A Journey Through Anxiety and Addiction

Sarah (pseudonym) is a woman in her mid-thirties with a cheerful blonde ponytail and light eyes. On the day that we speak to her, Sarah sports a wholesome look in a smart striped sweater. Her appearance does not reflect the more rebellious punk style she favored as a young adult, and certainly does not convey the various mental health issues that she has battled since her adolescence. Sarah is naturally endearing and is quick to laugh at herself. She is the kind of person who is easy to befriend.

Sarah's parents enrolled her in kindergarten at the age of four. This meant Sarah was a year younger than all of her peers, as children in the United States typically begin kindergarten at five years old or even six. Looking back, Sarah and her parents believe Sarah should have waited a year before starting kindergarten, as there are significant physical, cognitive, and emotional differences in childhood development between the ages of four to five.

While interested in her academic subjects, Sarah had difficulty comprehending lessons and paying attention. She also felt insecure about her abilities, particularly in her math courses. In mid to late elementary school, Sarah's teachers recommended that she complete after-school tutoring sessions and reading groups to improve her reading and writing. Sarah was not eager to attend these sessions. However, she developed good relationships with some of her instructors and has some fond memories of their kindness towards her. She did not mind being there if she felt a connection with them. Sarah felt that some of the instructors genuinely cared for her and were dedicated to helping her improve. Nevertheless, Sarah would have preferred to have just returned home after school, but knew that these sessions were necessary for her to keep up in school.

Anxiety

"My whole life, I've loved animals," Sarah shares. She aspired to become a veterinarian and begged her parents for a dog throughout much of her childhood. Her dad believed a dog was too much work, but permitted Sarah to get a small animal in the second or third grade. Laughing, Sarah remembers that she chose to get a pet rat. Finally, when Sarah was in fourth or fifth grade, she was surprised with a beautiful border collie. She opened the front door on Christmas morning to discover the then-puppy with a bow tied upon his head. As a shy child, Sarah quickly bonded with the dog and became closely attached to it.

After some time, Sarah's parents began wondering if they had overburdened themselves with the dog. Sarah's father picked a border collie even though Sarah preferred a golden retriever, because he had heard that border collies are very intelligent. However, Sarah's father did not anticipate or prepare for the dog's endless running and energetic barking. When Sarah was in sixth grade, she came home one day to find her dog missing. Her parents explained he had left to go visit a farm for the weekend, where he would run around and play with other dogs. After the weekend passed, Sarah's dog never returned (years later, Sarah came to understand that her parents had given her dog away). Heartbroken, Sarah recalls she had lost her best friend and was left traumatized and shaken. She developed resentment and anger towards her parents, who she believed had betrayed her. She grew saddened that she never had the opportunity to say goodbye to her beloved childhood pet. The loss of the dog instigated or exacerbated Sarah's depression and likely contributed to her developing anxiety.

Later on in middle school, Sarah clearly remembers an experience in her seventh grade industrial technology class. While looking at the clock, a sudden choking sensation overtook her and she abruptly struggled for air. Terrified and fearful that she was dying, Sarah hurried out of the classroom to the school nurse's office. The nurse examined Sarah and peered down her throat with a flashlight to see if she was choking on something. Confused, the nurse was unable to determine what was wrong with Sarah and called to have Sarah picked up from school. The other adults in Sarah's life were similarly at a loss as to what was happening to her.

Sarah's mother scheduled Sarah for an appointment with a primary care physician, who asked Sarah questions about the incident. Her physician was also uncertain of what was causing Sarah's choking experience and prescribed an inhaler, believing that Sarah might have had an episode of childhood asthma. The inhaler had no effect and Sarah's symptoms continued to resurface. These incidents were scary and confusing for Sarah. Even more frightening was not receiving a clear diagnosis, and not being able to understand what was happening to her body.

When Sarah's blood tests came back normal, her doctor and parents began wondering if Sarah's experiences were related to mental health. Eventually, as Sarah's symptoms worsened, she was sent to a mental health professional and began therapy for anxiety. Sarah learned that these terrifying experiences were panic attacks. Therapy helped some, but Sarah's depression worsened. Sarah remembers feeling suicidal from the terror of the panic attacks.

