1960’s

          My memories of my father are of a fun, loud, loving man who transformed when he drank jugs of Gallo wine. When drunk, Daddy fell. His  clothes fell off, he spoke gibberish, and he smelled like stale moldy fruit and sweat.  When sober, he smelled like soap and the shaving lotion he used.  He walked upright and proud, used clear diction, picked us up to swing, and rubbed his whiskers against our cheeks while spinning us around.  He often told us stories about his troops while trying to use his staff sergeant skills to corral us, while bragging about his booming voice. He used his voice lecturing his students, and used the same voice trying to lecture us.  We rolled our eyes and ran off to play. Occasionally Daddy blew up when we acted out and hollered empty threats; but mostly, he gave up and returned to drinking.  
          My father spent his free time lying on the couch. He drank most days. That's when he shared his paranoid thoughts. I concluded they came from the wine. Before he passed out, he yelled, "Wake me up when the bombs drop." Mama told us about Daddy’s old job, working for the CIA, classifying documents about nuclear fallout.  She said that job made Daddy sick.  As soon as he talked about bombs, I knew he'd fall asleep. Mama said he was 'tired'.
          Once I poured a full jug of wine down the drain. I hid the empty bottle under the sink. Daddy didn't get mad at me. He bought another.
          I went on the bus with Daddy to buy alcohol, thrilled at the individual attention. He filled out a form at the state liquor store.  A man wearing a suit disappeared through a curtain, returning with a bottle. I wanted to follow the man to see the room behind the curtain. I had more fun when we rode the bus across the Mississippi where Daddy bought and drank wine.  Sometimes adults asked me why Daddy took the time, on Sundays, to take four  buses for the round-trip of less than ten  miles, to buy alcohol in another state. Iowa didn't sell alcohol on Sundays; Illinois did.  I wondered why the adults didn't get how fun it was to ride the bus.  
          Daddy didn't like the phone when he drank. Twice he climbed up on the roof of our house and cut the phone wires. Something bad could get in the house through those wires. It sounded plausible to me. Since I often got confused, it was easy to dismiss. Daddy's fears and ugly yelling only happened when he drank, and only in the house at first. Later he walked around outside yelling about the government and Russians. I wanted my daddy to get better. Mama explained he was sick. I loved the times he smiled and hollered and threw us up in the air. The sick times increased as we got older until Daddy imploded and got taken away. I saw him as sober, kind and gregarious--an upbeat Daddy. I considered the daily drunkenness the exception.  

 

