“We readily feel for the suffering child, but cannot see the child in the adult who, his soul fragmented and isolated, hustles for survival a few blocks away from where we shop or work.”
- Dr. Gabor Mate, “In the Realm of Hungry Ghosts”
Editor's note: This is the second story in a four-part series about Sound Community Services, a nonprofit, New London-based organization devoted to helping people with mental health and substance use disorders heal and build lives of connection and meaning. You can read part one here.
One of the largest challenges confronting the field of substance use disorder treatment is the lack of scientific agreement about its cause.
Right now, our current and best information points to a host of possible factors, including genetics, family dysfunction, abuse and trauma, peer pressure, and the presence of other mental and physical illnesses, according to the National Institute on Drug Abuse and the Department of Substance Abuse and Mental Health Services Administration. There is evidence, too, that the use of alcohol and other drugs cause actual physical changes to reward centers in the brain. This helps to explain why addictive behaviors seem so illogical, and why willpower alone seems to fail the people who rely on it most. Still, our current understanding leaves much room for stigma and divided opinion about effective treatment.
“It’s important to understand that no one ever woke up and said, ‘I’d like this life,’” says Jason Hyatt, vice president of Programs and Integration at Sound Community Services. “No one says, ‘I’d like to suffer from mental illness. I’d like schizophrenia and drug addiction to guide my choices. I’d like to lose my job, and my friends, and my home…’”
For many, substance misuse can start as an attempt at self-medication. Someone trying to manage painful or frightening symptoms might not have $200 to see a psychiatrist or $30 for a prescription co-pay, but $3 for a bottle or $5 for a pill is within reach. Even for people with means, the immediacy of substances–the instant pain relief–can feel irresistible. "It's rare to see a straight mental health diagnosis anymore," Jason notes. More often, a person's problems feed on each other.
Kathleen, a mom and retail worker, is quick to smile as she talks about coming up on her seventh year of sobriety. Her expression changes though, when she recalls the darkest, most isolating days of her illness, when she was “terrified to leave the house, terrified of people, afraid to go outside.” She hadn’t held a full-time job in 14 years.
“The staff here helped me realize that my life wasn’t going where I wanted,” she says. “They didn’t push me; they understand that when you’re in that place, you can’t be told, ‘you have to do this.’ It’s too much.”
Matthew, a musician who lives with paranoid schizophrenia, also remembers a life defined by fear.
"When I first came here in 1995, I was so scared," he says. "They offered help, but also activities that would get people's minds off things–going bowling, going to see a movie. ... As time went on, I decided, 'OK, these are good people.' I started making friends, I started getting motivated to get through life."
For Matthew, and the other clients we spoke with at Sound, hope came gradually.
“Addictions are often deeply rooted in mental health issues and trauma,” Jason explains. “And people often don’t understand the psychology of trauma. The hurt plays out in day-to-day life, in what people believe about themselves and their place in the world."
This is more than just "feeling bad," he emphasizes. "It’s about not being able to make constructive choices. It’s like the world has a language that you don’t understand. There are deep defense mechanisms at play. ”
Erick, an artist and a client since 2012, had constructed a persona that he says helped him cope with schizo-affective disorder and depression.
"I didn't care about my life," he says. "My family had disowned me. I was so ‘hood’ people couldn't even understand me when I talked. All I knew was trouble and negativity. I didn't know where to go."
Comorbid disorders (meaning illnesses that occur simultaneously) often create a devastating loop, where the physical and psychological anguish brought on by abstaining from substances can be so severe that even people who sincerely want to change their lives, feel trapped and hopeless. The process of physical withdrawal can also be life-threatening.
Erick was homeless and using drugs when a hospitalization first put him into touch with the services at Sound. "I was very skeptical," he says. "I thought, what, is this the lottery? How are these people going to help me? I don't have an income. How am I even going to get medication?"
Complex problems call for dynamic solutions, and Sound’s approach is designed to be both comprehensive and life-affirming. Their services include individual psychotherapy and group counseling, life skills training, medication-assisted treatment for psychiatric and substance abuse problems, support and social groups, court and legal services, and supportive and supervised housing. The agency embraces harm reduction, which means that every step toward wellness has value.
Jason sums it up directly: "We meet people where they are. This is not setting the bar low; this is reality. If someone goes from drinking 30 beers a day, to 15 beers a day, that's an improvement. Is someone switches from heroin to marijuana, that’s arguably a healthier shift. We focus on progress." The majority of users make some attempts at moderating or "cutting back" before entering a stage of abstinence, he notes.
Ultimately, harm reduction creates an environment where people are more likely to seek help, because they aren't being asked to do what seems impossible.
"Everybody is at a different stage of change," says Errol Maurice, the director of Sound Residential and Young Adult Services. “We focus here on what success looks like for the individual. What is the big picture, and what are the realistic goals? Yes, people suffer. But the good news is that there is nothing but opportunity here, and that's special."
This is not just optimism. It's reality.
Erick remembers thinking that his family was a lost cause. He looks over at Errol. "I gave up hope," he says, and smiles. "But y'all didn't give up on me. The doctors and therapists didn't give up on me. And I said, 'Well then, why am I going to give up on me if you won't.'" This past Thanksgiving, Erick reconnected with his family for the first time in 10 years.
Erick also established a peer support group, a place for people to check in each morning and map out their day.
"He's really emerged as a leader here," Errol says. "And he took that upon himself, to look for ways to give back."
"I started from the bottom, so I know how hard it is," Erick says. "We're all in the same boat here, to grow and develop. … I like myself today. I'm my own man."
Matthew, too, describes experiences he wouldn't have imagined before getting treatment and care. The arts, he says, have always been a solace: "singing, writing, acting." First, he got confident enough to do open mics across the region, and when that response paid off, he signed up for WCTY's "Catch a Rising Star" audition in February of 2016. He placed 13 out of all the entrants. The confidence he gained there led Matthew to a place he never dreamed: auditioning for "The Voice" TV show in Philadelphia.
"That," he says, “was an amazing experience. Everyone was singing in the waiting room."
Matthew now performs all over the state, sometimes on keyboard, sometimes at open mics.
"If I could say one thing to someone who has doubts?,” he says emphatically: “Take the risk. Go for your goals in life."
For Kathleen, her work with Sound has touched her life, but most importantly her family.
“My kids (three ranging in age from 14 to 21) went from having a mother who was terrified of everything, to a mom who can show up for them. Who holds down a job and can go where they need me and stand up for them, if they need that. Even small things! Like if my mom wants cookies I can run to the store for her," she smiles. “I can’t thank them enough for everything they’ve done. Derek Rock, my employment specialist, gave so much emotional support when I was going to job interviews. They helped me believe that I can do what I set my mind to. In my eyes, Sound helped me become me.”
Erick echoes that feeling. "Here," he says, "they want you to fly."
For more information, visit soundcommunityservices.org or call 860-439-6400