Tag Archives: Relationships

A Different Path to Fighting Addiction

When their son had to take a medical leave from college, Jack and Wendy knew they — and he — needed help with his binge drinking. Their son’s psychiatrist, along with a few friends, suggested Alcoholics Anonymous. He had a disease, and in order to stay alive, he’d have to attend A.A. meetings and abstain from alcohol for the rest of his life, they said.

But the couple, a Manhattan reporter and editor who asked to be identified only by their first names to protect their son’s privacy, resisted that approach. Instead, they turned to a group of psychologists who specialize in treating substance use and other compulsive behaviors at the Center for Motivation and Change.

The center, known as the C.M.C., operates out of two floors of a 19th-century building on 30th Street and Fifth Avenue. It is part of a growing wing of addiction treatment that rejects the A.A. model of strict abstinence as the sole form of recovery for alcohol and drug users.

Instead, it uses a suite of techniques that provide a hands-on, practical approach to solving emotional and behavioral problems, rather than having abusers forever swear off the substance — a particularly difficult step for young people to take.

And unlike programs like Al-Anon, A.A.’s offshoot for family members, the C.M.C.’s approach does not advocate interventions or disengaging from someone who is drinking or using drugs. “The traditional language often sets parents up to feel they have to make extreme choices: Either force them into rehab or detach until they hit rock bottom,” said Carrie Wilkens, a psychologist who helped found the C.M.C. 10 years ago. “Science tells us those formulas don’t work very well.”

When parents issue edicts, demanding an immediate end to all substance use, it often lodges the family in a harmful cycle, said Nicole Kosanke, a psychologist at the C.M.C. Tough love might look like an appropriate response, she said, but it often backfires by further damaging the frayed connections to the people to whom the child is closest.

The center’s approach includes motivational interviewing, a goal-oriented form of counseling; cognitive behavioral therapy, a short-term form of psychotherapy; and harm reduction, which seeks to limit the negative consequences of substance abuse. The psychologists also support the use of anti-craving medications like naltrexone, which block the brain’s ability to release endorphins and the high of using the substance.

A 2002 study conducted by researchers at the University of New Mexico and published in the journal Addiction showed that motivational interviewing, cognitive behavioral therapy and naltrexone, which are often used together, are far more effective in stopping or reducing drug and alcohol use than the faith-and-abstinence-based model of A.A. and other “TSF” — for 12-step facilitation — programs. Results of an updated study have not yet been released.

Researchers elsewhere have come up with similar findings. In 2006, the Cochrane Library, a health care research group, reviewed four decades of global alcohol treatment studies and concluded, “No experimental studies unequivocally demonstrated the effectiveness of AA or TSF approaches for reducing alcohol dependence or problems.” Despite that research, A.A.’s 12-step model is by far the dominant approach to addiction in America.

Jack and Wendy’s son, who is in his early 20s, began drinking to alleviate crippling anxiety and ease persistent depression. His drinking, while worrisome, was not an entrenched pattern, his parents believed. Some of Jack’s friends suggested that if their son did not attend A.A. of his own volition, the only thing Jack and Wendy could do was attend Al-Anon.

“The implication was that there was no other solution,” Jack said. “There was a great deal of sadness on their part, empathetic sadness, which in some ways was frightening in itself.”

“A lot of people credit A.A. with saving their lives,” he added. “It’s understandable that they can’t dissociate themselves from a program that worked for them. But it’s an all-or-nothing commitment for life. That really freaked me out.”

In A.A.’s literature, “alcoholism” is defined as “a progressive illness that can never be cured.” Members describe themselves as being “in recovery,” which translates to lifelong abstinence and adherence to the 12 steps mapped out in the Big Book, published four years after the organization was founded in 1935. First among them is the obligation for members to admit their “powerlessness” over alcohol. It also relies heavily on faith; God is mentioned in five of the 12 steps.

On a warm evening last month, about a dozen parents gathered to hear Dr. Kosanke describe the center’s program for families, which goes by the acronym Craft, for Community Reinforcement and Family Training. It rejects, she said, the use of three words: “addict,” “alcoholic” and “enabling,” a term often used to describe the acts of loved ones that help perpetuate unhealthy behaviors.

Instead of addict or alcoholic, she prefers the terms favored by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, or the DSM-V, which says that patients suffer from “alcohol use disorder” or “substance abuse disorder,” terms that convey a spectrum of severity.

