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Ask an Expert: Previous Questions and Answers

By The Fix staff

07/01/14

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NOTE TO READERS: Your anonymous questions to the expert panel can be sent to editor@thefix.com.  Click here for full bios of our Experts.


My mother was a meth addict when she was young. Then she did a lot of ecstasy and, for a while, heroin. Now she smokes pot every day. My issue is she is extremely abusive and controlling even if also loving. I know it makes no sense. I have been on my own for years now -  I am 24 and doing well on my job and did very well in college  -  and I find myself having to avoid her because she won't stop the abusiveness and still tries to control me. I am not sure how to handle this as I want a good relationship with her. She did one round of recovery and won't do another, by the way. What do you think I should do?  -  Glenna

Rita Milios: Glenna: I know it seems like a no-win situation, when you have your mother behaving the way she is and you still desire to have a positive relationship with her. However, there is an aspect of this situation that you have perhaps not considered. A relationship is a two-way street; you cannot create a positive relationship with anyone (relative or otherwise) if they do not do their part. So, as it stands, you have pretty much zero chance of making the mother-daughter relationship you desire happen. And this is not your fault. So please do not become overly sensitive about your mom’s current choices regarding her interactions with you. She is making choices based on her agenda, not yours, and these choices have little to do with your worthiness as a daughter. Perhaps she feels that you are judging her and she is reacting to this. But whatever her reason, it is not about you…it is about her.

The best thing you can do, actually, is what you are doing–avoid her until or unless she behaves more appropriately toward you. If someone does not treat your gift of friendship/companionship with respect and appreciation, you do not have to continue to give that gift. If you do, you are actually contributing to the problem in several ways:

First of all, you teach people how to treat you. In allowing and accepting her abuse, you are teaching your mom that her abuse is something that you are willing to tolerate, and she therefore has no incentive to stop offering it up. 

Secondly, your acceptance further serves your mom’s purpose because it validates this kind of behavior in her eyes (If you accept it, you must agree that you deserve it, so therefore it is okay that she abuses you). 

Finally, because you are, in effect, validating her abusive behavior, you are contributing to your mom’s development of bad character. You are teaching her that being an abuser works for her and serves her agenda (to not accept responsibility for her bad behavior, but to blame it on you). Neither of these attitudes is helpful to your mom. 

So, in the end, only by taking a stand for your own right to be treated well, can you ever hope to achieve your goal of having a positive relationship with your mom. At this time, she likely does not have a positive relationship with herself, so it is highly unlikely that she can maintain one with you. If, however, you teach her that her bad behavior has consequences, and that you will not tolerate abuse, you can possibly help her learn a better way to deal with you and other people in her life. It is not a guarantee, but it is the only thing you can do to help. The rest is up to her; so do not take ownership of it. Even though it is painful, it is often better to remove yourself from a toxic relationship, rather than allow it to poison your life as well as the one who is generating the toxins.

I hope this helps, and that in time, your mom will become whole and healed.

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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 will keep this brief. I am 19 years old and in my second year in college. My dad who I lived with the last three years takes care of this cost. My mother is a functioning heroin addict (for four years) who has finally gone on methadone maintenance and who always begs me to visit her, though between her rages and her stonenedness, I haven’t been willing to see her for 3.5 years. Now she says she is clean and is begging me to visit her or to come visit me in school. My father says I should make her wait. I am torn. I found your website and decided to see what you had to say either about exactly what I should do or how to get the information I need to make the decision. Thank you. - Kathy 

Janice Dorn: Hi Kathy,

This is just a totally awful conflict for you.  You have to choose between your mother and your father. No person should have to do that. Not in this day and age when—perhaps more than at any times in history—children need both parents. OK.  Maybe you are not exactly a child. You are a young woman. Nineteen years old.  However, you are dependent on your Dad for money to pay for your college education and room and board. This is a good thing to do, and you are fortunate that you have him. I hope you get through college and do something wonderful and productive with your life.  

That said, you know about money and control. The person that has the money almost always has the control. So, your Dad is in charge right now. He is sacrificing so that you can do to college. You don’t want to upset him in any way. He wants you to “wait” to see your mother.

I am not exactly sure what “wait” means, but, perhaps, this would be a good place to start.  If you really want to see your mother, you must first talk to your father. Ask him exactly what he means by “wait.” How long? Days, months, weeks, never? This is a critical thing to know.  

Whatever he tells you is what you should abide by until you are out of college and on your way to a career. I don’t usually talk like this to young people because I believe in their (your) autonomy and ability to make decent decisions. However—in your case, the most important thing for you is to finish your education and begin your career.  Once you are independent financially, everything will change for you.

So- what is the bottom line: 

You have two options in terms of seeing your mother—Either you see her or you don’t. Right now, I suggest you don’t. Why? Because your Dad doesn’t want you to, your Dad is supporting you and you really need to finish college, get on your own and build a life and a career for yourself.

Perhaps the best thing would be to tell your Mom that you would love to see her but you really cannot take the chance to do it right now. You need your Dad to support you and get you through your education. Talk to your Dad. Run everything by him. Approach him with totally rigorous honesty and don’t hedge or pretend. If you are talking with your mother, tell him everything. Ask him if he would have any issues with your speaking to your Mom on the phone, SKYPE or texting her. If he says “No”—then the answer is “No.” Tell your mother that you would like to see her but have to wait until you are finished with college and on your own. See if you can work out something so that you can continue communication with her while you finish your college work.

I think it’s possible that if you have a totally honest conversation with your Dad, he may agree to let you at least SKYPE or text with her. Your Dad is in charge right now and it’s important that you respect that. Your Mom is pretty much an unknown in terms of her degree of sobriety or recovery. In the final analysis, I think it’s critical that you choose yourself. Finish your education, get a good job, and become independent so that you don’t need anyone to support you. Then, you can make the decision if you want to continue the relationships with your Mom and Dad—and at what level.

