Ask an Expert: Previous Questions and Answers - Page 3

By The Fix staff 07/01/14

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My 17-year-old daughter is showing signs of anorexia. For more than a year she has been obsessed about gaining weight and claiming she is too fat when she actually is pretty thin. Some months ago I caught her trying to throw up and don't have any idea of whether she is still doing it behind my back. We can't afford a shrink and the doctor I insisted she go to wanted to give her stress pills that when I looked them up, are highly addictive. So that didn't work. Any help on how I can help her move through this would be appreciated.  I am a single mother by the way - Roslyn

Stacey Rosenfeld: Eating disorders are serious mental illnesses that have high mortality rates. If you think your daughter is showing signs of an eating disorder, I would recommend her getting evaluated as soon as possible. A professional can help you understand the severity of the symptoms and different treatment options. If she is diagnosed with an eating disorder, the sooner she gets treatment, the better her chance for recovery. You may be able to do some of the treatment yourself, under a model called family-based treatment (FBT) but you'll still need the guidance of an eating-disorder specialist. 

Unfortunately, many medical doctors aren't sufficiently trained in how to address eating disorders.

Treatment can be a pricey endeavor, but there are some lower cost options. Many therapists will offer sliding scale fees. For help on finding those who do, you may want to put in a call to the counseling center at your local college/university. They often have a list of providers who are willing to work for a lower fee. Also, many therapist training programs will offer treatment at a lower cost - look into local graduate programs for psychology, social work, and counseling. Many of these are affiliated with clinics with low-fee treatment. You'll still want to make sure that the therapist has a background in treating eating disorders. 

Some organizations - Project Heal, for example - offer grants for eating disorder treatment for those who need help but cannot afford to pay. The National Eating Disorder Association's Helpline may be a useful resource for you - they offer free help and support at 1-800-931-2237. Also, the organization's treatment finder allows you to search for therapists who offer a sliding scale fee: http://www.nationaleatingdisorders.org/find-treatment

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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.

 

Do antidepressants interact with opiates or other street drugs, which I would guess they do, but I need to know what to look out for here specifically.  What are the particular bad mixes? I don't necessarily trust pill pushing shrinks to know the story here. - Bruce

Larissa Mooney: Antidepressants may interact with street drugs, but the risks are often difficult to quantify or predict. For example, antidepressants may increase the potential for seizure, and stimulant drugs such as cocaine and methamphetamine carry a similar risk. Therefore when stimulants and antidepressants are taken together, seizure risk may be further increased, particularly in the presence of more “stimulating” antidepressants such as bupropion or tricyclics. Other factors may also contribute to seizure risk, including medical conditions, electrolyte imbalances, and brain injuries. Therefore it is very important to discuss all drug use, medication use, and health conditions with your doctor so that risks and benefits may be weighed when making treatment decisions. 

Elevations in blood pressure may occur when amphetamines are combined with antidepressants that enhance noradrenergic activity, such as tricyclics, venlafaxine, or MAOIs (monoamine oxidase inhibitors). Certain antidepressants, such as fluoxetine and paroxetine, may also increase the concentration of amphetamines in the blood by inhibiting liver enzymes; this effect may also increase the potential for toxicity.  

It is difficult to determine the frequency of adverse interactions, and though amphetamines are not prescribed in combination with MAOIs due to the potential for severe events, many stimulant users take other antidepressants without consequences. 

Another medical condition associated with serotonergic antidepressants is serotonin syndrome, which is marked by symptoms including muscle twitching, rigidity, sweating, fever, rapid heart rate, agitation, and confusion. The risk of serotonin syndrome is increased when antidepressants are used in combination with other drugs that increase serotonin or activate serotonin receptors.  

MDMA/ecstasy is one example of a drug that may be involved in this interaction; certain opioid medications such as tramadol and meperidine also have serotonergic properties and may increase the risk of serotonin syndrome when combined with SSRIs (selective serotonin reuptake inhibitors) and other antidepressants. 

In general, medications with sedating properties enhance the risk of oversedation and of suppression of breathing when combined with other sedating drugs, such as heroin and other opioids. And while sleeping medications, alcohol, and tranquilizers are well known to enhance the potential for overdose when combined with opioids, this risk may be exacerbated in the presence other medications with sedating properties, such as mirtazipine and tricyclic antidepressants.  

Medications and street drugs may also have additive effects, and risks are amplified when more than one substance and medication are combined. 

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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 am 24 years old and like alcohol a lot and the problem is I get nasty when I get drunk, which happens pretty easily. All this anger comes out of me. I don't want to stop drinking because I like it and would feel excluded from going out after work with other employees and also with friends. I have heard of something called moderation management programs and would like to know if any of your experts endorse them and can give me some guidance about them. I read what they have to say at moderation.org but would appreciate some independent guidance here.  - Wendy

Tessie Castillo: Since you aren't ready to stop drinking, it might be good for you to look into moderation management programs (MM). These are harm reduction programs that work with you to create personalized goals to manage your drinking, whether it be abstinence or a reduction in drinking. If you get nasty when you get drunk, perhaps a worthwhile goal for you would be to control your drinking enough so that you don't develop those mood swings. 

MM programs have been shown to have fairly good success rates in helping motivated people to bring their drinking down to manageable levels or to stop altogether. Members of MM are also more likely to be female (49%), under 35 (24%) and employed (81%) than members of abstinence-only groups. 