        1967

          Mama took me with her that day.  I never knew where she went when she left, nor did I care enough to ask. I lived in the present, engaged wherever I was. That day I got to go with Mama, making me feel special. Daddy had been hollering and falling.  This time seemed more dramatic, Mama more anxious than usual.
          "Let's go Josie," Mama said. 
          Mama explained as soon as we left the yard.  "We have to use the pay phone because your father cut the phone wires again."
          We walked in silence as I pondered what that meant. We walked down the front sidewalk through our front yard, exiting to the left, out through the cast-iron fence missing its gate, onto the city sidewalk. 
          Mama and I walked past the four-story unoccupied green house taking up the lot next door, past our doctors' office in the much smaller gray house on the corner. I looked back over my shoulder at the empty lot behind those two houses where I spent hours climbing the trees and living in my imagination. We turned the corner, leaving behind the triangle-shaped park on our right, surrounded by old looking apartment buildings and duplexes, where neighborhood children gathered to play games.   Our house was the only occupied single family home in the two-block radius I called my stomping grounds for the 9 years we lived in the Jackson Park Historical District in downtown Dubuque, Iowa. We turned right after crossing Main Street at the corner of 16th, following my twice daily route to and from the Catholic school I attended. I saw the phone booth as we walked the last block past Jackson Park. 
          "We need the police. And to call your father's family."   Mama said, as we crossed the last street.  We were at the corner of Main Street and 15th, just blocks from the center of town.
          When we got to the phone booth attached to the corner of the school, Mama called Daddy's sisters in New York. I'm not sure what Daddy's family said. Mama told them what Daddy did, using kind words.
          "He's upset."  
          "He's not acting right." 
          "He's showing poor judgment."  
          "He cut the phone wires." 
          Mama hung up and shook her head, saying "denial," then got back on the phone. 
          "He's upstairs. Our children are downstairs. He has a knife.' 
          We quickly walked the two blocks back home. 
          I worried about my daddy. He could hurt himself with a knife. He needed the wires cut because he didn't want the Russians to get into our house. What's wrong with that? Last time Daddy went to sleep like he always does, then the phone company came out and fixed the wires while we were at school.  
          We got home.  My big sister Teri, age 12, not yet diagnosed with autism, got us all in one room--except Peter, age 13, not yet diagnosed with schizophrenia, who stayed in his room, always. Teri went in and out of the dining room, next to the kitchen toward the back of the house, corralling four of us children.  She told us bits and pieces of what was going on, telling us she could not tell us grown up secrets. 
          "Daddy had no clothes on," she told us, stopping after getting us all curious. We laughed over that. Mama came in. I asked if they were hurting Daddy. She told us about a straitjacket, how that would make him safe. She told us it was like a jacket with no arms. Mama told us we had to stay in that room with the door closed. The police officer came in and told us Daddy would be fine. By then we all crowded around. We waited for Mama to come get us. She did. Daddy left with the police in an ambulance.  I wanted to ask more questions.  I knew better.
          Mama left town. Daddy needed to go to a hospital far away because they didn't have his kind of hospital in Dubuque. He stayed gone a long time, weeks if not a month or more. Mama came and went. Once she stayed gone for days. Teri took charge. We were ages 7,9,11,12 & 13 at home. Mama kept my youngest sister with her, then age 3. 
          Mama told us not to tell anyone where our parents were. That was easy for me because I never knew.  My teacher caught on that we had a secret and kept quizzing me about both parents, where they were, and what they were doing. 
          "Where is your dad?"  
          "I don't know."  
          "What is he is doing?"  
          "Sleeping."  
          I knew I wasn't lying because I didn't know where he was, only that he was in a hospital somewhere far away, that he was taken with a straitjacket, that he was naked, and that he had a knife on the roof because someone could come get us through the phone wires. I worried about him. Why did the teacher keep asking me questions?  I stared, withdrew into my own thoughts, and the teacher left.
          Daddy came home. When he did, the sun shone through both front windows. He smiled, letting me know Daddy got better in the hospital.  He roared, in the voice that made me feel warm and secure.  He hugged us. He swung me around.  He quit drinking for the next 10 years. When he started again, the paranoia came back first, leading to losing his job and our house and the life we had in the small midwestern town we moved to trying to escape Daddy’s demons.  He packed us up and we all left town, six weeks before my high school graduation.  I went back to help him at the end of his life.  He told me his cancer doctor gave him medicine that ‘calmed’ his brain.  
          “If they gave me this stuff back then, I wouldn't have needed to drink, Josie.  It’s the darndest thing!”

