Terrible, Thanks for Asking

Addiction, Language and Education - Transcript

This is a transcript of a “Terrible, Thanks for Asking” episode entitled “Addiction, Language and Education.” The text may not be in its final form and may be updated or revised in the future for accuracy.

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I’m Nora McInerny, and this is “Terrible, Thanks for Asking.”

Since we’ve started this show, we’ve had a lot of stories that included aspects of addiction. The experience of losing a loved one to it. The efforts at getting sober. The aftermath of what it does to a life and to a family and to a body. They’re always really difficult to make, because it’s a difficult thing to experience. It’s the kind of topic where judgment is very easy, empathy is harder… as a listener, as a subject, as a producer.

Dr. Nzinga Harrison — who I’m just going to call Nzinga during this episode although I did ask, and I was like, “Maybe I should just call you Dr. Harrison?” She said it was fine… anyways. Nzinga is the co-founder of Eleanor Health, and she’s the host of “In Recovery.” Eleanor Health puts a people-centric focus on recovery. Her podcast is also very people-centric and has personally helped me examine a lot of my own biases and a lot of my own issues, and I wanted to have her on the show because addiction is one of those things that is just VERY FRAUGHT. And I have a lot of questions, and maybe you do, too. 

Questions about: How we can better understand and support people experiencing addiction. How we can take care of ourselves if we’re struggling with another person’s addiction. And about all those stickier, tanglier feelings about all this stuff!

You’ll understand why Nzinga is one of my favorites. By the end of this episode, you’re going to have new language, new understanding and probably more questions. And that’s okay. 

Dr. Nzinga Harrison is a physician with specialties in psychiatry and addiction medicine. She grew up in Indianapolis, Indiana.

Nzinga: As a psychiatrist now, I can see how my life laid the whole path for me to be exactly where I am. My dad was a commander of the Black Panther militia when I was growing up, a little Black girl in real, real white Indianapolis, Indiana. 

My dad taught us that, like, your voice is your power. You use your voice to speak up against injustice wherever you see it, no matter what the risk is. It is more important to take that risk than to protect yourself. That has really been the defining feature I would probably say my whole life, my career included. 

So I grew up with a significant amount of addiction on both sides of my family, my mom's side and my dad's side. And what I didn't know — which now I know as a psychiatrist, looking back, primed me to have the career that I am — it's like, my grandmother was like, “These are my kids, period. You can always come home. No, you can't spend the night. But you can always come here and you can get a meal. And we love you. And when you are ready to come home, you come home. If you call. I am picking up the phone. Period.” And I think I brought that into my career as an addiction psychiatrist, just like, I tell every single one of my patients before we get out of our visit, “No matter what happens, you can always come back here.” And that's easier for me as a professional. That is harder as a family member. But it always has to be, emotionally, “You can always come back, even if I'm setting these boundaries to protect myself, to protect you. Just know that I see you separately from this illness.”

When Nzinga got to medical school, it wasn’t with the intent to work in addiction and psychiatry, but her experiences in medical school made it obvious to her that that’s where she belonged.

Nora: Tell me about the deficits that you saw in medical school in the way that the medical field was addressing addiction or not addressing it.

Nzinga: Yea. So I mean, if I had not done addiction electives in medical school, I wouldn't have learned anything about it, honestly — besides in the emergency room, throw somebody in the drunk tank and let them dry out, or after surgery, when a person maybe is having withdrawal from alcohol and at risk of developing the DTs, consult the psychiatry team and kind of, like, get this off our plate. You could certainly be a person with schizophrenia and go to the ER with classic symptoms of a heart attack and get discharged without getting worked up because you're “crazy.” 