Keep in mind that MM is for people who want to manage their drinking but are not dependent on alcohol. If you experience signs of withdrawal when you don’t drink such as anxiety, shakiness, sweating, nausea or insomnia, then you may be alcohol dependent and should consider an abstinence-based program. 

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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.

 

My dear friend's 18 year old son is currently in a court-mandated treatment program (outpatient) as well as suboxone treatment. (First arrest was couple weeks ago for possession) He is addicted to snorting oxycodone. He has been using since 2012. Began Suboxone 2 months ago. Mother doubts he is fully compliant...but the random court drug testing will provide answers. He plans to begin college in the fall, located about an hour from home. He believes he will be safe from using because his suppliers will not be around. However, the school he plans to attend has a very bad heroin problem...our fear is that he will begin using heroin....

It defies logic to send him to this environment. My instincts, as well as others close to him, are to remove him from his current life and place him in a program like Intercept offered by Outward Bound. I have been doing research to determine the success rate of programs like this....do they work? The idea of 60 days removed from mainstream society, living in the wilderness, developing survival skills, and expanding the mind to break through dysfunctional thinking would be a powerful treatment.

Does anyone have any feedback on the effectiveness of these programs? We are working hard to find the best treatment option for him?

Rita Milios: There are both some real successes and some worrisome failures regarding wilderness programs. A 16-year-old Outward Bound wilderness program participant died in 2006 while participating in one of this organization’s programs in Colorado. According to a National Geographic report, she was the program’s first fatality in ten years, but their 24th fatality overall (in 46 years of running such programs).

On the other hand, a study by the Outdoor Behavioral Healthcare Council (OBH -- an organization formed in 1996 by a group of wilderness treatment program organizations to conduct research and collaborate on best practices) states that 81% of wilderness program graduates interviewed for a 2004 study reported their behavioral treatment as being “successful,” and their goals having been sustained for one year.

However, in your specific question, I detect some red flags. First, the potential program attendee is 18 years old, and for many programs this is the age where parents cannot force participation. It does not sound like this particular 18- year-old has sufficient motivation - you say his mom doubts his compliance with his current treatment. Most of these wilderness programs, as well as other recovery programs, stress that success is mainly determined by the motivation of the participant. So without sufficient motivation on the son’s part, this or any other treatment could be wasted.

My suggestion would be for the parents simply to reduce their co-dependent interactions with their son and require more personal responsibility and commitment from him before they shell out money for a recovery program or college. Realistically, he is probably not ready to go away to college right now, if doing so would put him at risk for continued (or even greater) addiction. And the parents certainly do not have to pay for college under these circumstances. They could simply tell their son that until he is completely drug-free and demonstrates a commitment to maintaining this status, they will not pay to send him to college.

The parents could suggest any number of different treatment programs to their son. But ultimately, it is up to him to decide if he is motivated and wants to be free from addiction. Perhaps giving him a wake-up call by withholding college funds could help him consider his options. (To view studies by the OBH Council, go to https://obhcouncil.com)

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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've been sober in a 12 step program for 3 years and some change. Presently, I do a lot of service. I have 6 commitments that take at least an hour a week, usually more like 2-3 hours, plus several sponsees. I keep being asked to do more, and I keep saying yes. We're supposed to say yes, right? My sponsor and network say I'll figure out how much is too much by taking too much, and I understand that, but I don't even know how to say no to it. - Brady

Janice Dorn: Thank you so much for bringing this issue to the attention of our readers.  It’s a powerful one that touches so many lives and has implications that are far-reaching and often complex. You may not like what I have to say to you, but I am saying this out of enormous compassion, concern and my own personal experience.

You have been sober for three years, so congratulations are in order. If you continue to do what you are doing at present, everything positive about your recovery is at high risk for reversal.

Let’s start with the fact that you are on overload. In addition to your job, you are spending maybe up to 18 hours in “service” plus sponsoring some people. I suspect you are relatively young and trying to hold down a job to support you and possibly another person. You are saying “Yes” - and you assume that “we’re supposed to say yes, right?”  Wrong. What you are doing is putting your recovery in jeopardy by saying “Yes.” In your words,” I don’t even know how to say no to it.”

Let me attempt to scratch the surface of this issue. You have many characteristics of what is sometimes called “people-pleasing.” As such, you have learned, likely from childhood, that you will be loved and accepted by your parents, siblings, friends or peers, if you go along and do things that people ask you to do. Don’t rock the boat.  Don’t be stubborn or act out. Go along to get along. Just say “Yes” to any and all requests or demands and you will avoid conflict, confrontation and be liked by everyone. 

In the process of doing this, you give up one of the most important aspects of self-growth - finding out who you really are. You wear a mask that says you are cheerful, pleasant, supportive, helpful, hard-working and ready to help with anything. Underneath this mask is fear and resentment. You are afraid that, if you say “No” people won’t like you, will abandon you, or speak badly of you. As a result, you find yourself worn out and feel like you are being taken for granted and not appreciated.  

