It may be easy to recognize when the people around you are going through a hard time, but recognizing it in yourself is much harder. Dr. Nzinga Harrison answers questions from people who aren’t sure how to help their family and how their depression can derail their addiction recovery. Relapse isn’t a single event, it happens over a period of time. In this episode, Dr. Harrison talks about how you can identify the warning signs and prevent addiction relapse.
Lillian, Dr. Nzinga Harrison, Claire Jones, Elizabeth
Dr. Nzinga Harrison 00:06
Hey, everyone, welcome to another episode of IN RECOVERY. I’m Dr. Nzinga Harrison, your host. This is our final Ask Me Anything episode of season two. And I just want to take a moment to thank all of the people who called in, wrote in and asked us questions throughout the season. You are a huge part of what makes this show possible. So thank you, Claire, should we happen? Yeah, let’s
Yeah, let’s get to it. Okay, so our first question comes from Taylor, which is a pseudonym for this listener. And they say “Hi, Dr. Nzinga, I used to abuse drugs a lot, especially cocaine during a period of about two years. This started during a depressive episode and got really bad, but I was scared to seek help or talk about it to friends and family. I regret trying to tackle it on my own, but I did eventually manage to stop, I’m looking forward to being 1000 days clean by the end of September. My recovery has felt steady for the past several months, but I know I’m not out of the woods. The thing that worries me the most is experiencing another depressive episode; I think it would take away a lot of my motivation and mental resources for staying in recovery. So it feels much more dangerous than my current state of mind. I’d love to hear your thoughts on maintaining recovery during periods of bad mental health. I would also like to tell some of the people I’m close to about my past drug abuse, and would appreciate any tips for doing this without burdening them, thank you so very much.”
Dr. Nzinga Harrison
1k, baby, congratulations, that is so awesome. And I know that it’s not been a cakewalk for 1000 days, it’s been work. So congratulations to you for doing that work. You already know what I’m gonna say the first piece of advice for maintaining recovery during periods of difficult mental health is to try to prevent those periods of difficult mental health. And a lot of times, we’re moving through life with things happening to us that we actually could have more control over the effect that it has on us. So I’m talking about mindfulness and meditation and stress reduction, and eating healthy and sleeping enough at night. And being in relationships that are nourishing and fulfilling, and doing activities that bring you joy, and increase life meaning and purpose. These are all of the ways that we fortify ourselves against the difficult things that life brings us. Because you know, we can get into that depressive state of mind, in a number of different ways. Very practically, is like, recognize the early warning signs. In this country, and I think a lot of places we get trained out of recognizing the early warning signs that depression or anxiety is developing, because it’s like, nope, can’t talk about that. Nope. Pull yourself up by your bootstraps. Nope, big girls don’t cry. Nope, big boys be tough, right?
Dr. Nzinga Harrison 03:12
And so I actually want to turn that on its head and encourage you to specifically be thinking about when I feel sad, what are the thoughts I have? What are the physical sensations I have? What are the emotional feelings I have, because those are what your early warning signs for depression will be and it might surprise you. So for myself, if I start obsessing about eating macaroni and cheese, I know that my stress level is too high. Now, I love macaroni and cheese. And sometimes I’m like, oh, I’m at a restaurant, there’s macaroni and cheese. But if I’m literally like going on Uber and sorting the restaurants by the pictures of their macaroni and cheese, which is something that I do, this is something that I do, then I’m like, you know what, my stress level is really high. Because almost like clockwork, I can predict a week or two after that I’m going to be in the bed like I feel so overwhelmed. I feel like I can’t get out of the bed.
Claire Jones 04:10
How did you first find out the mac and cheese pattern?
