Category Archives: For Caregivers

Understanding Trauma

Trauma. It’s the latest trend in therapy, right? Yes, yet it’s more than a trend. If we look at how trauma has been perceived historically, it’s easy to see how this focus on trauma could be considered a trend. However, when we look at what recent research has to say about trauma, it changes our understanding of why we need to focus on trauma. When all of this comes together, then we can better understand what we need to do to address the trauma in our lives and in the lives of our loved ones who may be continuing to use substances to cope.

Brief History of Trauma

Historically, people think about trauma as something that happens to veterans in war. Shell shock, battle fatigue, soldier’s heart, and combat stress reaction are all names that have, over the years, been employed in attempts to describe what we now call Post Traumatic Stress Disorder. Experts did recognize trauma as a possibility outside of a wartime scenario but believed these incidents to be limited. Therefore, these instances outside of wartime trauma exposure were not looked at much. So, when you look at trauma from this lens, it’s easy to see how limiting our understanding of trauma can be.

Current Understanding of Trauma

Image by John Hain from Pixabay 

Now days, though, researchers have done quite a bit of work around trauma in other settings. We understand PTSD can stem from things like abusive situations, bad car accidents, witnessing things that can be seen as life threatening, and more. And, thanks to researchers in the last few years, we also know how challenges and difficulties in the home environment that disrupt attachment can affect development. In fact, many researchers, therapists, and specialists are advocating for a new DSM-5 diagnosis of Developmental Trauma Disorder as a result. This is because research has found that symptoms of PTSD and symptoms of trauma stemming from developmental trauma are distinct, even though they do have some overlap.

In sum, this shift to focus on trauma is not just a trend. It’s a broadening of our understanding of what symptoms of trauma look like and what trauma means. In fact, for most clients who struggle to maintain recovery and who struggle with mental health symptoms, underlying trauma is likely part of the problem.

Supporting Someone with Trauma

So, then, what do we do about it? How do we support someone with underlying trauma in their lives? There are a few key things to remember. First, we must keep in mind, people with a history of trauma are living their lives hyperalert to everything around them. They are constantly keyed into anything that could be conceived of as a threat. This hyperarousal is also exhausting. Which means not only is the person scanning for danger all the time, they are exhausted on top of it. Put those two things together and it’s clear they’re not going to be thinking things through as clearly as someone not in this position would be.

Image by John Hain from Pixabay 

Also, keep in mind they cannot control this. Just because the rational brain can understand the threat is not there, doesn’t mean the emotional part of the brain believes it. A classic example is the idea of walking through a parking ramp late at night all alone. Men tend not to be as alert in this scenario when compared to women. Why? Because most women have been taught situations like this are dangerous. In general, men have not had this same lesson. It doesn’t matter if it’s a parking ramp a woman knows like the back of her hand, she’ll still most likely be on high alert for any danger if she’s there late at night and all alone regardless of what ration and reason may tell her.

Once we establish this understanding that the part of the brain controlling the traumatic stress reactions doesn’t respond to ration and logic, it becomes clearer we need to tap into the emotional part of the brain to calm that stress reaction. That’s mainly a role for therapists and specialists. As a support person for someone with trauma challenges, we can remember to honor as many of their requests as possible while still ensuring we are caring for ourselves. For example, if your loved one feels like they need to sit in a specific place and there’s no obvious reason not to honor it, let them. Also remember their anger is not about you despite what it may feel like. Accompany them to therapy appointments when appropriate and when possible. Learn what you can from the experts to help you support your loved one. And keep those healthy boundaries we’ve talked about in the previous articles here and here.

Trauma and Yoga

A final thought for you on how to support a loved one who’s struggling with trauma. Encourage yoga. Research from The Trauma Center, a leading training and research institute on trauma, shows the use of yoga in people with trauma can be a very effective tool in being able to rebuild the mind-body connection that can be broken with trauma. But go slow and be prepared for it to trigger trauma reactions. Make sure if you choose to offer this as a support to your loved one, you’re working with their therapist.

Image by Mary Pahlke from Pixabay 

Trauma is not just a trend in the therapy world. It’s a very real part of what clients in substance abuse treatment programs, mental health programs, jails, prisons, and more deal with. It can be an underlying reason why they struggle to remain stable in the community for long. Caring for a loved one requires lots of understanding, patience, and insight. And healthy boundaries.

