Do No Harm/ Safe Interventions

Have you ever thought about committing suicide? I have. Have I had a plan? Yes. Have I attempted it? No. Why?

Two factors I think. The love of my kids and being unwilling to leave behind the psychological trauma that I know they would carry.

My thoughts of suicide always followed the coming down from and off of mood-altering drugs. 

As a former RN I was aware that my brain chemistry, specifically dopamine, was depleted; that because I had supplied my brain with artificial dopamine through drugs, my mind had stopped producing its own brain chemicals. The result of this dopamine depletion was making me feel hopeless, unable to see the light in anything, making suicide an option to provide me relief from extreme mental pain.  

Suicide also occurs during active addiction due to an anesthetized brain. Impulse-control regulation is off-center, and if intense psychological pain is present for whatever reason, a person is more likely to follow through on suicidal ideation.

Having experienced decades of substance-use disorder, I knew the suicidal thoughts would abate, with time. I even learned what helped: extreme exercise to expedite my brain to equilibrium, and community. Never isolate—we need connection to others; it is built into our very existence as human beings. That fact has protected our survival for centuries. We are not built to be alone.  

I have never been diagnosed with severe mental illness, but because I have a strong recurring addiction history, I am statistically at higher risk of suicide than the average person, according to Dr. Carolyn C. Ross in “Suicide: One of Addictions Hidden Risks,” a Psychology Today blog post.

Depression and other mood disorders are the number one risk factor for suicide, but alcohol and drug abuse—even without depression—are a close second. In fact, research has shown that the strongest predictor of suicide is alcoholism, not a psychiatric diagnosis. People with substance-use disorders are about six times more likely to commit suicide than the general population.

That brings me to my style of performing interventions. 

I am not an arm-twisting, hold-a-gun-to–your-head interventionist. I achieve high success rates with the expression of love and no shame communicated by a group of family and friends who care for my patient. 

Saying “I will never speak to you again if you do not go to treatment” not only decreases the odds of long-term recovery—even if the person does go to treatment—but is dangerous. Leaving an alcoholic /addict alone physically or psychology through complete shunning if she refuses treatment increases theodds of suicide. The person many times will try to quit on her own or go on a bender. Either way, she is in the minefield of suicide.

Boundaries and doors left open with love go much further in predicting a person’s odds of accepting help in the future and can help decrease the odds of suicide.

Boundaries are different for every group I work with. Boundaries need thoughtful consideration and should be realistic. An example: You are always welcome in my home, but if I suspect you are under the influence, I will ask you to leave and come back next time sober. Ultimately this approach is more human and helpful in achieving the goal of the addict/alcoholic seeking treatment. 

You would not shun a family member with metastatic cancer who was refusing medical care. 

A text saying “I love you still and am willing to help you get treatment” following an intervention where the person refused help is far more effective and safer than estrangement.

I know this can be hard if you have experienced many negative life events due to a person’s substance-use disorder. You can distance yourself, but please do it with love and leave the door open. Your loved one will be far safer from suicide, the ultimate tragic side effect of addiction. 

One time, I had dropped off a patient at one of my favorite rehabs. My little dog rushed through the doors. “Just follow Lucy,” I told the patient. All five pounds of Lucy were exuding excitement—her eyes bright and tail wagging. I think her indescribable cuteness gives my patients hope and distracts themat this very scary moment in their lives. She has sat in their laps during the drive to rehab, looked back at them as they retrievedtheir luggage, and, with only body language, said, “Hurry up,follow me to heaven on earth,” as she eagerly waited for us to open the door.

I dropped off the patient with the intake counselor. “I will be right back,” I said. “Lucy wants to see her friends.

I opened the doors to the intake department, and she ran to one of her favorite cubicles, where Mike has sat at for 13 years, dispensing hope over the phone to potential patients and their families. 

His chair was empty. “Is Mike off today?” I asked another intake counselor. 

The look on her face and her hesitation about my question was a harbinger of something I was sure I did not want to hear.

“He committed suicide a few days ago, he jumped . . . ”

My first thought was, “This is not possible.”

But he had relapsed after years of sobriety. The devil really never stops chasing us addicts and alcoholics. 

Mike was the third high-functioning alcoholic/addict friend I have lost to suicide since I have been in recovery. 

Lucy, being blessed with no frontal brain lobes, just ran to another cubicle. 

I was silent in my mind.

I returned to say goodbye to my patient. We hugged, and both of us held each other for a long time. She was scared. I was the last familiar person to her. I whispered encouragement into her ear. I continued to hold her close and think of Mike. Not everyone survives this disease. 