You state “My sponsor and network say I'll figure out how much is too much by taking too much, and I understand that.” Yes. You understand that on an intellectual level, but you are not self-actualized (don’t know how to calm yourself or care for yourself or manifest your self-esteem) enough to truly understand that, in fact, you are taking on too much. Even if you do understand it (as is clear from your comments), you do not know how to stop. Why? Because you never learned how to stop. You are continuing to act out the script of your childhood drama - this time substituting your sponsor and network for other authority figures you have had in your life. In the process, you are becoming increasingly unsettled and frustrated. In other words, you are at high risk for burnout and relapse.

What can you do? The most important thing is to start taking care of you first. As much as you may hear the opposite, there is a true virtue to being selfish. If you are selfish enough to take radical self-care, to rest and restore and recharge, you then have more and more energy to give to others. If you do not do this, you are like a battery that has run out of charge. You are drained and will continue to be drained until you re-charge. Your stress levels are high and will get higher if you don’t take action to change your behavior.

The tasks ahead of you are not easy and will take time. You must begin slowly to break the pattern of being addicted to pleasing people. What follows are a few suggestions to get you started. They are not the be all and end all. This will be a gradual process for you, so please be gentle with yourself: 

-Become aware of what you are saying or doing to please people. Be aware of that feeling you get inside of you, that little twinge or actually physical sensation in your stomach or pain in your neck, that tells you that you are doing something that you really don’t have time or energy to do. Acknowledge that your brain will trick you, but your body doesn’t lie to you. Use these bodily sensations to guide you to hold back on accepting anything else or agreeing to do something. This is the beginning of learning to say “No.”

-Make a vow to yourself that you will stop saying or doing things just to please others.  Don’t be afraid to say or do what is really in your heart. Stop apologizing or feeling guilty. You are not perfect and not a superman. You simply cannot be all things to all people. Start slowly and practice gently with assertive words and gestures. Watch and learn from others who have learned to be assertive with grace and integrity. It’s absolutely OK to say “No” if you learn how to say it. Practice doing this until it begins to feel comfortable and natural to you. It will take time, but the rewards are worth the effort.

-Think about what you are saying “Yes” to when you say “No.”  Things like more time to spend on your own recovery, quality time to enrich precious relationships with friends or family, time for radical self-care so that you have energy and enthusiasm for outside tasks and can approach them with vitality and vigor.

-It may become necessary for you to have some therapy to heal whatever childhood wounds you are carrying with you. In the process, you will begin to develop a true sense of who you really are. Your self-esteem will increase, you will be much more comfortable around people, body aches and pains will diminish. You will begin to develop clear boundaries between where you end and others begin.  You will begin to feel real and natural in your own skin.

All of this is a process. It’s a discovery of the true you. It takes time to learn to be as gentle and loving and giving to yourself as you are with others. The risk is great for you, and probably a little scary right now, but I assure you that the rewards are magnificent.  I wish you every happiness and success in finding the true you that wants and deserves to be loved for exactly who you are. Perhaps the great leader Mahatma Gandhi said it best:  A 'No' uttered from the deepest conviction is better than a 'Yes' merely uttered to please, or worse, to avoid trouble.

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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.

 

What does the word recovered mean? I though it was still recovering after doing rehab but wonder what the benchmark is for simply being recovered? - Tess

Lance Dodes: Many words in the addiction field have been tossed around for years without being clearly defined or even being meaningful.  "Recovered," "recovery" and "being in recovery" are examples. In most of life, "being in recovery" means a person is making progress even though s/he isn't "cured." Sometimes it is used as a synonym for "being in remission" - indicating relapse is a clear possibility (as with being "in recovery" from cancer). Other times it means "on the path to a definite cure" - as in being in recovery after surgery. Neither of these usages is problematic, so long as we all understand what is meant. But in the addiction field, the term has been used in a third way in 12-step programs. 

There, it is traditional for people to refer to themselves as "in recovery," no matter how long they have been abstinent from their addictive behavior and no matter how well they are doing in life. Partly, this is the same as saying they are "in remission," based on the idea they can always suffer a relapse. But too often, being "in recovery" has come to mean something different: that they are on what they declare is the right path. When used this way, folks are condemned as not "in recovery" if they drop out of 12-step programs or are thought to not be "working the program" adequately. When "recovery" is used this way, it is more a political statement than a factual or medical one. 

Tess's question sounds like it has roots in this "recovery community" definition of addiction and its treatment. I hope that Tess would ignore the agendas of anyone attempting to define whether she is "recovering" or "recovered." Instead, I suggest that she think of her addiction as a repetitive behavior that arises with great force at key moments when she feels overwhelmingly helpless. These moments can be predicted and avoided once she knows just what her emotional vulnerabilities are. 

However, there will always be some risk of becoming overwhelmed, and responding with the old behavior. To this extent, it is true that she would never be "cured." But we are all at risk of repeating old behaviors (in my field it's called "regressing"), whether these old behaviors are addictions or anything else that used to be part of our solution to life. That's not a specific feature of addictions, it's just the way humans are. It makes no more sense to label oneself as "recovering" forever from an addiction, than it does for a person who used to be depressed to forever be "recovering" from depression, or a person who has been cancer-free for 15 years to still define herself as a cancer patient. It certainly makes no sense to define "recovering" in terms of whether you are in one treatment approach or another. 

Addiction is a terrible symptom, but it is not who you are, and once you understand how it works emotionally in you so it doesn't sneak up on you, there is no reason to dwell on what words you use.

