How do you explain a parent’s drug use to a young child?
In March 2018, I spoke with Carolyn Hannan Bell, a psychotherapist in South Jersey who works with families living with a member’s drinking or drug use. Her new picture book, Dad’s Addiction, was the third in her Helping Children Understand series. The first two were for children of a parent who drinks.
This is an archive episode, recorded when the show covered addiction and recovery broadly. We talked about how to explain a parent’s drug use to a child, how growing up around it shapes adult relationships, and what families can and cannot control.
Who is a book like this written for?
At 1:57, Carolyn said the right age depends on the child. In her view, a child who starts asking questions is ready for the answers. A parent can read the book aloud to a very young child and explain the ideas along the way.
Interestingly, some adults have shared the books with grown friends who have never lived with the problem. The ideas are simple, she said at 3:03. You have no control over another person’s drug use, and it is not about you. Yet, letting go of that is the hardest thing to do in any relationship.
Why did the father in the book seem to be using opioids?
At 3:44, I told Carolyn that I had read the dad’s unfinished sentences and the way he dozed off in the middle of a conversation as signs of opioid use. She said that was what she had in mind. Still, she left the drug unnamed on purpose, so the book would fit any family where a parent is not really there for the child.
From 5:23, she described how often opioid dependence begins with a prescription for an injury or chronic pain. A person does what the doctor says, the body keeps needing more, and the slope is slippery before anyone notices. She was careful to add that she was not demonizing medicine.
What is codependency, and how does it start in childhood?
At 10:29, Carolyn offered a definition of her own. She thinks codependency should really be called a focus disorder, because the person looks outside themselves to decide how to behave. Children see the world as revolving around them, so when a parent is erratic, angry, or using, the child assumes they caused it.
So, the child tries harder. They try to do better in school, be nicer, or be better at sports, hoping the parent will change. It never works, she said, because we do not cause other people’s behavior.
At 13:31, she described how the habit follows people into adult relationships. It looks like people pleasing and going along with everything, yet it is oddly controlling, because the person is guessing at what everyone else needs. At 15:38, she added that a parent’s depression or anxiety can set up the same pattern.
How can pets and creative outlets help a child in a difficult home?
Every one of Carolyn’s books has a dog in it, and at 16:57 she explained why. She believes animals can be wonderful therapy, and at 19:40 she described one of her own dogs sitting in on her sessions.
For a child in an explosive household, she said, a pet can be like a permanent good friend. At 20:59, I asked about art and music. Carolyn, who plays music herself, called creative expression essential, because it lets a person connect with others without having to find difficult words.
Can intelligence work against recovery?
At 22:13, I asked whether people who struggle with drug use tend to be more intelligent and creative. Carolyn saw that often, and she wondered whether depression, and the self-medication that can come with it, is part of the picture.
At 23:32, I shared a theory of mine. Addiction uses your best thinking against you. When a craving comes up, it arrives as thoughts, plans, and justifications, and a highly intelligent, creative person can build a very convincing case for using. In fact, that strength may make recovery harder.
What happens when a support group discourages medication?
At 28:43, I described something that changed how I advise patients. For years I suggested Narcotics Anonymous (NA) to people taking medication for opioid use disorder. Unfortunately, many of them were told at meetings that they were not really clean, and could not fully take part, while they took medication, and pressure to stop can put a person at higher risk of relapse.
I stopped telling people they had to go to those meetings, and I became open to other groups. As I said at 31:16, I want my patients to be safe, and I do not want people at a meeting getting involved in their medical decisions. Carolyn agreed that groups should not make decisions like that across the board.
Does tough love work when the drug is an opioid?
From 34:19, I talked about how frightening tough love becomes with opioid dependence, when the risk of overdose death is so high. Families feel torn between doing something dramatic and doing nothing. Florida law allows involuntary holds, but the person may resent the family afterward. When Carolyn asked whether people get better when they are forced, I said I did not think so.
Should more people carry naloxone?
At 35:16, I asked about naloxone, also sold as Narcan, the rescue drug that can reverse an opioid overdose. Some people worry that easy access encourages risk taking. Carolyn was uneasy about places where people can use with naloxone on hand, because some people see them as a no risk zone.
At 36:39, I described the other side. A person in that setting may be in front of a medical professional who can tell them about medication for opioid dependence, and that is at least a chance to show them a way out. At 38:20, I wondered whether people might start carrying naloxone to meetings, since many pharmacies now sell it without a prescription.
Who is Carolyn Hannan Bell?
Carolyn Hannan Bell is a psychotherapist in South Jersey. She earned a BA in psychology from Duquesne University and an MS in counseling from Chestnut Hill College. Her practice focuses on codependency and on families affected by a member’s alcohol or drug use, and she also offers sessions by telephone. She is the author of the Helping Children Understand picture books, and at the time of recording she was finishing a fourth, Mom’s Addiction.
What can listeners take away from this conversation?
A child who lives with a parent’s drug use will often decide it is their fault. Fortunately, a simple explanation, read aloud by a caring adult, can teach a child early that another person’s behavior is not theirs to cause or control. As Carolyn put it at 39:38, helping children before the problems take root may be the best psychological care we can give.
How do I approach this today?
My thinking has kept developing since this conversation was recorded. Today my practice is built on one idea that runs through all of it: when the body has adapted to a substance, the safest way off is usually gradual, with the smallest steps the person’s nervous system can tolerate. Physical dependence is not addiction.
A person who took a medication exactly as prescribed and now cannot stop it safely needs a plan, not a label. Where a medication can make the process gentler, I use it. Patients direct their own care, and a good plan includes the risks, the alternatives, an exit plan from day one, and the right to change course.
For opioid dependence I prescribe buprenorphine, which steadies the body so a person can rebuild their life without the cycle of withdrawal. Visits are monthly, or weekly when needed. Some people stay on it for a long time, and that is a legitimate choice. Others later taper slowly, using the same gradual approach I use for every other medication.