Sometimes in life, it becomes important to put you first. In fact, you may find something quite magical happens when you put “YOU” first. Everything falls into place. Things that you never thought would or could happen actually do happen.  People begin to respect you for the woman you are and the woman you are becoming.  

There is a wonderful wisdom-filled poem called “After A While” by Veronica A. Shoffstall. Google it. If I were your age, I would memorize it and print it out and keep it with me all the time. 

I send warmest wishes and much strength to you. I hope that you will come to understand that there is a time and a place for everyone and everything. Right now, it’s YOUR time. Go for it; stand in your truth and your integrity. Get your education and find something to do that you truly love. Once you do that, you will truly know a new freedom and a new happiness. Decisions that  once seemed so difficult will no longer be that way. You will be free to choose and find what is right for you. 

There is hope!

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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. Full Bio.

 

We are a Persian family in this country for 20 years.  I came here when I was 11 and  so mostly grew up with an American sensibility and have studied some psychology, though that is not my profession (I am a sales person).  Most of the immigrant Persian families I know are very tightly knit and keep this going partially by being very judgmental, blaming and emotionally controlling of each other. They all the speak the “you should” language. This is not unique by any means to Persians, and I recognize it was a survival system in the old country. The issue now is that the full weight of this way of relating is being slammed at my cousin, who we recently learned is addicted to methamphetamines. I don’t know how to get through to most of the family that he needs our support and not blame and condemnation, with almost everyone in the extended family defending themselves that they did nothing to create the situation for him.  I am pretty lost about what to do here to turn this around and asking for any guidance you can give. – Adar

Doreen Maller: Thank you so much for this question, I think issues of blame, shame and stigma arise in many families regardless of cultural background as you mentioned, and are very typical responses that tend to bubble up in families during times of crisis.  I appreciate your concern for your cousin and your desire to connect with your family to move beyond their initial response of blame and defense toward a more generative response of support and education.

Methamphetamine has its own culture.  Its use, abuse and addiction can be devastating to individuals and families and its culture of use can distance family members through concern, fear and secrecy.  Recovery from a meth addiction takes time and care; your cousin has a journey ahead, which will include physical and emotional recoveries.  As noted in your question, there are aspects of recovery that impact the family as well.   Here is a link to some information about methamphetamine.

Family therapy which can be a component of many recovery models provides support for the family toward education regarding drug use, abuse and addiction in general and for this substance in particular and also can provide support as the family comes to terms with their own healing.  Compassion for each other and an understanding of recovery as a process can be helpful.

One of the tools that I have found particularly useful is the Prochaska & Diclemente Model of Change.  This model illustrates the nuanced stages a person passes through as they incorporate change into their lives.  From a family systems point of view, all family members are in need of aspects of recovery.  This model breaks down that journey into the following steps:

Pre-contemplation:  The individual is not even contemplating changing behaviors and has no plan

Contemplation: The individual is considering making changes in their lives

Preparation:  The individual is pulling together the team, tools or considerations necessary for change to occur

Action:  The individual is actively working on change and incorporating elements of change in their lives

Maintenance:  Change has been incorporated into a person’s life and while support might still be necessary, a new way of being is somewhat dependable.

There is a caveat to this model that notes that relapse is possible at every step.

As a family therapist I use this model in numerous ways, not the least of which is to remind myself that change takes time, has many elements and that there are quite a few steps necessary before “Action,” also, that relapse may be part of the process and should be considered as possible rather than a surprise if it occurs. The goal at each stage (including relapse) is to remember that this is a generative model that moves forward with possibilities of hope and sustainable change.

From a family-systems perspective, when one member enters recovery it is important to remember that everyone in the family is in a cycle of change.  From that point of view, I find it helpful to introduce the “Wheel of Change” and take an inventory on where each family member may be on his or her own change process.  Often family members will find themselves to be in very different places; one may be assuming “Action” while another may still be in “Contemplation.”  Understanding that we all are paced differently and that we have individual journeys as well as collective journeys can yield ripe conversation and deepen a family’s understanding of themselves as individuals and their collective relationships.  Therapists believe that this kind of insight can deepen family trust, support and relationships and that accepting differences can lead toward realistic support and healing through the recovery process.

You can find an in depth free power-point of this model here.

I hope your cousin finds a program that works for them and that your family finds the support it needs at this time.  A quick Google search can yield results in many communities for Family and Individual support for families in recovery.

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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.

 

I am curious about substituting one drug for another milder one. I had a bout with cocaine, won it, then did a round with meth and was lucky to just about escape it by going for an early detox. I have a friend who got clean of an early heroin habit (snorting) and now swears that his salvation is pot. He seems to function pretty well. I have another friend who my take is he is addicted to pot and he doesn't function that well at all but that may be him and not the pot. I have still another friend who did coke a lot and now medicates with porn. A woman I know went from smack to ecstasy. (We're all mostly in a music circle, by the way, so drugs are all around us.) I've read about moderation management and it could be that this is their form of moderation management. Me, I think a couple of beers and a toke or so are helpful to me as I no longer seem to crave the heavier stuff. Most of us are now in our mid thirties and have a sense that our habits won't get worse and may taper off with age. So, are we deluding ourselves? Am I deluding myself, or are we on some natural moderation management path and shouldn't worry about it? I am making a living and am functional myself and am not doing any programs. - Ted

John C. Norcross: Dear Curious Ted, here’s what we can say with clinical and scientific certainty: Some folks can successfully moderate their addictions, and some folks cannot, requiring abstinence. Some folks can replace a serious substance addiction with a milder substance and function well, but many others cannot. Most substance addictions do taper off with age, but many addicts never make it to later years because of early deaths and the health ravages of their addictions.