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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 AddictionA 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 43 year old woman who has been struggling financially and gotten into debt as my industry is going through transformations. I am drinking a lot more now to help with the anxiety. I don’t seem to relate well to AA though I have a spiritual side to me. I am thinking of some anxiety and sleep meds but I know I am an addictive personality and am afraid to go on one of those. I read about the horrors of Ambien, for example. What kind of help you would suggest? - Natalie

Janice Dorn: Thank you so much for reaching out to us for help. You have shown great courage in doing this, as well as some excellent insight. It may or may not be of comfort for you to know that you are not alone in your worries about financial issues. It is estimated that 75% of the American population lists money worries as Number 1 on the list of situations that are causing them stress. Number 2 on the list of stressors - coming in at about 70% of the population - is concern about work. You have a double dose, since you are struggling with both financial and work issues.

You are under a huge amount of stress. This is manifested as anxiety and you are drinking to try to calm the anxiety. To the best of my knowledge there is not a definitive study on the incidence of alcoholism resulting from stress, or on the relationship between drinking behavior under stress and the development of alcoholism in human beings. However, the fact that you admit that you have an “addictive personality” puts you at high risk for development of alcoholism and other addictions. Perhaps you have some family history of alcohol or substance abuse that adds further risk factors? I don’t know this from your question, but I suspect this may be the case.

I have written and spoken a lot about what stress is doing to our society. I have labeled this the Dorn Dart Board. Take a medical book with just about every illness known to human beings and put all of the illnesses on a dart board. Now throw a dart. That dart will land on an illness that is either: 

(1) Caused by stress

(2) Made worse by stress

(3) If you get it, you are going to have stress

In my opinion, stress and the inflammation associated with stress are intimately related to the majority of illnesses of our time. You have stress that may well be causing or manifesting as anxiety and insomnia. The first thing to do is to go to a really good Family Practitioner and have a complete physical workup to rule out that the anxiety and insomnia are not secondary to another illness such as a thyroid, diabetes or a cardiac condition. If any physical cause is ruled out, the physician is like to recommend an anti-anxiety medication (such as a benzodiazepine) or a sleeping pill (such as Ambien).

At that point, just say “No” and ask the doctor if he or she can recommend any complementary or alternative treatments for your anxiety and insomnia. If the physician says “No” or “Nothing like that really works,” I suggest you politely thank him or her and leave (quickly!) before you are given a prescription for an additive drug.  Taking prescription drugs for anxiety or insomnia is the worst thing you can do in your present situation. You may want to seek out a homeopathic or naturopathic physician who can possibly offer you more natural and non-addictive alternatives to classical (allopathic) remedies.

In terms of support, get as much as you can. I don’t know anything about your life, but I suspect you may be presently unmarried and have no children or a child who may not be completely supportive to you. You are intelligent and resourceful enough to research your current challenge. If you have a trusted friend who is not an addict, reach out to him or her. Join a support group. There are many alternatives to 12-Step Programs. You can find these out by doing a search in your area for addiction recovery that is not 12-Step. Depending on where you live, you should also be able to find a therapist who treats addiction without the use of the 12-Steps. You will likely be well-served by exploring more deeply the spiritual side of you, as this may lead you to stress-reducing activities such as meditation, yoga, or Chi-gong (Qigong)

In terms of your financial issues, the most important thing is to begin to get out of debt. There are a number of ways to do this that are beyond the scope of this answer. You may want to start by making an appointment with a certified financial adviser (CFA). Make sure the person is licensed and reputable. If you pick the right one (many will give you a free initial consultation), you will be helped greatly. You will have to make some significant changes in the way you look at money and the way you spend money. A good financial adviser can be a great help to you in getting started. I caution you about employing so called debt counseling agencies or services. There are some that are reputable, but, as a general rule, you have to be very careful with these. There are few life situations that are as burdensome and troubling as being in debt. Having a plan to get out of debt is likely to reduce your anxiety and allow you to get some decent sleep. 

I really would like to hear back from you about what I have suggested.   Your question is a great one that affects so many people. I have really only scratched the surface in terms of an attempt to help you. If you wish to write more, please do so.

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’m just leaving rehab and considering half -way house options or a therapeutic community. Which would be better for me? -  Carl

Rita Milios: The real question here is not so much whether a half-way house or therapeutic community is the better option overall, but which is a better option for you, as an individual, with your specific goals and needs. And this question can only be answered by you, after some investigation and personal research about what is available in your community.

Over time, the distinctions between “half-way houses” (or sober living houses) and “therapeutic communities” have blurred. Many facilities now market themselves as “therapeutic community style” half-way houses. Originally, the term half-way house referred to residences set up to house people who were leaving jail or prison. They were designed to offer these individuals a safe place to learn how to re-integrate into society. In recent years, many half-way houses have changed their focus, and they now serve people in recovery who are seeking sober living options within a structured, supportive environment. They are no longer intended to appeal only to people leaving incarceration, but to anyone seeking such assistance.

There are still a few conceptual and theoretical differences between half-way/sober living houses and therapeutic communities. Half-way/sober living houses often still retain their main mission of reintegration into society for the resident, where the resident re-enters society as both a law-abiding and productive citizen. To this end, half-way houses tend to offer more help with things like job coaching, job search assistance, transportation to/from work and education regarding money management and coping skills that emphasize the needs of daily living. 