Stacy Overby, MS, LADC, CCTP is the program director. She has been a licensed drug and alcohol counselor since 2010 and a certified clinical trauma professional since 2017.

Support System Roles in Recovery

Over the last couple months, we’ve talked about what relapse means in recovery and how to set healthy boundaries with loved ones to support their ongoing recovery. The next piece of this puzzle of supporting loved ones in recovery is to understand how their behaviors and substance use has affected the people around them.

The Pond

Imagine for a moment a clear, still pond. The surface is just like a mirror it is so smooth and still. Now imagine someone comes along and throws a rock into that pond. What happens? That’s right. Ripples and waves spread out across that pond. When they get to the edges of the pond, those ripples affect the grass, the mud, and more at the edges. Then they bounce back across the pond in another direction. Those ripples continue until enough time has passed to return that pond to its still state. But that pond has been changed by those ripples. It can’t go back to what it was before the rock was thrown.

This image is what happens in a support system when a loved one uses. The rock is the loved one’s behaviors around their substance use. The pond is the support system. Those behaviors create disturbances in how people in the support system behave. The good news is that those ripples will subside, and things can find a new normal with time and support.

The Enabling Role

In order to find that new normal, though, it is important to understand what those ripples are and how they are working in your life. One of the more common ways a loved one is affected by substance use behaviors is to become enabling. It doesn’t happen overnight, but it can happen. Most often people we’ve worked with who have ended up enabling their loved one’s using talk about doing it because they’re scared of what could happen if they don’t. For example, with teens, parents and family have said they have allowed substance use in the home because that way they know their teen is safe while they’re using. They’re afraid if they set a limit preventing use in the home, the teen will leave and find somewhere else to use and potentially engage in even more dangerous behavior. That’s why someone who is enabling can be referred to as a caretaker—they see their role as taking care of the person using rather than enabling the use.

The Family Hero Role

Another common way these ripples affect loved ones is to become the family hero. Shame, fear, and guilt over the loved one’s using behaviors drive this person to become overly positive. They work to make everything look good and give the support system the illusion that everything is fine. Perfectionism is a common trait seen with people reacting to substance use behaviors in this way.

The Mascot Role

A third way these ripples can affect a support system is to create the role of a mascot for the support system. This role holds someone from the support system up as a clown and joker. The person uses humor to deflect and divert attention away from the person using and the dysfunction developing in the support system.

The Lost Child Role

Another role that can develop in a support system affected by substance use behaviors is where people in the support system disappear. They may still physically be present in the support system, but they are quiet and careful not to make problems. This means people in this role can be easily overlooked in the activity being generated elsewhere in the support system. It also means people in this role end up sacrificing their needs to the perceived need to keep a low profile with everything else going on in the support system.

The Scapegoat Role

The last role to be discussed here is a critical one to understand when it comes to understanding adolescents in a support system affected by substance use behaviors, as teenagers are often cast in this role. The role is called the scapegoat. The person or people in this role will often act out, rebel, use substances themselves, engage in illegal behavior, and more to divert attention away from the secrets the support system is holding. In essence, they take the blame and consequences for what the loved one using is doing.

Teens in Treatment

This last role is vital to understand when discussing teenagers in treatment programs, because often there are much bigger issues in their support systems than their own use and behaviors. And it is for this reason that substance use treatment should always include interventions and supports for the loved one’s support system. These interventions often include family groups and individual family therapy. But it doesn’t have to be limited to that. Sometimes it may be getting someone else in the support system their own substance use treatment or mental health therapy. It could be addressing legal, educational, and/or economic disparity issues.

The Connections

Now, to bring these roles back to the original discussion on boundaries and supporting loved ones in recovery. In order to best support and help a loved one in recovery, people in that loved one’s support system need to understand how the behaviors have affected how the rest of the support system thinks and behaves. Only when we understand how we have been affected by that rock thrown in our pond can we make the changes needed to set healthy boundaries and truly support a loved one in recovery.

Healthy Boundaries and Relapses

A couple weeks ago we talked about what to do if a loved one relapses. Part of what we talked about was maintaining healthy boundaries. Yet, this is something society does not talk much about. In fact, society often pressures us into letting go of healthy boundaries in favor of other, less beneficial gains. So, let’s take a little time today to talk about how we maintain healthy boundaries, so we are prepared when a loved one relapses.

What are Boundaries?

