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Tough Love: Helpful or Hurtful?

By: Michael Plahn

‘Tough Love’ has been recommended for families affected by addiction and untreated mental illness for years.  It has been the catalyst for greatly improving the lives of people I know very well.  I have also seen this backfire and become the impetus for further misery and even tragedy.

I see this topic divide, fragment, and many times disintegrate families.  What is the best approach for you and your family?  Only you (and your family) can make those decisions.  You have to live with the decisions and the repercussions of your actions.

For sake of example, let’s use the case of Paul, a 24 year-old male who has suffered from what Mom calls Depression (but he has never been diagnosed by an appropriate professional) and abused alcohol & drugs since he was 16 years-old.  He has been to two local Outpatient Addiction Treatment programs (for alcohol, cocaine, and opiate abuse) in the past five years.  However, after completion of each program, he relapsed each time within weeks of discharge.  Paul, currently unemployed, lives with his mother, father and younger sister (Angela 17 years-old).  Paul is verbally abusive to his entire family at times, and is currently using opiates (Vicodin, Oxycontin, and heroin), cocaine, and alcohol.

Dad, loves his son, but is frustrated and wants Paul out of the house unless he is sober and holds a full-time job.  Mom is upset with her son’s behavior, but concerned for Paul’s safety if she does not help him.  She cannot bear to see her baby boy “in the streets.” Paul manipulatively threatens, “if you throw me out, I’ll likely get killed in the streets.”  Angela loves her brother, but they rarely speak anymore.  Mom and Dad have warred for years over Paul and what to do for him and with him.  First Dad was supportive, but now he is intolerant and has begun to detach from the family.  There is a constant state of tension, but silence in the home and the parents’ relationship has suffered significantly.  Mom and Dad do not interact much, but if they do it is typically a verbal battle about Paul.

What should this family do?  I know individuals who were asked (in a ‘Tough Love’ approach) to either accept help and enter a reputable treatment facility (such as PromisesCaron, or Treatment Solutions Network approved programs), or leave the family home immediately.  That was just the beginning, but many are now happy and living amazing drug-free lives for several years.  They credit their parents’ refusal to allow them to live in the family home unless they were sober (and some gainfully employed) as the key event that lead to their long-term recovery.  Some were even required to take random drug screens as a condition to stay under their parents’ roof.  These individuals would tell Mom and Dad to “Kick Paul out if he is not willing to enter an appropriate treatment facility OR immediately stop using, attend 12-Step Meetings, and have a full-time job in a week.”

But, is that really the appropriate solution for this scenario with Paul and his family?  Will it work?  It’s not that simple.  Addiction and mental illness are much more complex issues than they may appear.  Honestly, if Paul could stop on his own, he likely would have long ago (there is very little fleeting pleasure at that stage of addiction).  True, there are success stories with a rigid consequential approach, but this can also be a very dangerous approach for some individuals.  Richard Rawson, associate director of UCLA Integrated Substance Abuse Programs claimed in a piece by ABC-News that coercive or confrontational approaches actually push the afflicted away from treatment.

Trust me, this could be an extremely complicated situation.  What works for one individual or their family may not have the same result for Paul’s family (or yours for that matter).  Let’s say that Paul was physically abused by his uncle (when Paul was 8-9 years-old).  What if he had a physical handicap during adolescence and as a result he was ridiculed and teased by his peers?  Either of these issues could change this situation significantly and may make Paul much more fragile than the family realizes.

These examples of underlying trauma are also likely to affect his ability to find long-term recovery.  If they are not addressed, it is likely that Paul will struggle and repeat dysfunctional patterns.  There is significant research that shows an extremely high percentage of addicted persons have also experienced some level of trauma  (which may be an underlying issue propelling the addiction).  At The Meadows, a facility that specializes in treating underlying causes of addiction such as trauma, they understand this reality.  Sadly, many people, minimize the significance of how trauma can negatively affect treatment outcomes and long-term recovery efforts.

