Ask an Expert: Should I Keep Paying For My Chronic Relapser Son?
Today's question is on whether it's a good idea to keep paying for rehab and treatment for a son who constantly relapses. Send your questions to firstname.lastname@example.org with the subject "Ask an Expert."
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How many times should I pay for help for my 24 year old son? He keeps relapsing, then keeps asking for help. Even though I have the money, it's me who need the help at this point. The treatment centers of course want me to stay with it, but this is not working and I am not sure where to turn and would appreciate some perspective here. - Serena.
Roland Williams: First of all, thanks for the question and let me be honest and up front and say I myself am a big advocate of treatment. So, admittedly I may not be the most objective person to comment here. But let me tell you why I feel this way.I have been working full-time since December 1986 in the field of addiction treatment. I’ve worked as a counselor, a teacher, a program developer, a consultant and as the Director of a few addiction treatment centers, which is what I continue to this day. I know treatment works and I’ve seen so many people get their life back as a direct result of having gone to treatment.
I also know what a terrible foe addiction is to those who fight it, I’ve seen the devastation and heartbreak as families struggle trying to make sense of the insanity and mayhem that goes with this disease. I have seen way too many people lose the fight against their addiction, good people, people with potential, and people with families and friends that love them. I know personally how hard it is to get clean and then stay clean. But I can tell you it can be done.
Most people who try to get clean and sober do fail, that is a fact, but millions of addicts and alcoholics world-wide have found a solution to their addiction, and treatment is often but not always part of that process. I know that most people who are successful in their Recovery have been to multiple treatment centers before it all “clicks” in their head and they have that “moment of clarity.” A relapse does not mean a person failed; it means they need more tools, It is very possible that your son may not have found the right treatment program for him yet. I am encouraged that he “keeps asking for help.” I’d be really concerned when he “throws in the towel” and surrenders to his addiction permanently. Each time he goes to treatment, to 12 Step meetings, to a therapy session, and even talks with you… seeds of Recovery are planted. It may take a while for those seeds to take root, but we should all continue to plant them.
My opinion is as long as he keeps asking for help and you can afford it, I would suggest continue to offer him the option of a treatment program. It’s actually pretty remarkable that a 24-year- old, is repeatedly asking for help to get clean and sober. Now, you may need some help in selecting the most appropriate program for your son, and a good, objective addictions counselor should be able assist you there. If you have trouble finding someone, give me a call. It helps for the counselor to know more about the specific issues your son struggles with, and what are the primary reasons he seems to relapse. Based on those findings it would be easier to select a program that might have the best chances for long term success. And the cost of the program is not necessarily a good indicator of the quality of the treatment so beware.
As for the help that you need, I would recommend an individual therapist who understands addiction, and also Al-Anon and/or Nar-Anon, both great, (and free) programs for people in relationships with alcoholics/addicts. Most of all, don’t give up. If it happened for so many others, it can happen for him. I’m crossing my fingers that he finds his way and that you get some peace. Thanks. - Roland
Roland Williams, MA, is an internationally recognized addiction interventionist, author, educator, trainer, counselor and consultant. He heads www.rolandwilliamsconsulting.com and is Director of Clinical Operations at DARA Thailand (www.dararehab.com) and Clinical Director at Lionrock Recovery’s (www.lionrockrecovery.com) Online Intensive Outpatient program. He has provided treatment and program development consultation to major institutions around the world. A popular keynote speaker, he authored Relapse Prevention Counseling for African Americans, Relapse Warning Signs for African Americans (with Terence T. Gorski), and the Relapse Prevention Workbook for African Americans. Full Bio.
I have been really conflicted for the past two years. I got into cocaine about 10 years ago. It started off fun and then progressed. Drinking has always accompanied my use. I indulge in anything that gives me momentary happiness. I've never really known how to moderate. Typically, I have to burn out in order to stop. I believe that's what happened two years ago when I entered an outpatient rehab. I was becoming increasingly paranoid and I was terrified. I was happy to discover that once I quit the drugs, the paranoia went away. Needing to give up the drugs was obvious; however, the idea that I could not drink socially left me very conflicted.
I stayed sober for a while and then started drinking again, only to end up doing coke on a regular basis and ending up putting myself in risky sexual situations. I scared myself enough to enter a 28 day rehab. I stayed sober for about 5 months. I got bored. I now drink moderately and I have slipped into doing coke every once in a while. I've been completely sober for the past 10 days. I would like to have periods of sobriety and periods of social drinking. Is this delusional of me to think that I can drink moderately?
A part of me feels that my actions were just apart of my young age. I feel like I have become much more responsible. I have a good job, I work out, I try and live a mostly healthy lifestyle, and I'm trying to develop healthy relationships with my family and friends. Having been in recovery and a treatment facility, I feel very guilty wanting to drink socially (not very often). I do not know if I'm in denial. - Said.
Rita Milios: You are certainly not alone in feeling resistant to the idea of having to remain completely abstinent from alcohol for the rest of your life. This kind of denial of a previously rewarding behavior sets up a competition between your logical, thinking brain and your inner subconscious mind. Your inner self is resistant to accepting the idea that deprivation will be your constant companion. You need to first re-train your inner mind that it is not really deprivation you are embracing, but rather a more balanced, healthy and life-enhancing (vs. self-destructive) mindset. If you can realign both your inner and outer mind parts so that they no longer feel in competition with regard to your intentions, you will be off to a good start.
You mention some positive new habits that you are working on establishing….a healthier lifestyle, healthy relationships. Continue reinforcing these and add more such positive habits; and with diligence, honesty (with yourself and others) and commitment, you may just be able to pull off what you desire…to obtain what is called “moderation management” in regards to drinking. (Note this method is for drinking only….not other drugs …so yes, you will need to give those up.)