Image by Gerd Altmann from

First, let’s talk about what boundaries are. In the broadest sense, boundaries are limits. Concrete examples include state and federal borders. They’re not as clear when we talk about boundaries with people, but the concept is the same. It’s the limits we place on what we deem acceptable and not acceptable. Examples include your physical space, the energy you spend in a relationship, and how much money are you willing to spend on a relationship. While these are not the only boundaries we have, they should help you understand what we mean when we talk about boundaries.

Healthy Boundaries

Now that we’re clear on what we mean by boundaries, we can address what healthy boundaries are. This gets a little trickier to define. Each person has their own definition of healthy boundaries, so it’s not as easy to give a universal definition. The simplest way to think about if a boundary you’ve set is healthy or not is to answer a set of questions.

The Why Part

The first question is why are you setting the boundary where you are? What is it doing for you? Is it to help provide safety and wellbeing? Is it to ensure you have enough resources left to take care of yourself? Or is it because you can’t bear to let go of someone and/or their issues? Or someone has hurt you several times and are working to keep yourself from getting hurt again? How you answer these questions still won’t give you a clear-cut answer on if a boundary is healthy or not, but it will give you some clues. If you are setting boundaries to make sure you can take care of yourself at the end of the day, it’s probably a healthy boundary. If your answer is more like the scenarios in those last two questions, you may want to consider that boundary further. These last two questions don’t mean the boundary is unhealthy but can indicate a problem at times.

The Energy Part

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The next question is how much energy are you willing to invest in enforcing this boundary? While this may seem like an odd question, consider this. If you set a boundary but are not willing to enforce it, you’re in effect teaching people not to take your boundaries seriously. So, it is critically important to enforce those limits where you’ve set them or make a conscious choice to adjust those boundaries to where you will enforce them.

The Goal Part

Finally, is the boundary you’ve set achieving the purpose you have for setting it? This circles back the first question about why you’re setting a boundary. It’s about testing to see if the boundary is working the way you want it to work or not. Even when we have good intentions and good reasons for certain boundaries, if they’re not working the way we want them to we may need to change them.

Changing Our Boundaries

That’s perhaps the best part of all this is that we can change our boundaries to work when we want or need. We need to keep these questions in mind when we make those changes. As long as we are satisfied with the answers we discover when evaluating our own boundaries, then it’s most likely a healthy boundary.

The toughest part with setting boundaries is everyone will have different boundaries. What one person considers a healthy boundary, others may not. It doesn’t mean we have to change a boundary when others disagree with that boundary, but we should consider why they’re concerned. It can get easy to think we are doing something good for ourselves and not see how it may harm us.

How Boundaries Apply to Relapse

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Лечение Наркомании from

Now, how does this connect back to what happens when a loved one relapses? The nature of addictive and using behaviors is to push limits, manipulate, and deceive. It’s not that our loved one is intentionally being cruel to us, it’s the disease driving those behaviors. That means we must be careful when considering why we are doing the things we are with that loved one. Is the decision to bail them out of a tough situation going to help them? Or will it enable them to continue the negative behaviors?

Perhaps the most important boundary to hold when a loved one relapses is that line between your loved one and the disease. Because we see the behaviors, we can slip into blaming the person for the choices they are making. Choice doesn’t play that kind of role though. Remember, the behaviors are about doing what they can to minimize the pain, shame, anxiety, and all the other uncomfortable feelings that come with addictions. This limits what choices the loved one has despite what it may look like on the outside.

In the end, none of this is an exact science. There are no easy answers. Supporting a loved one through a relapse can be painful, intimidating, and frustrating. They’re often feeling the same way, even if they won’t admit it. Next week, we will talk about how trauma plays a role in relapses and one way of working on that trauma while the loved one is in treatment.

When A Loved One Relapses

This is part one of a series on how to support loved ones through the ups and downs of recovery.

Relapse. It’s a scary word. Scary for people using, but just as bad for family and friends. So, as a parent, what do you do if it’s your child? After all, parents are supposed to help and protect their kids. But what do you do when you have to protect your child from him or herself? 

