The holiday season brings additional stresses for people in recovery and living with substance use disorder

But help is available around the state from several healthcare organizations

WARWICK – For Tammy Kruwell, the turn toward recovery from her opioid use disorder came a few years ago after she had gone from “popping pills” to injecting heroin. Kruwell had worked many years in the adult entertainment business and in the end, heroin controlled her life, she told Ocean State Stories in a recent interview.

“I taught myself how to shoot,” she said. “It was cheaper and I was just functioning. I would just go to my dealer, get what I needed for the day, go do my thing, go to work at the club, dance all day, make money, go meet my dealer to get it again, and then not even eat. And then I’d get up in the morning. It was just this every day.”

Tammy Kruwell – G. Wayne Miller / Ocean State Stories

By 2011, she said, “I was at the point where I just didn’t want to live anymore. I had enough. I didn’t want to dance anymore. I don’t want to talk to the men anymore. I just lost myself. So I made a phone call and it was to CODAC,” the behavioral healthcare organization that has offices and programs throughout Rhode Island.

“They set me up with an appointment,” Kruwell said. “They got me in, put me up with a psychiatrist and a therapist and a Suboxone doctor,” a specialist qualified to administer buprenorphine and naloxone, a medication assisted therapy that treats addiction.

Kruwell has maintained her recovery ever since.

After having been trained three years ago as a recovery specialist, Kruwell today works for Parent Support Network of Rhode Island, where she assists women with challenges like those she has faced.

And it is through that work and her own experiences that she understands how difficult this time of year can be for many people – this holiday season with its memories, good and bad, and its sentimental movies and music, “the most wonderful time of the year,” as the iconic Andy Williams tune proclaims.

“It’s so hard,” Kruwell said. “A lot of families don’t understand addiction or recovery. And there are so many people that don’t have family.”

Some, according to Kruwell, have lost hope.

“I see the sadness in their eyes,” she said.

Linda E. Hurley, president and CEO of CODAC, knows well what Kruwell describes.

“The holidays actually create stress for most people, regardless of mental health or substance use disorder [SUD] issues,” she told Ocean State Stories. “Having a history of those issues, however, magnifies the pressures. Much of that is due to the associated financial challenges related to gift-giving and travel costs, even food security can become and is often an issue for those who have been dealing with SUD chronically.

Linda Hurley – Submitted photo

“More importantly, there are the social and emotional stressors resultant of damaged relationships. For instance, parents whose custodial rights have been terminated, or whose visitation schedules have been inconsistent, or whose children choose not to see them.”

The stigma and misunderstanding often associated with substance use disorders, according to Hurley, can further burden individuals living with them.

“Often the shame that has been internalized causes individuals with this disease to isolate,” she said. “Many times, they believe that their family and friends think less of them so they don’t want to face that at holiday gatherings and may even choose to remain alone. So, for instance, as they are watching television shows with happy families celebrating together, they are isolated. The icing on the cake is that we know isolation leads to depression and can lead to substance use, overdose, suicide ideation, and even suicide and/or overdose death.”

To learn about CODAC’s many programs and services, visit https://codacinc.org/

Like Kruwell and Hurley, Benedict F. Lessing, Jr., President and CEO of Community Care Alliance, is acutely aware of the impact of the season.

“The holidays may be particularly stressful for people in recovery as the season brings with it financial stress and expectations to spend at a higher rate than one is earning for children and other loved ones,” he said.

“It is also a time when the loss of previous relationships may be exacerbated and even enhanced by loneliness if the person in recovery does not have a solid or consistent support system. If individuals are continuing to use substances and are facing homelessness, eviction, etc., an increase in the use of drugs and/or alcohol may be a means of dulling the pain of circumstances that may otherwise be intolerable.”

Ben Lessing

For help, Lessing suggests “BH Link or the 988-crisis line, which provide 24/7 assistance to provide support and guidance for individuals struggling to cope and whose circumstances have reached a tipping point. Anyone can walk into BH Link where they will receive immediate assistance from trained and compassionate behavioral health professionals.”

 Also, Lessing said Community Care Alliance’s “Acute Stabilization Unit provides a short-term alternative to traditional inpatient care provided by a multi-disciplinary team of behavioral health professionals. This program can also provide detox services and offers follow-up linkage with community-based treatment providers.”

Also available are an around-the-clock Emergency Services program, an Open Access program, a Serenity Center, and a Safe Haven “drop-in center staffed by peer specialists also in recovery to assist with an array of social needs,” Lessing said.