Therapeutic communities developed with a focus toward mental/emotional growth and personality development as their central theme.

Therapeutic communities may incorporate more types of counseling and psychotherapy techniques to achieve these goals, such as Cognitive Behavioral Therapy, Motivational Enhancement Therapy and Dialectical Behavioral Therapy. These therapies emphasize individual responsibility for changing thinking and behavior and learning about one’s self at a deeper level. These communities may also incorporate a more holistic approach to overall development of the individual vs. a solely sober living focus.

Still, every facility - half-way house or therapeutic community – sets up its own environment and treatment structure, so they will vary greatly, and concepts and techniques from one may be adopted by the other. 

That is why it is important that you visit several different facilities and discover for yourself which environment and lifestyle arrangement is best for you. Ask a lot of questions, both of the residents and of the staff, to determine which specific living environment would be the best fit for your needs and goals.

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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.

 

My brother is 26 and has been in a non-luxury recovery facility for heroin abuse and has been asking for me to visit him. I have always had issues with him and been reactive to him and I know that's not good for him, especially now. He's often been so difficult and selfish and self-absorbed that I don't trust him. He's very manipulative. I'd like to forgive him but it's hard to trust him. This is his second go-round. Is it best if I don't visit him? And if not, what advice would you give me as to how to best handle the visit?  I am two years older than he is, by the way.

Jay Westbrook: You sound like a very caring sibling, and I applaud you for seeking greater perspective before making a decision about visiting your brother.  Here are several points for your consideration:

1)  1) You are under no obligation to visit your brother, period. If you do decide to visit him, it would be very useful to know why you are making the visit. What is the purpose of seeing him? Would the visit be to support him, to shame him, to check up on him, to catch up with him, to guilt-trip him, to offer encouragement, etc. – the list could go on and on. Please make sure your motives are clean.

2)  Since you’ve always had issues with him, what steps are you going to take to protect yourself, to avoid becoming reactive, and to assure that you are not manipulated? Perhaps placing a call to his counselor at the treatment center, and asking that he or she be present during the visit, or even arranging a structured visit with that counselor could create a safer and more productive visit.

3)  You said, “I’d like to forgive him, but it’s hard to trust him.” The similarity between forgiveness and trust is that they are simply decisions on your part. The difference between them is that forgiveness is for you, so that you no longer sit in anger and resentment. It does not mean that you condone or excuse his past behavior, does not require that you trust him, and does not even require that you allow him back into your life. You forgive so that you can be free of corrosive thoughts and feelings. Trust, on the other hand, is also just a decision, but a decision you base on his behavioral change over time. If you don’t observe consistent behavioral change, you would be wise to maintain an untrusting posture and vigilance around your brother. You might also work with your brother’s treatment center counselor to identify and communicate the behavioral changes you would want to see before being willing to consider offering your trust again.

I hope these suggestions helped, and please let us know your decision and 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 [email protected] or 818-773-3700.Full Bio.

 

I am a 43 year old woman who has been struggling financially and gotten into debt as my industry is going through transformations. I am drinking a lot more now to help with the anxiety. I don’t seem to relate well to AA though I have a spiritual side to me. I am thinking of some anxiety and sleep meds but I know I am an addictive personality and am afraid to go on one of those. I read about the horrors of Ambien, for example. What kind of help you would suggest? - Natalie

Janice Dorn: Thank you so much for reaching out to us for help. You have shown great courage in doing this, as well as some excellent insight. It may or may not be of comfort for you to know that you are not alone in your worries about financial issues. It is estimated that 75% of the American population lists money worries as Number 1 on the list of situations that are causing them stress. Number 2 on the list of stressors - coming in at about 70% of the population - is concern about work. You have a double dose, since you are struggling with both financial and work issues.

You are under a huge amount of stress. This is manifested as anxiety and you are drinking to try to calm the anxiety. To the best of my knowledge there is not a definitive study on the incidence of alcoholism resulting from stress, or on the relationship between drinking behavior under stress and the development of alcoholism in human beings. However, the fact that you admit that you have an “addictive personality” puts you at high risk for development of alcoholism and other addictions. Perhaps you have some family history of alcohol or substance abuse that adds further risk factors? I don’t know this from your question, but I suspect this may be the case.

I have written and spoken a lot about what stress is doing to our society. I have labeled this the Dorn Dart Board. Take a medical book with just about every illness known to human beings and put all of the illnesses on a dart board. Now throw a dart. That dart will land on an illness that is either: 

(1) Caused by stress

(2) Made worse by stress

(3) If you get it, you are going to have stress

In my opinion, stress and the inflammation associated with stress are intimately related to the majority of illnesses of our time. You have stress that may well be causing or manifesting as anxiety and insomnia. The first thing to do is to go to a really good Family Practitioner and have a complete physical workup to rule out that the anxiety and insomnia are not secondary to another illness such as a thyroid, diabetes or a cardiac condition. If any physical cause is ruled out, the physician is like to recommend an anti-anxiety medication (such as a benzodiazepine) or a sleeping pill (such as Ambien).

At that point, just say “No” and ask the doctor if he or she can recommend any complementary or alternative treatments for your anxiety and insomnia. If the physician says “No” or “Nothing like that really works,” I suggest you politely thank him or her and leave (quickly!) before you are given a prescription for an additive drug.  Taking prescription drugs for anxiety or insomnia is the worst thing you can do in your present situation. You may want to seek out a homeopathic or naturopathic physician who can possibly offer you more natural and non-addictive alternatives to classical (allopathic) remedies.