I mean, I did my psychiatric training at Emory, and it was phenomenal. I graduated medical school in May. I started as a medical intern in July. And I was working the psychiatric emergency room by myself with no oversight three weeks out of medical school. Now that's at Grady -- and that's because Grady is the hospital that takes care of poor people, and people of color, and people with psychiatric illnesses and substance use disorders. It’s, like, not even important enough to have an attending physician overseeing your care, whereas that was very different down the street at Emory as a second-year resident. I had to call my attending for every case. And so you just see how the inequity and the injustice is just baked into the health care system against poor people — or, I should say, people who are poor, people of color, or people with psychiatric illness, people with addiction. It’s literally as if the system just really didn't even care whether you live or not. 

And I was like psychiatry's the most marginalized specialty. Even other doctors don't understand it. It's so fascinatingly biological, but also psychological and social. And I just… I immediately fell in love with it. I was like, this is a good fit. And then when I found addiction, which is the marginalized subspecialty of the marginalized specialty of psychiatry, like, let's not even talk about how people with addiction get treated in general in life, but also specifically by the medical institutions? Like, it's awful. I was like, this is what I was meant to do. I will teach other doctors. I will teach the public. I will bring compassion. I will advocate for people with this illness who are being treated like trash when they are people in desperate need of support. 

When we talk about addiction, the conversation easily focuses on drugs, or alcohol, maybe sex. But the conversation needs to be about more than just drugs, or alcohol, or sex. Because we can be — we are — addicted to pretty much anything and everything. So is every addiction a medical illness? Are all addictions basically the same? 

Nzinga: The definition of addiction that I use on the show, is: anything we keep doing, even though it has negative consequences, the caveat being we don't do anything that only has negative consequences. That's not how the human brain works. Like, there is something positive coming from it. And we find what that is, and then we try to make the positives outweigh the negatives or replace the positives by some other behavior that's not causing harm. The entire reason we did technology is because almost everybody can see themselves in that. And so you started with the question, so is every addiction a medical illness? No. OK, no. But is there shared neurobiology? Is the brain mechanism the same under all of these behaviors? Yes. 

And so to try to clear that up for people: Every symptom we have as humans is on a spectrum. And on that spectrum is, like, OK, they're stone cold normal. And then there's a little little bit at risk. And then there's mild, moderate, severe and extremely severe disease. And so you can think of the way I'm describing addiction, I'm putting us all in the same pot, because it's like, OK, your screen use is at risk. Believe it or not, there are some people that have screen use that is not at risk. I'm still looking for them. But I believe. [laughter] I believe they are out there. There are some people that we would just put in, like, stone cold normal screen use. 

Nora: That's my husband. He, like, honestly couldn’t care less. 

Nzinga: No way.

Nora: He doesn't. You could be like, where's your phone? He's like, you know, I don't know. 

Nzinga: Fascinating.

Nora: Like if I look at screen time, you're like, what century are you from?

Nzinga: So you know what's fascinating? I think, were it not for work, I would be one of those people. Because when I leave work, I leave my computer upstairs. I leave my phone upstairs. It also drives my husband crazy, because he's like, “Grab your phone.” And I'm like, “That’s upstairs. I'm not going up there for that.” And I don't even think about it. I'm on vacation this week, and so I just got my screentime alert this morning, and it was like, “Your screentime is down 78 percent.”

Nora: Oh, wow.

Nzinga: Because I don't have any reason.

Nora: Yeah.

Nzinga: Like, I told my job, “You're not going to find me,” and so I’m like, not on the computer. Stone cold normal. Like your husband. At-risk use sounds like me and you and the kids. Mild, moderate, severe and extremely severe. There are people for whom screen use, especially video game addiction, we see it for sure. Like, I have taken care of people who literally have lost their jobs, lost their husbands, children hate them because of video gaming. So at that point, yes, that is a medical illness. We have walked all the way along the spectrum from normal to at risk to mild, moderate, severe to extremely severe when your 4-year-old has wandered outside dirty and not eating, because you're in a room playing a video game. 

When we’re thinking of addiction and addictive behaviors as a spectrum, we also should be thinking about treatment like a spectrum… which is not how all of us have been taught to think about it. 