 To learn more about Community Care Alliance programs and services, visit https://www.communitycareri.org/

The roots of Matthew Brown’s substance use disorder lie in a severely traumatic childhood. Brown was in and out of state custody; frequently in trouble with the law; and he witnessed the deaths of many relatives, including some who had nurtured and protected him. All of that combined to incline him toward drugs and lead to crippling anxiety and PTSD.  

His saving grace, for a while, was his athletic ability.

“I took out my problems and stress with sports,” he told Ocean State Stories. “I put everything I had into sports. Football was my favorite. I played baseball, which was my second favorite, and basketball. And I had played soccer at a younger age but not older.”

Matthew Brown – G. Wayne Miller / Ocean State Stories

Brown said he was about 11 or 12 years old the first time he tried marijuana, and he began smoking regularly when he was about 13. A few years later, he began using crack cocaine and abusing alcohol. Brown eventually found sobriety but then, after an injury he sustained while working as a contractor – he had started his own business — he was prescribed Percocet, which contains oxycodone, an opioid. The drug was administered as a pill.

But the dose Brown received failed to relieve his pain, a situation he said was exacerbated by his work, which included roofing, which taxes the body, especially in summer.

“So I’m sweating and those drugs make you sweat as well so I was sweating them out,” he said. “The pain in my back was still there and I was taking three pills a day and I wasn’t getting high but they weren’t [alleviating the pain]. So I called my doctor and said ‘Sir, I’m not drug-seeking. I’m on three pills, I’m not abusing them, but they’re not working. I’m still in a lot of pain.’ And he said ‘This is a red flag. You are probably addicted to them or going to get addicted to them. So I’m cutting you off.’”

Brown began buying Percocet on the street.

“Then I started sniffing them because somebody told me that if I sniffed them they’d hit me harder and work better — but I’d feel a little buzz and a little kick and a little drive,” he said. “So I did and I felt good — you know, it’s a buzz — and I was used to sniffing cocaine. So the addiction crept back up.”

During this period, Brown experienced more tragedy: the death of a baby born to a woman with whom he was involved. And that coincided with the emerging dominance of deadly fentanyl in the illicit drug market. Many of the street pills Brown was using likely were laced with the drug, which was causing the vast majority of drug overdose deaths in America, with nearly 200 recorded in Rhode Island in the year 2019 and almost 300 in 2021.

The fentanyl-laced pills Brown began to use were “much cheaper” than the Percocet pills he’d been buying and “they got the job done better,” he said. “That’s the line I crossed with addiction. The disease took over.”

And his risk of dying soared.

“So now I’m playing Russian roulette with death,” Brown said.

He knew he had to change and in 2019, he engaged with CODAC.

With offices in Hope Valley and Westerly, Wood River Health serves people living in southern and southwestern Rhode Island. Nurse Penny Palazzo, a Medication Assisted Treatment Nurse Care Manager with the healthcare organization, agreed with other providers that this season is difficult for many – but help is available.

“This time of year is very difficult for people with substance abuse because many are homeless and either spend their holidays on the streets or in shelters. Many people have been shunned from their family and friends because of substance use, which can contribute to the increase in use due to loneliness at a time that is supposed to be happy and festive with family and friends. This can lead to hospitalizations from overdose or suicide attempts.”

Penny Pallazo – Submitted photo

She offers guidance to family members and patients.

“The person living with substance use disorder needs to be seeking recovery assistance for themselves first,” she said. “If the person enters recovery because of peer pressure, it sets the patient up for failure making it even harder and less likely that a patient will ask for help again, as many times the person is not ready mentally and/or physically.

“I advise both patients and family members that substance abuse is a disease. It is a lifelong battle and relapses will happen but it is not a failure, it is part of the process and we just need to take a different individualized approach to recovery.”

Wood River Health, she said, “provides our patients with a few different resources that can assist them in reaching sobriety. Our behavioral health services include group therapy with our weekly Men’s Recovery Support Group and Women’s Recovery Support Group, individual counseling, and nurse care management to assist with connections to outside resources such as inpatient detox, intensive outpatient therapy and housing assistance through sober and recovery houses.

“Our primary care providers offer medication assistance such as Suboxone for patients using substances such as opioids, oral Naltrexone, and long-acting Vivtrol for alcohol abuse. We provide care based on evidence-based techniques that offer medication and behavioral health services together, which has shown to have a much higher success rate in recovery.”

