The blogger at Her Big Sad posted a response to my recent post Parent of an Addict Asks: When Does the Lying End?
Here’s my comment in reply in the hopes of doing some clarifying and continuing a good conversation:
Thanks for reading my blog, commenting on my blog, thinking about what I wrote, and being so kind and gentle in your sharing of a different perspective! I appreciate all that.
I also appreciate you pointing out where I could stand to clarify…
When I say that people often lie to avoid the consequences of telling the truth about drug use, I’m just making an observation.
I don’t seek to impose consequences for a few reasons:
1. They aren’t very effective (check out the relapse rate after release from jail, or the ER)
2. Major consequences already exist (overdose, HIV, Hep C, loss of money, loss of family, loss of child custody, loss of job, loss of housing, negative emotions etc.), and I don’t need to add more
3. I spend a lot of my time working to limit drug-related harm (preventing drug overdose, transmission of HIV and HCV, incarceration, homelessness, loss of child custody etc.) so it would feel pretty odd to seek to add to the harm or “consequences” at the same time
4. I don’t see drug use as a moral failing, or something that morally or ethically justifies punishment
5. I want to establish a therapeutic relationship with my clients and not a power relationship with my clients (I’m a counselor not a probation officer)
6. Focus on consequences is ineffective and removes focus from what is effective… putting together a realistic and workable recovery plan, removing barriers to recovery, supporting recovery, reducing harm, and not adding to harm
I would also like to be clear that I encourage parents to set boundaries to protect themselves and other family members, but not to impose “consequences” in the sense of “punishments” intended to somehow force recovery.
Not having somebody live with you who is likely to steal is an example of a good boundary to set for your own benefit. It may also be a consequence, but it is much more likely to be an effective personal boundary than an effective incentive for recovery.
Also, let me clarify what I mean when I said,
“Often these consequences are counter productive to long term recovery.”
Let me give a common example:
Client has a probation officer who says, “I’m here to help you, I just need you to be honest with me.”
Client has a recovery plan, get’s into treatment, gets a place to live and a job. This isn’t easy.
Client relapses. Client is “honest” with the PO. PO puts client in jail for their “safety.”
PO does not allow for the relapse response plan to go into effect. As a result, a minor relapse results in discharge from treatment, loss of housing, loss of job, loss of trust in the system and the process.
People sometimes take years to come back from this kind of a set back. It may be years before they even feel able to try again.
The consequence was reactive and counter-productive to long term recovery.
As I like to say, real recovery is safe and sustainable.
The PO put the person at risk (decreasing safety not increasing safety). And instead of helping to re-stabilize the person following a relapse, they caused the person to become significantly more destabilized.
The medicine was worse than the ailment.
Her Big Sad wrote, “In the ten years I’ve been dealing with this in my family, I’ve not heard of one addict who got clean and stayed clean, while not experiencing consequences, or while sitting around, warm and cozy, with full rights and privileges normally given a non-using, productive member of society.”
In my experience, people suffer more than enough consequences without needing to have more imposed in the name of recovery. I have helped hundreds of clients successfully transition from current use to long term recovery without imposing a single consequence.
In fact, my program is built on a “low threshold” model. For example, we interact with clients in the same respectful and one hundred percent supportive way whether they are using or not using.
We don’t require people to have appointments (walk-ins are fine). There are no consequences for missed appointments other than a phone call checking in to see how the client is doing and inviting them to reschedule or stop in when they have time.
Our focus is on enabling recovery. To do that, we need to be in contact with our clients whether or not they are using, whether they are in jail or out of jail, and whether life is such that they can keep appointments or not.
We need them to feel safe communicating openly with us so that we can help them problem solve. We need to be on the same side –and it has to feel like we are on the same side.
Consequences are not useful to us.
If you haven’t already, I would ask you to read my post about “hitting bottom,” because I think it will add to this.
So when I say, “If you don’t like the lies, your best option is to help create a recovery environment that supports your loved one in becoming more open with you,” I’m advocating for taking this kind of approach as a parent.