Nora: I was raised to believe, like, you have a problem with alcohol. Like... you're 9 years old. You can never drink. You can never drink. And I was afraid of it. And then I went to college and was like, “Oh. Turns out, I can drink, and it makes me feel amazing.” And I don't think that I had a disorder in college, but I do think that I did abuse it. I think that I, you know, I just used it incorrectly. I was like, “How can I feel comfortable walking into a party?” I called it my beer jacket. If I drank three beers, I felt like I was wearing a jacket made of confidence. So, yeah, I was always taught it's either, like, you have a problem and you're drinking and that's the problem, or, like, you never drink at all. And one of the things that has been so just truly, truly astonishing to me in your show and the way that you talk about this is that there's a spectrum of management. 

Nzinga: So what I would call the way you were drinking in college, I would either call that at-risk drinking or hazardous drinking or harmful drinking. I would need more information, but I also… so I told you I'm genetically loaded for addiction. And I also used alcohol in unhealthy ways. I was captain of the cheerleading squad, and I got so hammered the night before homecoming that I missed the game. OK. 

Nora: Ooof.

Nzinga: So, problematic drinking? Yes. Yes. Would I have been able to be diagnosed with an alcohol use disorder by our diagnostic criteria? No. And so I think that's what's really important about it is the same spectrum that I said exists for the illness — so normal use, at risk use, mild, moderate, severe, extremely severe illness — the same is true, the majority of people actually recover to controlled use. And so this is part of, again, the image that we conjure up when we say “alcoholic.” Which, of course, you know, you won't hear me say it. But when we say “alcoholic” or when you say “addict,” that image that we conjure up is the most severe illness on that spectrum. And so yes, for my folks that have the most severe illness, then complete and utter total abstinence is most likely the only way that they would be able kind of to like, maintain functioning. That, though, is a small percentage of people who have the illness of addiction. The bell curve, you can think of a bell curve, the majority are going to have mild to moderate illness. And the majority of those people actually recover to control use, depending on what substance we're talking about.

But you're talking about this concept called harm reduction. I love this quote by Monique Tula. She's the executive director of the Harm Reduction Coalition. And she says, “Harm reduction is the practice of unconditional love for people who use drugs.” And what it means is: Just because you're not making the decision or the choice, or your illness is so severe that you don't have the ability to be completely abstinent, if I can help you reduce the harm of your illness even while you're still using, that is my responsibility to do that.

And so if I have a person that comes into Eleanor Health and they say, “I want to stop using heroin, but I'm going to continue to do Molly on the weekends.” Guess what? I'm going to help that person stop using heroin, because that's seven days of the week that I don't have to worry about a heroin overdose death, even though that person is using Molly. And it's completely different from the traditional addiction treatment landscape, which is complete and utter abstinence, or else that person would go somewhere other than Eleanor Health and say, “I want to stop using heroin, but I'm going to keep using Molly on the weekends with my friends.” And they would not prescribe that person Suboxone. They would say, you can't be in treatment with us, because you have to commit to complete and utter abstinence, or else. And that's how people die.

We’re going to take a quick break.

We’re back. Dr. Nzinga Harrison is talking with us about addiction — about the spectrum of addiction, the spectrum of treatment. And treatment in the United States is really, really problematic. Our entire health care system is, but addiction treatment is… well, I’ll let, I’ll let Dr. Nzinga tell you.

Nzinga: In America, health care is a big moneymaker. And part of the way it makes money is that you go to the doctor; the system drops the bill; your insurance, if you're lucky, pays for some of it; you pay the rest. And the prices are just ridiculous, but that incentivizes a volume of care because the more volume you provide, the more you get paid, whether people are getting better or not.

And so this has most certainly become a thing in addiction treatment — like, these 30-day, go pay $30,000 for 30 days of treatment, plus/minus whether they're doing evidence-based care. One, we already know that 30 days, we already talked about this earlier, is not the plan. Like, you might need 30 days, but then you need a whole lifetime after that. And it's like a tale of two health care systems. Who has $30,000? 