“Substance use takes on a lot of different shapes and sizes,” Dr. Kosanke said. “There are real downsides to labeling a child with a lifetime identity, when that truly may or may not turn out to be the case.”

And calling caring behavior enabling, she said, has a way of turning even acts of kindness into something negative. “Our field hasn’t done a good job of defining it in a narrow way that’s appropriate,” she said. “If you give your kid money knowing he will go buy pot, that’s enabling. If you take your kid to soccer practice, you’re encouraging healthy behavior. That’s not ‘enabling.’ ”

Part of the Craft approach has parents take care of themselves, too, said Lorraine McNeill-Popper, who volunteers for the parent hotline at the Partnership for Drug-Free Kids, a nonprofit group devoted to recovery for young people. “If you are sleep-deprived and stressed out, how can you think clearly?” she said.

Ms. McNeill-Popper has her own family history of drug abuse. Her twin brother died of an overdose, and she adopted his son, who later became a heavy marijuana user and ended up in rehab. “I tell parents, ‘It’s like when you’re on an airplane, and they tell you to put the oxygen mask over yourself first. That way you can help with the others.’ ”

The center’s approach is controversial in the recovery world. David Rotenberg, executive vice president of treatment at the nonprofit Caron Treatment Centers, a large drug and alcohol rehabilitation provider with branches in several states, cautioned against approaches that do not set abstinence as a goal.

“The majority of people who are chemically dependent would love to be able to drink and drug in a more moderate fashion,” Mr. Rotenberg said. “Most drug addicts and alcoholics would love to drink just a couple of drinks, and they try to do so, with poor results.”

The C.M.C. doctors say treatment for young people needs to be tailored for them, since teenagers and young adults are neurologically, psychologically, socially and legally different from adults, and have different treatment needs.

Dr. Wilkens founded the center with a fellow psychologist, Jeffrey Foote, in 2003. The two had worked together in larger hospital-based treatment centers where they struggled to introduce evidence-based treatments, she said. When it opened, the C.M.C. was one of the few centers in the nation that were not tethered to the 12-step model, she said.

“It was our strong belief that you can work with people at any stage of change, ranging from ‘I’m not even sure I have a substance problem’ all the way to ‘I just got out of rehab and want to go to A.A. meetings every day,’ ” Dr. Wilkens said. “We don’t have a judgment on how you address your substance use problem. Maybe A.A. is helpful to you and you find everything you need there. If it’s not, we genuinely believe there are many strategies for helping to resolve them.”

In fact, a majority of college binge drinkers do not go on to become alcohol dependent, said Stanton Peele, a Brooklyn psychologist who has studied substance use for decades and is a longtime critic of the A.A. model. While binge drinking and other drug use are risky, multiple studies show that most people “mature out” of such recklessness when they begin to have increased responsibilities.

A federally financed study of 43,000 randomly selected Americans, called the National Epidemiologic Survey on Alcohol and Related Conditions, or Nesarc, found that 75 percent of those who are heavy drinkers eventually regain control without rehab or A.A., Dr. Peele said. The survey, which was conducted in the early 2000s and was designed to be representative of the larger United States population, was aimed at helping researchers understand high-risk drinking patterns, design better-targeted treatment programs and monitor recovery. It found that over half of those who recover managed to cut back instead of abstaining, Dr. Peele said.

“Isn’t it more encouraging to know that most people are going to outgrow these habits than to think they’re going to have a disease for the rest their lives?” Dr. Peele asked. “The data show that the odds are in your favor.”

Dr. Wilkens is familiar with that pattern. She was a college binge drinker herself and also struggled with bulimia. Once she left her home state of Kansas for New York City, where she attended Hunter College, she felt culturally stimulated and intellectually challenged, she said, and the drinking and disordered eating disappeared.

“When you focus on building up the world around you, you find stimulation and rewards that are very different from using drugs and alcohol. You find other ways of soothing yourself, and things can get better,” she said.