In terms of support, get as much as you can. I don’t know anything about your life, but I suspect you may be presently unmarried and have no children or a child who may not be completely supportive to you. You are intelligent and resourceful enough to research your current challenge. If you have a trusted friend who is not an addict, reach out to him or her. Join a support group. There are many alternatives to 12-Step Programs. You can find these out by doing a search in your area for addiction recovery that is not 12-Step. Depending on where you live, you should also be able to find a therapist who treats addiction without the use of the 12-Steps. You will likely be well-served by exploring more deeply the spiritual side of you, as this may lead you to stress-reducing activities such as meditation, yoga, or Chi-gong (Qigong)

In terms of your financial issues, the most important thing is to begin to get out of debt. There are a number of ways to do this that are beyond the scope of this answer. You may want to start by making an appointment with a certified financial adviser (CFA). Make sure the person is licensed and reputable. If you pick the right one (many will give you a free initial consultation), you will be helped greatly. You will have to make some significant changes in the way you look at money and the way you spend money. A good financial adviser can be a great help to you in getting started. I caution you about employing so called debt counseling agencies or services. There are some that are reputable, but, as a general rule, you have to be very careful with these. There are few life situations that are as burdensome and troubling as being in debt. Having a plan to get out of debt is likely to reduce your anxiety and allow you to get some decent sleep. 

I really would like to hear back from you about what I have suggested.   Your question is a great one that affects so many people. I have really only scratched the surface in terms of an attempt to help you. If you wish to write more, please do so.

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.

 

So I'm in a bad situation. I have been heroin addict for 10 years but have been doing very well the past year, especially past 6 months. but something from my past 2 years ago came up and now I have to go to jail on the 16th of this month, for 6 months. I have also been enrolled in a methadone program for 7 months and been doing great. So the jail I'm going to doesn't give methadone at all, so I had to taper from 95 mg's to 0 in less than 2 weeks. Today is my first day at 0. I was fine with all the drops, felt no withdrawal even coming down 10 mg a day. Started feeling it around 10 mg. So now that I'm at zero i am obviously sick but by question is, how sick will I get? Because the taper went so well until the end, does that mean the hard part is over, or are the nasty withdrawals going to hit me all at once because i tapered so fast. Now that I'm on 0, what can I expect withdrawal wise? - Larry”

Larissa Mooney: Unfortunately it is often difficult to predict an individual’s course and severity of opioid withdrawal. We know that methadone withdrawal often mimics that of other opioids, but it may start later and last for a longer period of time because it takes a longer time for methadone to leave the body compared to heroin or other short-acting prescription opioids. Withdrawal symptoms may include muscle ache, nausea, vomiting, diarrhea, sweating, anxiety, insomnia, runny nose, and goosebumps. 

Tapering off slowly tends to minimize the onset and severity of withdrawal symptoms, whereas abrupt cessation of opioids or very rapid tapers may be associated with more uncomfortable withdrawal. Medical supervision and use of ancillary medications for gastrointestinal discomfort, pain, and other symptoms may also ease withdrawal symptoms. Since methadone is long-acting, symptoms may persist for more than two weeks. 

From anecdotal and clinical experience, an individual’s anxiety about opioid dose reductions may worsen his or her subjective experience of withdrawal. Thus in certain clinical situations, patients may agree to a “blind” opioid taper, during which they are not informed of their specific dose amount or dates of dose reduction. This may help to minimize the experience of anticipatory anxiety about stopping the medication and the severity of associated withdrawal.

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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.

 

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

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

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

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

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

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

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

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

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

 

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

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

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

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

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

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

I wish you all the best! 

Alternatives to AA:

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

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

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

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

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

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

 

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

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

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

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

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

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

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

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

 

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

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

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

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

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

 

Is marijuana addictive?

Tessie Castillo: Whether marijuana is considered addictive depends on how addiction is defined. A person with a physical addiction to a drug will experience physiological symptoms if he stops using. For example, withdrawal from alcohol, opioids or benzodiazepines may cause symptoms such as high blood pressure, increased pulse, discomfort, seizures or even death. If a chronic but not heavy marijuana user stops using, the symptoms, if any, are milder by comparison: anxiety, irritability or slightly increased pulse. As for "heavy users" who go through withdrawal, a 2012 study by National Institute on Drug Abuse researcher David Gorelick, PhD, MD, found that among the 100 heavy users in the study, 42% experienced withdrawal symptoms, such as cravings, irritability, anxiety and sleep disturbance. 78% of this heavy user group returned to pot use to reduce or avoid their withdrawal symptoms.

Thus, while marijuana is not generally considered physically addictive, the physiological symptoms experienced by heavy users suggest that for some people it may well be addictive, even if less so than opioids. However, anything can be psychologically addictive if a person experiences a strong and harmful need for it. Though most people use marijuana in moderation, there are some who develop such a strong need for it that marijuana use begins to negatively affect other areas of their lives. Those people may be considered addicted to marijuana. Anything can cause psychological addiction if used in excess: gambling, sex, food, video games, even exercise.

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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.