If an intervention is not successful at the moment the group has set up, please do not abandon the person completely. 

We are a fragile population, living with this still-maligned and misunderstood disease.

Love always . . . 

 

 

Joani Gammill, AIS

www.JoaniTheInterventionist.com

Joani@jJoaniTheInterventionist.com

443 926 4519

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Heroin took my Friend

Disheartened. Depressed. “Why bother, Joani, you are working at a losing game. Whack a mole, that is it, that is what you are doing.”

Do I believe in what I’m doing, interventions, to get people into treatment for their disease?

I am just plain sad and discouraged. My sweet (sometimes pain-in-the-ass friend) is gone. She answered my tweets often. She was the kind of person who stayed in touch. She took selfies with everyone she knew. Did she know her short life was going to need to be chronicled? Did she leave us gifts of pictures? Her singing voice had a range and beauty that literally made you stop and listen; it was so good that if you did not see her you swore it was someone streaming from a playlist. Then you would turn a corner and there she was, usually sitting on the floor, legs crossed. Her guitar, as it turns out, was gently weeping.

My last selfie with me was a month preceding her unintentional death at a mutual friend’s wedding. Her life was taken by a disease few comprehend, even those who have been in its vise grip. Addiction.

A monster is roaming this earth—strong, altered heroin, laced with fentanyl and ketamine. Fentanyl is a potent narcotic; ketamine is commonly known as an elephant tranquilizer. They combine with heroin to make a powder keg of unpredictable strength. The people who are making this aberrant form of heroin not only don’t have an FDA approval stamp for the dosage strength, they apparently have no morals. So addicts are rolling the dice as their disease overrides the rationality in their hijacked brains and they snort or inject the poison and they fall asleep. The brain stem that is the control center for vital functions in the body slumbers as well, shutting down respiration, and the person with no oxygen circulating through his body to supply all organs with necessary air drifts off to death.

The “heroin epidemic” is so much larger than me that I have faltered in my desire to fight it. It looms tall with a huge knife pointed at my neck. It laughs at me, “I won, Joani, I took your friend.”

But that was yesterday. A day of disbelief, tears, and grief.

Today, you son of a bitch, I will continue to hunt you. If enough of us play whack a mole, maybe we could win. Maybe, probably not.

But remember the Jewish proverb that came to the forefront of our modern recognition when a war raged, when another monster was roaming the European continent and murdering millions: “When you save one person you save the world entire.”

I will not give up, no matter how big the knife. In fact, my dear monster, you have ignited in me a bigger urge to carry on in my mission to save that one person. I laugh back at you. You are in fact stoking the flames of all of us in this fight against your poison . . . to cut your throat.

The last song I heard my friend sing was “Good Riddance.” The words now ring in my ears as a harbinger of what was going to be her fate:

Another turning point, a fork stuck in the road

Time grabs you by the wrist, directs you where to go

So make the best of this test, and don’t ask why

It’s not a question, but a lesson learned in time

It’s something unpredictable, but in the end it’s right

I hope you had the time of your life.

It was her life’s journey, I do not know why. I do know I will miss her.

I am not an “ Alcoholic”

I am a person with the disease of alcoholism and addiction ,I am not “an alcoholic.”

Similarly, some people call my children autistic. In reality, they are teenagers who have the neurobiological disease of autism. They are my children—quirky, lovable, with multiple personal traits that make them uniquely who they are. They are Mary and Max.

The distinction is important, especially to a person who has a disease that can be used to describe that person. “This is Erin, she is a diabetic.” She is a teacher, a daughter, a wife, a warm, funny person with a smile that can light up a room. She is human, good and bad, full of characteristics that make her the human being that she is. There is only one of her in the whole universe. To whittle her down to “a diabetic” negates the rest of her essence.

We are defined many times by what we choose to do to bring light and positive change to the disorder we have been presented with.

But we are not the disease. I am not an alcoholic.

I have alcoholism.

Suboxone … take it or leave it?

I have had intense opioid addiction in my personal past. I was not just a mild, once-in-a-while Percocet user.

I started with Percocet but quickly moved up the chain. Following spinal back fusion, my doctor gave me OxyContin, saying it was the “drug of choice” to prescribe to opiate addicts and telling me it was nonaddictive. A big pharmaceutical company was infiltrating the medical community, flooding doctors’ offices with samples of OxyContin. Follow the money. Big Pharma, a common term used to describe large pharmaceutical companies, has huge amounts of money at its disposal, giving it the ability to wage a campaign for the drug of the moment. When that drug causes physical addiction, your market becomes a guaranteed customer. I would say their primary motive is to make money. I am far from alone in this opinion, as the lawsuits that followed the OxyContin invasion illustrate that the pharmaceutical company knew all along that OxyContin was highly addictive. Phillip Morris claimed in the 1950s that cigarettes were not additive, and look how that turned out.