I believe medication for opioid dependence should be available wherever people need it. I prescribe in Florida only.
This page is educational. It is not medical advice, and listening to the episode or reading this page does not create a doctor-patient relationship. Decisions about starting, continuing, or tapering any medication should be made with your own physician.
Full transcript
A note from Dr. Leeds: my guests speak from their own experience and expertise, and the terminology they use is their own. Whatever the topic, this show holds to one distinction: physical dependence on a prescribed medication is not addiction. This transcript is educational content, not medical advice, and nothing here creates a doctor-patient relationship.
Read the full transcript (53 minutes)
Dr. Mark Leeds [00:09] Welcome to The Rehab on the Mental Health News Radio Network. I am Dr. Mark Leeds and I will be your host. Join me in exploring the world of addiction treatment. How can we improve the ways that we help individuals to overcome addiction? The goal of treatment is to save lives and help people to get back on track to a path towards success and happiness in life. Carolyn Hannan Bell is a practicing psychotherapist in South Jersey. She earned her BA in psychology from Duquesne University in Pittsburgh and her MS in counseling from Chestnut Hill College in Philadelphia. She often works with families and individuals suffering from the emotional effects of alcohol and substance abuse. This is her third children’s book in her Helping Children Understand series. The first is Daddy’s Disease and the second Mommy’s Disease, which are written to help kids understand parental alcoholism. So, hello Carolyn and welcome to the program.
Carolyn Hannan Bell [01:18] Hi Mark, thank you so much for having me.
Dr. Mark Leeds [01:22] Thank you. So, this third book, is it available yet on Amazon?
Carolyn Hannan Bell [01:27] Yes, it is. Yeah. You just type in Dad’s Addiction, Carolyn Hannan Bell, and it comes up. I also, you can go on my webpage and there’s a place where you can click and it’ll take you over to Amazon.
Dr. Mark Leeds [01:44] Okay, great. And so this current book is Dad’s Addiction. And I read it’s a great book. What level is this written for? Is it for children of a certain age?
Carolyn Hannan Bell [01:57] Well, it really depends on the child and, you know, their level of maturity. But I think, you know, when a child starts asking questions, then they’re ready to receive the information. So I think for a parent to read this to a child and then explain it as they’re going along, you could, you know, read it to a six-year-old or even younger if you’re explaining the concepts along the way. And then all the way up, I’ve had people tell me that they have shared these books with their adult friends, and that’s helped to explain the disease of addiction or alcoholism to other adults. Because it’s a really hard thing to explain when you’re not immersed in it, when you don’t have the disease. People really don’t understand.
Dr. Mark Leeds [02:51] Yeah, that makes sense. And so it could be a very young child. It’s not something you would just usually hand to your child to read on their own. It’s something that a parent would read to their child to help explain.
Carolyn Hannan Bell [03:03] Yeah, yeah, I think so. Yeah, they’re difficult concepts. They’re difficult, and they’re very simple. I think, you know, as human beings, we make things so much more difficult because I think we want to be able to control things, and we want to be able to understand things in terms of how we can control them. And that’s the whole problem with being in relationship with somebody with addiction, because we think that we have some control there and we don’t. And that’s what the simple part of it is that you have no control. This isn’t about you and you’ve got to let it go. That should be very simple, but that’s the hardest thing to do in any relationship really about any issue.
Dr. Mark Leeds [03:44] Now, when I was reading, I assume that the addiction in this book, the addiction that the dad has, is an opioid addiction. I mean, I was assuming that from the part where he doesn’t finish his sentences and he sometimes falls asleep in the middle of a conversation. Is that correct, or is it supposed to be open where it could be any drug of choice that he’s using?
Carolyn Hannan Bell [04:06] Yeah, I guess it really was more geared towards describing an opioid addiction, but I didn’t want to narrow it down to just one addiction because I wanted it to apply to many more situations. Any kind of situation where the parent is really not physically there for the child. So and of course the opioid addiction that I think is much more prevalent than some of the others maybe more obvious in the behaviors so yes this father definitely I would say has an opioid addiction although I don’t specify that in the book.
Dr. Mark Leeds [04:50] Okay yeah definitely I’m not really sure about the prevalence and that could be correct these days, but definitely opioid addiction is a more deadly thing compared to other drugs. I mean, maybe it’s on par with alcohol, but compared to, I think, cocaine and amphetamines and other drugs of abuse, opioids are, especially now with the poisoning of the opioids with fentanyl and carfentanil, it’s very deadly now. It’s obviously a major problem in the news?
Carolyn Hannan Bell [05:23] Oh, it’s so scary and so heartbreaking. And people just get addicted so easily through prescription medications a lot of times and sometimes not even aware that they’re heading down a path. You know, I talk in the book about people getting addicted because of prescribed medications for maybe injuries or chronic pain or something and you know your body just keeps needing more and more and more and you’re headed down a path that you’re not aware you’re headed down because you think you’re well this is you know prescribed medication and I’m doing what the doctor tells me and I’m not you know demonizing medicine in any way it’s just It’s a very slippery slope.
Dr. Mark Leeds [06:13] Yeah, and it’s true that, and, you know, nowadays there’s a lot of articles where people are trying to figure out how this whole thing started and where to place the blame. You know, is it the pharmaceutical companies and their marketing? And they definitely have a part in this. You know, but as far as, now you, in your practice, You see patients, families together and individuals with issues with addiction and family members of people who are addicted?
Carolyn Hannan Bell [06:47] I do, yeah. I do a lot of work with codependency, which is, I mean, sometimes even the people with addiction. I think we all have a little bit of codependency. But that is I guess the biggest problem that I’m trying to help children avoid having by teaching them early on that other people’s behavior is not their fault or theirs to control so you know that’s where my practice really is focused in helping people in addiction or families who have some member who is in addiction.
