The Opioid Crisis Changing Families in the 21st Century    

What is the Opioid Crisis?

The “opioid crisis”, also called the “opioid epidemic”, refers to the rapid increase in the use of prescription and non-prescription opioids in the United States.  On Oct 26, 2017, the president actually declared the opioid crisis a national public health emergency, freeing up federal funding for treatment and other resources.  Many federal agencies have joined to combat this crisis that is taking American lives at unprecedented rates.  It is devastating families and even entire communities.  While the causes of opioid misuse are highly complex and multifactorial, the goals of prevention and recovery focus on reducing risk and promoting resiliency.  The government is addressing the opioid crisis by helping to educate families, educators, and others about the dangers of opioid misuse and ways to prevent and overcome opioid addiction, along with supporting state and local agency efforts.

“Opiate” is a pharmacological term referring to a drug derived from the opium plant.  “Opioid”, a more modern term, is used to describe both natural and synthetic narcotic pain relievers.  They work via the central nervous system by reducing the number of pain signals sent to the brain.  Common types of opioids include prescription drugs such as codeine, OxyContin®, Vicodin®, fentanyl, and morphine.  Heroin is an illegal opioid.

Risk of Addiction

The risk of addiction is high with opioids.  With addiction, the drug use alters the brain and causes the person to crave its euphoric feelings, disregarding any consequences.  When people use opioids that have not been prescribed specifically for them or they begin to use more than what is prescribed, they are more likely to become addicted.  A person may also begin to build a tolerance where more of the drug is needed in order to have the same effect, as well as withdrawal symptoms upon stopping the drug, which all can be referred to as chemical dependency.  Opioid addiction can cause serious issues with family responsibilities, relationships, health and well being, finances, the law, employment, and education.  Overdose is a severe problem, especially for people who illegally use opioids, and it can lead to death.

As this nationwide epidemic continues, with devastating effects on individuals, families, and communities, few are left untouched.  In addition to deep psychological and physical impacts addiction has on a person, it also has profound effects on his or her family.  Research on the consequences of opioid addiction on families is abundant and seems to point to the same conclusions.  Opioid addiction profoundly affects the emotional, physical, and financial health of family members and the family as a whole.  These addictions drastically change family roles, rules, rituals, and both internal and external relationships.  The effects are seen across all family subsystems as well (relationships including adult intimacy, parent-child, sibling, the nuclear family, extended family, and social networks).

Families

Almost all addiction cases contain multiple family stories.  Opioid-affected family life is unfortunately rampant with shame, humiliation, anger, verbal confrontations, frustration, fear, anticipatory grief, guilt, helplessness, shock, confusion, denial, brief glimmers of hope, and social isolation.  These are amplified when there is threatening behavior, violence, lying, manipulation, failed promises, money requests, theft, or property damage involved.  There is often generational role disruption (for example, grandparents raising a child of an addicted parent), declining social life, financial stress (from the effects of opioid addiction, repeated treatments, and legal expenses), and actually a stress-related increase in their own substance use.  Also, each opioid overdose death affects numerous people and the loss of a loved one through death, incarceration, or incapacitation creates immense suffering for family members and others involved, causing pain that can persist for years.

Research and clinical experience on the psychological effects of opioid addiction on children and parental opioid addiction on parent-child relationships seem to all point the same directions as well.  Children of opioid-addicted parents are at increased risk of attachment issues, mood disorders (including depression, anxiety, and suicide), conduct and substance use disorders, as well as problems with school adjustment and performance.  Interestingly, these tend to be gender related with female children suffering greater mood disorders and male children experiencing more conduct and substance use disorders.  These are amplified when the parental intimate relationship is conflictual, violent, or there are cycles of engagement, abandonment, and re-engagement.  Studies on the effects of parental opioid addiction on parental effectiveness and parent-child relationships show patterns of disengagement, abandonment, and guilt-induced over-protection and over-discipline.  This is a recipe that frequently leaves children confused and defiant.

