Overdose Awareness — and How We Might Finally Break the Cycles of Shame, Silence, and Secrecy About Addiction

Is your loved one struggling with -- or hiding -- an addiction? You're not alone. Read on with an open heart and mind. And remind your loved one they aren't alone, either.

Photo by Warren Wong on Unsplash

Today, August 31, 2022, is International Overdose Awareness Day, the world’s largest annual campaign to end overdose. It’s a day to remember those we’ve lost to overdose, to acknowledge the grief of the family and friends left behind, and to renew our commitment to end overdose and related harms.

As a memoir coach, I regularly work with individuals who’ve journeyed through addiction and/or faced situations involving overdoses — as well as the traumas that accompany both. I work with many who are currently in active recovery, as well as those who support, struggle with, or have lost loved ones to addiction. I myself am a child of an alcoholic, and I’ve seen firsthand how addiction can steal loved ones from us, turning them into people we (and they) no longer recognize — often pitting families and friends against one another.

While I *could* throw a bunch of statistics at you about the horrifying rise in overdose deaths since the pandemic, you’re free to scroll down and dig into all the numbers (and many resources) later. If you remember any figures from this newsletter, keep in mind that the Center for Disease Control (CDC)’s provisional 2021 numbers suggest that someone dies of a drug overdose in America every five minutes. That means about 2-3 people will die by the time you finish reading this piece.

For now, I want to focus on the human experience and the critical need for everyone to speak openly about addiction.

Is It Addiction?

One of the most common things I hear from clients about addiction in their households is that, when a loved one is suspected of battling addiction (or is actively addicted), clients describe never having felt so alone, confused, angry, or afraid. I often hear mention of paralysis, frustration, resentment, worry, exhaustion, regret, and utter overwhelm.

Clients also report not knowing to whom they can safely turn, reporting that they rarely know who to trust with their situation or their concerns. Everything feels out of control, and many say that they don’t know how to talk to their loved ones without exacerbating an often tenuous, rapidly spiraling situation.

From what I’ve come to understand, the most common and disorienting dynamics in these situations include blame, judgment, and isolation — factors that only serve to exacerbate existing crises.

And at the root of every single story is shame.

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We all experience pain, be it emotional or physical, and when we numb it with something like Tylenol or an anti-depressant, it’s considered an acceptable coping technique, right?

And, I mean, how often do you see a gaggle of women laughing online and posing in their “It’s Wine-o-Clock!” t-shirts, lamenting a desperate “need” to “wind down”? To some, those images are funny…until they’re not.

When someone’s predisposed to addiction, be it through genetics, temperament, trauma, or other reasons, one cigarette might turn into a pack or two; a glass of wine might turn into a whole bottle in one night…or a blackout…or a DUI…or a hit-and-run. A “harmless” joint passed from friend to friend might turn into an everyday fixation on getting high. A “just this once” experiment with an illicit substance might turn into an obsessive need for more, evidenced by lying, stealing, hiding, risky behavior, or self-harm.

When loved ones catch even glimpses of these sorts of behavior changes, they can quickly become terrified and panicked. Worse, if they lack support or language to describe the situation, they may understandably become defensive or shut down, especially if the person in active addiction turns on them with phrases like:

“You’re the reason I’m so anxious. You drive me to do all these things.”
“If you weren’t so controlling/insensitive/distant/critical, I wouldn’t need to do this.”
“You make my life harder than it needs to be. I can’t cope unless I’m using.”
“You have no right to accuse me of [lying/stealing/hiding/etc].”
“You’re the one with the problem. Everyone sees that.”
“You’re too busy thinking about yourself to understand my pain.”
“It’s always about you and your selfish needs. Have you ever considered how hard it is for me?

The addicted individual truly believes these statements to be true and can’t see how they’re shifting attention away from themselves and onto the nearest person. This is how addiction works. It thrives and flourishes by tearing relationships apart, creating further isolation and opportunities for vulnerability. Just like a whirlpool, addiction pulls its victim down, drowning out rational thinking and perspective. Imagine a drowning victim flailing about, lashing out at the nearest bystander (or lifeguard) trying to help: there’s no clear thinking here. These are cloudy, desperate times, and it’s important to understand the signs of addiction and — even more importantly, potential overdose.

How Does Addiction Start? What Does Addiction Look Like?

