The Needs of African American Children of Parents with Substance Use Disorders

By Donald Gunther and Mark Sanders

An emergency room social worker from an African American community was distraught as she shared the story of an African American man who survived an overdose as he was rushed to the ER in the nick of time! He was accompanied to the ER by four adult relatives and his 10-year-old daughter.

The Social worker educated the family about how to use NARCAN and offered the overdose medicine to the family. All the adults refused NARCAN, and the 10-year-old daughter stated, You can give the NARCAN to me and I will use it if my daddy gets sick again at home.

That story reminds me of the nightmare African American children of parents with substance use disorders have been experiencing the past four decades. In 1986 there was a crack cocaine epidemic which intensified the War on Drugs. Some called it a war on African American men as so many were incarcerated and received felony convictions, in some instances for possessing minute amounts of cocaine. Thousands of African American children were now living with fathers behind bars. The next fastest growing population behind bars were African American women/mothers with substance use disorders.

In 1993 I had an African American client who was incarcerated at cook county jail for possession of a small amount of crack. She was pregnant and delivered her baby at Cook County hospital with her hands and feet shackled to the bed. Following the delivery, she was escorted back to jail by male guards, who incidentally were in her room during delivery. Her newborn was immediately taken by caseworkers into the child welfare/foster care system. I have spent 4 decades wondering about the impact of that delivery on the child. These draconian methods were repeated throughout the country. 

While advocacy measures were put in place to address the before mentioned disparities and practices, the needs of the children have primarily gone ignored.

This two-part blog series is written by Donald Gunther, a Certified Connecticut Community Addiction Recovery Coach Professional Facilitator and a Georgia Certified Mental Health Peer Specialist and Mark Sanders, Founder, Museum of African American Addictions, Treatment and Recovery. They both are adult children of fathers with substance use disorders. In part 1 they each share their story with the hope that readers will be inspired to facilitate their own healing and help African American children of parents with substance use disorders heal as well. Part II will include their recommendations to help African American children of parents with SUD thrive!

Donald's Story

My father was a War World II veteran who suffered from PTSD. His traumatic experiences would be the cause of our ACE’S. These adverse childhood events would teach us how to promote surviving in silence. Ironically, history reveals that in our early wars soldiers were given alcohol to cope with the trauma of war. Thus, my father returned home a hero with an alcohol use disorder. Thus, I am what is known as an ACOA, an adult child of an alcoholic. My father was a great man who raised ten children along with my mother. We were traumatized by my father’s trauma and alcoholism. My father had PTSD. I developed Complex Trauma (multiple layers of trauma), dealing with my father’s PTSD, addiction, and poverty, growing up in New York City with no hot water or bathtub, and no heat in the winter. Metaphorically, my silence would not be heard until five decades later when the consequences of being emotionally neglected became the root cause of my behavior and beliefs of myself. Silence would be the beginning of my underlying conditions (Codependency 101).

Mark's Story

Donald, I really relate to your childhood trauma. I feel like my four siblings, and I came out of a war too! My mother left my father when I was in third grade and that was traumatic! A year later she married my stepfather, who moved in with us from the battlefield, Stateville Penitentiary. We later learned that he was incarcerated for drug related crimes. He would beat our mother in front of us and my mother would beat us in front of each other. As war veterans described, we were walking on eggshells. It always felt like a bomb could explode at home at any moment. My mother took care of my stepfather. He ultimately died of an opioid overdose. I have carried the residue of that experience for decades.

The Good News!

The research says that 75% of children of parents with substance use disorders do quite well! The resilience which comes from being an ACOA can lead to great achievement. Presidents Ronald Reagan, Bill Clinton and Barack Obama are all ACOA's.

We both believe that growing up as COA's has contributed to our resilience and life purpose, to help individuals and families recover! In Donald's words, I am processing my pain, which has led me to my purpose.

Conclusion

While the majority of children of parents with substance use disorders do well in a racialized society, African American COA's disproportionately get expelled from school, attend alternative schools and wind up in the criminal justice system. In essence, their pain is more likely to be punished. It is our hope that you compassionately help these young people soar.

Native American Heritage Month: Great Lessons Taught About Recovery

November is National Native American Heritage Month. I have always felt a special kinship for Native Americans. As African Americans we share a similar history of historical trauma at the hands of Europeans who migrated to the new world. Both cultures are resilient. In this post I highlight some lessons learned from Native American Communities about recovery.

• The importance of massive group mobilization.  In order to heal historical trauma, which is a root cause of addiction, Dr. Maria Yellow Horse Brave Heart speaks of the importance of the entire community/tribe coming together and openly talking about what happened to us! This includes grieving together, crying together, mourning together. I have heard some Native Americans call Columbus Day and July 4th, national days of mourning. I foresee a day when entire African American communities have similar mobilizations in order to heal historical trauma.

• The importance of returning to culture. Historically, Native Americans had their culture taken away as a part of historical trauma. One way this was accomplished was by removing Native American Children from reservations and placing them in boarding schools. Trauma along with loss of culture contribute to high rates of substance use disorders. We are learning from the White Bison, Native American Wellbriety Movement that a return to culture can increase recovery rates. Increasingly, African Americans in recovery are taking journeys to Africa as a part of their own recovery and are returning to the United States and creating culturally specific recovery programs, based in African cultural rites of passages.

• Advocacy for reparation. In 1978 Native Americans took a case to the Supreme Court and the American Indian Freedom of Religious Act was passed. This law protected their rights to exercise tribal religions, possess sacred objects and the freedom to worship through traditional ceremonials and traditional rites. This success played a role in return to culture and eventual reparations received by Native American Tribes. Reparation can be used to protect culture and promote healing. One lesson I learned is how quietly Native Americans went about fighting for reparations. I think about this every time I see an African American Town Hall meeting featuring speakers such as Tavis Smiley, Dr. Cornell West, Jesse Jackson Sr etc. broadcasting to the whole world on television advocacy plans before executing the plans, while those who oppose the plan and those who will come up with schemes to block the plans are part of the listening audience.

Happy National Native American Heritage Month. Wishing you years of Wellbriety!