There seems to be a need for family-oriented work and research specifically regarding treatment, recovery, support, policy, and prevention.  Along these lines, support group organizations are key in addressing the shame and social isolation that plague addiction-afflicted families, and provide much needed education as well as referrals/linkage.  Al-Anon (which includes Alateen) offers hope and help to families and friends of those addicted to alcohol or drugs.  Also, “Learn to Cope” is a non-profit support network that provides education, resources, and peer support for parents and family members coping with loved ones addicted to opiates or other drugs.  In addition, with individual and family psychotherapy, confidential professional assistance can be obtained, treating the effects that addiction has on family members.  It is important to note that family counseling can be with or without the addicted family member present.

Hopefully, alternative, more natural ways to relieve physical pain, with reduced risk of addiction, can all continue to come to the forefront.  Along with the increased funding for education and treatment programs, it looks promising.  We can all work together to mitigate the devastating effects opioid misuse has on our families and communities, decreasing the overall amount of lives affected in the future.

Letting Go of Things You Can’t Control

Control and Free Will

Learning to understand what we have control over and what we do not is one of the epic challenges of being human. Figuring out what exactly it is that we have control over can actually be fairly anxiety-inducing. That’s because one of the things that makes us most human—free will—is something we share with everyone else and that can often make our experience unpredictable. We are constantly faced with people and situations over which we have no control—from our company downsizing to the over-eager driver who cuts us off at a traffic light.

To complicate things further, we are also at the mercy of how we interpret these experiences. We all see the world through a different lens and, while one person might see a layoff as a result of downsizing an opportunity to explore new employment opportunities, someone else might see it as a personal affront and commentary on their value as an employee, or even a person. We may find ourselves in a very angry frame of mind if our boss, who doesn’t have a family to support, retains his or her job, while we lose ours. That’s one of the keys to letting go of control—not taking things personally.

Barometer for Control

When we buy into the things we can’t control, we actually end up victimizing ourselves. One of our most powerful tools is developing the ability to differentiate between what we can control and what we can’t then using it as a barometer for our experience. Most of us have a great many things in our lives we can control. Making a list of these—things like clothing, food or activity choices—can provide us with some perspective. It can also help us to recognize that choosing between doing something and not doing it empowers us even more because, even before we make a choice, we have to make the choice to make the choice.

Another powerful tool for developing some perspective around what we can and cannot control is exercising gratitude. That sounds like a platitude—‘be grateful’—but it can be a powerful tool in the recognition of what you have done to create your life as it is today. Gratitude of this kind is little deeper than giving thanks around a holiday dinner table. It means taking a daily inventory of those things that nourish us. Some people do this through prayer or meditation. Others journal or keep a gratitude jar in a central location, like in the kitchen or family room of their home. In fact, research shows that practicing this kind of deep gratitude on a regular basis has enormous emotional benefits that can help you counteract those moments when life starts to feel out of control and unmanageable.

Understanding what we have control over based on our decision-making gives us a contrast for recognizing what we can’t control. Once we have developed the awareness to differentiate between the two, we can take the perspective we’ve gained from understanding what we can control and release those things that we can’t.

Sometimes it is difficult to recognize the difference between life circumstances that we can control and those we can’t. At times like this counseling can offer great benefit. If you believe counseling could help contact us here or call us at 860-571-4646.

Challenge of Change

Meeting the Challenge of Change

The challenge of Change, Dr. David Hovey West Hartford, CTOne of the only things we can be certain of is that change is inevitable. Good, bad or indifferent, nothing stays the same. When you think about that within the context of your life, it can be daunting— even overwhelming. Transition doesn’t have to be a struggle though. It can be an opportunity for growth, as well as renewal. The challenge of change you meet in your everyday life can be a source of inspiration for getting more out  of your day-to-day experience, as well as expanding your sense of who you are and your place in the world.

Relationships and Career

One of the most enduring aspects of our experience is our relationships, whether friendships or romantic partnerships. Sometimes those relationships cannot stand the test of time. There can be any number of reasons for this, but the outcome of a failed relationship is, ultimately, an ending. Whether you experience that ending for better or worse, it leaves a gap. That gap is where the work happens. It’s the place you enter into and find an opportunity for growth and change for yourself. It provides you with the chance to examine what happened—or didn’t happen—and what you’d like to see or do differently going forward. Change changes you, and, used as material for your own transformation, the changes you confront can be a springboard for growth, rather than something that keeps you stuck in your sorrow.