To learn more about Wood River health programs and services, visit https://woodriverhealth.org/services/behavioral-health

Newport Mental Health (NMH), headquartered in Middletown, serves residents of Aquidneck Island, Jamestown, Little Compton and Tiverton.

 “The holidays and anniversaries or special life events such as the passing of a loved one can be significant triggers for people with substance use disorders,” said Jamie Lehane, president and CEO. “For those in recovery and abstinent, they are more vulnerable to having a relapse.  For those who are not in recovery, the holidays are a time that may exacerbate their level of drinking and/or substance use.”

Jamie Lehane, president and CEO, Newport Mental Health – G. Wayne Miller / Ocean State Stories

Movies, music, television, social media and even a visit to a store or a mall can be compounding factors, Lehane said. “The marketing of the holiday spirit, with all the scenes of joyous people celebrating, puts a lot of pressure on people who are suffering with behavioral health disorders and may not have family and friends.”

Lehane has this advice for family members and friends of people living with substance use disorders: “Get help and support for yourself. Educate yourself about their illness. The new Certified Community Behavioral Health Clinics like NMH have counseling or group supports to help you deal with this.

“There are also support groups like ALANON to help you learn about their illness and how to deal with it. Be supportive but set limits. Understand that this is a serious illness and recovery is a long-term process. Don’t give up.  Understand that there will be relapses and this is often a part of the recovery process.” 

To learn more about Newport Mental Health programs and services, visit https://www.newportmentalhealth.org/

In February 2020, as the COVID pandemic was beginning to punish the state and world, Tammy Kruwell’s mother died. That October, her father also died.

“That’s when my recovery was very most challenged because I just didn’t know where to go,” she said. “But I held tight and I think it was within that same week of my father’s death that I signed up online” for the courses she needed to become a certified recovery specialist and community healthcare worker. After an internship, she was hired full-time by the Parent Support Network of Rhode Island.

Now, Kruwell uses her story in her interactions with the people she serves. A cornerstone of her work is a holistic approach to one’s wellbeing known as the eight Dimensions of Wellness: the physical, intellectual, emotional, social, spiritual, vocational, financial and environmental.

“People living with serious mental or substance use disorders are dying decades earlier than the general population, mostly from preventable, chronic medical conditions,” according to the U.S. Department of Health and Human Services. The Wellness Dimensions, the department states, aim “to increase overall quality of life, healthy habits and personal control.”

“I facilitate the eight Dimensions of Wellness through a recovery life skills program at multiple recovery women’s homes throughout Rhode Island,” Kruwell said. “We’ve got men on board now, too, to go to the men’s houses.”

In group sessions and one-on-one meetings, Kruwell said, “we instill that faith, that hope that it’s okay. Because when you’re in a recovery house, you’re coming either out of jail or off the streets and you don’t have documentation. So we assist with getting vital records, their birth certificates, getting their licenses, clothing, food, bus passes, anything they need.”

According to Kruwell, Parent Support Network of Rhode Island, or PSN, has many other programs, including “an outreach team and they go out and find the [homeless] encampments. PSN is like a tree with all these branches and we all have the same lived recovery, lived experience. That’s a prerequisite for this work. You have to know what it’s like to do it.”

Dr. Clifford Gordon, Director of Behavioral Health Services for WellOne, a community health center that serves western and central Rhode Island, frames holiday stresses in terms of “demands.”

These demands “from all sources go up for individuals during the holidays,” Gordon said. “Whether the demands are external or internal, there are many more. When we have more demands placed on us, more than usual, it causes symptoms for us. Whether they are physical symptoms, emotional symptoms, cognitive symptoms, etc. So, for example, where is the individual in their recovery during the holidays? If they are at the beginning of recovery, more demands are not a good idea.”

  According to Gordon, WellOne offers “individual evaluations and ongoing therapy, couple, and family evaluations and therapy as necessary for [alcohol] or substance use disorder patients at all spectrums of recovery. If a patient needs psychiatric medications throughout their recovery, we offer evaluations. We are a good starting point for a patient wanting help.”

His advice for family and friends of users and people in recovery?

“Therapy and talking not only helps the ‘user’ but also those around them,” he said. “I use the example of throwing a rock into a calm pond. There is a ripple effect of throwing that rock into the water. You can see the ripples in the water keep going.  And when an [alcohol] or substance user stops using, it has a ripple effect with family members/friends that need to get discussed.

“So talking is a method that has been researched, and outcomes show that this helps family members and friends.  Traditional therapy is available, as well as free support groups. An example of this is ALANON which is available for family members who have a loved one using.  And it is free!”

