If I Could Do It Over: Understanding Substance Misuse

I always feel a pit in my stomach that starts around the holiday season. At family gatherings, my eyes scan the room in search of him. I even casually walk by the front door when I hear the doorbell—maybe, just maybe, it will be him. It never is. Because in March 2007, I lost one of the most important people in my life—a cousin by blood, a brother by bond. Junior was found dead in his apartment with alcohol and pills by his side. He was only 39. 

Our last exchange was his birthday celebration at Friendly’s a few weeks before he passed. He did not seem like himself. I already started to notice that he was uncharacteristically withdrawn—in fact, he missed my 25th birthday in December. It was the first time that he missed a family celebration. I just thought he was not feeling well. And then, there was the phone call where he was incomprehensible and slurring his words. But, I never saw him misuse substances around me. I thought that he was likely exhausted. He was private about his current and past struggles. In respecting his privacy though, I now realize he was fighting this battle alone. How did I not act on these warning signs? 

As his hand poked shakily at his birthday sundae without taking a bite, I knew something serious was going on, but I did not know how to help him. He noticed my concern, yet he shifted my worry to how things were looking up for him. When we said our good-byes, we hugged and he shared his excitement with me that he was enrolling in classes toward a degree. Unfortunately,I did not know that exchange would be our last. 

I often ask myself questions trying to make sense of it all or even hoping that if I understood more, it would help alleviate the pain: Was it an overdose? Did he die by suicide? How did I not know that he was suffering so immensely? How did I not know how to help someone I love? What could I have done to prevent his death? And, honestly, I really don’t know any of these answers. To cope, I try to redirect my questions into actions, working alongside The Jed Foundation as a subject matter expert and NIH’s Helping to End Addiction Long-Term Initiative as faculty at Yale, and recommitting my efforts toward substance misuse and suicide prevention among our teens and young adults. In his name, I devote my life to this purpose. 

As a counselor, I learned that the struggles we face are not always seen on the surface. As a researcher, I learned that adverse childhood experiences are correlated to numerous detrimental outcomes. And, as someone who has experienced this type of devastating loss, I learned that my commitment to this work is so personal that in moments where I am shaken by the intensity of it, I am always grateful to my own support system who hold me, lift me, and love me through these moments.  

Junior cared so much about people. To continue in his legacy and because of his story, I vow to do my best to bring these discussions to light and do my own personal work in normalizing these conversations to destigmatize seeking help and to increase access to substance misuse and mental health services. Early intervention is critical in prevention and access to care is key in treatment. Stigma often causes people to suffer in isolation as it is one of several factors that can be a barrier to seeking help. With 35% of people experiencing a serious mental health disorder and 90% of people with a substance use disorder in the United States not seeking help, we can’t afford to ignore these discussions. Struggle with substance misuse and mental health is not something to be ashamed about. It is something to better understand. 

I share my story to highlight what I’ve learned since Junior’s death. If I was given the opportunity to “do it over” with Junior, I would: 

  1. Set up a time to meet in private; 
  2. start the conversation with compassion and concern by asking him about what he is experiencing; 
  3. suggest exploring resources for help and starting with a healthcare provider;
  4. and offer to schedule the appointments together and go with him. 

Throughout our conversation, I would listen so intently to him and make sure he knew that I was right there with him, by his side every step of the way.

During National Substance Use Prevention Month, I encourage you to join me in these efforts. Please join me by:

  • Sharing your personal story related to substance misuse and mental health with your friends and family, and using person-centered language to show compassion in our efforts 
  • Learning about the warning signs related to substance misuse and mental health
  • Encouraging people to seek help. Depending on their needs, help varies from talking to a trusted adult (if youth) to inpatient treatment. Talking to someone about their needs is a key first step. 

While I may not be able to bring Junior back, I will continue to fight this battle on his behalf. This type of loss, due to substance misuse and mental health challenges, leaves an enormous void that never really goes away. But, we can all do our part and our best to prevent it from happening to others.


Claudia-Santi F. Fernandes, Ed.D., LPC is an adolescent and young adult health promotion and mental health expert with experience in public schools, clinical settings, and research institutions. Currently, Dr. Fernandes is an assistant professor at the Yale School of Medicine, the deputy director of Mental Health & Well-Being at the play2PREVENT Lab, and a subject matter expert at The Jed Foundation (JED). She also practices as a licensed professional counselor and serves on the Board of Directors for the Connecticut Association of School-Based Health Centers and Society of Public Health Education (CT Chapter).

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