I believe—and the statistics support this opinion—that the extreme upswing in national prescription drug abuse followed this flooding of OxyContin into society’s health-care institutions.

For me, this period of time represented a decade of extreme opioid addiction.

The use of OxyContin following my back surgery sent me to a dark place that defies description in the hell it created for me and my family.

Enter Suboxone. My health-care provider claimed that maintenance—meaning daily administration of a substitute opioid—was safer and “a cure” for my unstable use of OxyContin.

Think of the methadone maintenance commonly used for heroin addicts.

I was in the early generation that was given Suboxone maintenance. At the time, it was administered in a gelatin square that went under the tongue. Suboxone was so new when I was prescribed it that it had to be dispensed through an apothecary pharmacy that made the gelatin squares and injected the drug into them.

Enter cross tolerance. Any opiate in any form will tweak the reward pathway in the brain, making it at risk for craving other mood-altering drugs. Suboxone no longer gave me the feeling of euphoria that it had produced in my brain at the beginning of its usage. Suboxone just made me sleepy. So I added amphetamines. Again, my reward pathway was being stimulated by the Suboxone. To make a long story short, I overdosed on amphetamines and ended up in the coronary care unit with a near heart attack as a result of coronary artery spasms caused by the amphetamines.

Now my brain was a complete chemical train wreck on Suboxone and amphetamines.

Upon release from the coronary care unit, I did my research. An antidote to amphetamine overdose is benzodiazepines, commonly known as tranquilizers, with name brands like Xanax and Ativan. So I took benzodiazepines daily to make sure I did not have a heart attack from the amphetamines.

Now I was on the trifecta from hell: Suboxone, amphetamines, and benzodiazepines. And it started with Suboxone.

As I write this blog, I realize I am not expressing the popular current point of view that Suboxone is the answer to our current opioid problem. And with all due respect, Suboxone replacement therapy may work for some.

But as an interventionist who is in the field weekly working with addicts, I see more abuse of the drug Suboxone than is suggested by the current aggressive marketing of it as the solution to the opioid epidemic.

That’s something to think about—and always follow the money.

Stigma……

I sat with a 57-year-old man last week in the emergency room at the hospital. He looked like he was ready to give birth to triplets. His liver had reached its limit to function properly because of chronic alcohol consumption.

His swollen legs literally wept their own tears of the illness as the built-up fluid squirted out of tiny holes in his calves. The leaking fluid reminded me of malfunctioning sprinkler heads.

In his demeanor, he fought to maintain an attitude of a man who had little to worry about. It was a mask, hiding his fear and trying to hold onto a shred of dignity. All alcoholics mistakenly believe that at this point in the disease’s process, what they are experiencing is their fault. This is far from the truth, as is documented in many highly regarded medical journals’ articles on the disease of alcoholism.

As a former long-term registered nurse and now a full-time alcohol and drug interventionist, I knew that he was in for the fight of his life.

But why did he have to be in a fight for his dignity?

This fact stirred in me an internal rage with some of the health-care workers assigned to take care of him. I had learned, having taken many alcoholics/addicts to emergency rooms, to not express that rage in ways that would further alienate them from the nurses and doctors.

So I advocated for my patient in quiet but clear clinical terms. This, I have always sensed, is not popular with the ER staff either. My presence is off-putting to them. Is this a projection of mine or the truth? In the end it does not matter.

I believe that being treated with dignity is a birthright. Yes, there are extreme times people have to straighten the course in their lives to earn that dignity back. But when it comes to having the illnesses of alcoholism and addiction, there is still has a stigma that seems to automatically diminish the dignity you are treated with. And in the process of losing dignity, shame about yourself creeps in, and the disease rains down on a person at a time when love is needed the most.

I am not saying that boundaries do not need to be set with people in active addiction, but never withhold your love, which many times is expressed by bestowing on them the dignity that we all deserve.

“What is this?” a bland and accusatory young doctor asks while skimming the contents sitting on top of the man’s backpack and holding up a bottle of aftershave. My patient is sitting on a bed, dangling his swollen legs over the side. He is looking at the doctor with his head tilted down in that peculiar way done by people who wear bifocals. We had waited hours to hear the results of blood work, X-rays, and other tests. We were not eagerly waiting to be shamed. He knew full well his alcoholism had reached a critical stage. He was looking for hope.