Intimate Partner Violence and Substance Use Disorders in African American Communities

I read last night that October is National Domestic Violence Awareness Month and went to sleep dreaming about the domestic violence my family endured when I was child. At age 8, I took a Greyhound bus with my mother to Stateville Penitentiary, located in Joliet, Illinois to meet my future stepfather who was incarcerated. When I met him, he extended his hand to shake my hand and stated, "Young man, when you shake a person’s hand, always look them in the eyes and offer a firm handshake.” He taught me something the first time I met him! Today, each time I shake someone's hand, including during job interviews, I follow the advice he gave me. I was eager for him to become my stepfather!

The first day my stepfather left prison, he moved in with us, I heard my mother scream about 5 am in the morning. My stepfather gave my mother a black eye because, "She had a job to go to and he didn't." She started her new job that day as a nurse, wearing sunglasses to hide the abuse. In the book, The Battered Woman Syndrome (2016), author Dr. Lenore Walker said that male domestic violence is not about anger. It is about sexism. Men who batter women tend to have a more traditional view of the role of men than their female partner in a relationship. He often tries to use physical force to "Beat her into traditional conformity." My mother had a job and my stepfather did not. In addition, her name was on the apartment lease and his name was not.

We soon discovered that our stepfather had a heroin addiction (opioid use disorder) and he left home frequently to chase his addiction. The battery towards my mother intensified in frequency and force. Substance use does not cause domestic violence, it can increase lethality (Walker, 2016).

There is no cultural group that has a monopoly on intimate partner violence. During this month I decided to come out of hiding and discuss some of the unique features of domestic violence in African American communities as I have witnessed firsthand and in my role as a clinician. Because of our history of police brutality, African American women who are victims of domestic violence might fear that if she reports her partner to the police, the police might kill him. This fear could intensify during this era of police killings of George Floyd, Breonna Taylor and other unarmed African Americans. Also, a cultural norm which has existed since slavery of "Not airing our dirty laundry in public," could also decrease the reporting of domestic violence in African American communities. As a matter of fact, I am nervous just writing this blog post. But I have too!

For African Americans who are LGBTQ, hesitance to report domestic violence could be connected to a fear of potential police brutality of the partner and the fear of the consequences of outing yourself to the police when you make the report.

For African American men, high unemployment, racism, and dehumanizing experiences such as stop and frisk, police brutality, poor to no community service, and being left to die by paramedics has played a role in undermining the sense of ‘manhood’ for African American men in a country that has historically defined manhood as being the head of household, bread winner etc. Prior to Dr. King being assassinated in Memphis Tennessee, striking African American sanitation workers were protesting unequal pay and poor working conditions in comparison to their white counterparts. These men held up signs which read, “I am a man too!” During the 1960's and 70's it was easier for African American women and children to receive public assistance if they were not married or there were no men living in the home. Public Aid workers routinely made impromptu visits to these homes to assure there were no men there. There are reports of African American men hiding in closets or leaving out of back doors when these workers arrived. This was also dehumanizing. Combining other risk factors for male perpetration of domestic violence such as experience corporal punishment as a child, witnessing domestic violence as a child, sexism, a narrow view of the role of men and women in relationships, juvenile arrests, hostility towards women etc., along with how racism and dehumanizing experiences can impact one’s feelings of manhood, is a potential recipe for domestic violence.

I did a presentation entitled, Boys in Crisis and I learned that women in every cultural group in America, have more college degrees than men in that same culture with the biggest gap being between African American men and women. College graduation increases wage earnings. In a sexist society, along with other risk factors, will this also contribute to intimate partner violence in African American communities?

In the meantime, author Jawanza Kunjufu offers the following suggestion. “The African American Community needs to define manhood more broadly than the size of your paycheck. Manhood can also include being kind and supportive of your partner, spending time with and nurturing of your children, being a positive influence in your community.” I had an African American male client who returned to drug use after he was fired from his job. He said to me, "I don't feel like a man, since I lost my job.” I thought of Jawanza Kunjufu's quote and reminded him that every day he got up at 3 am to drive his wife home, "To help assure her safety," then he would make it home to prepare breakfast for his daughters, take them to school, prepare dinner for them, help them with their homework, while looking for future employment at the same time. He smiled and said, “I am a man.” He discontinued his substance use.

The movie What's Love Got To Do With It depicted the domestic violence relationship with singing duet and married couple, Ike and Tina Turner. This led to discussions about domestic violence in African American communities and empowered many women to seek shelter from intimate partner violence. Domestic violence seems to run in families across generations. As far as I can tell, it is no longer as prevalent in my family as it once was. Interestingly enough, substance use disorders recovery in my family has increased.

Years ago, author Peter Bell stated that addictions is best treated, “When the cultural context in which it develops is taken into consideration.” Perhaps this is also true for intimate partner violence. Domestic violence specialists should learn about nuances unique to each cultural group served.

Hispanic Heritage Month!! Implications for Substance Use Disorders Treatment and Recovery

National Hispanic Heritage Month recently ended. It is a celebration of American citizens whose ancestors came from Mexico, the Caribbean, Central and South America. This is the only celebration that begins and ends in the middle of two months! The celebration begins September 15th as numerous Latin American Countries achieved independence on that date.

Hispanics have experienced a great deal of historical trauma both in the United States, the Caribbean Islands, Central and South America. There is a link between historical trauma and substance use disorders. We have learned from the Native American Wellbriety movement that cultural celebrations which increase cultural pride can be a substance use disorders protective factor and help increase recovery rates.

Hispanics are the fastest growing community in the United States. It is predicted that by the year 2050 they will be the largest cultural group in the country. As demographic shifts continue to occur, history reveals that we can expect an increase in racial tension leading to greater trauma and the potential for increased substance use.

Organizations such as Hispanic/Latino Behavioral Health Center of Excellence and the National Hispanic & Latino Mental Health Technology Transfer Center, are playing a major role in increasing culturally responsive and evidence based approaches for working with Hispanics with substance use disorders. We are also seeing an increase of Latino/Hispanic substance use disorders specialists in key leadership positions in the substance use disorders profession. This will help tremendously as well.