Dr. Nzinga Harrison
It took me a long time. And actually, my mac and cheese pattern is a COVID pattern. I have always been a lover of mac and cheese. But what I noticed during COVID was just like, I would go through these splits where I was posting so much about macaroni and cheese on Facebook, that it actually became a thing and like my friends, like started tagging me and post about mac and cheese and they’re like oh, Nzinga, mac and cheese. And I was like when does mac and cheese become such an important part of my life. And I just realized that it was part of a stress pattern. And that’s so silly. Nobody would think like obsessing over mac and cheese is an early warning sign. I have learned that to be an early warning sign, so the more you can learn your early warning signs, and it’s going to be behaviors, it’s going to be people, that you hang out with. Usually, like you keep a little distance from this person, because they actually make you feel a little bad about yourself, and you find yourself hanging out with them more. Because you’re reinforcing those bad feelings about yourself.
Dr. Nzinga Harrison
It’s going to be usually it’s not hard for me to exercise. Unless you’re like me, it’s always hard for me to exercise. But like for some people, it’s usually not hard to exercise. Suddenly, it’s hard to exercise. Usually, I love work, work is annoying. Usually, I love these kids, I feel like get these kids out my life, right? Like, you’ll see a change in the quality of your thoughts, change in the quality of your feelings, change in the pattern of behaviors, the earlier you can identify those, the earlier you can intervene, the more you protect yourself from the depth of that depressive episode you had before that eventually led to cocaine. And so the way you identify those early warning signs is, one, enlist your support system, because they will see it before you do. Right?
Dr. Nzinga Harrison 06:10
My kids are like, mom, we have macaroni and cheese every day for dinner this week. I’m like, Oh, snap, I’m stressed out. Okay. So your support system will see it before you do. Two, if you don’t already have a therapist, you knew I was gonna get a therapist, because your therapist will help you uncover layers that you actually that are just blind to you, just by effective their training, they’ll be able to help you get to those. And that therapist will also be able to help you put your safety plan in place. So when you see those warning signs, how do you protect yourself? As far as the second part of your question, I’m not exactly sure who are the people that you want to tell, or why you think it would be a burden to them. But it does always feel a little bit safer to tell people about your drug addiction. When you have 1k days clean baby, I’m gonna say it like that every time.
Dr. Nzinga Harrison
When you have 1k days clean, that makes it feel a little bit safer. But I would say a good strategy, because one of the things that scares people is like, what is my responsibility in helping you to stay sober? And so if you can actually just tee that up for people, because it’s like, why are you telling me this? Do you need something from me, I don’t know what you need from me. Now that I know what you need from me, I don’t know how to do that. That’s kind of usually the types of fears that people develop. And so you can practice number one, but craft your statement to have let’s call it three parts. The first part is how much detail you want to share with this person about your addiction. Know your audience, that will be different, depending on what role you are not asking them to play. Right? So if you’re asking them to help me identify my early warning signs, it might just be exactly what you told us here. I had a really severe depressive episode, I started using cocaine, it got out of control. I’ve been 1000 days sober. This is the early warning sign I’m asking you to help me recognize, right?
Dr. Nzinga Harrison 08:20
So determine the level of detail, know your audience that’s going to change. Two, know exactly what you’re asking from them, or if you’re not asking anything. So this is like why are you telling them and say that explicitly, right? I’m just telling you this because we’re close. And part of my being able to stay sober is not keeping secrets from people I’m close to, I actually don’t need anything from you. Right? Or I’m telling you this because we’re close. And I want you to be part of my network that helps me keep healthy. And part of that is blah, blah, blah, lay it out very explicitly. But then also, this is the third and final step. Make sure that you’re explicit that that person has their own autonomy and their choice whether to accept the invitation that you’re giving, right? So if you’re asking them to be part of your support system, that is their autonomy to say, Yes, I can do that or no, I can’t do that. I just came up those three steps off the top of my head.
Dr. Nzinga Harrison
That’s very impressive.
Okay, our next question comes from Elizabeth, who left us a voicemail.
