family – Opiate Nation

Recovery Options for Teens

Statue by Gustav Vigeland, Vigeland Park in Oslo, Norway.

(Translation into most languages at tab to the right.)

Understanding the teenage brain was the topic of my last post: Is Teenage Turmoil Inevitable? It is important to digest before parents consider a recovery program for their teen. Knowing that adolescents and teens feel and process information differently than adults is why they require a different approach to addiction and recovery.

Regardless of the type of program considered, the one absolute necessity is that the family be involved in the process – because family dynamics are an integral part of a young persons’ sober and addicted life. And the best place to start this discussion is to focus on the CRAFT model.

The American Psychological Association has an informative article, below. (1) In it they point to studies discussing how programs like Al-Anon for family members with an addicted loved one “may improve the well-being of friends and family members, they are not effective in getting the addicted person into treatment.”

Intervention programs, designed to help “family and friends work with a counselor to confront a substance user and urge him or her to get treatment” is only used by 30 percent of families due to discomfort with confrontation. And treatment is only the first step on the long road to recovery. After that, the family still needs other tools.

CRAFT (Community Reinforcement Approach to Family Training) originated at the University of New Mexico and was developed by Robert Meyers, Ph.D. and colleagues. Research on CRAFT shows that approximately 70% of families who receive CRAFT are able to help their loved ones start treatment within a year (Miller, Meyers, & Tonigan, 1999). CRAFT also helps family members improve their own lives, whether their loved one ends up seeking treatment or not.

CRAFT teaches real life skills to use connection to encourage positive change, because CRAFT is rooted in the belief that connection is the opposite of addiction. It teaches positive communications skills to foster the connection that is desired by the person who is struggling with addiction and their loved ones.

Helping Families Help is a great non-profit website resource for CRAFT information. (2)

SMART Recovery was established in 1994, here in the USA, to meet the increasing demand of those seeking a secular and evidence-informed alternative to the widespread 12-Step addiction recovery program. It is intended for adults over 18 and those seeking flexibility and independence, while AA offers structure and strong community support. It may be best for young adults in their 20’s, as most 18- to 25-year-olds who struggle with addiction are not yet “adult” in their thinking and coping skills. Smart Recovery is now in 23 countries. See info below. (3)

Basically, the steps in helping your teen who is addicted are this:

Getting them into treatment
Choose a program – inpatient or outpatient
Detox
Individual Therapy
Family Therapy
Contingency Management

Getting your loved one into treatment: sign up for CRAFT 10-week email training course through Helping Families Help or investigate other options.
Choose a program: based on the drugs involved and length of time used.
Detox: Most drugs will still be in your child’s system. Detox flushes them out. Detoxing under the care of professionals ensures that it’s done safely out of reach from harmful substances. Your teen will likely experience withdrawal symptoms as well.
Individual Therapy: To understand a teen’s problem and to address it comprehensively. The first course of action in rehab is one or more types of therapy, both one-on-one and group settings. Motivational Interviewing uses a person-centered, non-confrontational style where the teen is encouraged to examine the pros and cons of their use and to create goals to help them achieve a healthier lifestyle. This helps them gradually realize the consequences of their actions. Cognitive Behavioral Therapy (CBT) is goal-oriented therapy that helps teens express and understand their feelings and cope with difficult emotions. They learn to replace negative behaviors (such as using substances) with positive ones (like sports or art or service endeavors).
Family Therapy: Based on the premise that family carries the most profound and long-lasting influence on development, and in modeling both good and bad behaviors and beliefs. These sessions bring together those closest to an addicted teen and address issues such as poor family communication, cohesiveness and problem solving. Again, CRAFT is crucial here.
Contingency Management: This form of therapy tracks each patient’s progress in rehab, including each day they succeed in staying sober, and rewards them with a prize. The more teens feel satisfied with their rewards, not only will they continue striving to stay sober, but their brain will relearn how to appreciate rewards that aren’t drugs or alcohol. Following rehab, a teenager is thrust back into the world. Temptations lie around every corner and their problem stays with them for years after treatment. After you’ve helped your child kick their habit you must help prepare them with a plan to prevent relapse – or for all of you to know what to do when relapse occurs, which is likely especially for certain drugs like opioids. MAT (Medication Assisted Treatment) is vital for opioid addiction and the long-lasting changes in the brain that will continue to undermine all the best plans and determination to stay clean and sober. Our son and many of the hundreds of thousands of young people who died from opioids are the sad evidence of this truth.

I do not offer these steps and advice as a medical or addiction professional. I can only offer my opinion based on our personal experience and the stories from others, along with the research I’ve done over the past 20 years since my husband and I first discovered that our 15 year old son was using heroin. What we wish we had known I share with you in the hope that your story will end differently than ours.