You may also identify strongly with what you do for work. It’s not uncommon to see yourself through the lens of your profession or career. When changes happen, like job loss, illness, injury or some other eventuality that take you out of that space, it can be confusing and, in some cases, even traumatic. What if you thought about losing your job or having to reinvent yourself because of some other issue as the best thing that could happen to you, as opposed to the worst? A simple shift in perspective in the face of overwhelming change can open the door to limitless possibilities for you and your life.

Death

Probably one of the greatest life transitions we face is death. Losing a loved one, or even someone who is simply close to us, can be a traumatic experience. By the same token, confronting the possibility of our own death is, for most of us, a frightening thought. Many traditions, however, see death not as an ending, but as just another kind of change. In fact, the Buddhist tradition talks about ‘little deaths’, where every change we confront is like a death and should be treated with a balance of respect and possibility.

Challenge or Opportunity

There is little doubt that change can be difficult. Seeing the challenge of change as an opportunity rather than an obstacle can open up a world of possibilities. Rather than being stuck in grief in the face of change, we can access an occasion for reinvention, renewal and even personal revolution.

Are you in the midst of a life transition? Do you feel you need some guidance on your journey through grief or the changes you are confronting in your life? The experienced counselors at Greater Hartford Counseling Center can provide you with the support you may need to fully explore your understanding and personal potential.

Techniques to Help Manage Chaos and Maintain Calm

Dismiss the Chaos

The stresses we face in our daily lives can sometimes be overwhelming. Whether it’s our relationships, finances, family, children, career, or our personal struggle, things can pile up and leave us feeling paralyzed. The good news is, you don’t have to spend every day feeling buried. There are some simple techniques you can use to minimize or even alleviate your stress and anxiety, dismissing the chaos you might be feeling at the moment from your life.

dog-chaos-calmTechniques to Maintain Calm

Mindfulness

Practicing mindfulness helps you learn how to notice present thoughts, feelings and sensations, and then allow them to just go by, without judging them or yourself. This allows you to become aware of your experience, which is central to helping you let go of painful thoughts and emotions, helping you heal. Mindfulness is a focused activity that can help you free yourself from the stresses that may be weighing on you.

Meditation

There are many different forms of meditation. Most of us are familiar with the formal sitting meditation of Zen Buddhism or yoga. In fact, meditation can be done anywhere, at any time and by anyone. The simplest form of meditation as a means of quieting the mind is to simply sit and follow the breath by keeping your attention focused on it. Another form is guided meditation, where someone guides you through a series of steps—focusing on points in the body or asking you to visualize a particular experience—that bring you to a state of deep relaxation.

Visualization

Another way to de-stress is through creative visualization. One strategy for this is to develop a picture in your mind of somewhere that has brought you peace or happiness in the past. Once you have a hold of that picture, you sit with it and connect with those feelings to help calm you down. This can also be done by creating a picture in your mind that is not a real place, or is a place that you want to be. Again, by connecting with the positive feelings associated with what you’re imagining, it supports you in getting back to a place of balance.

Nadi Shodna (alternate nostril breathing)

This is a technique found in Kriya yoga. It’s exactly what it sounds like, and involves alternatively breathing out of one nostril and then the other. This is done by using the thumb and ring finger of the right hand. In the daytime, you start by closing off the right nostril with the thumb and inhaling through the left nostril. You then close off the left nostril with the ring finger, exhaling and then inhaling through the right. You repeat this for 11 rounds, with a round being an inhale and exhale on both sides. When you use this technique after sunset, you do it the same way, but starting with the right nostril.

One thing that’s important to keep in mind around managing the chaos you may encounter in your life is that it’s happening around you. That means, no matter how crazy things may feel like they’re getting, you can almost always remove yourself from those feelings. Using these simple tools can help you do just that, getting grounded and reducing, or possibly even eliminating, the stress and anxiety you may be experiencing in your daily life.

Parenting Tips for Managing Senior-itis and The Transition to College

Managing Senior-itis and The Transition to College

The transition from high school to college can be challenging for both parents and teens. As parents, you’ve watched your child grow away from you inManaging Senior-itis and the Transition to College, Kim Rinko, LCSW the past few years, as she begins to establish herself and find her way in the world. On the one hand, that transition has probably led to a certain amount of tension and conflict within the family. On the other, these changes have likely given everyone a certain amount of perspective on personal responsibility, self-management and the challenges of becoming a young adult.