Dr. Mark Leeds [07:29] Okay. And do you see people with telemedicine visits, like on the telephone or on Skype?
Carolyn Hannan Bell [07:37] I do. I do. Not on Skype. I do telephone sessions. And those actually are becoming more and more popular as people, I guess it’s just technology is more readily available for everybody or it’s just more of a common way to do things. It used to be kind of alien that people would think like, why, you do therapy on the telephone? That seems odd. But now it’s much more commonplace.
Dr. Mark Leeds [08:09] Yeah, definitely. I see more and more people are doing that. Even doctors are doing telemedicine, which is difficult because in a lot of cases we’re supposed to physically examine the patient, and there’s different laws from state to state. But it makes sense that therapy, you don’t necessarily have to have the person in the same room with you.
Carolyn Hannan Bell [08:30] Not at all. And especially if it’s the difference between somebody, you know, really won’t physically make the trip in to come see you, but they will make the phone call, then it’s definitely needed and helpful.
Dr. Mark Leeds [08:47] Would you also be able to handle patients who are not in your area who you’ve never seen in person?
Carolyn Hannan Bell [08:54] Yes, yes, definitely.
Dr. Mark Leeds [08:56] Okay, so for example, in my practice where I treat patients with medication-assisted treatment for opioid dependence, and part of that treatment plan includes therapy, I would, for example, be able to refer a patient to you and give them your information, and they could call in and do therapy on a regular basis with you?
Carolyn Hannan Bell [09:20] Yeah, definitely. Yes, they could. Yeah, I would be happy to.
Dr. Mark Leeds [09:25] What do you recommend as far as in that kind of situation, like the frequency of sessions?
Carolyn Hannan Bell [09:32] Typically I see people once a week or talk to them once a week. If someone is in crisis, then I definitely will talk to them more often. But most of the time it’s once a week and then as they start to get a handle on things and to feel better then we kind of go to once every two weeks and then you know kind of tapers off like that and then sometimes people just have what they call like tune-up sessions just to kind of check in and make sure they’re still using the tools that they learned and you know staying where they need to stay to be okay in their lives.
Dr. Mark Leeds [10:10] Can you can you tell me a little bit more about codependency Like when a child is growing up in a difficult situation and they don’t say that they don’t understand what’s happening with their parents with mental illness or addiction, what does it mean to grow up and become codependent?
Carolyn Hannan Bell [10:29] Codependency is kind of, I really think it should be called a focus disorder because what it really is when you’re focusing outside yourself for your direction and how you should behave rather than inside yourself to decide how you should behave. And the way that typically happens is if you’re growing up in a household with even what I call like moodism, where there’s problems with erratic moods or temper or alcoholism or addiction, where a parent is not treating the family or the child well or just, you know, kind of out of control, then children will think that behavior is because they did something wrong. Children are very self-absorbed and myopic and they think everything is about them because they’re just beginning to figure out how they fit in the world and what the world means and what is it all about. And they don’t really understand much outside of themselves. So everything that happens around them, you know, as children we all think, well, what did I do to cause that particular thing to happen? So if your parent is misbehaving and being mean or yelling at you or yelling in general or whatever, a child is typically going to think like, well, what did I do wrong? What did I do to cause this behavior? And then they’ll start looking inside themselves as to, okay, well, maybe I need to do better in school or maybe I need to be nicer or sweeter or prettier or better at sports or, you know, whatever. And then my parent will behave the way I want them to, which, of course, never happens. But, you know, a kid doesn’t put it together that, you know, my parent is behaving this way because of something going on inside my parent. So they just keep trying harder and harder. And sometimes the kid will even begin to act out and try and get the parent to pay attention or to somehow change and calm down or be who the kid needs them to be. So you see the pattern that starts is like, okay, how do I need to behave to get you to behave the way I want you to behave? And that’s codependency right there. And it never works because we don’t cause other people’s behavior, as you well know. So it’s the exact opposite of how things really work is like I’m responsible for my behavior and you’re responsible for your behavior and then everything will work the way it’s supposed to work.
Dr. Mark Leeds [13:10] So when a child grows up and they’ve been trying to change or do things in their life to hopefully affect the behavior of their parent, then when they grow up and they’re adults and they have relationships with other people, that would affect how they interact with other people, like in various relationships or friendships?
Carolyn Hannan Bell [13:31] Oh, completely. Yeah, you focus so much on, okay, well, how do you need me to be so that everything will be okay? And that can look like, well, I’ll just go along with everything you say, or I will, it’s a very oddly controlling kind of behavior. Most codependents don’t think they’re controlling at all. It’s more like you’re trying to go along with the flow and make everybody happy and do a lot of people pleasing and make sure everyone around you is getting what you think they need so that your world will be serene. And so you kind of even lose track of who you are as a person or what your path in life is because you’re so focused on what you’re trying to give everyone around you, which, of course, you have no idea because you’re reading their minds and just pretty much inventing what you think they need to be happy. So the whole thing is just kind of I don’t know a communication nightmare because you know the only way it can really work is you know I tell you what I need and you tell me what you need and you know then we have a chance of making each other happy but in actuality we’re supposed to make ourselves happy does that make any sense I feel like I was kind of all over the place with that one.
Dr. Mark Leeds [14:54] Oh, no, that makes perfect sense. It makes perfect sense. Now, besides addiction, I would imagine there’s, I mean, I think you said there’s probably a lot of things that can happen between, you know, in a household that could lead children to the, down that path to codependency. You know, for example, I was just, and I’m not an expert on these conditions, but it’s in the news a lot now, the narcissistic personality disorder, and another one, which I guess is different but similar or maybe not similar but borderline personality disorder and I guess there’s a whole series or a lot of different kinds of personality disorders that could you know affect children you know maybe in a similar way to addiction in the house
Carolyn Hannan Bell [15:38] Oh definitely absolutely depression anxiety you know are big ones as well you know you’ll see situations where you know a parent can be very depressed and then they can be not getting out of bed or being very angry or being very withdrawn and kind of negligent you know a child is definitely going to take that kind of behavior personally especially if he goes over to his friend’s house and he sees you know maybe a family that’s more intact and more functional and he comes home and he thinks okay well, this is my family, what do I need to do to make this better?
