | Handouts on self-care topics

Self-Directed Recovery | Downloadable resources from UIC Center

Shame Psychoeducation Handout | A 5-page PDF handout

Stages of Change: Primary Tasks | A 2-page PDF handout

Therapy Worksheets: ADHD ReWired | Thought records, behavior charts, and other tools

Understanding and Coping with Guilt and Shame | A 4-page PDF handout

Wellness Toolkits | Printable toolkits from NIH


Please contact me if a link is no longer valid or if you’d like to recommend a site!

Self-Care Strategies When Your Loved One Has an Addiction

Self-care is not a luxury; it’s necessary for survival when your loved one has a substance use disorder. By taking care of yourself, you gain the energy and patience to cope with your problems. Self-care promotes wellness and emotional intelligence; it puts you in a better space to interact with your loved one. Strategies include developing/building resilience, practicing distress tolerance, keeping perspective, and recognizing/managing your triggers.

By Cassie Jewell, M.Ed., LPC, LSATP

When your loved one has a substance use disorder (SUD), it can be overwhelming, distressing, and all-consuming. When we’re stressed, we forget to practice basic self-care, which in turn makes us even less equipped to cope with the emotional chaos addiction generates.  

In the book Beyond Addiction: A Guide for Families, the authors discuss the importance of self-care. This post reviews suggested strategies. (Side note: I strongly recommend reading Beyond Addiction if your loved one has an SUD or if you work in the field. This book will increase your understanding of addiction and teach you how to cope with and positively impact your loved one’s SUD by using a motivational approach. This is one of the best resources I’ve come across, especially for family members/significant others.)

Based on the premise that your actions affect your loved one’s motivation, taking care of yourself is not only modeling healthy behaviors, it’s putting you in a better space to interact with your loved one. Chronic stress and worry make it difficult to practice self-care. Self-care may even seem selfish. However, by taking care of yourself and thus reducing suffering, you gain the energy and patience to cope with your problems (and feel better too). Furthermore, you reduce the level of pain and tension in your relationships with others, including your loved one with a SUD. Self-care strategies include developing/building resilience, practicing distress tolerance, keeping perspective, and recognizing/managing your triggers. Therapy and/or support groups are additional options.

“An empty lantern provides no light. Self-care is the fuel that allows your light to shine brightly.”

Unknown

Resilience

The definition of resilience is “the capacity to recover quickly from difficulties” (Oxford Dictionary). Doctors Foote, Wilkens, and Kosanke wrote that having resilience is a way to “systematically reduce your vulnerability to bad moods, lost tempers, and meltdowns.” While you cannot “mood-proof” yourself entirely, resilience helps when facing life’s challenges, setbacks, and disappointments. To maintain resilience, one must practice at least the most basic self care practices, which are as follows:

  1. Eat well
  2. Sleep well
  3. Exercise enough
  4. Avoid mood-altering drugs (including alcohol)
  5. Treat illness (with prescribed medications, adequate rest, etc.)

Self-care is not something you can push in to the future. Don’t wait until you have more time or fewer obligations. Self-care is not a luxury; it’s a necessity. The authors of Beyond Addiction pointed out that self-care is something you have control over when other parts of your life are out of control. If you find it challenging to implement self-care practices, tap into your motivations, problem-solve, get support, and most of all, be patient and kind with yourself.

“Taking care of yourself is the most powerful way to begin to take care of others.”

Bryant McGill

Distress Tolerance

On tolerance, Doctors Foote, Wilkens, and Kosanke suggested that it is “acceptance over time, and it is a cornerstone of self-care.” Tolerance is not an inherent characteristic; it is a skill. And like most skills, it requires practice. However, it’s wholly worth the effort as it reduces suffering. By not tolerating the things you cannot change (such as a loved one’s SUD), you’re fighting reality and adding to the anguish.

Techniques for distress tolerance include distracting yourself, relaxing, self-soothing, taking a break, and creating positive experiences. (The following skills are also taught in dialectical behavior therapy (DBT), an evidence-based practice that combines cognitive behavioral therapy techniques and mindfulness. For additional resources, visit The Linehan Institute or Behavioral Tech.)    

Distract Yourself

  1. Switch the focus of your thoughts. The possibilities are endless; for you, this could mean reading a magazine, calling a friend, walking the dog, etc. The authors of Beyond Addiction suggested making a list of ideas for changing your thoughts (and keeping it handy).
  2. Switch the focus of your emotions. Steer your emotions in a happier direction by watching corgi puppies on YouTube, reading an inspirational poem, or viewing funny Facebook memes. The writers of Beyond Addiction suggested bookmarking sites in your Internet browser that you know will cheer you up.
  3. Switch the focus of your senses. This could mean taking a hot shower, jumping into a cold pool, holding an ice cube in your hand, walking from a dark room to one that’s brightly lit, looking at bright colors, listening to loud rock music, etc. Also, simply walking away from a distressing situation may help.
  4. Do something generous. Donate to your favorite charity, pass out sandwiches to the homeless, visit a nursing home and spend time with the residents, express genuine thanks to cashier or server, etc. By redirecting attention away from yourself (and directing energy toward positive goals), you’ll feel better. In Beyond Addiction, it’s noted that this skill is especially helpful for individuals who tend to ruminate. Also, it’s important to brainstorm activities that are accessible in the moment (i.e. texting a friend to let them know you’re thinking about them) that don’t take multiple steps (such as volunteering).

Relax

“Body tells mind tells body…” Relaxing your body helps to relax your mind. It also focuses your thoughts on relaxing (instead of your loved one’s addiction). What helps you to relax? Yoga? A hot bath? Mindful meditation? (I recommend doing a mindful body scan; it’s simple and effective, even for the tensest of the tense, i.e. me.)