Although Sarah had friends at the time, she felt that there was no one that she could talk with about these panic attacks and she became increasingly isolated. Around the same time, many of Sarah's previous friends joined cheerleading, an activity that Sarah did not have any interest in. Those friends naturally coalesced into a lunch group of cheerleaders, and Sarah drifted further away. Sarah remembers wandering around the school cafeteria, unable to find someone to join. Not wanting to be embarrassed about a lack of friends, she ended up eating lunch alone in the bathroom.

Teen Reform School

Sarah began cutting herself around eighth grade, a year after her first panic attack and the start of her severe depression. Looking back, Sarah is not sure why she cut herself. She wonders if she craved the attention that it garnered, but at the same time, remembers not wanting to be in the spotlight. When Sarah cut herself, she remembers feeling a wave of relief that alleviated her internal pain and anxiety. Sarah believes the emotional release of cutting was more significant for her than its "shock value."

At age thirteen, Sarah was still self-harming and performing poorly in her sophomore year of high school. Sarah nearly failed a couple of classes and her parents feared she was on a path to dropping out and failing to graduate. Sarah's father, well-known amongst the community for his role in law enforcement, worried about the optics of his daughter visibly struggling and did not want to jeopardize his career. As Sarah remarked, he feared gaining the reputation of "not being able to control his own daughter." Moreover, Sarah's parents also worried she would seriously hurt herself by continuing to self-harm. Sarah's parents ended up sending her to a program for troubled teens in Utah. This institution touted itself as a "therapeutic boarding school" with expert-led programs that could help wayward teenagers.

Sarah grimaces as she recalls the nightmarish memory of being awoken in the middle of the night in her bed by two stranger "escorts" without much context as to what was about to happen, loaded into a van, and driven out to the desert. Following her arrival at the facility, Sarah was stripped of her belongings and subjected to a cavity search. As a fourteen-year-old girl, Sarah was horrified that she was being treated like a criminal. Nearly all of Sarah's basic human rights were taken away; she had to raise her hand for the bathroom and was banned from shaving her legs. She was not permitted to speak to her parents except through monitored phone calls or letters, which were read and censored to ensure she did not reveal the inhumane conditions of the facility. The school's model for behavior modification – marketed as compassionate therapy amidst the unique Utah landscape – was in reality a pseudo-prison full of scared teenagers.

Students' progress at the reform program was delineated into six distinct phases. Once a participant reached phase six, that teen was permitted to "graduate" and return home. If a teen disobeyed or acted out in any way, that teen could be immediately demoted to a lower phase. The demotions were most severe for self-harm. Teens who were caught self-harming could lose all of their earned phases, essentially starting the program all over once more.

Sarah's days at the facility were extremely structured. During the day, Sarah followed the program's "classes," which consisted of a self-taught curriculum. Sarah would read a book, answer questions, and then take a test at the end. There was only one staff member overseeing the "classes," who could answer questions but did not teach anything. Sarah's grades actually improved that year, since she could retake her tests as many times she needed until she passed them. Looking back, Sarah realizes that the good grades probably convinced parents that their children were thriving. At the end of the day, after the "classes" finished, Sarah and the other teens were corralled outside for jumping jacks. For the rest of the night, they listened to tapes or videos by Zig Zigler, a self-help author. A staff member forced them to write essays afterwards about what they had learned. Before going to bed, the teens lined up and were counted to ensure no one had run away.

Under constant surveillance, Sarah was not able to self-harm like she had at home. She still experienced the urges, but was dissuaded by the idea of being caught and having to remain at the facility for longer. Looking out the window was also not allowed, as it could be considered plotting how to run away from the facility. With limited personal freedom, Sarah clung to the positive memories of her life outside of the facility. She tried to write down the lyrics to the songs of her favorite musicians like Green Day and Avril Lavigne but was disciplined harshly. Singing, humming, and even writing down notes or song lyrics were not permitted, as they were also considered potential "run plans."