Dr. Mark Leeds [16:21] Yeah. I once, there was a doctor when I was in training, he once made a comment. He said all families are dysfunctional. Would you agree with that?
Carolyn Hannan Bell [16:33] Yes, yes, definitely. I forget who said this, but it was a comedian who said, if you have more than one person together, you have dysfunction. I think that’s pretty true.
Dr. Mark Leeds [16:48] Yeah, definitely. That makes sense. Oh, I wanted to ask more about the book. Are you the illustrator also?
Carolyn Hannan Bell [16:57] No, I’m not. The illustrator’s name is Pepe, and I actually found her online. I’ve never met her in person but I just love I love the way she illustrates things and the colors that she uses and the way she illustrates the dogs there’s always dogs in my book I’m a huge dog lover I believe that animals provide such amazing therapy and I’m an advocate of children having pets if it works out for the family of course and there’s no allergies but they can be very wonderful friends.
Dr. Mark Leeds [17:35] And how many dogs do you have?
Carolyn Hannan Bell [17:38] Right now I have three dogs because I’m also raising my grand puppy, my son whose dog he has moved to Germany. So I have, and that is the dog in the book right now, Arthur. That is my grandson.
Dr. Mark Leeds [17:52] Oh, okay. Oh, wow. So did the illustrator actually look at a picture of Arthur and the real dog? Oh, wow.
Carolyn Hannan Bell [18:03] Yes, he does. She has many, many pictures of Arthur. And in the previous two books, the first dog was a dog I had years ago, and the second dog was my sister’s dog. So it’s definitely a family affair.
Dr. Mark Leeds [18:21] Oh, wow. And what is a therapy dog? I’ve seen that in the news with, you know, the airlines and people being allowed to bring therapy animals on the plane with them. Is that like a special kind of a dog or a dog with special training?
Carolyn Hannan Bell [18:36] Well, it used to be that service dogs had very special and specific training, but nowadays a lot of people are, you can get your dog certified as a therapy dog, kind of like an emotional support dog, I think they call them. And I think you can do it online. And people then can bring dogs on planes or wherever, and the dog provides emotional support, very helpful with anxiety and depression, but I think especially anxiety because people like with social anxiety to go out into the world by themselves versus going out into the world with their dog is a whole different ballgame. It’s like they bring their comfort with them when they can bring their dog with them.
Dr. Mark Leeds [19:28] Okay, so that sounds like a good thing. I mean, it almost sounds like we could all benefit from having a therapy animal. I mean, if we’re not allergic and that sort of thing.
Carolyn Hannan Bell [19:40] Yes, yes, definitely. I have one of my dogs does a lot of my therapy sessions with me. She sits in and, you know, sometimes people walk in and just give her big hugs and they sit quietly with her for a couple of minutes before they even start talking. I think, yeah, they can provide such kind of unconditional serenity. Yeah sometimes craziness but you know you get a little of both
Dr. Mark Leeds [20:12] Yeah I might go with a therapy cat but either one I like dogs and cats but you know I like holding a cat
Carolyn Hannan Bell [20:20] I think it could be the same you know any animal that you connect with that you bond with and you feel comfort from it’s an amazing thing and I think for a child especially in a kind of erratic explosive family having a dog is like having a permanent really good friend or cat obviously it could be a guinea pig it doesn’t really matter
Dr. Mark Leeds [20:47] Yeah yeah I can imagine any it depends on the person any animal would probably work depending on the person and the animals that they like
Carolyn Hannan Bell [20:55] Yeah yeah I think so
Dr. Mark Leeds [20:59] Yeah what do you think about art therapy or music therapy or even just you know creative expression for maybe maybe someone who’s maybe for the children in the house but also I maybe even for the person who’s dealing with addiction or recovering and getting getting clean it seems like something that’s helpful you know getting involved in a you know creative outlet you know maybe getting into whatever a person likes to do like painting or writing music or playing music
Carolyn Hannan Bell [21:29] Oh I think it’s essential I think I’m also I play music too and I think that just having the connection with other people who play music or do art or another it’s just another way to express yourself where you don’t have to use words and you don’t have to be as I guess it’s a different kind of vulnerability but you can still connect with people and you can still express what’s inside of you without having to put difficult words to it I think it’s essential that people have an alternate way to express themselves other than words
Dr. Mark Leeds [22:13] Yeah, definitely and would you agree, I mean you’ve seen a lot of people who are recovering from addiction and struggling with addiction would you agree in general that they tend to be more intelligent and creative people? I mean, it seems like, you know, if you took a room full of, you know, people off the street and then a room full of people who are dealing with addiction, the addiction group would tend to be more on the side of highly intelligent, creative people.
Carolyn Hannan Bell [22:42] Yeah, I definitely see that a lot. And I wonder if it has to do with, you know, there’s a lot of depression in highly intelligent, creative people. And with depression, there tends to be a lot of self-medication. And I think, you know, all of those things can kind of create a perfect storm. You know, they tend to be the deeper, darker thinkers. And it can result in amazing creative accomplishments. But it can also result in, you know, darkness and isolation and a lot of times alcohol, drugs, those kinds of things can really seemingly lift some of those terrible feelings, at least in the beginning, but then, of course, it gets much worse.
Dr. Mark Leeds [23:32] I have a theory about that as far as intelligent, creative people, that addiction uses your best thinking against you and that people in that situation may have intelligence and creativity is actually a disadvantage because, you know, when a craving comes up, it expresses itself as, you know, thoughts and plans to go get more drugs and justify it to yourself. You know, someone who is highly intelligent and creative is going to come up with, you know, they may even be able to convince the people around them that they should be out using drugs. I mean, it’s just, if you’re using your own best thinking against yourself, that’s going to be a disadvantage in that situation, which may make it more difficult for them to recover.
