No one wants to wake up one day and realize their son or daughter has a serious drug and/or alcohol problem. Most parents would rather be thinking about how to help their child navigate through more “normal” adolescent challenges. Unfortunately many families will run into this problem. An issue some parents struggle with is the recognition that priorities will have to temporarily change. The sooner a parent figures this out the smoother the recovery process will be for everyone.
One Size Does Not Fit All
Substance abuse recovery for young people is not “one size fits all.” Problems with drug and alcohol abuse among adolescents and young adults can range from periodic alcohol and marijuana use to severe opiate addiction. Some young people are relatively functional while others have no direction. What all young people have in common is that early sobriety is extremely difficult. The more a young person is able to focus on recovery in the beginning, the better. It is extremely important for parents to recognize that it may be necessary to temporarily shift priorities. The simplest example is with school.
This Is Not Forever
We are all conditioned to believe that if a certain level of education hasn’t been attained by a specified age that somehow the child and the parent have failed. Think about that for a minute. There are many things wrong with that perspective. That is not to say that education isn’t important. Obviously, it is critical to gain a worthwhile education. However, if a young person isn’t functioning emotionally it will be extremely difficult to learn, excel, or care. In fact there are some drug abusers who are able to do well in school primarily to keep people off their back. The point is that while a young person is learning to stay sober, his or her focus will not be on school. Once the newly sober person is stable his or her ability to care about work, school, and other aspects of a healthy life will change. It is vital to trust the recovery process. A couple of points to remember:
- early recovery is difficult for everyone involved
- once an addict is thinking clearly his/her priorities will change
- this is temporary
Patience is difficult but in this case it is vital. Remember that building a strong foundation in early recovery sets the addict up for success in life.
There has been some recent interest in the use of smoking marijuana as a harm-reduction strategy to treat opiate/heroin addicts. To further evaluate this issue, we conducted clinical interviews with 10 opiate/heroin severe substance abuse use disorder patients being treated in an Enthusiastic Sobriety Intensive Outpatient Program.
Ten patients between the ages 14 to 19 years were interviewed; eight males and two females; all met DSM 5 criteria for severe substance use disorder, opiates/heroin. They had been sober between five days to nine months when they relapsed by smoking marijuana. All ten were motivated by the belief that smoking marijuana would help them not to return to opiate use; however, within the range of a few days up to six months, each resumed opiate use.
Patients described the following: “marijuana use was not enough-made me want to use heroin;” “smoking weed make me not care and I went back to opiates;” “the weed made me want more;” “each time I relapsed on weed, I would immediately think heroin is so much better;” “weed just didn’t cut it. I’m smoking weed to get high, but heroin is so much better;” “The weed was just not enough and accelerated my need for a better high.”
All of these patients relapsed by smoking marijuana, which they thought would help them not to return to opiate use. In each case smoking marijuana was not sufficient, and they all returned to heavy opiate/heroin use. Since they all smoked marijuana which contains THC, these case reports are not helpful as to whether just CBD would have a beneficial effect.
In summary, 10 young opiate/heroin severe substance use disorder patients tried to smoke marijuana as a way not to return to opiates/heroin use. In each case this failed.
Steven L Jaffe, MD
Professor Emeritus of Psychiatry, Emory University, Clinical Professor of Psychiatry, Morehouse school of Medicine
Enabling is a word that has been used in drug and alcohol recovery circles for decades. It can be a term that is very misunderstood and misused. No loved one of an addict or alcoholic wants to be thought of as an “enabler.” To enable literally means to make something possible or easy. It can also mean to permit. An enabler is often believed to be complicit in the drug abuser’s self-destruction. The most common forms of enabling include: providing money to an active user, allowing an active addict/alcoholic to remain at home, paying for an addict/alcoholic’s legal costs, and other actions. Sometimes providing help in these ways is not enabling. How can one determine the difference?
Demonstrations of Love
The enabler will say that he or she is “just trying to help” or “what am I supposed to do, let him go broke or die?” It is never a question as to whether or not a parent or significant other loves the addict or alcoholic. The issue is always the demonstration of love. When most people think about “love” they are actually referring to sentiment. Love, as an action, is not always the easiest path to take. Sometimes love is best demonstrated through not accepting behavior that is harmful to one’s self or other people. When an active addict or alcoholic is allowed to avoid consequences of his or her behavior he or she is not being “loved.” This sounds harsh but consider the alternative. Someone actively using is not rational. His or her decisions are not made based on concern for self or others. The addict only wants to be left alone so he or she can continue to use. People are either a means to this end or are in the way. Until he or she is abstinent this way of thinking will not change.