Soothe Yourself

In Beyond Addiction, self-soothing is described as “making a gentle, comforting appeal to any of your five senses.” A hot beverage. Nature sounds. A cozy blanket. A scenic painting. Essential oils. A cool breeze. A warm compress. A massage. Your favorite song. Find what works for you, make a list, and utilize as needed. Seemingly small techniques can make a big difference in your life by creating comfort and reducing out-of-control emotions.

Take A Break

“Taking a break” doesn’t mean giving up; it’s a timeout for when you’re emotionally exhausted. Learn to recognize when you need to step away from a situation or from your own thoughts. Find a way to shift your focus to something pleasant (i.e. a romantic movie, a nature walk, a day trip to the beach, playing golf for a few hours, traveling to a different country, etc.)

Create a Positive Experience

Doctors Foote, Wilkens, and Kosanke refer to this as “making it better,” not in the sense that you’re fixing the problem (or your loved one), but that you’re making the moment better by transforming a negative moment into a positive one. Suggested techniques include the following:

  1. Half-smile. Another mind-body technique, half-smiling tricks your brain into feeling happier.
  2. Meditate or pray. As explained in Beyond Addiction, “meditation or pray is another word for – and effective channel to – awareness and acceptance. Either one can open doors to different states of mind and act as an emotional or spiritual salve in trying moments.”
  3. Move. By moving, you’re shifting your focus and releasing energy. Stretch, run, play volleyball, chop wood, move furniture, etc.
  4. Find meaning. The authors of Beyond Addiction wrote, “Suffering can make people more compassionate toward others. Having lived through pain, sometimes people are better able to appreciate moments of peace and joy.” Suffering can also inspire meaningful action. What can you do to find meaning?
  5. Borrow some perspective. How do your problems look from a different viewpoint? Ask a trusted friend. You may find that your perspective is causing more harm than good.

Perspective

Perspective is “an understanding of a situation and your reactions to it that allows you to step back and keep your options open… [it’s] seeing patterns, options, and a path forward” (Beyond Addiction).

When Trish married Dave nearly 20 years ago, he rarely drank: maybe an occasional beer over the weekend or a glass of wine at dinner. After their fist daughter was born, his drinking increased to a few beers most nights. Dave said it helped him relax and manage the stress of being a new parent. By the time their second daughter was born several years later, his drinking had progressed to a six-pack of beer every evening (and more on weekends). Currently, Dave drinks at least a 12-pack of beer on weeknights; if it’s the weekend, his drinking starts Friday after work and doesn’t stop until late Sunday night.

Dave no longer helps Trish with household chores or yardwork as he did early in their marriage. He rarely dines with the family and won’t assist with the cooking/cleanup; he typically eats in front of the TV. Dave occasionally engages with his daughters, but Trish can’t recall the last time they went on a family outing, and it’s been years since they went on a date. Dave struggles to get out of bed in the mornings and is frequently late to work; Trish is worried he’ll get fired. They frequently argue about this. Dave is irritable much of the time, or angry. Most nights, he doesn’t move from his armchair (except to get another beer) until he passes out with the television blaring.

Trish is frustrated; she believes Dave is lazy and lacks self-control. When she nags about his drinking, he promises he’ll cut back, but never follows through. Trish thinks he’s not trying hard enough. She can’t understand why he’d choose booze over her and the kids; sometimes she wonders if it’s because she’s not good enough… maybe he would stop if she was thinner or funnier or more interesting?  At times she feels helpless and hopeless and others, mad and resentful; she frequently yells at Dave. She wonders if things are ever going to change.  

A different perspective would be to recognize that Dave has an alcohol use disorder. He feels ill most of the time, which affects his mood, energy level, and motivation. He wants to cut back, but fails when he tries, which leads to guilt and shame. To feel better, he drinks. It’s a self-destructive cycle. If Trish understood this, she could learn to not take his drinking personally or question herself. Her current reactions, nagging and yelling, only increase defensiveness and harm Dave’s sense of self-worth. Alternative options for Trish might include learning more about addiction and the reasons Dave drinks, bolstering his confidence, and/or creating a supportive and loving environment to enhance motivation.

Triggers

In recovery language, a “trigger” is anything (person, place, or thing) that prompts a person with SUD to drink or use; it activates certain parts of the brain associated with use. For instance, seeing a commercial for beer could be triggering for a person with an alcohol use disorder.

You have triggers too. For example, if your loved one is in recovery for heroin, and you notice that a bottle of opioid painkillers is missing from the medicine cabinet, it could trigger a flood of emotions: fear, that your loved one relapsed; sadness, when you remember the agony addiction brings; hopelessness, that they’ll never recover. It’s crucial to recognize what triggers you and have a plan to cope when it happens.

Therapy and Support Groups

Lastly, therapy and/or support groups can be a valuable addition to your self-care regime. Seeing a therapist can strengthen your resilience and distress tolerance skills. Therapy may provide an additional avenue for perspective. (Side note: A good therapist is supportive and will provide you with tools for effective problem-solving and communication, coping with grief and loss, building self-esteem, making difficult choices, managing stress, overcoming obstacles, improving social skills/emotional intelligence, and better understanding yourself. A good therapist empowers you. A bad therapist, on the other hand, will offer advice and/or tell you what to do, disempowering you.)

Regarding support groups, there are many options for family members, friends, and significant others with a loved one who has a SUD, including Al-Anon, Nar-Anon, and Families Anonymous. Support groups provide the opportunity to share in a safe space and to receive feedback, suggestions, and/or encouragement from others who relate.


“I have come to believe that caring for myself is not self indulgent. Caring for myself is an act of survival.”

Audre Lorde

In sum, self-care is not optional; it’s essential for surviving the addiction of a loved one. Self-care enhances both overall wellness and your ability to help your loved one; in order words, take responsibility for your health and happiness by taking care of yourself.

For more information on how you can help your loved one, visit The Center for Motivation and Change.