Moderation Management is not for everyone. It requires that you monitor yourself and be responsible and dedicated about making sensible choices. According to the website, www.moderation.org, “ 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. MM is run by lay members who came to the organization to resolve personal issues and stayed to help others.”
The MM website offers an online forum, online alcohol-drinking limit guidelines, and an online calendar where users can report their drinking. There is a book about MM that can be ordered from the website. Face-to-face meetings also take place in certain geographic areas; a listing of in-person meetings can be found on the website as well.
There is some research that suggests that MM is helpful for reducing both overall drinking behavior and problems associated with drinking. You can read about one such study, in Psychology Today’s online blog “All About Addiction” (March 9, 2011). You can also find information about MM at the government’s Substance Abuse and Mental Health Services Association (SAMHSA) website.
These are excellent resources for you, should you decide to go this route. But the bottom line is that you are the most relevant factor in determining your success or failure. If you take responsibility for your choices and use the tools that are available to you, you could attain your goal. But be aware of the slippery slope of habit and the risk of “inch by inch” returning to old patterns. You must be diligent and determined in order to overcome these risks…yet it is possible.
Good luck. Feel free to report back regarding your results.
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.
Two months ago I was diagnosed with diabetes, type 2, and my doctors put me on a disgusting strict diet. Why I look to you is I am a sugar freak - and yes, I am overweight and my booty is huge. I am down with sugary food and sweets big time and can't stop the craving for it. The doctors said I had to cut my carbs and eat a lot less sugar and I am trying but I have to say I am a mess and can't stop grabbing at the sweets. What do you offer that might get me out of this before it kills me? My doctors seem to just expect me to stop and I can't and they don't get it. I live in a small town and know about the Fix because my BF is in recovery and suggested I write you. He thinks I am addicted to sugar. - Dolores
Stacey Rosenfeld: The jury's still out on the concept of sugar addiction, as there really isn't good evidence for this concept in humans. That said, you could certainly be used to a substantial amount of sugar, and cutting back can be difficult. Typically with food issues, we recommend intuitive eating - allowing yourself to eat what you crave - toward the goal of reducing the experience of deprivation (which can trigger increased cravings and overeating). In cases of medical illness, however, intuitive eating may need to be modified to allow for doctor's recommendations.
How do you feel after you eat sugar? My guess is, because of your diabetes, not great. Is there any way you could try to change your intake based on this negative feeling, so that it doesn't feel like you're depriving yourself of sweets, but rather, listening to your body? I would also recommend consulting with a dietitian who specializes in diabetes - a professional can help you flesh out a meal plan so that you don't miss modifications as much. For instance, there may be a way to integrate certain types of diabetes-friendly carbohydrates in your diet, which can satisfy you and help ward off sugar cravings.
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.
I want to get off my meds (Paxil) and frankly, just smoke marijuana when I get in a bad mood. Paxil scares me because I think I am dependent on it and I read about how hard it is to kick. I have been on it for only a year and want off even if I have to go through withdrawal as if I was on heroin. I think I can handle it. So what’s the best way to detox from it? What should I be taking as I cut back? I need to ask because my doctor is telling me not to do it and I don’t trust him. I am going to do this no matter what and I just want some guidance about it. - Jeremy
Lance Dodes: There are several reasons why your plan is not good for you, Jeremy. First, I assume there was some reason your doctor prescribed Paxil. Whatever that reason was, marijuana is not a treatment for it. Marijuana has important medical uses, including treatment of pain, nausea, and glaucoma, but none of these overlap with indications for Paxil. Second, it is always wise to discuss changes in treatment plans with your doctor. You may be feeling better and no longer need the medicine, but that would be part of the discussion, as well as reviewing your diagnosis and how your doctor understands the basis for your problem. Other questions would be whether there are other treatments, or treatment modalities (such as psychotherapy), that you should consider instead of, or in addition to, medication, and any risks of stopping.
Your doctor should answer any questions or concerns that you have, including a respectful conversation about your distrust of him or her. If, following this discussion, you believe that the advice you get is not based on adequate knowledge, then you owe it to yourself to obtain a second opinion from another doctor, rather than stopping on your own.
Lastly, your fear that you are "dependent" on Paxil is unrealistic. It's true there is a discontinuation syndrome, but it's not possible to be physically addicted to Paxil in the way people can become physically addicted to heroin. Narcotic physical addiction involves becoming tolerant to the effects of the drug. That's not seen with Paxil or the other SSRIs. Consequently, the SSRI withdrawal symptoms (irritability, flu-like feelings, etc.) are far less severe than narcotic withdrawal, and fear of withdrawal is not a sensible reason to stop taking them. If what you're describing is more an emotional sense of dependence, that's something to talk with your doctor or therapist about, rather than acting on it. Give yourself a chance to consider this decision with whatever doctors you choose, but not on your own.
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 Addiction, Breaking Addiction: A 7-Step Handbook for Ending Any Addiction and The Sober Truth, have been described as revolutionary advances in understanding how addictions work. Full Bio.
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 Addiction, Breaking 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 email@example.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.
|Roland Williams, MA, is an internationally recognized addiction interventionist, author, educator, trainer, counselor and consultant. He heads www.rolandwilliamsconsulting.com and is Director of Clinical Operations at DARA Thailand (www.dararehab.com) and Clinical Director at Lionrock Recovery’s (www.lionrockrecovery.com) Online Intensive Outpatient program. He has provided treatment and program development consultation to major institutions around the world. A popular keynote speaker, he authored Relapse Prevention Counseling for African Americans, Relapse Warning Signs for African Americans (with Terence T. Gorski), and the Relapse Prevention Workbook for African Americans.|