 

My name is Frank & I feel that I am at a crossroads in my recovery. I have been clean & sober through AA/NA for just a hair over 4 & 1/2 years. I have worked the steps twice, I have had the same sponsor the entire time and I have sponsored others. The ways that my life has changed have truly been immeasurable and I don't want to be wasted again. 

I used alcohol destructively and I had a strong bout of troubles with all other drugs, except hallucinogenics, which I always found to be helpful. The last 3 years of my "using", I was physically addicted to heroin. It went from smoking to snorting and in the final year before I got clean I was injecting it. It was hell to get clean. I was medically detoxed and relapsed immediately for 6 months then I got clean on my own using suboxone. I have been 100% drug free since my clean date including from suboxone. I have battled with smoking cigarettes on & off since then and have happily drunk coffee daily. 

The crossroads part has been very recent. I have never loved meetings & honestly have never attended regularly. I am also not convinced that addiction is a disease and hate thinking of myself as having a disease. I am also unsure if I am truly powerless since I found so much power in stopping. I don't think (I am open to many things so this is an open ended subject for me) I believe in a higher power & I am a non-theist. I do believe in the subconscious. These things rub  me the wrong way in AA/NA & I am at the point today of speaking with my sponsor about it. 

The most surprising thing that I learned about myself getting clean was recognizing & admitting how much pain & how hurt & damaged I felt from my abusive childhood. I've done some ACA as well and really like it, although, again, I dislike the disease-model idea but that work is valuable enough for me to want to at least work the steps once in ACA. It's hard for me to believe that my relationships with drugs & alcohol isn't different now that I'm so different. Just the fact that I'm looking at it in this way versus "relapsing" is really an answer I think. 

I am thinking of experimenting with drinking and some drugs to see where I'm at with them. I don't want to be wasted but if I could drink socially and use marijuana and hallucinogenics successfully, I couldn't imagine why I wouldn't. Have you encountered someone that was a hard-core drug user that can then successfully use anything? l'm not running out & using but I'm very curious. There is nothing that could make me give up the strength & clarity I've found & I want to remain sober in the sense of staying true, clear, and on a path I'm proud of. Thank you for your time.

Stanton Peele: Let me answer your question about becoming a moderate drinker and marijuana user in five parts, if I may:

(1) I never tell anyone they can or cannot use substances moderately.  I cannot make that determination for you, or for anyone.

(2) Having said that, I respect your desire to try to moderate your substance use. People do it all the time, and your logic that you feel differently about yourself and your life are good grounds for contemplating this choice.

(3) Obviously, you are thinking about the milder end of your substance use panoply - the alcohol/marijuana/hallucinogenic part, as opposed to the heroin part. But you haven't made clear rules and limits about what you are prepared to use, how often, and how much. You should think these parameters through and write them down and share them with friends and family.  You might then review them regularly (starting with weekly) with a therapist, friend, or family member, in order to be objectively clear whether you are working within these parameters or not.

(4)  If you are serious with yourself, with me, and with heaven above (whoops, that's not your bag) you WILL be sensitive to your success and failure at sticking to your plan. I don't accept denial, and - before you start this experiment - make clear to yourself and others that you don't either. The fact that you weren't explicit in your definition of moderation IS a counter-indicator of success, since you are not anchoring your change to clearly defined standards. Are you serious about this business, or are you crapping around?  I don't like it when people crap around with me.

(5)  An experiment is an experiment, and it implies that you can simply revert to abstinence should your experimentation fail. And you can - NOTHING stops you from doing this. Please make this clear to yourself, to those you discuss your plan with, and to anyone reading your question and my answer. Repeat after me: "I can, and will, revert to abstinence should I fail to meet the limits I have set for myself, so help me Stanton."  If you don't succeed, that you recognize and amend your plan is a sign of integrity and honor, and not something to be ashamed of.

You've respected me enough to ask me this sensitive question. Please respect me - and yourself - enough to be honor bound and committed to measuring your progress, involving others in assessing this progress, and acting with authenticity and integrity in responding to this objective feedback.

Write us about the results of your experiment.

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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.    Full Bio.

 

I am having issues with a family member around drug usage and what I now believe is addiction. Is "tough love" going to help or hurt?

Lance Dodes: If addiction were viewed as a kind of bad habit, or a sign of laziness or immorality, then it might make sense to be "tough" on the person who has the problem. Indeed, people have been trying to deal with addicts by punishing them, withdrawing from them, and condemning them for much of human history, without helping the problem at all.  It makes sense that these approaches fail, since addiction is neither a bad habit nor a sign of laziness or immorality. 

Far from it, addiction is a very understandable psychological symptom, one that is essentially identical in its mechanism and function as other compulsive behaviors such as having to compulsively clean your house or exercise. Of course, addictions are more dangerous but their inner emotional workings are the same. And nobody would suggest that we deal with compulsive house cleaners by withdrawing from them, or would believe that they will stop cleaning if only we discipline them. So why do people think it makes sense for addiction?

When people engage in compulsive activities like excessively cleaning their houses, they generally don’t cause much harm or pain to those around them. It is easy to empathize with them, to see their suffering and to be drawn toward them to help, rather than feel like beating sense into them. But when people’s behavior is harmful or painful to those around them, they are often consciously or unconsciously viewed as self-centered, thoughtless, and immoral. Once this thought has set in, it’s very difficult to maintain a rational perspective toward either the person or the problem from which he or she suffers. It begins to seem reasonable and fair to treat the person as though she is bad, or stupid, or lazy. 