Book Review: Staying Sober Without God

Munn wrote this book because, as a nonbeliever, he felt the 12 steps of AA didn’t fully translate into a workable program for atheists or agnostics. This inspired him to develop the Practical 12 Steps.

Reviewed by Cassie Jewell, M.Ed., LPC, LSATP

  • Staying Sober Without God by Jeffrey Munn, LMFT
  • Published in 2019, 165 pages

I stumbled upon Staying Sober Without God while searching for secular 12-step literature for a client who identifies as atheist. Jeffrey Munn, the book’s author, is in recovery and also happens to be a licensed mental health practitioner. Munn wrote the book because, as a nonbeliever, he felt the 12 steps of AA didn’t fully translate into a workable program for atheists or agnostics. (For example, the traditional version of Step 3 directs the addict to turn his/her will and life over to the care of God as they understand him. If you don’t believe in God, how can you put your life into the care of him? Munn notes that there’s no feasible replacement for a benevolent, all-knowing deity.)

The whole “God thing” frequently turns nonbelievers off from AA/NA. They’re told (by well-meaning believers) to find their own, unique higher power, such as nature or the fellowship itself. (The subtle undertone is that the nonbeliever will eventually come around to accept God as the true higher power.) Munn writes, “There is no one thing that is an adequate replacement for the concept of God.” He adds that you can’t just replace the word “God” with “love” or “wisdom.” It doesn’t make sense. So he developed the Practical 12 Steps and wrote a guide for working them.

The Practical 12 Steps are as follows:

  1. Admitted we were caught in a self-destructive cycle and currently lacked the tools to stop it
  2. Trusted that a healthy lifestyle was attainable through social support and consistent self-improvement
  3. Committed to a lifestyle of recovery, focusing only on what we could control
  4. Made a comprehensive list of our resentments, fears, and harmful actions
  5. Shared our lists with a trustworthy person
  6. Made a list of our unhealthy character traits
  7. Began cultivating healthy character traits through consistent positive behavior
  8. Determined that the best way to make amends to those we had harmed
  9. Made direct amends to such people wherever possible, except when to do so would cause harm
  10. Practiced daily self-reflection and continued making amends whenever necessary
  11. We started meditating
  12. Sought to retain our newfound recovery lifestyle by teaching it to those willing to learn and by surrounding ourselves with healthy people

The Practical 12 Steps in no way undermine the traditional steps or the spirit of Alcoholics Anonymous. Instead, they’re supplemental; they provide a clearer picture of the steps for the nonbeliever.


Before delving into the steps in Staying Sober Without God, Munn discusses the nature of addiction, recovery, and the role of mental illness (which is mostly left untouched in traditional literature). He addresses the importance of seeking treatment (therapy, medication, etc.) for mental disorders while stressing that a 12-step program (secular or otherwise) is not a substitute for professional help. In following chapters, Munn breaks each step down and provides guidelines for working it.

The last few chapters of the book provide information on relapse and what the steps don’t address. Munn notes that sustainable recovery requires more than just working the steps, attending AA meetings, and taking a sponsor’s advice. For a balanced, substance-free lifestyle, one must also take care of their physical health, practice effective communication, and engage in meaningful leisure activities. Munn briefly discusses these components in the book’s final chapter, “What the Steps Miss.”

Staying Sober Without God is well-written and easy to read. The author presents information that’s original and in line with current models of addiction treatment, such as behavioral therapy (an evidence-based approach for substance use disorder). Working the Practical 12 Steps parallels behavioral treatments; the steps serve to modify or discontinue unhealthy behaviors (while replacing them with healthy habits). Furthermore, a 12-step network provides support and meaningful human connection (also crucial for recovery).

In my opinion, the traditional 12 Steps reek of the moral model, which viewed addiction as a moral failure or sin. Rooted in religion, this outdated (and false) model asserted that the addict was of weak character and lacked willpower. The moral model has since been replaced with the disease concept, which characterizes addiction as a brain disorder with biological, genetic, and environmental influences. The Practical 12 Steps are a better fit for what we know about addiction today; Munn focuses on unhealthy behaviors instead of “character defects.” For example, in Step 7, the addict implements healthy habits while addressing unhealthy characteristics. No one has to pray to a supernatural being to ask for shortcomings to be removed.

The Practical 12 Steps exude empowerment; in contrast, the traditional steps convey helplessness. (The resulting implication? The only way to recover is to have faith that God will heal you.) The practical version of the steps instills hope and inspires the addict to change. Furthermore, the practical steps are more concrete and less vague when compared to the traditional steps. (This makes them easier to work!)


In sum, Munn’s concept of the steps helped me to better understand the 12-step model of recovery; the traditional steps are difficult to conceptualize for a nonbeliever, but Munn found a way to extract the meaning of each step (without altering overall purpose or spirit). I consider the practical steps a modern adaptation of the traditional version.

I recommend reading Staying Sober Without God if you have a substance use disorder (regardless of your religious beliefs) or if you’re a professional/peer specialist who works with individuals with substance use disorders. Munn’s ideas will give you a fresh perspective on 12-step recovery.


For working the practical steps, download the companion workbook here:

Note: The workbook is meant to be used in conjunction with Munn’s book. I initially created it for the previously mentioned client as a format for working the practical steps. The workbook is for personal/clinical use only.

From Survival to Endurance to Fulfillment: How I Found Meaning in Life

“I gave up on having a future. And I was strangely okay with it.”

By Cassie Jewell, M.Ed., LPC, LSATP

Without delving too deep into my past, I will tell you that my late teens and early to mid 20’s were not the best of times. They were dark. Lonely. Depressing. I was living a life of chaos and hopelessness. At one point, I didn’t think I was going to survive; I gave up on having a future. And I was strangely okay with it.

