By Kathryn Berlá, Ed.D.
Dear Dr. Berlá,
My 23-year-old sister still lives at home with my parents. She has been abusing alcohol and cocaine since she was around sixteen. She has made a couple of attempts at getting substance abuse counseling, but she has not been able to stick with it. I am frustrated with her, but am more frustrated with my parents who continue to support her financially, even as her addiction is tearing up our family. Everything revolves around her, to the point where my parents’ activities and routines are becoming restricted. She has destroyed property and even stolen from them. They complain to me, but get angry and accuse me of sibling rivalry when I make suggestions that sound harsh to them. I have been seeing a lot on television lately about interventions for addictions. What do my parents and I need to know?
In my experience, the only thing more intractable than an actual addiction is changing the dynamics of the family of an addict. It doesn’t mean it can’t be done, but it is difficult, and the statistics are not pretty. Studies show that the relapse rate for addicts getting treatment for the first time can be anywhere from 45-95%. It is not uncommon for severe addicts to go through several treatment programs, if they can survive that long, before getting clean and staying clean. The costs of addiction to the addict and to society are pretty obvious. Treatment costs alone can rival that of college tuition. The “hidden” costs of addiction are not the ones we automatically think of. Addictions chew through families, create estrangement, financial hardship and social ostracism. Addicts, by definition, are selfish; they don’t care who they take down with them, and all too often it is the loved ones with whom they are closest.
Loving an addict, the way your parents love your sister, is a complicated endeavor. Parents love their children and can’t tolerate seeing them in pain. The presence of an addiction can cloud a parent’s view of how best to protect their child. Often, a parent or loved one believes that by “helping” the addict just a little bit, that they can save the addict from a much worse fate and much greater pain. For example, your parents may believe that by letting your sister live with them, they are saving her from being homeless, because she would use her rent money for drugs. They could be right about the homeless part, but the problem remains: she is still using her rent money, and all the rest of her money, for drugs. In addition, she now has a comfortable place to do drugs and crash.
Your parents probably think that they are taking care of your sister the only way they know how, but they are doing it at their own and everyone else’s expense. They would do well to ask themselves: is what we are doing helping to perpetuate a bad situation? Remember that “enabling” means providing the means or opportunity. If we provide the means or opportunity for a friend or loved one to abuse drugs or alcohol, then we are enabling their addiction.
Changing enabling behavior and surviving addiction in one’s family is very difficult to accomplish without outside help. There are many fine support groups, such as Al-Anon and parent groups at drug treatment centers. In addition to a good support group, you and your family may benefit from psychotherapy independent from any treatment your sister may receive. Look in the phone book, ask friends, or ask your family physician. Get some names of some therapists and start interviewing.
For many addicts, the first real attempt to quit using comes after an intervention. A formal intervention is facilitated by a trained therapist who may be in private practice or affiliated with a treatment center. The intervention requires careful preparation and the participation of many friends and family members who are committed to the addict’s recovery. It is usually an emotionally wrenching experience where everyone tells the addict in a direct yet loving way how the addiction has negatively affected their lives. It also requires a commitment from the participants that they will not engage in enabling behavior any longer. Usually, inpatient treatment has been prearranged for the addict, and the expectation is that the addict will go directly to treatment from the intervention. It is standard and encouraged for family members to give the addict ultimatums if they do not take advantage of treatment. They can include statements such as “If you do not go to treatment today, you will no longer be allowed to live in our house,” or “If you do not start treatment today, will no longer be allowed around my children.” These can be hard things to say, but they are harder to follow through on. Tough love can feel counterintuitive and just plain bad when it comes to someone you care about. Maintaining resolve, however, can be easier when you consider the alternatives.
Addiction counselors say that intervention is inevitable for every addict. Sometimes it takes the form of death by overdose or accident. Sometimes it takes the form of arrest and jail time. Sometimes, and preferably, it takes the form of the decision to seek treatment. The point is, something will happen to intervene with the addiction spiral. We just have more control over a planned intervention now than we do arrest or death later. If the intervention can occur under these more controllable circumstances, then there is always hope.
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Kathryn Berlá, Ed.D. is a licensed psychologist in private practice in Louisville. She may be reached at 502-412-2226.