​

        1975

          In the little rented row house where I lived with my dad while going to college were three units. 1975, my last summer spent in Canton, Ohio, I became friends with the neighbors in the other units.  
          I learned about alcoholism from my friend who I drank with the most.  I went with her to her Alcoholics Anonymous meetings, ordered by a court after her arrest for public intoxication. She insisted that since I drank with her, I needed to go to AA with her. I listened and talked to the guys during my AA visits. Everyone was male, except us two teenage girls.  An older man told me I wasn't an alcoholic--because alcoholics hit rock bottom. I went with my drinking buddy to AA a dozen times during her short stint in recovery. She began drinking again. I continued to ingest substances--LSD, diet pills, and alcohol being my favorites.  The speed and LSD took the edge off my binge drinking episodes. 
          That was how I learned all about AA, which taught me I could claim alcoholism and get cured once I got to a rock bottom, a place all in AA went before they quit drinking. Grim.  
          I came up with a plan. I would hit rock bottom during the summer because then I had nothing to lose. I'd be off school and didn't have a summer job. Genius. I called my older sister Teri and let her know my plan. I told her if I got stuck at rock bottom, I needed her help. She agreed to help me. I was to check in every week. 
          When my big sister Teri and I discussed my plans to hit rock bottom, with her supplying a life jacket in case I could not resurface as a recovered alcoholic, we did so laughing. We made plans to escape the inevitability of our downfall, as the offspring of an alcoholic father. We had folk rumor knowledge. We took theories and custom-fitted them to the point of absurdity.  I described what I learned from the few forays into AA. I was destined to be an alcoholic. I behaved like a pre-alcoholic. I listened carefully to stories from recovered alcoholics, all identical to each other. 
          "I had fun drinking until the fun ran out. I lost everything. I lost my wife and my job and my house and my reputation. I hit rock bottom when I lost my freedom."  
          Arrest during blackouts led to most of the rock bottom moments.  I thought about losing a job, husband, and children after spending years accumulating such things. 
          It's hard to execute a plan like this. The first step was to drink every day starting in the morning. I chose MD 20/20 as my poison. The real alcoholics mentioned worse drinks like ouzo and mouthwash. Those sounded too extreme for me. I drank Mad Dog before. It tasted good. Sugary. I knew I would throw up since that had already become part of my drinking routine. I often ate high calorie food before getting drunk as my brand of bulimia. Waking up in the morning, buying Mad Dog, and getting drunk by noon made me feel like a badass. By the end of the week, we had a neighborhood party going on our neighboring porches. As each day progressed, the mood of the party got ugly. By five o'clock, every day, a conflict would end the party. 
          By the time I got up that last morning, the party started without me. Two of the neighbors, usually friendly if not friends, got into a verbal altercation over their kids and wives.  It devolved into a physical altercation. The instigator's wife, watching from the window, called the police. I left, wandering around town drunk for quite some time. The next day, no one was speaking nor were they coming out of their homes. I had to give a statement to the police about what happened. Both families moved out shortly thereafter. My friend ended up back in rehab, having been arrested again. I got a job somehow, rock bottom diverted. 
          I did stop drinking before age 25, inspired by the hours I wasted sick the next day with hangovers, and my fear after having a couple of blackouts.  I never found a bottom.  I wandered in-and-out of 12-step programs.  I practiced abstinence while pregnant and nursing two children, then discovered prescription medications for anxiety, which doctors freely prescribed.  That lasted a dozen years, followed by an obsession with overexercising, and the highs associated with being exhausted.  I am old with arthritis now, so marijuana has more appeal.  It caused me anxiety when I was younger.  I follow my father’s advice these days, things he told me to do but didn't practice himself.  
          “Stay away from synthetic chemicals. Josie.  Stick to what nature produces.”  Coffee and pot suffice.

​

        2010

          Four evenings per week, my son and I drove the few miles to the only private inpatient mental hospital in town, a multi-storied white stone building on the banks of a creek, in the middle of a business district, next to an urban trail snaking under bridges over busy roads.  Two evenings out of the four, I joined my son, going through the metal detector attended by two friendly smiling security guards; putting my belongings in a locker; riding up the stark white elevator to the fifth floor where the inpatient and outpatient drug treatment programs were found.  We sat around in a circle of chairs, listening to information on the latest research into the family dynamics that go along with alcohol and drug problems.  Most of the time, the topic of mental illness didn't come up.  Occasionally the counselor referred a child participant to psychological services, but primarily stuck to the creed forced upon her profession, twelve-step programs.   This counselor adeptly incorporated counseling techniques used across the field for multiple conditions--family therapy, group therapy, peer-to-peer counseling, cognitive therapy and talk therapy being a few of them. One model used in family rehab she borrowed from twelve-step programs, incorporating it into the 5-week, 20 session medical model the hospital used.  Larry and I sat side by side on the nice institutional chairs, looking to the front at the dry erase board used by the counselor as she led the session for parents and teens.  The three other teens sat in the half circle across from us, side-by-side with their parents, a girl with her mother; a girl with her father; a boy with both parents; all watching the confident 30+ year old woman writing down a list of words.
          “Scapegoat, Hero, Lost Child, Mascot, Caretaker, Enabler, Mastermind, Truth-teller, Peacekeeper, Victim, Dependent (the sick person)”.
          "This is a family model used to describe roles taken by members in a family when addiction takes over,"  said Joy, as she turned to her audience to explain the separate roles.  
          Different family members take on these roles to adjust to the interruptions in normal family activities, holes created by the person suffering from drug or alcohol abuse.  
          Larry and I discussed the roles animatedly in our ride back home, then sitting in our driveway for two hours.  In our case, we agreed in our car discussions, his dad's rare early onset dementia caused more of the holes than Larry's self-medicating for his few minor conditions.  Sometimes the actions of a family member sprouted from individual dysfunction; sometimes behavior sprang from dysfunctional family roles.  
          "I am the 'Lost Child'" said Larry, after incorporating the evening’s lesson into our family history.  His acute pain caused a stab of shame and horror in me, as I looked at my son sitting in the darkness, staring ahead.  
          "Yes, you are." I acknowledged, thinking about how his brother had his dad and me to hover over him, exclaiming at his every minor deed.  That ended when Larry started kindergarten, when his dad began showing symptoms, diagnosed later with early onset dementia.  Larry never learned to ride a bike, nor other things his brother learned from their hands-on dad.  As our family roles deteriorated under the weight of illness, Larry was neglected. I didn't fill in for the undone things, as I frantically tried to impose a normal life onto a tragic situation.  The counselor leading our sessions agreed in our discussions that evening that in any family, when sickness takes over, no matter the sickness, others in the family must change roles. 
          "Sometimes I am the scapegoat – when I get in trouble – and sometimes I am the mascot, because I am younger," continued Larry, matter-of-factly, interested in looking at his own place in this model.  The scapegoat acts out; the mascot makes jokes. We could not place him in the sick person role, even though that was why we came to rehab.  That spot belonged to his dad. 
          "You are right,"  I added.  "People take on distinct roles at different times.  That's how it was in my family growing up.  I was in separate roles at different times too," again commiserating on our commonalities.  "I was also the scapegoat and mascot, plus I was the truth-teller; and now I'm the caretaker.  I can't call myself the enabler, though, since your dad's illness can't be treated."  
          These roles are not rigid, but flexible.  In both my early and later families, we cycled in and out on an as-needed basis. In my adult life, my children's father got frontotemporal dementia while our two boys were in elementary school.  FTLD includes episodes of paranoia, scapegoating me like my father blamed my mother. Unlike my magical thinking from childhood, where my yelling cured my father, my husband’s symptoms didn't disappear when I knee jerked  loudly and declared them crazy. 