If you were Paul’s Mom, I would recommend that you engage a qualified objective professional who can assist in determining an appropriate treatment facility and executing a compassionate loving process to intervene on your son. A competent professional would suggest solutions for the entire family’s treatment, not just Paul.  Granted, I’m biased, but LSA’s Pre-Treatment Solution is an ideal fit for this family’s situation.

There may be good reason to protect yourself and others in your home by asking an afflicted family member, who is acting dangerously, to leave.  But, as mentioned, this is more complicated than many well-meaning lay-people realize.  If you are going to embrace a ‘Tough Love’ stance, then please make sure you have professional guidance, that the family agrees as a group not to cave under manipulation, and become willing to accept the potential consequences of your ‘Tough Love’ approach.

 

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How to Select an Appropriate Level of Addiction Treatment (Part 2 of 2)

By:  Michael Plahn

In Part I of this article, I wrote about 12-Step programs, individual and group counseling, and different levels of Outpatient Treatment.  The highest level of care and support is available at an in-patient ‘Residential’ program.  These programs are designed to encompass 30-90 days of primary treatment (but length of stay depends on the patient’s condition and progress as well as family resources).  There are some amazing residential treatment facilities that can help your loved one.

I am a big proponent of facilities that offer comprehensive multi-disciplinary assessments (e.g. Caron Treatment Centers) to determine the correct diagnosis and subsequent treatment plan.   It just makes sense, doesn’t it?  Facilities that I personally like offer an entire continuum of care, as is the case at Promises, which allows the patient to continue to progress while maintaining the continuity of the same surroundings and treatment team.  Facilities such as The Canyon and Casa Palmera treat addiction and Co-Occurring Disorders (also called ‘Dual-Diagnosis’) for individuals struggling with mental illness along with addiction.  Some residential facilities, such as The Meadows, specialize in treating addiction and trauma.  For licensed professionals, there are facilities that offer specialized tracks catering to their specific concerns and needs (available at Hazelden’s Center City location).  I have also found companies such as Treatment Solutions Network to be very helpful as they represent a variety of facilities.

Although programs may share a similar classification (IOP, PHP, or Residential) there are tremendous differences in one facility’s program versus another.  This is one of the big reasons why a knowledgeable objective professional can help with this decision (you may be comparing apples and bowling balls without realizing it).  To further complicate the situation, if you are counting on your health insurance plan to cover the treatment, think again.  It is essential to ascertain the level of coverage you have in your particular plan.  Many residential programs do not accept any insurance coverage (it can be a self-pay facility), but some do and I hate to keep making you read this, but without an objective professional, you may never find the facilities that may be appropriate for your loved-one AND accept your loved-one’s insurance.

The goal, as I see it, is simple, you want to make sure that if your loved one is going (that is a big if without a professional to facilitate an objective and compassionate Intervention) to an addiction and/or mental health treatment facility, that they get APPROPRIATE TREATMENT to meet their needs.  If not, it is very likely they are going to get discouraged, struggle, possibly drop-out of the program, and or relapse (or worse).

It can play out like this: the afflicted person who was pushed into treatment by their significant other and without professional guidance required a different or higher level of care, they were approached with this by the treatment clinicians and staff, the patient became agitated and refused to change levels of the program, let alone facilities, and leaves the program.  Another sad, but common situation is:  the afflicted person agrees to enter treatment but only if they can go to a program that they approve.  Being an over-achieving people pleaser, who is certainly not telling the staff how they feel or divulging all of the secrets they are ‘taking to their grave,’ does everything necessary to quietly and successfully complete an outpatient treatment program.  They say they plan on attending AA as a maintenance program, but are hiding bottles and pills in a matter of weeks.  Many times, in either of those cases, those same individuals are even branded with “they just weren’t ready to change or stop using,” by family or friends.

