The political and emotional complexities of PTSD (post-traumatic stress disorder) and TBI (traumatic brain injury) can lead to stigmatization and inaccurate attributions. It has long been assumed that soldiers, especially those who have served in combat, are at higher risk for violence. Following WW II several congressmen introduced proposals to send returning combat troops to islands for "retraining" before returning to civilian life. Following Vietnam we had Rambo movies and veterans "going postal". The facts are both simple and confusing: sudden outbursts of violence are rare and very hard to predict.
The article referenced above summarizes some of what is clear: PTSD and TBI can produce shifts in emotional management and changes in "executive brain function" resulting in possible impulsiveness. Complex phenomena like PTSD and TBI are difficult to study and data is scattered, sometimes inconsistent or contaminated by selective sampling or agency agendas. What is clear is that spectacular episodes of sudden violence are extremely rare, despite media attention. There are often multiple factors involved and these include co-occurring disorders, use of drugs or alcohol, lack of sleep, number of tours, severity of symptom or injury, just to name a few. We would love to have instruments that predict these rare outbursts, but they do not exist. We are reduced to the old maxim I learned decades ago: "the best predictor of future behavior is past behavior".
I do not wish to oversimplify; however, I want to reassure readers, especially military readers, that they are not likely to explode in some horrific headline-grabbing fashion. The title of the Washington Post article is generally accurate. Put aside the complexities of multiple tours, diminished capacity, head injury, partial recall, fugue episodes, sleep deprivation, isolation, and alcohol, and let's focus on the reassuring take-away message. There is no data supporting the worst fear carried by many. Most veterans are well trained, restrained, disciplined, highly ethical, and filled with a sense of justice, loyalty and honor. Most veterans I have treated live with the dread that they could lose control of their impulses and inadvertently hurt someone. Newspaper headlines about sudden violence and suicide add to their burden of fear. As a 66 year old combat Marine with severe health and mobility problems recently stated, "I am still afraid of what I could do to others.- That's why I need to stay away from others." The fear of losing control results in isolation, self-medication, avoidance, and a whole host of symptoms we see with PTSD.
I would argue that the most common symptom is not violence but extreme dedication to work or mission. I do not have the statistics, but from my years of experience I see pro-social zealousness- not antisocial outbursts- as the most common coping mechanism. Over dedication to work/mission becomes almost addictive. It is easy to get lost in working excessive hours, and it is rewarded by recognition and increased revenue. Channeling one's anger is difficult, but workaholism is an extreme response rewarded in our culture. However, family members can be angry and confused, and the internal burden remains hidden. Sleepless nights, avoidance, occasional road rage and other symptoms flourish, often visible only to a few. Spectacular outbursts are rare. PTSD tends to be a condition that most often fits the following: "Great souls suffer in silence." (Friedrich Schiller). The articulation of suffering is often the first step toward recovery.
Jerry Boriskin, Ph.D, has been at the forefront of the treatment of PTSD, addiction, and co-occurring disorders for more than 30 years. He is the author of several books, including PTSD and Addiction: A Practical Guide for Clinicians and Counselors and At Wit's End: What Families Need to Know When a Loved One is Diagnosed With Addiction and Mental Illness. For more information about Dr. Boriskin, please visit his website at www.jerryboriskin.com.
For more about The Meadows' innovative treatment program for PTSD and other disorders, see www.themeadows.com or call The Meadows at 800-244-4949.
Parents of young addicts suffer the aftershocks of trauma long after the addict has entered REHAB and begun recovery. The Family Member PTSD Scale © Note1 which assesses family members of drug addicts for SHOCK, ISOLATION, VICTIMIZATION, SHAME, OVER-RESPONSIBILITY, LACK OF HOPE, and GRIEF, as well as for other symptoms of Post-Traumatic Stress Disorder (PTSD) or Complex Post-Traumatic Stress Disorder (C-PTSD), is the first tool to use when starting to work with families of addicts. The scale was designed to determine the degree of trauma and the residual effects that trauma has had on parents and siblings. There are stages of unresolved trauma which must be known before beginning family reconciliation.