Carolyn Hannan Bell [24:17] No, that’s a really important, that’s a great point, and I think you’re exactly right. Yeah, it’s a very powerful brain to use as for good or for a weapon, I guess. But I think you’re right.
Dr. Mark Leeds [24:32] What do you think about 12-step recovery, AA or NA? Do you have a preference, or do you prefer one that’s not a 12-step program?
Carolyn Hannan Bell [24:43] I’m a huge fan of the 12-step programs. I think they’re wonderful. I think that they can be really helpful. People have to really commit to it. I also think Al-Anon is a wonderful program. I think it would be great if they taught the 12 steps in school. I think it’s a way to just teach you how to be a responsible, accountable, good person with integrity in the world. I think people get hung up on the, they think that it’s more of a religious kind of a program than it actually is. People get, I think, turned away sometimes by the idea of a higher power, and they get confused that you have to have faith or believe in a god or a religion to be helped by the program. And I kind of wish that there was a way to, I don’t know, get that message out better that it’s not a religious program and that your higher power could be anything at all. Because, yeah, I really do think the programs are great and extremely helpful. As they say there, it works if you work it.
Dr. Mark Leeds [25:53] Yeah I mean it almost seems silly that when someone is on the verge of death from from addiction to be you know at the same time you know saying well I don’t I don’t believe so I you know I’m going to stay away from the people that can help me you know because I don’t want to pray because I mean what you know there’s nothing bad is going to happen if a person prays even even if they don’t believe yeah
Carolyn Hannan Bell [26:14] Exactly I think it probably just means that they really don’t want to get better. They’re not ready for whatever reason.
Dr. Mark Leeds [26:22] Yeah, and I have a theory about that maybe, you know, like we were talking about, you know, people that are intelligent and creative, that their addiction uses their own best thinking against them, that maybe the part of the brain that’s spiritual is kind of off limits to addiction. You know, the part of the brain that’s involved in service to others and prayer. I mean, regardless of what’s real or not real in the universe, that there is a part of the brain that is probably spiritual in nature and is just off-limits to the effects of addiction.
Carolyn Hannan Bell [26:53] I agree with you 100%. Yeah, I think that spirituality, that part of the brain is gone. I think the brain just becomes about getting high, staying high. So anything spiritual or deep or connective or, I don’t know, bit, I don’t know, the humanness seems to, you’re just not yourself. You lose your own spirit. And I think that’s what’s so hard for families and children is to, you know, you keep trying to connect with that person who you know and you love, but that person isn’t there.
Dr. Mark Leeds [27:32] And when a person does connect spiritually, when they are trying to recover, it seems like a safe place. And if you’re in a meeting, you know, a person is praying or reading their literature or, you know, they’re in a safe space that maybe that’s something that addiction really can’t go there and affect them in that space.
Carolyn Hannan Bell [27:52] Right. Yeah. Because I think, you know, spirituality and the programs are about growing and learning as a person. And when you’re in addiction of any kind, you can’t grow, you can’t learn, you can’t evolve. So those things are mutually exclusive.
Dr. Mark Leeds [28:10] Yeah, that makes sense. And I mean, so if a person starts using drugs and becomes addicted, say at, you know, say 25 years old, and, you know, they’re in active addiction for 25 years, they would come out at the other end 50 years old, you know, say when they get they get clean, hopefully, they would still be in the emotional state of a 25 year old at that point.
Carolyn Hannan Bell [28:33] Yeah, yeah. That’s what a lot of the research says, and I’ve certainly seen that. I’m sure you must have, too.
Dr. Mark Leeds [28:43] Yeah definitely now that’s as far as the 12-step groups one interesting thing when I when I first started doing medical treatment for addiction I did the training in I think 2006 and I went out and did research and I you know looked into the you know they told us at that time it’s a you know three three pronged program or you know they described it in the class is a, like a three-legged stool, you know, that you have the medication, you have private therapy, and then you have group therapy or group sessions. And, you know, that a patient, a person should be involved in all three, you know, if they’re involved with medication or taking medication to treat addiction, they should be going definitely to private therapy and to some sort of a group session or group support. So I looked into, meetings, and I’ve gone to a few just to see what it was all about. I’d read the literature, and I thought NA would be perfect for my patients. And for a long time, I told everyone. I gave them the hotline number, and I recommended NA. And one issue that I’ve had with my patients, and the more I’ve done treatment, the more I’ve seen it, is that in NA, there’s kind of a stigma with medication treatment, and people are told they’re not really clean and they can’t participate as long as they take medication, which for some of my patients is a dangerous situation. If they’re influenced to stop their medication, it may put them at a higher risk of relapse. So I’ve had a lot of patients who have told me that they prefer to go to AA meetings, or they’ve even found these other groups. I don’t know a lot about SMART Recovery. I’ve heard it mentioned, and I think there’s one called a Christian group which is different. I can’t remember the name. But yeah, that’s one issue specifically with NA. And I had researched it a little bit and found that they actually have an official position on what they call replacement medication. And so I’ve kind of changed that. I don’t definitely tell people you have to go to an NA meeting. I’m open to them going to AA or other groups.
Carolyn Hannan Bell [30:56] Yeah, I agree with you. I’ve heard the same things. And I think I know a lot of people who just go to AA meetings, and I think that’s absolutely fine and great. And it doesn’t really matter what your addiction is. The course of treatment, you know, in a 12-step program is going to be the same.
Dr. Mark Leeds [31:16] Yeah, that makes sense. And, you know, people say, well, I’m not an alcoholic. I mean, they can identify verbally as an alcoholic, but in their own mind, you know, kind of cross that out and replace it with whatever their substance. Is, you know, of choice. And I mean, that’s what I like. I mean, I do like the concept with NA is that they’re talking about addiction in general, because if a person is using one substance, they’re likely to go, you know, say an alcoholic could go get addicted to Xanax or Valium. You know, there’s definitely a crossover. But yeah, I mean, I want my patients to be safe and not have people in the meetings getting involved in their medical decision making.