Consider the Motives
There are some simple questions a loved one can ask when confused about whether or not a pattern of enabling is taking place:
- is this going to help my loved one find sobriety?
- am I doing this/providing this help because I feel guilty?
- am I worried about what others will think?
- am I doing this because it helps my loved one or because it will make me feel better?
These are not the only questions to ask but it is a beginning. Not every situation is the same. What one person does may be enabling while someone else does the exact same thing and it is not. There is no exact formula. Always seek the guidance of someone who is objective and has experience in this area. No loved one ever has to face these difficult decisions alone.
Twelve step recovery can be very challenging for young people because so much of it is based on concepts that are usually associated with an adult perspective. A realization of powerlessness, any admission of wrong doing, reliance on a Higher Power, and a willingness to face people who have been hurt is difficult. This is particularly a challenge for adolescents and young adults. Adults in recovery have a difficult time taking responsibility for their actions, much less a young person. In the mind of a young drug and/or alcohol abuser there is nothing wrong with what he/she is doing. In his or her mind if everyone would just back off, there wouldn’t be a problem. This has always been a challenge for young people who need help but is especially difficult today.
Drug and alcohol treatment is not immune to the current climate of identity separation. If you look around, there are 12-Step meetings available to almost every imaginable classification of people. Many of these group distinctions are unnecessary and can water down the message of recovery. It is generally dangerous for a person with drug and alcohol problems to be “terminally unique.” However, young people are at a different stage of development. Not only are they working through a dangerous drug and alcohol problem they are experiencing normal brain development along with hormonal changes. This can be a lot to deal with. These factors don’t excuse poor behavior but must be understood when treating young people. An 18 year old with an opiate or marijuana addiction is not going to experience early recovery the same way a 45 year old alcoholic does. (Yes, I am aware that I wrote marijuana addiction)
Sobriety: The Great Equalizer
Any recovering addict or alcoholic learns the importance of “living life of life’s terms.” The sober man or woman recognizes the value in being a productive member of society. The same is true for a young person. Although some of the definitions may differ, a person in recovery needs to mend broken relationships, become responsible, and learn to adapt to changing circumstances. These characteristics are essential to long term recovery. The twelve steps provide a simple framework to achieve these goals. Change may not happen immediately but with patience and perseverance these turnarounds can be permanent.
Another year is coming to an end. For many people 2017 was an emotional rollercoaster. If you happened to enter into a recovery program this year you certainly know what I mean. Drug and alcohol abuse tears families apart with unrelenting voracity. The healing process can be unpredictable and painful. However, as sobriety takes hold emotions start to calm and a new perspective takes shape. Finally, those who have experienced tremendous fear, anger, and anxiety can begin to be grateful for a new lease on life.
Gratitude Is An Attitude
In recovery programs it is common to hear people talk about “an attitude of gratitude.” This generally
means that those who are affected by addictions of any kind tend to have a pessimistic and hopeless outlook. A change in thinking can begin to
melt away the negativity that keeps people stuck in destructive patterns. When someone is a
ble to take a step back and be grateful for a new opportunity to change,hope is reinforced. A family in crisis desperately needs to see the possibility for life to improve. There are simple ways to begin to shift into an attitude of gratitude.
A Simple Exercise
One way to begin to shift into gratitude is to start focusing on it. For example, take five minutes every day to write five aspects of life for which to be grateful. This gratitude list can be something to look forward to each day that can have a significant impact on someone’s way of thinking. The person focused on gratitude will seek more situations to build the list. It certainly accomplishes more to think about what is good rather than to obsess over all that is wrong. Granted, we need to be aware of problems in order to find solutions. Denial is never healthy. But think about how much easier it is to remember what is wrong. Coming up with a list of items that elicit a feeling of gratitude may require some effort but it is certainly worth it.
On behalf of the entire staff at Insight I would like to wish you and your family a blessed 2018! Merry Christmas and have a wonderful New Year.