Hi there. My name is Elizabeth. I am 39 years old. And I’m a wife. I’m a mother of two. I’ve got a 10 and a 12-year-old. I have been in recovery for three years. I got sober a little over three years ago, and I’m super plugged into a 12-step recovery program in my area. But during COVID, I really, really got away from my program. And now I’m just suffering a lot of residual results of getting away from my program and getting away from my, my work on my recovery. So at the time, when I was in isolation at home with my kids, I really wasn’t having a hard time. But now because my disease digressed, I’m having all these wacky thoughts and all this crazy thinking, and I’m obsessed with myself again. And it’s a lot of the same traits that I had when I was drinking, except for I haven’t relapsed, yet. also forgot to mention the concept of an emotional relapse. I have heard you refer to emotional relapses on your podcast and some of your guests also. But I don’t feel like there’s a lot of time devoted to emotional relapse and what that looks like. So I would just love to get some more information about that, too. Alright. Thanks so much. Thanks for your time. I appreciate you.
Dr. Nzinga Harrison
Hey, Elizabeth, I appreciate you. And first of all, shout out three years in recovery. Whoo, that’s amazing. Shout out to your 12-step recovery program that helps you get there. I think you’re experiencing Elizabeth, what a lot of people are experiencing. And so I want you to think about it and I know if you’re in the 12 steps, you’ve heard this concept of your disease in the corner lifting weights, right? So you said when I was at home isolated with the kids, I wasn’t really having a hard time. But that disconnection, being separated from your 12-step program, think about it just like if you had high blood pressure, and you stopped taking your high blood pressure medication, you don’t feel your blood pressure going up, just one day, you’re like, damn, I have a headache and you check your blood pressure, and it’s off the charts. And your alcoholism is the same way. So you didn’t necessarily feel it going up. But now, what you’re feeling is that disease haven’t been in the corner kind of lifting weights.
Dr. Nzinga Harrison 12:23
To stay with this lifting weights concept then, when you get back to work in your recovery program, you’re having to retrain those muscles that you had gotten into a routine with, that you had kind of operating on autopilot going well, it’s like, I used to be able to run a 5k, I haven’t run in a year, I can’t go straight back out and run a 5k. I’m working my way back up to it. And I’m sore. And I’m short of breath. And I can’t drink enough water. And I don’t really want to do it like it’s difficult. And so I think this is probably the process that you’re experiencing right now. So I have a couple of, I guess, pieces of education. And then a couple of pieces of suggestions. The education, I think you’ve probably heard this also. So for our other listeners, this concept that relapse is a process, not an event. So we tend to think about, I relapsed as when I picked up the alcohol or when I picked up the drug and I used but that is actually the last step. What you’re experiencing right now is exactly this process of the emotional relapse, so relapse actually happens in your mind, in your thoughts. It happens in your emotions. And then the last step is that it happens in your behaviors when you actually pick up and I hear a lot of risk for you, Elizabeth, because you said except I haven’t relapsed yet.
Dr. Nzinga Harrison 14:03
We got to get the yet out of that sentence, okay? Because we got to get from three years to three years, 3 years, two months, you know how we do. So we have to get that yet out of the sentence. A couple of pointed suggestions. Number one, I hope you are already doubling down on your 12-step recovery program. second Suggestion, I need you and with a therapist. So here when you say I’m obsessed with myself, again, I’m having all of these wacky thoughts. That sounds like to me anxiety, even though you didn’t use the word anxiety. And so I want you in with a therapist that can be specifically targeting those wacky thoughts and that obsessive thinking so that we can back you back from what sounds like an anxiety ledge and anxiety definitely drives craving for drinking. So I need you double, triple, quadruple, quintuple down on that 12-step program, I need you with a therapist ASAP to get at what sounds like anxiety. But big part of what COVID stole from us was kind of those meaningful purposeful life activities that we didn’t even realize were so important.
Dr. Nzinga Harrison
And so I need you to think of something that brings you joy, and a sense of meaning and purpose. And I need you to do a little bit of it several times per week. And then I definitely on this concept of the emotional relapse, you are there, because you said I haven’t relapsed yet. And so, you know, in 12, step language, they say, oh, you’re making plans, or you’re making reservations, we need to get those reservations off the book. We don’t want you to actually drink that alcohol. But it sounds like your anxiety is at a point right now that your brain subconsciously is telling you that it’s an option. Okay? So triple down on those 12 steps. Get a therapist who can help you with anxiety, and obsessive thoughts. That person should also evaluate you for depression. Other stress reduction should work on mindfulness. Find something that brings you joy and a sense of purpose, schedule it in your week to make sure you’re doing it at least three to four times per week, and specifically focus on getting yet off at the end of that sentence. And I think we’ll be looking at four years baby.