Addiction (let alone adding mental illness if present) is a progressive and potentially fatal disease that rips apart families and takes lives prematurely.  A comparison to another potentially terminal disease, Stage IV Lung Cancer, is on point.  So, if a professional recommends professional treatment, I would not suggest that you navigate the different levels and facilities on your own (no matter how adept you are at Google searches), look for a convenient program that is “In-Network” for the insurance plan, or ignore it because “your loved-one would never agree to it” (you might be surprised if you have a professional facilitate an Intervention/Family Meeting).  Get the best and most appropriate help! In my experience (clinically and experientially), to do so will likely require an objective professional.  Contact LSA to work with an objective professional who will help with every aspect of this process in the LSA Pre-Treatment Solution.

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How to Select an Appropriate Level of Addiction Treatment (Part 1 of 2)

By:  Michael Plahn

This can be a simple question to answer in some cases.  But, in others it can be a bit more complex.  One thing is certain, I do not recommend that you tackle this issue without the guidance of an objective addictions professional.  That means, I do not recommend that you seek counsel on this decision from: your family doctor, a physician friend (who is a well-known surgeon and you’ve know since high school), your Psychologist (who you have seen for ‘years’) who does not specialize in addictions and Co-Occurring Disorders, or your brother who has been in AA for twenty-five years (God Bless him).  SEEK OBJECTIVE GUIDANCE FROM AN ADDICTIONS PROFESSIONAL to help you make the decision (and not necessarily the nice person from the insurance company; remember that your insurance company is trying to keep their costs down).

This is such a large topic, that I will have to break it into two entries.  My hope is that you will get a cursory understanding of some of the primary treatment available and the jargon used to describe it.  I will write soon about Aftercare, Extended Care, Recovery Coaching, and other subsequent solutions that are extremely important to a long-term solution.

There are a variety of options that could be considered a positive action for an addicted person to take to address their addiction (and possibly related issues).  However, there are some important things to consider.  First, if your loved-one is addicted to alcohol, then they are at risk for a serious and potentially deadly side effect during detoxification (called delirium tremens) that must be monitored by medical professionals.  Similarly, if they have been taking a class of drugs called benzodiazepines, they are also at risk for seizures.  Additionally, your loved-one may have other issues (trauma, Depressive Disorders, or other mental illness) that must be taken seriously, need to be screened for or addressed, and as a result, this makes professional treatment the prudent choice.

A 12-Step program such as Alcoholics Anonymous could be a first-entry point to help the addicted person, but only after the aforementioned issues have been screened for and addressed.  AA is a non-professional spiritual solution that has saved and changed millions of lives (it is not group therapy).  12-Step programs are a crucial component of a proven path of long-term recovery (that are usually introduced during primary treatment) and will likely be recommended by professionals for your loved-one after they successfully complete a professional treatment program.

Now to tackle the different types of professional treatment.  First, there is individual or group counseling—it is a minimal amount of care (roughly one hour per week) and usually better served as a means of support and help after an individual has been to a professional treatment facility.  However, if you were seeking such a solution, I would recommend looking for a professional with a minimum of a Masters Degree (Social Work, Counseling, or Clinical Psychology) along with a certification called a CADC (Certified Alcohol and Drug Counselor).

Typically, most professionals consider ‘treatment’ to begin with outpatient programs at a professional addiction treatment facility.  The lower level of this type of treatment is called an Intensive Outpatient Program or “IOP,” which typically may meet for three (3) hours (usually in the evenings) for four days a week for roughly six weeks.  The next level of care is called a Partial Hospitalization Program or “PHP”.  This is usually 6-9 hours/day Monday-Friday and a few hours on Saturday for about 25+ days (many times determined by insurance coverage and the progress of the patient).  In most cases, unless otherwise noted, there is not housing for the patients; they typically stay at home and commute to these programs.  The advantage with semi-supervised housing (available at a program like The Professionals Program at Resurrection Hospital in Chicago, IL) is in developing peer support and keeping the focus on treatment (it also allows the family a break and time to begin healing).

As this article is getting lengthy, I will stop here and continue in Part II.  In the second part of this piece, I will continue to write about the types of treatment, beginning with Residential Treatment, and what to look for in a program if your loved-one needs help.  Please remember that my succinct solution for this topic is to engage an objective addictions professional (available through LSA’s Pre-Treatment Solution) to guide you through this process as your advocate.

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