In the future there will need to be an increase in the number of bilingual/bicultural professionals who are able to serve Hispanic communities. Special emphasis will need to be placed upon substance use disorders prevention, treatment and recovery for recent migrants who have fled Central and South America escaping trauma.

Personally, I feel a special kinship with Latino/Hispanic Communities. When the Africans were brought to the ‘New World’ to be enslaved, millions were first brought to the Caribbean Island, Central and South America. They are our brethren! I also attended a high school in which 70% of my classmates were Latino/Hispanic and was able to witness the richness of the culture up close.

I hope you have enjoyed Hispanic Heritage Month.

Rest In Peace Wayne Williams!

I learned this week of the death of my longtime friend and colleague Wayne Williams. I have known Wayne for nearly two decades and our relationship started with my providing supervision for adolescent clients he counseled with substance use disorders. Wayne successfully worked with a range of clients in a variety of substance use disorders settings including: outpatient settings, detox facilities; methadone maintenance clinics and criminal justice settings. He was constantly seeking new knowledge and dedicated to the work. Rest in peace Wayne.

Integrating Spirituality and Counseling for African American Clients with Mental Illness and Substance Use Disorders, Part 2

By: Kisha Freed, Success Coach, Six Seconds Certified EI Practitioner/Assessor, Mindfulness Meditation Instructor        Mark Sanders, Licensed Clinical Social Worker, Certified Substance Use Disorders Counselor. Photo credit: Delmaine Donson

The first article of this series establishes the contextual framework that we build upon in this discussion—especially regarding the historical significance of spirituality for enslaved Africans in America, the cultural importance of community and spirituality for African Americans, and the effectiveness of spirituality as an instrument of self-connection for African Americans engaging in mental health and substance use recovery services.

In this installment, we explore various methods for integrating spirituality and counseling for African American clients in recovery and fostering a connection of trust and care in therapist-client relationships.

Kisha: Mark, you have a lot of first-hand experience with spiritually integrated therapy. What advice can you give to providers who are interested in offering spiritually integrated services for African American clients?

Mark: My approach to integrating spirituality and counseling begins by asking clients a series of questions so I can better understand their perspectives, their needs, and what's culturally or spiritually important to them:

1.    What are your sources of comfort, strength, peace, love, joy, and connection?

2.    What do you hold on to or what gives you strength during difficult times?

3.    When you experience racism, discrimination, or oppression as an African American, what sustains you and keeps you going?

4.    Do you believe there are differences between religion and spirituality? If yes, what are those differences?

5.    Are you a part of a religious or spiritual community?

6.    Did your parents follow any specific religion or spiritual belief system? If yes, what were their views? Do you believe their beliefs influenced their response to experiences of racism, oppression, and other life challenges?

7.    Have you kept the same religion or spiritual beliefs you were raised with (if any), adopted new beliefs, or integrated new beliefs with those you were taught as a child?

8.    Which aspects of your religion are helpful to you (if any)? Which do you find challenging or not so helpful (if any)?

9.    Have challenges caused by mental illness or substance use changed the manner or modality through which you express your spirituality? If yes, how?

10. Many African Americans celebrate and/or share their spirituality through artistic expression (e.g., music, poetry, painting, dancing, rap, drama, creative writing, etc.) How do you celebrate and/or share your spirituality (if at all)?

11. Are you interested in pursuing any creative expressions of spirituality and/or art therapy in your recovery?

12. As a counselor, is there anything I can do to help you access resources so you can stay connected with your spirituality and/or support a burgeoning sense of spiritually or artistic expression on your recovery journey?

Kisha: These are some powerful questions–they invite the client to review how the past has affected their present and they provide an opportunity for clients to openly discuss both secular and spiritual motivations within the scope of self-empowerment. This approach has been known to speed recovery by compounding clients' desires to address the problem. By using open-ended questions, you are creating a space for the client to exercise self-agency and get in touch with themselves as the author of their life. It might be a bit uncomfortable at first, but the discussion can help them ease into a mindset of personal responsibility.

How has integrating spirituality with counseling impacted your clients, and how has it changed your practice on a larger scale? Click here to continue reading.

Recent Surge in U.S. Drug Overdose Deaths Has Hit Black Men the Hardest

BY JOHN GRAMLICH

Nearly 92,000 Americans died of drug overdoses in 2020, marking a 30% increase from the year before, a 75% increase over five years and by far the highest annual total on record, according to the Centers for Disease Control and Prevention (CDC). Preliminary figures suggest that the 2021 death toll from overdoses may be even higher.

While overdose death rates have increased in every major demographic group in recent years, no group has seen a bigger increase than Black men. As a result, Black men have overtaken White men and are now on par with American Indian or Alaska Native men as the demographic groups most likely to die from overdoses.

There were 54.1 fatal drug overdoses for every 100,000 Black men in the United States in 2020. That was similar to the rate among American Indian or Alaska Native men (52.1 deaths per 100,000 people) and well above the rates among White men (44.2 per 100,000) and Hispanic men (27.3 per 100,000). The overdose death rate among men was lowest among Asians or Pacific Islanders (8.5 per 100,000).

As recently as 2015, Black men were considerably less likely than both White men and American Indian or Alaska Native men to die from drug overdoses. Since then, the death rate among Black men has more than tripled – rising 213% – while rates among men in every other major racial or ethnic group have increased at a slower pace. The death rate among White men, for example, rose 69% between 2015 and 2020.

As has long been the case, women in the U.S. are less likely than men to die from drug overdoses. But death rates have risen sharply among women, too, especially Black women. The overdose fatality rate among Black women rose 144% between 2015 and 2020, far outpacing the percentage increases among women in every other racial or ethnic group during the same period.

Despite the steep rise in the overdose death rate among Black women, American Indian or Alaska Native women continued to have the highest such rate in 2020, as has been the case for most of the past two decades. There were 32 overdose deaths for every 100,000 American Indian or Alaska Native women in 2020, compared with 21.3 deaths for every 100,000 White women and 18.8 deaths for every 100,000 Black women. Fatality rates were much lower among Hispanic women (7.5 per 100,000) and Asian or Pacific Islander women (2.7 per 100,000).