Carolyn Hannan Bell [31:56] Oh, yeah. Yeah, it’s, I don’t think these groups can make decisions across the board like that’s a little scary. Speaking of the 12-step programs, I think Alateen and Alatot are really great programs for kids, too, because it allows them not only to learn to understand what is theirs to control and what’s not theirs to control, they get to be around other kids who are dealing with similar situations is I think the isolation that people can feel that like they’re the only person in the entire world who is dealing with situations that they’re in that can you know lead you to be more withdrawn and more shut down and more dysfunction.
Dr. Mark Leeds [32:48] You said Alatot?
Carolyn Hannan Bell [32:51] Alatot, yeah. There’s Alatot and Alateen. There probably aren’t that many Alatot meetings, but I think you could probably go to the Alateen and it would be fine.
Dr. Mark Leeds [33:03] And if, say for example, there’s not an Alateen or Alatot meeting in a particular area, I would assume that’s something that a person could found a new group and start a meeting?
Carolyn Hannan Bell [33:12] I think so. I know you could contact the headquarters and probably get something going. I’m really not sure how that works, though, but there seem to be meetings popping up all over the place. I mean, all over the world, you can find a meeting everywhere at any time, it seems.
Dr. Mark Leeds [33:34] Yeah, I once heard someone, one of my patients told me, anyone who’s determined can actually start a new group and a new meeting. And apparently the saying is all you need is a coffee pot and resentment and you go off and start your own group.
Carolyn Hannan Bell [33:49] Oh, I love that’s good. That’s very good. There are definitely good resources and so many professionals out there too. You know, help is there. It’s just, you know, as somebody who has a relationship with someone in addiction, The problem is that we can’t make them be ready to get help, and that’s a really difficult place.
Dr. Mark Leeds [34:19] Yeah, definitely. And one, I mean, that’s something that, you know, when people talk about tough love and, you know, cutting someone off and, you know, not enabling them, it’s a scary thing, particularly with opioid dependence, you know, as far as, you know, when, I mean, the risk of overdose death is so high now that, you know, you kind of like, you’re torn, like, do I, you know, do something dramatic? Do I not do anything? And I guess I know in Florida we have various laws that allow people to take action, but then that person may really resent the family. If they have the Marchman Act where they can have someone locked up against their will, I guess, in long-term treatment and the Baker Act where a person can be put in a psychiatric facility for three days minimum.
Carolyn Hannan Bell [35:09] Well, do you find that does that work? Do people get help when they’re forced to?
Dr. Mark Leeds [35:16] Probably not. I don’t think so. What do you think about naloxone or Narcan, making that more available? I mean, some people think that by making this rescue drug available to people with opioid dependence that they’re going to be more risk-taking and use drugs more freely, thinking that there’s somebody nearby who can save their life if they take too much. Or do you think that it’s a good thing to have out there, just give people more of a chance that they might come out of that overdose that they weren’t going to survive?
Carolyn Hannan Bell [35:48] Well, you know, I was talking to a client of mine who is a member of AA, and he has a lot of friends who are more addicts who are in recovery. And he tells me that it’s just like a free-for-all. It’s like, yay. In Philly right now, they’re establishing places where you can go and you can, you know do your drug of choice and the narcan is available and you know it’s kind of like wow this is kind of a no risk zone and he says people are looking at that like wow this is great this is a free-for-all so although I understand that you know it’s designed to be a safer place where you know fewer people will die I really I don’t know it seems I don’t know it’s very complicated it.
Dr. Mark Leeds [36:39] Yeah, it’s difficult. It’s difficult to decide because on one hand, you’re, you know, you have the opportunity to introduce people to, for example, medication assisted treatment. And I mean, even if a person is in that safe zone, I mean, that, you know, they’re living a miserable life. I mean, there’s just no way that they’re, I mean, they, at some point, hopefully they’re going to see, you know, things are not good, even though they have the safe area to use heroin or whatever they’re using. And now they’re in the presence of hopefully a medical professional and someone who can say, well, you know, there’s medical treatment and along with medical treatment comes other forms of treatment. And, you know, it’s at least an opportunity to, you know, to show people that there’s a way out.
Carolyn Hannan Bell [37:25] Yeah. Yeah. I mean, it’s trying to be helpful. And I guess it could save lives, but it’s a tough one.
Dr. Mark Leeds [37:39] One article I read, I don’t remember the name of it, whatever politician had said this years ago with car safety, he said that the best form of car safety rather than having seatbelts and safety features would be just to put a big spike in the middle of the steering wheel and then everybody would drive more safely.
Carolyn Hannan Bell [38:02] Yeah, that’s true. It’s all about consequences. You take away consequences and people’s behavior just becomes a lot more decadent or less thoughtful. I don’t know.
Dr. Mark Leeds [38:20] Yeah, it’s true. And I actually, I had asked the question on a discussion group online for NA, where it asked if anybody carries Narcan with them, you know, to a meeting, because I had heard of a situation where an ER doctor was telling me that one of their patients had actually overdosed in the middle of an NA meeting. And I know that in meetings, people are told, even if you use before the meeting, still sit through the meeting. Don’t share. Don’t get involved. But you’re welcome to a meeting whether you’re clean or high or whatever. But that’s a scary thing that a person might actually in the middle of a meeting these days stop breathing and turn blue and you have to call 911. And I know it’s not the responsibility of the group or NA in any way, but it almost seems like people might want to start carrying Narcan with them, which you can now get at a lot of pharmacies without a prescription.
Carolyn Hannan Bell [39:15] Wow. Yeah, I guess maybe that would be a better answer, more people carrying Narcan than safe zones to go use and have doctors at the ready. I don’t know. I don’t know.