You beautifully capture the dilemma of every substance abuser and treatment professional: In this particular case, is this safe moderation or is this massive rationalization? A natural course of recovery or delusional denial? 

Four guidelines can help you differentiate between the two. 

1. Level of functioning: Glad to hear that you are making a living and functioning well. Would you function substantially better without those few beers and an occasional toke? For those functioning well, moderation may be the sensible path. But for those who try to moderate and continue to struggle, abstinence is the preferred route. 

2. Others’ observations: Addiction robs us of clear thinking and accurate self-awareness, so our appraisals need to be strengthened with observations from other, unbiased people. What would good friends, mental health professionals, and coworkers (not heavily involved in drugs themselves) say about your current use and functioning? Please do not rely entirely on your own analysis; obtain some feedback from trustworthy sources. 

3. Intensity of craving and use: This is an obvious defining point. If you hanker constantly for the substance and your life revolves around it, then moderation, at least at this point, is contraindicated. But if the beers are indeed occasional and unnecessary, then moderation is indeed possible. 

4. Defensiveness: A cardinal feature of active addiction is defensiveness about the topic, the substances, and their consequences. How openly and honestly one can discuss these topics marks a line between those caught in denial and minimization, on the one hand, and those aware of various healing paths, on the other. I am impressed that you are asking these important questions about addiction and recovery; that’s a favorable sign for moderation management, as long as it does not deteriorate into an intellectual defense. 

So, Ted, take a fearless inventory of your functioning, request that trustworthy people offer their observations, gauge the intensity of your cravings, and determine your level of openness. Those answers will assist you in determining whether moderation management can work for you.

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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. Full Bio.

 

I went through rehab four years ago and have been doing pretty well. Recently my mother who is a very difficult person got sick and I took a leave of absence from my job to take care of her. It is oh my God stressful, with lots of nasty comments from her that bring up my childhood issues. I am resisting medicating (I was a downer person and drank). I live in the Bay area and there are two therapists here my friends rave about and go to who take their patients on guided journeys with Ecstasy (they say it is very good MDMA). Both my friends have made a lot of progress with therapy on E and both say I should go and one says I should take my mother. I'd like to get the thoughts of one of your experts who knows a lot about pharmacology as well as therapy. Thank you. - Melissa

Larissa Mooney: Melissa, there has been considerable interest in the use of MDMA to facilitate psychotherapy; recent research has focused on the potential utility of MDMA to augment therapy for post-traumatic stress disorder (PSTD) and anxiety disorders. However, though your friends have had a positive experience with MDMA-guided therapy, MDMA is not approved for this purpose and we do not have sufficient data or regulations to recommend this approach. My initial suggestion is to schedule a clinical evaluation with an addiction psychiatrist to thoroughly evaluate your symptoms and treatment options. There may be other treatments available to help you that pose less risk. I would caution against basing personal decisions on anecdotal reports from friends or loved ones, because individuals may vary widely in their responses to any treatment.  We do not yet know the range of experiences or risks to individuals who participate in MDMA-assisted psychotherapy.

MDMA has serotonergic effects that cause a sense of euphoria, alertness, empathy, and pro-social feelings and behaviors (e.g. friendliness, openness, confidence, and closeness) after use.  MDMA use may also initially improve feelings of trust and dampen fear. In combination, these psychological effects may have clinical benefit in therapy, and preliminary evidence has been demonstrated for MDMA in the treatment of PTSD. However, negative effects of MDMA include jaw clenching and other medical consequences as well as feelings of sadness and distrust several days after use, consistent with effects of serotonin depletion. More research including larger trials would be necessary to delineate the range of potential benefits and consequences of MDMA-assisted therapy.

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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     Full Bio.

 

I have been in recovery (from cocaine and booze) for 12 years with just one six-months relapse after a breakup eight years ago. Now I am just beginning with another breakup and while I am stronger, I am on the shit end of this one again and feeling very bad. I am not a 12-stepper and didn't relate when I tried it. I'm concerned about how bad the pain will get and whether I will relapse. Any thoughts on how best to fortify my sobriety? I can get some small amount of counseling via my health insurance, but not much, and I am not sure counseling is the answer anyway.- Carlton

Jay Westbrook: I applaud you for recognizing the magnitude of your feelings, and the behaviors in which you might engage to avoid feeling them, and for reaching out for help.  

Break-ups are never easy, even when they are the best choice. We may realize, intellectually, that the relationship is not providing joy for either partner. We may also be aware that the only way to find another person with whom we can share joy is to end the joyless relationship. That being said, we will still experience grief (the normal and natural reaction to loss), hurt, loss of identity, a wounded ego, and possibly anger, bitterness, or regret. None of these are easy to deal with, and they are made more difficult when we are alone.

The first thing I would do, if I found myself in your situation, would be to reach out to my friends in recovery and tell them that I really want to stay clean and sober through this difficult time. I would then ask for their help – hang out with me, keep a watchful eye on me, call me on any BS thinking or behavior you observe in me, and don’t offer me any mind-altering substances.

You stated that you were not a 12-stepper, but that you were in recovery. I’m not sure what that means. Are you clean and sober on your own, or are you part of a non-12-step program?  If you are part of a program, tell them what’s going on and that you’re worried about your recovery being at risk. If not, you may want to go, temporarily, to some 12-step meetings (either Cocaine Anonymous or Alcoholics Anonymous), stand up and ask if anyone in the room has experience with staying clean and sober through a romantic breakup. I’m sure those that do will share their experience with you.

As long as you have insurance, why not see a counselor for whatever number of visits the insurance covers? Tell the counselor you want to explore coping strategies for staying clean and sober through a romantic breakup, and make that the focus of your sessions together. I can’t imagine anything bad coming out of that.

