September 10, 2012

How do I bring up treatment with a loved one?

By Dr. Harris Stratyner, Ph.D. one of the most caring, yet difficult things you can do is approach a loved one about a possible addiction or abuse of substances. But before you embark on this process (and it is indeed a process), you need to do some homework.

The first step is to speak with a professional – more specifically, an individual who specializes in addiction, who also understands psychiatric illness, which may be encountered as well. Ask this professional every single question that you have. Make sure when you speak with them, you come prepared with a history about what you have seen — type of drugs used, quantity, a family history or genogram of alcohol or drug use, as well as psychiatric illness in the family, if applicable — you get the idea.

As one of the “fathers” of “Carefrontation,” it will not come as a surprise that I will warn you there is no room for confrontation when you speak with the person. You are not going to make it about them, but about what you are observing: Their behavior. (For more information on this process, refer to the Johnson Institute, which utilizes many of these approaches in their formal intervention process conducted by a professional. And, of course, you can always work with a professional interventionist).

One must bear in mind, that addiction is a disease. The loved one you are approaching is not a “criminal,” but someone who has an illness – addiction is primary, progressive, chronic and if not treated fatal – like every other disease. There is no room for screaming, accusations, guilt, etc. And chances are your loved one has been doing this in their own head at some point – even if just as a passing thought.

Do not approach the individual believing that you will speak with them and off they will go to treatment – rather, view approaching them as the beginning of a process. They may very likely try to protect their abuse or addiction by utilizing defense mechanisms such as denial (“I don't have an issue.”), projection (“You are the one with the problem not me.”) or rationalization (“The reason I use is …”). Be prepared for this and don't argue with them.

When an individual is approached about something they find disturbing, their ego (the self) looks to protect that which is perceived as being “attacked.” Again, confrontation just raises defenses, and before you know it you are caught up in a screaming match and quite often a “shutdown” of the conversation. A loving, caring, prepared approach is your only chance of avoiding this – however, you still need to stick to your guns and not back down about what you have observed. You might even begin to see why professional interventionists are often called upon, because it is not easy to accomplish all of these seemingly conflicting processes. But remember, practice makes perfect.

It is always a good idea to have referral sources for your loved one. A specialist's name, a list of Twelve Step meetings, etc., and of course don't be afraid to reach out to other individuals your loved one knows – another relative, friend, their medical doctor (if that individual is willing to get involved and can justify any potential confidentiality issues being breached. The professional must agree it is a matter of life or death. You may be able to talk to them, but don't get angry if they can only listen and not share).

Last, but certainly not least, you, as the person who is willing to approach your loved one, must make sure you are taking care of yourself through this process. I cannot over-emphasize the importance of rest, proper nutrition, meditation and again, support from others, perhaps self-help such as ALANON, friends and professionals. This process is difficult but saving an individual's life makes it worthwhile.

Dr. Harris Stratyner, Ph.D., vice president of Caron Treatment Center and clinical director of the New York region, is internationally known for developing and implementing the groundbreaking clinical model of “Carefrontation,” a treatment approach that doesn't shame or blame the patient. It recognizes addiction as a disease and stresses each individual's responsibility to work with healthcare providers to reach the goal of complete abstinence. 

For more answers to Tough Questions, see Renew's Resource Section.

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