Examples of some of the typical SHOCK questions on the scale that parents of addicts endorse include: "I am numb from dealing with the crisis of addiction" or "I am shut down emotionally and do not respond like I used to" or "I have flashbacks of incidents that happened in our family when we were dealing with active addiction" or "When the phone rings late at night, I sometimes still experience startle, fear and vivid memories."
Most families have some form of PTSD. A parent who found their child collapsed in the bed or bath nearly dead from an overdose, who experienced a surge of adrenalin to handle the emergency, and never processed the crisis, is frequently haunted by vivid recollection, and nightmares. The nightmares can last for years. For many parents, the long battle with trying to save their teenager's life has resulted in C-PTSD. C-PTSD was first described in 1992 by Judith Herman in her book Trauma & Recovery. It is a psychological injury that results from protracted exposure to prolonged interpersonal trauma with "loss of feeling in control", "disempowerment", or "feeling trapped," which parents suffer knowing they are responsible for underage children in grave danger. The key difference between PTSD and C-PTSD is the concept of "protracted exposure."
All previous family models for working with addiction have approached the family system from the point of view as if addiction began with adults and was passed down generationally. Today we are seeing a very high percentage of first-generation addicts, and the devastation to relatively normal parents when their children turn to drugs is incomprehensible. We have begun to work with families using a different model from the traditional model of family systems theorists of 20 years ago. Once the addict is admitted to REHAB, an immediate assessment for Post Traumatic Stress (PTS) of parents and siblings of these young addicts is begun. Some form of relief from the PTS symptoms is the most immediate need of family members. For some parents, the admonition to just "start working on your own issues" feels like a slap in the face. When the very first advice parents get from treatment center staff are things like "look at your enabling" or "look at your codependency" or "go find an ALANON group and work on your own stuff", some are offended and further traumatized by the lack of empathy for their current state of SHOCK.
"The most painful thing that we see parents dealing with," says April Lain, M.Ed, L.L.S.A.C, who has facilitated over 360 family workshop sessions integrating young adults back into their family of origin, "is the confusion of being told to disengage and leave the addict on their own - the concept of ALANON of "detach with love" is healthy but can be confusing. Parents are sometimes even made to feel guilty for continuing to seek help for their adult children who are caught in the grip of addiction, when intervention is required." She goes on to say, "I tell these parents not to feel guilty for seeking help. If you saw a stranger standing out on the ledge of a 14-story building about to jump off, wouldn't you at least call 911 and try to save their life? If you would do that for a stranger, why not for your own son or daughter who is standing on the proverbial window ledge and their life is in great danger from drug and alcohol use?" For parents who are in the trenches strategizing interventions, they are still on the battle ground. The adrenalin is still pumping. Lives are at stake.
The PTSD/C-PTSD approach to dealing with families is cutting-edge and compassionate. Without fail, along the way, the family members have suffered severe abuse from the addict. Abuse comes in several forms: Overt, Covert, Stealth, Structured, and Impulsive.
Overt abuse is clear-cut and easily recognizable and easy to describe. Cursing, name-calling, fighting, and verbal threats are overt and obvious. If your beloved son or daughter is standing in your kitchen threatening you with a knife, it is obviously abuse and is easily describable to others. If your teenager is throwing things or kicking holes in doors, you have evident visible damage. If you have bruises, broken lamps and you've started to put locks on your bedroom door out of fear, you are dealing with overt, tangible abuse.
On the other hand, covert abuse by an addict revolves around the addict's need to assert and maintain control over his/her parents or brothers and sisters. Covert abuse may not be visible to others such as to the non-custodial parent in divorced families, or with grandparents or schools and even police or coaches who continue to see the addict as charming. These "outsiders" will say, "Oh, you are making a big deal out of nothing." Or, "They will grow out of it, quit nagging them." Covert abuse is emotional and manipulative. It takes advantage of trust and costs parents their self esteem and confidence. Covert abuse is made all the more painful because others do not see the emotional damage - they only see a seemingly "crazy person" who is dealing with the aftermath of addiction.