My turning point was a spiritual awakening of sorts. A near-death experience led to a realization that I didn’t want to die; and it was either die or change my life. I picked change.

What helped me to live again (and ultimately find fulfillment)? You might guess family or a relationship or God. But at the time, I wasn’t close with my family, I didn’t have any significant relationships/friendships, and God wasn’t a part of my life. It was the following that helped me become the person I am today:

A Therapist

Having not a single shred of self-esteem, I went to see a counselor. She created a safe space and then uplifted me, making me feel worthwhile. She normalized what I was going through; I felt less alone. She affirmed me for positive choices I made. She initiated the mending of my fragile self. I gradually gained confidence, not only in myself, but in the idea that I could live a better life.

My Dog

She loved me unconditionally… and she depended on me fully. If I died, she would think I purposely left her. I couldn’t bear the idea; I wouldn’t do that to her. She played a huge role in my recovery. I sometimes think she saved me.

My Potential

I’ve always known I have potential. I’m smart and creative. I’m motivated and driven. But that potential died somewhere along the way in young adulthood. In moments of clarity, I mourned my lost potential. I wanted to be better and to do better with my life. I was meant, maybe not for great things, but for better things than living out of my car, broke and friendless. When I decided to live, my potential reawakened; it became a driving force – a bright, glowing beacon that revitalized and inspired me.

“You have to forgive yourself.”

Self-Forgiveness

I couldn’t bear to tell my therapist about some of the things I’d done. I was ashamed; late at night, lying in bed, I would think about past events. I’d feel sick to my stomach – then, an unpleasant head rush heart racing not able to get enough air… (That’s the feeling of shame seeping from your mind into your being.) My therapist didn’t push me to share; instead, she said, “You have to forgive yourself.” It became my mantra, quietly uttered in the dark. I would repeat, “I forgive myself, I forgive myself, I forgive myself…” until I internalized it. (That being said, it didn’t happen overnight… it took weeks, months, years. But all was set in motion with that one simple statement.)

Education

I went back to school and was able to fully immerse myself in my studies. As a naturally curious person, learning is a sort of fuel for me. The more I learn, the thirstier I become. My classes provided me with not only knowledge, but with a spark that generated purpose.

Passion

While in school, I discovered a new passion; I fell in love with research. (#nerd) I thrived in my research/statistics class; my undergraduate study was even published in a national journal. It felt good to be passionate about something again; it stirred up (from the dust) long-forgotten loves, like reading and writing – passions I thought I’d left behind in childhood.

A Meaningful Career

After finishing college and starting graduate school, I became a counselor… and found meaning in helping others. My first job in the field was tough, heart-breaking at times, and deeply fulfilling. It solidified what my education had started to shape – I no longer needed to survive or endure life; I found my purpose for living.

12-Step Recovery Groups

(Updated 5/21/20) An extensive list of support groups for recovery

Compiled by Cassie Jewell, M.Ed., LPC, LSATP

There are a variety of 12-step support groups for recovery. 12-step meetings are not facilitated by a therapist; they’re self-run. Support groups are not a substitute for treatment, but can play a crucial role in recovery.

The following list, while not comprehensive, will link you to both well-known and less-familiar 12-step (and similar) organizations and support groups for recovery.

Click below for a downloadable PDF version of this post.

Support Groups for Addiction

Alcoholics Anonymous (AA)

Narcotics Anonymous (NA)

heroin anonymous (HA)

pills anonymous (PA)

Cocaine Anonymous (CA)

Crystal Meth Anonymous (CMA)

Marijuana Anonymous (MA)

Nicotine Anonymous (NicA)

caffeine addicts anonymous (cafaa)

chemically dependent anonymous (CDA)

all addicts anonymous (AAA)

recoveries anonymous (R.a.)

pharmacists recovery network

international doctors in alcoholics anonymous (IDAA)

international lawyers in alcoholics anonymous (ILAA)

association of recovering motorcyclists (A.R.M.)

For Families and Others Affected by Addiction and Mental Illness

Al-Anon/Alateen (For Family and Friends of Alcoholics)

Nar-Anon (For Family and Friends of Addicts)

Adult Children of Alcoholics (ACA)/Dysfunctional Families

Families Anonymous (FA)

parents anonymous

NAMI Family Support Group (For Adults with Loved Ones Who Have Experienced Mental Health Symptoms)

S-Anon/S-Ateen (For Family and Friends of Sexaholics)

codependents of sexual addiction – COSA (for those whose lives have been affected by another’s compulsive sexual behavior)

gam-anon (for families and friends of gamblers)

Secular Alternatives

SMART Recovery (Self-Management and Recovery Training)

Women for Sobriety

Rational recovery

sECULAR aa

Secular Organizations for Sobriety (SOS)

LifeRing Secular Recovery

Religious Alternatives

Celebrate Recovery

Christians in Recovery

Addictions Victorious

alcoholics victorious

Alcoholics for Christ

overcomers in christ

overcomers outreach

the calix society

jewish alcoholics, chemically dependent persons and significant others (jacs)

BUDDHIST RECOVER NETWORK

REFUGE RECOVERY

Additional Support Groups & Organizations

violence anonymous (VA)

Adult Survivors of Child Abuse Anonymous (ASCAA)

Survivors of Incest Anonymous

lds family services

porn addicts anonymous (PAA)

Sex Addicts Anonymous (SAA)

Sexaholics Anonymous

Sex and Love Addicts Anonymous (SLAA)

sexual compulsives anonymous (SCA)

Sexual recovery anonymous (SRA)

Co-dependents Anonymous (CoDa)

Emotions Anonymous

Dual Recovery Anonymous

Depressed Anonymous

social anxiety anonymous (SPA/Socaa)

PTSD Anonymous

Self Mutilators Anonymous

obsessive compulsive anonymous

obsessive skin pickers anonymous (OSPA)

Clutters Anonymous (CLA)

Overeaters Anonymous (OA)

Food Addicts Anonymous (FAA)

Food Addicts in Recovery Anonymous

Recovery from Food Addiction

Eating Disorders Anonymous (EDA)

Debtors Anonymous (DA)

Underearners Anonymous (UA)

spenders anonymous

Workaholics Anonymous

Gamblers Anonymous

internet & tech addicts anonymous (ITAA)

Online Gamers Anonymous (OLGA)

offenders anonymous

reentry anonymous

GROw in america (peer support for mental illness)

hearing voices network

AA Sites for agnostics and atheists: AA Agnostica and AA Beyond Belief


Do you know of a 12-step support group not listed here? Share in a comment!