To learn more about WellOne programs and services, visit http://welloneri.org/

Like Tammy Kruwell, Matthew Brown found lasting sobriety with the support of CODAC. “I finally was just tired of the whole thing and I said, ‘You know what? I’m done,’” Brown told Ocean State Stories. “I lived in sober houses for six months and worked and humbled myself and focused on myself and my recovery.”

Since then, Brown has started a successful carpentry business and, like Kruwell, he has committed to helping others, in partnership with CODAC.

“I’m dealing with Linda Hurley,” he said. “I have her like on speed dial. I’m basically doing press conferences and campaigning on behalf of CODAC.”

One of those conferences was with U.S. Senator Jack Reed and Hurley in August at CODAC’s Newport offices. “I am living proof that there is a way out and if you are willing to do it, if you are willing to put in the work, then you can have a life outside of your addiction,” Brown said. “That is a promise.”

Reed, Hurley and Brown also spoke about the dangers of fentanyl, with Brown endorsing harm reduction strategies and stating: “There is no safe supply within the illicit drug market.  There’s no safe fake pills. There’s no safe heroin. There’s no safe any drugs.”

More recently, Brown has been assisting in shooting CODAC public-awareness commercials.

“Going out and giving back is what I’m trying to do, is what you do in recovery,” Brown said. “People helped me along on my journey, but a lot of it — 90% of it — I had to do myself because I didn’t have any family. I didn’t have anybody, and it was very, very hard. And you know what? I was blessed and I had angels watching over me to get me here.

“And this is why I have been so open to meeting with people and to getting my story out there — so that it gives hope and awareness to the people that are out there still struggling or maybe thinking that it’s not possible [to recover] or are scared to come forward. Because there’s a lot of guilt and shame with [addiction] and not wanting to admit that you have a problem.”

As December 25 and January 1 near, Brown said “holidays are probably one of the biggest triggers in the sobriety or recovery scene. I have a lot of people that I stress and worry about.”

He urges people in need or crisis to seek help through CODAC or another behavioral health center – and to keep in mind the old adage of one day at a time.

“We only really have 24 hours in each day,” he declared. “And you’ve going to wake up and focus on the day. It’s so overwhelming to think about staying sober for the rest of your life. So just focusing on staying sober today is a lot easier.

“And so, we all really just have today because we’re not promised tomorrow and yesterday’s already gone. So, all we have is our 24 hours that we’re sober for today. That’s as long as I have and that’s as long as somebody who has 30 years sobriety has. That’s something I learned in AA.”

Tammy Kruwell knows people living with a substance use disorder who carry memories of a traumatic upbringing similar to Brown’s. She knows others, still using or in recovery, who experienced “times when they were with their family. And they have those memories, those cherished memories, of the Christmas tree and Grandma and Grandpa and everybody getting together.”

But for them now, she said, “it’s not like that. They don’t celebrate. They’ll just wake up and go along their day. And they’re liable to go out and use to numb themselves.”

Or worse, they will lose their lives to suicide, according to Kruwell.

Like Brown, Kruwell urged individuals to seek help. It is available through many agencies, listed below, at any hour of any day or night.

“You have to hold out hope and you have to hang on and you have to have that courage to continue no matter what and know that there is another side,” Kruwell said.

“The more that you do for yourself and the more support you have, the more safety nets are in place, the more opportunities you have, you are going to grow. And once you get that little bit of a taste of growing, you’re going to get hungry for it and you’re going to believe in it because I’ve seen it happen.”

Anyone in immediate danger should call 911.

Call 988 if you are having thoughts of suicide or are in crisis. 988 is free, available 24/7, and confidential.

Other resources:

● BHLink: For confidential support and to get connected to care, call (401) 414-LINK (5465) or visit the BHLink 24-hour/7-day triage center at 975 Waterman Ave., East Providence. Website: bhlink.org

● The Samaritans of Rhode Island: (401) 272-4044 or (800) 365-4044. Website: samaritansri.org

● The Crisis Text Line: Text HOME to 741741 “from anywhere in the USA, anytime, about any type of crisis.”

Butler Hospital Behavioral Health Services Call Center: Available 24/7 “to guide individuals seeking advice for themselves or others regarding suicide prevention.” (844) 401-0111

Healthcare providers offering assistance include:

CODAC

Community Care Alliance

Thrive Behavioral Health

Wood River Health

WellOne

Newport Mental Health

The Providence Center