Claire Jones 16:28
Great. Our next question comes from Lillian, who also left us a voicemail.
Hi, Dr. Harrison. My name is Lillian. I’m calling about my brother, he’s 33 years old and struggles with depression, anxiety, substance abuse, and mostly managing of his type one diabetes. At different times over the past five years, each of these has been the primary concern. But I have no idea what is most important right now. I’ve always said he has a complicated relationship with the truth. He lives with our parents and has for at least the past five years; he has not had a consistent job. And over a year, the backstory is when he was 25 and in college, he developed diabetes and his life, which, you know, he was kind of struggling to mature to be independent, probably to deal with his mental health and tendency towards alcohol abuse. That was all really derailed when he became diabetic. There’s been a lot of ups and downs and details and all of this. And I’m sure I only know a fraction of the truth. Some of it’s pretty scary, like injecting cocaine.
But I’m calling because we are desperate for help. We just don’t have the money to send him to a rehab. We haven’t been able to find anything that’s really diabetes focused, which is, I think the primary concern he has a lot of neuropathy from really not managing the disease over the past seven, eight years. My mom told me recently, she thinks she’s not long for this world. It’s breaking my family’s hearts. I want him to be happy to thrive. And I just don’t know if it’s too late or not. I would really appreciate any recommendations or resources, particularly for someone on Medicaid, or Medicare, whichever I can always forget. Thank you so much.
Dr. Nzinga Harrison
Hey, Lillian. So thank you for calling in. I can hear your sadness and worry for your brother. So I’ll start with that first really big question. I don’t know if it’s too late. It’s not, it is definitely not too late. Your brother has a lot going on. So 25 is definitely a very difficult time to get diagnosed with Type 1 Diabetes because it basically like steals our concept of the 20s that we have in this country. And I can also imagine if he has neuropathy, that he probably has chronic pain and that probably contributes to substance use. And so he has a lot going on. What I asked families to do here and I heard you don’t have money for a residential treatment. I think maybe is take a couple of steps back. And I know, you said I want my brother to be happy and healthy. And I think maybe we need to understand what your brother wants at this point.
Dr. Nzinga Harrison 20:19
Because our healthcare system is very fractured. And so the door for diabetes is a different door for cocaine, sometimes is a different door for alcohol, and it can be hard to try to walk in all those doors at once. But if you can get your brother to walk into one door, and it might not even be a healthcare door, right? Like, what if he, I don’t know much else about your brother, but maybe he’s an artist. And he’ll walk in a door where there are other artists, but finding something I think a lot of times when we have loved ones that are this sick with diabetes, and sounds like alcohol use disorder and other drug use disorders, cocaine and socially struggling, not working and not being independent, those concepts that we have of what a person should look like, at 33 years old, then sometimes we lose the view of that person in front of us. And so maybe it is just sitting down with your brother and saying, I see you struggling, and I see you hurting.
Dr. Nzinga Harrison
And I don’t want you to be struggling and hurting, where do you think we could start. And he might give you an idea of where he has some motivation to be able to start and it may not be in a healthcare setting, it may be in a different setting, that brings him meaning and life and purpose. And that’s okay. Because as he starts to live in his meaning, and life and purpose that will often bring people to the health care setting for diabetes, for alcohol for substance use. Even if you’re not able to do that, I think it’s definitely not too late to drop into a harm reduction posture for your brother. So the harm reduction posture is just like, super sad to hear your mom say I don’t think he’s long for this world. She feels that his life right now is, is dangerous for dying. And I think you can just say that directly to him, like, we’re afraid that you’re gonna die soon, like we’re gonna call get a call that you’re dead. And we don’t want that.