The racial groups in this analysis include people of one race, as well as those who are multiracial. All death rates are adjusted to account for age differences between U.S. demographic groups.

John Gramlich is an associate director at Pew Research Center.

Click here to continue reading.

Celebrating Dual Recovery in African American Communities

September is National Recovery month. In honor, there will be marches, parades and other celebrations of substance use disorders recovery. African Americans have caught the spark of recovery month and have joined the rest of the country in celebrating this sacred month. While research indicates that substance use disorders and mental illness overlap at the rate of 50-70%, little attention is paid to mental health recovery.

This post is meant to encourage African American communities to also celebrate mental health recovery. Because of historical trauma, as a community we have our fair share of PTSD, complex trauma, depression, anxiety disorder, and ADD. According to Dr. Joy Degruy, we also suffer from a condition she calls Post Traumatic Slavery Syndrome as a result of 400 years of historical trauma,

So let us march and celebrate mental health recovery in African American Communities! This visibility could help reduce the stigma of mental illness in African American communities. Once mobilized we could also form African American mental health advocacy movements. This movement could fight for treatment as an alternative to incarceration, Medicaid expansion, an increase in mental health services in African American communities, and the need for more African American mental health professionals.

Graduation: From Marijuana to Crack and Opioids

For years I specialized in working with African American adolescents who primarily smoked marijuana. Most began smoking marijuana between the ages of 11 to 13 and just about all made a declaration that marijuana was not addicting and that they would never use real addictive drugs like crack and heroin. When asked the reasons they would never use crack or heroin, they would say things like:

My aunt smoked crack and she sold her body for pennies to buy more crack

 or 

My uncle used heroin and overdosed in an alley with a needle in his arm.

Evidence indicates that in spite of the declaration of marijuana only, many of these youth will graduate to cocaine, opioids and other drugs as they age and as addiction progresses. Many of these youth begin experimenting with xanax, molly and other pills. When they turn 21, they celebrate adulthood by buying their own liquor, legally for the first time. As they enter emerging adulthood many will begin to add stimulants like cocaine, Oxycotin and heroin to their menu of drugs.

One study found that if an adolescent smokes marijuana for over 200 days in a year, they become more vulnerable to stimulant and opioid dependence. I have seen this in clinical practice and have talked with colleagues who have also witnessed this phenomenon.

For states which legalize marijuana, legalization begins at age 21. For teens who begin smoking marijuana before age 16 they become more vulnerable to mental health symptoms and a permanent drop in IQ caused by early marijuana use. In addition, many youth who start smoking marijuana at young ages do so to medicate childhood trauma and are at an increased risk of addiction. Many African American adolescents have said to me, “There is gun violence and gangs in my community. Of course I smoke marijuana to deal with that!”  Once the addiction process has set in, they become more vulnerable to cocaine and opioid dependence, in spite of the early declaration, “I'll never use those drugs!”

For African American adolescents, prevention of stimulant and opioid dependence can involve addressing marijuana use as early as possible including primary and secondary prevention. Early treatment for those whose marijuana use has been diagnosed as early stage dependence is also recommended. Addressing the trauma which often precedes substance use is of the upmost importance.

A Tribute to Roman Coronado-Bogdaniak, MD

by Mark Sanders, LCSW, CADC

Between the mid-1980's through the early 1990's Crack Cocaine hit General Motors Corporation in Detroit Michigan hard! Substance use disorders treatment facilities in Michigan were at capacity with GM employees and the overflow wound up in treatment centers throughout the country. This included Chicago where I worked as the gatekeeper for the General Motors Substance Abuse Program.

When a GM Employee was admitted into a substance use disorders treatment facility within a 40 mile radius of downtown Chicago, my job was to drive to the treatment center and do an assessment to determine the level of care and length of stay. Then treatment centers were mostly in suburban communities. The majority of the GM employees were African American men. Most often, the entire treatment team, the majority of other clients in treatment and the city where the treatment center was located were white. The GM employees were always happy and surprised to see me. Their eyes would light up like a Christmas tree when I appeared. I was often told by them that I was the only Black face they had seen since they entered treatment. One GM employee humorously told me, “Even the squirrels in this place and city are white." These employees spoke of feeling isolated while in treatment.

It became clear that most of the treatment facilities were not trained to provide culturally responsive treatment for African American nen. Wanting to be a part of the solution, in 1989 I started writing a handwritten book, which I titled, Treating the African American Male Substance Abuser. I completed the handwritten manuscript in 1991 and in that year, I met Roman Coronado-Bogdaniak. Dr. Coronado was the first Addictionologist I had ever met. He received his doctors degree (M.D.) at Warsaw Medical Academy in Poland in 1981 and his masters degree in Addictions Studies from Governors State University in 1985. Dr. Coronado spent his career teaching and writing about addictions treatment and recovery.

When I met Dr. Coronado-Bogdaniak I mentioned the book and he volunteered to edit it. As an amateur writer, I welcomed his edits! In his role as Director of the Addiction Counselor Training Program at Montay College in Chicago, he also sponsored the first trainings I ever did on Treating the African American Male Substance Abuser in his role at Montay College He coordinated and sponsored these trainings and the book wasn't even published yet! I am forever grateful that this doctor, who was of Polish heritage saw the importance of work which focused on African American males with substance use disorders and he put his talents behind support of the project.

After the book was edited, I was scared to publish it. I had never seen a book in my profession exclusively focused on counseling African American men and feared that publishing the book would be like ‘career suicide’. I feared that if the book were published, I might never be hired again, because of the stigma we face as Black men. 

My work with Dr. Coronado-Bogdaniak continued. I was approached by an agency called Travelers and Immigrants Aid, a program that worked with South East Asian and African Refugees, whose substance use was increasing when they migrated to the United States. They wanted me to educate the staff on how to address substance use with their clients. Dr. Coronado-Bogdaniak coordinated the program through Montay College and students were able to receive college credits. We established the first Southeast Asian and African Refugee Addiction Counselor Training Program in the world. Our students were from Laos, Cambodia, Vietnam and Ethiopia.