Most aftershave lotions have a high level of alcohol in them. Rarely do people carry around a bottle of it in a backpack.

My patient’s father had taken his truck keys from him, preventing him from driving to the liquor store. He had no access to alcohol, and at this point in his disease, it was literally necessary for him to drink to live. Withdrawal from alcohol is life threatening. Thirty percent of patients who suffer delirium tremens, or DTs, from abrupt discontinuation of alcohol die. And the patient knows this through a feeling of impending doom as the process of withdrawal is experienced in a tsunami of physical and mental sensations preparing to cascade the body as the brain begins to start off an explosion of misfiring, causing every vital system in the body to be negatively affected, ultimately breaking down the body’s ability to function. Death follows, and the alcoholic does not experience a peaceful exit from this world.

“Well he brought this condition on himself,” the uninformed public will cry out.

Alcoholics do not choose this hell. Nobody would. Their brains are on autopilot as they drink. But that is only one of the contributing factors that causes an alcoholic to drink. As I have written many times before, alcoholism/addiction is the perfect storm. When alcoholism rears its ugly head, it is the result of three overlapping factors: a genetic propensity combined with psychological and social influences.

In general, emergency room health-care workers increase the psychological component exponentially by expressing their negative perception of the suffering alcoholic through shame. So yes, because of how they treat alcoholics/addicts, particularly in emergency rooms across the country, health-care workers worsen the disease of alcoholism and addiction by lowering the patients’ perceptions of themselves.

In the ER, I jump up—no one shames my patients on my watch. I, too, have been victimized by this biased treatment when being active in my disease.

I grab the aftershave from the doctor’s hand and ask, “What man does not want to smell good while on his way to rehab?” I turn and maintain eye contact with my patient to let him know that I am attempting to protect his dignity, dignity that every patient in that ER deserves.

The doctor gets ready to leave the room. “Hey,” I say. “That big guy the EMT’s just brought in with chest pain, I’m just curious, did you find junk food in his possessions?

I am off-putting, I know, but my goal is for that doctor to maybe, just possibly, shift the way he treats alcoholics and addicts who so desperately need help in America’s emergency rooms.

Hear this: When I am with patients who are entrusted to me, I protect their rights and dignity. And yes, maybe I am a bit pushy in the process, but understanding and expressing empathy to the alcoholic seeking help will ultimately begin the process of healing the psychological component of this disease. Shame will worsen the disease of alcoholism, and worsening a disease is not the goal of emergency rooms, as they attempt to heal the sick.

Please, those of you who deal with alcoholics and addicts, attempt to see past your bias. Educate yourselves. And in spite of the sometimes lousy behavior exhibited by active alcoholics and addicts, which is not always pleasant to deal with, remember you are dealing with a sick mind. But a mind and a spirit that deserve the basic right of being treated with dignity.

Cigarettes are the Gateway Drug

http://cdn2.momjunction.com/wp-content/uploads/2014/09/teen-smoking.jpg Cigarettes. Lethal in ways not spoken of often enough. For those individuals with a propensity for addiction, cigarettes are the gateway drug.

From drugabuse.gov:

“Similar to other addictive drugs like cocaine and heroin, nicotine increases levels of the neurotransmitter dopamine, which affects the brain pathways that control reward and pleasure.”

In my second book, Painkillers, Heroin, and the Road to Sanity, I write about the brain science of addiction. Physical addictions boil down to getting dopamine hits to the brain. Every puff of a cigarette taken will set off the neurotransmitter chain letter that will end up producing dopamine in the brain.

When I say cigarettes murdered my mom, maybe it would be more accurate to say that the cigarette companies in the ’50s—which are still lurking around today, maybe less obvious but still a powerful global force—got untold numbers of people addicted to their product in America and around the world through their false advertising. Always follow the money.

For some, the addiction to cigarettes never goes further than smoking. But I believe that for those who are inherently predisposed to the disease of addiction/alcoholism, most likely through genetics, cigarettes are the gateway drug that wakes up the monster in the brain, making the mind vulnerable to a smorgasbord of other addictive substances.

When I see a teenager smoking, I see into the future: a dark cloud looms around them, like the smoke that is circling their head.

I digress.

“Joani, a phone call from your sister,” someone yells. This can’t be good, I think. My sister lives 3,000 miles away, on the opposite coast to me in Maryland.

“Hey,” I say. Like me, my sister is straightforward in her approach to communicating.

“Mom is in the hospital. She was typing at work, and her fingers would not work. They think she might have had a stroke. She has been admitted to the hospital for testing.”