#JunkieLivesDontMatter

A person who struggles with a substance use disorder is choosing that life. Why interfere? (Especially when all that money could be spent saving more DESERVING lives.) “Junkies” don’t deserve second chances because #JunkieLivesDontMatter

By Cassie Jewell, M.Ed., LPC, LSATP

Disclaimer: If you happen to believe that addiction is a choice – “They’d quit if they really wanted to” or “They made the choice to use; they made the choice to die” – then scroll on to the next blog. You’d only scoff at this post because #JunkieLivesDontMatter

This blog post is inspired, in part, by a Facebook meme.

The meme said,

“So if a kid has an allergic reaction the parents have to pay a ridiculous price for an Epi pen. But a junkie who has OD’d for their 15th time gets Narcan for free? What a screwed up world we live in.”

Implications: “Junkies” don’t deserve a second chance at life. They’re a waste of resources because they lack the willpower to stop using. A person who struggles with a substance use disorder is choosing that life. Why interfere? (Especially when all that money could be spent saving more deserving lives.)

If you believe it’s screwed up for a “junkie” to have a chance at life (and recovery) because they “chose addiction,” your opinion is contrary to the National Institute of Health, the American Medical Association, the American Psychiatric Association, and decades of scientific research. You’re either ignorant (maybe willfully so) or impressively arrogant. (Alternately, you could just be a jerk.) You’re a part of the movement: #JunkieLivesDontMatter

Many have joined the movement, as evidenced by the following Facebook posts:

“Out of all of the houses, 2 hobos decided to overdose on my front steps… thank god the medics got here in time to ensure they could die another day…”

“I think we had less ODs before Narcan came on board. They realize they can be saved if gotten to in time. Maybe they need to be locked up & not let out until they attend rehab while in jail.”

“If it can be easily established that they have a recent history of drug [abuse]… then yes… withhold the lifesaving drug because they chose this. It’s harsh, but justice is not served by saving them.”

“If you don’t have it figured [out] by the 3rd overdose, you are just prolonging the inevitable and wasting tax payers money.”

“If we are repeatedly saving your life and you are not willing to change this behavior, why should we be obligated to keep saving you?”

“My personal opinion is we can’t keep letting people overdose and saving them just so they can repeat the cycle.”

“By continuously administering Narcan, sure, we’re saving their life, but are they really living? I don’t think so.”

#JunkieLivesDontMatter

“No CPR for You, Fatty — You Chose Soda and Fast Food… Now Suffer the Consequences!”

According the the American Psychiatric Association,

Addiction is a complex condition, a brain disease that is manifested by compulsive substance use despite harmful consequence. People with addiction (severe substance use disorder) have an intense focus on using a certain substance(s), such as alcohol or drugs, to the point that it takes over their life. They keep using alcohol or a drug even when they know it will cause problems.

Addiction is a scientifically proven brain disease. Despite this, many persist in the belief that it’s a choice, or worse… a moral failing. (Note: This notion comes from an early model of addiction, “the moral model,” which was deeply rooted in religion. Addiction was attributed to a sinful nature and weakness of character. Therefore, the addict must repent… or suffer the consequences of his/her actions; addiction warranted punishment, not empathy. Unsurprisingly, this created stigma. It also prevented those struggling with addiction from seeking treatment. Centuries later, many hold on to the view that an individual suffering from a substance use disorder is lazy or weak.)

Today, in the midst of the opioid epidemic, stigma’s unrelenting grip perseveres. Stigma is a poison; it’s dehumanizing. It’s easy to forget a person is a person when you view them as garbage, trash… a “junkie.” Stigma tells us, “Take out the trash.”

To fully recognize stigma’s impact, compare addiction to other diseases. Consider common medical emergencies; many are related to lifestyle. Imagine being hospitalized after your third stroke, and the doctor telling you, “This is the third time I’ve saved your life, yet you refuse to exercise. I shouldn’t be obligated to continue to provide life-saving care.” Or, imagine a long-time smoker who develops lung cancer; they’re not demeaned, called names, or denied treatment. Moreover, an EMS worker wouldn’t withhold CPR from an individual in cardiac arrest if they were obese. It’s not a debate.

If You’re Dead, You Have a 0% Chance of Recovery

We’re in the midst of an epidemic.

According to the CDC, 115 Americans die from an opioid overdose every day.

In 2016, over 42,000 individuals died from opioid overdose.

Life expectancy in America is actually declining due to an increase in fatal overdoses.

Narcan does not enable addiction. It enables life. (A dead addict can’t recover.)

#Recovery #Empathy #FightStigma #EndTheEpedemic #SaveALife


If you live in Fairfax County, sign up for a free REVIVE! Training!

Helping Vs. Enabling: How to Tell the Difference

If you’re unfamiliar with the term “enable,” it means “to provide with the means or opportunity.” When applied to substance use, it means a person in active addiction is provided with the means to continue to use. With substance use disorders, how can you know the difference between helping and enabling? This post explains how to tell the difference and provides 7 tips for helping a loved one who struggles with addiction.