You’ve heard how complicated addiction is, and how many factors are at play. This link to the National Institutes of Health (NIH)’s Institute on Understanding Drug Use and Addiction helps break things down a bit.

The Hazelden Betty Ford Foundation also offers this list called “How to Tell if You or a Loved One Needs Help”:

Behavioral Signs and Symptoms

• Always uses substance to intoxication

• Uses substance at inappropriate times such as before driving, at work, or at school

• Misses work or school

• Damages relationships

• Poor performance at school or work

• Steals or borrows money from work, home, or friends

• Secretive, defensive behavior about activities and possessions

• Unusual mood changes

• Abrupt temper outbursts

• Changes in eating or sleeping habits

• Changes in peer group or social group

• Loss of interest in usual activities, pastimes, and hobbies

• Aggressive or physical behavior

• Money or valuables missing from home

• Traveling to locations outside of normal range

Physical Signs and Symptoms

• Rapid weight gain or loss

• Slow or staggering walk

• Inability to sleep or awake at unusual times

• Unexplained bruises or marks

• Glazed or red eyes

• Pupils larger or smaller than usual, blank stare

• Cold, sweaty palms or shaking hands

• Puffy face, blushing or paleness

• Extreme hyperactivity; excessive talkativeness

• Runny nose, hacking cough

• Needle marks on lower arm, leg or bottom of feet

• Nausea, vomiting, or excessive sweating

• Unusual nose bleeds

• Unexplained breakout of acne/rash

• Unusual odors

• Low or no energy

• Depressed or anxious

• Deterioration of personal appearance or hygiene

During the pandemic, when human contact was significantly diminished, it’s no wonder that overdoses increased by nearly 30%. Having fewer eyes on loved ones and decreased access to substance abuse support systems meant more opportunities for drug use — and abuse.

Stigma, Shame, and Secrecy

A few years ago, I interviewed Susan*, an agent of the United States Drug Enforcement Administration (DEA) task force. I hoped to learn her opinion on how stigma, shame, and secrecy fuel addiction — and what might be done to break out of these cycles. Susan explained the desperate need for more open dialogue around overdose deaths.

We talked about how, if you lose a child to cancer, the disease is mentioned in the obituary — along with social media requests for donations and signups for meal trains and marathon fundraising pledges. But if you lose a child or a partner or another loved one to an overdose? Nine times out of ten you won’t see the word “overdose” ANYWHERE.

Why is that?

Susan explained that oftentimes, loved ones are worried about others looking down on them for causing or not preventing the overdose, worried they’ll be vilified by society, and/or worried their loved one will be thought of as a ‘junkie’.

She went on to explain that the stigma keeps loved ones silent, and that the silence only perpetuates the cycle of addiction.

If we don’t talk about what’s happening and why it’s happening, she said, we’ll keep seeing it happen.

I asked, “So how do we begin to talk about what’s happening? How do we wrap our arms around why it’s happening? Because if it was really that easy, wouldn’t we be in a better place right now?”

Using her fingers, Susan ticked off a rapid fire list of ways to talk about what’s happening and why it’s happening, all of which seemed to point to being compassionately courageous:

• If you suspect someone’s actively using or abusing substances, say something to them from a place of love and concern, not blame. I see changes in you that concern me, and I want you to know I’m here if you need me.

• If you’re being blamed (or abused) by someone you suspect is actively using or abusing substances, communicate that you’re establishing boundaries with them — not because you want to isolate them, but because you’re feeling hurt/fearful/afraid for them/concerned. Let them know you love them and that you’re willing to connect when they stop lashing out. It’s important to note that they may not (or may not be able to) stop, and that you are not to blame for their choices.

• The worst case scenario imaginable — the one you’re frantic to prevent — is to lose the loved one to an overdose. And this is perhaps where the compassionate courage comes in most. Susan said that when a loved one dies from overdoses, the immediate reaction is to blame and shame oneself:

Why didn’t I do more?
What could I have done differently?
What signs did I miss?
Why did I say X?
Why didn’t I think to say X?
Why didn’t I push to get them into a program?
What is it about me that contributed to this?
Why don’t other people have these problems?
I can’t believe we’re one of ‘those’ families now.

Although Susan said she regularly saw loved ones torn apart by guilt and shame after a loved one’s overdose, the two worst things she said she’s seen are:

a) when families and friends turn on each other with blame and resentment and
b) when the victim, in effect, dies a second death by not being talked about due to the circumstances of their death.