Dr. Nzinga Harrison 22:24
And so the first harm reduction thing is just creating the opportunity for pure honesty, you please just tell us what you’re using, how you’re using it, no judgement zone, just so that we can figure out how to reduce the chance that you die from an overdose, die from withdraw. Those are the two big ways that you die from the substance use. And so one trying to understand what maybe he still has a passion for and where he could find some life meaning and purpose to falling into this harm reduction posture, which is creating that opportunity for complete and utter honesty so that we can just figure out how to not get the phone call that you’re dead. And then three in terms of resources that you can look for. Shatterproof Atlas has a really beautiful tool online, Claire, if you’ll drop that in the show notes for Lillian to be able to look at, you’ll sit with your brother and or give him the link and he can answer a bunch of different questions. And they’ll actually make recommendations for treatment programs that have been vetted for quality that’s on the substance use disorder side.
Dr. Nzinga Harrison
The other is I don’t know if your brother has a primary care doctor. But our primary care doctors are fantastic for helping people navigate the healthcare system and getting them connected to nurse care managers that can help them navigate. And so whether we’re starting with diabetes, or alcohol or cocaine or something different on the primary care doctor is a good place to start. And literally, whether it’s Medicaid or Medicare, you can just call the number on the back of his card, and they can help you find someone. So I hope this has been helpful to recap. Number one, don’t let all of these illnesses make you lose sight of your brother. Sit with him. Have that relationship with him. Try to figure out where he’s looking for joining meaning and purpose and support that number two harm reduction, complete and utter honesty without judgment. We want you alive. Number three, Atlas by Shatterproof we’re going to drop it in the show notes. Number four, primary care doctor could probably help with navigating the health system. So I hope that’s helpful to you.
Claire Jones 24:40
That was great answer.
Dr. Nzinga Harrison
Welcome. Okay, this is our last question is from an anonymous listener who wrote in to say, “Hi, Dr. Harrison, thank you so much for the show. I’m writing because I’m worried about my sister. She’s been struggling with depression and severe anxiety for the past four plus years. She’s had weight issues in the past, but things are spiraling out of control. And I’m worried about her well-being. I have legitimate concerns about her mental and physical health, but I have no idea how to broach it without feeling like I’m fat shaming her. She’s already constantly avoiding our family most of the time, she’s probably gained well over 100 pounds in the past year, and is at the point where she can’t walk from one room to another without breaking a sweat and getting out of breath. When we hang out, I have to find activities that don’t require walking, and I’m constantly worried that spaces won’t be physically comfortable for her.
The worst part is that she’s struggling financially. And I know she’s spending money she doesn’t have on takeout. I don’t know where to start trying to help her. We’ve talked about budgeting, and I’ve tried to open up about my own struggle with weight. But so far, nothing leads to any action. How can I help her without pushing her away? And no, she’s in a very dark place. And I just want to find a place to start. I don’t mean for this to go on for so long. But it’s important to note that we’ve tried repeatedly to get her into therapy, but she can’t follow through and bills on appointments. She just lost her job. And now she’s uninsured. I feel so powerless, because there’s little stable ground to build from. Please help.
Dr. Nzinga Harrison 26:07
Hi, anonymous. First of all, you’re talking to Dr. wordy […] So you never have to apologize for going on for too long. A couple of things I’m going to answer a little bit similarly to how I answered Lillian’s question, which is don’t lose sight of your sister. So I think you’re focused in on the weight. I don’t know if she’s focused in on the weight, we know that she’s struggling. So when you talk about how to approach your concern with her without fat shaming her, you can probably just take weight out of it, we know that weight is one of the symptoms that we’re seeing for her. But you can probably just start with one. I love you. Two, I’m really worried about you. And the same as I answered kind of for Lillian, which is does she have any nugget? Like can she see an activity that brings her joy, or brings her life purpose, and try to start there.
