Archive for December, 2014

Wealthy, famous, powerful, and addicted – Part VII (cont’d)

Dec. 9th 2014

Barriers to recovery: PTSD symptomatology in affluent addicts

In Pain Part II, we continue to explore the question: “Why am I destroying myself with alcohol and drugs?” Answering this question requires much more than simply identifying painful situations, attitudes, and events common in wealthy families – it requires accessing the associated emotions and understanding how they are related to using. Unfortunately, this proves very difficult to put into practice. Many of us are truly baffled as to why we keep relapsing and often succumb to a pattern of continued use and dysfunctional behavior, due to what can best be characterized as post-traumatic stress disorder (PTSD).

PTSD as manifested in the affluent

You might say, “Wait a minute. How can we, wealthy people, have PTSD, when we have it so easy?” Well, the degree of absent, neglectful, destructive parenting – combined with societal hatred of the wealthy (wealthism) – often inflicts major damage during childhood. The damage continues into adulthood, although sometimes in more subtle forms. These experiences alone can lead to PTSD. Add in actual abuse in its many forms or the unexpected loss of loved ones, and it’s almost a guarantee.

 

In Part I, we identified causes of suppressed pain in childhood and how that pain impacts us in adulthood by keeping us detached from our feelings and from others while seeking ways to mask the pain and fill the void (often with drugs, alcohol, and other compulsive behaviors).

 

The combination of bad parenting, societal resentment, and trauma (i.e., abuse, death, etc.) often results in our adopting “survival roles,” where personal identity is significantly changed or lost.

 

Survival roles allow us to get by as best we can when we’re struggling to effectively handle everyday life. We often live a double life, either secretly drinking or using pills or keeping dual sets of friends. Working too much or other “isms” are common as well. Money helps keep the façade intact – we’re trying to look good on the outside, while dying inside. We block the cognitive, physical, and psychological meaning to these painful events and experiences.

Drinking: My solution to losing my son

To use my personal experience as an example, drinking was my ultimate way of coping with the loss of my beloved son. Born with Down syndrome, he died from an inoperable heart condition at age six. I had also lost my 10-year-old brother from a similar condition when I was nine. I knew alcohol wouldn’t fix my pain, but it did provide some relief … until it took over my life.

 

While I could talk about their deaths, I had great difficulty showing feelings when doing so. I could cry when Lassie was lost, but not over my brother or son, which was very confusing to me. This is a common experience for many others as well, who either can’t connect feelings of pain and unease to experiences or can’t give themselves permission to explore the implications on our substance use and recovery.

Internalized self-oppression and loss of identity

When we can’t access or make sense of our experiences and emotions, the resulting depression, chronic anxiety, and anger are often turned inward. We belittle ourselves for our inability to cope with life. This self-oppression becomes internalized with loss of esteem and increasing shame, leading to a weak sense of personal identity and alienation from our core values of family and culture. Many chronic substances users – even those with lots of money – have toxic shame, hating themselves on some level but unable to figure out why.

Treatment as trauma

In the context of affluence, it’s hard for us even to accept a PTSD diagnosis – let alone accept outsiders, including those in the helping profession. But I know many individuals from wealthy and prominent families who fit the definition, based on childhood experiences and mistreatment due to exploitation and resentment. In response, we become paralyzed – unable to take positive steps toward healing, with treatment becoming an additional source of trauma.

 

We come into therapeutic settings such as treatment scared, mistrustful, and reserved – evaluating whether it is a safe space and whether staff or patients can be trusted. Will our life experiences and feelings be heard and respected? Or will we be told not to talk about money (“It has no place in treatment!”) or labeled grandiose? The phrase “I’m not going there!” is so much more than fear of exploring feelings. It’s about being mistrustful – if not re-traumatized – by damaging therapeutic experiences.

 

Negative messages about the danger of feeling

 

Many of the childhood hurts are hidden but sending powerful messages about self-worth and the danger of feelings, because no listened to us as children. If we feel, we might get out of control, and who knows what might happen? As a result, we fail to experience appropriate emotions and to trust “the process.”

 

The isolation trap

 

We believe: If I talk, people will resent me, take advantage of me, or hurt me. If I don’t talk, people will see me as unresponsive, aloof, and withholding.

 

Detachment

 

We don’t feel connected to others and, in fact, fear connection to others. When our emotions are frozen or unavailable on a conscious level, simply being asked to describe our feelings puts us on the spot – we don’t know what to say.

 

Low self-worth

 

We feel shame, including the shame of being different. Our differences become particularly difficult when we try to relate to others in treatment and don’t fit in.

 

Self-pity

 

We feel sorry for ourselves and tell ourselves, “No one wants to know the real me. They only want to know me for my money/body/public image.”

 

Staying in the image

 

We prioritize maintaining the public persona as a rich, famous, important, or professional person to avoid introspection and to protect ourselves from further resentment and exploitation.

