Ending the Shame: Why the Opioid Crisis demands a new approach to parenting

by Harry Nelson

Reading through the various responses to the opioid crisis, you won’t find much if anything about parenting. One of the simultaneously most depressing and urgent items of the 2017 Opioid Commission Report was the data on kids as young as 6th, 7th, and 8th grade being at risk, and the need to focus more attention on younger children to help prevent addiction and address kids already engaged in at-risk behavior.

Even though health data has highlighted a rising level risk of opioid use in the very young -- kids in middle school as young as 6th grade – there has been little attention to what parents can do about it. The government report talk about prevention efforts, including “SBIRT,” which stands for Screening, Brief Intervention, and Referral to Treatment, in schools, from middle school to high school to college, but nothing about parenting skills, approaches, and lessons for the home.

Personally, the question of what parents can do is a central part of my decision to write The United States of Opioids: A Prescription for Liberating a Nation in Pain. My conversations leading up to the book kept coming back to the question of what we can do for our kids. I talked to grieving parents like, Sheila Scott, who lost her son, Luke, to a heroin overdose. I talked to one close friend after another who had felt powerless, watching their kids go through years of cycling between addiction, recovery, and relapse, who just prayed their kids would stay alive. I came away from these conversations searching my own relationships with my children, and convinced that the answer to the opioid crisis lies not in schools screening children, but in our homes and our relationships with our children and families.

Why does home matter? The opioid crisis represents a series of complex, interwoven challenges: an exponentially rising overdose death toll, some accidental and some intentional. Rising epidemics of chronic pain and addiction. And an underlying uptick in rates of suicides, anxiety, chronic stress, trauma. These are issues that manifest early in life for many people. And there is no more important question for parents to ask than what we can do about it.

A New Attention to Eradicating the Shame in the Name of Open Conversation

One story that I share in The United States of Opioids is that of Lauren, an upper-middle-class teen who at 13 began a common progression. It began with stealing adults’ drinks off of tables at bar mitzvah parties. She then progressed to smoking marijuana after school. Before her 14th birthday, she was stealing Vicodin and Percocet leftover from prescriptions from her parents’ medicine chest. As those supplies dwindled, Lauren was stealing money from her parents to buy drugs from kids at school.

Lauren’s mom shared with me that it took her years to realize that what was really going on was that her daughter was experiencing profound anxiety socially, and turning to substance use as a way to self-medicate -- to numb herself against the pain she felt. The problem is that this insight was only clear in hindsight. Like so many children, Lauren had internalized a deep sense of shame about her anxiety that led her to mask it and keep it far away from her parents. Lauren’s own form of self-protection was to suppress the anxiety. Alcohol and then drugs became an attractive way to deal with it, without the pain or shame of a conversation she was not prepared to have.

While not every child takes the same pathway to drug use, the role of shame in preventing conversations that could have addressed issues came up constantly in my research. Children experience other negative emotions that serve some positive purpose: Fear, within reason, keeps us alert to dangers. Anger pushes us to demand fair treatment. Loneliness drives us to seek connection. But shame serves so beneficial purpose. It is a toxic ingredient in our belief systems, thoughts, and feelings. It makes us want to hide, disappear, and, in the worst cases, not exist.

Children learn shame early on, as parents and society conveys a set of expectations about what is and is not safe to express. We experience it by disappointing parents and other adults. We feel judged by other people, and we disappoint ourselves by not fitting in. We blame ourselves for not living up to other people’s expectations. We are self-conscious, plagued with insecurity.

In the course of thinking about shame as a trigger, I became much more self-aware of the extent to which I implicitly convey disappointment – and shame – in my communication with my children (and many other people in my life). I feel let down, and then pass that feeling on to my kids or colleagues as shame.

We need to eradicate the shame, because it gets in the way of real communication. A person who feels ashamed is not likely to want to talk about the source of the shame. And so a child plagued with insecurities and anxiety holds it in, making substance use a more likely outlet. If our children know that we love them and do not judge them, no matter what they say, the chances that they will talk to us about what’s really going on -- long before drug use comes into their awareness as an alternative source of relief – go up dramatically. Getting rid of the unspoken, pervasive shame is the first step towards protecting our children from the opioid crisis.

There is much more to say about how to eradicate the shame, and about how we can parent differently. It starts with becoming self-aware of when we are conveying unspoken messages of judgment and criticism. Sometimes praise can have a dark side of implicit criticism; when we tell our kids they are smart after getting a good grade (rather than praising their effort), we also convey an expectation and set them up for disappointing us in the future. We need to learn a different language. The payoff for doing so will be kids who feel safe talking with parents about what’s really going on in their lives.

For more ideas about how learning new parenting skills can be part of keeping kids safe and tackling the opioid crisis, order a copy of my book, The United States of Opioids: A Prescription for Liberating a Nation in Pain. Together, we can become a nation of parents who are effective agents of prevention and intervention in our own families and the lives of everyone around us.

Harry Nelson is the author of The United States of Opioids: A Prescription for Liberating a Nation in Pain, published by Forbes with a Foreword by Lisa Marie Presley. The book shares the lessons of Harry’s deep dive into opioid crisis response, and lays out an essential understanding of the interwoven crises of pain, addiction, and overdose deaths – and the first comprehensive plan for addressing the crisis at a grassroots level.