Some people start with a legitimate prescription and then keep using. Some start with a gift from an acquaintance, just for fun. After a while, a person might give up the drugs entirely, might use them as a casual habit — or might discover that life revolves around the drugs. Then what do can a person do?
What can you do when you notice a family member has started to develop an unhealthy dependence on drugs?
No matter how a person becomes dependent on drugs, the people who treat drug problems do not offer any easy or quick way back out.
“We should put the panic about opiate addiction in perspective. In the U.S., about 200 people die of opiate addiction each day; each day about 2,200 people die of heart disease. People express outrage about drug use; food addiction and sedentary lifestyles may be 11 times as deadly, but these typically evoke much more sympathy.”
— Rabbi Jose Gomez
Rabbi Jose Gomez, a certified substance abuse counselor, says “clients have to know that their struggle with opiate addiction will take a sustained effort of more than a year to achieve meaningful change.”
Gomez is the clinical supervisor for Bio-Med Behavioral Healthcare, an opiate treatment center with facilities in Waterford, Roseville and Flint. The condition he treats there, opiate-use disorder, often co-occurs with mental health disorders, such as depression, bipolar disorder and schizophrenia. Statistically, 70 percent of those with opiate-use disorder also have these mental or physiological issues that make it hard for them to cope with ordinary stresses of life.
Environmental factors, including the people with whom one lives or works, contribute to making this disorder difficult to overcome.
Gomez is certified by the Michigan Certification Board for Addiction Professionals as a substance abuse counselor and by the Michigan Department of Licensing and Regulatory Affairs as a professional counselor. He earned his master’s degree in counseling from St. Mary’s University in San Antonio. He also has earned a law degree and rabbinic ordination. Gomez lives in Oak Park with his wife and children and belongs to Young Israel of Oak Park.
Many people take opioid drugs and only some become addicted. Gomez explains that the same opioid receptors in the brain deal with physiological pain and emotional pain. It is not a coincidence that we use the same word — pain — for how we react to a physical injury and to an emotional injury, he says. Our endorphin system modulates the release of serotonin and dopamine, which allows us to cope with emotional and physical pain. If someone feels trapped or stuck for lack of social mobility, a functioning endorphin system counteracts this pain.
A person with an underperforming endorphin system cannot cope with the everyday stresses of long-term relationships, employment and finances, Gomez says. These stresses lead to pain and suffering, and the person does not have much resiliency.
Such a person, he says, is more likely to become addicted. While the person does not have adequate endorphin responses, opiates can fill the physiological endorphin gap.
Addiction ruins lives.
“Someone who has developed a tolerance for opiates might well need a dose of opiates five or six times a day, at a cost that might come to $100 per day,” Gomez says. “Getting the next fix and getting the financial means to get the next fix become the center of this person’s life. Without that next fix, the person will experience withdrawal symptoms. Keeping withdrawal in check becomes more important than any other commitment in the addict’s life.
“What the addict has to do to get the next dose often has more anti-social consequences than the drug dependency itself.”
And if he doesn’t get that next dose? A person would suffer withdrawal symptoms, which an addict avoids at all costs. Addicts feel compelled to find the next dose and that search replaces social, occupational and recreational activities. Everything revolves around avoiding withdrawal.
Opiate-use disorder is treated with methadone-assisted recovery. A dose of methadone can last for 24 to 100 hours. During that period, the client does not have to worry about withdrawal and can begin to focus on the rest of life, including job, interactions with people and concern for mental health. As the client rebuilds the network of life, he or she can begin to taper off the use of methadone.
The patients also need intensive counseling.
“We do compassion-based therapy,” Gomez says. “Compassion differs from pity. Pity lets us off the hook. Compassion makes demands. It means that we have to say, ‘Let’s figure out how to make this better.’”
Even with counseling and methadone, Gomez reports that “the recovery rate stays at about 50 percent. The client has to be ready to overcome the addiction for this treatment to work.”
The long course of treatment and the uncertain results frustrate observers. While ER physicians and emergency medical technicians generally work to stabilize their patients in crisis, addiction medicine physicians and counselors like Gomez work with the patient over the long term to help him or her change.
This also involves a change in the way the public perceives the disease of addiction and the way individuals struggling with the disease are perceived.
Sometimes patients get written off. People who make policy want to punish. Maybe long prison sentences will prove effective. Yet Gomez asks, “If it were your son or wife or daughter, would you write them off so easily?”
Gomez, speaking as a drug rehabilitation counselor and also as a rabbi, says, “The first rule for treatment of opiate-use disorder comes right from the Mishnah. ‘Hillel says: Do not judge your fellow until you have stood in his place’ (Avot 2:4). We have not experienced what the patient has, and we should not judge the patient.”
Feinberg Consulting in West Bloomfield provides case management for people coping with addictive drugs and for their families. When people come in looking for treatment recommendations, “we do a thorough assessment that provides the information necessary to make appropriate recommendations,” says Steve Feldman, COO at Feinberg Consulting.
But sometimes, he says, the situation calls for a dramatic intervention.