Sarah felt like screaming at her parents during their few phone calls, but confiding in parents would mean regressing to the previous level needed in order to finish the program. Every day, Sarah lived under the threat of being disciplined and punished. She was hardly ever permitted outside of the locked building, which was located in a remote region far from any local towns or roads. All teens were forced to wear flimsy flip flops so they could not run far if they managed to escape. As with other teens in the program, if Sarah disobeyed the instructors, she could be locked into a cold isolation room for days. Some staff members tried to psychologically intimidate Sarah and other teenagers by threatening that repeated misbehavior, or "dropped levels," would result in a demotion transfer to Tranquility Bay in Jamaica or Casa by the Sea in Mexico. Sarah heard that these two facilities – despite their luxurious sounding names – had even worse conditions and abuse than her reform school in Utah. Sarah distinctly recalls hearing rumors that a teenager at Tranquility Bay was padlocked into a dog cage.

Sarah was not the only teenager struggling amidst the horrific conditions. One girl removed the top of the porcelain toilet, broke it, and sliced her wrists. She nearly died, but was rushed to the emergency room for treatment just in time. A couple of other girls attempted to kill themselves by intentionally leaving tampons in to cause toxic shock syndrome.

Sarah became incredibly paranoid and stressed from absorbing all of this chaos and trauma surrounding her. Worst of all, Sarah continued to wonder when her parents would pick her up and save her. Initially, Sarah assumed she would be in the program for thirty days, before being safely brought home. However, as the months passed, and eventually an entire year passed, Sarah grew worried she would have to live in the facility until her eighteenth birthday. Demoralized and broken, Sarah went through the motions of abiding by the rules to reach higher phases. Believing she had been forgotten, Sarah slowly lost hope and the courage to survive.

During her fifteen months in the program, Sarah saw her parents only two times. The first time, Sarah met with her mother and father privately on the campus facility. She begged them to pull her out and bring her home. However, her parents had been briefed by staff who had preemptively warned them not to fall for their daughter's pleading and manipulation. Heartbroken, Sarah watched her parents walk out and leave without her. The second instance when Sarah's parents visited was near the end of her stay. As Sarah had progressed through a number of phases, she was allowed to leave the facility for a few hours under parental supervision. Her family went bowling. Sarah acted very compliantly hoping her parents would notice her changed behavior, but her parents still did not bring her back with them.

Sarah's escape from the program resulted from some personal sadness. During Sarah's stay at the program, her grandmother died from pancreatic cancer, and Sarah was heartbroken that she never had the opportunity to say goodbye. The bereavement echoed the time when her childhood dog was taken away without her knowledge. When Sarah's grandfather's health deteriorated rapidly, her parents released her from the facility to see her grandfather before he passed away.

Even two decades later, Sarah is still haunted by recurring flashbacks and inescapable memories of the facility. She has joined the ranks of other survivors of the "troubled teen industry," who share their stories through the #breakingcodesilence campaign. Reform schools today are well known for abuse, in large part due to adults like Sarah speaking out about the torture they endured as teenagers in the 1990s and 2000s. Many facilities have been forced to shut down due to abuse, suicides, and other horrifying incidents.

Despite how terrible the conditions were, Sarah can see why her parents might have sent her there, even though the schools were clearly not a good solution to her mental health issues. Misled by the colorful website and brochure, her parents were unaware of the extent of the facility's abuse. Sarah does not believe her parents were actively trying to harm her; they likely envisioned Sarah hiking outdoors and enjoying productive therapy sessions.

Reintegration

When Sarah returned home, her parents enrolled her in a much smaller private school. Sarah started her junior year feeling as if she had returned from prison or war. In her new school, Sarah met another girl who had completed the same program and she took Sarah under her wing. While it was nice to return home, everything seemed strange and foreign. Sarah's parents had remodeled her bedroom and Sarah had not seen her friends in what felt like an eternity. Meanwhile, Sarah struggled with paranoia and the persistent fear that she would be sent back to the facility at any time. As a minor, she knew that she could be re-enrolled in the program against her will. Sarah tried to be on her best behavior and remembers worrying that her parents were plotting to send her back for a minor misdeed. In reaction, she asked friends at school to sign a petition saying she was "a good kid" and did not need to return to the program.