Set appropriate boundaries for yourself (and explain them in that way), but don’t try to assert control by imposing consequences.
Your power to contribute in a positive way to your child’s recovery comes from your status as a parent. Your appropriate support is highly meaningful and effective.
Her Big Sad also said, “Since there are consequences to certain truths at my house, the lying stops not when it is safe to tell the truth (I’m using); the lying stops when the truth is safe to tell (I’m not using).”
The problem with this approach is that you may not hear the truth until (unless) your daughter is already successful in recovery.
As a treatment provider, I’m not satisfied with the “wait until they hit bottom” approach, or the “come talk to me when you are already sober” approach. I want to intervene now, build motivation to change in a positive way, and support recovery every step of the way.
This is an approach that can work for parents too.
My point is that by letting go of the need to control or impose consequences you can place yourself in a better position to be a part of a process that results in earlier and more effective recovery.
I realize this is a non-traditional approach. But I think it is a more effective approach, and one that is more respectful of individual dignity and choice. It also is more humane.
I’ve got lots of personal experience with this approach, and I know it works.
Thank you for contributing to an interesting and respectful conversation.
{ 8 comments… read them below or add one }
Thanks for elaborating on this, great post!
Wow, Tom, good one. I would like to add my own experience.
When I first got into MMT (methadone treatment) 10 years ago, I was using IV heroin. I was mostly a RX pain pill addict but for 6 months my husband and I were using heroin. I had never been on MMT before and did not know much about it so I simply looked at it as a way to keep from getting sick when I could not “score”.
The clinic did take UA’s regularly and none of ours were “clean”. They did not give us takeout doses due to this, bot otherwise we were not penalized. They did not threaten to discharge us from treatment, lecture us or in any other way punish us. They treated us with respect as fellow human beings.
Had we been shamed and punished, I have no doubt we would have quit attending. As it was, though, we had reduced our heroin use and were seeing medical personnel (the nurse) on a daily basis. And even better, I got the opportunity to see other patients who WERE doing well–people who came in once a week instead of every day–people in business suits, with nice cars, who looked clean and healthy–and I was impressed and wanted that for myself.
I was only in treatment briefly–about 4 months–when I had to leave to serve a jail term for a positive UA while on probation. However, I remembered how I was treated with dignity and respect, and how well so many of the patients I had seen were doing, and when I relapsed again 4 years later, I went back into MMT. This time I went in with more knowledge and a different goal, and I have been free of illicit drugs since that first day over 5 years ago. I have also become a major advocate for MMT patients nationwide, sit on several major BOD’s of national orgs, administer two major MMT patient forums, teach classes at my own clinic, and have restored my personal life to one of productivity and responsibility.
And I credit this in large part to the way that first clinic treated me while I was there.
As you said, the “consequences” of our use are extreme in any event–loss of career, children, home, freedom, health, etc. If we truly view opioid addiction as a medical illness–and are not just giving lip service to the idea–then surely punishment would not be viewed as “therapeutic”, and having more and more consequences heaped upon them does not “cure” what is in effect a biological disorder of the brain chemistry, not a character defect or moral flaw.
Thanks again, Tom. I appreciate the elaboraton as I more clearly understand your viewpoints now!
I’m at a loss to know what steps to take. Our safety requires that she not live with us. Our finances require that we not bankrupt ourselves paying for treatment, especially since we don’t know if she is truly seeking recovery, or seeking a 90 day pj party/warm bed/further delay of facing her wreckage
Might you suggest a few things you feel we could do that might enable her to find recovery on her own? (did that make sense?)
The whole detach with love/stay involved thing still troubles me, and I value your opinion too.
Thanks again.
If I was meeting your daughter for the first time, I would spend time listening to her as she explained her situation. I’d be listening for her to tell me what she wants.
I’d give her a chance to size me up and figure out where I am coming from. You may need to take some time to signal a change in where you are coming from if what follows is new for your relationship with her.
I’d start with what she wants/needs (not what I want/need).
