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Dr Holly Parker – Psychology at Harvard University – Addiction

Discussing the Stigma of Addiction

Charles:

Hello and welcome! Today we have with us Dr Holly Parker is a lecturer on psychology at Harvard University and an associate director of training at the Edith Nourse Rogers Memorial Veterans Hospital. In this role, she provides individual, couples, and group psychotherapy, and trains future generations of clinical psychologists. Parker received her doctorate in experimental psychopathology from Harvard University, where she engaged in research on topics ranging from anxiety disorders to coping and resilience after traumatic loss. We will be discussing the Stigma of Addiction. How are you today Dr Parker?

Dr Holly Parker:

I’m doing great, thank you very much for making time to speak with me today.

Charles:

It is my pleasure; especially to discuss such an important subject. Thank you for taking the time out yourself. I want to start by letting our audience get to know a little more about you; especially when it comes to the field of addictions. Can you tel us a little more about yourself and the work you do?

Dr Holly Parker:

I’d be glad to. My earliest clinical work actually started in the area of addiction. I became trained in a fascinating and highly effective approach known as Community and Family Training (CRAFT), which actually involves treating addition through the loved ones of the person struggling with addition. I did this work individually and in groups, and eventually trained other clinicians in this model. In addition to the family members, I’ve had the honor of walking side by side people who have grappled with abuse and addiction, whether we’re talking about someone who’s on the fence about recovery, as well as those who have maintained sobriety for many years and seek to hold onto it. In an effort to help a wider number of people, I also address dynamics related to addiction in a book on denial that’s coming out this year.

Charles:

Very interesting; based on your unique experience I would like to really address the Stigma of Addiction as it pertains to family, spouses and children. I want to start with the most complex: children. The media can be harsh as can certain periods of education; for example a child who is at an age where they are aware of their parent’s substance abuse issues. What can be done to help the child process the stigma that in many ways society drives them to place on their parent? (let’s assume that the parent is in recovery)

Dr Holly Parker:

That’s an excellent question. Assuming that the parent is in recovery, I think there’s a powerful opportunity to actively challenge not only the stigma of addiction, but of all difficulties, and to transform a parent from a potentially stigmatized figure to a powerful role model. After all, that’s exactly what a parent in recovery is–a role model for how to courageously face what we fear and to get back up after we struggle. Let’s face it, every human struggles in some way, at some time; that struggle just takes different forms. It’s a vital lesson for children to learn that the crucial issue isn’t whether someone wrestles with pain or problems, but what they do in the face of that. Suffering is something to be understood, and recovery is something to be applauded. This is also a wonderful message for children to have as they get older, when the temptation to stigmatize themselves may arise. Hopefully, they’re experiences with their parent will help them to challenge the flawed notions that come with stigma.

Charles:

I am sure that the following three are not at all scientific but if you can work with me on the following:
Active addict – Dormant Addict – Recovering Addict
There is a difference between someone who is actively using, someone who may be dormant but not maintaining any mechanisms/support to avoid a relapse and the recovering addict. I want you to take this statement and give me your opinion on it. Spouse: “I will live with someone that has an addiction problem; yet not with someone who is an active addict.” I believe trust issues to be quite common in relationships where substance abuse is present. What advice do you give to someone that finds themselves stigmatizing a spouse with a substance abuse disorder. What does it take for them to bridge the gap?

Dr Holly Parker:

Another excellent question. It’s an interesting statement, as it has some real ambiguity here, particularly the first part. “An addiction problem” can mean different things to different people. Some people would mean the dormant variety of addiction that you mentioned, one in which someone is sober but not actively engaged in supports or using skills to hold onto that sobriety. And then there are others who would use the term “addiction problem” to refer to anyone who has wrestled with addiction in their life, even if they are sober and are actively involved in promoting their recovery. This kind of language speaks to the stigma around addiction that can arise in relationships. My first suggestion to partners is to really consider how they see their partner’s addiction. When they use the term “addiction problem,” what do they mean, exactly? Do they look down on their partner’s journey with addiction, and if so, why? Acknowledgement and understanding is the first step; we can’t challenge what we don’t know. The second piece of advice would be for partners to recall a time when they had difficulty avoided painful thoughts or feelings in some way. Did they avoid through eating, shopping, binge tv watching? Have they ever had a hard day and found themselves drinking, or drinking too much? What about times when they tried to change and struggled? These kinds of questions are a way of helping people to empathize with what their partner is going through.