It's a short step from there to believe that it makes sense to be "tough" on her. Certainly, living with an addict is very often frustrating, enraging and depressing. But these reactions, understandable as they are, are not a good basis for deciding how to deal with loved ones, or with the problem they are facing.

The first step in dealing with someone suffering with addiction is to understand for yourself how addiction works as a psychological symptom (my first two books - The Heart of Addiction, and Breaking Addiction - are devoted to this). Having this knowledge can help you avoid the extra pain of believing that a family member's addiction means that person no longer cares about you, or is intentionally trying to hurt you. It also opens up a way to talk with the addicted person, and to help that person understand his own behavior in a new way. At the point you both appreciate that addiction is something comprehensible and, therefore, potentially solvable, the possibility opens up of restoring the damage that has been done to your relationship.

A spouse or friend can never fix another person's addiction, but there is a much better chance of helping both yourself and your addicted friend if you approach the problem by understanding it better, rather than attempting to control it through discipline or withdrawal.  Said another way, you may have to withdraw for self-protection, or simply to move on with your life. But that is very different from the false idea that you can affect addiction by punishing the person suffering with it.

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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 AddictionA 7-Step Handbook for Ending Any Addiction and The Sober Truth, have been described as revolutionary advances in understanding how addictions work.   Full Bio.

 

How do I talk to my young child about his father's drug addiction?

Doreen Maller: While every family’s addiction journey is different, in general kids do well when someone is able to listen to their needs and curiosity, and relate information back to them in an age-appropriate way. Depending on the level of drug use and its impact on the family, there is a handful of ways that conversation can be initiated.

If there are safety concerns, all efforts should be made to keep the child safe, including leaving the home. In issues regarding safety you can say, “When Daddy is using drugs we aren’t safe around him, we need to go away until he is safer to be with.” Sometimes the child’s own behaviors are impacted by the tension in the home. Children are often confused by erratic adult behaviors and can feel frightened or unsafe when they witness family tension and drama. As a child and family therapist, my goal is to help the child integrate what he or she has seen and heard into something that makes sense from a child’s perspective so that they can return to the behaviors and tasks necessary in their own lives (like school, exercise and sleep). 

Children often miss the absent parent. Being able to talk about the person, separate from their behaviors, can help a child feel more grounded, “When my Daddy drinks I get scared, but I miss him anyway…” Therapy can provide an opportunity for the child to explore their curiosity or strong feelings with a neutral party.

If a family is comfortable with a medical model for intervention, an addiction can be characterized as an ailment - “Daddy has an allergy to alcohol.” Or if the addiction began as pain management, “Daddy hurt his leg and now he has a problem with his leg and his medicine too.” 

There are studies that show that people who can control their impulses and postpone pleasure for a greater reward have more success in life. With that in mind, addiction can be discussed as an impulsive action, “Mommy has a hard time stopping when she starts drinking. Do you ever have a hard time stopping something? How do you stop something once you start it?” 

If incarceration is part of the process, “Mommy had such a hard time with her addiction that she got in so much trouble and has to go away for a while.”  Hospitalization may require another type of explanation, “Daddy was having a hard time and needs some extra help feeling better and getting better. Sometimes you have to go someplace else to do that.”  

Truth telling, though difficult, can help set clear expectations. A child may be concerned and ask "Will Mommy come home soon?" A response might be “We sure hope so, getting better is difficult and takes a lot of work, for now, we want to be sure you are OK and doing all the things a kid needs to be doing, and that Mommy is safe and doing what she needs to do and can come home when she is ready…”

Asking the child how he or she feels can be helpful; “Mommy is having a hard day today, how are you doing?” Young children can find adult behaviors confusing, or they may want to provide comfort, or they may get angry. Helping the child express their feelings: “I know you get angry when Daddy is out of control. I do too. And I think Daddy maybe too." "We need to be sure you’re OK even when Daddy isn’t.” Or: “We need to go be with Grandma to be safe until Mommy can be safer to be around” is a good place to start. The goal is to create a safe place for the child to talk about and process her or his feelings, rather than internalize or deny them. 

As a therapist I often rely on therapeutic children’s books to help combat the natural isolation some kids feel when dealing with issues in their family. I have a collection of books that discuss what jail is like, and how to act on visiting day. I have books that explore trauma though a child’s eyes and help explain how they may act out as a result. Some of the books even help introduce kids to working with and talking to a therapist. Knowing that there are other kids out there experiencing similar issues can give a child a sense of comfort. 

Working with families to provide structure, clear expectations, extra support, pro-social activities (exercise, good nutrition, time outdoors) during particularly stressful times can be very helpful for families working though issues, experiencing loss or adjusting to change.  Allowing the child to share their thoughts and feelings in a calm non-judgmental way can help relieve some internal tensions.

Here are some great kid’s books:

Overview of Kids and Trauma: A Terrible Thing Happened by Margaret M. Holmes, Sasha J. Mudlaff, Cary Pillo

Family in Divorce Transition: Dinosaur’s Divorce by Marc Brown and Laurie Krasny Brown

Incarceration: My Daddy Is in Jail by Janet M. Bender

Visiting Day by Jacqueline Woodson and James Ransome

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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.

 

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