Families, she said, who make up an excuse or don’t acknowledge the truth often can’t — and don’t — move past their grief and pain. Though it’s not easy to talk about it, she said, it’s necessary to let the truth into the light.

“Why don’t some families ever get to that point?” I wondered.

Again, Susan pointed to courageous compassion. Loved ones need to extend compassion to the deceased for the battle they lost. It’s hard, Susan said, to work through shock and anger and grief at the same time. It’s a complicated process, for sure.

Most importantly, though, loved ones need to offer themselves some courageous compassion. Oftentimes, loved ones witness untold horrors when someone dear to them is consumed by addiction — kind of like a slow death unfolding before your eyes. You’re losing the person you once knew to an invisible force, and you realize you have little to no agency against it. If that person succumbs to an overdose, your worst nightmare comes true and you rip yourself apart wondering why you couldn’t have done just ONE THING DIFFERENTLY so they’d still be here. I believe this is what memoirist Joan Didion refers to as “magical thinking”.

And yet, what so many of my clients describe is a visceral need to protect the overdose victim by staying quiet. Whether they’re attempting to protect the victim’s reputation, legacy, or family members from society’s judgment, apprehension, discrimination, or perceptions, the fact is, addiction is the villain, not the victim. Addiction is the bad seed, not the victim. Addiction, not the victim, destroys lives and relationships. Addiction, not the victim, tears people apart. A victim doesn’t set out to become addicted; instead, addiction consumes a human from the inside out. So why in God’s name would someone avoid describing that process?

“I don’t want my son to be known as a bad father,” one of my clients once told me. “Since he died, I’ve been so sad — but also so mad at him for getting involved in drugs and losing so much in the process.” Still, my client didn’t want to openly acknowledge to others how his son passed away. “I just tell them it was sudden,” he told me. “I can’t bring myself to say he died of an overdose.” He continued. “I’ve already lost my child. I can’t bear to imagine people thinking less of him because he overdosed.” But then, he added quietly, “The saddest part is, people have absolutely no idea how hard or how long he fought against his demons...”

I considered my response, and how he might take it. And then, I just went for it.

“Remember: You have the power of the pen to set that record straight,” I offered.

I swear he sat up a little straighter as his shoulders lowered just a little bit.

“I do,” he said, nodding. “Yeah…I definitely do.”

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Eliminating the stigma and shame of addiction will definitely take time, but it’s clearly already happening. Events like International Overdose Awareness Day will make a massive difference, encouraging dialogue and opening eyes, but it’ll take lots of brave people sharing their authentic stories — over and over and over again — before society finally reframes its perspectives and attitudes about addiction. It’ll take patience and compassion and countless offerings by suffering hearts before we truly get there.

Nevertheless, I know we’re moving in the right direction.

International Overdose Awareness Day

The goals of International Overdose Awareness Day (IOAD), first held in 2001, are:

• To provide an opportunity for people to publicly mourn loved ones.

• To send a strong message to people who use drugs and people in recovery that they are valued.

• To inform people around the world about the risk of drug overdose.

• To provide basic information on the range of support services that are available.

• To prevent and reduce drug-related harm by supporting evidence-based practice.

As mentioned earlier, the CDC reports that drug overdose deaths rose by nearly 30% in the U.S. in 2020 — the highest number ever recorded.

Esther Wilding, comparing the withdrawal symptoms of breakups and addiction, writes, "When addicts experience withdrawal, the only thing they want is another hit, despite knowing it’s the last thing they need. It’s likely that they need friends, family, or even professionals around to keep them from getting another dose. They can’t trust themselves and their thoughts; they can only focus on what will make them feel better in the moment, not in the long-term."

How to recognize an overdose

Recognizing an overdose can be difficult. If you aren’t sure, it is best to treat the situation like an overdose—you could save a life. Call 911 immediately. Administer naloxone, if it’s available. Do not leave the person alone. Signs of an overdose may include:

• Small, constricted “pinpoint pupils”

• Falling asleep or loss of consciousness

• Slow, weak, or no breathing

• Choking or gurgling sounds

• Limp body

• Cold and/or clammy skin

• Discolored skin (especially in lips and nails)

Lifesaving naloxone

Naloxone can reverse an overdose from opioids, including heroin, illicitly manufactured fentanyl and fentanyl analogs, and prescription opioid medications. Often given as a nasal spray, naloxone is safe and easy to use.