Charles:

Not at all, that was a big question and I appreciate you taking the time to answer it. I want to dig a little deeper, I think empathy and understanding is one of the biggest drivers of stigma in all areas; from addiction to xenophobia and so many other things in between. I’m going to make another statement often used and I want your opinion on it. “once an addict always an addict!” How accurate is this and more importantly; if it is accurate how does a loved one get past it in a way that enables recovery and continued sobriety?

Dr Holly Parker:

I couldn’t agree with you more that empathy and understanding are two significant players in a host of issues that humans face – individually, in their relationships, and as a society. I think that the language we use also plays a vital role in building up or tearing down empathy and understanding, and the statement you gave is a prime example of this. I’m glad you asked about it, because, as you rightly noted, it’s one that people often say, unfortunately. There are two layers here in the statement, both of which get clouded and messy, so let’s tease them out a bit. When someone says, “once an addict, always an addict,” one layer reflects a highly pejorative, stigmatizing, and simplistic view of people who have faced addiction. It implies that addiction is the entirety of a person’s identity, that “addicts” are all the same, and that the person is eternally going to be whatever the speaker attaches to the term “addict,” which is likely to be negative, if the tone is anything to go by. But the second layer reflects an idea about the nature of addiction and recovery – the belief that someone is always addicted to alcohol or other drugs. Of course, the first layer is a stereotype and is plain wrong – I’m going to just name that one! The second layer is more complex. Although it’s true that some people are more likely to become addicted to substances than others, I think that anyone has the potential to become addicted because addictive substances are, by their very nature, addictive. The current widespread addiction to heroin which often starts with an addiction to prescription drugs, is a sad example of this. Ultimately, people who have struggled with addiction can lead lives that aren’t dominated by the addiction, and so in that way, the statement is not accurate. I think this is something that people who love someone with addiction need to understand.

Charles:

I want to dig deeper. Stigma; whilst unhealthy is a common thing we humans do, in a sense I feel we take short cuts in processing people based on labels because it is easier that way. Before we challenge how to get past the point of stigma, I’d like your help with the following: When an individual relapses, this tends to reinforce the stigma. Maybe even resulting in a self whispered I told you so. How do you recommend people reduce the impact of this reinforced stigma?

Dr Holly Parker:

We absolutely take short cuts in processing people based on labels. We even come “pre-packaged” to do this because there are certainly plenty of times when it’s adaptive for our well-being and survival. For example, if someone’s running down the street with a gun wearing a mask, we need to be able assess that quickly! But just like a tool that can work for us, it can also work against us, leading us down a road of unwarranted, incorrect assumptions. In the case of a person who relapses, this can definitely reinforce the stigma, especially for those of us who have it in our minds that the road of recovery is a linear, one-way street. If we believe that, then we’re liable to see someone who relapses as “hopeless,” “lacking willpower,” or “just not caring enough,” to name a few. For anyone who is witnessing a loved one relapse, it’s important to remember that relapses are often an inherent part of recovery. I double dog dare anyone to say that, for every single change they’ve ever tried to make, they’ve never taken a step backward. It happens, and if anything, these relapses can fuel recovery by becoming experiences to learn from. I think that by normalizing relapses as an inherent part of change, and stressing that the key is to learn from the relapses when they occur, this can help change the frame that people have.

Charles:

You reference change a lot; which makes sense in this case since moving from addiction to sobriety is very much a large change for such individuals.
How does this point of view help in reducing stigma?

Dr Holly Parker:

I think that the view of recovery as a process of change helps in reducing stigma by placing it in its larger, all-too-human context. If we draw a line between people who struggle with addiction and the rest of us, holding them out as a separate group of people who aren’t “normal,” (I don’t like that word, but I’ll use it here for the sake of clarity) then we do them and ourselves a grave injustice. We’re then painting people with a history of addiction in a false, unfair light, and grossly simplifying what addiction is all about. Instead, by seeing the road to,. through, and out of addiction as a process of change, I think it highlights how anyone can find themselves in that place, how we all strive to change something in our lives and understand how difficult that can be, as well as the very human and understandable elements (like avoidance of pain) that can lead people toward addiction.