No Easy Answer

 Let me start by saying there’s no easy answer. Sure, there’s the canned answers of “tough love” and “they made a bad choice, so they have to live with it”. These answers aren’t helpful though. Remember, the definition of an addiction is a compulsive behavior you cannot stop. Yes, choice plays a small role in that a person makes a choice to use that first time, but even that isn’t as clear cut as it seems. Way back when someone first used, choice existed. Once the person learned to cope by using, the role of choice becomes minimized. The person cannot unlearn that getting high takes away the problems they have. At least for a while. It’s guaranteed to make you feel better quickly. So, when things get rough, the compulsion to use overrides the good sense of choice. 

They Do Care

Another thing to remember is that “users don’t care about anything or anyone but using” is not true. They care. And they care quite a bit. In reality, that is a big part of the problem. See, the loved one using knows just how much they’re hurting everyone around them by their actions. So, on top of the struggles with depression, anxiety, anger, self-hatred, and more, they’re adding large amounts of shame. It becomes more of an issue of the person using feeling too much, caring too much, not being apathetic despite what they may say. 

Another Way to Look at Addiction

But what should a parent or other caregiver do? Remember first, another way of looking at addiction. Addiction is isolating. People leave. Addiction ruins relationships, loses jobs, until no one is left but the person using. Not an ideal situation for someone battling depression, anxiety, anger, shame, self-hatred, and more. 

So, if the opposite of addiction is recovery, then recovery means connections. As hard as it is, finding a balance between setting boundaries while also not abandoning the person using is important. Encourage the person to take their medications as prescribed if they have them, to see a therapist or counselor, to attend community sober support meetings. Anything you can think of to help connect the using person to positive sober supports. 

Now, I know setting boundaries with a loved one, particularly your child, can be challenging. When minors are involved, there’s a whole different set of legal obligations to think about on top of healthy limits within the family. We will discuss setting healthy boundaries next week, so please stop back. In the meantime, please call or email us with questions or concerns. We are happy to help.

Stacy Overby, MS, LADC, CCTP is the program director. She has been a licensed drug and alcohol counselor since 2010 and a certified clinical trauma professional since 2017.  

Parenting Teenagers 101

I’ve worked as a substance abuse counselor for over eight years now. Most all of that time has been with adolescents, and one of the things I hear frequently from parents and guardians of teenagers is they struggle to engage their teen in meaningful conversation. How do you parent when they won’t talk to you?

Parenting Means Listening

I talk and talk and talk to them but they just won’t listen. While the words vary, I’ve heard many parents and guardians say things like this. The problem with this style of parenting is it relies on the spirit of “do as I say and not as I do” mentality. Teenagers are good at spotting those seemingly hypocritical behaviors and using them as a reason not to “do as I say”. While it can be so difficult to do, turning that pattern around tends to improve the relationships and overall parenting process. Let the teen do more of the talking and listen. Listen not just to what they say, but what they don’t say. Look at what their body language and facial expressions are saying. Teens often struggle to put their thoughts and feelings into words, so these non-verbal cues are a good tool to help them learn how to do that.

Parenting Means Admitting When You’re Wrong

Admitting you’re wrong. That is something so many people struggle to do. We’ve come to equate this admission to somehow being less than or not as good as others. Yet every single person on this planet has been wrong. And more than once. Yes, sometimes teenagers try to hold it against adults when adults are wrong. However, rather than letting the focus turn to who’s wrong and who’s right, deflate their argument by admitting it. Two things will start to happen when we admit we are wrong to teenagers. First, it will boost our teenagers’ self-esteem by hearing they are right at times. Second, it is an excellent way to work on building mutual respect. By acknowledging we are wrong, it tells teenagers we are listening to what they have to say.

Parenting Means Admitting We Don’t Have All the Answers

Another thing I’ve seen is when parents and guardians struggle to admit they don’t know something. It gets easy to pretend you have an answer to try to get them to do what we want them to do. However, when we pretend we have all of the answers, we also teach teenagers to pretend the same thing. This, in turn, sets up situations where teenagers get in over their heads pretty quickly. Instead, learn to admit when you don’t have the answer. Then work with your teenager to learn the answer together. It teaches your teenager the skills to find answers to things they don’t know and it helps them learn to admit they don’t know everything.

More Parenting Resources

Eowyn Gatlin-Nygaard, a therapist from Headway Emotional Health, wrote a great article with additional insight into decoding teens for Minnesota Parent. You can find it here.

Mayo Clinic also has some good insight here.

Stacy Overby, MS, LADC, CCTP is the program director. She has been a licensed drug and alcohol counselor since 2010 and a certified clinical trauma professional since 2017.