Finally, I was taught two important things about recovery: 1) there is no situation so good, that it can’t be destroyed by getting loaded, and 2) there is no situation so bad, that it can’t be made worse by getting loaded. You will get through this much faster if you’re clean and sober, and you are far more likely to find a new partner with whom you can build a joyful relationship if you are clean and sober. I wish you well Carlton.

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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.

 

I am in the process of kicking opioid pain meds I was taking for my back. I am actually also in a pain management program. So far so good on that front though it is slower than I would want and harder than I would like to readjust. Not so good on the home front where my wife is in turmoil over my mood swings. She almost would prefer I stayed on the meds.

The pain management people say we should do therapy together. She doesn’t want to. Yes, she is being selfish but telling her that puts her in fits. I am thinking about moving out until I am somewhat normalized even though I would hate it and it would really impact my finances and small savings. I thought someone in our group might have some guidance or out of the box ideas here. Any fresh thinking would be appreciated.  - Dean 

Janice Dorn: Hello Dean and thanks for submitting this question. I congratulate you for being in the process of “kicking” the opiates. Also, I think it’s great that you are in a pain management program.

I would like to know a little more about how you are going about getting off the opiates. Is this part of your pain management program? Is it separate and you are under the care of another medical professional for the opiate tapering process? I would also like to know if you have had challenges in your marriage previously related to your mood swings or other issues.   

It’s important to know the answers to these questions before I am able to help you with the issues you are facing with your wife. So, I am going to make the assumption that you are trying to get off the opiates under the direction of a pain management program - not separately. I am also going to assume that this is not the first time you have had issues with mood swings

I think it’s important for you to get a thorough work-up from an Addiction Psychiatrist. I am being quite specific about this in terms of Addiction Psychiatry for several reasons. A good Addiction Psychiatrist will be able to know if the mood swings you are having are the result of opiate withdrawal/discontinuation, or are part of a separate mood condition (such as bipolar disorder or depression). The psychiatrist would also likely have specific  suggestions for you in terms of certain medications that can be used to stabilize your mood. 

In terms of your marriage, it is pretty clear that there are real issues and that they are not going to go away easily. The fact that you say your wife is selfish because she won’t go to therapy with you is not helping at all. This is your issue and you need to fix it. If she is willing to stand by and go through it with you, she is to be congratulated, not made to feel foolish or responsible for a situation that is not of her making. Your sobriety is not the responsibility of your wife. It is yours and you have to own it and stop making it seem as if she (or the two of you as a couple) go for therapy, it will fix everything. It won’t.  In fact, it may make everything worse.

I suggest you focus on you and get the true high-level professional help you need from a seasoned Addiction Psychiatrist who is familiar with all aspects of mood swings and opiate withdrawal. Also, it would seem that time is of the essence for you right now. I would do this as soon as possible. It’s not too late.  You can recover from addiction and your marriage can be saved, but it is going to take action and work. I wish you the best. There is hope!

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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. Full Bio.

 

I have 2 DUI's and the judge assigned me to a treatment program. It is pretty basic and uninteresting. I really need to be driving and can't get another DUI but this program is not going to do much. AA didn't do much and was boring. I don't drink every night but when I do I have a hard time stopping. What other programs are out there that I might get more out of?  Thanks.  - Richard

Tessie Castillo: Dear Richard: If group programs aren’t meeting your needs, then you might consider individual therapy. Substance abuse counselors can work one-on-one with you to create a plan to manage your drinking based on what your personal goals are and what behavioral changes are realistic for you. If your goal is total abstinence, there are counselors who can help you create a plan to achieve that. If your goal is to drink less, you might consider seeing a counselor who specializes in harm reduction or moderation management. Under these methods of treatment, the idea is to work toward any positive behavioral change based on a treatment plan that fits your needs and objectives.

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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.   Full Bio.

 

Are there differences in detox?  My wife has been in and out of treatment for serious alcoholism for several years and then relapses very badly every two or three years. Her physical craving seems to become overwhelming. Over and above insurance I have spent a fortune on this. Also, I am sorry to say, I don't help the situation sometimes by showing my frustration. Recently I have been reading there are a number of forms of detox. I am looking for recommendations about the most effective, maybe something even out of the box, so we can compare it to past detox experiences she has had which have not stopped the physical craving in its tracks. Yes, she is in therapy as well.- Arthur.

Lance Dodes: Arthur, you stated your question as if it is about detox, not rehabilitation facilities, which makes a big difference.  Detoxification from drugs on an inpatient basis is a medical procedure which is basically the same everywhere.  It is not related to the relapses you describe, since once the detoxification is completed (usually no more than a matter of days), there is no more physical addiction. For that reason, your wife's relapses much later are not due to "physical craving." Relapse urges are driven by emotional factors for which drug use is an attempted solution.  The appropriate treatment is to figure out the factors that repeatedly precipitate these urges (I describe this in detail in my book, Breaking Addiction).

If what you are asking about is not detoxification itself, but inpatient rehabilitation programs, then you should understand that the rehab industry is unregulated, so rehabs may offer any kind of unproven treatments and claim any wonderful results they want, without evidence. There is also no reason to think that paying more will get you better treatment. Indeed, the most expensive and well-known facilities charge for such irrelevant "treatments" as horse therapy, "ocean therapy" (a trip on a yacht), aerobic exercise, and more. If you are considering an inpatient rehabilitation stay, 

I would look for a shorter (no more than 2 weeks) and less expensive facility that offers zero horses and does not insist that everyone buy into whatever is their standard program. Ask if most treatment is done in groups or whether there is truly individual therapy, and ask about the academic qualifications of the "therapists." Avoid places that are "12-step-based" unless your wife is in the 5-10% who do well with that approach. Finally, if your wife has had extensive periods of abstinence and not benefitted from longer hospitalization beyond physical detoxification, I would obtain a careful review of her situation before embarking on another inpatient stay.