Dr. Mark Leeds [39:32] So you’re working on a fourth book. This one was Daddy’s Addiction. Is it Mommy’s Addiction that you’re working on now?
Carolyn Hannan Bell [39:38] Yes, Mom’s Addiction. And it should be, I’m still putting together the illustrations. So within a month it should be finished. And I’ll get it out there. And it’s kind of hard to get the word out, but it’s a slow-moving train. But I will keep persevering. I really think that the best psychological care that we can give is in prevention and helping kids before they start developing some of the psychological issues that we’ve all been saddled with I think is the best therapy that we can do.
Dr. Mark Leeds [40:20] Yeah, definitely. Now, the books, if someone orders them, is it a hardcover book?
Carolyn Hannan Bell [40:26] No, they’re paperback.
Dr. Mark Leeds [40:28] Oh, okay. And have you considered a Kindle e-book?
Carolyn Hannan Bell [40:34] I did. Mommy’s disease and Daddy’s disease, the alcoholic parent books, are both available on Kindle. But because they’re picture books, not very many people were ordering the Kindle books. So I didn’t put Dad’s Addiction in Kindle form because of that.
Dr. Mark Leeds [40:52] Oh, I hadn’t thought about that’s true. Some people actually like to read the Kindle books on an actual Kindle, and the Kindles don’t show pictures very well.
Carolyn Hannan Bell [41:02] Right, right. So, yeah, I guess if enough people were wanting it, I would do it’s not a hard thing to do, but I just didn’t think it was that popular an idea.
Dr. Mark Leeds [41:20] Okay, and I guess an audio book would be the same thing. You wouldn’t have the illustrations to look at.
Carolyn Hannan Bell [41:26] Right, right. Yeah, and without the dog pictures, it’s a lot less cute.
Dr. Mark Leeds [41:30] Yeah, I guess you could put the dog sounds in the background, but it wouldn’t be the same.
Carolyn Hannan Bell [41:35] Right, right. Yeah, I definitely, I wanted the kids to be engaged when they’re reading the book, and I wanted the pictures to, I don’t know, give them a little bit of laughter. It’s such a heavy subject. I tried to, I wanted the dogs to provide a little levity as well as some comfort.
Dr. Mark Leeds [41:53] Yeah, this would be a great thing to have in doctor’s offices. I mean, I can imagine, you know, I actually thought about that as selling books to my patients and, you know, maybe even, you know, having like the AA big book and the NA basic text and, you know, the kind of books that they sell in meetings anyway. I think they can be sold anywhere, I’m pretty sure. At least I’ve seen that there’s like these, what do you call them, you know, the places where they have meetings all day, like the clubhouses, and they sell books at the front counter. And so I don’t know. I was going to look into that. But then your book would be perfect. I mean, that would be relevant to anybody. And a lot of times it’s the family members that bring patients in. And so in fact, I actually brought your book up to a patient. I mentioned it. I said, you need to look up this book on Amazon. And she was excited about it because she was getting back together with her children who she hadn’t seen for a long time. And was definitely interested.
Carolyn Hannan Bell [42:52] Oh, that’s wonderful, and I thank you so much. Getting people to know that this is a resource out there that they can use if they want, that’s wonderful. Yeah, definitely. The work that you do for people is really, really important and wonderful and makes such a difference.
Dr. Mark Leeds [43:11] Yeah, thank you. Oh, I was going to ask you about, as far as alcohol, and I definitely would like to I’m going to go get those other books the first two books that you wrote have you heard about this there’s a thing out there and I don’t know if this is a good or a bad thing it’s called the Sinclair Method have you heard of that? And I only heard about it recently because a patient came in and brought it up to me and it was completely new to me and her husband said she saw it on YouTube and wants to do it so I looked it up and there’s a famous actress who’s promoting it, and there’s a book about it was written by, I think, a psychologist. But the Sinclair Method is, I think, for alcoholics. And they say somehow they’ve determined it’s superior to abstinence, where they take naltrexone, the opioid blocker, but naltrexone also helps to reduce alcohol cravings. And they recommend that the Sinclair Method apparently is that they reduce their alcohol intake, but they don’t stop drinking alcohol. And somehow they, you know, I guess that you don’t get the same high from the alcohol that you would get normally because naltrexone is blocking the receptors. And it’s about, you know, regulating, you know, maybe instead of drinking bottles of wine every night, you’re drinking like one or two glasses a night. And, I mean, I don’t, it doesn’t sound right to me. So I ask, you know, we have a rep that comes in periodically for Vivitrol, which is, you know, the once-a-month shot version of naltrexone. And I asked her, I said, what do you think of the Sinclair method? And she said, well, I disagree with it’s wrong, but it gets people in the door. It gets people interested in alcohol treatment and maybe just like those safe houses, it’s a way to get talking about it and say, well, I don’t agree with it and you can try it out, but it’s probably not going to work and then the next step is to quit alcohol altogether.
Carolyn Hannan Bell [45:10] Oh, yeah, that’s a good point. It is a good way to get the foot in the door, but I agree with you. It sounds almost like a rationalization.
Dr. Mark Leeds [45:19] Yeah, I don’t think, I mean, at least for the one patient she’s trying it, but they claim to have a 78% success rate. I don’t know how they determined that. I haven’t read the book yet. I was, you know, briefly looked over the description of it, but it’s out there, I guess, so people may bring that up. The Sinclair method. It’s supposedly a way for alcoholics to control their drinking and still be able to drink, but it seems like a dangerous idea.
Carolyn Hannan Bell [45:51] Yeah, I’m going to check it out too. It’s really interesting. I mean, it certainly would be better than somebody who is never going to quit drinking who needs to quit if they, I guess it would be better, but it’s an interesting idea. I’ll check it out too.
