Wednesday, October 14, 2015

In Addiction, Who Is It That Has to Change?

Something has been on my mind a lot lately, ever since I started working on this grant on methamphetamine abuse (and no, crazy conspiracy theorists, this is not a veiled reference to any of my daughters).

As I was saying, I was working on this proposal with the Circle of Life program on the Fort Berthold Reservation, and we were reviewing the current research on family therapy for people addicted to meth. They are the substance abuse prevention and treatment experts and I am working with them to create a game that models what effective counselors do, just like our current games model what effective teachers do.

All of these treatment models assume that everyone in the family has to change. Now, I will admit up front that neither I nor anyone in my family has ever been addicted to anything, so I have no personal experience. I'm certainly willing to consider that if your 13-year-old son or daughter is addicted to meth, you took a wrong turn somewhere on the parenting journey. For one thing, how can you not know where your kid is for that amount of time?

It seems like, though, a lot of this treatment requires the people who are NOT addicted to change. When I read statements like,

"If you are too critical about their appearance, drug use or other behavior, you'll drive the person away and then the opportunity for treatment will be lost." 


"Because access to the drug is so important to an addict, you may need to accept having the dealer around until you can convince your loved one to enter treatment."

I found it all very confusing, and there is a reason that I focused on statistics and assessment instead of counseling. That's why I was wise enough to partner with the Circle of Life people. I know my own weaknesses.

Isn't denial supposed to be one of the problems of people with addiction? So aren't you feeding into that?

But then if you go along with the denial, or don't confront the person, then it's enabling their addiction. But if you don't go along with it, then it's not accepting the person and then worsening  their problem or driving them away?

It's all very confusing to me, and I think it is not just me because the rate of failure in therapy is pretty high. Not as high as the failure rate for startups, but still pretty high.

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Anonymous said...

This is one of my favorite articles about addiction.

Maybe it will give you some insight. Drug addiction makes more sense if you ask addicts WHY they like to use. What effects are they after? People don't say, "I love waking up hungover and vomiting", they say "It helps me calm down. It helps me relax. It helps me talk to people. It helps me not remember my shitty past." This person is an alcoholic. But that's not the first problem they have. The first problem they have is not having the skills to deal with social pressure or anxiety, or memories of the past.

If you can help them with those problems, they won't need the drugs. They'll still be addicted to them, but they won't NEED them. The drugs are a solution to something. It's a shitty solution, but it's the best one they could come up with. Helping them come up with a better solution before trying to take away the drugs I think is really important. That's why you might read stuff that seems counter-intuitive like what you quoted.

Russell Brand also has a really good documentary on netflix called From Addiction To Recovery which I think is quite good.

Anonymous said...

Hi, girl working on her masters degree in clinical mental health counseling here. It does initially seem counterproductive. The initial contact with any client is often referred to as "establishing the relationship." Pretty much meaning you need to establish, or lay a foundation of trust and empathy first before trying to dig any deeper. Initially the counselor is taught to pick and choose their battles till they know the client is ready and can produce about change. Also helps make sure the potential client doesn't further regress without getting treatment due to untrained hands. Hope this helps!

Anonymous said...

Wow I've read a few of your blogs and this stood out the most to me. I had a friend who worked at an addiction clinic and she told me that the worst addicts were people who come from very wealthy families. She also said that some had access to these drugs from doctors who would enable their addiction and get thousands of dollars. I do believe that these people come from broken families I can see why getting the help that they need would be difficult. So your creating a game that would help with therapy?

Sylver said...

These are some of the worst BS advises I have ever read. Giving them a free pass on their drug habit and the behavior that comes with it? Tolerating the drug dealer? Are they F*ing kidding?

The family must be educated about the problems and effects, understand the sequences, the crash period, the withdrawal process, the symptoms and the extra risk factors (alcohol, other drugs, antidepressant) and the dangers (a meth addict can go completely paranoid and attack without warning), but none of that involves giving the addict a free pass on taking more drugs or allowing access to the fucking dealer!!!

Anonymous said...

I am a recovering alcoholic (sober over 10 years) and am very interested in the work of Dr. Nora Volkow. Dr. Volkow’s work has been instrumental in demonstrating that drug addiction is a disease of the human brain. Although for the majority of addicts, there is probably some familial dysfunction - there are some addicts who are naturally predisposed to being an addict and once they try something (or maybe twice) they are addicted. I did the majority of my drugs and drinking before starting my day in high school, therefore, my mother thought I was at school.

I think the reason they talk about the family changing is become in most addict families there is a level of enabling happening. The same as with eating disorders. And until everyone recognizes their contribution to the situation, it's hard for things to change. When I first got sober, my family was continuing to treat me as they did when I was drinking and it didn't work anymore. Therefore, they needed to develop new skills to interact with me as a sober person.

Recovery for me happened as a result of AA and inpatient therapy. Although I don't practice the 12 Steps currently, it was very helpful for me to be around a group of people who knew exactly what I was going through and were actively trying to get their lives together.

I'm not sure that this comment addresses your post specifically, but at the same time I thought it might be helpful hearing from an addict.

Ventus said...

Addiction develops incrementally, through many small steps, so curing it also has to go through small steps. Most often simply going "cold turkey" or cutting out the supply of the drug is just one step in the process. But that doesnt deal with the actual addiction of the psyche.

It does very little or nothing to the addiction in the mind and changed thinking of the addict. That is what changes the most in an addiction, thats the biggest problem of it. So the most you get in a lot of cases is people relapsing back as soon as they get the opportunity.

Keeping the addict on the drug for some time at the beginning is sometimes just necessary and a much lesser evil in the overall scheme. And in some cases it helps by keeping the addict out of trouble for some time, which makes further treatment easier. It is especially difficult with the methamphetamine types of drugs since they have one of the worst effects on the brain physically, with many cases of extreme violence and homicide caused by it, as easily seen in the police and other official statistics.
It is a specific kind of a drug since its damage develops over a longer time and so for the most early users it seems as if the drug doesnt have any or very little bad effects. While one of its most common effects is to make the abuser feel very certain about themselves, very convinced in the absolute correctness of whatever they are thinking. Very satisfied about themselves.
Which lasts only as long as everyday circumstances allow it, while everything is going good. Once any unsolvable problem or issue appears the reactions keep getting worse and worse, more aggressive and violent.

So that creates a very difficult to break kind of a self reinforcing circle, which goes on deep into any therapy.
Yet the physical damage to the brain is such that in most cases the person is never quite the same or they have to be on additional medication for quite some time even with successful treatment.

Most often you will find that a lot of misinformed early users think about amphetamines and methamphetamines as some sort of a cheap cocaine, (which itself is far less special then it seems in movies) while the truth is very different. Its a very cheap and dirty chemical, with disastrous effects on the brain structure over time. And therefore on the consciousness and sense of self of every abuser.

In this case prevention and keeping people correctly informed would do the most good.