You should carry naloxone if

• You or someone you know is at increased risk for opioid overdose, especially those with opioid use disorder (OUD).

• You or someone you know are taking high-dose opioid medications prescribed by a doctor.

• You or someone you know have both opioid and benzodiazepines prescriptions or use illicit substances like heroin or fentanyl.

Remember: You can’t use naloxone on yourself. Let others know you have it in case you experience an opioid overdose.

As overwhelming, complicated, and defeating this journey is for so many, I believe hope lies in the personal stories we share. There’s never been a more important time to help end the cycles of shame, silence, and secrecy. If you have a story about addiction or overdose, please share it. Please let others know what you’ve gone through, how it felt, and what you hope they’ll remember about your experience.

Addiction thrives in the dark. Addiction likes to control the room. Addiction doesn’t want us to tell these stories.

So, let’s turn on the light and start talking with compassionate courage about addiction and overdose.

Photo by Tony L on Unsplash

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Resources

Books:
1. American Cartel: Inside the Battle To Bring Down the Opioid Industry
2. Empire of Pain: The Secret History of the Sackler Dynasty
3. Death in Mud Lick: A Coal Company Fight Against the Drug Companies That Delivered the Opioid Epidemic

Online Articles & Studies:
Overdose Basics
Facts & Stats
Overdose Prevention (CDC)
The Opioid Crisis (Bloomberg)
Supporting Those Grieving An Overdose Loss (Full Circle)
2018 National Drug Threat Assessment (U.S. DEA)
The Fentanyl Failure (Washington Post)
Addiction and Emergency Responders (Addiction Center)
At Height of Crisis, Walgreens Thrived (Washington Post)

Podcasts:
Dear Dealer by Nadia Bowers (This American Life)
We Want To Feel Seen with Kathleen Glasgow (Terrible, Thanks for Asking)
Opioids History, Supply and Demand Pt.1 (Freakonomics Radio)
Opioids History, Supply and Demand Pt.2 (Freakonomics Radio)

Streaming:
Dopesick (Hulu)
The Crime of the Century (HBO)

From the CDC:
Naloxone: What is available?
CDC created a suite of naloxone materials and tools to support your efforts to co-prescribe naloxone when indicated. These tools can help clinicians inform patients, families, and/or caregivers about the value of naloxone in a non-stigmatizing manner.

• Factsheets
  Include basic information on naloxone for a variety of audiences ranging from patients to clinicians and healthcare executives.

• Conversation Starters
  Start talking about the role naloxone can have in saving lives. Despite the known benefits of naloxone, discussing it can be a sensitive topic due to the subject of overdose and the stigma associated with its use. 

• Full Naloxone Training

  • Mini modules

    • Assessment: Do You Know the Risk Factors for an Opioid Overdose?

    • Engaging Patients in a Conversation

    • Reducing Stigma Surrounding Naloxone

  • Interactive patient cases

    • Practice strategies for effectively engaging patients and their family, friends, and caregivers in a conversation about naloxone and helping eliminate the stigma associated with its use.

Additional CDC Releases:
This year, CDC’s Division of Overdose Prevention in the National Center for Injury Prevention and Control is marking International Overdose Awareness Day with three releases:

• A new Morbidity and Mortality Weekly Report (MMWR) analyzes emergency medical services (EMS) data and highlights trends in nonfatal opioid-involved overdoses. This report identifies disparities in overdose rates by patient and county characteristics, and provides strategies on what can be done to decrease overdose.

• An up-to-date CDC’s State Unintentional Drug Overdose Reporting System (SUDORS) COVID-19 data brief describes overarching COVID-19-related themes that may have contributed to increased overdose deaths during the start of the COVID-19 pandemic. Based on the identified themes, this brief gives examples of prevention approaches that can be used in future public health emergencies to help reduce overdose deaths.

• CDC’s International Overdose Awareness Day feature can help you learn more about nonfatal opioid-involved overdoses and what can be done about the rising opioid-involved overdoses.

#EndOverdose #IOAD2022

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*named changed at subject’s request

Note: This newsletter contains affiliate links for books. Purchases made using affiliate links provide a small commission to me which I then invest in further research on the subject of addition, overdoses, and the opioid crisis. Thank you for your support.