That is precisely what L.S. learned five years ago. L.S., a Manhattan lawyer in his early 30s who asked to be identified only by his initials to protect his privacy, spent nearly a decade as an episodic binge drinker. He began drinking as a student at his large Midwestern university, where he played rugby and where many of his best friends belonged to fraternities. Alcohol, he said, flowed freely through both subcultures. L.S. said he thought his drinking — weeks of no drinking followed by serious binges of a few dozen drinks over several days — would end after college. Yet the behavior did not fade. The morning after his wedding, he awoke with a hangover that lasted a day and a half.

His father, who drinks socially, told him that people either were alcoholics or were not. But L.S. was unprepared to accept that label and began researching moderation on his own. He found a New York branch of Moderation Management, or M.M., a secular, peer-led support group that takes a cognitive behavioral approach.

In contrast to A.A., which stresses a drinker’s lack of power in the presence of alcohol, M.M. encourages personal responsibility for drinking. The group, founded in 1993, encourages members to start with an alcohol-free month, and then allows for the reintroduction of moderate amounts of alcohol. (Critics note that one of its founders, Audrey Kishline, was involved in a fatal accident while driving drunk. She left the group in January 2000 with the intention of joining A.A., and three months later, crashed head-on into another vehicle, killing the driver and his 12-year-old daughter.)

L.S. now attends hourlong meetings once a week at which he and about a dozen others discuss their goals for moderate drinking, as well as tips, challenges and progress on avoiding triggers. Since he began attending, L.S. limits himself to about five drinks a week, well below the 14 drinks M.M. advises as a safe limit for men.

L.S. is convinced that there is no single approach for all problem drinkers. “M.M. doesn’t profess to work for everybody. It has a scientifically based approach that works for some people,” he said.

The C.M.C. psychologists are blunt about the reasons many teenagers and young adults use drugs: When it comes to decreasing anxiety and relieving depression, substances tend to work for the short term. “Kids aren’t crazy for using them,” Dr. Wilkens said. “They have an effect that is reinforcing in some way. If you understand that, you can strategically work to support and reinforce other healthy, competing behaviors.”

That approach runs through the book she wrote with Dr. Foote and Dr. Kosanke, “Beyond Addiction: How Science and Kindness Can Help People Change.” It was published in February, just as the death of Philip Seymour Hoffman from a heroin overdose struck fear in the hearts of many parents whose children use drugs. It landed Dr. Wilkens on several talk shows and drew scores of calls to the center. (In addition to its New York office, the group has opened a residential treatment center in the Berkshires.)

Dr. Wilkens’s message struck a chord with Wendy. Her son had just left school, and the couple was exploring treatment options. Wired in the evenings with extreme anxiety, he drank excessively to get himself to sleep. Once in bed, he’d stay there till 5 p.m.

Before she read the book, Wendy said, she would stomp upstairs hourly to announce in an exasperated voice, “It’s 2 o’clock. You’ve got to get out of there.”

“I’d do that three or four more times and then be fuming,” she said. “I’d be fuming all day, at home doing my work and knowing he was upstairs sleeping off whatever he’d been drinking the night before.”

After learning the Craft approach, Wendy said, she stopped nagging, changing her negative, accusatory tone to a more pleasant one by asking open-ended questions.

Today, Wendy and Jack’s son is working with his psychiatrist and getting help for his depression and anxiety. He seems to be bingeing much less. When the family went out to dinner on a recent night, the parents each ordered a beer or a glass of wine and sipped slowly through dinner. “How will he learn moderation if he doesn’t see it modeled?” Wendy asked.

Ellie hopes her daughter, too, will be able to change her drinking patterns. Ellie is a New York editor, who asked that her last name be withheld to protect her family’s privacy. Her daughter, 23, has struggled with binge drinking since she was 16. While her daughter graduated from college and holds a responsible job, she still binges on weekends. “It’s so much a part of the culture, it’s everywhere,” Ellie said. “She says she’d have no social life if she stopped drinking.”

Ellie, who grew up in a home in which many relatives attended A.A., at first tried Al-Anon. “They talk about ‘disengaging,’ ” she said. “But it’s your child, and I’m not one of those people who can put her out on the street.”

While their daughter has resisted treatment so far, Ellie and her husband have begun seeing a therapist at the C.M.C. to better navigate their relationship.

“My child is much more than a label or a diagnosis,” she said. “She’s not a problem to be solved, but a child to be loved and guided toward a better life.”