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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.

 

I am a recovering alcoholic and have been sober for 3 years, 3 months and 8 days. I am also a mum, a wife and a professional. Because of my life and responsibilities I have done much of the work to get sober from home: online (your website is an enormous help to me) and through reading at the library. I have wanted to attend AA but I have small children so it's not possible. My reason for writing today is that in November I have a girls weekend away in another city from where I live. It will be the first time I am away from my children, or my husband for that matter, in sobriety and I am terrified of relapse. It is with friends from childhood, and yes old drinking buddies. Everyone knows I no longer drink but I'm so scared that my brain will just tell me 'go for it' and I'll drink. I truly believe that if I drink again, it will kill me. This situation feels life and death for me and it's making me not want to go on the trip. What advice can you give me on how to handle myself on the trip. I have OCD (the self medication of which led to my addiction) so I'm starting to obsess and all this thinking about drinking is difficult also. 

Your help is greatly appreciated. Kind regards - Barbara

Roland Williams: Hi Barbara. Thanks for your question. t’s a tough one actually, so much comes up for me when I read and re-read your email. You seem to have a lot going on and I don’t want to minimize any of these very important issues in my response. So I think it would be easiest for me to break it down into what I am getting from you. 

  • You are sober and obviously proud of that accomplishment
  • You did most of the work to get sober from home, online and reading at the library
  • You want to attend AA but it’s not possible
  • You have not been away from your children in a long time
  • Your first trip away will be with old friends that drink away from your home 
  • You are afraid that your disease will take over and you might possibly drink
  • You believe that if you drink again it will kill you
  • You are obsessing about thinking about drinking

 

When you look at it like this, it looks overwhelming, doesn’t it? In one short paragraph you outlined a series of very complicated issues, each one could be a separate therapy session. So here’s what I think, in order of how you presented it all. 

First and foremost, protect your 3 years, 3 months and 8+ days of sobriety, at all costs. I’m sure that your ability to be a mum, a wife and a professional are all contingent on you staying sober. If you drink, your ability to be either and all of those becomes compromised. So your Recovery has to be your number one priority - you need it to do all that other good stuff. 

I think it’s great that you were able to get and stay sober primarily from home. However, from your email I can’t determine exactly what your Recovery program looks like in practice. It’s very difficult to achieve Recovery in a vacuum. It’s usually not enough to just stop drinking, because abstinence is not the same as Recovery; it’s a prerequisite for Recovery. It gives you the clarity to do the work you need to do to heal, and I can’t tell what that “Recovery Work” looks like in your life. 

I know Recovery is a fluid process and it changes as we change…. we get older, acquire responsibilities etc. and we have to do whatever we can to keep our Recovery program fresh, current, and applicable to our issues. A lot of people are finding themselves challenged by a working a program that was appropriate in year one, but not so appropriate in year five. 

The fact that you “want” to do AA is encouraging, and if that’s the case, then I would challenge whether it is truly “not possible.” I believe if you wanted to go, you could make it happen, and that might be one of the updates you need in your Recovery program at this time in your life. 

I know a lot of people who don’t want to go to AA. They have many reasons, from philosophical differences, to conflicting schedules, bad experiences, new responsibilities, etc. And certainly a lot of people actually stay sober without AA, but the fact is if you are an alcoholic/addict seeking Recovery and are not going to 12-step meetings, you actually have to work twice as hard to achieve Recovery. AA provides a fellowship, a social network, accountability, a mentor, a set of guidelines for living your life, a sounding board, a routine, a laugh or two and a constant reminder of what to do and what “not to do”… all for free. Without AA a person has to try replicate as many of these things as possible in their lives, and that's not as easy as it sounds. 

The fact that you have not been away from your children in I’m not sure how long implies that your life could use a little balance, some mum time, some wife time, some professional time and some Barbara time. It doesn’t seem as if  you are getting enough Barbara time. So now you are tempted to go away from the city you live in for a “girls weekend” with women you used to drink with, In Relapse Prevention Therapy, we would refer to that as a “High Risk Situation” and the first rule in dealing with a HRS is to ask yourself “do I have to go?” You see we treat any person, place or thing that poses a threat to our Recovery, the same way Superman would treat Kryptonite. 

By your own admission you are afraid that your alcoholic brain will tell you to "go for it," so it sounds risky. I’m not telling you whether or not you should go, that’s your choice, but I wish you were connected to some women in Recovery who you could go and hang out with. It sounds as if you need a break, but I’m not sure if this is the best way for you to get one, I wish you had healthier and safer options. 

If you decide to take such a gamble with your Recovery, and I only say this based on the thoughts you are having about going, I think you need a real solid Relapse Prevention Plan, i.e. have your own transportation, call someone everyday and check in, have a drink in your hand at all times, (Coke, soda water, etc). Have a person there that you can tell if things get uncomfortable for you; have your own living area so you can get away from the drinking if you need to, etc.

Don’t underestimate the seriousness of this situation. By your own admission you believe if you drink again it could kill you. So again I challenge you to consider the stakes as you weigh the pros and cons of putting yourself in such a situation, and ask yourself is there a better, safer way for you to have a good time. In the first sentence of your email you describe yourself as a “Recovering” alcoholic, so now is the time to use your Recovery tools. 

Finally if your OCD is kicking in and your are obsessing about this… pay attention to your intuition. Listen to that voice inside - it might save your life. I wish you all the best and I would love to hear what you decide to do.

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Roland Williams, MA, is an internationally recognized addiction interventionist, author, educator, trainer, counselor and consultant. He heads www.rolandwilliamsconsulting.com and 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.