By Cassie Jewell, M.Ed., LPC, LSATP

With substance use disorders, how can you know the difference between helping and enabling? I’ve worked with family members who inadvertently fueled their loved one’s addiction. They “helped” by bailing them out of jail, giving them money, etc., which only permitted the individual to continue to get high. It’s hard for family members to differentiate between behaviors that help versus enable.

If you’re unfamiliar with the term “enable,” it means “to provide with the means or opportunity” or “to make possible, practical, or easy” (according to Merriam-Webster). When applied to substance use, it means a person in active addiction is provided with the means to continue to use.

When I worked at a substance use treatment center, I taught families and loved ones that helping a person in active addiction means supporting their basic needs, such as food, water, shelter, and clothing. (If someone is in jail or treatment, their basic needs are met; therefore, bailing them out would be enabling.) Thinking in terms of “needs vs. wants” helps you to recognize enabling.

Recently, I answered a woman’s question on Quora about how to distance herself from her heroin-addicted daughter. The following paragraph is from my response:

Distancing yourself (or setting a boundary) with your daughter will be difficult because you want to help. In the past, by “helping” her, you’ve enabled her addiction (which hurts her in the long run) and leaves you emotionally depleted. There’s a very fine line between helping and enabling; it’s not clear-cut. (Plus, it can be counterintuitive for a parent whose job has always been to protect your child.)

When a parent has a son or daughter who struggles with addiction, it’s especially difficult to make the distinction between helping and enabling. A parent’s natural inclination is to nurture and protect from harm. It’s heart-wrenching to see your child in pain. But if a parent doesn’t set (and adhere to) healthy boundaries, they will quickly become emotionally drained (as they enable their child’s addiction).

Here are some suggestions for helping (instead of enabling) a loved one who’s actively using:

  1. Never (ever) offer money.

If asked for cash for food, for example, buy groceries instead (or offer to take them to lunch). I worked with a father who bought a bag of groceries for his son, who struggled with severe alcoholism and was homeless, on a weekly basis. This is an excellent example of helping a loved one versus enabling their addiction.

  1. If asked for help paying bills, say no. 

If your loved one doesn’t have to pay the electric bill, they’ll spend the money on drugs or alcohol. Furthermore, if you protect them from the consequences of not paying bills (i.e. having the power shut off), your loved one is less likely to see a need for change. (People don’t change when they’re comfortable.)

  1. If your loved one is addicted to opioids (heroin, morphine, hydrocodone, etc.), attend a training or take an online course on opioid overdose reversal (Narcan [naloxone] administration).

If you’re unsure where local trainings are offered, a Google search for “Narcan training” or “opioid reversal training” will link you to resources in your area. Most trainings are free. Keep a Narcan kit on your person at all times. Provide your loved one with a kit (or two) as well. This is not enabling. This is potentially saving a life and offering an opportunity for recovery. (A dead opioid-user will never recover.)

  1. Offer to help them get into treatment.

Become familiar with the different treatment options in your area. Don’t give ultimatums (i.e. “If you don’t get treatment, I’ll divorce you”) or make threats (especially if you’re not willing to follow through). Be supportive, not judgmental. Be patient; when your loved one is emotionally and physically drained from addiction’s painful consequences (or when they hit “rock bottom”), they may decide it’s time to get help. And you’ll be ready.

  1. Recognize that your loved one is not the same person they were before addiction.

Substance use disorder is a debilitating disease that damages the brain; it changes how a person feels and thinks. With addiction, the brain’s reward center is rewired, resulting in a biological “need” for drugs/alcohol. (Compare this to your need for food or water or air.) Your loved one’s addiction will lie to you; they will do whatever it takes to get their “needs” met. Your loved one’s addiction will steal from you. (Lock up your valuables if they have access to your home… and even if they don’t. I’ve worked with more than a few individuals who have broken into their parents’ home for either money for drugs or valuables to pawn for money for drugs.) Your loved one’s addiction will betray you. Accepting the nature of addiction allows you to set healthy boundaries.

  1. Attend Al-Anon or Nar-Anon meetings.

By engaging with others with similar struggles, you’ll learn more about supporting your loved one (without enabling their addiction). You’ll also build a supportive network by connecting with others, strengthening your emotional health.

  1. When in doubt, try asking yourself one (or all) of the following questions:

Will my actions allow my loved one to continue to drink or use? Is this a “want” versus a basic need? Will my actions prevent them from experiencing a natural consequence? If the answer is yes, it’s probably enabling.

Addiction is a devastating, but treatable, disease. The road to recovery is difficult and long (with many detours). If your loved one has a substance use disorder, be kind and compassionate; they’re in an unthinkable amount of pain. They didn’t choose addiction. The best way to support them is by setting healthy boundaries to ensure you’re not enabling continued use. Boundaries allow you to help them without furthering their addiction. Boundaries also serve as protection for you and your emotional health; you’re in no position to help if you’re emotionally, financially, and spiritually depleted.


Please share in a comment your suggestions for helping a loved one who is struggling with addiction.

Interview: Breakfast Beers, Bloating, & Blackouts

“Every night, I would drink until I passed out, often fully clothed with a beer in hand. I would then wake up, brush my teeth and immediately vomit. I would brush my teeth again and then go to work.” This was the daily routine for JMS, who wore his alcoholism as a badge and didn’t plan to live past 30. In this interview, a recovering alcoholic discusses addiction, sobriety, what everyone should know about alcoholism, and why you might be a jerk if you believe a common myth.

Interviewer: Cassie Jewell, LPC

updated interview jms.png

JMS, a recovering alcoholic, has been sober for nearly six years. He started drinking at the age of 13. He continued to drink throughout his 20s, a “dark and miserable existence,” and didn’t think he’d live to be 30. In 2012, a suicide attempt nearly claimed his life. He woke up in a psych unit, having no memory of what happened, and decided he wasn’t ready to die.