Sarah's social anxiety from middle school came roaring back, evolving into a pervasive feeling of awkwardness. Even though she had gone shopping for new clothes and cut her hair before starting school, she felt out of place. In addition to not knowing anyone who went to her new school, certain trends had changed and Sarah had missed out on a steady stream of teenage pop culture in the fifteen months she was gone. Sarah was uncertain of how to represent herself to others. Her preferred style was more punk or skater-looking, but when she walked into her new school, people were in their preppy Abercrombie & Fitch outfits. Feeling entirely out of place, Sarah thought to herself, "shoot, I guess I didn't get the memo on what I was supposed to wear."

Around this time, Sarah was officially diagnosed with ADHD and began taking Concerta. This medication significantly improved her focus and her schoolwork, to the point that even teachers began to comment on Sarah's concentration. However, despite these positive effects, Sarah felt that the medications made her feel robotic and lose her appetite and she eventually stopped taking Concerta. Sarah continued to struggle with ADHD, and never received accommodations such as extended time on tests.

One aspect of her new high school that Sarah enjoyed was joining the cross country team. This was her first time in high school when she was a member of a sports team or group. However, Sarah was forced to stop participating due to low grades in her senior year. In fact, Sarah barely graduated as she was on the verge of failing a few of her courses. In particular, Sarah's challenges with math almost prevented her from graduating with the rest of her class. Fortunately, her math teacher allowed her to retake some math tests, and Sarah was relieved to have been allowed to graduate.

Substance Abuse

Following graduation, Sarah enrolled in cosmetology school and began working a number of different jobs. Sarah did not finish her cosmetology classes (she speculates that ADHD might have had something to do with it), and she felt unsure about the direction of her career. Around this time, Sarah was dating and living with a guy she met at her high school. Her boyfriend had a severe alcohol addiction, and she witnessed his drinking problem grow out of control. Sarah would frequently find him blacked out, once with cuts on his face from falling into a picture frame.

Initially, Sarah hated alcohol. As a teenager, Sarah's mother had lost her own mother (Sarah's maternal grandmother) due to organ damage and illness caused by long-term drinking. Sarah was horrified that her boyfriend, someone she deeply cared about, might be fated to a similar demise. She remembers pouring out his liquor bottles into the sink, desperate to save him from sliding into the quicksand of addiction.

Eventually, however, being around her boyfriend's alcohol addiction led Sarah to start drinking as well. A pattern of codependence started where drinking became a daily activity. They drank every day, morning and night, for an entire year. At some point, blood work revealed Sarah had impaired liver function and she could physically feel her health suffering. Sarah recalls being covered in bruises and not knowing where they came from.

After being together with her boyfriend for about two years, Sarah received a call from her boyfriend's mother one day in 2010. Her boyfriend's mother had called to break the news that Sarah's boyfriend had been found dead from shooting himself. Straight away, Sarah ran to the freezer for a bottle of vodka, which she immediately began chugging in her state of shock. Next, she called her parents and declared, "John's dead." Her parents thought Sarah had misheard, but upon hearing Sarah contemplating suicide, they begged Sarah to not harm herself. Sarah's parents stayed on the phone with her as they rapidly drove to Sarah's apartment a few cities over. Meanwhile, someone (likely a neighbor) called the police to perform a wellness check on Sarah. Her parents and police officers arrived at Sarah's apartment at nearly the same time. To the shock of Sarah's parents, the police officers confirmed that Sarah's boyfriend was indeed dead.

Against the backdrop of this emotional trauma, Sarah struggled to recover and continued to drink. Sarah's struggles did not go unnoticed. One day, a coworker and personal friend offered Sarah OxyContin to alleviate her depression and grief. "You'll feel better," the friend advised. The OxyContin did make Sarah feel better, but it also started her on a thirteen-year opiate addiction. Sarah stopped drinking and switched to solely consuming OxyContin and other forms of opioids.

Sarah moved back home, but continued her substance abuse. She successfully concealed her consumption of drugs from her parents for some time. However, one morning on her way to work, Sarah dropped some OxyContin from her barista apron onto the driveway. Arriving at work, Sarah realized the drug was not in her apron and she was terrified of being discovered. When she returned home, she found her parents sitting down in the family room. They staged an intervention and insisted that Sarah enter into a substance abuse treatment program.