Dr. Coronando-Bogdaniak died a sudden death in the early 1990's. He was in his late 30's at the time of death. I attended his funeral and decided afterwards that life was too short to be afraid. A few months after his death I published, Treating the African American Male Substance Abuser. Since then I have given hundreds of speeches on counseling African Americans with substance use disorders, written additional books and articles on the subject and provided consultations to organizations wanting to provide culturally responsive services for African Americans seeking recovery. Today I offer a salute and heartfelt thank you to Dr. Roman Coronado-Bogdaniak, one of the first to believe in the importance of this work.

African American Married Couples in Recovery

An Interview With William S., one of the Co-Founders of Married Couples in Recovery

Historically, there is no precedent about how to have a successful marriage when both partners are in recovery. Neither the spouses of Bill W. or Doctor Bob, the co-founders of Alcoholics Anonymous were members of the AA fellowship. This is also true for Jimmy K., the founder of Narcotics Anonymous.

Whole person recovery is physical, emotional, mental and spiritual. Physical recovery often occurs first. You start to gain healthy weight, your skin starts to look better, your youthful vitality and your smile return. You look in the mirror and say to yourself, “I look good!” You go to a peer led recovery support group meeting and one of the other members of the group finds you attractive too! You start to date. A year later you decide you want to marry. Neither of you have practice of maintaining a marriage and recovery simultaneously. How do you do it?

Another common scenario is a couple who married when they were both were getting high. They enter early recovery and for the first time they try to make their marriage work without being under the anesthetic influence of drugs. They acknowledge not knowing how.

Interviewer: William S, what are the reasons you co-founded Married Couples in Recovery?

William S:     We were some of the biggest partiers in the world when we were getting high. In recovery, some of us still like to party, sober. I saw married  couples in recovery go to parties and some would spend the evening dancing with people at the party who were single and wouldn't interact or ignore their spouse all evening. Resentments would build. Some of us have had to learn how to communicate, negotiate and problem solve with our spouse drug free. How to be romantic, drug free. We saw a value in bringing married couples together to learn from each other how to  maintain a happy marriage in recovery. Interviewer:   Why African American Married Couples in Recovery? 

William S:      Many of us have never witnessed healthy marriages. In families, at the movies or TV. All of the marriages on reality TV are unhealthy. That includes what we see on the housewives of Atlanta and Potomac. I thought we could figure this out together in recovery. 

Interviewer:   What are some activities you engage in as a part of African American Married Couples in Recovery? 

William S:      We have hosted some meetings together as married couples. We also recognize the value and importance of attending separate recovery support group meetings. Some of us are members of 12 step fellowships and we have found that those principles could help us through some of the bumpy roads of marriage. We have also had married couple cookouts. We have had workshops for married couples preceded by a dance. It’s great to see married couples dance with their spouse! We have organized Married Couples Speak-athon meetings, where one married couple after another share their story including their challenges and victories as married couples in recovery. Our big event was always a formal married couples in recovery dinner-dance on Valentines Day. 

Interviewer:   Valentines Day! Frederick Douglass is the first prominent American recovering alcoholic. His birthday is thought to be February 14th, Valentines Day. Do you have a big wish for African American Married Couples in Recovery? 

William S:      When we have healthy relationships, the next generations, including our  children, grandchildren, nieces and nephews are the beneficiaries. That  makes all the work worth it.

 Interviewer:   Thank you William for this interview.

Thank you, John Pitts!!

By Mark Sanders, LCSW, CADC

In January of 1986 I applied and became an instructor of Addictions Studies at Harold Washington Community College, Chicago. My desire to teach was inspired by my frustration as a young drug counselor. I felt there were too many counselors doing too much talking and not enough listening to clients! I decided to try to change that by teaching a new generation of drug counselors.

I was hired quickly for one semester by the chair of the Addictions Study Department, Jeffrey Shore. Jeffrey told me that at the end of the semester he would do a classroom observation to decide if I would be asked to continue to teach at the college. 

The start of the observation was a nightmare. I had a student that was monopolizing the class while Jeffrey was observing. An African American student, John Pitts, who was older than me and wise, interrupted the monopolizer by asking me a question I could answer. I was back on track! I looked at John Pitts to say thank you non-verbally and he gave a wink. John Pitts saved my teaching career!

I continued to teach at Harold Washington College for 14 years and ended my college teaching career as an Addictions Studies educator at the University of Chicago. I have lectured all over the world and can trace every lecture (6 degrees) to the 14 years I taught at Harold Washington College. Thank you again, John Pitts! Without your fast thinking, much of what I accomplished might not have happened.

If there have been John Pitt's who have played an important role in your life and career, please let them know.

The Early Years of the HIV/Aid Epidemic: Lessons Learned Counseling Gay African American Men With HIV and Substance Use Disorders

As a therapist I counseled Gay African American Men living with HIV or Aids and substance use disorders. These were the early 1990's prior to effective medication for HIV and increased life expectancy. Many clinicians and clients back then viewed a HIV diagnosis as ‘an immediate death sentence’. This post reflects those early years.

The Impact of solid recovery prior to HIV diagnosis – The African American clients I worked with that had 2 or more years of recovery prior to their HIV diagnosis, were much more successful in maintaining their recovery compared to those little to no recovery prior to the HIV diagnosis. A lesson learned is how quality recovery can equip clients with tools to cope with life challenges. This can include: loss, divorce, evictions, and progressive medical diagnoses.

Resilience and empowerment – A well know African American HIV Case Manager, upon sharing news of a positive diagnosis with African American male clients would say to his clients, "You have survived being a Black man in America and homophobia. You'll handle this too.” Tennis star Arthur Ashe was diagnosed with Aids following a blood transfusion. Ash stated, "Living with Aids has not been the greatest challenge of my life. The greatest challenge has been being a Black man in America."

Purpose and desire to help the Black Community – In groups many of these men reported that they were living their life purpose for the first time in their life, after being diagnosed with HIV or Aids. Renowned psychiatrist and Holocaust survivor Victor Frankl said the most common source of life purpose is life pain. In group one client stated, “Because of internalized homophobia, I was a people pleaser my entire life. After being diagnosed I am living my life for the first time without being a people pleaser. My purpose is to be happy!" Another client stated, "The last 10 years I stole things and I sold my body to pay for drugs. Now I found my purpose. Every week I go to a different mid-week church service in a Black neighborhood, share my story and give the church a wakeup call. I tell them that members of their congregation and community they serve are possibly HIV positive and they needed to take off their blinders and do something." His testimony and advocacy led to the formation of several church based HIV Ministries.