 

My partner has suddenly become very distant and secretive. I suspect something's up. Best way to confront? Should I suggest help? Give an ultimatum? – Chloe.

Doreen Maller: Social withdrawal can be a sign of many things: depression, addiction, a change of heart… and it can be very confusing to partners and loved ones. When a person shuts down and resists connection, it may feel that all attempts to relate seem to drive the person farther away. Often the people closest are the first to detect shifts and changes. These can begin subtly and then move toward the situation you describe. Feeling distance in intimate relationships can be confusing and painful.

Using statements about yourself can start conversations that are less threatening and accusatory which can then lead to a deepening of connection. Therapists call these “I” statements, which means you are speaking from your own experience rather than stating your observations about someone else’s life. Saying, “I’m frightened and confused and concerned,” rather than “You have a problem,” can cut through resistance and provide opportunities for dialogue. Asking your partner to join you for counseling or support can be a good first step. If addiction or abuse is contributing to the secrecy, early treatment and intervention can help connect your partner into a recovery model that works best for them. Getting your own support in the process can be helpful, too. 

There are many opinions regarding the efficacy of confrontation and ultimatums. Some suggest that holding the person accountable to solve their own problems is the best approach. Others feel that doing everything in your power to move them toward recovery is a better choice. Ultimately, you may both need support to move through your current situation. Asking your partner to join you in support and sharing the responsibility for education and a plan of action with a professional can reduce tension, and move both of you toward informed choices.

There are many resources online for guidance for these types of concerns.  Try: http://newsinhealth.nih.gov/2009/March/feature1.htm

You can contact rehabilitation centers in your area and ask for guidance or set up an appointment with a therapist to discuss your concerns. Mental health care providers can walk you and your partner through the first steps of relationship challenges and education toward recovery. Primary care physicians and clergy are also good resources who can refer you to programs and support. 

Shifts and changes in relationships can be isolating and frightening regardless of the cause. Asking for help and support in these times can help build coping skills as well as treatment plans to move both of you toward appropriate services.

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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.

 

My husband had an affair for several months with someone he met in rehab. Now he says it's over and he wants to go on like nothing happened. I'm glad he got sober and is now back in AA but I wonder how this could get by his sponsors and whether these character defects are just never going to get fixed in an addict. I am not trusting him and can't forgive him for the infidelity, though I do care about him. I clearly need some guidance here and an overall plan. Do you think this is fixable or should I just move on, given how he has revealed himself. - Laurel

Stacey Rosenfeld: This sounds like a difficult situation, but the good news is, you have a say in how things proceed. I'd conceptualize this as less an addiction issue and more a marital concern at this point. We might debate whether or not someone can recover from a character defect, but what seems more useful is determining if your marriage can recover from this affair. 

Does the relationship seem salvageable? Is your husband willing to acknowledge the pain he's caused? Does he seem committed to working on the marriage? What is keeping you in the relationship at this point? What could your husband do, if anything, to earn back your trust over time? These are some questions to consider. A course of couple's counseling might help you and your husband determine whether the relationship is fixable and, if so, guide you through the process. Individual therapy could provide you with support and a place to process your feelings and develop a plan that feels right for you.

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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.

 

I have been reluctant to write this but now need to. Our son died from a heroin overdose four years ago and it crushed us. I still don't sleep well. Last month we discovered that our daughter is now using methamphetamines and appears on the way to real trouble. We are beside ourselves. The fear and already sense of loss and confusion are terrible. It is more than double grief over both children. My husband is a mess as well and going between anger and sorrow. We just don't know what to do. A cousin suggested we have her arrested since she is not talking about recovery because there is supposedly a decent prison program. Any wisdom here would be greatly appreciated. -  Judith

Jay Westbrook:  It sounds as though you have been dealt more than your share of suffering, and I can’t imagine how painful the loss of your son and this situation with your daughter must be. I strongly urge you to contact the Grief Recovery Institute (800/334-7606800/334-7606) for assistance with the grief over the death of your son; their tools are among the most effective, accessible, and rapid in addressing grief.

I cannot tell, from your question, how old your daughter is, i.e., whether or not she is a minor. If she is a minor, you may well be able to place her in an adolescent treatment program, even if she doesn’t want to go. You can Google “Adolescent Treatment Programs” or you might contact either Visions Adolescent Treatment Center (866/889-3665866/889-3665) or Sovereign Health Adolescent Program (866/348-4818866/348-4818) and they should be able to help.

If your daughter is no longer a minor, your situation is made more difficult, as you cannot force her into a treatment program. The dynamics of her using may (or may not) have ties to her brother’s death, and therefore, a skilled interventionist could well be invaluable in helping move her to a willingness to enter treatment. Again, you can Google “interventionists” or, as I said in a previous article, “If the volume of the [Google] search results seems overwhelming, you might consider using either Stasie Kardashian or Ed Storti. There was a recent interview with Stasie (The Other Kardashian - Stasie, The Interventionist)  in this publication, and Ed Storti is spoken of in that article.  Whether you use them or not, you will probably find great value in reading everything on their websites.”

As for your cousin’s suggestion that you have your daughter arrested so she can access the prison [drug] program, there are multiple considerations. First, you have no way of assuring that she will actually be arrested, or convicted, or sentenced to a facility that has a drug program, or that she will enter that program. Second, there is always access to drugs behind bars, so an arrest brings no guarantees that she will become drug free. Third, prisons are violent, and if something were to happen to her, my guess is that you would blame yourself, in part. Fourth, you would alienate her from an important source of support – you.  And, finally, if her using is related to her brother’s death, she may be too fragile to do very well in prison, and would be unlikely to receive the comprehensive treatment she may require to really recover, treatment she is far more likely to receive in a non-prison treatment program. I hope this has helped, and please let us know the outcome.

