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Ask an Expert: What Can I Do For My Son When He Returns From Rehab?

Today's question is on how a mother can help after her teenage son returns from rehab. Send your questions to editor@thefix.com with the subject "Ask an Expert."

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By The Fix staff

06/23/14

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Send your anonymous questions to the expert panel at editor@thefix.com with the subject "Ask an Expert."  Click here for full bios of our Experts. And click here for earlier Q&A.

Question of the Day (Scroll down for previous Q & A).  

EDITOR'S NOTE: "Ask An Expert" is guidance for the general public and expert responses are not to be construed as doctor/patient relationships, which require private and extensive consultation.

Hello, I am a recent mother of a teenage addict to marijuana and alcohol. My son will be going to a treatment facility for six months out of state. He was a sophomore in high school, but didn’t pass his sophomore year. I'd appreciate any suggestions about how to work with him when he returns home. I know its going to be a tough road ahead but I will do what I can to help him. I would greatly appreciate any suggestions or insight you may have to help prepare for his return home.

Doreen Maller: As with any and all issues, my general responses here do not replace individual support and should not be considered medical management for any individual or family. Any answers here are for informational purposes only. Personal treatment, interventions and case management are between you and your medical care providers.

That said, as a general rule, treatment is best considered as a family issue and not just rehabilitation for the child. Most programs include various aspects of family sessions, family training and psychological education, family support, and peer-to-peer counsel. This might include face-to-face forums, on-line chat and support forums.

Outside of programmatic support, personal support is helpful, including personal therapy, peer support, co-dependency support groups and groups such as NAMI (the National Alliance on Mental Illness), which supports families dealing with the co-occurring disorders of mental illness and substance abuse. 

As your family begins its relationship with recovery, it is important to remember that each person and each family navigates recovery differently. The intention of residential treatment is to return positive control back to the client, teach behavioral and coping skills and create positive alternatives for stress management, addictive behaviors, as well as identify and address underlying emotional issues. It is helpful that family members use the time apart for their own healing, learning and recovery. Find restorative time and rest for yourself, carve out time for positive experiences with other family members, and obtain professional support for yourself if you have not already. Engage in your son’s program, learn about addiction, co-occurring disorders and cross addiction, and fight isolation by participating in peer to peer support.

It is hard to predict re-entry needs this early in your son’s recovery but, in general, moving from a residential program back home is a process that will require additional support. Lining up services for yourself and your child in anticipation of his return can provide a system-of-care safety net.

Residential treatment provides structure 24/7; returning to a less structured environment can be a challenge to all. Setting clear ground rules and expectations should be part of your son’s exit from rehab and of your re-entry protocols, and these should inform your dialogue with your child upon his return. Establishing a clear sense of routine and expectation is important. Some families utilize a step-down process where children return into an intensive outpatient program or a sober living environment before their full return back home. Typically, inpatient programs will provide guidance in these transitions.

Re-entry into the family and home environment can be a particularly triggering time so make sure services are in place for yourself, other family members and your son to cushion the stressors of return.

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Doreen Maller, MFT, PhD, began her practice in community mental health with a specialty in high-risk children and their families, including numerous families coping with addiction issues. Dr. Maller is the series editor of the three-volume Praeger Handbook of Community Mental Health Practice. See  www.doreenmaller.com   Full Bio.

 

Previous Questions


I was talking with a friend the other day about the lack of options especially women ( I feel ) face today in recovery.  I have written a lot on my “getting sober.”  I have written poetry that may or may not get published but helped me get my thoughts from being a tornado in my brain.  I am extremely frustrated by AA and all its suggestions albeit rules. I am just as frustrated that there is nowhere else to go so to speak. I happened upon your site after I told my sponsor that maybe AA isn't for me. 

Who is me?  I am a divorced 49 yr old college educated working professional that drank her way out of an unhappy marriage. Once divorced I tried social drinking only to find all the AA jargon was swirling through my brain and the guilt overpowered me. Once my anxiety kicked in, for added measure, I was back to drinking to stay calm. That doesn't work, it just increases the need of alcohol to keep the anxiety from overpowering my brain for a short while, too short, so I think you can imagine how I ended up. 