Anchoring recovery in the natural environment – A young African American man in recovery had sex with a partner. After the partner shared a few weeks later that they were HIV positive, the young man took an HIV test. Back then one had to wait 30 days for HIV tests results. He stated, "The wait seemed like forever! While I waited, I had a conversation with God. I said to God, if you let this HIV test come back negative, I will commit my life to helping members of the community who are HIV positive.” His HIV test was negative. He started a non-profit program which provided support groups and advocacy in the African American community for individuals living with HIV and addiction.

Harm reduction – Harm reduction is quite popular today. Three decades ago outreach workers in African American communities promoted harm reduction through regular condom distribution. They would encourage members of the community who were not HIV positive to wear condoms to avoid HIV infection. If they were already HIV positive the outreach workers would encourage condom use to avoid reinfection and to avoid infecting others. They provided needle exchange activities to reduce HIV transmission for IV drug users and methadone maintenance as an alternative to heroin addiction. A well-known medical doctor was accused of genocide because of his promotion of methadone in Black communities. The doctor stated, "I now feel vindicated because I know my prescription of methadone helped prevent many cases of HIV because with methadone there is no risk of needle sharing.” At a conference an African American harm reductionist stated "Harm reduction is community determined. In my community harm reduction is about jobs. When unemployment is high, despair sets in. Heroin use increases and so does the spread of HIV."

Heathy Suspicion vs. paranoia – Many members of the African American community were suspicious about the HIV virus. Many believed that HIV was a ‘nan made virus’ created to eliminate the Black community and some feared taking HIV medication. They were accused of being paranoid by non-African Americans. This was discussed in a forum at an HIV conference and a Black psychologist weighed in. "What some people view as paranoia, in the black community is actually healthy suspicion. All you have to do is remember the Tuskegee experiment and you can see how some members of the black community would be suspicious of HIV and the medicine to treat it." A white male at the conference, who identified himself as a person living with Aids spoke next. While coughing he said, "When people in communities of color say the issues around HIV in their community are different, we need to believe them!" 

This was some of the most rewarding work of my life!

Recovery In African LGBTQ Communities

June is National Pride Month. In this post we highlight Marsha P. Johnson (1945-1992), a person in recovery, advocate and founding member of the Gay Liberation Front and co-founder of the group Street Transvestite Action Revolutionaries (S.T.A.R). 

Marsha is credited with playing an important role in the Stonewall Rebellion of 1969 by push back as the New York Police raided the Stonewall Inn, a popular Gay Bar in Greenwich Village. During the riots Marsha yelled, "I got my civil rights." The aftermath of this rebellion played a major role in the Gay Liberation Movement and the first Gay Pride Rally, which ultimately became an important international celebration during National Pride Month.  

African Americans seeking recovery who are LGBTQ face triple discrimination based in race, sexual orientation and having a substance use disorder. Your resilience is celebrated.

Happy Pride Month!

Culturally Responsive Treatment for African Americans With Substance Use Disorders

For years I have heard substance use disorders professionals discuss culturally sensitive, culturally specific, afro-centric, African centered treatment for African Americans with substance use disorders. When I hear them describe their ‘Afro-Centric Program’ it is often, business as usual. In this post I will share my view of components of a program that is culturally responsive to the treatment needs of African Americans Seeking Treatment.

The Program Creates a Welcoming Environment. This can include warm and sincere greetings, pictures on the wall and magazines in the waiting room which reflect African American culture, a tour of the facility and positive service from the intake specialist. This says to African American clients, you are welcome here!

African American Staff. While I am not suggesting that all the staff need to be African American, research indicates that when African American clients work with African American counselors trust is developed quicker, the clients feel less of a need to code switch, that is, changing their dialect or style of speech to make the counselor comfortable. They also stay in treatment longer when working with Black counselors and they make more progress. The organization should strive for inclusion at all levels of the organization. When race determines who gets promoted, turnover among African American staff is the likely outcome. When that occurs, African American clients suffer.

Materials Which Reflect African American Culture. It is important that reading materials, audiovisual materials reflect the experiences of African Americans seeking recovery so that they can see themselves in the material.

Respect For the Diversity of African American Culture. In the book, Disintegration: The Splintering of Black America, Pulitzer Prize writer Eugene Robinson describes 5 sub-groups in the Black Community. The groups include: The Culturally Elite, which is the rich and influential such as Oprah Winfrey, Michelle and Barack Obama, Biillionaire Robert Johnson etc; The Bi-racial group, including individuals such as Halle Berry, Don Lemon, Tiger Woods, Naomi Osaka, Barack Obama; The Middle Class, which is the majority of African Americans; The Emergent, recent immigrants from Africa and the Caribbean Islands; The abandoned, 25% of African Americans who live in generational poverty. It is clear that there are cultural differences between each sub-group, therefore, a one size fits all treatment plan for African Americans would be ineffective.

Holiday Celebrations. Treatment centers often celebrate holidays. Consider adding Frederick Douglass Day to the list of celebrations. According to historian William White, MA, Frederick Douglass was the first prominent American Recovering Alcoholic. Another Holiday to consider is Malcolm X Day. In recovery, Malcolm was an advocate for millions. Another holiday to consider is the annual Afeni Shakur day. She was the mother of rap star Tupac Shakur. At the time of her death she was in long term recovery and founded the Tupac Shakur Center for Performing Arts. These holidays could be celebrated on the birthday of these 3 great recovery pioneers. These celebrations could send the message to African American clients that they are important and provide drug free celebrations for them post discharge from treatment.

Family Involvement. In African American culture the extended family is the primary unit. Efforts should go into assertive outreach by staff to involve the family in treatment.