Sarah's parents scheduled and organized the treatment. In the rehab center, Sarah participated in both group and individual therapy sessions, most of which centered around the twelve-step recovery method. While Sarah found some of the therapy sessions in rehabilitation helpful, she was not fully committed to recovery and was mainly going to ease her parent's worry and criticism. Sarah disliked the atmosphere of the center and felt miserable. Sarah did graduate from the program, but mostly because of threats from her parents that she would have nowhere to go if she left the program early. After completing the rehabilitation program, Sarah lived in a couple of different sober living houses. She ended up relapsing in each one. When Sarah failed mandatory drug tests, she was kicked out and forced to find another house. Sarah stayed in a total of three sober living houses. Looking back, Sarah believes that she did not truly want recovery for herself, and therefore did not stay sober.

Angry and consumed by her addiction, Sarah packed her things into her car and began living out of it. This arrangement did not last long; Sarah's boyfriend at that time and his friend borrowed the car and got into a high-speed chase. The car was damaged and taken to a car lot. Sarah's father got the car out, but refused to return it to Sarah. For nearly a year following this incident, Sarah slept on the streets. During this time, Sarah met someone else who was also living on the streets and ended up dating him out of fear for her own safety. Also an addict, he encouraged Sarah to shoplift from stores and commit petty theft to fund their substance abuse habits. Her addiction and desperation impaired her ability to make rational decisions. During this time she was charged a few times for petty theft and once for possession.

The court ordered Sarah to enroll in another rehabilitation treatment program; this time, Sarah welcomed the opportunity to break free from her chaotic lifestyle. When she began therapy sessions at the treatment facility, she found herself more receptive than she had been in her previous rehabilitation program. Sarah was sober for a period of time following this second rehabilitation program.

Sarah has since tried other substance abuse treatment routes, including a week-long detox, an outpatient program, and a methadone and Suboxone medication program. Sarah encountered positive and negative aspects of these different approaches. In one outpatient program, Sarah developed a strong bond with one of the program's therapists who specializes in addiction treatment. This therapy helped Sarah work through negative emotions and behaviors relating to substance withdrawal. Sarah finally felt progress and hope towards long-term recovery. Unfortunately, Sarah was forced to stop attending therapy sessions, as they were expensive and not covered by her insurance. Sarah has also tried the twelve-step programs of Narcotics Anonymous, with varying degrees of success. Due to her social anxiety, it is difficult for Sarah to attend meetings, participate in phone conversations, and to speak in front of large groups. She does find solace in hearing other people's stories and learning about their successful recovery strategies.

Although Sarah has managed to maintain some periods of sobriety, she acknowledges these periods have been temporary. For example, when Sarah was expecting a child, she was able to stay sober throughout the pregnancy and breastfeeding. Sarah remembers at one point feeling judgmental about parents who could not pull their lives together for the sake of their children. However, as her own son grew up, Sarah relapsed and went back to substance abuse. Sarah's addiction makes her feel somewhat powerless, since a motivating force as strong as her son has not been enough to keep her off of drugs permanently. Sarah is grateful for her family's support in raising her son.

Thoughts on Mental Health

Sarah has seen the stigmas surrounding substance abuse prevent many people from speaking out or requesting help. For example, she wishes her boyfriend who committed suicide had sought out treatment. He likely stayed silent for fear of sabotaging his military career and of risking the acceptance of his Catholic family. Sarah believes that anyone suffering from substance abuse issues should seek out professional help: people should not feel ashamed or judged for addiction and mental health issues, which are just as much an illness as diabetes.

Sarah also praises the benefits of therapy for individuals like her who endure social anxiety. She encourages individuals to seek out therapists whom they trust and feel comfortable confiding in. Sarah also advocates for increased awareness and acceptance of mental health issues in teenagers, encouraging teens to reach out to trusted adults for support. She envisions a world where mental health resources, including those for substance abuse, are more readily available and socially acceptable.