These may be practical things relating to housing, employment, medical issues, legal issues. She may not immediately identify treatment/recovery as her priority.
That’s fine. It’s all related to recovery.
I’d start with a need she identifies. An area where she wants help and support.
I’d help her with no strings attached (not, I’ll help you with this if you agree to do x, y, z).
As a provider, I have professional boundaries. I’m not going to let her move into my house or get involved with her financially either! As a parent, you have your personal boundaries. Just explain them in terms of yourself, and with love.
Dont’ bet me wrong –sometimes it is appropriate for a parent to allow their adult child to live with them, or to support them financially. I met with a mother and son today, and the son is living at home for now. Nothing wrong with that. You are telling me that is not where you are at right now. Nothing wrong with that either.
I’ve taken the time and made the effort to become educated about addiction and recovery, and resources in my area. This is an area that you should focus on too, so that when the opportunity arises, you can be a good resource for your daughter.
Over time, you will find times that you can offer information/options, or identify and address misinformation/myths that may be preventing her from accurately understanding her options. Maybe this is about avoiding overdose. Maybe it’s about safer injection. Maybe it’s about avoiding incarceration. Maybe it’s about exploring treatment options.
Tell her about an article or website you found interesting. Tell her about a resource or treatment program you’ve heard about. Does she know anyone who has been there. What has she heard about it?
What are the options locally or otherwise for free/affordable treatment?
My focus is on looking for opportunities to support her in reducing harm up to and including abstinence from opiates or other drugs. My focus is not on controlling her.
The program I supervise is 100 percent voluntary. We don’t require abstinence or even having the goal of abstinence. But 100 percent of our clients in case management last year participated in treatment.
Most people want recovery at some level. We are just very good at setting the stage for recovery so that recovery becomes a realistic option for people.
It is something of an art. But it is really just about taking an approach that is informed, non-judgmental, non-coercive, respectful, helpful, and supportive. Isn’t that what you would want if you were in her shoes?
As a parent, you have an opportunity to do the same.
1. Get the right mindset
2. Let her observe the change in approach
3. Acquire the knowledge necessary to be an effective support as you go
4. Provide support as you are able
I’m not sure how helpful that is…I feel like it’s kind of just a quick sketch…but I hope it’s a start.
Thanks Tom, I appreciate hearing more. I am at a loss to know what else we could do. I could list everything we’ve done, but trust me, it covers all you mentioned above, and more. I am respecting her choices, I have tried to be helpful in the ways you have mentioned, knowing full well that it was up to her to take advantage of it, or not. I no longer coerce or try to persuade her to get sober. It would be pointless for her to do it for me. She needs to do it for herself. She knows I love her. I guess I just have to accept that she isn’t done. Again, thanks for your input.
I haven’t observed the issue to be whether or not someone is “doing it for themselves.” Some people absolutely are motivated by doing it for someone else…often a child. But wanting to be sober for yourself or someone you love isn’t always enough. It’s not just about willpower.
I also haven’t observed that the key issue is whether or not someone is not “done.” I think it is closer to the truth to say that the issues is about whether or not someone has found an acceptable and workable path out yet.
I guess I would need to learn more about your daughter’s specific situation to have an idea of what that path might be for her, and what the barriers might be that have prevented her from finding that path or making more progress so far.
Let me know if you would like to schedule a time to chat at junkjunk.ning.com and maybe we can figure some of that out.
I was an x y z myself, but many were written and a natural consequence before hand. Sometimes I was just out of control with a fear factor, but then I am just a Mom not a professional, even if I had perfect parenting skills, which i did not, it helped to listen, see and remember not to be baited or cycled into an argument, I tried to state my point, view, or yes demand and walk away and let her process it. I had to learn new tool and liked Total Transformatioin very much.
Alanon does not teach us to impose consequences on our addicts. I have noticed that AA talks about this but alanon says……………do not create a crisis nor stand in the way of the natural consequences of drinking.
My own take on this is that I let the consequences happen if they might result in learning but I do my best to stop them if I think they might kill her especially if they might kill her immediately.