It has become common for young people with substance abuse problems to go through multiple treatment programs. Sometimes this is due to a parent not knowing what else to do. In other cases it is because another round in treatment may be necessary to save a young person‘s life. A young person’s motivation to enter drug rehabilitation is usually different than an adult’s. In most instances a young person enters rehab because of outside influences; parents, school, or the law. Adults often enter treatment because of similar factors but can usually see more clearly the responsibility they have for the problem’s existence. What adults and young people have in common is that without significant lifestyle and attitudinal change, long term recovery will not take hold.
Addiction Treatment and Approaches
A philosophy that is gaining momentum in treatment is MAT. MAT stands for medication assisted treatment. This approach is in response to the increasing rates of opiate addiction and is built on the premise that addiction is a brain disease. In other words, the addict is a victim of brain dysfunction. His or her behavior is as the result of something being “organically” wrong. Yet again, we are at the place of treating drug issues with more drugs. Although it seems easier to accept that someone is suffering from a brain disease, the fact remains that if an individual is to achieve long term recovery he or she must address all areas of life. Harm reduction methods, MAT, or any other alternative substance abuse treatment may provide temporary relief and may open the door to long term recovery but the addict must change his or her behavior.
Recovery Doesn’t Always Feel Good
Today it is popular to avoid feelings of discomfort. Who likes to feel any kind of pain? Unfortunately this has led to an increased desire to make sure addicts “feel ok” rather than work through issues. Referring to an addict as an addict is not shaming or demeaning. It gives an individual the opportunity to acknowledge and address the problem. Whether there is an issue in the brain or not the door needs to be open to the recovering substance abuser to own his or her behavior. This can be uncomfortable but with the appropriate level of support the person in recovery will not feel lost or alone. Substance abuse affects a person physically, emotionally, and spiritually. For recovery to be effective all areas need to be addressed.
Substance abuse treatment for young people is full of different philosophies. New innovations come up on a regular basis. In spite of this constant pursuit of a better way, effective substance abusetreatment for young people usually comes back to some simple techniques. Problems surrounding substance abuse treatment for adolescents include:
- a misunderstanding of the pressure young people feel
- a lack of alternatives to the drug and alcohol subculture
- failure to address the whole family
- a lack of follow-up and aftercare
- There is no perfect approach for all young people but there are some key elements a parent can look at regarding a program under consideration.
1. Who Is Being Served?
One issue often forgotten is that an adolescent does not think like an adult. An adult who has been abusing drugs and/or alcohol for several years has suffered a number of consequences . This person has to realize in a clear way the gravity of the problem and must have a depth of willingness to change that an adolescent isn’t capable of reaching. A young person needs to simply recognize the aspects of his life that have been directly harmed by drug/alcohol abuse.
2. What Is the Motivation
When reaching young people the carrot is almost always a better motivator than the stick. This isn’t to say that one must be permissive when counseling a teenager but a young person needs something to look forward to. Adults are often tricked into believing a substance abusing adolescent can be “scared straight.” Any young person abusing drugs and alcohol is desensitized to this kind of tactic. It never works.
3. It Better Be Real
One of the keys to helping teenagers with drug problems is to meet them where they are. When an adult tries to act like a teenager it comes off as non-authentic and condescending. Talk to a young person as a first class citizen. When seeking help make sure the counselor or therapist really understands adolescent substance abuse. It is very easy to mistake a drug and alcohol problem for a serious psychological disorder. If a young person is abusing drugs and alcohol the substance abuse issue has to be dealt with first.
Substance abuse allows a young person to feel accepted, provides a social outlet, and provides a coping mechanism. If recovery doesn’t involve an element of peer support, real social options, and better tools to deal with feelings the chances of it working are slim. Beware of anyone who promises quick vocational, educational, or disciplinarian solutions. Horses will not help a young person stay sober nor will massages, yoga, or diets. Recovery is not fast and easy.It takes time for an individual and a family to heal.
Teen drug abuse continues to be a tremendous problem in our country. Although the substances young people abuse change, the plague of addiction is the same as it has been for decades. No matter how people try to solve this issue it continues to grow. There is no simple answer as to why this scourge remains but there are some simple steps people can take to provide young people with some alternatives.