​

        2018

          "I'm sorry.  You got that from me."
          I looked across the table at my 25-year-old son eating his burger, picking at it, nibbling, as he chews and chews, before he swallows and nibbles again.  He took three times the time to finish his sandwich without fries than I took to finish my salad.  Larry sported six new pearly white perfectly straight top front teeth which replaced the ones he got from me, the ones he knocked out five  years ago jumping on the trampoline while drunk.  The young drunk female sharing the trampoline found one of the six in her head.  If any teeth moved up into the gaping bloody hole in my child’s mouth, nobody told me about it.  I cringe remembering waking up at 3AM to my older son banging on my door. 
          “It’s not as bad as it looks Mom.”  
          I imagine his teeth didn't remain lodged behind his skull.  No matter.  His new teeth give him an aura of good dentistry, a sign of success.  That gives him an edge, I think to myself. 
          To a casual observer, my son resembled a hipster, newbies to Austin blamed for the cost-of-living increases over the past decades.  His dark beard and dark curly hair contrasted with his pale Irish skin; the bright red beer t-shirt paired with black jeans and gold high top Converse stood out.  He scoffs when I call him hipster, never one to care about appearances.  Larry's brother brews beer for a living and gives Larry extra t-shirt swag, adding to his wardrobe made up 100% of gifts from his brother, me, and the flock of roommates he lived with over the past few years.  He chooses daily outfits based on secret internal rules he tries to hide. According to tests and professionals, my youngest son has dyslexia, obsessive-compulsive disorder (OCD), a communication disorder on the autism spectrum, and language processing disorder—all mild and all he claimed to have grown out of.
          I listened to my son describe an incompetent boss, distraught about work and other everyday annoyances, my heart full of pride and hope, noticing his maturity.  His voice strained, he shifts around in his seat as his tone exposes his strong emotions, another gift from my genes.  My son, like me, vents to relieve stress. Occasionally, he needs help; less often, he accepts help.  I remember his advisers in college led to one rare instance Larry accepted help from me.  
          When he tried to meet with the two sixty-something female professors, he could not understand them.  Their mode of communication mirrored the graduate school level textbooks assigned in the community college program my son attended, hinting that the two women preferred to work with privileged populations.  When I met with him and his professors, they referenced the beer shirts he wore to school.  I remember Larry's confusion. He looked down, almost surprised to see the beer shirt.  I knew it was an OCD ritual and I knew he wouldn'c defend himself. I knew he hid his OCD that led to both choosing and wearing shirts advertising alcohol while studying for a Licensed Chemical Dependency Counselor (LCDC) certification.  I interjected on Larry's behalf, explaining how he finished the program, completing the coursework and fieldwork for the degree--the stated qualifications.  
          "No," said the two women who looked and talked like they wanted to be retired, nodding together to reinforce their authority. 
          “All licensed programs require abstinence; all drug counselors need to abstain,” explained one of the women.  
          “Your coursework applies to a recreational therapy certification.  You can transfer that to a four-year degree.”
          My son agreed.  He decided to work with other special populations, using recreational therapy.  The therapist helps clients develop interests for free time, an activity-based therapy that says to do what you enjoy during your free time.  I remembered that type of thinking helped me transition from drinking and drugging regularly to instead concentrating on physical activity, a better outlet for my own strong emotions.
          After several years working, Larry returned to drug counseling, choosing to work with incarcerated inmates sentenced to rehab instead of jail.  He himself was sentenced to rehab back in the day. Within two years, he was appointed supervisor.  He returned to the same educational program, finishing his LCDC certification.  He learned about privacy, and how drug tests catch some substances but not others.  He learned what to report about his clients to help them with recovery and what not to report.  He learned abstinence isn't the only path to recovery.
          While working with parolees, Larry found his recreational therapy training as useful as his LCDC license.  He successfully scheduled clients, did intakes, learned to chart, and helped dozens of his clients re-enter society during the pandemic.  At the same time, he struggled with the mandatory group programming from the state that wasted the time of his clients.  In place of the 12-step discussions, Larry incorporated film, what he himself uses as a therapeutic tool for life, into the groups.  He used his scant salary to buy a library of films, now part of his toolbox going forward.  He is using whatever works.  
          2 million people enter prison each year needing treatment for mental illness and drug addiction.   Half of those afflicted with one have the other; both have medical roots known about since ancient Greece; and both have symptoms that have been criminalized.  Medical advances throughout the ensuing three millennia for these two common conditions have not kept pace with disease research for physical conditions.  There is hope. More research has been done on brain disorders this century than all of human history combined. 