Dr. Nzinga Harrison
The second part of my answer to Lillian also applies here, which is the harm reduction. And so it sounds like your sister is using food as a drug. And we know that food works through the same dopamine pathway as the worst of our drugs, we spent the earlier part of this show talking about macaroni and cheese. And so I think you can also drop into a harm reduction posture for her. So you don’t have the risk of overdose and death. But you’ve put a lot of risks here in your question, right? Like the risk of losing social time, the risk of the physical toll that it’s taking on her body, the risk of the physical conditions that come with it. And so I think where you first start with that harm reduction posture is just like complete in utter honesty. I’m not trying to hurt you. Where can we start, and I’m willing to get in that point to start with you, right? Because a lot of times, what we do is we formulate a plan in our heads, we’re like I see my sister really struggling, she’s gained 100 pounds, let’s start at weight loss.
Dr. Nzinga Harrison 28:19
And she may not be ready to start a weight loss, she might be struggling more with depression, she might be struggling more with anxiety, she might be struggling more with something else that we don’t even know about. So creating that opportunity for just like a real, no holds barred, complete honesty, no judgment, tell me where we can start. And I will start there with you. And then the third in terms of trying repeatedly to get her into therapy, but she’s having trouble following through difficulty bailing on the appointments, I think you can just ask what are the barriers? Because if she’s making the appointments, either she’s just doing that to appease you, in which case, she’s just doing that to appease you. More likely, she sees some value in that and parts of her wants it but there are barriers to her getting there. And so what are those barriers? And can we figure out how to troubleshoot those. So maybe there’s an app, maybe she can do therapy virtually where she doesn’t have to actually go somewhere?
Dr. Nzinga Harrison
Maybe if she’s not going to connect, do you know what time the therapy appointment is? And you’re there with her and you connect virtually and you get on together? Maybe she’s afraid of what she’s going to uncover in therapy. Maybe she’s afraid of what she will face when she starts talking about what she’s really going through. The other thing I would ask here, I know you didn’t mention anything about suicide. Your sister sounds desperate to me. And so whereas the last caller I was like her mother said, I don’t think her brother is long for this world, I would ask your sister specifically about thoughts of suicide. Like I’m worried about you, I see you in what seems like to be a very desperate place. And when people get desperate thoughts of suicide often creep in. Are you having any? And it might surprise her, but you just have to straight up, ask, no frills, just ask.
Dr. Nzinga Harrison 30:32
And then last very kind of practically now that she lost her job, so she doesn’t have insurance. We have mental health safety nets; I don’t know where you’re calling from. But if you Google, there are almost always nonprofit organizations and government mental health organizations that take care of people that don’t have insurance, that have resources. And so you should just be able to Google mental health support for someone without insurance in whatever your location is. And those options should come up, whether it’s sliding fee scale, or free, or county mental health. They’re typically all around. And sometimes some of those actually have mobile, mental health that will come to people’s homes. The last, just like I told, Lillian, I’m going to tell you anonymous is our primary care doctors are so underutilized. So it may be less scary for her to get to a primary care doctor than it is for her to get to a therapist, or a psychiatrist. So I would definitely try that.
Great. That’s it for our last Ask Me Anything. Those are all really good answers.
Dr. Nzinga Harrison
Oh, I thought you were gonna say really good questions. I didn’t mean, myself on that.
They were great questions. I think we’ve gotten really good questions all season, honestly.
Dr. Nzinga Harrison 32:03
People really being open, you know, like really sharing. That’s what I really love about it. It’s like things that previously have been too dangerous to share in public. People are really being vulnerable with us. So I appreciate that.
Yeah. Thank you to everyone who has written in or called in or also just listened. That’s what makes the show possible. So thanks to everyone. And we will be back next week.
Dr. Nzinga Harrison
All right. talk to y’all next week. Bye.
IN RECOVERY is a Lemonada Media Original. This show is produced by Claire Jones and edited by Ivan Kuraev. Jackie Danziger is our supervising producer. Our theme was composed by Dan Molad with additional music by Kuraev. Stephanie Wittels Wachs and Jessica Cordova Kramer are our executive producers. Rate us, review us, and say nice things. Follow us at @LemonadaMedia across all social platforms, or find me on Twitter at @naharrisonmd. If you’ve learned from us, share the show with your others. Let’s help to stigmatize addiction together.