“Recently, we coached a family on inviting their relative to come to a meeting about the crisis in the family,” Feldman says. “He attended. The other family members each shared a letter they had written him, sharing their thoughts about him and about how he had changed — not to blame or shame him, but, please, please, to get him to accept help. He did decide to enter a residential facility in another state.”
Feldman explains that helping the individual also means helping the family and the whole support system. “By the time we get a call about someone in crisis, there has usually been a breakdown in the whole system. Intervention means finding an alternative to the road the person is now on. A person addicted to drugs or alcohol is on a road that leads to pain and misery and destruction.”
At first, Feldman notes, the family response is likely to be, “It is not so bad; we do not need to do anything today.”
“The disease wants that response,” Feldman says. “It thrives in shadow. We illuminate options. There is an alternative to the pain and misery of active addiction.”
Feldman travels the country to learn about treatment alternatives.
“Each treatment center has its own strengths and specialties,” he says. “We try to vet the facilities from a clinical and an ethical standpoint. We want to know which facility would be a good fit for which client. Some specialize in working with clients of a certain age; some work exclusively with male, or female, or gay, lesbian, or transgender clients; some with clients who suffer only from addiction, and some with clients who have mental health issues.”
Finding the proper facility is difficult and confusing to navigate on your own, he says.
Feldman first came to Feinberg Consulting as a business consultant, but that is not the whole story.
“There is another reason why I work in this field,” he says. “I have been in recovery for over 25 years, completely sober from drugs and alcohol. When I first went for treatment, I felt like I was totally alone. No one would understand where I stood. A man got up to speak — he is black, from the inner city, homeless. I had nothing in common with him — I was a Jewish kid from the suburbs with a good home. When he began to speak, in just a few minutes, I realized that his story was mine, I had everything in common with him. I learned then that I was not alone, and that provided me with hope.”
Now he provides that hope for others professionally all the time. Feinberg Consulting, in its coaching role, connects people with a network of other providers, including residential facilities like the one operated by Rabbi Jose Gomez and another kind of organization, Friendship House in West Bloomfield, that provides a different kind of service.
Connecting With Others
Family, friends and co-workers can represent danger for recovering addicts.
Avoiding these environmental dangers can make the path forward look lonesome and bleak for someone recovering from addiction. Rabbi Benny Greenwald, Friendship rabbi at the Daniel B. Sobel House, says, “If a recovering addict can connect with people in the recovery community, he or she will have a much better chance to achieve long-term sobriety.”
When people struggle with isolation, addiction or other life crises, Friendship House provides “a Jewish recovery community offering friendship, support and a variety of programs that facilitate lasting success.”
People come to Friendship House for sober barbeques, Shabbat dinners and holiday programs. Friendship House is a safe place to enjoy the celebrations. People in recovery often have to learn how to be joyous, happy and free without the chemical help.
“Life should not just be boring,” Greenwald says. “People come to realize they can love life being sober, that it is possible to have an exciting healthy life.”
Greenwald provides spiritual counseling and referrals for professional help. He is trained as an interventionist and is a member of the Oakland County substance use disorder oversight policy board.
“I am not a therapist; I am a rabbi,” he says. “I refer people to therapists. I was taught from a young age: ‘You have to know your job and do it well, as well as you can.’ So, I do not try to be a therapist; I try to refer people to the most appropriate professional.”
Friendship House was established in 1994 by Rabbi Levi and Bassi Shemtov. Inspired by the Lubavitch movement, Friendship House has a strong Jewish component. Although most people attending are Jewish, Friendship House is open to everyone.
The organization offers different groups each night, Sunday through Thursday. Many nights, there are Twelve Step meetings of all sorts, including Alcoholics Anonymous, Al-ANON and Narcotics Anonymous. Twelve Step meetings take place in a spiritual context, but it is disrespectful at a Twelve Step meeting to speak of a particular religion. These meetings are non-denominational, open to anyone in recovery.
“On Thursday nights, we run a program that is explicitly not a traditional Twelve Step meeting,” he says. “At this program, we connect the Twelve Step process with the Jewish tradition. Some Jews feel wary of the Twelve Step process; they are proud Jews, and they feel that the Twelve Step process is somehow not in sync with their religion. Our Thursday night conversation is not a replacement for Twelve Step; we think of it as a supplement to Twelve Step — a safe place for Jewish people to connect their recovery with Jewish sources.”
Greenwald has been touched by addiction. A close family member suffered from addiction and has recovered.
“From a very young age, I knew I wanted to help people suffering from such life crises,” he says. “I can’t tell you any stories about specific people. That would break confidentiality. I can tell you that when you see people who change their own lives, with the help of God, it is like a miracle before your eyes. People take ownership of their lives, pull themselves together, become productive members of a community. It is the most awe-inspiring thing to see.”
Louis Finkelman – Contributing Writer
To contact Friendship House, call (248) 788-8888 or email firstname.lastname@example.org. To reach Feinberg Consulting, call (877) 538-5425 or go to feinbergconsulting.com. To reach Rabbi Jose Gomez, call (248) 706-5041 or go to biomedbehavioralhealthcare.org.