Charles:

Inclusiveness vs divisiveness.

Dr Holly Parker:

Yes, that’s exactly right. I would also add that this can apply to a person’s relationship with themselves. Self understanding, compassion, and acceptance, versus self-stigma and shame.

Charles:

It is often that addiction is coupled with other disorders that also receive their fair share of stigma. Often as you mentioned above this also results in self directed stigma. The term I’m broken is something I’m sure you have heard. Of all the stigmas I think self directed is the most damaging. What do you tell the individual that has so damagingly labeled themselves ? (In your experience) Why do they do so?

Dr Holly Parker:

I agree with you 100% that the self-directed stigma is the most damaging. And I’ve definitely heard people refer to themselves as broken, and it’s painful to hear it because that’s such a personal cut to the quick. It’s a dig at their very person that implies there’s no hope, rather than a struggle they’re having or a difficult place they’re in that can shift. When people say they’re broken, I like to ask them to define that first, because they’re generally buying into that idea without really clarifying it for themselves. What does broken mean, for them? What I do next depends on what they say. Broken can mean that someone is comparing themselves to other people and who don’t struggle with addiction, as though they “should” be able to drink or use other drugs without an issue. Broken for others can mean that they’ve wrestled with the problem for so long and don’t see it getting better. I remind people that there are understandable reasons why they traveled down the road of addiction, and invite them to have more self-compassion, which I model by showing them compassion and understanding. toward addiction. I also emphasize that anyone can become addicted, and that change is possible. Just because what they’ve tried hasn’t worked doesn’t mean that it can’t work now.

Charles:

I want to play devil’s advocate. Some stigma is sometimes worn with pride. Or at the very least can be highly enabling to a substance abuse user. If I am broken an unfixable; then I don’t have to put the effort in to change because it is futile. Is this kin of thinking something you come across? How do you recommend a love one/family member/ spouse; react to such a statement?

Dr Holly Parker:

Yes, it is. People can say they’re broken as a way of not needing to change, but the reason for not wanting to change can vary. Someone may not be ready to recover and face what they’ve been running from because it’s too frightening, and because the costs of living the way they’re living haven’t outweighed the benefits of change. Other people can find it very hard to recover because, if they can recover now, why didn’t they do it before? It can bring up pain and regret for lost time and opportunities in life for some people. If they don’t recover, they don’t have to face that. If someone says they’re broken and unfixable, a wonderful place to start is to offer compassion and listen. Gently ask what leaves them feeling that way, and offer support and acceptance. Loved ones can share that they don’t see the person as broken, but I’d advise them to remember that they can’t control how their loved one feels about themselves, and that it’s probably better to hear how they feel without trying to deny it (e.g., “No you’re not broken!”). Ultimately, in the broader scheme of change, if a loved one is struggling with addiction and isn’t ready to change, family members generally can’t talk the person into changing. In fact, sometimes this can have the opposite effect, as people tend to resist when they feel like they’re being told what to do. Instead, if family members can reward behavior that reflects change by, for example, spending extra quality time with someone when they’re sober, that’s a great place to start.

Charles:

Excellent answer. I have to ask this next question as a follow up. Some argue that treating addiction takes the proverbial village. Others believe it is a purely personal issue. Others of course sit somewhere in the middle. Considering the things we discussed above. Is stigma accurate when the individual does not want to change? I believe there is much fear of change in many people’s hearts but should a family member give up?

Dr Holly Parker: No, I don’t think stigma is ever warranted. It’
Dr Holly Parker: Oops! Sorry!

Charles: 🙂 devil’s advocate here – listening 🙂

Dr Holly Parker:

It’s a situation in which someone is walking a difficult and painful line between continuing to avoid what they fear and making the daunting journey forward toward recovery and dealing with the gut wrenching medley of feelings and issues that have been kept at bay. I don’t think there’s any shame in that. I do think that this is separate from the question of whether a family member should ever give up. On that latter point, which is a great issue you’re raising, one of the traps family members can fall into is to think that they can make the other person change if they just argue enough, nag enough, shame the person enough, or beg and plead enough. This approach, as in virtually all aspects of relationships doesn’t work. The only thing that loved ones can do is change themselves, and this is actually what can have powerful consequences. In the grand scheme of things, for all of us, we continue patterns of behavior that work, and we stop what doesn’t work. When loved ones create a warm, inviting world for someone who is making steps toward recovery, but does not support use-related behavior (e.g., hanging out with someone when they’re actively drunk or high, covering for someone’s absence from work because they’re hung over), then the balance for that person can start to shift, making the benefits of continuing to use drugs and alcohol less worthwhile. And let’s say that a loved one’s struggle with addiction is so painful for the person that they need to create some emotional distance for themselves, they can always clearly say why they’re withdrawing, and emphasize that when the person is ready to recover, they’ll be there with love and support. So it becomes not avoid the person, but about the addiction.