The next level down from that then is, OK, so you have outpatient clinics that take insurance... who has insurance? In North Carolina, 50 percent of people with addiction don't have insurance. And so you get into this hamster wheel where even you have a company with the right value set, wants to take care of people, you actually can't afford to because of the way health care is reimbursed in this country. 

And so we operate on what's called value-based payment. And our value-based payment is like... we take responsibility for this group of people with addiction. If their illness doesn't get better as a result of the care we're providing, then we pay money back. Right? We share the risk on the health of these folks so that our financial incentive can be aligned with our human incentive, which is getting people better. So we get paid a block of money, and we take care of you. And it's like, we don't have to do more and more and more and more and more to make more and more, more, more, more and more money. We just have to take care of people and help people get better. And then you can keep the doors open. And so... it is a tragedy what we have let health care reimbursement turn into in this country, and our most, most vulnerable, marginalized folks with illnesses like substance use disorders — and now COVID on top of it — get the brunt of it, get the brunt of it. Fee for service reimbursement drives health care inequity and disparities. It just does. Keeps you from taking care of people.

All of Nzinga’s work — with Eleanor Health and with the “In Recovery” podcast — is about PEOPLE. Putting PEOPLE at the center of the treatment AND and at the center of the conversation. 

Nora: One of the things that I also appreciate about your show is the careful way that you use language. 

Nzinga: Yeah. So I said “poor people.” And, and I changed it to be “people who are poor,” because I think a lot of the mistake that we make, in this country anyway, in American culture, is assigning environmental attributes as systemic attributes and structural attributes to the people who are suffering because of those environmental factors, those systemic factors and those structural factors. So when I say “poor people,” for every listener, that conjures up an entire set of biases. And so I always just try to lead with the person and describe whatever it is like as a part of the situation or as a part of what they're experiencing or as a part of what they're going through, as opposed to a defining feature of who they are. 

Nora: That really shows up in the way that you talk about recovery and the way that you talk about addiction. What do people think the recovery process is or what addiction is vs. what it is truly in your experience and in your expertise? 

Nzinga: Yeah. So, I mean, we're starting to make a little progress on this, which I'm super hopeful and excited to see. But without question, addiction has been considered a moral failing. It's been considered a series of bad choices made by people with poor judgment who don't know how to take care of themselves and don't care about their families. Wasn't that awful the way I just described that? [laughter] You're like, yeah, dawg, that was awful.

Nora: Yeah.

Nzinga: Because it is. And and so you can see when that's kind of, like, an underlying belief, that's why my people are getting treated the way my people are getting treated. And so people think that recovery is easy and so tend to think about addiction as a series of bad choices. And it's like a sore throat. You can just go do a five-day detox. And if you had enough willpower, you would be done with it, and it would be over. And that's just really, really not at all what we're dealing with here. 

And so, I'm a nerd for neurobiology and the brain. I could talk about it all day. I absolutely love it. And this is part of the narcissism of being human, like, we think we're the most highly of all species and that we got this thing figured out. Like, narcissism is part of being human. And part of that is thinking that we have complete and utter control over our thinking and our emotions and our decisions. And it's shocking how much the environment has control over that and how much of it is out of our control and just how biological it is.

And so substance-use disorders and other psychiatric illnesses are chronic medical illnesses. So just like you know you have some control over your heart rate, and you have some control over your breathing, you have some control over your blood pressure, but you accept that high blood pressure is an illness that you don't have full control over. You accept that diabetes is an illness, that you don't have full control over your pancreas. The same is true about your thinking, your feelings and your decision making. And that's where substance-use disorders, other addictions and other psychiatric illnesses lie. 

It's just because, although we think we can just choose not to use drugs, there's a whole lot of biology and psychology and environmental effect that is driving those, quote, choices to be somewhat out of our control. And so the treatment is lifelong. It's not a sore throat. It's diabetes. It's every single day. And sometimes life is going to bring things that make your blood sugar go up and sometimes life's going to bring things that make your cravings go up. And if we could just conceptualize it the same way, then I think we could open up more compassion for people who are suffering with this illness rather than judging people that we think are making bad choices. 