Source:  The New York Times


Domestic Violence & Substance Abuse

Both domestic violence and substance abuse are community issues. They can affect anyone regardless of age, race, gender, sexual orientation, religion, marital status, socioeconomic status, education level, and profession. While substance abuse DOES NOT CAUSE domestic violence, the two often co-occur and may exacerbate each other.

Drugs, Alcohol and Domestic Abuse: The intersection
Substance use does NOT cause domestic violence (DV) but may be present in abusive relationships.

  • Abusers believe it is their right to exert power & control over their partners – substance use does not cause a person to feel this way but may increase the risk that he/she will assault his/her partner.
  • Abusers often use substance abuse as an excuse to justify their abusive behavior.
  • Abusers may force their partner to use drugs or alcohol – the victim’s sobriety may threaten the abuser’s power and control. Victims may also be encouraged to engage in drug or alcohol use to please the abusive partner.

Substance use and DV often exacerbate each other, making it increasingly difficult for the victim to address either one of the issues.

  • Victims who are using drugs and/or alcohol may not be able to accurately assess their own level of danger, their ability to defend themselves, and their ability to safety plan.
  • Victims with substance use issues may be reluctant to call the police – or even DV programs – for fear that they will face repercussions for their drug or alcohol use.
  • Victims of DV may turn to drugs or alcohol as a coping mechanism or may become addicted to medicine prescribed to treat injuries caused by the abuse (e.g., painkillers or sedatives). Additionally, the outcomes of victimization (feelings of guilt, shame, powerlessness, depression) can set a victim up to fall further into a cycle of substance abuse.

Substance use and domestic violence are separate problems that often go hand-in-hand but treating one does not treat both.

  • Abstinence from drugs or alcohol does not mean that the violence (verbal, emotional, sexual, and/or physical) will end.
  • Use of drugs or alcohol – on the part of the abuser, the victim, or both – does not mean that violence will automatically ensue.

For many people, the decision to seek help for an abusive relationship, for substance use treatment, or both is a complicated one. Victims of abuse and substance users often face similar barriers when trying to access help. Below are just some of the challenges people may face.

Barriers for Ending an Abusive Relationship
FEAR… Of death or serious injury, of the abuser hurting him/herself or others, of not being believed about the abuse, of exposing one’s substance use or addiction, of being stalked by the abuser.

ISOLATION… Abusive relationships often result in the deterioration of the victim’s support systems including friends and family members, access to money, transportation, childcare, housing, and social services. Soon, the abuser’s voice is the only one the victim can hear.

ECONOMIC REALITY… Victims may not be able to support themselves (and often children) on their own. She/he may not have marketable skills, may have limited access to economic assistance, and may have no access to important documents due to the abuser’s economic abuse.

CHILDREN… The abuser may threaten to take custody of the children. The victim may not want to further disrupt a child’s life by moving him/her away from friends, family and school. The children may also resent the parent for taking them away from their father or mother figure.

SOCIAL PRESSURES OR EXPECTATIONS… It can be a heart-breaking decision to leave any relationship, especially when the consequences can mean losing the support of family, friends or other social relationships. Cultural and religious values may limit a victim’s options within the relationship.

HOPE & LOVE…Abusive relationships are not abusive 100% of the time. They may still have many happy moments. Abusers often apologize for their actions, making empty promises not to do it again. This gives the victim false hope for the future. Many just want the abuse to end, not the relationship.

Barriers to Accessing Substance Abuse Treatment
An abusive partner may be threatened by the victim’s attempts to stop using and may undermine her/his efforts to get clean or sober. Victims of domestic violence may turn to substance use as a way of coping with the abuse – without an alternative coping mechanism it is difficult for the victim to address her/his substance use. Additionally, outcomes of victimization such as feelings of shame, guilt, powerlessness, depression can contribute to substance use and an inability to seek help.

Lack of resources, lack of coverage for treatment – few inpatient facilities that can take children; few facilities that can accommodate pregnant women; lack of child care to make outpatient appointments; may be denied access to emergency shelters due to substance use; many insurance policies do not cover the cost of substance use treatment programs, which may discourage people from seeking help

Social pressures – oftentimes getting treatment for substance use can mean the loss of a shared activity between friends, family members, and other support systems; many also worry about the stigma of labeling themselves “users” or “addicts”.

