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[ Opinion ]

Death over sobriety: treating depression and addiction 

Sam first admitted into drug and alcohol treatment after her involuntary hospitalization release.

This had been her second suicide attempt in less than a month. Her method to die had been brutal, with premeditated and scientific precision.

Her making it out alive, despite all the intentional efforts to end it all, felt like a strange joke- a loophole that wasn’t supposed to happen.

In our first session, she acknowledged that she still wanted to be dead.

She also told me that if she needed to be alive, she definitely did not want to be sober.

Sam was nineteen with a constellation of cuts and scars up and down her body. She was nineteen with enough traumatic material that, if written down, could fill an entire bookshelf. She was nineteen and devoid of any youth, of any vitality, pleasure, or motivation.

At that point, Sam was maybe the most depressed client I had ever worked with.

Her attitude surrounding drug use and lifestyle was lax and haphazard. It was just alcohol and marijuana and Xanax. Oh, and lots and lots of acid. Sam took whatever substance was in front of her. Drug of choice? I don’t discriminate– that’s what she told me. Whatever is around is fine. 

At that point, her parents had already thrown all her clothes on the front lawn and changed the door locks. They had tried all the psychiatrists and therapists, all the medications and holistic methods. None of it had worked- not as well as the drugs, anyway. They cut off money, threatened to remove her from the family will. They felt helpless and distraught, unsure how to help their daughter’s unstable mental state and progressive drug use.

This was their angle on tough love, their necessary approach to boundaries.

Her family’s efforts intensified feelings of shame of guilt. Though Sam felt tormented by life, she could experience love. She could experience gratitude. She had so much love, for other people and for the world at large. She just didn’t know how to absorb it back. Nor did she know how to give it to herself.

If she couldn’t die, she wanted to return home. That was the compromise. She wanted to rebuild some kind of harmony or connection with her family. She loved them, completely, but how can you love others when you feel so disconnected from yourself? 

Sam was entwined with depression, but she was not depression itself. This was the crux of therapy- at least according to me. We had to prove that her identity- as the fragmented and hollow victim- had the capacity to change. I told her that, rather than just accept and take in the depression at face value, we could work together to find any light underneath the darkness. I asked her if she was willing to try this abstract experiment. 

In many ways, agreeing to this commitment to see herself with a new identity would surpass the commitment to sobriety. After all, it’s hard to be sober when you don’t want to be alive, and it’s even harder to be sober when you actively want to end your life.

This was a girl who romanticized suicide like an unrequited lover, like it was a tall, dark, handsome man just waiting to rescue her from the sorrows of her existence.

My goal was for her to glamorize life as much as she glamorized death. 

These were lofty goals, but she told me she was willing to try. 

We started with a bucket list. Yes, the cheesy and ridiculous bucket lists sprawled with skydiving and bungee jumping and African safaris. She looked at me like I was crazy- and I oftentimes am- but she began brainstorming. She started identifying places she wanted to visit and experiences she wanted to have. She started labeling things that gave her even the tiniest twinge of excitement. It was corny, but it was necessary.

We also challenged her depression. A lot. We gave it a name and voice, and we argued with it, like it was this enemy, like it was every bully she had ever encountered wrapped into one dreadful voice. We talked around her depression and about her depression and to her depression- I continued to emphasize that depression was part of her, just as drug use was part of her, but it only could define her identity as much as she allowed it.

She practiced accepting her mental state, including her depression, as an old and gentle friend, as someone who protected her when life felt unbearable. After all, for so long, it had felt safer to fantasize being dead than contemplate the ambiguity of being alive.

The more she began accepting exactly where she was- and who she was- the more the depression lifted. And, as her depression lifted, the more she realized how problematic the drug use really was. 

I don’t chalk this work up to anything miraculous. I don’t think I particularly performed any brilliant therapy work. Most of my sessions were devoted in getting her to laugh or just think a bit differently about her perspective on life. When I think about what worked, I think about the acceptance I had for this struggling, vulnerable girl. I think about how, even though it seemed like the world had already disregarded her, I held onto a ripped shred of hope.

Ever heard the phrase, fake it until you make it? Sam was the poster child. She didn’t want to be sober. She didn’t want to be alive. By all means, she was half-involved, half-trying, and even half-caring.

AA warns, half measures availed us nothing. And, maybe this is true. And, when I look back on her, I wonder, was it a half measure? Was she different? Or, was she more willing than anyone- including herself- really gave her credit for? 

Was it because this recovery process is less about where you start and more about how you finish? Was it because we really don’t even know what whole measure means? And, I mean, really, really means? 

Regardless of the reasons and philosophies, today she’s still sober and she’s very much alive. She’s back in school, and she’s thinking of becoming a therapist or counselor herself. Suicide is no longer an option, and numbing herself out with a cocktail of substances is off the table as well.

She doesn’t completely glamorize life- not yet, anyway- but she’s still adding items to her bucket list. 

*While these are based on true experiences, all reasonable efforts have been made by this writer to protect utmost client and treatment confidentiality. Because of this, names, ages, features, and identifying details in this piece have been changed, omitted, and/or embellished.