We can KNOW that addiction is not a moral failing but still treat it like one. And that shows up in our language, in our expectations… and in our health care systems. 

Nora: What are some of the most important changes that people who believe themselves to be outside of this spectrum of addiction or people who want to be helpful can stop perpetuating? 

Nzinga: So number one, stop assuming treatment is quick. Treatment is not quick. Treatment is lifelong. And stop assuming that treatment can be done by that individual alone, because it cannot. It takes an entire support system. And so the way I ask people to think about this is the same way we think about cancer. First of all, a person should be as easily able to tell the world that they have addiction and need help as a woman right now is — thank you to Susan G. Komen and all of the pink ribbon work — is able to say, “I have breast cancer.” It should be that easy. And the reason it should be that easy is because a woman knows, and I know men get breast cancer also, and people who are non-binary and identify not as male or female also get cancer, so let me get my own self right and stop excluding people, right? When a person gets breast cancer, you automatically know that all of the arms are going to wrap around you and breast cancer is the enemy. And we are going to do whatever it takes for however long it takes forever and ever to kill that enemy. And if that enemy comes back, we're not going to blame you that your cancer came back. We're just going to rally the troops again and figure out what we need to do differently to beat that enemy back to its place.

And so it should be that easy for a person with addiction to ask for help, because they should be able to know that they're going to get the same response. We are gonna stand up with you. We are going to fight this enemy that is substance use disorder for the rest of your life for however long it takes. And if that addiction comes back, we're going to be here with you, not to blame you for having symptoms of this illness, but instead to fight with you against this illness.

Now, that is Pollyanna, pie in the sky, because that ain't what is going on right now. OK? So if you truly want to be an ally, I'm going to put my number two in between your one and your three. So number one, treatment is long-term. Yes, you might do a three-day detox. Yes, you might do a 30-day residential rehab. It is not over my friends. Life-long relapse prevention support system, number one.

Number two, implicit bias. It is the way the brain works. And you usually hear people now talking about implicit racial bias or implicit gender bias. It is also the same for implicit bias against people who are poor, against people who have substance use disorders, against people who have HIV. Although we've made a lot of progress on that front, we have to accept that we have bias against these people. And the way you do that is when you accept… so, like, when I said “poor people,” that conjured up a whole bunch. You won't ever hear me call people “addicts.” When you get when you say the word addicts, that conjures up a whole bunch for people. Right? You always hear me say “people with addiction,” because I always lead with the people, because no person is defined by one thing about them, that being equally true, if that one thing is that they have an addiction. That's not who they are. They, like, have it, not they are it.

And so when we feel ourselves — because there is a period of time, just as humans, where you're having a reaction before it rises to your conscious brain — once it rises to your conscious brain, don't judge yourself for that. That is how the brain works. That's why you eat crunchy apples and not rotten apples. Like, you know that apple is rotten before you take a bite of it, and so you don't take a bite. That is how the brain works. And so don't judge yourself for that reaction. But when that reaction lands on your conscious brain, grab it and say, “This is a human. This is a human who is suffering. A suffering human needs help. How can I help?” One, two, three, four. No matter what your initial reaction is. Your initial reaction might be “ick.” Your initial reaction might be anger. Your initial reaction might be based on something you experienced in your childhood and it is, like, full-out fulminating pain and grief and sorrow. Let yourself have that reaction. But once it lands on your conscious brain, remind yourself this is a human who is suffering. When humans are suffering, they need help. How can I help?

And if you can just go through those four steps, this is how you start to actually change what your initial reaction is. And eventually, you'll have the same reaction as when you see a woman with a bald head and a mastectomy. And we've been trained now into an initial reaction of compassion. So we have to train ourselves — that's number two — into an initial reaction of compassion for substance use, disorders and other addictions. And then number three is exactly what you said, is language. Part of the way we train ourselves is in language. And so if we let ourselves use language that is marginalizing and stigmatizing and other-izing — I made it up, but it works. OK? If we let ourselves use language that is other-izing, rather than language that is inclusive and draws the connections that we have with other people who are going through whatever they're going through, then that's actually training our brains out of compassion.