JMS’s “official” recovery date is July 5, 2012. The following is an interview about how he got sober, why AA isn’t for everyone, and why you’re a shitty person if you believe addiction is a choice.


alcohol-1901845_960_720

What’s your definition of recovery?

JMS: I don’t see recovery as an end goal. To me, recovery is a path towards my end goal, which is contentment. I have found that I will never be content and happy with my life if I am using some sort of substance. For me, recovery is complete sobriety from all mentally and physically altering substances. I have tried and learned that I cannot pick and choose what to use. It does not work for me. More than just abstinence, recovery is a way of life. It is about being accountable for your actions, admitting when you are wrong, trying your best, and letting things go. Just trying to be a better person than I was yesterday.

  

Is alcoholism a disease?

It is difficult for people to accept that alcoholics suffer from a disease and are not just a bunch of selfish degenerates that don’t care about their lives.

JMS: I feel the word “disease” can be quite polarizing when discussing addiction. Alcoholism is chronic, progressive, and fatal. Much like diabetes, alcoholism is a relapsing disorder that needs a lifetime of monitoring and treatment. Based on these facts, yes, alcoholism is a disease. I feel this is a difficult idea for people to swallow. Much of addiction has been seen as a moral issue or a failing of willpower. It is difficult for people to accept that alcoholics suffer from a disease and are not just a bunch of selfish degenerates that don’t care about their lives.Obesity holds a similar stigma, though fat shaming has started to catch a bad rap.



When did you realize you had a drinking problem?

I knew for a long time that I was unable to stop drinking, but I didn’t care. I never had any intention of making it to 30 years old

JMS: Hmm, that’s a tough question to answer. My gut response here is to say when I went to jail for my 3rd DUI in 2010, which is when I started to actually try to get sober. But if I am honest with myself, I was well aware that there was a problem years before that. I knew for a long time that I was unable to stop drinking, but I didn’t care. I never had any intention of making it to 30 years old.I lived a really dark and miserable existence for most of my 20s. I could identify story after story about when I should have realized that there was a problem. Destroyed friendships, arrests, hospital visits, blackouts, poor choices, breakfast beers, etc. The truth is, I knew that I drank differently from my friends when I was a kid. When we would wake up hung over after a party, I was the one that would sneak vodka shots. So, I think somewhere in there, I was always aware that it was a problem. I come from a family of alcoholics. My father, his sisters, and his parents are/were all alcoholics. So it was almost a badge of honor to be another alcoholic [last name].



In active addiction, how did alcohol affect your health and appearance?

I learned that it is not normal to have diarrhea everyday for 10+ years.

JMS: I lost 60 lbs. when I stopped drinking. I changed absolutely nothing other than cutting out beer and dropped 60 lbs. I looked and felt a lot less bloated. I also learned that it is not normal to have diarrhea everyday for 10+ years. Honestly, the biggest physical change I experienced, that I am still grateful for today, is acid reflux. While drinking, I kept TUMS in business. I never went anywhere without them. Today, I need to eat some TUMS when I eat pizza or spicy food… you know, like a normal person. I never noticed the impact that drinking had on my sleep until I was no longer drinking. The first few months I really struggled to sleep well since I never had healthy sleep hygiene. Allow me to paint you a picture. Every night, I would drink until I passed out, often fully clothed with a beer in hand. I would then wake up, brush my teeth and immediately vomit. I would brush my teeth again and then go to work. Shower or not, I always reeked of alcohol, so showering was not a top priority. I always thought that I never got hangovers, but once sober I realized that I only thought that because being hung-over was my normal and I was experiencing them every morning. Ugh, the physical impact that had on my life is really something I do not miss.



How (and why) did you get sober? Who and/or what helped? Also, share about some things that were not helpful to you.

JMS: I got sober because I did not want to die. I tried to kill myself the last time that I drank. I do not remember what happened, but I remember waking up in a psych unit in the hospital. There are a bunch of people that were integral to the success of my sobriety at this time. My family is number one. They never gave up on me, despite the hell I put them through. I moved back into my mom’s house when I got out of the hospital. She and my siblings were nothing but supportive of me then and still to this day. I do not know if I would be sober today without their unconditional love and support.There are four other people that I owe my life to at this point. My therapist, my addiction counselor, Bob, my friend Alex, and my friend Jon.  I had been working with my therapist for a few years prior to my last drinking adventure. She has always been willing to challenge me and has been a safe space for me to work through some of my biggest fears. She has really helped me understand the nature of my addictions and helped me reframe my thinking and processing of my emotions.

I didn’t buy into [AA].

I have been through multiple addiction treatment programs in my life and none of them stuck. I always approached them with a cynical eye and was just going through the motions to get my family or the courts off my back. A condition of my discharge from the hospital was to enroll in an intensive outpatient program. This is where I met Bob. I figured this was another bullshit program that I was going to have to work through to keep people off my back. Bob was different. He encouraged us to go to 12-step meetings. Of course, I refused. I didn’t buy into those programs. Bob challenged me here. He asked that I attend one meeting in the coming week and write a list of everything that I hated in the meeting. I gladly did this and came back and an entire 8.5×11 sheet of paper full of my gripes. Bob listened to my list and challenged me to go to another one the next week and make a new list with different complaints. I rose to this challenge and did it again, glad to prove my point that AA was stupid and not for me. Bob again listened to my list (without arguing against any complaints) and provided another challenge. Bob asked me to go to another meeting and make a list of the things that I liked from the meeting. I did and, as any alcoholic can tell you, you are bound to hear things in an AA meeting that resonate with you, whether you buy in to the program or not. Bob continued to challenge me to go to meetings, not to go and drink the kool-aid and say some prayers, but to see what I can find that I like. There were other aspects of Bob that I couldn’t figure out why I liked him until one day, I walked into an AA meeting and he was sitting at the front table leading the meeting. Bob is an alcoholic. In that moment I knew that he understood my struggle. Bob was sober and doing meaningful work. Bob was ok. I wanted to be like Bob.