 

History of addiction treatment

1938

Two men developed a 12-step group therapy model for alcoholics to use for recovery.  They called it Alcoholics Anonymous.

 

1944

AA had 10,000 members in 400 groups nationwide.

 

1954

Narcotics Anonymous started, using the success of AA, to apply the 12-steps to other substances.
 

1964

Neurotics Anonymous started, but did not catch on like AA or NA.  This group was formed for those with ‘emotional or mental illnesses.’

 

TODAY

2 million members of AA, with 120,000 groups worldwide; NA has 67,000 meetings per week.

https://americanaddictioncenters.org/rehab-guide/12-step

“Twelve-Step programs remain a commonly recommended and used treatment modality for various types of addiction. According to the Substance Abuse and Mental Health Services Administration (SAMSHA) in its National Survey of Substance Abuse Treatment Services from 2013, 12-Step models are used, at least occasionally, by approximately 74 percent of treatment centers.”

    
For more information on treatment options for mental health and addiction:

The Substance Abuse and Mental Health Services Administration (SAMHSA) is the agency within the U.S. Department of Health and Human Services (HHS) that leads public health efforts to advance the behavioral health of the nation and to improve the lives of individuals living with mental and substance use disorders, and their families.
https://www.samhsa.gov/
Congress established the Substance Abuse and Mental Health Services Administration (SAMHSA) in 1992 to make substance use and mental disorder information, services, and research more accessible.
https://www.samhsa.gov/find-treatment
This site has information on the many types of recovery programs now available for those with addiction problems, and with dual diagnoses of both mental health and drug dependency, a common co-morbidity.

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NAMI is the National Alliance on Mental Illness, the nation’s largest grassroots mental health organization dedicated to building better lives for the millions of Americans affected by mental illness.
https://nami.org/Home
From their webpage:
’Dual Diagnosis’ is a term that describes when someone experiences a mental illness and a substance use disorder simultaneously.  People experiencing a mental health condition may turn to alcohol or other substances as a form of self-medication to improve the mental health symptoms they experience. However, research shows that alcohol and other illegal substances worsen the symptoms of mental illnesses.
The Substance Abuse and Mental Health Services Administration (SAMHSA) has released the 2018 edition of the National Survey on Drug Use and Health, the nation’s primary resource for data on mental health and substance use in the United States.  A notable area of concern is in co-occurring conditions. Approximately 9.2 million adults experienced both a mental illness and a substance use disorder in 2018. To learn more, please visit the SAMHSA website.