Because, again, the way the brain works is that we have more compassion for people who are like us. Period. That is innately biological. We don't have to judge ourselves for that. But what we do have to do is take ourselves through an exercise to find we have in common with people that we think we don't have anything in common with. Because you know what we have in common? We have in common being unable to put that phone down, even though we truly want to put that phone down. We have that in common with a person who doesn't want to shoot heroin. But the compulsion to shoot heroin overcomes that desire. We have it in common. And so how do we find our compassion along the lines of how we are the same, rather than the knee jerk, which is how we're different.

So, to recap. Four things we can do:

  1. Stop assuming treatment is quick. It’s lifelong.

  2. Address your implicit bias to train yourself to have an initial response of compassion for a person experiencing addiction

  3. Adjust to people-first language — which is not something I’ve always done in life or on this podcast

  4. Continue to train yourself towards that initial compassion response, focusing on how we’re the same instead of how we’re different.

Time for a quick break — we will be right back.


And we’re back. 

When we’re trying to rewire our thinking and behavior and language, it’s one of those things that yes, it makes sense and yes, I want to be better at implementing this in my life and on this podcast. I know that a person with cancer is NOT THE CANCER ITSELF, so of course a person with addiction IS NOT THEIR ADDICTION… but in reality, I have struggled with that comparison, and I know that a lot of other people have, too. 

Nzinga: It's extremely hard. And so I always say when I talk about it on the mic, like, I probably make it sound easy, even though I know it is not easy. And so what's so hard about it is that the symptoms, like you said, of a substance use disorder are happening between people and in relationships. They're interpersonal. The symptoms are thinking. The symptoms are behaviors. The symptoms are emotions. The symptoms are relationship symptoms. And so it is so hard for us as humans, what I was saying earlier, to tease that apart from the actual person.

Cancer symptoms do the same things. They steal our loved ones from us. They make them unavailable to us. They make our loved ones suffer. They make us suffer. They make our children suffer. Everything you name, cancer does it. But because the symptoms are physical, it's easier for us to conceptualize those as symptoms of an illness as opposed to something that person is doing. It’s way, way, way, way harder when it comes to the symptom of the illness is the decision making. It feels like that person is making that decision. When it’s actually that illness that is making that decision as a symptom. And so, that's part of the work that I do with family family members and loved ones, and support systems, is really being able to see that illness as separate from their loved one. And to see even though those are choices, yes, they are choices, but those are choices as a result of an impaired brain. Yes, those are lies. Yes. Those are things that are harming you. But they are still symptoms of a disease. And that person is also suffering. And so if we can see that that person is suffering and see that those are symptoms of the disease, we try to direct all of that anger and hurt and grief at the addiction, the way we direct that at the cancer instead of at the person with the addiction, the way we don't direct that at the person with the cancer. 

Beyond just the way you perceive the people you know who struggle with addiction, there’s the relationship itself. And any illness will complicate any relationship. And that is where things get really, really hard. Not in the theory, but in the DOING. 

Nora: What if the person just won't do the… like, won't participate in any of the stuff at all? Don’t worry, I’m going to submit this as a question for your podcast.

Nzinga: Oh good!

Nora: But it’s like, you know, when a person doesn’t participate in any of the things at all, and so, like, you know that it is a sickness, but also, like... it does become nearly impossible to maintain a relationship with the person. 

Nzinga: Yeah, this is a real experience. And… and I'm going to give you a little nudge. Although this, like, is what people are going through. I'm going to give you a little nudge, because people are also going through this for illnesses that are not addiction, but we don't talk about it. So there are definitely loved ones that have family members with diabetes who are not participating in things that can help diabetes get better. Who have cancer, and their family want them to do chemo and radiation, and they're like, “No, I'm not participating in that, even though it could make the illness better and it could make it easier on the family.”