Self-management is probably one of the biggest obstacles for a teen, as he starts to sort out his adult responsibilities, along with the natural and logical consequences he may face as a result of not fulfilling those responsibilities. One of the most common and concerning aspects of faltering self-management is that months-long lapse in judgement we like to call senior-itis.

For most teens, senior-itis starts right around winter break of senior year and intensifies until it peaks as school acceptances start rolling in. Teenagers often take this time as a cue for what may begin as an extended coffee break and then lead into the forsaking of just about everything that has led to those admissions letters showing up in the mailbox in the first place.

Consistency

As a parent, you may feel more than a bit powerless in the face of your teen’s noncompliance. You’ve probably also learned that calling her on it will only lead to conflict and strife, rather than any kind of substantive resolution. One of the most effective tools to redirect behavior—especially when you find yourself consistently coming up against the immovable object that is your teenager—is using consistent, scripted responses. This is not to be patronizing, or bully your teen into compliance. Rather, it’s a way to deliver a consistent, gentle reminder of the ground rules that have, thus far, served everyone fairly well. “Can I sleep over Casey’s tonight?” can easily be met with, “It’s a school night. We don’t do sleep overs on school nights.” Even better is using a question, rather than a statement. “Can I sleep over Casey’s tonight?” “Is that OK with Casey’s parents? I’m not sure I’d be up for that on a school night.”

Pre-Teaching

Another effective strategy for supporting your teen with the challenges he or she may be facing is called “pre-teaching”. One of the underlying stresses for anyone experiencing change is the unknown, and, for teens, this can be especially true. Pre-teaching is an effective means for setting expectations around change, making those transitions less disruptive both socially and emotionally. For example, something as simple as saying, “You’re going to have to decide what to bring to school with you, so it might be a good idea to start thinking about that.” simultaneously delivers an instruction on your part, while setting an expectation for your teen.

Holding Space

Something else to take into consideration for both you and your teen is that for the past several years, your teen’s life has been nothing but change—physically, emotionally and socially. While that social change may have included shifting friend groups and the exploration of romantic attachments, the difference between that period and this new phase of life is that, now, his or her entire social landscape is changing. It’s not just connections and the way he or she is connecting, but the context those connections are happening in. That can be overwhelming, and some of the behavior and attitude you’re experiencing with your teen may not just be acting out, but could be an expression of stress, fear, anxiety and even depression. The source of your frustration may, in fact, be a marker for your teen’s deeper struggle around finding his or her place. Holding space for that struggle, and finding ways to walk with your teen on his or her journey into life will create balance for both of you as you move forward.

Step Family Dynamics

Have you found yourself in the role of stepfather, tangling with an adolescent stepdaughter or son?  Here’s some friendly advice: be careful. It’s not your role to parent your stepchildren and, unless you iron out some ground rules right from the start, is likely to upset your new bride more than you imagine.

Blended families can be more difficult than what you may have experienced in your first go round, even if your relationship with your new spouse is a hundred times better. There is some fabulous research on step families, and I’d recommend two books in particular, The Smart Stepdad by Ron Deal and Step Families by Dr. James H Bray and John Kelly.

family-counselingToday’s blog post is about parent focus and the comfort of each parent in the step-family. I hope you find it interesting and useful. Moreover, raising your awareness around this topic could save your second marriage.

Let’s take a scenario where Mom has several of her own kids from her first marriage. Let’s further imagine that they’re teens by now; going through their own identity issues and further doing their normal share of rebelling. Step-dad moves in, perhaps as just a partner, or even as a spouse. Research tells us that parent focus is not symmetrical; and Step-dad’s temptation to parent is in fact a trap.

In this scenario, Mom knows her kids. She has parented them from the beginning, and is confident in her understanding of how to work with them. If, on the other hand, even she is becoming unsure of herself in this new realm of adolescence, she knows she still cares about her relationship with them and has tried to coax them. In contrast, she may be unsure of the relationship with her new partner or spouse. This relationship is something new to her, and research suggests she will typically be less sure of this new relationship, particularly as the new relationship impacts her children.