Trauma Informed Care. Trauma is at the care for many clients with substance use disorders, including African American clients. For African American clients, this trauma often includes dehumanizing experiences such as: police stop and frisk, police brutality, police arrests, jail and prison, trauma, the trauma of shopping and eating in restaurants while Black. Trauma also includes community and family violence. Programs striving to be culturally responsive to the needs of African Americans seeking recovery should provide training on the organizational level on how to become a trauma informed system of care and provide training for front line staff on unique trauma experienced by African Americans and how to address that trauma and retraumatizing them while in treatment.

Continuous Care. We often use the term aftercare, but often aftercare is an afterthought. Continuous care often involves creating a plan to help support the recovery of African American clients post discharge from a current level of care. Continuous care planning can involve making referrals to mutual aid groups with reputations of being African American friendly and helpful. It is important to be aware of the community African American clients are returning to and discover in discussion with the client community factors which help support recovery and community factors which put the client at risk for relapse. Protective factors can include: a family that is supportive of recovery, jobs, prosocial recovery support groups, recovery coaches indigenous to the community. Risk factors include: easy access to drugs; the absence of drugs, a non-supportive family and the absence of mutual aid groups which support recovery

Continuous care planning can involve a plan to connect with the protective factors and avoid the risk factors. It is important to remember that African American clients have different stressors. Stress for those working in corporate America can include dealing with micro-aggressions, micro-insults and micro-invalidations. Those living in economically poor communities might have to deal with community violence which could trigger traumatic stress disorders. Others might be dealing with racial identity issues in recovery as First Lady Michelle Obama stated, My husband Barack Obama was too Black for some people and too white for others.

Conclusion. This writing was meant to be a start. Not a complete blueprint on how to provide culturally responsive services for African Americans seeking treatment and recovery. To learn more, click here  http://www.museumofafricanamericanaddictionsrecovery.org/webain

Letter To My Father

May 29, 2023

Mark Sanders, LCSW, CADC

May 29, 1986 I was giving a speech. Within the first 5 minutes of the speech I received an urgent phone call that my dad died at work while smoking crack cocaine. This is the 37th year Anniversary of his death. Two weeks after my fathers death college All American Basketball player LenBias died while snorting cocaine in celebration of his being drafted number one by the Boston Celtics. Following Bias's death, Congress intensified the war on drugs and the U.S. prison population increased from 400 thousand inmates in 1985 to 2.5 million in 2005. Disproportinately African American men with substance use disorders.

Dad, I spent the next 3 decades, speaking, advocating, writing books and articles on substance use disorders treatment and recovery for African Americans in honor of you. All of the speeches and materials I collected, culminated in the creation of this online museum. This year the Museum of African American Addictions, Treatment and Recovery was honored with the 2023 Faces And Voices of Recovery, Innovations In Recovery Award. I dedicate this award to you! Your son

Mark

Integrating Spirituality and Counseling with African American Clients With Mental Illness and Substance Use Disorders, Part 1

By: Kisha Freed and Mark Sanders

Publication Date: May 19, 2023

This post, the first in a three-part series, shares perspectives from Kisha Freed, a Success Coach, Six Seconds Certified EI Practitioner/Assessor, and mindfulness meditation teacher, and Mark Sanders, Licensed Clinical Social Worker and Certified Substance Use Disorders Counselor.

Over the years, counseling has addressed mind and body. There has been some apprehension about the effectiveness of integrating spirituality into counseling practice. However, in Does Spirituality Still Have Relevance For Recovery?, licensed professional counselor James E Campbell mentions that “interest in the spiritual implications of substance use, treatment, and recovery appears to be gaining momentum once again.”

In his article Integrating Spirituality in Counseling Practice, author Gerald Corey indicates “There is growing empirical evidence that our spiritual values and behaviors can promote physical and psychological well-being. Exploring these values with clients can be integrated with other therapeutic tools to enhance the therapy process.”

While continuing research studies are underway to identify the beneficial effects of spirituality in mental health and SUD practices, a 2009 survey conducted by the California Mental Health & Spirituality Initiative revealed that 88% of African Americans agree that their faith is an important factor for their personal and family’s well-being.

In this three-part series, we explore some implications of integrating spirituality and counseling with African American clients with mental illness and substance use disorders. We hope that mental health and addiction recovery counselors will find that integrating spirituality into their practice can help them to increase connection, foster a safe space for belonging, and promote quicker recovery for their clients.

In Part 1, we build a foundation for the overall discussion by defining spirituality, discussing the differences between spirituality and religion, and, lastly, the importance of spirituality for present-day African Americans within the context of past oppression and survival. In parts 2 and 3, we will discuss the integration of spirituality and counseling, how to conduct a spiritual assessment, and varieties of spiritual interventions that can be helpful when counseling African Americans with mental health and SUD.

Click here to continue reading.

Black, Hispanic Patients Receive MOUD After Opioid-Related Events Less Frequently Than White Patients

Tom Valentino, Digital Managing Editor

05/16/2023

Despite making a similar number of visits to healthcare providers in the 6 months following an opioid-related event, White patients receive medication for opioid use disorder (OUD) up to 80% more frequently than Black patients and up to 25% more frequently than Hispanic patients, according to a recent study by researchers at Harvard T.H. Chan School of Public Health and Dartmouth College.

Findings from the study were published in the New England Journal of Medicine.

Researchers reviewed a random sample of Medicare fee-for-service beneficiaries with disability—a group of Americans who are among the most affected by OUD—who experienced at least 1 acute OUD-related event, such as overdose, infection, or detox admission, between 2016 and 2019. Among the Medicare claims reviewed, researchers identified 25,904 OUD-related events—15.2% of which occurred among Black patients, 8.1% among Hispanic patients, and 76.7% among White patients.

In the 6 months following OUD-related events, Black patients received and filled a prescription for buprenorphine 12.7% of the time. For Hispanic patients, the rate was 18.7%, and among White patients, the rate was 23.3%. Rates for naloxone, the opioid overdose reversal medication, were similar: 14.4% for Black patients, 20.7% for Hispanic patients, and 22.9% for White patients.

In a news release announcing the findings, study lead author Michael Barnett, associate professor of health policy and management at Harvard Chan School, noted that opioid overdoses have been rising more quickly among Black individuals than any other racial group, surpassing overdose rates in the White population for the first time in decades in 2021. Overdose rates in the Hispanic population are up 40% recently, he added.