And so that dynamic persists because, again, as humans, like, we have autonomy. We're going to make our decisions. That dynamic persists across every illness that we have. But we feel it differently for addiction, partly because of that belief that addiction is a series of choices. The fact that it persists across illnesses doesn't make it any easier. It is extremely hard on families and loved ones, no matter what the illness is. When you're like, “There are things you could be doing to get this illness under control and you are not doing them. And that makes me angry at you.” Like that, that is very, very, very difficult. And it gets into your question about boundaries and keeping yourself safe. And so this is true from any illness.

Kind of another corollary that I draw is when you have a loved one that has Alzheimer's or some other type of dementia, and that degenerative brain disorder gets so severe to the point that it has stolen your loved one from you — like, maybe there's only a glimpse of your loved one every now and then, and the rest of the time the dementia is so severe they don't know who you are. They're agitated. They're wandering off. Like, it is just eating you alive and killing you as it is eating them alive and killing them. It is the same kind of situation. It actually is harder, I think, sometimes for families with a loved one that has Alzheimer's, because they don't blame their loved one for having Alzheimer's, and yet it's killing them emotionally. It's killing the loved one. It is stealing your ability to live life. It is hurting you. It is stolen. Your loved one is eaten alive. It is often harder for people to draw their boundaries for an illness like Alzheimer's, because there's no blame there, than it is for an illness like addiction or substance use disorder. Because the blame kind of makes it easier for you to separate yourself. 

What’s happening for me in this interview and this recording — what I hope is happening for you as you listen — is that you’re finding yourself in step 1 and 2. That you’re noticing your own twinges of implicit bias, that you’re seeing where you have to recalculate and recalibrate yourself to have an initial compassion response.

But again, beyond the response is the relationship. And relationships of all kinds are hard. It’s hard to maintain a relationship while we maintain our compassion and also… our boundaries and our personal health.

So number one, period, in all relationships, regardless of what the illness is, emotional safety and physical safety are number one and number two period. Has to be. And so to maintain emotional and physical safety from whatever the illness is, you have to set boundaries that include taking care of yourself to protect your emotional safety and your physical safety. The problem is that when we set those boundaries for people with addiction a lot of times, it's not a compassionate boundary setting, and it's sometimes a boundary that will actually make things worse. 

So think about it. Your loved one with Alzheimer's. You may get to the point that, for your emotional and physical safety, that person cannot live with you. But you wouldn't just put that person out in the street and say, “Good luck living.” You would say, “For my emotional safety and for my physical safety, I cannot have you in this house, so let me get you to a professional, to a residential place where there are staff who can take care of you in a way that is safe for you. And so that I can be over here in a way that is safe for me.” That's a compassionate way to set that boundary of, “You can't be in my house.”

The same is possible over here for a person with addiction. “You can't be in my house for my emotional safety, for my personal safety. I'm not putting you out of this house because I hate you, or because I think you want to be treating me this way. I am not equipped to handle your illness at this severity. So I need you to go somewhere where there are professionals who are trained and who are equipped to be able to safely manage your illness.” And then that person has autonomy. Right? They may be like, “I'm not going to residential.” And I say I've had a lot of heartache taking care of people where I'm like my patients have the right to make decisions that I would not make for them, because guess what? They are their own people, and they have autonomy.

And so I say this to family members, and I say this to people who are using: Sometimes your illness has damaged your family relationships such that they cannot keep themselves emotionally and physically safe and be in a relationship with you. A professional can be in a relationship with you, no matter how severe your illness is. So even when your illness has killed everything around you, you can come to Eleanor Health, and we will keep that relationship period, through active use, the early remission, through sustained remission, through periods of relapse. We are able to have that relationship persist because a professional relationship is easier to manage, through pain and heartache and barriers, then sometimes the personal relationship where the consequences of your illness is pouring on that person. 