In dramatic contrast, Step-dad is confident about his relationship with his new wife. Let’s assume that he’s had a bad experience before. This experience is new and the relationship more compatible, but there are these kids that sort of came with the deal. Sure he likes them—maybe even loves them in his fashion—but they don’t behave, or give him respect like his own do.  They demand attention from Mom and soon the little things turn into big things.

This sets up one of the big issues that we can have in a second marriage. She’s kid-focused and confident of her relationship with them, while simultaneously unsure of her new spouse. He’s sure of the new spouse, and confused by the kids. His classic mistake is to act like a parent; particularly when it comes to disciplining without going through mom. That sets up a cycle where:

Step-dad punishes a Step-child who rebels and the Birth mom shields child, seeing her child hurting the Birth mom is further confused by new relationship with Step-dad, as she knows how to interact with her children—not like this—and feels more distance in the new partner relationship.

Things can go south pretty quickly when they’re this way. It’s worth remembering as a stepdad to:

  1. Establish your role. For the first two years, being in a blended family for the stepdad is more like being an uncle than a dad. Talk about it. It’s new—all the research says it’s difficult. Ask questions, engaging your partner and your step-children.
  2. Use House Rules as a way to influence order and discipline. “You are in this house and we have all agreed that we don’t roast marshmallows in the middle of the living room floor; indeed, you are aware of this house rule. Let’s work together on cleaning this fire thing up, so your mom doesn’t have to get involved in the mess.”
  3. Stay calm. See if you can explain what you want. Make an effort to convey how it seems to make sense to you. Reflect on the feedback you get. Listen. Does the child seem to have been heard? Have you asked if they have been heard?
  4. Be patient. They have their own father, they will be concerned about loyalty to him, as well as who you are and your loyalty to them.
  5. Spend time with your Step-kids. As you do try and praise at least 20 times for each correction. You will win their affection with positive reinforcement. (Though surely at times it will not feel natural, make the effort.)
  6. Don’t criticize their father in when communicating with the kids. If he becomes an issue, try and bring him up in private with your spouse.
  7. Respect your step-children’s space and privacy.
  8. Most importantly, engage with your step-children in the way that their mother requests. Communicate issues over parenting with mom first, as a couple and in private. There will be times when mom may not want to be the disciplinarian, and there will be times when she does. Work on how to make that work, without negatively impacting your relationships with her or her kids.
  9. A big part of modeling appropriate communication is to be very careful of how you communicate with your spouse in front of her children. You are modeling how partners communicate effectively against a background of what may be a history of failed communication.

Step-parenting can be rewarding. I’ve gained a son in my own process, but I’ve learned to respect how my three sons are all different. What motivates them, what concerns them and, indeed, how they have dealt with their respective mothers are all different. I’ve learned the most from them by listening to them, although it didn’t come naturally—I’ve personally held my tongue enough to give it finger marks!

If you have questions or comments please reach out. I am always reachable through hello@greaterhartfordcounselingcenter.com.

The Impact of Gaming on Your Child

Is your child running around forgetful, with limited attention span, or are they focused and calm?  It might be time to ask about what role their gaming is playing in their reality?

I am increasingly running into boys who have been “diagnosed” with ADD or ADHD. As part of the intake process I always ask about their activities. Too often I’m told that the young man or adolescent doesn’t really have any outdoors activities, and he spends his time playing video games( gaming)—sometimes more than 40 hours a week. I think that for many of these little guys, it is too often a real addiction. It is perhaps, short term, a convenience for parents, but ultimately devastating for the adolescent.  I might also add that, for parents, this convenience ultimately becomes quite inconvenient, as the young person “spins out” and has trouble launching into a world that requires long term focus and commitment, as well as resilience.

The Impact of Gaming on Your Child Robin Johnson West Hartford CTSo what’s happening here?  First, the business of video gaming has progressed, and the realism is acute enough that the action has become a remarkable experience. Yep—it works as a business. Video gaming world-wide is a $100 billion dollar-a-year business. I would argue, however, that the attraction works too well, given the ultimate impact on young people. This intense game involvement leads to antisocial behavior and, all too often, a form of an actual addiction.

Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations.