Charles:

We have kept you quite a while; so I won’t keep you much longer. On the above I want to move to another area of stigma. The stigma (sometimes perceived, sometimes actual) of the loved ones of an addict. A parent may feel they are stigmatized as having failed; a spouse may blame themselves for not being supportive enough, even a child may blame themselves or find themselves labeled due to a parent that is a substance abuser. (This not taking into account the psychological impact and family dynamic for the child of a substance abuser.) With this in mind, many make the fight their own. This ranges of course from self-stigmatizing to many other elements but lets focus on the stigma for element. What advice do you give such individuals to overcome the stigma of addiction from peers etc; and more importantly from themselves?
To elaborate slightly – The son or daughter of an addict may find themselves identifying as the Son of an addict as opposed to the unique individual they are. Same may go for the parent, spouse etc. In such cases what is your advice?

Dr Holly Parker:

Excellent question. There are two pieces I would encourage people to keep in mind. First, I would invite them to reframe that sentence and say that they are the spouse, child, parent (fill in the blank) of someone who is struggling, and that struggle happens to take the form of addiction. In that light (a true one), a spouse/child/parent who feels stigma is in the same boat as many others who love people who wrestle with other issues. Virtually everyone loves someone who hurts. Second, a history of addiction is quite common, and so even if we stay in the realm of the struggle of addiction, these loved ones are far from alone. Then, finally, there’s the issue of secrecy and isolation. Keeping the fact of loving someone with addiction a closely guarded secret transforms it into a secret, and I think gives the stigma more power. Instead, by opening up to others who are in the same situation (there are support groups and online communities for loved ones), it can reduce the secrecy and, in seeing others who are in the similar situation, hopefully lessen the shame and isolation. We’re not meant to go through life alone, and this kind of struggle is no exception.

Charles:

I want to ask you one last question. We have discussed stigma from many angles today. Labels, have always existed and probably always will, self-labeling and society labeling us. Furthermore we are different things (labels) to different people. To a father we are a son/daughter, to a client we may be a supplier. For people to change the way they label us they must see us in other lights. How important is it to recovery and also breaking stigma: that individuals seek to develop an identity that goes far beyond the negative label of addict?

Dr Holly Parker:

I think it’s important to recovery, to breaking self-stigma, and to people’s wellness and quality of life that the they develop an identity that goes beyond the label of addict. People are multilayered and complex, in wonderful ways, and if someone defines themselves as an addict, then that implies that this is all they are and they can’t be anything else. I don’t believe that. People can be, and are, much more than any one thing. I strongly believe that people need to be defined by who they are as people, not they’re struggles. In fact, I think that when people recover from addiction, they come back to who they truly are. I’ve heard people talk about getting away from themselves when they’re in the grip of addiction, and I think they’re right. For anyone who thinks they’re “an addict,” I’d encourage them to explore what else they are. What other roles do they fill? What positive characteristics and qualities do they possess? What’s meaningful to them? I’ve explored these questions with people who have wrestled with addiction, and they’re able to find answers that go well beyond “addict.” And my apologies for the typos and accidental sends! 🙂

Charles:

That is a beautiful answer. I would like to thank you for taking the time out today for this interview. If there is a final thought you would like to share. Or maybe an important point I did not ask about. Please feel free to share.

Dr Holly Parker:

Thank you very much for taking the time to explore this vital issue, and for allowing me to be a part of this process. I just would very much like to tell anyone who is struggling with addiction to take heart. Your journey is a human one, and you’ve been doing the best you can in was I’m sure are trying circumstances. Rest assured that there is a way out, even though the road is a challenging one. Regardless of what you decide and when you decide it, you are not alone, and I wish you the very best.

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