So much of this is easier to say and understand and practice when you’re an adult. And a lot of people experience the effects of another person’s addiction when they’re children, when the person who was supposed to keep them safe was struggling with an illness that the kid couldn’t understand and couldn’t fix. Some of us now, even as adults, are struggling with what it means to hold compassion and empathy and boundaries all together. And it’s really, really hard. And I brought that up. How people in our Facebook group and people who email us are dealing with people they love who have hurt them. Parents who stopped showing up. Who never did the reunification steps the court laid out for them. Parents who yes, were in pain and yes, also CAUSED pain.

Nzinga: Part of it, and sadly, a lot of kids that have parents with addiction don't have other adults that can stand in a supportive, compassionate role to make sure that their needs are met. Because a lot of times it’s a generational illness that's, like, just ripping through, killing families. And so for my kids that didn't have any other adults kind of to stand in that healthy, supporting, parental, unconditional, loving role, it's extremely difficult. And what I just always say is that sometimes we lose family members to illness, whether they're physically dead or not. Sometimes we lose those relationships. And if you lose that relationship, then I cannot overemphasize how important it is to get your own therapist and walk through that grief process towards acceptance, so you can get through all of those phases. Right? Bargaining, anger, all do all the five stages of Kubler Ross, to get to to acceptance that that relationship with that parent was lost. But then also, if that parent isn't dead, what that individual therapy does is, if at some point that parent 30 years later, like you are now a full-grown adult, you are 42. And that parent comes to you and says, “I'm in treatment, and my illness has been in remission for a year. Can we start a new relationship?” What individual therapy can do for that now adult child is one, help them make the decision whether they want to start this new relationship, because autonomy, and that is your decision, and your emotional and physical safety comes first, period. And two, if you do want to start that relationship, to have a professional that's helping you navigate all… because it's going to bring back childhood hurt. But what we have to do is let this relationship be a new relationship.

I mean, just like you wouldn't try to put a cast on your own broken leg. Like, you just wouldn't do that without an orthopedic specialist. [laugh] Right? It's the same thing. We think that we should be able to navigate these emotions on our own, because that's what we're taught from the time we come out of the womb, like “Be a big girl. Big girls don't cry. Be a tough little guy. Get a hold of it. Pull yourself up by the bootstraps.” Like, we're taught that we should just be able to manage our emotions and our thoughts and our decisions ourselves. And a lot of times it's not the case. A lot of times we need professional help to do it. 

Nora: Big girls cry frequently. 

Nzinga: I love crying. And if you listen to the podcast, you already know. 

Nora: I love to cry. It's like, honestly, if I still had LinkedIn, it would be “Special skills: Crying, Emoting.”

Nzinga: I would give you a run for your money. I literally have a doctorate degree in crying. I love it. 

See? See why I love her? I learned so much in our hour long conversation, and I hope you did, too. I can tell you that in four years of making this show, there are ways I could have used language differently, and ways I could have framed up stories and ideas differently, too. So let’s all just keep learning together, okay?!


This is “Terrible, thanks for Asking.” But if you have questions about addiction and recovery of ANY kind, you’re going to want to call Dr. Nzinga Harrison at — and I will repeat this number twice — 833-435-6662. That’s 833-435-6662. You can leave her a message, and she will get to it on her podcast, probably! And if you want to have more Nzinga on our show, let us know.

I’m Nora McInerny — your host, your creator, your producer. You know, what don’t I do? Frankly, I do it all. Our producer is Marcel Malekebu. Phyllis Fletcher is our editor — holy crap, are we glad to have her. Geez, louise. Hannah Meaccock Ross is our project manager — jill of all trades. Jordan Turgeon, digital producer.

Jeyca Maldor… [stumbles] blerg blerg blerg… Jeyca Maldonado-Medina is just helping with production. I don’t know what her specific title is. Associate producer. A produh… a produsser. A produsser. She’s doing great. We’re so glad to have her back. And our theme music is by Geoffrey Lamar Wilson. We’re a production of American Public Media and… I think that’s it, everyone! I think that’s it! Good job! Okay. See ya later.