 

Becoming a survivor

 

The ultimate goal is to shed our survivor roles and become survivors in the true sense of the word – “thrivers” – flourishing in our new life. But once the drugs are gone, all these feelings come up: fear, overwhelming sadness, anger, and despair. As Terry Hunt suggests, pain can be a source of helpful information from our “engine room.” It’s firing up, but can we embrace our pain and use it as motivation for a different life? Can we gain enough understanding about what happened to us to realize how it affects our efforts at quitting and staying quit?

How suppressed pain impacts recovery

Negative messages about us or our families

 

After internalizing all of the bad things that the world has to say about us, we struggle to develop enough self-esteem to want to recover. Am I worthy of recovery?

 

Parental pressure to be perfect

 

It is hard to feel OK about ourselves as addicts or our relationships with others if we expect perfection or think others expect perfection. Am I OK with being good enough? Or am I marching to another’s drum?

The molded child

 

When we follow the path our parents have laid out for us and use it to identify ourselves, the focus is only on externals. This leads to little insight into addiction. Growing up protected and sheltered, we have very few resources to deal with addiction. And we refuse extended care to learn these tools because we must go home to the people and place that form our identity. Finding my own identity is scary. What if I don’t like who I am?

 

Parents relate to us on their terms and ignore our wishes

 

Our own feelings aren’t acknowledged or considered, so we learn to deny them. “What I feel doesn’t matter.” We also feel we can’t change things because we were unable to do so as a child. So, we feel powerless – stuck in the situation. Can I learn to self-actualize? Can I learn from a 12-step program?

 

Parents absent, raised by servants

 

This abandonment leads to lack of connection to ourselves, meaning we cannot get in touch with our feelings or the feelings of others – not in treatment or through A.A. fellowship. How can I find the courage to join in?

 

Turnover of (hired) primary care giver

 

The inconsistency results in distrust and feelings of powerlessness. “You, too (counselor), will not be there for me.” Yes, it’s difficult finding good treatment and therapists.

 

Parents confuse being present in the home with having a relationship with children

 

Pseudo-parenting can lead to pseudo-recovery (only fixing what shows, not working on what’s inside). If our anxiety and fears can be addressed, it feels so good to rejoin humanity.

 

The awareness of us versus them

 

The effect of this separateness is isolation for those who believe their background and resources make them unique, with crippling fear around having to do what everyone else does. We have little experience in doing so. “Who are we if we are not different – better than?” For those of us trying to blend in, we harbor the fear of being outed – of getting honest. I can chose to stay stuck or chose to try something different.

The healing process

Assuming we can overcome these hurdles and find welcoming therapists and safe spaces, in my experience, honest, open, truthful communications from the heart are a good beginning. Just being able to talk to someone with similar experiences was life-changing. No matter how embarrassing or painful the subject, the deadly stresses and desire to use – born of multiple traumas – can begin to be released and healed.

 

Essentially, the healing process begins with learning to accept the consequences of our life and our actions and developing the maturity to bear our feelings – whether joy, sorrow, anger, or fear. In future blogs, we will elaborate on recovery settings and practices allowing us to understand and manage our experiences and emotions.

Pills, pot, and legalized impairment

Dec. 4th 2014

Cautions for parents, family offices, and wealth advisors

At recent conferences in Colorado and California, several colleagues asked for my thoughts on legalizing marijuana and how it might impact families and the workplace. It’s all over the news and one everyone’s mind, but frankly, it’s not just pot that’s a concern – there’s a whole range of substances family offices and advisors should be aware of.

 

So it’s time to introduce a new concept into our lexicon: legalized impairment. This term refers to society-sanctioned drugs that significantly alter mood, behavior, and judgment. As they become more widespread and readily available, more and more people are using these drugs to excess. This group includes underage users, who, as we know, have easy access to all kinds of substances.

 

Due to their legal or quasi-legal status (often doctor-prescribed), these substances pose a significant risk to family office integrity. As a family office executive or wealth advisor, the last thing you want do is explain odd, unprofessional, or improper behavior by a colleague or employee to clients. While you may want to address the concern in family members, increased drug use is growing and impeding efficient professional-client interactions.

 

So, what drugs are we talking about?

 

Pain killers, benzodiazepines, ADHD meds, sleeping pills, e-cigs, weed, salts/herbs, and alcohol.

 

It’s quite the list and growing weekly. No doubt these drugs have already invaded your office and befriended your clients. As an advisor said to a friend of mine in recovery, “You mean when you wake up in the morning this is the best you will feel all day?” This question reflects the reality that in our culture, we routinely use drugs to feel better. And now we have more and more-potent options that bring with them greater risk of abuse and dependency.

 

Let’s look at these drugs in greater detail:

Pain killers: oxycodone, Percocet, hydrocodone

Over-prescribed in large quantities for relatively minor injuries or procedures, they are easy to get hooked on and hard to quit. When doctors do restrict refills, pills are available from dealers but are often more expensive or harder to obtain than heroin. Substituting more readily-available heroin for pills is a main reason why apparently well-off and functioning people die of opioid overdoses. (Dealers offer free samples, so why not give it a try?) Pain pills are also highly sought after by students to come down from Adderall and Ritalin and other stimulant-induced study or test-taking highs.