I owe my life to Alex.

I met Alex in the IOP [program] that Bob ran. Alex and I came from different worlds (he was smoking crack on the streets in Baltimore [and] I was drinking in bars in DC), but we had the same reality of sobriety or death. Alex went with me to those AA meetings [around the time that] Bob was challenging me. Alex also brought me to the meeting that would become my home group and introduced me to the people that would soon be my AA family. I owe my life to Alex. I would be remiss not to pay homage to Alex. Alex was murdered in an Oxford house a year in to our sobriety. Alex died sober, which was something he never believed would happen. I miss him every single day.

Finally, my friend Jon; he and I started drinking together as kids. He and I lived together after college and blossomed into the full fledged alcoholics we became. And he and I got sober around the same time on different coasts of the country. When I got out of the hospital, Jon moved back east from California and moved into my mom’s basement. He and I went to AA meetings daily, often more than just one each day. We then spent that first year of sobriety living together trying to figure out how to live.

I did not give a damn about anything while in my active addiction, so telling me you were going to breakup with me or I was going to lose my job did not matter.

What was not helpful? Counselors who tried to tell me about sobriety that clearly did not understand addiction. Ultimatums also did not help. I did not give a damn about anything while in my active addiction, so telling me you were going to breakup with me or I was going to lose my job did not matter. Probation was useless. The biggest impact the state had on my drinking was when I was sent to jail.



What prevents you from going back to drinking?

There is nothing in your life that a drink can’t make worse.

JMS: My life now. I love the person I am today. When I was drinking, I hated myself. I never want to be that person again, and I don’t have to be as long as I don’t drink. I have come to the realization that my worst day sober is infinitely better than my best day drinking. I don’t attend AA meetings anymore, but many of the slogans still bounce around in my head. The most important one I ever heard was, “There is nothing in your life that a drink can’t make worse.” I’m not going to lie and say that now I am sober, life is easy and happy and super fun all the time. It’s not. However, I am better equipped to handle the bullshit in life with a clear head. I would be lying to say that I don’t experience cravings but I know that a drink is not the solution to life’s problems.



What’s something you wish you had known before you became addicted to alcohol? (If you could go back in time and have a word with your younger self, what would you say?)

JMS: I feel like most people will expect me to say something like, “I would slap that first drink out of my hand!” That is not true for me at all.I am the person I am today because of my history with drinking. I am proud of the person I have become and I am not sure I would be who I am without the struggles I went through. I would want to assure myself that it was going to turn out okay and that I would not be that miserable forever. I do wish I had understood and cared about (at the time) the severity of the pain and worry I put my mom and siblings through.



What something you wish everyone knew about alcoholism?

JMS: It is not a choice. Alcoholics don’t drink the way they do because they don’t care about you or their families. They drink the way they do because they cannot control the cravings and urges and are overcome by guilt/shame/fear/pain. I am fairly confident that if every alcoholic could “just stop drinking” they would. Alcoholism is exhausting.

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What are your thoughts on AA?

JMS: AA can save lives. I attribute my sobriety to the teachings of, and people I met in, AA. That being said, AA does not work for everyone. I like to [view] AA [as] a religion. AA meetings are akin to going to church, the Big Book is the bible, and sobriety is heaven. Some people need to go to church daily to find their way to heaven. Others only need to read the text to understand the tenets of the religion to find their way there. And some people find their way into heaven following other religious texts or none at all. There is no wrong way to get sober. I do have complaints about AA and I feel there are aspects of it that prevent people from finding their way to sobriety. The focus on actual religion in AA is a major turn-off for people. While AA espouses that it is non-denominational and that we alcoholics are welcome to choose the God of our understanding, we are then thrown into a prayer circle to recite the Lord’s Prayer at the end of the meeting. For a low-bottom newly sober person, it is difficult to believe that there is a God that would allow us to sink so low and experience so much pain. But as I mentioned above in my story about Bob, he challenged me to find what I hated (and you better believe that GOD was written in huge letters on that first sheet of paper) and taught me to focus on what I liked.

If you are struggling, try it.

So, my thoughts? If you are struggling, try it. Ignore the God part for now. Listen to other people tell your story and see that it is possible to get better.

How do you feel when people drink around you?

JMS: In a word, annoyed. Slurred speech, glassy eyes, stumbling, and repetitive stories are not a cute look for anyone. I often feel embarrassed for the people I am around as well. It is always a nice reminder of why I don’t drink. I see absolutely nothing attractive to it and I am glad I don’t do that to myself anymore.

What’s the worst thing about being in recovery? The best?

JMS: The worst part [about] being in recovery is trying to explain to people that they don’t have to behave differently around me once they find out. I can’t count the number of times people have asked me if it is okay to drink around me or warned me that there was going to be alcohol at their house. You don’t ask a person with Diabetes if it is okay if you eat a Twinkie, you don’t have to ask me if it is ok for you to have a beer.

There is just an indescribable freedom that comes along with [sobriety].

The best part is being free. I was a slave to my addictions for years. I do not have that struggle anymore. I do not have to worry about where I will find money to buy alcohol. It is a huge struggle in my life that does not exist anymore. There is just an indescribable freedom that comes along with it.

In your opinion, what’s the biggest misconception out there about addiction?

[If you believe addiction is a choice], that just makes you a shitty person.

JMS: I mentioned it above; that addiction is a choice. That idea is closed-minded and short-sighted. And I think it speaks volumes about the person [who] believes that. I cannot fathom believing that someone would do this voluntarily. It is not fun, it does not feel good, and does not make us proud. In my eyes, the belief that this is a choice tells me that you could choose to behave in this manner if you wanted to, and that just makes you a shitty person.

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Please share your thoughts on addiction and recovery in a comment!