Being an eternal optimist I tried several times over the past few years to “social” drink only to have that whole thing happen each time. Today I am 6 months sober and trying desperately to fit in somewhere. I have no idea why I am telling you all of this but I do hope that reading your newly found website can be a tool in helping me find me or at least where I fit in.  - Eileen

Rita Milios: I am so sorry that you have been feeling overwhelmed and frustrated, but I also congratulate you on remaining sober even despite these trying circumstances. Yes, I can understand that AA might not be right for you -  many people report similar experiences as yours, where AA may feel too “regimented “ or that the slogans, intended to be motivating, can be “guilt-inducing” instead.

Please do not give up! As the saying goes, “Sometimes you have to kiss a lot of frogs before you find the prince”…in other words, you may have to try out a number of alternatives before you find the source of support that you feel “fits” you.  And actually, it is a good thing that you have recognized that the dilemma is with “fit” and not with you or your ability to make the changes you desire in your life. Many people give up after trying AA and failing; then they feel that they are without hope and their goals are unachievable. That, however, is certainly not the case.

Below are several of the most promising “alternatives” to AA, with a brief description of each. Perhaps one of these support systems might be a better fit for you. Also, please do not discount the value of individual counseling. Issues such as you describe (unhappiness, anxiety, and frustration with life circumstances) are indeed triggers for drinking, but they do not exist in a vacuum. Unresolved anger, self-doubt and fears are often “residuals” of a failed marriage and lost dreams. Resolving these underlying issues via therapy might be a good option to consider as well.

I wish you all the best! 

Alternatives to AA:

SMART Recovery is recognized by the American Academy of Family Physicians, the Center for Health Care Evaluation, The National Institute on Drug Abuse (NIDA), U.S. Department of Health and Human Services, and the American Society of Addiction Medicine. It offers free face-to-face and online mutual help groups, as well as an online message board.

Women For Sobriety, Inc. is a non-profit organization dedicated to helping women overcome alcoholism and other addictions. It is the first national self-help program specifically for women alcoholics. It does advocate total abstinence.

The Recovery International Method uses cognitive behavioral techniques and psycho-education to teach people to control self-destructive behaviors and change self-defeating attitudes. The Method advocates that learning to change thoughts and behaviors leads to positive changes in attitude…and from there, changes in beliefs follow, resulting in long-term positive change

Rational Recovery provides counseling, guidance, and direct instruction on self-recovery from addiction to alcohol and other drugs through planned, permanent abstinence. The group believes that individuals are on their own in staying sober, so there are no meetings or treatment centers as part of the approach. The website provides information about the method (Addictive Voice Recognition Technique® (AVRT®), frequently asked questions, and other free information.

Moderation Management (MM) is a behavioral change program and national support group network for people concerned about their drinking and who desire to make positive lifestyle changes. MM empowers individuals to accept personal responsibility for choosing and maintaining their own path, whether moderation or abstinence. MM promotes early self-recognition of risky drinking behavior, when moderate drinking is a more easily achievable goal.

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Rita Milios, LCSW, is a psychotherapist in private practice, author of more than 30 books, and frequent professional lecturer and on-camera expert. She also facilitates workshops and training for clinicians, therapists, writers, holistic practitioners, businesses and associations. She is known as "The Mind Mentor" because of her unique approach to “mind tools training." RitaMilios.linktoexpert.com   Full Bio.

 

I am a binge eater. Every two or three months or so I go into a panic and can't stop eating. Therapy hasn't helped yet.  I read the medical literature and know this is dangerous and that there are millions of us who have the same problem.  What's your suggestions about what I should do?

Stacey Rosenfeld: There are a few ways to address binge eating. Therapy isn't an overnight solution, so while I understand your impatience, I'd encourage you to give it some time. That said, I'd make sure you and your therapist are working from an evidence-based model - using techniques from cognitive-behavior therapy and perhaps some skills from dialectical behavior therapy - to help get you on your way.

Have you noticed what seems to lead to your binges? One helpful technique is keeping a log of the episodes. This allows your to keep track of some of the patterns that might occur around them. If you binge, try not to beat yourself up for the behavior. Instead, use it as a data collection experience. Make careful notes on what was going on prior to the binge episode. Do you tend to binge when overly hungry, when you didn't get enough sleep, when stressed at work, after you've had an argument? What seems to precede the panic you mention? 