 “We need to understand barriers to obtaining life-saving addiction treatment for minority populations to address this huge demographic shift and public health crisis,” Barnett said in the release.

 Prescriptions for opioid analgesics and benzodiazepines, meanwhile, were received and filled frequently. Regardless of race, prescriptions for opioid analgesics were received and filled 23% of the time after OUD-related events. Benzodiazepine prescriptions were received and filled by Black patients 23.4% of the time, 29.6% by Hispanic patients, and 37.1% by White patients.

“Skyrocketing rates of overdoses in minority groups are unlikely to shift without a major overhaul in the addiction treatment system,” Barnett said. “Addressing the overdose crisis and racial disparities in addiction will likely require community-specific interventions that engage with minority populations and the clinicians who serve them to reduce stigma and bolster trust.”

Reference

Substantial racial inequalities despite frequent health care contact found in treatment for opioid use disorder. News release. Harvard University T.H. Chan School of Public Health. May 10, 2023. Accessed May 16, 2023.

https://www.hmpgloballearningnetwork.com/site/ap/news/black-hispanic-patients-receive-moud-after-opioid-related-events-less-frequently-white

Community Mobilization is No Guarantee of Long Term Success in Movements to Address Addictions Treatment and Recovery in African American Communities: Lessons From the Civil Rights Era and Other Ideas

Never in history have more groups come together to address substance use disorders treatment and recovery in African American Communities like we are seeing today. This mobilization could be inspired by the Black Lives Matter Movement and the murder of George Floyd by a Minneapolis, MN. police officer. Communities are now motivated to address addiction in Black Communities comprised of individuals in recovery, allies, Ph.D.’s, MD's, researchers, university educators, frontline clinicians, writers etc. In essence, because of this commitment and talent pool we are in position to do a work which can have a lasting impact as it pertains to treatment and recovery in Black Communities. A review of the past 60 years suggests that this great impact should not automatically be assumed. History reveals that each decade a crisis occurs, the community responds, and when the crisis decreases in intensity the work stops. Usually with no blueprint for the next generation to follow to continue the work beyond the crisis. Here are some examples.

1960's Heroin crisis in Black Communities. Groups such as The Black Panthers and Nation of Islam called addiction a form of genocide in the Black Community and advocated nonuse as a form of protest. 

1970's Alcoholism seen as a major problem throughout the country. A profession was born to certify addictions professionals nationwide. The National Black Alcoholism Council (NBAC) was formed to help African Americans to become certified addictions professionals and to advocate for Black people with alcoholism.

1980's, 90's, 2000's Peter Bell begins writing on Counseling The Black Alcoholic. The Crack Cocaine crisis occurred. Len Bias died snorting cocaine; congress intensified President Nixon's War on Drugs. African American men became the most imprisoned group on planet earth and thousands of African American women had their new born and older children taken away because of the stigma of addiction. Advocacy started occurring across the country, second chance legislation was passed. Black churches across all denominations formed church based drug ministries in response to the crisis. An incredible movement which fell apart primarily because of denominational differences. Recovery homes owned by African Americans were opened throughout the country. Visionary leaders such as Joe Powell, Andre Johnson, Anita Bradley, Dora Wright were a part of the RCSP and RCO movement.

Today Comprehensively, a group of talented professionals have come together to address substance use disorders in African American Communities. While the groups today represent, in my opinion the most talented group ever assembled to address the issue, there are several things that are important to help assure a lasting impact. These are suggestions for us to consider.

Always prepare the next generation to continue the work. In the before mentioned movements the leaders died or the crisis subsided and the movement stopped. This pattern can also be seen in our civil rights movements. Death and retirement can halt movements for years.

 We should put as much of the work as possible in writing which leaves a blueprint for the next generation.

As soon as we are ready, come together  as organizations to assure comprehensive planning. Our history reveals that fractions within ranks usually stop our movements. We can apply what we have learned from civil rights and other movements to this work.

Create a 20 year vision. Thinking about and planning for the future and what it will take to get there can help propel us to have a lasting impact.

Addressing Alcohol Use Disorder in African American Youth

Addiction comes in many forms and does not discriminate. However, it’s important to understand its impact on specific populations to develop more targeted and effective strategies aimed at improving health equity. In honor of Black History Month, we will explore alcohol use disorder (AUD) and its impact on African American (AA) youth. We will also discuss the role of research in achieving more equitable health outcomes.

Across the U.S., underage drinking is a serious public health concern. Alcohol remains the most, and often, first substance used among youth. In 2021, nearly 6 million people aged 12 to 20 reported drinking alcohol. Among those, more than half (3.2 million) reported binge alcohol use (SAMHSA, 2023). An estimated 29.5 million people aged 12 and older were diagnosed with an AUD in 2021 including 900,000 youth aged 12-17 (SAMHSA, 2021). Nearly 5% of those youth identified as Black or AA and 3% identified as two or more races (SAMHSA, 2021).

Understanding the development of alcohol behaviors is important to understanding why some adolescents drink. First, alcohol-related cognitions, known as alcohol expectancies (AE), develop as early as age 4 (Smit, et al, 2018). AE significantly influences drinking behaviors. A positive AE is the belief that alcohol leads to more pleasurable outcomes (e.g., being more social) and is associated with increased drinking. In contrast, a negative AE is the belief that alcohol leads to undesirable outcomes (e.g., feeling ill) and is associated with less drinking (Smit, et al, 2018). 

Longitudinal examination of AE and alcohol use outcomes show that AA youth aged 7-10 reported higher positive AE compared to White youth (Banks, et al, 2020). Despite higher positive AE in AA youth, White youth were more likely to use alcohol, suggesting positive AE posed lower drinking risk for AA youth (Banks, et al, 2020). However, even though AAs report later alcohol initiation and lower rates of use, they still have more significant alcohol-related problems compared to Whites. Unfortunately, the lack of diversity in most studies makes it difficult to understand why the relationship between AE, alcohol use, and its consequences differ among racial and ethnic groups. Click here to continue reading.