Substance Abuse, Mental Illness, and Access to Care in Rural America
Getting adequate health care can be a challenge in rural America, particularly when addiction treatment and rehabilitation services are needed.
It is very common for people who struggle with psychiatric or substance use disorders to have difficulty trusting themselves and others during the recovery process. First of all, this may be the result of situations in the past which involved unhealthy family systems and sexual abuse. Many people were raised in families where trust was broken or where it was not even safe to trust others. A large percentage of men and women in treatment experienced childhood sexual abuse. A person who has experienced violations, abandonment, and assault will naturally develop defenses against the world and in relationships. These defense patterns can lead to a lack of trust and prevent the intimacy with others that the person desires or even craves. A person may feel unworthy of developing trusting relationships because they mistakenly feel they are not “good” enough to be protected against violence, abuse, or neglect.
Secondly, the lack of trust may burden someone who has kept family secrets. In families where addiction or psychiatric disorders are hidden, children may be told their feelings, thoughts, beliefs, and even what they’ve seen and heard are not true or real. This can have long-term effects on how a person relates to others. They may begin to place more importance on the beliefs of others because they start to believe their own perceptions of reality are flawed. It is very difficult to trust others when you do not trust yourself. When the people closest to you are not honest, you may become distrustful of most in your life. The process of losing control of an addiction will involve breaking promises, despite a sincere desire to get sober. This is not the same as deliberately lying. It is a part of the distorted thinking caused by alcohol and drug abuse.
Lastly, a pattern of untrustworthy behaviors and unhealthy relationships contribute to lack of trust in oneself. Alcohol and drug abuse often cause behaviors which are less than trustworthy. In a relationship where alcohol and drugs are at the center, trust is not possible or a high priority. A lack of trust is a product of the addictive process. Until a person realizes that substances create an atmosphere of distrust, suspicion, and paranoia, they will feel that no one can be trusted.
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When people are unwilling to share themselves, they make it hard for others to care about them and share with them. Developing trust in yourself and in others takes time and practice through gradual self-disclosure. Self-disclosure is not just providing information to another person, but sharing information with others that they would not normally know or discover. Self-disclosure also involves risk and vulnerability on the part of the person sharing the information.
So, self-disclosure is not letting it all hang out, revealing one’s innermost secrets and digging into one’s past, or sharing every fleeting reaction toward others and telling stories about oneself that have no meaning to other group members. Rather, self-disclosure is revealing oneself to others, revealing thoughts, feelings, and reactions to what is happening in a therapy or group setting, and revealing current struggles, personal issues, goals, moments of joy, strengths, weakness, and the meaning of certain personal experiences.
Even though people in recovery may be comfortable with trust and disclosing information, they may not be willing to invite feedback. They may just want to vent. Many people talk about things as a way of working through them. By asking for and receiving supportive feedback from others, a person can then test the reality of who they are, see more clearly how they appear to others, and grow as a person.
Helpful feedback is not given if it is not requested, if it can’t be accepted, if it isn’t usable, and if it isn’t likely to result in a person feeling better about themselves. Also, feedback is not deliberately hurtful or indirect. If it is, this says more about the person who gives the feedback than the person who receives it. Feedback is really about focusing on people’s strengths, not their faults. When giving feedback, it is important to avoid psychologizing, making assumptions, and judging intentions, actions, or behaviors of other people. Feedback needs to be non-threatening because critical feedback can intentionally or unintentionally hurt others, causing an even greater lack of trust in recovery.
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