Looking for some of the precursors to the episodes might help you address them over time. Speaking of hunger, we know that a common trigger for overeating is under-eating. Are you dieting or otherwise restricting your food? If so, I'd discourage this and encourage you to flesh out your intake so that you're eating three meals a day and likely 1-3 snacks. People who binge often skip meals - make sure that you're keeping yourself fueled throughout the day. If you need help with meal ideas, I might consult with a dietitian who specializes in eating disorders. In any case, make sure you aren't ignoring hunger - again, this can be a big trigger for a binge. 

Are there certain foods that tend to trigger your binges? I wouldn't eliminate these foods from your diet - this only tends to result in an experience of deprivation that can further trigger binge eating. However, I might be mindful of how you interact with these trigger foods. For instance, if you tend to binge on bread, you can practice eating bread in moderate amounts (e.g., ordering a sandwich at a restaurant), but you might decide that keeping a loaf of bread in the house might be too difficult at this point in your treatment.

Do you find your binge episodes are a way to cope with difficult emotions? If so, you might want to work with your therapist on alternate ways of experiencing and expressing these emotions. Sometime people will experience the urge to binge as a wave, which ultimately will die down if they sufficiently distract themselves and engage in an alternately soothing or tension-relieving behavior. Again, none of this will work if you're trying to restrict your food - the binges can be your body's way of keeping you nourished. 

Finally, many people who suffer from binge eating are concerned about the weight implications of their behavior. Most of us who treat eating disorders have found that successful recovery efforts typically involve putting weight-loss or weight-maintenance as a goal aside and instead focusing on developing a healthy relationship with food as the primary goal.

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Stacey Rosenfeld, PhD, is a clinical psychologist who treats patients with eating disorders, anxiety/depression, substance use issues, and relationship difficulties. A certified group psychotherapist, she has worked at Columbia University Medical Center in NYC and at UCLA in Los Angeles and is a member of three eating disorder associations. The author of the highly- praised Does Every Woman Have an Eating Disorder? Challenging Our Nation's Fixation with Food and Weight, she is often interviewed by media outlets as an expert in the field. www.staceyrosenfeld.com   Full Bio.

 

When my grandmother was dying, I only showed up once, and I stole her pain meds. Now I'm sober, and on Step 9; how do you make amends to someone who's dead?

Jay Westbrook: Great question - I believe this is a situation that calls for both a living amends and a direct amends.

For the living amends, as you go forward in life, simply do two things. First, show up whenever someone in your family (however you define “family”) is sick or dying, and show up with both the attitude and behaviors of service. Second, stop stealing, and not just pain meds or money or stuff. Stop stealing people’s trust, time, emotions, joy, and peace of mind.

For the direct amends, write out a formal amends to your grandmother, saying everything you would say if you were making that amends to her face-to-face. Then, you can do one of several things. You can go to her gravesite, and read the letter to her. Or, you could take the letter outside at dusk, burn it, and watch the smoke drift up towards the sky. Or you could do both – read the letter at her grave, and then burn it, setting an intention that she receive the message.

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G Jay Westbrook, M.S-Gerontology., R.N, is a multiple award-winning clinician (Nurse of the Year), Visiting Faculty Scholar at Harvard Medical School, speaker and author who specializes in both substance abuse recovery and End-of-Life care and is an expert in Grief Recovery©. He has both consulted to and served as a clinician in multiple treatment centers and hospitals, guiding clients through their grief, and working with them and their families on healing broken relationships. His lectures to physicians and nurses include trainings in When Your Patient is a Substance Abuser: Currently or Historically. He can be reached at CompassionateJourney@hotmail.com. Full Bio.

 

Click to read our Previously Asked Questions. Your anonymous questions can be submitted to editor@thefix.com

 


Our panel of experts. Click for full bios. 