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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.

 

I am pushing 50 and for a year have been clean and I think I am doing well except in one area. I want my three children, all adults in their twenties, to forgive me and they are still holding a lot of resentment. I don't have a therapist and not sure I am getting the best advice from my sponsor. I'd like to hear from one of your people. Thank you. - Arlene

Larissa Mooney:  Arlene, rebuilding trust in recovery can take a long time – perhaps longer than you would like. You have accomplished a great deal by achieving sobriety over the past year, and healing damaged relationships with friends and family may be one of the hardest challenges in recovery. 

Without knowing the details of your situation, I would encourage you to have open and honest conversations with your children about this process and the goals you are striving for in your relationships. I would reflect on what you have been through as a family and factors that may be making it difficult to move forward at this time.  I would also ask yourself whether you are consistently dependable, accountable, and responsible in your daily interactions with others. These are important steps to earn trust from those around you.  

Throughout this process, I would focus on changing things that are within your control, such as your reactions to others, choices, and activities, and accepting what may not be in your control. With consistency, patience and time, your relationships will strengthen and heal.

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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     Full Bio.

 

My wife is a recovering alcoholic who is obsessed with workshops for healing. She is almost compulsive about it, as if she is madly in search of herself and so goes to anything she hears about where someone is giving a workshop that promises your authentic self or great success in life or finding the meaning of your life etc. She has all these tapes and books around the house and is still emotionally unstable and unhappy and pretty drained of energy. It's like she replaced one addiction for another. She doesn't have much time for me, and so now I just bury myself in work. It's all taking a toll. So, my obvious questions is where do I turn? Where's the way out of this weirdness? My appreciation in advance. -  Jorel

Lance Dodes:  I think the answer to your question, Jorel, lies in your statement that your wife is unhappy and emotionally unstable.  It's likely that she has been dealing with her feelings with compulsive behaviors whose emotional purpose is to try to undo or reverse her feelings of being overwhelmed. Compulsions are not weird; in fact they're among the most common psychological symptoms. It is also common for them to shift direction, as your wife appears to have done by moving from compulsive drinking to compulsive book-buying etc. I suggest that you speak with her about seeing a good therapist to get to the issues behind her compulsive behaviors.

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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.

 

My daughter and I are both in recovery from being lushes. Me for eight years, she for two. I am 46 and she is 23.  Sometimes we go to the same AA meetings. She met a man in rooms three months ago who is 47 and they hooked up pretty quickly. I don’t really like or trust this man, this aside from their age difference. He has been sober for only three months and hasn’t done all the steps. I have the impression he is faking it and hanging in there because of her and sort of playing the game. I am not comfortable around him. My daughter is taken with him, though, and I am not sure how to handle this. Friends in the room give me mixed counsel – let her be, it is her challenge, to I really need to share my concerns. And other ideas. I’d like to get your opinion. Thank you. – Ruth 

Janice Dorn:  Dear Ruth, first of all, please accept my congratulations on your eight years of sobriety. It really does work if you work it, and you appear to be working it! Regarding the situation with your daughter, my heart goes out to you. This presents so many conflicts for you. It could turn out OK, or it might end very badly. I don’t know if she came on to him or he came on to her, but, in my opinion, it is not likely to end well.

This man is one year older than you are, i.e., old enough to be her father.The fact that they met and “hooked up pretty quickly” indicates to me that she is starved for male attention - possibly yearning for acknowledgement from her father or a male figure. I don’t know his motives, but it is entirely possible that they are each getting certain needs and wants filled. He has three months sobriety and this may not be his first time around the AA rooms. What do you know about him? Is he court-ordered to AA? Does he have a history of seeking out women at 12-step meetings? Does he have a criminal past? Is he a good guy? What other women has he been involved with and did he meet them at 12-Step meetings? Who else knows him and what do they say about him?  These are questions that are important to ask .

There are guys who go to AA meetings to meet vulnerable women. I am not blaming him, as I do not know the history, but it sounds as if your daughter was progressing pretty well before she met him. That can now change. The probability for her relapse is great at this point. Anyone who has been around the rooms for any time at all will tell you that.  

There is also the potential for real danger. You may find it of interest to read the story of Karla Brada Mendez and Eric Allen Earle entitled: "Twelve Steps To Danger: How Alcoholics Anonymous Can be a Playground for Violence-Prone Members." I don’t know if anything like this applies to your daughter, but it is a tragic story of two people who hooked up, attended AA meetings together and then went through a series of horrific events that culminated in Karla being murdered by Eric. 

There is a long history in AA of sexual and financial exploitation. It is believed that one of the founders of AA ( Bill W) was so sexually aggressive that the members feared that the organization would have to be disbanded.

That said, this is not a condemnation of AA or any 12-Step group. Many people have benefited enormously from participation in AA. This type of situation can happen anywhere or anytime that there are men and women gathered together. In your daughter’s case, it happened to be at an AA meeting. It is good to always be alert to the possibility for people to take advantage - sexual, financial or otherwise. Your daughter may know what she is doing, but it seems she is quite young and impressionable. Perhaps it is a truly loving relationship and they will live happily ever after. Nobody knows the future, so all we can do is go by the past instances of similar situations. What we do know for certain is that getting sober and into recovery requires an enormous commitment of mental, emotional, physical and spiritual energy. If her energy is now directed to this man and her life with him, there is real risk her recovery will suffer.

So what can you do? Sit down with her and have a serious conversation where you express your concerns. Don’t be angry or condemning. Remain calm and be loving but firm. If you have to, do this several times. She is young, but no longer a child. She is going to do what she wants to do and you won’t be able to stop her. Work on yourself and your sobriety and pray for her. Do not allow this situation to derail you from recovery. Speak your truth, and then release her with love to her higher power and her greater good.