Dr. Mark Leeds [46:06] Yeah, and naltrexone itself is really an interesting medication. It’s an opioid blocker, and it can be taken as a tablet or the shot. The tablet is a lot cheaper, and it supposedly blocks alcohol cravings, and then they’re discovering all kinds of uses for it, for I guess even pain management at low doses.
Carolyn Hannan Bell [46:28] I have a client who does the low-dose naltrexone for, I guess it’s like for depression, anxiety, and autoimmune disease repression.
Dr. Mark Leeds [46:39] Yeah yeah that’s it
Carolyn Hannan Bell [46:40] It’s really cool that’s a cool drug
Dr. Mark Leeds [46:43] Yeah yeah they say it very low doses it can reduce inflammation of the central nervous system and yeah it’s really interesting but just I actually have one patient he claimed that it stimulated his creativity and he actually went and got an invention patented I don’t know if the naltrexone did that or if it was just him quitting alcohol made it you know kind of woke up his brain
Carolyn Hannan Bell [47:05] That is so cool do you also treat people who are doing the low-dose naltrexone?
Dr. Mark Leeds [47:13] I have a couple of patients with that. And also, buprenorphine, the ingredient in suboxone, is very effective for different kinds of pain. And one patient who’s doing very well with that has a theory that the naloxone in the, you know, naloxone is similar to naltrexone. It’s a potent opioid blocker. When a person takes suboxone as directed, the naloxone that’s in it’s a potent opioid blocker. The naloxone doesn’t do anything. It’s just, the only purpose for it is as an abuse deterrent. It’s to stop people from, I guess, shooting up the suboxone. But some of it is absorbed. You put the suboxone into your tongue, it absorbs. And some of that naloxone does get into the person’s system. So this one patient has a theory, and it could be true, that it’s kind of acting as a low-dose naltrexone and working in conjunction with the buprenorphine as a treatment for fibromyalgia. And it’s an interesting theory. It’s something that could be studied, and it’s a possible thing, but it’s just a theory.
Carolyn Hannan Bell [48:23] Well, it seems to be something to it with these drugs. It would be wonderful to get some pain relief for all these people who are suffering.
Dr. Mark Leeds [48:35] Yeah, and that’s a whole other issue, the pain management. I don’t think everybody that was going to pain clinics and getting medication was definitely addicted. And now we have that situation where there’s people in chronic non-malignant pain that are suffering because there’s no access to the medication anymore and some of those people may end up turning to heroin on the street and end up getting addicted.
Carolyn Hannan Bell [49:02] Yeah, and it’s kind of like an innocent path to addiction that’s just life-crushing.
Dr. Mark Leeds [49:13] Yeah, so that actually came up with one of my patients. He said if only he’d been able to continue getting his medication, he’d be fine. And after years, he eventually did turn to, I think it was kratom, which is a herbal or a plant form of an opioid. He thought kratom might help him, and one thing led to another, and he ended up on heroin.
Carolyn Hannan Bell [49:34] Oh, my God. Oh, that’s really sad. Life is hard enough without all this stuff.
Dr. Mark Leeds [49:43] Have you seen that? Have you had patients that were addicted to kratom?
Carolyn Hannan Bell [49:50] No, I haven’t. Most of the people that I see are family members. It’s just every now and then that I will get a person who is actually addicted because I’m not a substance abuse counselor, so it’s mostly people who are coming in with codependency or just trying to deal with a family in trouble because of an addict or an alcoholic in it. Yeah. But every now and then I will get the person who is addicted who comes in and, you know, they’re often trying desperately to figure out how to be sober and live and deal with all of, you know, life’s difficulties and all of the things that they didn’t learn and mature during the years that they were addicted, it’s a really tough battle.
Dr. Mark Leeds [50:42] So, yeah, I don’t want to take up too much of your time now. We’re coming up on an hour almost, which is great. But, yeah, so I highly recommend your books. People listening, please go to Amazon. We’ll put links in the show notes to go to Amazon. And you can, is that the best place to get these books or can they get them from you directly or do you recommend going to Amazon to buy them?
Carolyn Hannan Bell [51:08] Yeah, it’s all on Amazon.
Dr. Mark Leeds [51:10] Okay, and I hope you continue. I mean, you’re coming out with a fourth book and I can imagine a whole bookshelf full of these books. I mean, there’s so many different individual conditions that people might identify with. I mean, I don’t know if you’ve considered it, but like you said, depression, anxiety, and then there’s this whole series of personality disorders that some of them are becoming prominent now in the news that they’re being talked about. That would be incredible to have just a whole series of these books. Yeah, so anyway, thank you for coming on. I appreciate it. Thank you for coming on the Rehab Podcast. Again, Carolyn Hannan-Bell, practicing psychotherapist in South Jersey. That’s New Jersey, right? You don’t get to pump your own gas there, right?
Carolyn Hannan Bell [52:01] Yeah, that’s the one beauty of living in New Jersey.
Dr. Mark Leeds [52:05] Yeah, yeah, definitely. Do you have Costco in New Jersey?
Carolyn Hannan Bell [52:08] And Costco, yes. I do love Costco.
Dr. Mark Leeds [52:11] Do they have gas at your Costco? Do they have to pump your gas when you go to Costco Gas? Oh, wow. I just thought of that.
Carolyn Hannan Bell [52:21] It’s a wonderful thing.
Dr. Mark Leeds [52:23] Yeah, so thank you. And definitely I hope to have you back when the new books come out. This is great. And I’m going to order some of these books and at least put them out in my waiting room and recommend them.
Carolyn Hannan Bell [52:34] Thank you so very much. I really appreciate the support and the wonderful work that you do.
Dr. Mark Leeds [52:39] Thank you. All right. Take care. Thank you for joining us today on The Rehab on the Mental Health News Radio Network. I hope that you have found this show to be interesting and useful. If so, please subscribe to The Rehab Podcast and share on social media. I appreciate your taking the time to listen to The Rehab.