Stealth abuse such as gaslighting is a form of abuse where the truth gets denied so often and so convincingly that the parent starts to believe they are going crazy. It is the deliberate use of false information to make others doubt his or her own reality, doubt their own memory, and not trust their own perceptions. (The term gaslighting comes from a 1944 film called "Gaslight" starring Ingrid Bergman. Her charming new husband deliberately attempts to drive her crazy, i.e., gaslighting.) Many parents report a feeling "like I was losing my mind".
Sometimes addicts manifest what is known as a patterned (or structured) abuse. That is someone who abuses everyone around them, not just parents but other children, friends, authority figures. The abuse is predictable- everyone gets a fair share. Other addicts are more unpredictable and impulsive with their abuse - they are nice at times and then they strike "out of the blue" in a flurry of chaos. One never knows when the rage fit will hit.
Bessel van der Kolk, in his "Assessing and Treatment of Complex PTSD" identified depression, lack of self worth, problems with intimacy, inability to experience pleasure, satisfaction, or to have fun, as symptoms of C-PTSD. There are no reliable statistics of the number of marriages that do not survive dealing with a child addict, but it appears it could be as high as 20 percent. It is complicated because other factors might have impacted the marriages. The emotional toll is very high on the family.
Drugs and alcohol have taken a foothold on our younger generations on an epidemic scale. Validating the stress that the families have endured is the first step for starting to work with the family. Helping the family to recognize the PTSD characteristics of their reactions, helping them to heal and finally, helping the addict to feel and show empathy for how the trauma has impacted those who love them- that is the work of a REHAB Family Counselor.
Bonnie A. DenDooven
Bonnie A. DenDooven, MC, LAC, a family workshop therapist at Gatehouse Academy, is a former business owner-turned-therapist. The author of the MAWASI© for therapy and healing of financial disorders and work behaviors. She is a former primary and family counselor and assistant clinical director for Dr. Patrick Carnes at The Meadows. Bonnie was schooled in Gestalt therapy and is a member of Silvan Tomkins Institute of Affect Script Psychology, an advocate of Martin Seligman Positive Psychology, and a champion for the initiative for VIA Classification of Strengths and Virtues (jokingly referred to as the "un-DSM").
OPIATE MEDICATION: THE NEW GATEWAY DRUG?
KAREN ZAZZERA, DBH, LPC, BRI-II
FROM 7pm - 8:30pm
CHAPARRAL CHRISTIAN CHURCH
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As part of its ongoing video series, The Meadows presents an 11-part interview with John Bradshaw, world-renowned educator, counselor, motivational speaker, author, and leading figure in the field of mental health.
In the seventh video of his series, Mr. Bradshaw, senior fellow at The Meadows, discusses addiction recovery in personal terms. During his own journey through Alcoholics Anonymous, psychotherapy, family-of-origin healing work, cognitive work, and skill building, he learned to set boundaries, say 'no,' and express anger.
"Most importantly, I had to get back to my values," he explains."Because when you're an alcoholic or an addict or emotionally disturbed, you're morally and spiritually bankrupt. You've lost your sense of values.” He adds that full healing in recovery comes only when one begins to lead a truly virtuous life.
Over the years, Mr. Bradshaw has enjoyed a close association with The Meadows, giving insights to staff and patients, speaking at alumni retreats, lecturing to mental health professionals at workshops and seminars, and helping to shape its cutting-edge treatment programs. He also has authored several New York Times best-selling books, including Homecoming: Reclaiming and Championing Your Inner Child, Creating Love, and Healing the Shame That Binds You.
Other videos in The Meadows' series feature discussions with leading experts in the fields of addiction and trauma, including Dr. Jerry Boriskin and Maureen Canning. To view all the videos in the series, visit www.youtube.com/themeadowswickenburg.
For more about The Meadows' innovative treatment program for addictions and trauma, see www.themeadows.org or call The Meadows at 800-244-4949.
HOW EFFECTIVE RECOVERY DEVELOPS THE ABILITY TO MAKE HEALTHY CHOICES
By JOHN BRADSHAW, MA
THE COUNCIL ON ALCOHOL AND DRUGS HOUSTON
303 JACKSON HILL
HOUSTON, TEXAS 77007
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