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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. Full Bio.

 

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 needs 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 to 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

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Roland Williams, MA, is an internationally recognized addiction interventionist, author, educator, trainer, counselor and consultant. He heads www.rolandwilliamsconsulting.com and 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.

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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.

 

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.

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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.

 

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.

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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.

 

I used to be an opium addict then became a heroin addict and used everything for almost 20 years. I started going to AA  + NA and could stop for a while and start again. Then my doctor prescribed me Suboxone 8mg/2mg and since that time (2004) I've been taking Suboxone. Well, I'm 59 years old and I asked my doctor when should I stop taking this Suboxone. He said as long as I have a sponsor and go to the meeting and am close to program, I have to take this. My question is should I stop taking Sub or just be on a maintenance program for the rest of my life? Thank you so much in advance. - David.  

Larissa Mooney:  David, you bring up an important question that almost all individuals on Suboxone have wondered at some point:  “How long will I have to take this medication?”  I recently answered a related question about the risks and benefits of Suboxone, which is a combination of buprenorphine and naloxone approved for opioid dependence treatment, so I encourage you to refer to last week’s September 2 post for more details.  

The length of time someone will remain on Suboxone will vary depending on his or her individual history of addiction and relapse and how well he or she is doing on the medication (as evidenced by abstinence from opioids, functioning in daily activities, etc.). I encourage you to discuss your questions about discontinuing Suboxone with your doctor, who has evaluated you over time. If you are stable, feeling well, and tolerating the medication, you may be advised to continue your current treatment plan since it is effective. Your history of prior relapses, both on and off medication, will be taken into consideration when deciding how best to proceed.  

We know from prior research that buprenorphine treatment lowers opioid relapse rates, and that longer-term treatment seems to be more effective than short-term. Though certain individuals are able to maintain abstinence off Suboxone, it is not always easy to predict who will be successful and the optimal duration of treatment.  Thus, if you have reasons why you wish to reduce your dose, it is best to do this only after a detailed discussion with your doctor and under close monitoring and guidance. For some individuals, we are able to find the lowest effective maintenance dose that still provides protection against cravings and withdrawal, which are common triggers for relapse. 

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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     Full Bio.

 

[EDITOR'S NOTE: Last week Jay Westbrook responded to reader Emily's email about an addicted cousin she cares about by recommending that the family consider an intervention. Here is Emily's reply and a further response from Jay Westbrook.]

I thank you for taking the time to write such a thoughtful and informative response. Unfortunately, the idea of an intervention was not well received by my family. One of the biggest reasons being that my aunt is in such deep denial, she won't/can't even admit that he is using drugs, let alone has a serious problem. (Complicated family dynamics also contribute). In the meantime, I plan to look into Nar-Anon (I've had some experience with Al-Anon), send him my letter and some info about treatment options, and hope for the best. Thank you again so much. - Emily 

Jay Westbrook:  Emily, I'm so proud of you, and your healthy approach. You know, Malcolm X once said, "If you see a man drinking from a glass of muddy water, do not tell him not to. Rather, place a glass of clean, clear water next to the muddy one, and step back; allow him to choose." From my perspective, the loving letter and treatment information you've sent, the kindness and concern you've visited, and the self-care you've role-modeled, are the glass of clean clear water. And he gets to choose it, or not. Move forward in your life, and I have little doubt that as you do, many will benefit from your kindness and compassion (including Emily).

As always, in love & service - Jay 

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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.

 

Three years ago I had a very bad experience with LSD and ended up on meds. They make me feel pretty numb much of the time. One way I found myself compensating is gambling for high stakes and watching a lot of violent movies to feel more. I am realizing this is not a life but feel trapped by the meds and my limited options. I am almost tempted to blow off the meds before I go broke and go back to psychedelics for the rush, though I know that's not real. So what would you advise? Thanks. - Merrill.

Rita Milios:  First of all Merrill, good for you for reaching out for help. Your letter indicates that you recognize, at least on some level, that “going back to psychedelics for the rush” is a bad idea, and essentially a dead end. Unfortunately, what you are experiencing is not uncommon - psychotropic meds can dull all feelings, not just the bad ones. But you are not trapped; there are options. Even though there may be no quick and easy way out, it is always worth the effort to work toward becoming whole and healed. Consider yourself lucky to have “dodged a bullet” with the LSD experience. You probably don’t want to take a chance on being lucky long-term… So focus on the wise, inner part of you that made the decision to seek help and listen to that voice more often.

The first thing you may want to do is to return to your doctor or psychiatrist and ask him/her to check your dosage. It is possible that it is too strong.

The other thing that you can do is to find a good therapist and address your issues through counseling. Meds often cannot do the job alone, and you don’t want to be dependent on meds long term. Working through your issues emotionally is a better way to address difficult or repressed feelings. Seeking out emotional intensity via gambling or violent movie viewing may just cause your feelings to become more repressed over time, as you habituate yourself to the intensity.

You may need to “try out” several different therapists in order to find one that you feel comfortable with and that you can really open up to. But it will be worth the effort. Finding emotional balance, inner peace and self-acceptance is possible. If you can refrain from high-intensity-seeking behavior long enough to give counseling a real chance, you can improve your life, not only in the immediate, short-term time frame, but long-term as well.

Your unfortunate experience could eventually prove to be a blessing, if it motivates you to address your emotional well-being in a serious and dedicated manner.

I will be sending positive vibes your way… please don’t waste them!

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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.

 

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Last February, my oldest friend died of a heroin overdose at the age of 49. He beat me to recovery, and he beat me to death. He also gave a final, drug-alogue interview on my radio show 20 hours before he died.

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