Benzos: Xanax, Klonopin, Valium, Librium, Ativan

Commonly prescribed for anxiety, these drugs are known as “alcohol in a pill.” Contrary to the opinions of some doctors, they do lead to increased tolerance and dependency. They’re also known for their boomerang effect: Over time, they produce the same symptoms they are designed to alleviate. Supposedly prescribed for the short-term, many are in it for the long haul, with mind-boggling withdrawal symptoms when users run out or try to ease off.

ADHD medications: Adderall, Ritalin, Vyvanse

Known as study drugs, parents seek them out for their children to give them an advantage on tests. Whether used for legitimate ADHD or just for a leg up on the competition, these drugs open the door to illegal stimulants such as cocaine, ecstasy, or meth. Coming down from the high can be a problem, and kids resort to fighting the high with depressants. Common “antidotes” include pain medication, weed, or alcohol.

Sleeping pills: Ambien, Lunesta

Touted as risk-free, when taken regularly these drugs cause restlessness, anxiety, memory loss, and occasionally bizarre nighttime behavior. When taken with alcohol in the blood stream, it can be difficult to wake up in the morning.

E-cigarettes: nicotine

E-cigs contain varying doses of nicotine – a highly addictive stimulant. They’re a go-to for people who’ve overdone it the night before and need to shake the cobwebs off in the morning. Other users believe nicotine helps them concentrate, so it can serve as an alternative to Adderall and other stimulants.

Marijuana

The younger generation believes it’s benign. The older generation is getting back into it (or never quit) – for medicinal purposes, of course. So what do we know about it? Marijuana can interfere with memory, perception of time, and motor function. Repeated use during adolescence can result in long-term changes to brain function. Available in increasingly higher percentages of THC (the active ingredient), drug-induced psychosis is becoming more prevalent.

Salts and herbs

Claimed to be unregulated and largely flying under the DEA’s radar, they are often as potent and destructive as the other drugs discussed here and can be highly hallucinogenic. Available online, from head shops, and from your friendly shaman, these substances run the gamut from bath salts to rue plant derivatives and ayahuasca.

Alcohol

Alcohol is easily the most prevalent of the legalized impairment substances. As the accepted social lubricant among the affluent, you’d be hard pressed to find a work, family, or social gathering that doesn’t serve cocktails before, during, and after the event at hand.

 

It’s no secret that excessive drinking is considered a major public health problem, but most of us in the affluent community would scoff at the medical definition:

  • For men, it’s five or more drinks in one sitting or 15+ in a week.
  • For women, four drinks in one sitting or eight in a week.

In our culture, these suggested limits are exceeded regularly and with little awareness that tolerance is increasing. We ultimately can become dependent, particularly as we age. After age 40 or so, alcohol takes longer to leave our system, meaning drinking the same amount will have greater effect.

What to do?

I encourage drug testing because it is the only way to truly determine actual substance use. It also has a preventive effect because people are less likely to use when they know they will be tested regularly.

 

For the family office:

 

Because of fiduciary responsibilities and client relationships, it’s important to regularly drug test all employees. There’s nothing more maddening than trying to figure out why an employee is acting strangely and mishandling client interactions. I also recommend establishing a policy for persons using prescription narcotic medications – and include marijuana as well. Of course, these procedures will need to be vetted and approved by a lawyer who is familiar with state and federal employment and disability laws.

 

I’d also recommend an educational program for staff on different types of narcotic prescription drugs, dosages, and their effects and side effects. This will help with self-awareness and also with client relations because many clients discuss medical conditions with their account representatives.

 

For clients:

 

Encourage your families to establish effective provisions in their policies and governing documents to address substance and behavioral health disorders (see my article, “Model Language for Addressing Substance Use Disorders [Addiction] in Trust Documents: Best Practices for Treating Substance and Other Behavioral Disorders). Educational programs are also helpful, as are discussions among the younger generation about what they would like to see happen if someone is abusing alcohol or drugs. Taking a strong stand on alcohol and drug use can set the tone for the family, especially if it is backed up by moderate, responsible drinking at family events.

 

For families with a history of addiction or mental health issues, a joint project such as a family genogram can help trace these disorders through the generations to the present (see: www.2164.com). It really helps illustrate the concept of “genetic load,” meaning that when the gene linked to addiction is present, there is good chance that the next generations will be susceptible to the disease.

 

This may sound very controlling and Machiavellian, but drug testing young adults as a condition of receiving funding might also be appropriate, given the widespread substance use in this group. Family members don’t like to see a relative destitute, so there might be two levels of payment for compliance and non-compliance (e.g., minimum subsistence for positive test and the regular payment for passing the test).

Address legalized impairment head on it will steamroll you!

Addiction is already the primary threat to family stability and well-being. With more heavy-duty drugs legalized, legitimatized, and available, this risk is only going to increase. Your choice, as an advisor, leader, or family member is to attack this issue head-on, or it could very likely become the predominant driving force in your clients or your own family system.

 

Due to popular demand, a future blog will explore in detail the topic of marijuana. Before doing so, I wanted to place weed in the overall context of legalized impairment.