1. An underappreciated intervention

The CRAFT model is giving family and friends the skills they need to help get loved one’s treatment for substance use problems By Katherine Lee – December 2017, Vol 48, No. 11

https://www.apa.org/monitor/2017/12/underappreciated-intervention

2. Helping Families Help – CRAFT Information

https://helpingfamilieshelp.com/about-craft

https://www.npr.org/sections/health-shots/2018/08/10/636556573/families-choose-empathy-over-tough-love-to-rescue-loved-ones-from-opioids

3. SMART Recovery

https://smartrecovery.org/what-is-smart-recovery

4. The Different Types of Adolescent Treatment Programs

New Horizons Recovery Centers (USA)

https://www.newhorizonscenters.com/blog/the-different-types-of-adolescent-addiction-treatment-programs

Holiday Perspectives and Prospects

(Translation into most languages at tab to the right.)

The holidays are upon us. Some believe that it’s our perspective that makes all the difference in how we feel about them. Looking ahead may fill a person with joyful anticipation of what’s planned, dogged determination to make it through, or a feeling of dread and desire to escape. But are these situations only just a matter of one’s perspective or one’s prospects? Is much of how we feel based on what is happening in our life: are we living with abundance, security, good health, and healthy relationships? Unsatisfying work, too much debt, illness, and strained relationships? Or is our income irregular or non-existent, our housing insecure or non-existent, and our relationships like vampires or non-existent?

Unwelcome Reminders & Another Anniversary

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“We were trying, all of us, so hard, and he just wanted to live.” (1)

Ursula Rauh said this about her brother, Tommy, after his death from a fentanyl overdose and a dozen stints in rehab in ten years. He became addicted to Oxy’s at 23 after being prescribed an unlimited amount for tendinitis and a year later, another prescription for wisdom teeth extraction. Sam Quinones retells the family story in The Least of Us: True Tales of America and Hope in the Times of Fentanyl and Meth. “The tragedy wasn’t just the death of her brother; it was all the time, effort, love, and pain that the family traversed, the hoping and living for the smallest encouragement.” (1)

When my husband, John, and I returned from Australia in May, we decided that we needed to address the decades of files we had saved and ‘stuff’ we had accumulated and ‘stuffed’ away in closets. We have shredded and recycled dozens of boxes of documents, cleared out half the books in our library, and now I have moved on to scanning and sorting thousands of photos. While I was pulling bins of photos and albums out of closets, I came upon a few more file bins. I sighed out loud to John, “Oh boy…more of JL’s file’s I’d forgotten about.”

Grieving The Living

(Translation into most languages at tab to the right)

In a world where ‘nothing is certain except death and taxes’ and loss is unavoidable, grief is guaranteed to be an emotion each of us will experience in our lives sooner or later. If we have lost a loved one and grieved well, we can understand grief in others and empathize more fully.

But what about those who are living with a loved one with mental health problems, or in active addiction, or in a recovery program for the umpteenth time, or whose whereabouts are unknown? How do they live with the constant flux between hoping against hope, waiting, and praying for a miraculous change, and discouragement and depression as they watch their loved one struggle against an unrelenting enemy no one can see? My husband and I lived in this twilight zone for years – as do millions of others. While he was still living, we were grieving the loss of the son we loved and raised and had hoped to see move successfully into adulthood.

In an excellent article, Grieving the Living, Dr. Susan D. Writer shared insights that are an invaluable help and source of comfort for this all too common situation:

Teenage Perils

(Translation in most languages available at tab on right)

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Most of us have heard that the category of “teenager” came about after WWII. Before that, in a mostly agrarian society, you were either a child or an adult and the demarcation was when you went from being directed and cared for by your parents to being responsible for yourself and caring for others.

The word “teen” was introduced as early as 1818 referring to a person who was 13-19, “teener” from 1894, and “teen-ager” from 1922 (1). But the terms didn’t stick and didn’t carry a sociological group identity until after WWII. Being a teenager became its own sub-culture that revolved around like-ness, popularity and a fear of being on the outside.

Increasingly, the modern teenager relies more on peer-pressure than family relationships and values. And, peer pressure and group dynamics is known to be one of the highest risks for adolescent drug and alcohol experimentation and use. In one chapter of Hit Makers: The Science of Popularity in an Age of Distraction, Derek Thompson discusses teenagers at length (2). He writes, “Psychologist Laurence Steinberg, put people of various ages in a simulated driving game. Adults drove the same, whether or not they had an audience. But teenagers took twice as many “chances” when their friends were watching. Teenagers are exquisitely sensitive to the influence of their peers.”

