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4 Strategies for Families Facing Addiction
Lloyd I. Sederer, MD
Is there a family today not experiencing addiction in a loved one, relative, friend, or co-worker? Whether it is the opioid epidemic seizing this country, or alcohol, stimulants (like cocaine, meth, Adderall or Ritalin), marijuana, or a variety of tranquilizing and sedating drugs doesn’t really matter. What matters is that someone you care about is reaching or has reached dependence on a psychoactive substance that can pirate away their brain, their life and their future. I will not speak here to tobacco, which warrants a post of its own as the leading preventable cause of death, worldwide.
There are four strategies to help families face addiction. They can help clear a path to recovery and a life restored to its potential.
1. We need to start with prevention. As has been said, an ounce of prevention turns into at least a pound of cure. Maya Angelou wrote: “. . . let us try to offer help before we have to offer therapy. That is to say, let's see if we can't prevent being ill by trying to offer a love of prevention before illness.”
While in many instances the addiction already has set in, there are others still at risk, especially the younger children in a family or other youth in school and faith-based settings.
There are two proven strategies we do too little of; and they meet the test of common sense. The first involves youth and the second their families. Life Skills Training (LST), with curricula for elementary, middle and high schools, provides youth vital, often underdeveloped problem-solving and decision-making skills, as well as emotional regulation techniques that protect them from turning to drugs (http://lifeskillstraining.com/). Taking dinner together as many nights as possible is another proven protective activity; President Obama did that with his wife and two daughters throughout his eight years in the White House.
For families, especially with children still at home, there is the Strengthening Families Program for Parents and Youth. Parents too can learn skills that enable them to support their children in positive ways and to encourage school and after school activities like sports, music, dance, art, and volunteer work – which we know to be protective against turning to drugs (http://www.strengtheningfamiliesprogram.org/).
Remember too, that you are not alone. There are so many others who are facing or have faced addiction in their loved ones and friends. Find out who they are, and talk with them. Turn to trusted family members and others you know. Facing the challenges of addiction will test the strongest of people, and we all do better when we are not alone.
2. Uncover the problem and seek help as early as possible. I urge mothers and fathers, sibs and others as well, to trust what they are seeing at home - observable changes in their child, such as labile mood, irritability, isolation, unusual sleep patterns, poor hygiene, muddled and tangential thinking, loss of weight, and other changes in mood, thinking and behavior. Write these down, simple notes about what you see, especially what you see over weeks or longer. Not what you feel, but what you have seen. Share these with someone you trust, who knows your child, to validate what you are observing.
We often don’t want face into the problems our children are demonstrating right in front of us, concerned about starting a fight, their denial, and more distancing. Yet those reactions are to be expected, they are part of the problem. The difficulties you are seeing will only grow if avoided. Find the right moment to speak with your child, clearly when not high; only say what you observe (e.g., you haven’t slept in a couple days, your pants are falling off you, you don’t answer calls from friends or go to practice, etc.) Do so with another person who also has witnessed what you have. Don’t expect a miracle, just begin the conversation, and commit to continue your effort until that person sees someone who can help, like a doctor, clergy person, or mental health clinician.
This same approach applies to friends and co-workers. Speaking with someone you care about who is in trouble is hard, but it is a true measure of concern and love.
3. If your loved one is beginning treatment, or not responding, you need to be active, and advocate for good care. There are two principles of good care for you to pursue: treatment that is comprehensive and treatment that is continuous.
Comprehensive care means that the program or clinician is not simply relying on one approach. 12-Step Recovery programs (like AA and NA) can be very useful for youth and adults. But they work better when combined with therapy, especially cognitive-behavioral therapy focused on helping a person resist the power of cues to drink or drug; with family education and skill building (as above); with evaluation (and treatment) of a co-occurring mental disorder (like depression, bipolar disorder and PTSD); and with offering a person with an addiction a medication to help control cravings and prevent relapse (the three most common are Suboxone and methadone for opioid addiction, and Vivitrol for alcohol and opioid use; there is also NAC, an over-the counter supplement). Each form of treatment enhances the other: more is really more.
Continuous treatment means not stopping and starting. Recovery is facilitated by an ongoing effort and care. This is true for physical illnesses like diabetes and asthma, and is as true for addictions.
4. Stay the course, and don’t give up hope. Experienced clinicians know that recovery is possible for a great many people with addiction. But we are not very good at predicting when the corner will be turned. Relapse is commonplace, to be expected, in all persistent disorders, including addiction. Recovery is not a straight line. Relapse tests the morale and will of all involved, the person with the addiction, family and friends, and the treating clinicians themselves. So, don’t give up, keep hope alive – there are very good reasons to do so, and over time you are likely to see why.
Addiction is pervasive in our country and our culture. Hardly any family, friend or co-worker is spared. When we have confidence in what we see, know what to do, how to ensure effective treatment, and when we don’t give up hope, addiction can be beat.
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Dr. Lloyd Sederer is a psychiatrist and public health doctor. The opinions offered here are entirely his own.
His next book, The Addiction Solution: Treating Our Dependence on Opioids and Other Drugs, will be published by Scribner (Simon & Schuster) in May, 2018.
@askdrlloyd