Patrick J. Carnes, PhD, CAS, is the best-known sexual addiction expert in the country. An expert in all addictions, he is the founder of the therapist-training International Institute for Trauma and Addiction Professionals (IITAP) in Arizona, of Gentle Path Press and of the 12-step based Twelve Principles Online Recovery program. He also created the Gentle Path Program, a residential treatment program for sexual addiction. 
Tessie Castillo is the Advocacy and Communications Coordinator at the North Carolina Harm Reduction Coalition, a leading public health and drug policy reform organization in the Southern United States. She is an expert on harm reduction, overdose prevention and response, naloxone, the drug war, and policy reform.  
Lance Dodes, MD, has been Director of the substance abuse treatment unit of Harvard’s McLean Hospital, Director of the alcoholism treatment unit at Spaulding Rehabilitation Hospital and Director of the Boston Center for Problem Gambling. His books, The Heart of AddictionBreaking Addiction: A 7-Step Handbook for Ending Any Addiction and The Sober Truth, have been described as revolutionary advances in understanding how addictions work.
Brian Donohue has an MA degree from Long Island University in clinical psychology, and has worked in private practice as a therapist with a loosely Jungian perspective and as a meditation teacher. He has worked with depressed people, anxious people, and people undergoing major life changes, challenges, and crises. See briandonohue.org.
Janice Dorn, MD, PhD, specializes in psychiatry, addiction psychiatry and addiction medicine. She holds a PhD in Anatomy and has done extensive research and teaching in brain anatomy and physiology. She is also an expert on addiction to stock trading and on stock trading itself. Her second book, Mind, Money and Markets, with co-author Dave Harder, is scheduled for publication in the fall. 
Doreen Maller, MFT, PhD, began her practice in community mental health with a specialty in high-risk children and their families, including numerous families coping with addiction issues. Dr. Maller is the series editor of the three-volume Praeger Handbook of Community Mental Health Practice. See  www.doreenmaller.com
Rita Milios, LCSW, is a psychotherapist in private practice, author of more than 30 books, and frequent professional lecturer and on-camera expert. She also facilitates workshops and training for clinicians, therapists, writers, holistic practitioners, businesses and associations. She is known as "The Mind Mentor" because of her unique approach to “mind tools training.”  RitaMilios.linktoexpert.com
Larissa Mooney, MD, is the Director of the Addiction Medicine Clinic at University of California, Los Angeles, and is a board certified addiction psychiatrist with expertise in the treatment of substance use disorders and psychiatric co-occurring disorders. She is also Assistant Clinical Professor of Psychiatry at UCLA. www.LarissaMooneyMD.com 
John C. Norcross, PhD, is the author of the critically acclaimed book Changeology  as well as co-writer or editor of 19 other books. He is Distinguished Professor of Psychology at the University of Scranton and Adjunct Professor of Psychiatry at SUNY Upstate Medical University. His ideas have been incorporated into addiction treatment by many therapists. 
Harold Owens is Senior Director of the MusiCares/MAP FUND, the charity arm of the National Academy of Recording Arts & Sciences (the GRAMMY organization). He is responsible for the implementation of all aspects of the MusiCares addiction recovery program for artists. Earlier, for three years, he was Program Director of The Exodus Recovery Center. He can be reached at harold@grammy.com.

Stanton Peele, PhD and attorney, is an innovator in the field of addiction, beginning with his breakthrough 1975 book, Love and Addiction (written with Archie Brodsky) and followed by 11 others, most recently Recover! Stop Thinking Like an Addict. He has created his own rehab program (The Life Process Program) for individual substance abusers. See www.peele.net and his Facebook and Twitter.

Stacey Rosenfeld, PhD, is a clinical psychologist who treats patients with eating disorders, anxiety/depression, substance use issues, and relationship difficulties. A certified group psychotherapist, she has worked at Columbia University Medical Center in NYC and at UCLA in Los Angeles and is a member of three eating disorder associations. The author of the highly- praised Does Every Woman Have an Eating Disorder? Challenging Our Nation's Fixation with Food and Weight, she is often interviewed by media outlets as an expert in the field. www.staceyrosenfeld.com

G Jay Westbrook, M.S-Gerontology., R.N, is a multiple award-winning clinician (Nurse of the Year), Visiting Faculty Scholar at Harvard Medical School, speaker and author who specializes in both substance abuse recovery and End-of-Life care and is an expert in Grief Recovery©. He has both consulted to and served as a clinician in multiple treatment centers and hospitals, guiding clients through their grief, and working with them and their families on healing broken relationships. His lectures to physicians and nurses include trainings in When Your Patient is a Substance Abuser: Currently or Historically. He can be reached at CompassionateJourney@hotmail.com.

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