Substance Abuse and Domestic Violence: Myths vs. Facts

Substance use and domestic violence are two separate problems that do not impact each other.
Although substance use and DV are separate problems, both often occur at the same time and exacerbate each other. This can make it increasingly difficult for someone to effectively address either of these issues. For example, victims may be encouraged to engage in drug or alcohol use to please or appease the abusive partner. Abusers may also force their victims to use drugs or alcohol as a means of gaining or maintaining power over their partner – in fact, the victim’s sobriety may be seen as a direct threat to the abuser’s control in the relationship. Furthermore, a victim may be reluctant to call the police or a DV agency for fear of being blamed or punished if her/his substance use is discovered. A victim may also hesitate to access help because the substance use has affected her/his ability to make safe, logical decisions.
Most women in substance abuse treatment have no history of trauma (such as domestic violence).
A large proportion of women in substance abuse treatment programs have extensive histories of trauma, including physical, sexual, and emotional abuse in their childhood and adult lives.
Use of drugs and/or alcohol directly causes someone to abuse his/her partner.
Drugs and alcohol DO NOT cause anyone to become abusive toward his/her partner but may intensify an abusive situation. As many as 25-50% of men who commit DV also have identified substance abuse problems. This also means that between 50-75% of men who commit domestic violence DO NOT have an identified substance abuse problem. Drug and alcohol use is often used as an excuse for the abusive behavior. Also, substance use by the victim DOES NOT cause her/his victimization. It may, however, reduce one’s ability to accurately assess her/his own danger and defend her/himself.

Leaving an abusive relationship is always the best and safest option for a victim.
Research continues to show that leaving is the most dangerous time for a victim in an abusive relationship. From the 2 weeks prior to leaving to the 2 weeks after leaving, domestic violence victims are most at risk for serious injury and even death. According to a study conducted by the National Coalition Against Domestic Violence, leaving puts the victim at a 75% greater risk of being seriously injured or killed by their partner. Moreover, there are many barriers to accessing help or leaving an abusive relationship, including fear (of retaliation from the abuser, of losing children, of not being believed about the abuse, of exposing a drug or alcohol addiction, etc), financial limitations, medical concerns, generational and cultural values, concerns for the wellbeing of children, social pressures and expectations, hope that things will change, and love for the abusive partner.

Choosing to stay in an abusive relationship is an example of co-dependent behavior.
Many times, a domestic violence victim’s survival strategies are mistaken for codependent behaviors. Choosing to stay in an abusive relationship may be the best way for a victim to protect her/himself from serious injury or death.

Service providers, including drug and alcohol treatment counselors, are required to report to the police when a client says that she/he is being abused by her/his partner.
Domestic violence is NOT a reportable crime. Clients that disclose domestic abuse are entitled to confidentiality, and it is the role of the service provider to uphold that confidentiality. Service providers should not report incidents to the police, or even to other local service agencies – including domestic violence organizations. The victim is the expert in her/his situation, and it is her/his right to choose whether or not to access help.

So I asked my son a question..

I asked my son, “How do you feel now that Mommy is in recovery?” and this was his answer..

“It feels good that you’re in recovery. It’s really nice because now we get to spend way more time together as a family. I don’t cry anymore because you don’t pick us up. You’re becoming a really good Mother because you buy us everything we need and some things we want… like a 3DS and a PS Vita.  I’m really proud of my you because we have fun, we go to the park, and you’re sober.”

Recovery has given me a lot. Most importantly, my children.
It’s given me the opportunity to work on my relationship with them, and be the mother I was blessed with being. Even when things get rough, I remember something my son told me early in recovery.. that all I need is them, they’ll make me happy when things get rough, and they’re right. They’re ALL I need to get by.

How to create meaningful relationships

Be a best friend to others first.
Think about how you can give vs. receive.

Identify with who you want to build authentic relationships with.
Best connections happen when there are similar conscience levels and values.

Create opportunities to know each other. 
Take the first step. No need to wait!

Get to know them vs. fringe topics.
Former builds true friendships; latter builds superficial connections.

Focus on positives not negatives.
See the beauty in each individual.

Share your life with them.
Let them know you for you.

Build trust first.
Nothing can develop without trust.

Let them in during your down times.
Open up an let yourself be vulnerable.

Be there for them when they need you.
Support, empathize, understand, don’t impose.

Focus on those who reciprocate your efforts.
These are the gems and the keepers.