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My mom was diagnosed with a rare muscle cancer in her left arm several years ago. She had surgery, recovered nicely, and has been doing well ever since. At the time, I remember how family members and friends rallied and supported her by telephoning frequently, sending flowers and get-well cards, and bringing casseroles and other gifts of food so she would worry less about cooking for herself and my father and focus more on her recovery.

When a friend’s son died of a heart attack, many of her family members and friends provided care before, during, and after the funeral. Again, several people prepared meals like casseroles and many others showed their support with cards, flowers, monetary donations, and their physical presence.

To me, this uninhibited and eager display of kindness and concern transforms cancer and heart disease into conditions that I refer to as casserole illnesses—ones that people view and approach with unrestrained compassion. People seem to understand that cancer and heart disease are acute and chronic conditions whose causes and consequences are, for the most part, outside the control of the person who is ill. From my experiences as an addiction psychiatrist and the spouse of someone with a debilitating addiction, I know that addiction is rarely seen in a similar light.


Unfortunately, in our culture, alcoholism and other addictive disorders as well as drug overdose deaths are not casserole illnesses and events. Oftentimes, families struggle in isolation and friends and relatives struggle with the awkwardness of not knowing how to respond. Additionally, feelings of shame and embarrassment may cause caregivers not to ask for help or to cover up a loved one’s addictive disease or cause of death.

For instance, when my ex-husband was hospitalized for alcoholism and suicidal ideation in 2008, I did not want anyone in my family or circle of friends to know what was going on. I was ashamed to ask for help. At the time, I thought, “If only he needed hip surgery or had pneumonia, this would be much easier to talk about.” Back then and even today, a loved one’s addiction and related struggles are typically not topics for open conversation. Discussions about addiction and overdose often occur in hushed whispers behind closed doors.


Why all the secrecy? First of all, we forget or do not realize that addiction grows best alone and in the dark. When my ex-husband missed work because he was passed out from drinking, it was easier for him and me to tell everyone that he had stomach flu. When he got arrested for his first DUI, we told the story of a car accident caused by someone else. Also, we explained our financial problems as being the result of stolen credit cards and identity theft, which actually did not occur.

We told so many lies that I started to believe them. I told myself, “This is just a phase. He will get himself together. Life will get easier once things settle down.” In addition, I started to blame myself for my family’s problems. I believed that if I had been a better wife, he wouldn’t drink so much. I feared that if I were to tell the truth, I would be judged for his behavior:

  • Why didn’t I hide the alcohol so he couldn’t get drunk?
  • Why didn’t I take away the keys?
  • Why didn’t I work harder to fix the financial problems?

The shame I felt was very deep and seemed to come from many directions. Under this veil (and iron curtain) of isolation and self-loathing, addiction gained power and took increasing control over my ex-husband, my family, and me.

Again, why the secrecy? Is it necessary? Why not just tell people the truth and explain that addiction is an illness which is part of the human experience? For sure, that would be a great form of advocacy but, truthfully, very difficult to do alone.

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