Connection is Crucial

(Translation into most languages is available to the right.)

During a recent podcast on Straight from the Source (1), David Higham (founder of The Well, a peer-run alcohol and other drug service in the northwest of England) spoke about his life.

For more than 20 years, David was a habitual heroin user more accustomed to life in prison than the outside world. He joined a 12-step program during his final stint. Upon release, he found that sustained well-being and recovery was rare and he knew he had to help change that. What interested me most from his story was this insight:

“Drug treatment is trying to find a solution for my solution…But what’s the solution for my problem?”

Anne’s Story: Cultural Influences

(Thirty-fourth in a series of topical blogs based on chapter by chapter excerpts from Opiate Nation. Translation into most languages is available to the right.)

This week’s Story of Hope is from a young friend of ours, Anne (not her real name). Here are some excerpts from her story in Opiate Nation (5 min read):

I was eleven years old when I first experienced shooting heroin. Looking back, I can hardly believe it and I am so thankful to be alive, and to be sharing my story.

My boyfriend and I watched the movies Trainspotting and Requiem for a Dream and they really piqued our interest in drugs. The way it was portrayed in those movies made me think using heroin would be an amazing dream sequence, when in actuality, it made me violently ill. My boyfriend insisted we keep trying. He became obsessed with all drugs: ecstasy, LSD, cocaine, and various pills and so I tried them all.

Stories: Common Threads

(Thirty-second in a series of topical blogs based on chapter by chapter excerpts from Opiate Nation. Translation into most languages is available to the right.)

During the years since our son died, we have been encouraged and supported by his friends –many of whom have awe-inspiring recovery stories. We asked several of them to share their stories in Opiate Nation with the hope that they will give insights for parents and encourage other young adults to know they can be sober and have a meaningful life full of joy, love, and hope.

What we learned from these stories – and from the many stories we have heard in recovery meetings, in the news, and in books – is that there are some common threads that run through the lives of people struggling with addictions. And although there are no formulas for raising kids who will not use drugs or abuse alcohol, becoming aware of the common threads and risk factors in families with addiction and alcoholism is a good place for parents to start. If these commonalities are understood and taken into consideration, they might help avert tragedies such as the one we experienced.

I have written about each of these threads in separate chapters of Opiate Nation, but I will summarize them here:

The Rescuers: Enabling, Caretaking, and Drama

(Twenty-fourth in a series of topical blogs based on chapter by chapter excerpts from Opiate Nation. Translation into most languages is available to the right.)

Historically, “enabling” referred to facilitating or empowering someone in order to help them accomplish something. By teaching children to read, we enable them to develop their intellect and further their learning. Or, as in 1933 Germany, “The Enabling Act” gave Adolf Hitler the power to enact laws without the involvement of the legislative bodies: he was enabled to become a legal dictator. In modern psychology, enabling can be positive, but it is also used in a negative sense when it encourages dysfunctional, unhealthy behavior and habits, as it is used in addiction and recovery vocabulary. Rescuing and caretaking are terms that mean what they say. They are closely connected to enabling: we rescue people from their responsibilities and we take care of people’s responsibilities for them.

Melody Beattie (Codependent No More) refers to the “Drama Triangle” roles of victim, persecutor, rescuer, and says “Rescuing/caretaking looks like a much friendlier act than it is. It requires a victim who is actually capable of taking care of themselves even though we and they don’t admit it…After we rescue, we will inevitably move to the next corner of the triangle, persecutor. We become resentful and angry at the person we have so generously helped…Then we move to the victim corner of the triangle, at the bottom, the predictable and unavoidable result of a rescue.”

The Vortex of Shame

(Twenty-third in a series of topical blogs based on chapter by chapter excerpts from Opiate Nation. Translation into most languages is available to the right.)

For generations, the combination of personal shame and public stigma has produced tremendous obstacles to addressing the problem of alcoholism and drug addiction in America. Addiction stigma prevents too many people from getting the help they need. –Hazelden-Betty Ford Institute for Recovery

Historically, the word shame was used interchangeably with guilt – the appropriate pang of conscience that followed doing something wrong. In reality, there is an important distinction between shame and guilt. Shame is about who you think you are; guilt is about what you have done.

Stigmas are linked to shame. In the Greek and Latin worlds, a stigma was a mark or brand, especially for a slave, identifying them as “inferior.” Later, it became known as a mark or stain we can’t see with our eyes: social stigmas that are based on perceivable characteristics, associated with certain behaviors that distinguish a person from other members of society. They convey disapproval and disgrace.