Remember The Angst Of Adolescence
Most young people can’t wait to become adults. In the mind of a teenager this is the time in life when there are no longer any restrictions. Unfortunately, in society today many teens are expected to act as adults before they are truly capable. Rather than adolescence being a time in life when a person can make mistakes and learn from them, in the age of “zero tolerance” and increased isolation, young people are often left to fend for themselves. At some point almost every teenager will have to face the temptation of drugs and alcohol. It is impossible to predict who will wind up with a serious problem but there are certain factors that increase the odds.
Be Available And Listen
Most of how a person views the world starts at home. Throughout childhood and adolescence other factors start to influence how someone thinks but the foundation is laid early on. In substance abuse treatment the person with a strong emotional footing is more likely to grasp a program of recovery quickly. People that grew up around a lot of dysfunction, instability, or spent very little time with positive family members will have a more difficult time connecting with basic concepts common in treatment. At this point figuring out “why” a teenager has a drug problem is far less important than having a stable and secure environment in which to heal. Most teenagers thrive on friendship, security, and (most importantly) fun. Often what they need more than anything else is to be listened to. An easy response to adolescent substance abuse doesn’t exist but society can make a difference with a shift in attitude.
August has arrived which means school has either started or is right around the corner. For familieswho are new in recovery, this can be very challenging. Some parents desperately want life to be “normal” and the newly sober young person is terrified by the idea of facing old friends and other social situations.These can be daunting circumstances for anyone to handle, much less someone trying to develop a whole new set of coping mechanisms. There is tremendous pressure on everyone. This is a good opportunity to take a longer view. Eventually the family will settle into this new way of life and everyone will be more secure. Facing a drug or alcohol abuse issue opens the door to having a healthier perspective and having a different set of priorities.
Recovery Is A Marathon
Long term recovery is contingent on an addict or alcoholic learning to live on life’s terms. This means reintegrating into “normal” life responsibilities. School, work, and healthy relationships are important for addicts and alcoholics in recovery. However, in order to have success the drug abuser must put “first things first.” This means that recovery has to be the top priority. Parents must remember that for an addict or alcoholic, drugs and alcohol are all encompassing. Substance abuse touches all areas of life. Gaining the maturity to make better life decisions takes time. Over the long haul, relationships within the family need to heal. School, work, and other important activities will fall into proper place in due time.
Some Simple Suggestions
Whether new to recovery or not, it is good to be reminded of some basic tools. Some examples include:
- Manage expectations. Everyone has expectations but it is vital to expect what a person is actually capable of doing
- Seek Outside Help. It is never a bad idea to seek advice from someone who isn’t involved in the family’s situation
- Stay On The Same Page A recovering addict needs stability. If there are conflicting messages this can lead to unnecessary insecurity
There are many other useful tools available. Finding the right support is a key element in recovery. Contact other parents or a counselor for suggestions.
A common misconception is that if addicts were more aware of what they were ingesting they would be more likely to stop using. The reasoning is that this form of education would scare the drug abuser into sobriety. The problem is that addicts are either aware of what they are putting into their body and don’t care or they simply don’t care. In fact, many addicts are very well informed as to what they are using. Some have a vast pharmaceutical knowledge. In order to achieve sobriety an addict needs to have the proper motivation. No amount of education can provide this.
First Things First
Most addicts enter treatment because of external factors. The most common reasons are:
- legal consequences
- loss of employment
- being caught at school
- family intervention
More often than not an addict will say anything to get out of trouble. If this includes completing a treatment program, so be it. An addict’s willingness to change cannot be based on entrance into a program. The true test comes after a period of sobriety once the initial crisis has abated.
Recovery Is a Process
Every addict is different and some take longer to develop strong recovery tools than others. It generally takes an addict or alcoholic about 18 months to stabilize. This doesn’t mean that someone in recovery can’t reintegrate into “normal” life prior to this time. This simply illustrates there will be some challenges along the way that are directly related to learning to live sober. A person in early recovery (up to 36 months sober) needs a lot of support from family, friends, and an understanding peer group. If sobriety isn’t the addict’s top priority he or she will likely sabotage any success experienced in the beginning stages of his or her new life. Coping with life’s challenges without a chemical crutch is very challenging for any addict or alcoholic. With a strong system of support someone with addiction issues is more likely to maintain long term recovery.