Be skeptical about what you read:

The lobbying power of the industry, and the misinformation it puts out, are actually pretty wild. Here are some examples of this misinformation, and please ask yourself if it makes and sense to you. This was published by the Interactive Software Rating Board (ISRB)—an industry mouthpiece.

ISRB suggest:

  • the average gamer only plays 8 hours a week
  • 83% of parents limit game use
  • 40% of gamers are female
  • only 25% of gamers are under 18

If you believe those numbers, you haven’t around a 14-year-old boy recently. There are not enough limits on game use and among my clients who play, the average use per week would have to be closer to 40-50 hours. Think about that: a full time job. Girls are not playing games, just walk into a game store if you are uncertain. The younger gamer market is critical to the business, and it is underestimated in their stats for what I believe is good reason.

The alleged information on gaming found on the web is extraordinarily misleading, and, again, I’d encourage you to think about whether any of this makes sense):

  • a researcher at University of Illinois suggests that heavy users of video games are more fit than non-users
  • The Chicago Tribune suggests video games improve moral sensitivity and physical fitness, as well as improved cognitive skills

The real health world suggests otherwise:

Countering this are more credible health sources:

  • “The American Psychological Society task force on violent media concludes: ‘The research demonstrates a consistent relation between violent video game use and increases in aggressive behavior, aggressive cognitions and aggressive affect, and decreases in pro-social behavior, empathy and sensitivity to aggression.”
  • Health Central suggests that games cause muscle pain, seizures, obesity, aggressive behavior, poor grades, sleep deprivation, and attention problems.
  • An older National Institute of Mental Health study suggested:
    • Children may become less sensitive to the pain and suffering of others.
    • Children may be more fearful of the world around them.
    • Children may be more likely to behave in aggressive or harmful ways toward others.

What to do, if you are a parent

  1. Some folks confiscate smart phones and video games after 8, and always make them inaccessible if homework is not done.
  2. I simply did not introduce games in the home. There are no Wii players, X-Boxes or PlayStations, and computer time is limited to a machine where the administrative password is locked, allowing only certain programs and disallowing downloads.
  3. Have dinner together; set a time, talk about the day and check in about relationships.
  4. If a child is visiting another home, ask if there are limits on game use. Explain that you are strictly limiting the use of games in your home and would appreciate consideration.
  5. Much of what is required involves clear limits around what is acceptable and what is not. Make these agreements ahead of time. Be a parent, and set limits. Giving in undermines authority and actually conveys that all limits are potentially negotiable.

So if kids through gaming are suffering from attention deficit… what can we do to increase attention?

It stands to reason that some kind of attention training would be in order, and the good news is this kind of intervention has been around for a long time.

Thich Nhat Hanh is a well-known Buddhist teacher who advocates focus through mindfulness and meditation. He is among my favorites for explaining the benefits of being present and giving your full attention to your experience. He suggests, “Our true home is not in the past. Our true home is not in the future. Our true home is in the here and the now. Life is available only in the here and the now, and it is our true home. The opposite of forgetfulness is mindfulness. Mindfulness is when you are truly there, mind and body together. ”

The Mayo Clinic suggests that meditation can help:

  • Gaining a new perspective on stressful situations
  • Building skills to manage your stress
  • Increasing self-awareness
  • Focusing on the present
  • Reducing negative emotions

The National Institute of Mental Health suggests that practicing meditation may reduce blood pressure, positively impact anxiety and depression, insomnia and the incidence, duration and severity of acute respiratory illnesses, like influenza. Please see”Meditation: In Depth for more information.

Will meditation be a good substitute for games at home? Probably not initially, but, as a parent, you can encourage slowing down and taking stock of the “now”.

Any time you see…

  • underperformance in school or sports
  • lack of reasonable listening skills
  • trouble sleeping
  • trouble starting or finishing a task
  • angry outbursts
  • prioritization and time management issues with school work or weekend time
  • impulsivity

Think about activities and interactions that slow it all down. Develop observation skills, go for a walk with your child, talk as a family—particularly at regular meal times—and encouraging hanging out with friends away from a computer terminal.

If you don’t like the behavior you see in your child—and the behavior includes any of these seven symptoms—consider a change.  Learning to focus might be a great start.