I know—this phone call is heralding her imminent death.

Starting maybe in second grade, I would hide my mom’s carton of cigarettes. I always knew somehow that cigarettes were her nemesis, even without being told so at such a young age. How did I know this? Only the universe has the answer to that question. In the long run, it made little difference, other than perhaps preparing me for the premature death of my mom, caused by metastatic lung cancer from her years of smoking.

She was also a daily beer drinker and a lifelong benzodiazepine user. She did not drink large quantities of alcohol but had marked personality changes after a few beers. Most likely the effects of the alcohol were enhanced by the tranquilizers she was consuming. But the trifecta was in play: cigarettes, beer, and benzodiazepine. Cigarettes preceded the other two substances by years. I believe cigarettes woke up that monster in her brain, the disease of addiction. Her father was a raging alcoholic who smoked as well.

I left work immediately to arrange a flight home to Arizona, where I was to meet my sister and go to the hospital. That night, after arriving at my apartment and while preparing to leave for what I considered to be my real home, I sat of the edge of the tub and sobbed into a towel. It was the beginning of grief I was not sure I could survive. I was in my early 30s, not married. My dad had been gone since I was 17 in a car accident: he had been driving while intoxicated.

My mom was a flawed woman. Her parenting skills would not get her a gold star. But I knew, felt, that she loved me intensely, was proud of my achievements, especially my nursing career. As I aged, she and I became great friends. She was my family entire. And I was going to lose that. And she would lose her life, and not quickly. My father’s car accident seemed way more humane: he was dead on arrival at the hospital.

But those nine-and-a-half months it took for the cancer to take her life were the worst and the best time of my life. Looking back, I would not have missed that period of time that she lived with me and died alongside of me, but I never want to go through an experience like that again. The grief brought me to knees, as I howled at the moon, looking upward in hopes of getting just one last glance of the mom who meant the world to me.

I started smoking at age 15. Yes, in spite of my deep-seated feelings about the dangers of cigarettes, peer pressure, in the end, was stronger than my beliefs about smoking. Anybody who knows me knows how that turned out. My disease of addiction progressed to a level that almost defies words in its consumption of my mind and soul.

And it started with cigarettes.

After writing this blog, as I closed my computer, the phone immediately rang. (I am not writing this for literary drama)

“Hi,” a mom says quietly. I know the tone well.

“Tell me, what is wrong,” I immediately ask.

The tears come. “My daughter was suspended from high school for selling drugs.”

I quickly tell her about the blog I just wrote.

“Can I ask, does your daughter smoke?”

“Yes, she started with the cigarettes at 15.”

Bingo.

Now it is time to help this kid get back on track.

Until then . . .

CNN: Shame On You, Your Producers and Anthony Bourdain

CNN: Shame on You, Your Producers, and Anthony Bourdain

I am an alcohol and drug interventionist. Daily I listen to fearful,heartbroken families talk about their children’s use of alcohol and marijuana. Kids’ brains are forever changed by using alcohol and marijuana before their minds have had a chance to fully develop around the age of 25. As the National Institutes of Health tells us, every year until the age of 25 that we can keep kids off of alcohol and drugs, the greater the chance is they will not develop substance-use disorder.

“See, Mom,” my 16-year-old son says, tapping me on the shoulder. “Anthony Bourdain got famous and kept his show going for 10 years by drinking alcohol; booze must not be that bad.”

I boil with the irresponsible behavior that CNN and Bourdain are promoting with a commercial for his show. Sure, Bourdain looks hip to kids: tatted, tanned, wearing sunglasses. He is an mature man who should have more respect for his influence on the youth that look up to him. Mentor our youth with your media influence.

CNN, please explain how you could allow this commercial to play over and over again, influencing our children into believing that drinking alcohol is “cool” and the reason that world traveler Bourdain is successful. Kids see, they hear, and it becomes ingrained in their minds that “booze” is cool and can cause a man to be successful. I had to explain marketing to my son and the negative effects it can cause. Follow the money,Max, I said. It is a catchy commercial—and in truth, a very damaging one. Think of the cigarette-smoking Marlboro Man of earlier generations.

This week, Bourdain is smoking pot on TV in Seattle. It’s another damaging message to our youth.

Here’s a challenge to you, Bourdain. Take my calls for a day and listen to parents’ tears and fear. Please, CNN and Bourdain, end this damaging campaign you have going on. Take it a step further and apologize to the public and see it for what it is: reckless endorsement of alcohol and drug use. Predicating your success on alcohol is simply reprehensible and a part of society’s problem, not the solution.